Paeds - Respiratory Flashcards
ICS side effects
PO candidiasis
Brief slowing of growth
Adrenal suppression
DOES NOT AFFECT ADULT HEIGHT
Chronic asthma assessment
Growth and nutrition
Signs of CF
Clubbing
Atopy
PEF
RCP3 questions - ASThma
Signs of respiratory distress
Nasal flaring
Tracheal tug
Accessory muscles - Subcostal and intercostal recession
CF respiratory features
Cough
Purulent sputum
Recurrent infections
O/E
- Hyperinflation
- Coarse inspiratory crackles
- Expiratory wheeze
- Clubbing
CF diagnosis
Guthrie heel prick test
Immunoreactive trypsinogen - Pancreatic enzyme precursor
Sweat test
- Pilocarpine ionotophoresis
- Elevated Cl- concentration
Genetic testing - CFTR gene on chromosome 7
Bloods
- Decreased lipase/amylase
- Faecal elastase
CXR
- Hyperinflation
- Peribronchial shadowing
- Bronchial wall thickening
- Ring shadows / train tracks
Stridor vs Wheeze
Monophonic, inspiratory, high pitched
DDx - Upper airway obstruction
- Croup
- Epiglottitis
- Bacterial tracheitis
- Inhaled foreign body
- Anaphylaxis
- Laryngomalacia
Wheeze - Polyphonic - Expiratory or inspiratory
Bronchiolitis aetiology and presentation
- RSV
Parainfluenza
Human metapneumovirus
More common in winter
Coryzal SOB Poor feeding Sharp dry cough High pitched expiratory wheeze
Respiratory distress
Bronchiolitis investigations and when to admit
RSV swab - Nasopharyngeal aspirate
O2 sats
CXR - Hyperinflation
Admit if…
- Poor feeding
- Apnoea
- Lethargy
- RR > 70
- Cyanosis
- Severe chest wall recession
- Nasal flaring
- Fluid intake < 50-70%
Bronchiolitis management and prophylaxis
Supportive
Fluids
Nebulised salbutamol
Humidified O2
Suction of secretions
Palivizumab IM
October - February
At risk groups…
- Premature
- Immunocompromised
- Downs
- CHD
Croup aetiology and presentation
- Parainfluenza
RSV
Human metapneumovirus
Initial fever
Coryzal symptoms
Barking cough
Stridor
Hoarseness
Worse at night
Croup investigations and management
O2 sats
DO NOT EXAMINE THROAT
ABCDE
Dexamethasone
Nebulised epinephrine
Epiglottitis aetiology and presentation
HiB - Rare now due to vaccine
Tripod sign Accessory muscles Drooling Soft stridor High fever Absent cough
Epiglottitis investigations and management
DO NOT EXAMINE THROAT
CXR - Thumb sign
O2 sats
Blood cultures
ABCDE
Cefuroxime IV
Rifampicin to household contacts
Whooping cough
Bordatella pertussis
Catarrhal phase - Coryzal for 1 week
Cough with inspiratory whooping noise for 3-6 weeks
Straining can lead to…
- Vomiting
- Conjunctival haemorrhage
- Apnoea
Investigations - Nasal swab
Management - Azithromycin
Bacterial tracheitis
- Staph aureus
HiB
High fever
Toxic child
Airway obstruction due to secretions
ABCDE
IV cefuroxime and clindamycin
