This document discusses paediatric asthma, including its various types, pathophysiology, clinical features, diagnosis, investigations, management, and assessment in children. It describes how asthma is common in infancy and can be transient early wheezing or persist into childhood. The diagnosis is made based on a history of recurrent wheezing and reversible airflow obstruction. Investigations include assessing symptoms, triggers, lung function tests, and ruling out other conditions. Management involves reliever medications for acute symptoms and controller medications like inhaled corticosteroids to prevent exacerbations. Assessment of asthma in children evaluates severity, control, and monitors for growth, lung function, and appropriate treatment use.
Asthma is a chronic inflammatory disorder of the airways that causes recurring episodes of wheezing, breathlessness, chest tightness and coughing. It affects people of all ages and its prevalence is increasing worldwide. Asthma can be diagnosed based on symptoms and medical history and confirmed through lung function tests. Effective asthma management requires a partnership between the patient and doctor to control symptoms, identify and reduce risk factors, treat exacerbations, and monitor the condition.
This document provides guidance on evaluating and treating a child presenting with vomiting. It begins with definitions of related terms like nausea, retching, and regurgitation. It then reviews the major neurophysiological pathways that can induce vomiting. Etiologies are discussed including central, infectious, metabolic, and peripheral causes. An approach is outlined involving obtaining a thorough history and physical exam to determine potential causes and guide testing. Common etiologies are reviewed for different age groups. Complications, treatment principles targeting the underlying cause, and sick day management for diabetes are also summarized.
This document provides an overview of the approach to cough in children. It begins with background on cough and the cough reflex pathway. It then discusses classifications of cough based on duration, quality, and etiology. The document outlines the important components of history taking and physical examination for a child with cough. It recommends investigations such as chest X-ray, pulmonary function tests, and bronchoscopy if needed. The document concludes with guidelines for managing cough in children based on its underlying cause.
This document provides information on chronic liver disease in infants and children. It discusses the classification, etiology, differential diagnosis, and specific diseases that cause chronic liver disease. Some key points include:
- Chronic liver disease is seen in children of all ages and is defined as liver disease lasting more than 3-6 months. Cirrhosis refers to late-stage scarring of the liver.
- Common causes in infants include neonatal hepatitis, biliary atresia, and progressive familial intrahepatic cholestasis. In children, common causes are hepatitis B, hepatitis C, Wilson's disease, and autoimmune hepatitis.
- Clinical features may include jaundice, hepatomegaly, spl
COMPLETE EXAMINATION OF RESPIRATORY SYSTEM IN PEDIATRICS. IT HAS BEEN SUMMARIZED FROM ALL WELL KNOWN 32 BOOKS UNDER GUIDANCE OF ONE OF THE BEST PEDIATRIC DOCTORS AND PROFESSORS .
BY DR. SURAJ R. DHANKIKAR.
Bronchiolitis is a common viral infection that affects infants under 2 years old, usually caused by RSV. It involves inflammation in the small airways of the lungs. Symptoms include cough, wheezing, difficulty breathing, and low oxygen levels. Infants may require admission if their oxygen levels drop below 94%, respiratory rate is over 70, or they have trouble feeding. Treatment focuses on supportive care like oxygen, feeding support, and nebulized saline. Most infants recover in 4-5 days but cough can last 2-4 weeks.
This document discusses constipation in children. It defines constipation and notes that approximately 5% of schoolchildren suffer from it. The majority of cases are functional rather than organic causes. A history and physical exam are important to evaluate for constipation. Functional constipation is usually due to a low fiber diet, lack of exercise, painful bowel movements causing withholding, and a cycle that perpetuates harder stools. Organic causes include conditions like Hirschsprung's disease. Treatment aims to soften stool and promote motility through diet changes, behavioral modifications, stool softeners, and laxatives. Complications can include fecal impaction if left untreated.
This document discusses paediatric asthma, including its various types, pathophysiology, clinical features, diagnosis, investigations, management, and assessment in children. It describes how asthma is common in infancy and can be transient early wheezing or persist into childhood. The diagnosis is made based on a history of recurrent wheezing and reversible airflow obstruction. Investigations include assessing symptoms, triggers, lung function tests, and ruling out other conditions. Management involves reliever medications for acute symptoms and controller medications like inhaled corticosteroids to prevent exacerbations. Assessment of asthma in children evaluates severity, control, and monitors for growth, lung function, and appropriate treatment use.
Asthma is a chronic inflammatory disorder of the airways that causes recurring episodes of wheezing, breathlessness, chest tightness and coughing. It affects people of all ages and its prevalence is increasing worldwide. Asthma can be diagnosed based on symptoms and medical history and confirmed through lung function tests. Effective asthma management requires a partnership between the patient and doctor to control symptoms, identify and reduce risk factors, treat exacerbations, and monitor the condition.
This document provides guidance on evaluating and treating a child presenting with vomiting. It begins with definitions of related terms like nausea, retching, and regurgitation. It then reviews the major neurophysiological pathways that can induce vomiting. Etiologies are discussed including central, infectious, metabolic, and peripheral causes. An approach is outlined involving obtaining a thorough history and physical exam to determine potential causes and guide testing. Common etiologies are reviewed for different age groups. Complications, treatment principles targeting the underlying cause, and sick day management for diabetes are also summarized.
