Respiratory disorders Flashcards
What are the clinical features of Cow’s milk protein allergy?
GI symptoms: • Vomiting • Abdominal pain • Blood in stool • Diarrhoea
Skin symptoms:
• Hives
• Eczema
Babies: • Wheezing • Facial swelling • Poor growth • Irritability
What is the management of Cow’s milk protein allergy?
Investigation:
• Skin prick
• Specific IgE antibody test
Treatment:
• Remove cow’s milk from diet
• Dietician review
What is the management of allergic rhinitis?
For relief of immediate symptoms:
• <5 = Oral antihistamine (Cetirizine)
• >5 = Intranasal antihistamine (azelastine)
For preventative treatment:
• Nasal blockage/polyp = Intranasal corticosteroid
• Sneezing = Oral antihistamine (Or intranasal corticosteroid)
What are the clinical features of tonsillitis/pharyngitis?
Causes of pharyngitis: Adenovirus, Enterovirus, Rhinovirus. Group A Strep in older children
Causes of tonsillitis: Group A Strep + EBV
Bacterial infections typically present with constitutional disturbances: • Headache • Abdominal pain • White tonsillar exudate • Cervical lymphadenopathy
What is the management of tonsillitis/pharyngitis?
If not severe, low centor score, then symptom relief (paracetamol)
Arrange admission if: • Difficulty breathing • Clinical dehydration • Tonsillar abscess • Signs of sepsis
Medication:
• Phenoxymethylpenicillin
• Clarithromycin if allergic to penicillin
What are the clinical features of otitis media?
Most common age: 6 months - 1 year
Due to children having short and straight eustachian tubes
Symptoms:
• Fever
• Ear pain
NOTE: Any child presenting with fever should have tympanic membrane examined
Examination:
• Red, bulging tympanic membrane with loss of normal light reflection
Causative organism:
• RSV
• Rhinovirus
• Pneumococcus
What is the management of otitis media?
In most cases, it will resolve by itself in 3 days
If no improvement after 3 days or have become worse, prescribe amoxicillin 5-7 days
Admit if:
• Signs of complications (Meningitis, mastoiditis)
• <3 months old + >38 degrees
• Severe systemic infection
What is the complication of recurrent otitis media?
Glue ear (Otitis media with effusion)
Children are asymptomatic but suffer from hearing loss
Eardrum is dull and retracted with visible fluid level
What is the management of otitis media with effusion?
Usually resolves spontaneously
However if child suffers from hearing loss, a grommet (ventilation tube in ear) can be inserted
If after removal of grommet, hearing loss is still present, reinsertion plus adenoidectomy is required
What are the clinical features of sinusitis?
Infection of nasal sinuses via viral URTIs • Post nasal drip • Nasal discharge (Green) • Headache • Face ache
What is the management of sinusitis?
<10 days: • NO ANTIBIOTICS • Simple analgesia • Nasal decongestants • Resolves after 2-3 weeks
> 10 days:
• High-dose corticosteroids for 2 weeks
• Symptoms will improve but duration likely to stay the same
What are the indications for tonsillectomy and adenoidectomy?
Tonsillectomy alone:
• Recurrent severe tonsillitis
• Tonsillar abscesses (Quinsy)
Tonsillectomy and adenoidectomy:
• Obstructive sleep apnoea
• Otitis media with effusion associated with hearing loss and failure to treat with grommet
What are the clinical features of stridor?
Typically causes by parainfluenza virus
Commonly presents at 6 months - 6 years
* Fever * Coryza * Stridor * Barking cough * Chest recession
Thumb sign & steeple sign on x-ray (though diagnosis is normally clinical)
What are the levels of severity of croup?
Mild = Barking cough, but no stridor or recession
Moderate = Barking cough, stridor and sternal recession at rest. No lethargy or agitation
Severe = Barking cough, stridor, sternal/intercostal recession, lethargy and agitation
Impending respiratory failure = Pallor, cyanosis, reduced consciousness, RR >70 breaths per minute
If worse than mild: REQUIRES ADMISSION
What is the management of croup?
If mild/no admission necessary: Single dose oral dexamethasone immediately
• Resolves after 48 hours
If severe, nebulised adrenaline with oxygen
NOTE: Never perform a throat examination on a patient with croup as it can lead to airway obstruction
What are the clinical features of acute epiglottitis?
Caused by H. influenzae
Commonly presents in 1-6 year olds
Very acute symptoms: • High fever • Intensely painful throat, can't speak or swallow. • Drooling heavily • Child sits immobile with mouth open • No coughing • Stridor
What is the management of acute epiglottitis?
