Flashcards in Cough/Dyspnoea/Wheeze Deck (24):
How many RTIs can children have per year?
DDx acute cough
• Respiratory infection: common cold, bronchiolitis, croup, pneumonia, pertussis
• Inhaled foreign body
DDx persistent/recurrent cough in ADULTS
3. post-nasal drip
DDx persistent/recurrent cough in PAEDS
- Protracted bacterial bronchitis
- Tracheomalacia: onset in infancy, barking
- Post-viral cough
- Suppurative lung disease: wet (productive)
- other e.g. smoking
Examples of suppurative lung disease
• Chronic suppurative lung disease
• Cystic fibrosis
• Primary ciliary dyskinesia
• Inhaled FB
• Protracted bacterial bronchitis: especially following a predisposing viral infection
DDx of cough in:
- school age
• Infancy: infections (URTI, bronchiolitis, pneumonia), congenital malformations of airway, GORD, CF
• Pre-school: infections (URTI, croup, acute bronchitis, pneumonia), FB aspiration, asthma, CF
• School-age: asthma, URTI, cigarette smoking, post-nasal drip, psychogenic, CF
DDx paroxysmal cough
- Foreign body
Acute cough vs chronic cough
Acute < 4weeks
Compare cough and fever in:
- Foreign body
- URTI: +/- fever, non-productive cough
- Pneumonia: fever, productive cough
- Asthma: +/- if URTI present, wheeze often nocturnal cough or on exercise
- Foreign body: fever if infection, cough often preceded by choking episodes
Pulmonary causes of dyspnoea (upper airway, lower airway, pleural causes)
• Upper airway
○ Foreign body
○ Laryngeal oedema
○ Retropharyngeal abscess
• Lower airway
○ Pleural effusion
Cardiac causes of dyspnoea
• Cardiac tamponade
List a few non-pulmonary/cardiac causes of dyspnoea
• Acidosis (e.g. DKA)
• Raised ICP
DDx for wheeze
• Asthma: recurrent wheezing episodes, identifiable triggers
• Viral-induced wheeze
• Bronchiolitis: first episode of wheezing
• Recurrent aspiration: often neurological impairment
• Pneumonia: fever, cough, malaise
• Croup: stridor
• Foreign body
• Congestive heart failure
What might a persistent vs intermittent wheeze tell you about the cause of the wheeze?
- Persistent more likely structural
- Intermittent more likely functional
What is a common cause of persistent, acute onset wheeze?
Foreign body aspiration
Compare stridor and wheeze.
• A high pitched inspiratory noise due to partial obstruction of upper airways (trachea or larynx)
- expiratory sound through narrowed airways (e.g. asthma, bronchiolitis, CHF, foreign body, GORD)
Why do children grunt? What is it indicative of?
• Exhalation through closed glottis is an attempt to maintain FVC e.g. pneumonia
What is the most common cause of stridor in infants?
What are some causes of stridor?
• Within the lumen (e.g. foreign body, mass)
• Within the wall (e.g. epiglottitis, croup, oedema from anaphylaxis, laryngospasm)
• Extrinsic (e.g. goitre, lymphadenopathy, oesophagus)
List some signs of increased WOB, from most mild to most severe.
- Mild: tachypnoea
- Mod: retractions - subcostal (i.e. abdominal breathing), substernal, intercostal, nasal flaring
- Severe: head bobbing, tracheal tug, retractions - supraclav, suprasternal, sternal
- Very severe: grunting
- Other: body posture, behaviour, conscious state, ability to talk
- NB: accessory muscle use = posture, SCM contraction, head bobbing
What is the tracheal tug?
Downward movement of thyroid cartilage towards the sternal notch on inspiration - sign of severe airflow limitation
What is the cause of crackles? What do they sound like?
- Discontinuous, bubbling sounds
- fluid/substance in lower aiwrways
What are rhonchi (previously rales)?
Low pitched wheeze continuous throughout insp and exp, clear after coughing