This document provides an overview of the approach to cough in children. It begins with background on cough and the cough reflex pathway. It then discusses classifications of cough based on duration, quality, and etiology. The document outlines the important components of history taking and physical examination for a child with cough. It recommends investigations such as chest X-ray, pulmonary function tests, and bronchoscopy if needed. The document concludes with guidelines for managing cough in children based on its underlying cause.
This document provides information on chronic liver disease in infants and children. It discusses the classification, etiology, differential diagnosis, and specific diseases that cause chronic liver disease. Some key points include:
- Chronic liver disease is seen in children of all ages and is defined as liver disease lasting more than 3-6 months. Cirrhosis refers to late-stage scarring of the liver.
- Common causes in infants include neonatal hepatitis, biliary atresia, and progressive familial intrahepatic cholestasis. In children, common causes are hepatitis B, hepatitis C, Wilson's disease, and autoimmune hepatitis.
- Clinical features may include jaundice, hepatomegaly, spl
COMPLETE EXAMINATION OF RESPIRATORY SYSTEM IN PEDIATRICS. IT HAS BEEN SUMMARIZED FROM ALL WELL KNOWN 32 BOOKS UNDER GUIDANCE OF ONE OF THE BEST PEDIATRIC DOCTORS AND PROFESSORS .
BY DR. SURAJ R. DHANKIKAR.
Bronchiolitis is a common viral infection that affects infants under 2 years old, usually caused by RSV. It involves inflammation in the small airways of the lungs. Symptoms include cough, wheezing, difficulty breathing, and low oxygen levels. Infants may require admission if their oxygen levels drop below 94%, respiratory rate is over 70, or they have trouble feeding. Treatment focuses on supportive care like oxygen, feeding support, and nebulized saline. Most infants recover in 4-5 days but cough can last 2-4 weeks.
This document discusses constipation in children. It defines constipation and notes that approximately 5% of schoolchildren suffer from it. The majority of cases are functional rather than organic causes. A history and physical exam are important to evaluate for constipation. Functional constipation is usually due to a low fiber diet, lack of exercise, painful bowel movements causing withholding, and a cycle that perpetuates harder stools. Organic causes include conditions like Hirschsprung's disease. Treatment aims to soften stool and promote motility through diet changes, behavioral modifications, stool softeners, and laxatives. Complications can include fecal impaction if left untreated.
This document discusses status asthmaticus in children. It covers the epidemiology, pathophysiology, presentation, assessment and treatment of severe or life-threatening asthma exacerbations in pediatric patients. Key points include rising rates of asthma morbidity and mortality in children, risk factors for fatal asthma, the inflammatory mechanisms that drive asthma symptoms, signs of impending respiratory failure, and first-line as well as advanced treatment approaches including bronchodilators, steroids, mechanical ventilation and other interventions.
This document discusses respiratory distress and respiratory failure. Respiratory distress refers to increased work of breathing, while respiratory failure is the inability of the lungs to provide oxygen or remove carbon dioxide. Respiratory failure can be acute or chronic. It can occur due to problems with the respiratory pump (central nervous system issues, muscle weakness) or due to airway/lung dysfunction (conditions affecting gas exchange like asthma, pneumonia). Proper monitoring of patients with respiratory distress or failure includes clinical examination, blood gas analysis, and oximetry. Immediate treatment of acute respiratory failure focuses on oxygenation and ventilation. Chronic respiratory failure often has a more insidious onset and requires careful monitoring, especially during sleep or illness.
Wheezing in children can have many causes. It is often due to viral infections like RSV bronchiolitis in infants, which causes inflammation and narrowing of the small airways. Asthma is another common cause and presents with recurrent wheezing episodes. Younger children are more prone to wheezing due to their small airway size and lung mechanics. A thorough history, physical exam, and diagnostic testing can help identify the underlying condition causing wheezing to guide treatment.
to differentiate b/w wheezing and stridor....lead to know to make clinical dx for asthma, croup, laryngomalacia, epiglottis...there many noisy breathing....our focus wheezing n stridor....
This document provides guidance on evaluating and diagnosing childhood arthritis. It distinguishes arthritis from arthralgia based on clinical features. It lists various differential diagnoses for childhood joint pain or swelling including infectious, rheumatological, neoplastic and traumatic etiologies. It describes tender points seen in fibromyalgia. It outlines features that can distinguish inflammatory, mechanical and sinister causes of joint pain. The approach involves assessing onset, number and type of joints involved, associated systemic symptoms and precipitating factors. Key clues from history and physical exam are described. A review of systems guides evaluation of specific organ systems. Common clinical presentations like acute monoarthritis, chronic monoarthritis and polyarthritis are reviewed. Characteristics of juvenile idiopathic arthritis subtypes
This document provides guidance on evaluating and managing childhood constipation. It defines functional constipation and outlines risk factors, such as diet and psychological stresses. The pathogenesis is described as a vicious cycle of hard stools and pain that worsens retention. Evaluation involves history, physical exam including digital rectal exam, and considering red flags requiring further workup. Management begins with disimpaction if needed, followed by maintenance therapy including diet, toilet training, and laxatives. Refractory cases may require advanced testing and have underlying motility issues.
This document provides information on chronic cough in children, including definitions, epidemiology, pathophysiology, causes, diagnostic approach, and management. It defines chronic cough as lasting 4 or more weeks based on expert guidelines. Specific cough has an identifiable cause while nonspecific cough does not after evaluation. Common causes include asthma, aspiration, and suppurative lung diseases. The diagnostic approach involves detailed history, physical exam focusing on cough characteristics, chest imaging, and additional tests as needed based on findings. Management targets treating the identified cause for specific cough or watchful waiting for most nonspecific cough cases.
