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Paediatrics > Wheeze and coughs > Flashcards

Wheeze and coughs Flashcards

1
Q

Cough

A

“A forced expulsive manoeuvre, usually against a closed glottis with a characteristic sound”
Chronic = daily cough for over 8 weeks
Recurrent = cough for >2wks more than twice yearly

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2
Q

Wheeze

A

A polyphonic expiratory, high pitched whistling sound due to lower large airway obstruction

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3
Q

Causes of Cough without wheeze

A

URTI - most commonly viral - most common cause (10% of young children) - unrelated to colds and without wheeze
can also be caused by TB or Sinusitis

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4
Q

Causes of Wheeze without cough

A

Viral induced wheeze

Mediastinal mass or cancer

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5
Q

Causes of both cough and wheeze

A

Cystic fibrosis Asthma
Bronchiolitis Pneumonia
Croup GORD

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6
Q

Features of asthmatic wheeze (4,4)

A

Multi-trigger wheeze - Diurnal variation (nocturnal), exertion, cold air, viral illness
Atopy –> Food allergies, eczema, rhinitis and FH

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7
Q

Features of a viral wheeze

A

Viral illness prodrome –> develops into wheeze

If under 1yr may be bronchiolitis, if older viral induced wheeze

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8
Q

Risk factors for cough and wheeze

A

Parental Smoking – biggest single factor - 50% of children <11yrs when both parents smoke
Dampness in home, air pollution, SE status
Allergic responses - house dust mites, pollen, cats or dogs

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9
Q

Asthma treatment ladder for children under 5yrs

A

Step 1 - Inhaled short acting Beta-2 agonists PRN (salbutamol)
Step 2 - Add inhaled steroids 200-400mcg/day
Step 3 - Add leukotriene R antagonist to steroid or visa versa
Step 4 - Refer to resp paediatrician (if <2yrs consider skipping stage 3)

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10
Q

Complications of viral respiratory Illness

A

Tonsilitis - painful to swallow leading to dehydration
Obstructive sleep apnoea
Middle ear infection/effusion
Hearing loss and Glue ear

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11
Q

GORD

A

Commonest in infants and the overweight - occurs after meals and when lying down - sandifer’s syndrome, feeling of ‘globus’ in the throat
Complications –> feeding aversion and strictures

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12
Q

Sandifer’s syndrome

A

A combination of GORD and neurological movement disorder (spasmodic torticolis, dystonia and hypotonia)
Treatment of the reflux generally leads to remission of symptoms

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13
Q

Tuberculosis in children

A

Lymph nodes obstruct airways - cause cough
Night sweats and weight loss —> haemophtysis is unlikely in children
Check travel and family history

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14
Q

Cystic fibrosis

A

Chronic moist cough with phlegm - systemic signs and history
Should now be screen when neonate
Associated with Mec ileus, recurrent chest infections, malabsorption (steatorrhoea, FTT), liver disease. Also: short, DM, delayed puberty, rectal prolapse, nasal polyps, infertility (male) or subfertility (female).

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15
Q

Aspirated foreign body

A

Especially in younger children

Sudden onset cough or wheeze

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16
Q

Mediastinal causes of wheeze in children

A

Usually T cell lymphoma most commonly in teenagers with weight loss

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17
Q

Congential causes of cough or wheeze (6)

A

Tracheobronchomalacia or vascular rings (will give stridor)
Tracheo-oesophageal fistula or Laryngeal clefts (cough after feeding)
Primary ciliary dyskineasia or psychogenic cough

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18
Q

Physical examination of wheeze (6)

A

Finger clubbing or chest wall deformities (pectus excavatum or caraium )
Check air entry – equal?, normal or reduced? Wet or dry crepitations, resonance, Wheeze (general or localised)

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19
Q

Signs of respiratory distress (7)

A

Increased respiratory rate Head bobbing
Recession (subcostal or intercostal) Expiratory grunting
Nasal flaring Tracheal tug
Signs of tiring

20
Q

Facial Signs of allergy

A 
Allergic salute (wiping the nose upwards)
Allergic shiners (dark circles under the eyes due to sinus congestion)
Dennie-Morgan folds (extra suborbital folds due to oedema in atopic dermatitis)
21
Q

Glue Ear

A

Otitis media with effusion (see ENT deck)

