Respiratory exam Flashcards
OSA
complications:
- FTT
- cardiac: pulm HTN, cor pulmonale
- neuro: cognitive, behavioural
Respiratory
NMD
causes: weakness in inspiration/expiration, bulbar dysfunction
measures: SNIP, VC, FVC
PFT: FEV1/FVC>80%
prognosis:
- VC<60%: problematic
- VC<40%: ventilator required
treatment: BiPAP
Goals asthma treatment
- Control of symptoms
- Prevention of exacerbations
- Achievement of normal physical activity and growth
- Minimal treatment side effects
Complications CF
Respiratory
- bacterial infections
- ABPA: igE/igG, eosinophilia, culture +ve
- asthma 20%
- cor pulmonale: raised JVP, hepatomegaly, oedema
GI
- pancreatic insufficiency 85%: FTT, steatorrhoea
- meconium ileus 15%
- DIOS 20%
- rectal prolapse (toddlers) 20%
- chronic liver disease 20% (URSO)
Endocrine
- insulin dependent diabetes 7%
Metabolic
- hyponatraemia in summer (hyponatraemic, hypochloraemic met alkalosis)
Management CF
MDT
physio: 20 minutes BD
- forced expiratory technique
- exercise program
nutrition: height and weight 3 monthly
- high caloric/protein diet
- vitamin A, D and E supplementation
- pancreatic enzyme supplementation
respiratory:
- AB
- DNase
Causes wheeze
Acute:
- asthma/bronchiolitis/bronchitis
- bacterial tracheitis
- foreign body aspiration
Chronic or recurrent:
structural
- tracheo-bronchomalacia
- vascular rings/compression
- tracheal stenosis/web
- other masses
- cardiomegaly
functional
- asthma, CF, primary ciliary dyskinesia
- GORD, recurrent aspiration
- immunodeficiency
- bronchopulmonary dysplasia
- retained foreign body
Premature infants
CLD
- if weaned off oxygen within weeks/months: good prognosis
- episodes of bronchiolitis more severe and longer
- recurrent wheeze
- lower threshold for admission
- influenza/pneumococcal vaccines
PDA
- treatment usually supportive
- medical treatment: indomethacin (renal impairment/NEC), ibuprofen
- surgical ligation if unresponsive to medical tx but ussualy relapse
Feeding/nutrition
- TPN (extravasation injury, infection, thrombosis, hyperbilirubinaemia)
- FTT, NEC
IVH (subependymal germinal matrix)
- extension into parenchyma: cysts, PVL, post haemorrhagic ventricular dilatation, hydrocephalus, shunt
- large IVH: 50% significant neurodisability
PVL
- ischaemic damage to brain supplied by branches MCA
- motor impairment (descending corticospinal tracts)
- CP (diplegic)
- cortical blindness
Vision (secondary to ROP, PVL, direct cortical damage)
- laser tx for ROP
Hearing
- RF: aminoglycosides, jaundice, hypoxia, IVH, PVL
Developmental delay
- risk across all gestations
causes clubbing
respiratory:
- bronchiectasis/CF/primary ciliary dyskinesia
- empyema/lung abscess
- pulmonary TB
- fibrosing alveolitis
cardiac
- cyanotic congenital heart disease
- bacterial endocarditis
gastrointestinal
- biliary cirrhosis
- chronic active hepatitis
- IBD
causes bronchiectasis
causes:
- post infectious: staph, strep, adenovirusm pertussis, influenza
- bronchiolitis obliterans
- primary ciliary diskinesia
- A1AT
- asthma
- recurrent aspiration
- lobar sequestration
- immunodeficiency
primary ciliary dyskinesia
features:
- bronchiectasis
- nasal polyps
- sinusitis
- chronic suppurative SM
- male infertility
*50% patients have Kartagener’s
investigations:
- saccharin test
- exhaled NO levels (low in PCD)
- ciliary brush biopsy
causes stridor
acute:
- croup, epiglottis, tracheitis
- foreign body
- anaphylaxis
chronic:
- laryngomalacia (most common)
- tracheomalacia, bronchomalacia
- prolonged neonatal intubation (subglottic stenosis)
- intraliminal web/haemangioma
- extrinsic compression
- Pierre-Robin syndrome
investigations: CXR, barium swallow, ECHO
tracheostomy
indications:
- subglottic stenosis
- prolonged intubation
- severe GORD
- irradiation
- neuromuscular weakness
- severe sleep apnoea
complications:
- hypoxia
- decannulation
- ulceration
- infection
- bleeding
- arrhythmia