This document discusses chronic kidney disease (CKD) in pediatrics. It defines CKD as kidney damage lasting at least 3 months as determined by structural abnormalities and/or a glomerular filtration rate below 60 mL/min/1.73m2. The stages of CKD are described based on GFR. Common causes in children include congenital abnormalities and glomerulonephritis. The pathogenesis involves hyperfiltration injury and other factors like proteinuria that accelerate kidney damage. Management aims to address complications through careful monitoring, nutrition, treatment of mineral bone disorders, and controlling blood pressure and electrolyte abnormalities.
This document discusses chronic diarrhea in children, including definitions, causes, diagnosis, and treatment. It defines chronic diarrhea as diarrhea lasting 2-3 weeks or more. Common causes in infants include post-infectious lactase deficiency, celiac disease, cow's milk allergy, toddler's diarrhea, and infections like giardiasis. Diagnosis involves taking a thorough history and physical exam, with investigations tailored to the child's age and suspected causes, such as stool exams and tests for carbohydrate malabsorption.
This document discusses chronic diarrhea, defining it as diarrhea lasting more than 2 weeks. It outlines different types of diarrhea based on duration, including acute (<2 weeks), prolonged (7-14 days), and persistent (>14 weeks). The causes of chronic diarrhea are discussed for different age groups, including post-gastrointestinal infections, cow's milk protein intolerance, and celiac disease in infants. Pathophysiological causes of chronic diarrhea include secretory, osmotic, steatorrheal, inflammatory, and dysmotility mechanisms. The importance of a thorough history and physical exam is emphasized to guide diagnostic testing and treatment approaches, which may be curative, suppressive, or empirical depending on the underlying cause.
1. The pediatric ECG document reviews cardiac physiology and ECG findings in children of different ages. It discusses how the size of the ventricles changes from birth through childhood and how this impacts ECG measurements.
2. Key aspects of the normal pediatric ECG are described, including typical heart rates, axis shifts, and "juvenile" T wave patterns. Common abnormalities seen in pediatric patients such as chamber enlargement, conduction abnormalities, and arrhythmias are also reviewed.
3. The document provides guidance on interpreting ECG findings and correlating them to possible diagnoses in children, taking into account how measurements may differ based on age. Examples of ECG strips are included to illustrate various normal and abnormal
1. The document discusses different types of seizures including focal onset seizures, generalized onset seizures, and seizures of unknown onset. It provides definitions and examples of motor and non-motor seizures.
2. Etiologies of seizures in the neonatal period and beyond are outlined, including infections, metabolic disorders, brain malformations, drugs/poisons, and epilepsy syndromes.
3. Febrile seizures are defined as seizures associated with fever in children between 6-60 months old. Simple febrile seizures are brief and do not recur within 24 hours, while complex febrile seizures are prolonged or recurrent.
Wheezing in children can be caused by narrowed airways from conditions like asthma or tracheomalacia. It is heard more during expiration and can be either a single pitch (monophonic) indicating large airway obstruction, or multiple pitches (polyphonic) indicating different levels of obstruction throughout the airways. Children are more prone to wheezing due to increased airway resistance, less compliant chest walls, and differences in cartilage composition compared to adults. A thorough history, physical exam assessing signs of air trapping, and diagnostic testing can help identify the underlying cause and guide treatment and prevention strategies.
Asthma is a chronic inflammatory disease characterized by recurrent episodes of wheezing, breathlessness, chest tightness and coughing. It is the most common chronic disease in childhood. There are different phenotypes of asthma in children including transient wheezing associated with viral infections that typically resolves by school age, persistent non-atopic wheezing, and atopic asthma associated with family history and sensitization to allergens. Diagnosis is based on clinical history, examination findings, response to bronchodilators, and ruling out alternative causes through differential diagnosis. Control is assessed based on daytime and nocturnal symptoms, limitations, need for rescue treatment, and exacerbations.
A Child with Vomiting (problem based approach)Sariu Ali
This document discusses the causes, evaluation, and management of vomiting in children. It begins by distinguishing vomiting from regurgitation and describes the physiology and control of vomiting. It then discusses obtaining a thorough history, including details on the vomiting episodes, associated symptoms, past medical history, and physical examination findings. The document outlines potential investigations that may be guided by the history and examination, including blood tests, imaging studies, and other tests. It concludes by stating that management involves rehydration, correcting electrolyte imbalances, encouraging oral intake, and treating any underlying causes.
The document provides an overview of diarrhea including definitions, causes, clinical features, diagnosis, evaluation of dehydration, treatment including oral rehydration solutions, and prevention. It discusses approaches to acute, prolonged, persistent, and chronic diarrhea. Evaluation involves assessing dehydration, laboratory tests, and considering various infectious, inflammatory, and structural etiologies.
COMPLETE EXAMINATION OF RESPIRATORY SYSTEM IN PEDIATRICS. IT HAS BEEN SUMMARIZED FROM ALL WELL KNOWN 32 BOOKS UNDER GUIDANCE OF ONE OF THE BEST PEDIATRIC DOCTORS AND PROFESSORS .
BY DR. SURAJ R. DHANKIKAR.
The document discusses various pediatric arrhythmias including tachycardias and bradycardias. It provides details on normal heart rates at different ages and describes common supraventricular tachycardias like AV nodal reentrant tachycardia, accessory pathway mediated tachycardias. It also discusses idiopathic ventricular tachycardia and management strategies for different arrhythmias including medication and ablation. Congenital complete heart block is described along with its association with maternal autoimmune conditions.
