Respiratory Flashcards
Name some differentials for a wheeze
bronchiolitis
toddler wheeze
asthma
foreign body
Name some differentials for stridor
croup epiglottitis laryngomalacia foreign body anaphylaxis peritonsillar abscess
Name some differentials for a cough
asthma infective post-nasal drip GORD habit CF
How does obstructive sleep apnoea present?
- snoring
- daytime sleepiness
- headaches
- dry, cracked lips
+/- repeated ENT infections if due to adenotonsilar hypertrophy
What are the causes of OSA and therefore the management?
Obesity = weight loss
Adenotonsilar hypertrophy = remove them
Craniofacial abnormalities = orthodontic/ maxillary surgery
How would CF present in a neonate?
Meconium ileus
- delayed meconium
- distension
- bilious vomiting
Prolonged jaundice
What is distal intestinal obstruction syndrome?
Insufficient pancreatic enzymes + thick mucous leads to faecal obstruction in ileocecum
What are some signs and symptoms of CF?
- nasal polyps
- recurrent sinusitis
- recurrent chest infections
- DIOS
- steatorhhoea
- failure to thrive
- osteoporosis
- infertility in males
- diabetes
- liver disease and gallstones
Neonatal heel spot will be positive for what in CF?
immunoreactive trypsinogen
What can cause a false +ve sweat test?
- malnutrition
- G6PD
- hypothyroid
- adrenal insufficiency
What organisms commonly infect CF patients?
- staph aureus
- pseudomonas aeruginosa
- burkholderia cepacia
- aspergillus
What would the CXR of a CF patient show?
- hyperinflated with flat diaphragm
- nodules
- bronchiectasis
- pulmonary artery dilation
- RV hypertrophy
How is CF managed?
- chest physiotherapy
- annual influenza vaccine
- avoidance of other CF patients
- mucolytics
- fat soluble vitamins ADEK
- creon (enzyme replacement)
- high calorie intake
- screening for diabetes and osteoporosis
How is asthma diagnosed under 5s?
clinical diagnosis
How is asthma diagnosed in 5-16 y/o?
What constitutes a positive result for these investigations?
- spirometry with bronchodilator reversibility giving >12% FEV1 improvement
If spirometry is normal or obstructive but <12% reversibility then….
- FeNO which is +ve if >35ppb
How is asthma managed in under 5s?
- SABA
- 8 week trial of moderate dose inhaled ICS
- if no improvement then consider alternate diagnosis
- if improves with trial but symptoms return on stopping then….
- SABA + low dose inhaled ICS
- SABA + low dose inhaled ICS + LTRA
How is asthma managed in 5-16 y/o?
- SABA
- SABA + low dose ICS
- SABA + ICS + LTRA
- SABA + ICS + LABA (ditch LTRA)
- SABA + MART
- SABA + MART with moderate ICS
- Refer or theophylline or high dose ICS
Describe the features of a moderate asthma attack
Can talk
Sats >92%
Peak flow >50% predicted
Describe the features of a severe asthma attack
Can't complete sentences Sats <92% Peak flow 33-50% predicted HR >140 in 2-5 y/o >125 in 5-16 y/o RR >40 in 2-5 y/o >30 in 5-16 y/o
Describe the features of a life-threatening asthma attack
Sats <92% Peak flow <33% predicted Silent chest Cyanosis Poor respiratory effort Hypotensive
Describe the management of an acute asthma attack
SABA (can be via spacer if mild/moderate)
Prednisolone
+/- ipratropium bromide
+/- magnesium sulphate
What investigations might you do to investigate pneumonia?
Sputum sample
Nasopharyngeal aspirate
Blood cultures
CXR
How is pneumonia managed? How is this different if mycoplasma or chlamydia are the suspected causative organism?
Amoxicillin
Erythromycin
What causes bronchiolitis?
RSV leading to increased mucous production and bronchiolar inflammation and obstruction
At what age and how does bronchiolitis present?
<2 but commonly 3-6 months
- Few days of coryza
- Dry cough
- Wheeze and crackles
- Tachypnoea
- Recession
How is bronchiolitis managed?
Supportive management
- oxygen
- NG feeds
+/- Ribavirin
+ prophylactic Palivizumab in at risk
How is pre-school wheeze managed?
SABA 10 puffs 30 seconds apart
What causes croup?
Parainfluenza leads to subglottal inflammation and oedema
How does croup present?
Few days of coryzal Symptoms worse at night: - Barking cough - Hoarse voice - Stridor
How is croup managed?
Single dose of oral dexamethasone
O2
Nebulised adrenaline
What causes epiglottitis?
Haemophilus influenza B
How does epiglottitis present?
- Sore throat
- Drooling
- Hot potato voice
- Systemically unwell
- Neck hyperextended to open airway
Compare an effective vs an ineffective cough
Effective: loud, breath in between, responsive and alert
Ineffective: quite/silent cough, no breaths in between, unable to vocalise, cyanosed
What could you see on a CXR of a child who inhaled a foreign body?
- Visualise the FB (often R main bronchus)
- Hyperinflated lung on expiratory CXR (trapped air can’t escape)
- Lobar collapse
What is laryngomalacia and how does it present?
Cartilage problem leading to a soft, floppy larynx
- Stridor worse when supine
- Noisy breathing
What is subglottic stenosis and how does it present?
Narrowing of the subglottic airway due to malformed cricoid cartilage
Presentation depends on severity
- Biphasic stridor
- Hoarse weak voice
What organism commonly causes tonsilitis?
EBV
Streptococcus pyogenes
When would you give abx in tonsillitis?
What abx would you give?
>3 Centor criteria fulfilled: Tonsillar exudate No cough Fever >38 Tender anterior cervical lymphadenopathy
Phenoxymethylpenicillin
What are the indications for a tonsillectomy?
7 in 1 year
5 in 2 years
3 in 3 years
Each episode should be disabling and prevent normal functioning
What organism causes whooping cough?
Bordetella pertussis
How does whooping cough present?
Few days of coryzal prodrome Characteristic cough lasting >14 days - Dry hacking coughing bout - Inhalational whoop - post cough vomit - can gasp, flail arms, go red, eyes water etc
How can whooping cough present in infants?
Apnoea
When would you give abx in whooping cough and what abx would you give?
If present within 21 days of cough
Give Azithromycin to whole family
What are the complications of whooping cough?
Conjunctival haemorrhage Pneumonia Hernias and prolapse (high intra-abdo pressure) Apnoea Seizures
What are the school exclusion criteria surrounding whooping cough?
48 hours after starting abx
What is transient tachypnoea of the newborn?
increased fluid in the lungs due to reduced mechanical squeeze and reduced lymphatic removal
How does TTN present?
Within hours of birth:
- Tachypnoea
- Distress
- Increased O2 requirements
What does the CXR of TTN show?
Peri-hilar streaking indicating interstitial oedema
Prominent pulmonary vasculature
Fluid in horizontal fissure
Hyperexpanded
