Week 3 - Respiratory conditions Flashcards
Allergic rhinitis
- AR is a disorder that results in nasal mucosal inflammation due to Th2 cell. Eventually histamines are activated causing sneezing, vasodilation which leads to obstruction of nasal passages, nasal secretion and sensory nerve hyperresponsiveness
Two phases of allergic rhinitis
- Immediate 15-30 min after exposure due to mast cell release
- 6-12 hours afterwards due to t cells, basophils and eosinophils infiltrating the nasal mucosa
Clinical diagnosis for allergic rhinitis
Based on the presence of rhinorrhea, nasal pruritus and congestion, and sneezing.
Symptoms are seasonal or perennial depending on the allergen
Allergic rhinitis - intermittent vs persistent
Intermittent, 4 weeks or less
Persistent, longer than 4 weeks
Physical exam findings for allergic rhinitis
- Reduced nasal passage patency or bilateral obstruction due to congestion/inflammation
- Mouth breathing, snoring, nasal speech
- Pale, purple, edematous nasal mucous membranes (boggy)
- Clear secretions
- Itching or rubbing nose (allergic salute)
- Nasal stuffiness, postnasal drip, sneezing, congestion, cough
- Allergic shiners
Treatment of allergic rhinitis
- Oral or nasal H1 antihistamines or oral/nasal decongestants, inhaled nasal corticosteroids
- Allergy immunotherapy
Streptococcal pharyngitis symptoms
- abrupt onset
- lack of nasal symptoms
- pharyngitis
- cervical tender lymph nodes
- arthralgia
- myalgia
- headache
- moderate/high fever
- nausea & vomiting,
Diagnostic test for streptococcal pharyngitis
Rapid strep test
Streptococcal pharyngitis treatment
Penicillin V potassium –
250mg 2x or 3x a day for 10 days,
children over 27kgs 500mg BID or 2xday for 10 days
MORE COMMON
* amoxicillin suspension more palatable 50mg/kg/day (max 1000mg) or 25mg/kg/day BID for 10 days
Cause of scarlet fever pharyngitis
Caused by erythrogenic toxin (bacteria) common in kids who have had strep throat
S/S of scarlet fever pharyngitis
- sore throat
- vomiting
- headache
- chills
- malaise
- tonsils are erythematous, edematous and exudative
- pharynx covered with gray/white exudate
- plaate and uvula are erythematous and redended
- tongue coated aond red (strawberry tongue)
- scarlatina rash begins on neck and sprads to trunk
- resolves in 5-7 days
- finely papular
- feels like sandpaper
- spread is contact and droplet
Treatment for scarlet fever pharyngitis
penicillin or amoxicillin as strep throat
Penicillin V potassium –
250mg 2x or 3x a day for 10 days,
children over 27kgs 500mg BID or 2xday for 10 days
MORE COMMON
* amoxicillin suspension more palatable 50mg/kg/day (max 1000mg) or 25mg/kg/day BID for 10 days
Mastoiditis
- Infection of the mastoid cells that may occur with or follow AOM
- Lining of the mastoid air cells become inflamed with progressive swelling and obstruction caused by drainage from the mastoid
S/S of Mastoiditis
- Recurrent AOM
- Fever
- Otalgia
- Persistent OM unresponsive to ABX
- Postauricular swelling
- Discharge from EAC
Mastoiditis managment
- Urgent referral to ENT
- Hospitalization
- IV abx
- Possibly surgical intervention with myringotomy, tube placement and mastoidectomy
- CT (preferred – shows inflammation and coalescence of mastoid air cells)
- Xray – coalescence of mastoid air cells
- IV antibiotic therapy – cefotaxime or ceftriaxone until culture results obtained
- Myringotomy for culture and drainage
Peritonsillar abscess
- Usually caused by streptococcus
- Area of puss filled tissue at the back of the mouth next to one of the tonsils. Painful and can caus swelling that pushes the tonsil toward the uvula.