Childhood Asthma Management
Dr. C.S.N. Vittal provides an overview of childhood asthma including:
- Asthma is characterized by chronic airway inflammation and reversible airflow obstruction.
- Childhood asthma is triggered by allergens, infections, pollution and can cause coughing, wheezing and difficulty breathing.
- Diagnosis involves assessing symptoms, lung function tests and ruling out other conditions.
- Treatment focuses on reducing inflammation with daily preventer medications and managing triggers.
- A written asthma action plan is recommended to help patients manage their symptoms and know when to seek medical help.
Asthma attack(status asthmaticus) Groups Mzhda Salman
This document provides an overview of asthma, including:
1) Asthma is a chronic inflammatory disease of the airways characterized by recurrent wheezing, chest tightness, coughing, and shortness of breath.
2) Risk factors include genetic and environmental factors such as exposure to allergens, tobacco smoke, and viral infections.
3) Diagnosis is based on a patient's respiratory symptoms and improvement following bronchodilator treatment; spirometry can also be used.
This document discusses status asthmaticus in children. It covers the epidemiology, pathophysiology, presentation, assessment and treatment of severe or life-threatening asthma exacerbations in pediatric patients. Key points include rising rates of asthma morbidity and mortality in children, risk factors for fatal asthma, the inflammatory mechanisms that drive asthma symptoms, signs of impending respiratory failure, and first-line as well as advanced treatment approaches including bronchodilators, steroids, mechanical ventilation and other interventions.
This document discusses respiratory distress and respiratory failure. Respiratory distress refers to increased work of breathing, while respiratory failure is the inability of the lungs to provide oxygen or remove carbon dioxide. Respiratory failure can be acute or chronic. It can occur due to problems with the respiratory pump (central nervous system issues, muscle weakness) or due to airway/lung dysfunction (conditions affecting gas exchange like asthma, pneumonia). Proper monitoring of patients with respiratory distress or failure includes clinical examination, blood gas analysis, and oximetry. Immediate treatment of acute respiratory failure focuses on oxygenation and ventilation. Chronic respiratory failure often has a more insidious onset and requires careful monitoring, especially during sleep or illness.
Wheezing in children can have many causes. It is often due to viral infections like RSV bronchiolitis in infants, which causes inflammation and narrowing of the small airways. Asthma is another common cause and presents with recurrent wheezing episodes. Younger children are more prone to wheezing due to their small airway size and lung mechanics. A thorough history, physical exam, and diagnostic testing can help identify the underlying condition causing wheezing to guide treatment.
to differentiate b/w wheezing and stridor....lead to know to make clinical dx for asthma, croup, laryngomalacia, epiglottis...there many noisy breathing....our focus wheezing n stridor....
This document provides guidance on evaluating and diagnosing childhood arthritis. It distinguishes arthritis from arthralgia based on clinical features. It lists various differential diagnoses for childhood joint pain or swelling including infectious, rheumatological, neoplastic and traumatic etiologies. It describes tender points seen in fibromyalgia. It outlines features that can distinguish inflammatory, mechanical and sinister causes of joint pain. The approach involves assessing onset, number and type of joints involved, associated systemic symptoms and precipitating factors. Key clues from history and physical exam are described. A review of systems guides evaluation of specific organ systems. Common clinical presentations like acute monoarthritis, chronic monoarthritis and polyarthritis are reviewed. Characteristics of juvenile idiopathic arthritis subtypes
This document provides guidance on evaluating and managing childhood constipation. It defines functional constipation and outlines risk factors, such as diet and psychological stresses. The pathogenesis is described as a vicious cycle of hard stools and pain that worsens retention. Evaluation involves history, physical exam including digital rectal exam, and considering red flags requiring further workup. Management begins with disimpaction if needed, followed by maintenance therapy including diet, toilet training, and laxatives. Refractory cases may require advanced testing and have underlying motility issues.
This document provides information on chronic cough in children, including definitions, epidemiology, pathophysiology, causes, diagnostic approach, and management. It defines chronic cough as lasting 4 or more weeks based on expert guidelines. Specific cough has an identifiable cause while nonspecific cough does not after evaluation. Common causes include asthma, aspiration, and suppurative lung diseases. The diagnostic approach involves detailed history, physical exam focusing on cough characteristics, chest imaging, and additional tests as needed based on findings. Management targets treating the identified cause for specific cough or watchful waiting for most nonspecific cough cases.
This document discusses chronic kidney disease (CKD) in pediatrics. It defines CKD as kidney damage lasting at least 3 months as determined by structural abnormalities and/or a glomerular filtration rate below 60 mL/min/1.73m2. The stages of CKD are described based on GFR. Common causes in children include congenital abnormalities and glomerulonephritis. The pathogenesis involves hyperfiltration injury and other factors like proteinuria that accelerate kidney damage. Management aims to address complications through careful monitoring, nutrition, treatment of mineral bone disorders, and controlling blood pressure and electrolyte abnormalities.
This document discusses chronic diarrhea in children, including definitions, causes, diagnosis, and treatment. It defines chronic diarrhea as diarrhea lasting 2-3 weeks or more. Common causes in infants include post-infectious lactase deficiency, celiac disease, cow's milk allergy, toddler's diarrhea, and infections like giardiasis. Diagnosis involves taking a thorough history and physical exam, with investigations tailored to the child's age and suspected causes, such as stool exams and tests for carbohydrate malabsorption.
