Respiratory Flashcards
Usual cause of bronchiolitis?
Respiratory syncytial virus (RSV)
Usual age for bronchiolitis?
Under 1 (most commonly under 6 months)
Presentation of bronchiolitis?
Coryzal symtpoms Dyspnoea Tachypnoea Poor feeding Wheeze and crackles on auscultation
Signs of respiratory distress?
Raised resp. rate Accessory muscle involvement Intercostal and subcostal recessions Nasal flaring Head bobbing Tracheal tugging Cyanosis Abnormal airway noises
Abnormal airway noises?
Grunting
Wheezing
Stridor
Typical RSV course?
Coryzal symptoms
1-2 days chest symptoms
Day 3-4 usually worst
Lasts 7-10 days
Management of bronchiolitis?
Supportive management
- intake
- nasal suctioning
- oxygen if needed
Palivizumab?
Monoclonal antibody against RSV given to ex-premature or congenital heart disease
Viral induced wheeze or asthma?
Viral induced wheeze more likely if:
- Presenting under 3
- No atopic history
- Only occurs during viral infections
Presentation of viral induced wheeze?
Evidence of viral illness
SOB
Respiratory distress
Expiratory wheeze throughout the chest
Focal wheeze in children?
Think inhaled foreign body
Presentation in pneumonia?
Cough (wet and productive) High fever Increased resp. effort Tachypnoea Tachycardia Lethargy Delirium
Signs in pneumonia?
Derangement in basic obs. could indicate sepsis Tachypnoea Tachycardia Hypoxia Hypotension Fever
Characteristic chest signs in pneumonia?
Bronchial breath sounds
Focal coarse crackles
Dullness to percussion
Bacterial causes of pneumonia?
Strep. pneumoniae (most common) Group A strep Group B strep (pre vac) Staph aureus Haemophilus influenzae Mycoplasma pneumonia
Investigations in pneumonia?
Sputum cultures and throat swabs
Blood cultures if sepsis suspected
Blood gas
Management of pneumonia?
Nothing if symptoms are mild
1st: oral amoxicillin
2nd: oral macrolide
3rd: IV if vomiting
Causes of croup?
Parainfluenza virus (classic)
Adenovirus
RSV
Croup typically affects ages?
6 months - 2 years
Treatment for croup
Oral dexamethasone
Presentation of croup?
Generally well Barking cough Stridor Hoarse voice Low grade fever
Epiglottitis symptoms?
Sore throat and stridor
Drooling
Tripod position
Investigations in epiglottitis?
Lateral x-ray of neck shows thumbprint sign (also to rule out foreign body)
Treatment of epiglottitis?
Intubation if needed
IV ceftriaxone
Steroids (dexamethasone)
When should you trial inhaled corticosteroids?
If quality of life affected by symptoms (no wheeze, no asthma)
Asthma diagnosis?
Wheeze
Variability
Responds to treatment
Presentation suggesting asthma?
Wheeze and dry cough SOB Diurnal variability Typical triggers Family history of atopy Other atopic conditions
Presentation suggesting something other than asthma?
Wheeze only related to coughs and colds
Isolated or productive cough
Normal investigations
Unilateral wheeze
Typical asthma triggers?
Dust (HDM) Animals Cold Exercise Smoke Food allergens
Asthma treatment?
Inhaled corticosteroids for 2 months, then inhaler holiday for 2 months
Step 2 (regular preventer) asthma treatment needed if?
Using SABA more than two days a week
Symptomatic three or more days a week or waking in the night
Step 2?
Low dose inhaled corticosteroids (or LTRA in under 5s)
Step 3?
Add long acting beta agonist or leukotriene receptor antagonist (Montelukast)
