Summary Final year MD notes - paediatric respiratory
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Course
Institution
Macquarie University (MQ
)
A collection suite of final paediatric MD notes to ace your penultimate and final year exams!
Look no further and save the stress of accessing multiple resources as this PDF collates and summarises information from several resources including but not limited to:
-Talley and O’Connor clinica...
PAEDIATRIC RESPIRATORY
INCOMPLETE fusion of tracheoesophageal folds in 4th
week leads to TEF – recurrent pneumonitis
Embryological Defects
QUICK QUESTIONS
What is one outcome of the lack of lymphatics
in Reinke’s space?
Ø Tumours don’t metastasise
Difference between nasal cavity respiratory
and olfactory epithelium
Ø No goblet cells
Ø No cilia
Do bronchioles have hyaline cartilage?
Ø No
What is the difference between terminal and
respiratory bronchioles?
Ø Respiratory bronchioles have alveoli
for gas exchange
Risk Factors of Respiratory Distress in the Newborn
, RESP H+E
• Age important (< 3/12 most vulnerable to apnoea)
• Feeding + drinking Hx: sig. changes?
• Activity levels + sleeping: Quiet or clingy
Reason for young age:
• PMHX:
o Pattern of wheeze (assoc. w/ bronchiolitis) OR 1) Soft cartilage (easier
Resp.
collapse)
o FHx of atopy (eczema, asthma, hayfever) 2) Narrower airways
• Red-flags: ? 3) May be unvaxxed
Hx
o fevers, 4) Immature immune system
o pre-term, NICU,
o Hx of apnoea, CV or resp. diseases
o parents report sig. change
o stridor at rest
o quiet chest
1) ?Level of alertness – interactive/playful ® agitated ® lethargic/tired
2) Check for any vomit ® aspiration pneumonia?
3) ?Posture – propped up (easier to breathe) or lying down
Inspect 4) ?Ability to speak – normal ® short sentences ® cannot speak or
complete sentences
5) Body / facial dysmorphia
Petechiae due to heavy chronic cough
Clubbing in Children
• Hereditary clubbing
• Cyanotic heart disease URTI LRTI
• Infective endocarditis • Coryza • Productive cough
Hands
• Cystic fibrosis • Wheeze • Crackles
• Tuberculosis • Stridor • ↓air-entry
• Inflammatory bowel disease bilaterally
• Liver cirrhosis
Check with child’s age to determine if tachycardic, tachypnoeic
Ø Tachypnoea ® late sign (bradypnea) ® resp. arrest
VITALS
Ø Detect hypoxia early (i.e. before it fall below 90% -- prevent decompensation)
o Supp. oxygen given if sats < 92% ® NP, HM, NRBM, CPAP
• Rib recession (mild-mod-severe) – tracheal tug, supraclavicular, sternal (=severe), intercostal, subcostal
Exam
WoB o Younger children show recession more frequently, due to their softer chest walls
• Accessory muscles ® head bobbing (SCM = severe), abdominal breathing, nasal flaring
(ABCDE) • Coryza (runny nose) – common in URTIs, bronchiolitis and well infants!
• Wheeze (exp.) – narrowed lower airways during expiration – asthma, bronchiolitis, viral-induced wheeze
• Stridor (insp. + exp.) – upper airway obstruction
Abnormal o Acute stridor è croup (+ hoarseness), anaphylaxis, FB inhalation
airway
noise
o Chronic stridor è laryngomalacia, subglottic stenosis
o *THE SOFTER THE STRIDOR – THE WORSE THE NARROWING
• Grunting (exhaling while glottis is partially closed creating PEEP) OR crying in prolonged expiration – closed glottis to keep alveoli
open - infants with severe respiratory distress
• Hot potato voice = laryngitis
• Cushingoid -= steroid usage
• Nasal flaring/grunting è increased WoB è congenital cyanotic HD or HF
• Micrognathia (undersized jaw) è genetic issue (e.g. Marfan, Noonan, Pierre-Robin),
• Ears = tympanic membrane (otitis media – URTi), hearing loss (primary ciliary dyskinesia)
• Throat = tonsiillitis, pharyngitis, quinsy (trismus), EBV (white exudates), poor dentition (caries)
• Audible wheeze (e.g. croup, viral-induced wheeze, bronchiolitis)
Auscult • WET Crepitations (secretions = infection) è RHONCHI
• Bronchial breathing (consolidation due to pneumonia) – coarse sound
• VITALS, FiO2, • Sputum sample
• UA (nephrotic, subacute bacterial endocarditis) • PEFR + inhaler technique
Ix • VBG • Measure + plot height and weight on growth chart
• CXR
• ECG (3-lead)
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