This document discusses chronic diarrhea, defining it as diarrhea lasting more than 2 weeks. It outlines different types of diarrhea based on duration, including acute (<2 weeks), prolonged (7-14 days), and persistent (>14 weeks). The causes of chronic diarrhea are discussed for different age groups, including post-gastrointestinal infections, cow's milk protein intolerance, and celiac disease in infants. Pathophysiological causes of chronic diarrhea include secretory, osmotic, steatorrheal, inflammatory, and dysmotility mechanisms. The importance of a thorough history and physical exam is emphasized to guide diagnostic testing and treatment approaches, which may be curative, suppressive, or empirical depending on the underlying cause.
1. The pediatric ECG document reviews cardiac physiology and ECG findings in children of different ages. It discusses how the size of the ventricles changes from birth through childhood and how this impacts ECG measurements.
2. Key aspects of the normal pediatric ECG are described, including typical heart rates, axis shifts, and "juvenile" T wave patterns. Common abnormalities seen in pediatric patients such as chamber enlargement, conduction abnormalities, and arrhythmias are also reviewed.
3. The document provides guidance on interpreting ECG findings and correlating them to possible diagnoses in children, taking into account how measurements may differ based on age. Examples of ECG strips are included to illustrate various normal and abnormal
1. The document discusses different types of seizures including focal onset seizures, generalized onset seizures, and seizures of unknown onset. It provides definitions and examples of motor and non-motor seizures.
2. Etiologies of seizures in the neonatal period and beyond are outlined, including infections, metabolic disorders, brain malformations, drugs/poisons, and epilepsy syndromes.
3. Febrile seizures are defined as seizures associated with fever in children between 6-60 months old. Simple febrile seizures are brief and do not recur within 24 hours, while complex febrile seizures are prolonged or recurrent.
Wheezing in children can be caused by narrowed airways from conditions like asthma or tracheomalacia. It is heard more during expiration and can be either a single pitch (monophonic) indicating large airway obstruction, or multiple pitches (polyphonic) indicating different levels of obstruction throughout the airways. Children are more prone to wheezing due to increased airway resistance, less compliant chest walls, and differences in cartilage composition compared to adults. A thorough history, physical exam assessing signs of air trapping, and diagnostic testing can help identify the underlying cause and guide treatment and prevention strategies.
Asthma is a chronic inflammatory disease characterized by recurrent episodes of wheezing, breathlessness, chest tightness and coughing. It is the most common chronic disease in childhood. There are different phenotypes of asthma in children including transient wheezing associated with viral infections that typically resolves by school age, persistent non-atopic wheezing, and atopic asthma associated with family history and sensitization to allergens. Diagnosis is based on clinical history, examination findings, response to bronchodilators, and ruling out alternative causes through differential diagnosis. Control is assessed based on daytime and nocturnal symptoms, limitations, need for rescue treatment, and exacerbations.
A Child with Vomiting (problem based approach)Sariu Ali
This document discusses the causes, evaluation, and management of vomiting in children. It begins by distinguishing vomiting from regurgitation and describes the physiology and control of vomiting. It then discusses obtaining a thorough history, including details on the vomiting episodes, associated symptoms, past medical history, and physical examination findings. The document outlines potential investigations that may be guided by the history and examination, including blood tests, imaging studies, and other tests. It concludes by stating that management involves rehydration, correcting electrolyte imbalances, encouraging oral intake, and treating any underlying causes.
The document provides an overview of diarrhea including definitions, causes, clinical features, diagnosis, evaluation of dehydration, treatment including oral rehydration solutions, and prevention. It discusses approaches to acute, prolonged, persistent, and chronic diarrhea. Evaluation involves assessing dehydration, laboratory tests, and considering various infectious, inflammatory, and structural etiologies.
COMPLETE EXAMINATION OF RESPIRATORY SYSTEM IN PEDIATRICS. IT HAS BEEN SUMMARIZED FROM ALL WELL KNOWN 32 BOOKS UNDER GUIDANCE OF ONE OF THE BEST PEDIATRIC DOCTORS AND PROFESSORS .
BY DR. SURAJ R. DHANKIKAR.
The document discusses various pediatric arrhythmias including tachycardias and bradycardias. It provides details on normal heart rates at different ages and describes common supraventricular tachycardias like AV nodal reentrant tachycardia, accessory pathway mediated tachycardias. It also discusses idiopathic ventricular tachycardia and management strategies for different arrhythmias including medication and ablation. Congenital complete heart block is described along with its association with maternal autoimmune conditions.
Childhood Asthma Management
Dr. C.S.N. Vittal provides an overview of childhood asthma including:
- Asthma is characterized by chronic airway inflammation and reversible airflow obstruction.
- Childhood asthma is triggered by allergens, infections, pollution and can cause coughing, wheezing and difficulty breathing.
- Diagnosis involves assessing symptoms, lung function tests and ruling out other conditions.
- Treatment focuses on reducing inflammation with daily preventer medications and managing triggers.
- A written asthma action plan is recommended to help patients manage their symptoms and know when to seek medical help.
Asthma attack(status asthmaticus) Groups Mzhda Salman
This document provides an overview of asthma, including:
1) Asthma is a chronic inflammatory disease of the airways characterized by recurrent wheezing, chest tightness, coughing, and shortness of breath.