22
Q

ENT exam in children

A

Big tonsils compared to adults

Mouth breathing – suggest nasal obstruction (polyps, Nasal haematoma, swollen turbinates)

23
Q

Asthma treatment ladder for children 5-12yrs

A

(Step 1+2 as <5s but steroid 200-800mg)Step 3 - Add long-acting B2 agonist.Step 4 - Steroid to 2000mcg + leukotriene R antagonist, theophylline, consider adding B2 agonist tablet. Step 5 - Add daily steroid tablet - optimise other drugs to minimise steroid tablets

24
Q

Differentials for chronic cough

A

Asthma or Rhinosinusitis (upper airway cough syndrome)
Protracted bacterial bronchitis or Post-infectious cough
GORD or other (10%)

25
Q

Asthma

A

Cough with wheeze + chest tightness
If cough without wheeze = cough variant asthma –> nocturnal exacerbations, triggered by exercise and cold air
Decreased exercise tolerance

26
Q

Rhinosinusitis

A

Nasal obstruction or congestion - rhinorhoea, sneezing, purulent nasal discharge, post-nasal drip, repetitive throat clearing

27
Q

Protracted bacterial bronchitis

A

Bronchoalveolar lavage –> check cytology for neutrophilia, culture (Hib - 50%, moraxella catarrhalis - 20%, strep pneumoniae 30%
Should response to antimicrobials within ten days

28
Q

Post infectious cough

A

Transient airway hyper-reactivity and inflammation

Due to: Viruses (RSV and Parainfluenza) or Bacteria (chlamydia pneumonia or pertussis)

29
Q

Management of non-specific cough

A

Watchful waiting up to 8 weeks

In many cases removing smoking is enough

30
Q

Management of rhinosinusitis

A

Allergen avoidance
Trials of long-acting anti-histamines +
Intranasal steroids

31
Q

Management of protracted bacterial bronchitis

A

Sputum culture before treatment

If pertussis start a macrolide antibiotic early (end in mycin)

32
Q

Management of GORD

A

May not require empirical treatment - if pH shows reflux start treatment on full dose PPI for 1-2mths (if responds switch to low dose, if not double dose). Otherwise consider prokinetic or H2 antagonists –> consider fundoplication

33
Q

Management of aspirated foreign body

A

Urgent bronchoscopy

34
Q

Causes of wheeze in under 5s

A

Typical –> transient early, nonatopic/viral or atopic wheeze.
Atypical –> GORD, congenital abnormalities, cystic fibrosis, cardiac disease, Foreign bodies, TB, bronchopulmonary dysplasia, immunodeficiency, primary ciliary diskineasia, Mediastinal mass/Ca

35
Q

Transient early wheeze

A

Starts in infancy - up to 3yrs
Related to reduced pulmonary function up to 16yrs
RFs –> prematurity, male, exposure to other children, exposure to tobacco smoke

36
Q

Non-atopic wheeze

A

recurrent viral infections - normal lung function but with intermittent airway obstruction

37
Q

Persistent atopic wheeze

A

Discrete attacks with symptom free intervals - worse at night
FH of asthma or atopy – Elevated IgE and blood eosinophilia
responds to bronchodilators and corticosteroids – early form/develops into asthma as airways remodel

38
Q

Asthma phenotypes (5)

A

Concordant disease - Benign asthma or Early onset asthma
Discordant symptoms – obese non-eosinophilic or early symptomatic
Discordant inflammation - Eosinophilic inflammation predominant

39
Q

Obese non-eosinophilic asthma

A

Late onset, in obese females, high symptom expression compared to eosinophil infiltration

40
Q

Benign asthma

A

Mixed middle aged patients
Well controlled symptoms and inflammation
Benign prognosis

41
Q

Early onset asthma

A

Standard Asthma - concordant levels of symptoms, inflammation and airway dysfunction

42
Q

Early symptomatic asthma

A

Early onset with atopy in patients with normal BMI

Very high symptom expression compared to the level of inflammation

43
Q

Eosinophilic inflammation predominant asthma

A

Late onset with a male preponderance - Few daily symptoms but active eosinophilic inflammation

44
Q

Infections in cystic fibrosis

A

Staph aureus
Pseudomonas aeruginosa
Burkholderia (pseudomonas) cepacia
Aspergillus

45
Q

High white cell count in child with respiratory issue

A

Neutrophilia- pneumococcus

Lymphocytosis- pertussis

Paediatrics (18 decks)

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