Respiratory system/ENT Flashcards
Definition of asthma
recurrent, reversible obstruction of the airways due to inflamed bronchi
triggers for asthma
infection - eg rhinovirus especially in the winters
allergy - dust mites etc
emotions - severe emotional upset , excitement, anxiety etc
exercise - esp. running in cold air
atmosphere - dusty air, stuffy an smoke filled rooms etc
symptoms of asthma
triad of cough, SOB and wheeze
asthma should be syspected in any child with wheezing > one occasion
wheeze - exploratory high pitch wheeze, worse at night and early morning
Cough - dry, nocturnal cough usually after midnight
Chest tightness - esp with exercise and at night
SOB - establish when in exercise normally, but in severe attacks: SOB at rest, agitation, feeding difficulties and attenuated cry (infants), drowsy and confused
symptoms usually have a clear trigger and intervals in between exacerbation
strong FHX of atopy
what are some of the questions to be asked in suspected asthmatic patient
how frequent are the symptoms
what triggers the symptoms such as sport, general activities etc
how often is sleep disturbed by asthma
how severe are the interval symptoms between exacerbations?
how much school has been missed due to the illness #
examination findings of asthma?
long-standing asthmatic patients - hyperinflation of the chest/Harrison’s solci §
generalised polyphonic expiratory wheeze and prolonged expiratory phase
widespread wheeze on auscultation
harrison’s sulci possibly
evidence of eczema - atopy
growth may be affected
investigation of asthma
Usually clinical diagnosis over the age of 5 due to the present of viral wheeze
<5 yr - Diagnostic test
- treat then diagnosis after 5 yrs old
5-16 yrs
- spirometry —> BDR —> feNO
> 17 yrs follow adult diagnostic pathway
what are some of the differentials for asthma
inhalation of foreign body allergic rhinities GORD aspiration syndrome bronchiectasis bronchiolitis bronchopulmonary dysplasia primary cillary dyskinesia
chronic management of asthma for children < 5 yrs old
PRN SABA
Step 0 - consider monitored initiation of treatment with very low to low dose ICS
Step 1 = LTRA < 5 years
Step 2 = v low dose ICS + LTRA
Step 3 = if not adequate response from LTRA, then stop LTRA, inc dose of ICS to low dose
if benefit from LTRA then continue LTRa and inc ICS to low dose
If benefit from LTRA still, can consider ICS and LABA
Step 4 - inc ICS to mediaum dose +/- theophylline + specialist input
Step 5 - daily steriod tablet in the lowest dose + medium dose ICS
what are the classification of asthma in children between 2-5yrs
moderate asthma SpO2 > 92% able to talk HR <140 RR<40
severe asthma SpO2<92% too breathless to talk HR>140 RR >40 use of accessory neck muscle
life-threatening SpO2 <92% any of the following 1) silent chest 2) poor respiratory effort 3) agitation 4) altered consciousness 5) cyanosis
what are the classification of asthma in children >5 yrs
moderate asthma SpO2 >92% PEFR>50% able to talk HR <125 RR < 30
severe asthma SpO2 <92% PEFR 33-50% too breathless to talk HR >125 RR > 30 use of accessory talk
life-threatening SpO2 <92% any of the following 1) silent chest 2) PEFʀ < 33% 3) poor resp effort 4) agitation 5) altered consciousness 6) cyanosis
acute management for moderate asthmatic attack
2-10 puffs of inhaled/nebulised salbutamol not exceeding 4 hourly
one puffs every 30/60 secs to make sure not excess
consider oral prednisolone if necessary
acute management for severe asthmatic attack
2-10 puffs of inhaled/nebulised salbutamol
oral prednisone or ɪV hydrocortisone if vomiting
assess response to treatment after 15 mins
acute management for life-threatening asthmatic attack
ɴebulised salbutamol and ipratropium bromide
ɪv hydrocortisone/ɪV salbutamol if necessary
consider ɪV aminophylline/ɪV Mg
who does inhaled foreign body most commonly occur to?
Mobile toddlers who would put objects into their mouth - objects that are small enough to pass the pharynx.
clinical features of inhaled foreign body
unilateral wheeze
resp distress
asymmetrical dull on percussion if collapse occur post obstruction
hyper-resonance on percussion around the collapse area due to compensatory emphysema
most commonly occur in the R main bronchi since it is straighter than the L one
Ix for inhaled foreign body
CXR- - segmental collapse or hyperinflation seen
bronchoscopy
management for inhaled foregin body
Bronchoscopy and removal of foreign body at the same time
if complete blockage - medical emergency - Heimlich manoeuvre
what are the prognosis of inhaled foreign body
bronchiectasis occur distal to obstruction –> dilated air sac and inefficient exchange of air –> recurrent/chronic infection –> require surgical removal
what is ottitis media
inflammation and possibly infection of the media ear
epidem of ottitis media
most frequent up to 7yrs
2.5-5yrs most common
most children will have an episode of OM but some 20% will have at least 3 episodes
Aetiology of Ottitis Media in children
children have a much shorter, more horizontal and poorly functioned Eustachian tube and so the drainage of the middle ear is not as good as in adult
causes of Ottitis media
virus - RSV, rhinoviruses
bacterial - strep pneumonae, haem. influenzae
what condition predisopse children with dysfunction Eustachian tube?
Down’s
post- common cold
adenoidal hypertrophy
cleft palate
clinical features of Ottitis Media
fever
painful ears
hearing loss
Preceded by URTI
younger children - anorexia, vomiting + diarrhoea
what examination must you carry out if a child has a fever
exam of the tympanic membrane for ottitis media
what are the exam finding of ottitis media
inflamed tympanic membrane
bulging tympanic membrane
loss of light reflex
perfusion of eardrum along with pus present
management of ottitis media
many causes are viral - supportive and should resolve in time
delayed Amoxicillin prescription - give the prescription to the parents but ask them only to get the medication after 2-3 days if not better - ABx only indicative if children >6mnths old and symptoms persist > 48 hrs
prognosis of ottitis media
most cases resolve fine
some might have recurrent infection and have ottitis media with effusion, more severe - mastoiditis, meningitis
what is ottitis media with effusion
glue ear - recurrent ottitis media leading to exudate production and and building up pushing against the eardrum and so conductive hearing loss
exam finding of OME
tympanic membrane thicken, retarted, absent light reflex
IX for OME
flat trace of tympanometry and conductive hearing loss
management of OME
if significant hearing loss - insert ventilation tube ( grammets)
if fluid still persist - insert another grammet (might be blocked) + consideration of adenoidectomy (long term benefit)