2) Risk factors include genetic and environmental factors such as exposure to allergens, tobacco smoke, and viral infections.
3) Diagnosis is based on a patient's respiratory symptoms and improvement following bronchodilator treatment; spirometry can also be used.
Bronchial Asthma - Epidemiology, Pathogenesis and ManagementShashikiran Umakanth
Bronchial asthma is a chronic disease with airway inflammation as a central theme in its pathogenesis. Prevalence of this condition is gradually increasing, especially in developed countries and in countries that are getting "westernized". With early diagnosis, regular monitoring and prompt and rational treatment, most patients with asthma can lead a symptom-free life.
This document provides guidelines for diagnosing and managing asthma in children ages 5 and younger. It outlines symptoms that suggest an asthma diagnosis, including recurrent coughing worse at night or with triggers. It also lists risk factors for poor asthma outcomes and discusses treatment using low-dose inhaled corticosteroids with a short-acting bronchodilator as needed. The guidelines further cover assessing asthma control, treating exacerbations, inhaler device selection, and follow-up after an exacerbation.
jodhpur presentation [Autosaved].pptx12 final copy1-1.pptxjasveer15
This document provides an overview of asthma management in children. It defines asthma and discusses its heterogeneous nature. Asthma is characterized by reversible airflow limitation and various patterns of inflammation. The document outlines classifications of asthma phenotypes in children based on factors such as age of onset, triggers, treatment response, and inflammatory features. It also notes several comorbidities that are important to assess for in children with asthma. The stepwise approach for managing asthma in children involves initial treatment with environmental control and rapid-acting bronchodilators, escalating up to low-dose inhaled corticosteroids and other controllers as needed based on asthma control.
This document presents a case study of a family with multiple asthmatic children who experience recurrent breathing difficulties. The family has limited financial resources. The case focuses on a 2-year-old child with mild persistent asthma and nutritional deficiencies. Interventions discussed include regular medical checkups, environmental controls, medication adherence, and addressing the family's social determinants of health.
- Asthma is a chronic inflammatory disease of the airways characterized by airway hyperresponsiveness and reversible bronchospasm.
- It most commonly begins in childhood, with over 77% of cases presenting before 5 years of age. Diagnosis can be challenging in young children due to their inability to perform pulmonary function tests.
- Treatment involves inhalation of corticosteroids and bronchodilators. Short courses of oral corticosteroids are used for acute exacerbations. Patient education is important for proper inhaler technique and trigger avoidance.
This document provides an overview of asthma, including its definition, epidemiology, risk factors, pathogenesis, diagnosis, classification, and management. Some key points:
- Asthma is a chronic inflammatory airway disease characterized by variable airflow obstruction and airway hyperresponsiveness leading to recurrent wheezing, breathlessness, chest tightness and coughing.
- It is a common disease worldwide with increasing prevalence. Risk factors include genetic, environmental and infectious factors.
- Diagnosis involves assessing symptoms, lung function tests, and allergy testing. Severity is classified based on symptoms and lung function.
- Management follows a six-part asthma action plan including education, monitoring, avoiding triggers, medication plans,
This document provides an overview of asthma, including its definition, epidemiology, risk factors, pathogenesis, diagnosis, classification, and management. Some key points:
- Asthma is a chronic inflammatory airway disease characterized by variable airflow obstruction and airway hyperresponsiveness leading to recurrent wheezing, breathlessness, chest tightness and coughing.
- It affects over 300 million people worldwide and its prevalence is increasing, especially in children. Common risk factors include atopy, air pollution, infections and obesity.
- Diagnosis involves assessing symptoms, lung function tests and allergy testing. Severity is classified based on symptoms, lung function and medication needs.
- Management follows a six-part asthma
This document provides guidance on the management of stable bronchial asthma. It discusses the components of asthma management including monitoring symptoms and lung function, patient education, controlling environmental triggers, and pharmacologic therapy. The goals of asthma treatment are to reduce impairment from symptoms and risks of exacerbations. Treatment involves both non-pharmacologic and pharmacologic approaches, with all asthma medications ideally taken via inhalation for rapid onset and fewer side effects. Pharmacologic treatment includes use of relievers for acute symptoms and controllers for long-term control. Classification of asthma severity and control help determine the appropriate treatment approach.
Latest GINA guidelines for Asthma & COVIDGaurav Gupta
What are the changes from 2019 onwards till 2022, in the GINA guidelines for developing countries like India.
Includes COVID guidelines and also a FUN QUIZ !
Talk about why these guidelines have changed - use of ICS - formoterol combination for treating even intermittent asthma
This document discusses pediatric asthma. It notes that asthma is the most common chronic disease in childhood, affecting over 7 million US children. The prevalence has increased over 160% in children under 5 in the last 20 years. Asthma causes 13 million missed school days annually and significant economic costs. Factors contributing to the rise include improved hygiene, indoor air pollution, early viral infections, and host susceptibility. The pathophysiology of asthma involves chronic airway inflammation, constriction, and hyperreactivity. Diagnosis involves assessing symptoms, lung function testing, and ruling out other conditions. Treatment involves acute rescue inhalers and long-term controller medications like inhaled corticosteroids. Barriers to care disproportionately impact minority
The document discusses asthma, including its definition, epidemiology, risk factors, pathogenesis, diagnosis, classification, and management. It provides details on defining asthma as a chronic inflammatory airway disease characterized by variable airflow obstruction and hyperresponsiveness. Key points include that asthma is increasing worldwide, especially in children, and its severity varies depending on symptoms, lung function measurements, and medication needs. A six-part management plan is outlined focusing on education, monitoring, avoiding triggers, long-term medication plans, managing exacerbations, and follow-up care.
