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The Respiratory System Paediatrics The Respiratory System Paediatrics

The Respiratory System Paediatrics - PowerPoint Presentation

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The Respiratory System Paediatrics - PPT Presentation

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

chest respiratory child asthma respiratory chest asthma child cough infection children throat step examination dose symptoms severe inhaler history

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Presentation Transcript

Slide1

The Respiratory System

Paediatrics

OSCE Revision

Elizabeth Evans

Slide2

Plan

What could come up in the OSCE

Respiratory

examination

Respiratory conditions

Slide3

Key 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!

Slide4

What 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.

Slide5

Respiratory 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

Slide6

Dyspnoea in a child

Nasal flaring

Subcostal and intercostal recession

Expiratory grunting

Difficulty feeding

Added sounds

eg

expiratory wheeze

Slide7

CONDITIONS

Slide8

Respiratory infections

URTI: common cold

sore throat

otitis media

croup

diptheria acute epiglottitisLRTI: pneumonia bronchiolitis whooping cough

Slide9

Croup

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

Slide10

Acute 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

Slide11

Diptheria

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

Slide12

Bronchiolitis

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)

Slide13

Whooping 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

Slide14

Asthma

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

Slide15

History:

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

Slide16

Asthma 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.

Slide17

Metered 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 +

Slide18

Cystic 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.

Slide19

CF 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

Slide20

CF 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

Slide21

Thank you