Respiratory Flashcards
Differential diagnosis of acute cough
Upper respiratory tract infection Cough Bronchiolitis Pneumonia Acute exacerbation of asthma. viral induced wheeze Pertussis (usually unimmunised) Inhaled foreign body
Differential diagnosis of chronic cough
Asthma - cough may be the only symptom (related to exercise, nocturnal)
Infection: TB, recurrent aspiration
Gastro-oesophageal reflux
Chronic illness - CF, Kartagener syndrome (Primary biliary dyskinesia)
Rare - extrinsic compression of trachea/bronchus by enlarged heart, glands or tumour
Differential diagnosis of acute stridor
Acute laryngotracheobronchitis (croup)
Acute epiglottitis/bacterial tracheitis
Inhaled foreign body
Rare retropharngeal abscess, acute agioneurotic oedema, vascular rings
Features/facts of croup
Usually caused by parainfluenza
Hoarse voice
Barking cough
Stridor
Treat with oral dexamethasone and give nebulised adrenaline in severe cases
Do not upset the child, as this will worsen the stridor (avoid - looking in the throat, venepuncture, cannulation)
Causes of pneumonia
Viral infection common in young children - RSV, influenza, parainfluenza
Bacterial: S.pneumoniae most common, mycoplasm in 5-14 years. Remember Group B streptococcus in neonates
Aspiration syndromes poorly coordinated swallowing e.g. prematurity, cerebral palsy, CNS depression, epilepsy
DEfintion of bronchiolitis
Acute lower respiratory infection with inflammation of small airways affecting infants mostly
What is bronchiolitis most commonly caused by
Usualy due to Respiratory Syncytial Virus (50-90%), also parainfluenza A, rhinovirus, adenovirus and human metapneumovirus
Clinical signs and symptoms of bronchiolitis
Clinically cough, dyspnoea, hyperinflation, recession, fine creps, wheeze
Seasonal October - April
Incubation period 5 days followed coryzal symptoms for 1-3 days. Lower respiratory symptoms building to a peak between day 3 and 5, but symptoms lasting total of 7-21 days.
Management of bronchiolitis
Management is supportive:
O2 if hypoxic
NG feeds or IV fluids if poor feeding
Pathophysiology of asthma
Triggered by cold weather, exercise, stress, viral illness
Bronchial hyper-responsiveness
Smooth muscle constriction prevents normal expiration
Thickening and oedema of bronchial wall bu cellular infiltration and inflammation
Mucus hypersecretion
Key points in history of patient with asthma
Symptoms: wheeze, cough, nocturnal cough, or exercise/cold weather related, shortness of breath, chest tightness
Pattern of symptoms: seasonal, continuous or intermittent
Precipitating/exacerbating factors: viral infections, exercise, environmental (i.e. pets, smoking), stress, foods, weather
Development of disease: age of onset, age of diagnosis, number and severity of previous admissions i.e. ITU, HDU, oral steroids. Current drugs, when introduced
Past medical history of atopy
Family history: asthma, allergy, eczema
School: days off due to asthma
Social: housing damp
5 steps of asthma treatment
Mild intermittent: treat with short acting inhaled beta2 agonist (salbutamol)
Add regular preventer therapy with inhaled corticosteroids twice daily.
Add on inhaled long acting beta 2 agonist in over fives and can increase inhaled steroid
Consider leukotriene receptor antagonist
Continuous or frequent use of oral steroids
(need to know Mx of acute asthma attack in child - see BTS guidelines)
Top 5 facts on genetics of CF
Autosomal recessive, 1 in 25 carry gene in Caucasian population
Mutations in CFTR gene cause abnormalities in cystic fibrosis transmembrane conductance regulator (CFTR) protein
Gene for CFTR located on chromosome 7
>2000 CF mutations found to date
Most common mutation is Delta F508
Pathophysiology of CF
- CF is a multisystem disorder of exocrine gland function involving multiple organ systems including lungs, pancreas, sinuses and reproductive tract. This principally results in chronic respiratory infections and pancreatic enzyme insufficiency
- When CFTR acts normally it allows chloride ions out of a mucosal cell into the lumen. If defective this results in thickened secretions which can’t be cleared from the chest and infection and airways obstruction occurs
- Pulmonary involvement occurs in 90% of patients. Lung disease is the principle cause of death. Colonisation with, haemophilus influenzae, staph aureus, pseudomonas aeruginosa and burkholderia cepacia may occur.
- 98% males infertile due to congenital bilateral absence of vas deferens
- Liver and pancreatic problems include pancreatic insuffiency, diabetes, fatty infiltration of liver and biliary cirrhosis
Symptoms and complications of CF
ENT: nasal polyps/sinusitis
REsp - cough, purulent sputum, pneumonia, bronchiectasis, resp failure
Poor growth - increased metabolic demand, failure to thrive, short stature.
Gastro - pancreatic insufficiency, meconium ileus at birth, biliary staiss and eventually liver cirrhosis, poor fat absorption with deficiency in fat soluble vitamins A, D, E, K, Steatorrhoea (fatty stools), rectal prolapse.
Endocrine - may develop diabetes
Miscellaneous - finger clubbing, ACD, delayed puberty, reduced fertility in females due to abnormal cervical mucous
