Respirology Flashcards
Consequences of Missed foreign body aspiration
- recurrent pneumonia
- bronchiectasis
- cardiac arrest and death
Differential for Chronic Cough
Healthy Children:
- frequent, viral resp tract infections
- postviral cough
- pertussis/pertussis like cough
Chronic Cough
- Cough variant Asthma
- Chronic rhinitis
- Persistent Bronchitis
- GERD
- Psychogenic Cough
- Non-specific Isolated Chronic Cough
Potentially Serious Lung Disorders
- CF
- Immunodeficiency
- PCD
- FBA
- Recurrent Pulmonary Aspirations
- TB
- Anatomic Disorder
- Interstitial Lung Disease
Chronic Wet Cough DDX
- CF
- PCD
- Immunodeficiency
- Bronchiectasis
- Persistent Bacterial Bronchitis
- Missed Foreign Body
- Chronic Infections
- Asthma +/- Allergic Rhinitis
- Recurrent Viral Infections
CF Clinical Presentations:
Infancy:
- FTT
- Meconium Ileus
- Recurrent Resp Symptoms
- Hyponatremic, hypochloremic metabolic alkalosis
- Prolonged Jaundice
- Severe Pneumonia
Chidlhood/Adolescents
- recurrent resp symptoms
- FTT
- Recurrent rectal prolapse
- Clubbing
- Bronchiectasis
- Nasal polyps/sinus disease
- Chronic Pseudomonas aeroginosa colonization
How to interpret Sweat Chloride
- > / 60 mEq/L is abnormal
- Normal:
- < 30 1st 6 months of life
- > 40 after 6 months
Protracted Bacterial Bronchitis
- emerging (controversial) diagnosis
- > 3 - 4 weeks of chronic wet cough
- resolution of cough with antibiotic txt
- association with significant pus and neutrophils on bronchoscopy
- most common in children < 5 yrs
- H influ, S. pneumoina, M catarrhalis, S. aureus
What syndromes are Laryngeal Cleft associated with?
VACTRL
CHARGE
Opitz Frias
Midline Defects
Need rigid bronch to rule out
How to managed non-specific chronic cough
- medium dose ICS
- intra nasal corticosteroids +/- antihistamines
- always look for red flags and give a time defined treatment trial
DDX for Wheezing
- Asthma
- CF
- Large airway obstruction
- Foreign body asp
- PCD
- Infectious adenopathy
- Chronic Lung Disease of Prematurity
- Rare Interstitial Lung Disease
- Congestive Heart Failure
- GERD
Asthma Control Criteria
Daytime symptoms: < 4days/wk Nighttime symptoms: < 1 night/wk Physical activity: normal Exacerbations: mild, infrequent Absence from work/schoo: none Fast acting B-agonist use : < 4doses/wk (no longer excludes pre-exercise B-agonist use) FEV1 or PEF: >/ 90% personal best
What is the Modified Asthma Predictive Index
Predicts who likely to progress to asthma into school age, NOT a test for who should be treated
1 Major Criteria
- Parental Asthma
- Doctor Diagnosed Eczema
- Sensitization to an aeroallergen
OR
2 Minor Criteria
- wheezing in between pisodes
- peripheral eosinophilia
AND
> 3 wheezing episodes
DDX for Recurrent Pneumonia
Same Location
- Anatomic abnormality: external airway compression (i.e. lymphadenopathy, vascular abnormality), intrinsic airway compression
- congenital malformation: CPAM, pulmonary sequestration, bronchogenic cyst
- foreign body
- right middle lobe syndrome (smallest and likely to have congestion)
- bronchiectasis
- persistent infection
Multiple Locations
- immune deficiency
- CF
- PCD
- Recurrent aspirations: anatomical, swallowing disorder, neurologic impairment
Sequalae of OSA?
- Neurocognitive: behavioral, attention, school performance, development
- Cardiovascular: HTN, Cor Pulmonale
- FTT
- Inflammatory
- Quality of life
Daytime Features of OSA
- Behavioural Problems
- ADHD symptoms
- Poor School Performance
- Developmental Delay
- Shyness
- Difficulty waking up in the AM
- FTT
- Enuresis
- Daytime Fatigue
Risk Factors for OSA
- Craniofacial syndromes: micrognathia, retrognathia, glosoptosis, midface hypoplasia, macroglossia, nasal deformities
- hypotonia
- T21
- obesity