A 3-year-old boy named Rohit has been brought to a doctor for recurrent cough over the past year. His cough worsens at night and after activities like running or laughing. He has also frequently had colds requiring nebulization. The doctor suspects Rohit may have asthma based on his symptoms. Asthma is characterized by wheezing, shortness of breath, coughing, and other symptoms that are often worse at night or with exercise. Through a medical examination and history, the doctor seeks to determine if Rohit displays signs of asthma and rule out other potential causes of his symptoms. If asthma is confirmed, the doctor outlines treatment and management strategies to control Rohit's condition.
This document defines asthma, discusses its risk factors, diagnosis, differential diagnosis, types, goals of therapy, and management. It begins by defining asthma as a chronic inflammatory airway disorder causing wheezing, coughing, and breathlessness, especially at night or early morning. It then discusses diagnosing and differentiating asthma from COPD, assessing asthma severity, initiating treatment, managing acute exacerbations, chronic asthma, seasonal asthma, and exercise-induced asthma. The document provides guidelines for long-term control and management of asthma with the goals of reducing symptoms and exacerbations while allowing normal activity levels and lung function.
Made by Ranjith R Thampi. A decent powerpoint on Bronchial Asthma, a short summary on various presentations and treatment options starting at Primary health level. Was made mainly for Primary Health setup. I've also added options at higher centres and also a few references for latest drug modalities and use.
Pharmacotherapy of Asthmatic patient in hospitalAhmanurSule5
This document provides an overview of asthma, including:
1. It defines asthma as a chronic inflammatory airway disorder characterized by reversible airway obstruction.
2. Environmental triggers and allergens can cause asthma symptoms by inducing inflammation and bronchospasm.
3. Treatment involves controlling inflammation with inhaled corticosteroids and bronchodilation with inhaled beta-agonists for acute symptoms and prevention of exacerbations.
4. Proper inhaler technique and patient education are important for effective asthma management.
This document outlines the key objectives and content of a lecture on pediatric asthma. It will define asthma, discuss prevalence and risk factors, identify trends, warning signs, triggers, causes, clinical manifestations, diagnosis, prevention, and management of asthma. It will also describe asthma complications. The lecture aims to educate students on pediatric asthma through discussing its definition, epidemiology, etiology, pathophysiology, clinical presentation, diagnosis, treatment and nursing management.
Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
This document provides information about allergies including:
- Allergies are on the rise, with food allergies affecting 7% of children in the UK and a five-fold increase in peanut allergies between 1995-2016.
- Natural history of allergy shows increasing prevalence of conditions like eczema, asthma, and hay fever with age. The "atopic march" describes the progression from food sensitization to conditions like asthma.
- Rhinoconjunctivitis affects up to 25% of the population and is associated with impaired quality of life. Guidelines recommend avoidance of triggers and stepped treatment including antihistamines and intranasal corticosteroids.
- Treatment
This document discusses congestive cardiac failure in children. It defines congestive cardiac failure as a state of systemic and pulmonary congestion resulting from impaired ability of the ventricle to fill or eject blood. The most common causes in children are congenital heart defects and cardiomyopathy. Symptoms vary by age but can include poor feeding, tachypnea, coughing, and fatigue. Diagnosis involves history, physical exam assessing vital signs, heart sounds and edema, as well as tests like echocardiogram, ECG and chest x-ray. Management depends on whether the failure is acute or chronic, and involves diuretics, inotropes, oxygen, surgery or catheter interventions, and long-term therapy based
1) A 1.5 month boy presented with fever and pancytopenia. Examination found pallor. Blood tests found normocytic anemia, leukopenia, thrombocytopenia.
2) Bone marrow aspiration found erythroid dysplasia and megaloblastosis. Chromosomal breakage study and karyotyping were normal.
3) Flow cytometry found B cell immune deficiency. The pancytopenia and symptoms improved with supportive care.
4) Genetic testing in Germany found a MYSM1 mutation, which has been associated with bone marrow failure and immunodeficiency. The patient will require long term supportive care including transfusions, immunoglobulins and G
This document discusses pediatric urinary tract infections. It covers the incidence, etiology, risk factors, clinical presentation, investigations including urinalysis, urine culture and radioimaging tests, management including choice of antimicrobials and prophylaxis, prognosis, and prevention of urinary tract infections in children. The management involves treating with antibiotics based on culture results and sensitivity, with inpatient versus outpatient treatment determined by factors like age and severity of symptoms. Prognosis depends on factors like presence of renal abnormalities, with recurrence increasing risk of long term issues like renal scarring and failure.
A 2 year old boy was admitted multiple times with vomiting, loose stool, lethargy and severe dehydration and hypoglycemia. Critical sample and tests showed lactic acidosis, ketones in urine and normal hormone and acylcarnitine levels, consistent with a diagnosis of ketotic hypoglycemia. Differential diagnoses included inborn errors of metabolism like fatty acid oxidation defects or gluconeogenesis defects based on the recurrent presentation and metabolic profile.
1. Fahad Fayyaz Butt, a 6-year-old boy, presented with chronic diarrhea, abdominal pain, weight loss, and reduced appetite for 6 months. Physical examination found pallor, mild clubbing, diffuse abdominal tenderness, and anal fistulas.