Medical emergency - Urgent ITU admission Secure airway and give oxygen Blood cultures Antibiotics (IV) - Cefuroxime Steroids/Adrenaline if necessary
What are the clinical features of bronchiolitis?
Caused by RSV
Commonly presents in 1-9 months
* Dry cough * Coryzal symptoms * Wheezing * Dyspnoea (Leading to feeding difficulties) * Recurrent apnoea
More common in preterm infants that develop bronchopulmonary dysplasia or have an underlying lung condition
Examination: • Subcostal/Intercostal recession • Hyperinflation of chest • Tachypnoea/Tachycardia • Wheezing/Crackles
What is the management of bronchiolitis?
Hospital admission if: • Apnoea • Persistent oxygen saturations <90% • Inadequate fluid intake • Severe respiratory distress (RR >70, marked chest recession, grunting)
Humidified oxygen supplementation vs optiflow
Fluids by nasogastric tube
Recover after 2 weeks
Palivizumab used for prevention if high risk
What is the management of viral episodic wheeze?
When the child is wheezy give them up to 10 puffs of salbutamol with a spacer
If this is unsuccessful, ipratropium is tried in conjunction via spacer (2 puffs)
Inhaled corticosteroids may be offered if still no improvement
Finally an LRTA (Montelukast) may be used
What is the management of asthma for a child <5 years?
Step 1: SABA (Salbutamol)
Step 2: 8 week trial of moderate dose ICS
Step 3: After 8 weeks, stop ICS treatment and monitor child:
• If ICS didn’t help, reconsider diagnosis
• If symptoms resolved, but returned within 4 weeks restart ICS at low dose
• If symptoms resolved, but returned after 4 weeks repeat 8-week moderate dose ICS trial
Step 4: If uncontrolled with low dose ICS, add LRTA (Montelukast)
Step 5: If no improvement, remove LRTA and refer to asthma specialist
What is the management of asthma for a child >5 years?
Step 1: SABA (Salbutamol)
Step 2: Add low dose ICS (Beclomethasone)
Step 3: Add LRTA (Montelukast) and review after 4-8 weeks
Step 4: If unsuccessful, remove LRTA and add a LABA (Salmeterol)
Step 5: Change ICS and LABA to MART regime
Step 6: Increase ICS to moderate dose
Step 7: Refer to allergy specialist
What are the features of sever acute asthma?
- PEFR 33-50%
- RR >25
- HR > 110 BPM
- Inability to complete sentences in one breath
- Inability to feed
- SPO2 = >92% (Below in life threatening asthma)
What is the management of foreign body inhalation?
Conscious: • Encourage coughing • Back blows • Infant = Chest thrusts • Child = Abdominal thrusts • Removal of foreign body: ○ Flexible bronchoscopy ○ Rigid bronchoscopy if stridor, asphyxia, decreased breath sounds or obstructive hyperinflation
Unconscious:
• Secure airways with endotracheal tube
• Removal of foreign body using above methods
What are the clinical features of pertussis?
Catarrhal phase:
• Coryzal symptoms for a week
Paroxysmal phase:
• Paroxysmal cough followed by inspiratory whoop
• These spasms are worse at night and may lead to vomiting
• Child may go red/blue during coughing
• Lasts for 3 months
What is the management of pertussis?
Investigations:
• Culture of perinasal swab
• PCR (Most sensitive)
• Marked lymphocytosis
Treatment: Admit if: • <6 months or acutely unwell • Significant breathing problems • Complications (Seizures, pneumonia)
If admission is not needed, prescribe antibiotics if the onset of cough is within 21 days;
• <1 month = Clarithromycin
• >1 month = Azithromycin
• Pregnant adult = Erythromycin
Avoid nursery/school until after 48 hours of antibiotic treatment or 21 days of cough onset
What are the clinical features of primary ciliary dyskinesia?
Caused by a congenital abnormality in the structure or function of cilia lining the respiratory tract
Results in impaired mucociliary clearance • Recurrent URTIs and LRTIs • Recurrent productive cough • Purulent nasal discharge • Chronic ear infections • If untreated, leads to bronchiectasis
50% of PCD patients will have dextrocardia and situs inversus (Kartagener syndrome)
What is the management of primary ciliary dyskinesia?
Daily physiotherapy
Proactive treatment of infections with antibiotics
Appropriate ENT follow-up