Treatment for peritonsillar abscess
Treat with penicillin or augmentin
Upper respiratory infection cause
Usually viral
S/S URI
- Low onset fever
- Rhinnorhea (key finding)
- Sore throat – dysphagia
- Mild cough
- Poor sleep
URI treatment
- Saline nose spray
- Increase fluids
- Humidifier
- Treat pain/ fever
Asthma symptoms
- varying degree of airflow obstruction that presents as coughing, wheezing, chest tightness, breathlessness, and respiratory distress
- persistent cough without significant wheezing
- bronchospasm
- long term airway remottling
- airflow obstruction reversible w or w/o treatment
Triggers for asthma
- viral respiratory infections,
- environmental allergens,
- change in the weather,
- stress,
- emotional expression,
- exercise
- comorbid conditions such as sinusitis and gastroesophageal reflex
Asthma biphasic reaction
- Early asthmatic response – within 15-30 min of exposure, resolves 1 hour after removal
- Late phase response – 6-26 hours after exposure, last hours to weeks, needs a corticosteroid for treatment (response to beta agonist is muted)
Causes of allergen induced asthma
- House dust mites, cockroaches, indoor molds
- Saliva and dander of cats and dogs
- Outdoor seasonal molds
- Airborne pollens—trees, grasses, and weeds
- Food allergy, including egg and tree nut
Asthma PE findings
- Wheezing
- Coughing
- Prolonged expiration
- Diminished breath sounds
- Altered levels of alertness, nasal flaring, retractions, accessory muscle use, nasal flaring, restlessness, apprehension, agitation, drowsiness to coma
- Tachycardia/HTN, Hypotension
- Cyanosis
- Sinusitis, AR, AD
Asthma diagnostics
- O2 saturations
- CBC if secondary infection or anemia suspected
- Allergy evaluation
- PFTs
- Spirometry
- FEV1
Spirometry values for asthma obstruction
FEV1
- > 75%: Normal
- 60% to 75%: Mild obstruction
- 50% to 59%: Moderate obstruction
- <49%: Severe obstruction
Intermittent asthma
- symptoms 2 or less times per week
- SABA 2 days a week
- No interference with nomal activity
- Night time symptoms 2 or less per month
- FEV1 >80%
Mild persistent asthma
- Symptoms more than 2x week but less than daily
- SABA more than 2 days a week but less than daily
- Minor affect on activity
- Nightime smptoms 3-4x per month
- FEV1 >80%
Moderate persistent asthma
- Daily symptoms
- Daily SABA
- Exacerbations affect activity 2+ times per week – may last day
- Night symptoms mmore than 1x week less than nightly
- FEV1 >60% but <80% predicted
Severe persistent asthma
- Continual symptoms
- SABA several times per day
- Extremely limited physical activity
- Frequent exacerbations
- Night symptoms every night
- FEV1 <60%
Gold standard testing for asthma diagnosis
Pulmonary function testing
Control measures for chronic asthma
- Avoid allergens/ irritants
- Use AC – close windows and doors, remain inside when allergens are high
- Control environment to eliminate allergen
- Allergen immunotherapy
- Treat AR, GERD,
- Use a written action plan
Acute bronchitis history
Usually viral.
- dry hacking unproductive cough
- chest pain with coughing
- family history of asthma, CF, atopy, smoke and allergen exposure
- exposure to infection at daycare
- nature of cough
Acute bronchitis PE
- Variable degrees of URI symptoms
- Low-grade or no fever
- Coarse breath sounds changing rhonchi and rales
Acute bronchitis treatment
- analgesia
- hydration
- antiviral therapy for those with underlying respiratory disease
- trial of bronchodilators if asthma suspected
Respiratory Syncytial Virus
- common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious. Infants and older adults are more likely to develop severe RSV and need hospitalization
RSV symptoms
- Runny nose
- Decrease in appetite
- Coughing
- Sneezing
- Fever
- Wheezing
- Apnea
RSV diagnosis
PCR swab
RSV treatment
- Manage pain and fever
- Increase fluid intake
Cystic fibrosis
- multisystem genetic disorder manifested by chronic obstructive pulmonary disease (COPD), GI disturbances, and exocrine dysfunction; it is the most common autosomal-recessive disease
- Chronic airway infection, mucus that is adherent and stringy, dysfunctional mucociliary transport, airway obstruction, chronic infections
Cystic fibrosis diagnosis
Diagnosis is based on evidence of CFTR (gene on chromosome 7) dysfunction and signs and symptoms of the disease.
Newborns are screened.
