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Flashcards in The infant or child with breathing difficulties Deck (38):
1

Most common cause of wheezy child-coryza, breathless, cough (3)

URTI
Asthma
Bronchiolitis

2

Causes of 'chestiness' (10) and important features

Bronchiolitis
Asthma
Pneumonia
Heart failure
Viral induced wheeze
Foreign body
Whooping cough
Croup
TB

Traumatic->pneumothorax, hemothorax
DKA, acidosis, deH, anxiety
Peritonsillar abscess
Spontaneous pneumothorax of teenager
Cough without breathlessness

3

Causes of cough without breathlessness (5)

GORD
Post nasal drip
Tracheoesophageal fistula
Passive smoking
Cystic fibrosis

4

History

Evidence of infection- fever, poor feeding
Previous history of wheezing- recurrent asthma
Atopic- eczema, hay fever
Known history of disease which may +risk of developing bronchiolitis- congenital heart disease, prematurity
Relevant family history- TB, CF, CHD

5

Examination

Signs of respiratory distress->grunting, intercostal recession, nasal flaring
Are there additional noises->whooping, stridor, barking cough
Signs of chronic respiratory conditions->clubbing, chest wall deformities
Cyanosis?
Pyrexial?
Evidence of congenital heart disease?
Evidence of consolidation
Can the child talk in full sentences?
Is the PEFR normal?

6

Investigations and importance

CXR->consolidation (lobar/diffuse), collapse, heart failure, hyperinflation
FBC->leukocytosis (penumonia), lymphocytosis (TB)
Nasopharyngeal swab->viral immunoflurescence
Sputum->acid fast bacilli
Perinasal swab->Bordetella pertussis
Viral titres->atypical pneumonia (Mycoplasma)
Blood cultures->S pneumonia if bacterial pneumonia
Mantoux test->TB
Bronchoscopy->Removal of foreign bodies

7

Viral causes of pneumonia

RSV
Parainfluenza
Influenza
Adenovirus
Coxsackie

8

Bacterial causes of pneumonia

S. Pneumonia
Haemophilus influenza
S. Aureus
Mycoplasma pneumonia

GBS in newborn

9

Which infectious agents more common in those with underlying respiratory disease

Pseudomonas
Staphylococcus aureus

10

Predisposing factors in penumonia

Congenital anomaly of respiratory tract
Aspiration
Foreign body
Immunosuppressioin
CF

11

First line treatment for lobar pneumonia

Penicillin

12

Complications of pneumonia

Empyema
Septicemia
Pleural effusion
Abscess

13

Cause of bronchiolitis

Most commonly RSV

Parainfluenza
Adnovirus

14

Clinical features of bronchiolitis

Coryza
Cough
Respiratory distress
Wheeze

15

Examination findings in bronchiolitis

Widespread wheeze
Fine crackles
Hyperinflation

Patchy collapse/consolidation on CXR

16

How is RSV diagnosed

Nasopharyngeal aspirate

17

Indications for hospitalisation in bronchiolitis

++Respiratory distress
Need for oxygen
Poor feeding
Apnoea

18

How long does RSV usually last

7-10 days

19

Mortality in RSV

1-2%

20

Prophylaxis for those at high risk of RSV in winter months

Pavilizumab
Monoclonal antibody against RSV

21

How if bordatella pertussis cultured

Peri-nasal swab

22

How long can the paroxysms of cough last in whooping cough

Months
100 day cough

23

Age typically affected by croup, causative agent, signs of severe

6 months to three years
Parainfluenza
+work of breathing, cyanosis and restlessness

24

How does epiglottitis present

Sepsis
Inability to swallow or talk
Lean forward
Drool saliva

25

Confirmation of diagnosis

Laryngoscopy- cheer red swollen epiglottitis

26

Causes of apnea

Bronchiolitis
Pertussis
Sepsis
Meningitis
Fits

27

When should apnea be considered

Floppy and cyanosis

28

Red flags

Choking
Apnea
Status asthmaticus

29

What is status asthmaticus

When does not respond to three + medications, requiring repeated nebulisers.

30

Differential of cyanosis in a newborn

Cyanotic heart disease
-TGA
-TOF
Pulmonary atresia
RDS
Transient tachypnea of the newborn
PPHN
Pneumothorax
Aspiration pneumonia
Pulmonary edema
Congenital diaphragmatic hernia
Upper airway obstruction
Polycythemia
Asphyxia
met-Hb
Hypoglycemia
Neonatal sepsis

31

If cyanosis does not improve when given oxygen, likely explanation

Congenital heart disease with left to right shunt

32

How does cardiac failure present in neonates and infants

Symptoms - sweating, poor feeding due to breathlessness (ultimately poor weight gain)
Signs - tachycardia, tachypnoea, hepatomegaly
Note: basal crepitations and dependent oedema are very late signs in childhood.

33

Common differential for cough

Pneumonia
Asthma
URTI
Bronchiolitis
Croup
Whooping cough
Inhaled foreign body

34

Common differential for wheeze

Bronchiolitis
Asthma
Heart failure
Inhaled foreign body

35

Common differential of stridor

Acute:
Croup
anaphylaxis
inhaled foreign body
epiglottitis

Chronic:
Laryngomalacia
laryngeal anomalies

36

When to suspect bronchiectasis symptoms and signs

Indigenous child
Symptoms:
chronic cough
excessive sputum production
clubbing
suboptimal weight gain

Signs:
chest deformity
persistent crepitations and wheeze on
auscultation.

37

Differences in respiratory system in pediatrics

Up to 6/12 obligate nasal breathers
Smaller
Trachea and rib cage more cartilaginous
Larynx at cervical spine 2-3, more difficult to view with laryngoscope
Cricoid ring narrowest
Short trachea->ETT can pop out

38

Sinus anatomy

1. maxillary->first to develop, 3 & 7-8 years
2. ethmoid
3. Frontal
4. Sphenoid

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