OSCE Revision Elizabeth Evans Plan What could come up in the OSCE Respiratory examination Respiratory conditions Key Points Likely to be one examination from CV Resp GI May have a station with images or recordings ID: 930161
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Slide1
The Respiratory System
Paediatrics
OSCE Revision
Elizabeth Evans
Slide2Plan
What could come up in the OSCE
Respiratory
examination
Respiratory conditions
Slide3Key Points
Likely to be one examination from: CV/
Resp
/GI
May have a station with images or recordings
May have a history
Mostly normal children
Know a little about
everything:
Vivas
are v. short
Easiest way to get
marks:
B
e
nice to the child!
Slide4What could come up?
OSCE:
-Normal
-CF
-
Hyperexpanded
chest from asthma
History:
-Asthma-CF-Infection
Most respiratory disease in children presents acutely, thus unlikely to appear in the OSCE.
Slide5Respiratory Examination
Inspection- increased work of breathing
Hands- cyanosis, clubbing (CF or CHD)
RR and HR – remember changes with age
Face- central cyanosis
Avoid trachea in children – indicate to examiner
Chest shape
Palpation- apex beat and chest expansion
Percussion- do not go straight for this on the chest!Auscultate
Slide6Dyspnoea in a child
Nasal flaring
Subcostal and intercostal recession
Expiratory grunting
Difficulty feeding
Added sounds
eg
expiratory wheeze
Slide7CONDITIONS
Slide8Respiratory infections
URTI: common cold
sore throat
otitis media
croup
diptheria acute epiglottitisLRTI: pneumonia bronchiolitis whooping cough
Slide9Croup
Viral
laryngotracheobronchitis
(
parainfluenza
virus)
6 months – 6 years (peak in 2
nd year)
URTI symptoms (coryza/fever) for 2 days before onset of a characteristic barking cough and stridor (subglottic oedema) lasting around 3 days Most improve spontaneously within 24h 1 in 10 require hospitalisation: under 12months, severe illness or signs of respiratory failure Single dose of dexamethasone or nebulised budesonide is beneficialNebulised adrenaline provides transient improvement (reduces oedema) and is used in more severe cases to enable time for transfer to ITU
Slide10Acute epiglottitis
Life-threatening emergency
Haemophilus
influenza type B (
Hib
immunisation
has caused reduction)1- 6 years
Rapid onset, intensely painful throat, febrile child, unable to swallow and reluctant to speak. Sat upright with open mouth drooling saliva.Resus room, call ENT and anaesthetist Do not examine the throat!Secure airway, then take bloods for culture and commence IV cefuroximeRifampicin for household contacts
Slide11Diptheria
Cornyebacteria
diptheriae
Sore throat, fever, lymphadenopathy and stridor
Hallmark sign=
thick grey material on back of throat
Potentially fatal, highly infectious Eliminated by immunisation programme
Slide12Bronchiolitis
Commonest serious respiratory infection of infancy
1-9 months
Viral infection (mainly RSV)
Coryzal
symptoms followed by
dry cough
with increasing SOB
Tachypnoea, hyperinflation, bilateral fine crackles and wheeze CXR: chest hyperinflationSupportive management to address hypoxia and maintain hydration (1% require assisted ventilation)
Slide13Whooping cough
Bordetella
pertussis (highly contagious)
Spread by droplet infection
Characteristic
inspiratory whoop
(may be absent in infants)
During paroxysms of coughing the child may go blue and vomit
May persist for 3 monthsCulture organism from nasal swabErythromycin reduces infectivity but does not shorten duration of symptoms
Slide14Asthma
Most common chronic respiratory disorder of childhood- 10%
Clinical diagnosis usually based on history and examination
If >5 able to demonstrate diurnal variation in PEFR
Wheeze= whistling noise made by the chest
Slide15History:
Nocturnal cough
Intermittent symptoms
Triggers
Exercise tolerance
Atopy
FH of asthma
Parental smoking
ExaminationUsually normal between attacksIn chronic severe asthma:-hyperexpansion
-
pectus
carinatum
-Harrison sulcus
Slide16Asthma Treatment
Aim- asymptomatic with no exacerbations
Educate child and parents on avoidance of triggers,
importance
of regular therapy and correct inhaler technique
Stepwise approach: British Guidelines for Asthma Management:
Step 1: Inhaled SABA
Step 2: Low dose inhaled steroids (if requiring 3xday SABA) Step 3: Add LABA or leukotriene antagonist Step 4: Increase inhaled steroid. Oral Theophylline. Leukotriene antagonist. Step 5: Alternate day oral steroids.
Slide17Metered dose inhaler: competent older children
Metered dose inhaler plus spacer: useful in all children, highly effective as do not rely on technique.
Dry powder inhaler: 5 years +
Slide18Cystic Fibrosis
Autosomal recessive disease affecting 1 in 2500
Mutation in CFTR protein resulting in defective chloride channel,
increased
viscosity of
secretions
in respiratory tract and pancreas
Consider in any child with recurrent chest infection or failure to thrive Repeated infections lead to bronchial wall damage and abscessesDeficiency of pancreatic enzymes results in malabsorption and steatorrhoeaDiagnosis: screening performed as part of Guthrie test. Gold standard diagnostic test is the sweat test. Genetic testing also useful to confirm diagnosis.
Slide19CF Examination
General: small for age, Creon supplements or insulin around bed
Peripheral: finger clubbing
Airway: nasal polyps,
hyperinflated
chest, crackles
GI: scar from meconium ileus operation
Slide20CF Management
MDT approach
Respiratory:
physio
, aggressive treatment of lung infections
Nutritional: high calorie diet, vitamin ADEK, Creon (pancreatic enzyme supplements)
Severe lung disease may be considered for lung transplantation
Slide21Thank you