2. Initial investigations showed anemia, elevated inflammatory markers, and positive anti-gliadin antibodies. Endoscopy found patchy erythema in the esophagus, stomach, and colon.
3. Based on the findings, Fahad was diagnosed with Crohn's disease, an inflammatory bowel disease. His treatment plan included Modulen milk, steroids, 5-aminosalicylic acid, and
The document summarizes the structure and anatomy of the human brain. It describes the major divisions of the brain including the cerebrum, diencephalon, brainstem, and cerebellum. It also outlines some of the functional areas and blood supply of the brain. Key structures mentioned include the ventricles, thalamus, midbrain, pons, medulla, and circle of Willis.
The document discusses growth and development from prenatal to postnatal periods, outlining key factors that influence development such as genetics, sex, nutrition, and socioeconomic status. It also provides charts detailing motor, social, language, and other milestones from infancy through age 5 years. Assessment of growth is done through anthropometric measurements including weight, height, head circumference, and chest circumference.
This document discusses various hemolytic diseases of the newborn. It describes the causes of hemolytic diseases including Rh incompatibility, autoimmune hemolytic anemia, hereditary spherocytosis, sickle cell disease, G6PD deficiency, and thalassemia. It provides details on the presentation, laboratory findings, diagnosis, and management of each condition. The most common cause of maternal isoimmunization is Rh incompatibility. Prevention involves administering anti-Rh D IgG to Rh negative mothers. Hemolytic diseases can cause anemia, jaundice, hepatosplenomegaly, and in severe cases, erythroblastosis fetalis.
1. Malaria is transmitted through the bite of an infected female Anopheles mosquito which injects malaria parasites into the bloodstream.
2. The parasites multiply in the liver and infect red blood cells, causing symptoms like fever, chills, and sweating in cyclical patterns.
3. Complications from severe malaria can include cerebral malaria, respiratory distress, kidney and liver failure, and death if not promptly treated.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
10. Major Risk Factors Minor Risk Factors
Parental Asthma Allergic Rhinitis
Wheezing without URTI
Eczema
Eosinophilia >4%
Loose Index Stringent Index
1 episode of wheezing in 3 years
+
1 major
> 3 episode of wheezing in 3 years
+
1 major
1 episode of wheezing in 3 years
+
2 Minor
> 3 episode of wheezing in 3 years
+
2 Minor
Conclusion: Conclusion
2.6-5.5 times likely to have asthma 4.3 – 9.8 times likely to have asthma
11. Viral Associated wheeze Early Onset Asthma
Febrile Episodes Afebrile episodes
No Personal Atopy Positive Personal Atopy
No Family history of atopy Positive Family history of atopy
Variable response to bronchodilators Predictable response to bronchodilators
12.
13. History Of presenting
Illness
Age • Birth
• Early infancy
• Early Childhood
• Adolescents
Associated symp. • Choking
• Fever
• Feeding
onset • New or recurrent
Temporal Pattern • Episodic or persistent
Control of wheeze • Difficult to control
Past Medical History
• Recurrent pneumoniae
• Neurodegenerative disease
Birth History
• Antenatal Antenatal USS.
• Natal Preterm
Family history • Atopy
14.
15. General Examination:
Denny morgan lines
allergic salute
Clubbing
Erythematous conjuntiva
Growth Charts :
Weight: Underweight
Length: Short stature
Head circumference: Macro or microcephaly
Vital Signs Temperature: fever
Systemic Examination:
Skin: Urticaria
Eczema
ENT: Boggy turbinates
Rhinorrhea
Polyps
Stridor
CNS: Features of neurodegenerative
diseases
Chest: Increased AP
Local vs generalized
Inspiratory vs expiratory
23. 1. recurrent episodic symptoms of airflow
obstruction
2. Airway flow obstruction is at least partially
reversible by administration of a bronchodilator.
3. Alternative diagnoses are excluded
Symptoms are
often worse at
night or on waking
Symptoms occur
variably over time
and vary in
intensity
Symptoms are
often triggered by
exercise, laughter,
allergens, virus
25. • Minimal need <2/wk for SABA
• Maintenance of normal daily activities
Reduction in
impairment
• Prevention of recurrent exacerbations
• minimal or no adverse effects of drugs
Reduction of
risk
32. COMPONENETS OF SEVERITY
SEVERITY
INTERMITTENT
PERSISTENT
MILD MODERATE SEVERE
IMPAIRMENT
DAY <2 times/ week
>2 times/
week
DAILY FREQUENT
SABA USE <2 times/ week
>2 times/
week
DAILY FREQUENT
NIGHT <2 times/ MONTH
>2 times/
MONTH
>5 times/
MONTH
FREQUENT
ACTIVITY NONE MINOR SOME EXTREME
>80% >60 <60%
LUNG FUNCTION
>5YEARS
FEV1% PREDICTED >80%
FEV1/FVC RATIO
>85 >80% >75 <75%
>12y
= NORMAL
NORMAL REDUCED 5%
REDUCED 5%
RISK EXACERBATIONS <2TIMES /YEAR >2TIMES /YEAR
33.
34. COMPONENETS OF CONTROL
CONTROL
WELL NOT WELL VERY POOR
IMPAIRMENT
DAY <2 times/ week >2 times/ week FREQUENT
SABA USE <2 times/ week >2 times/ week FREQUENT
NIGHT <2 times/ MONTH >2 times/ MONTH
>5 times/ MONTH
ACTIVITY MINOR SOME EXTREME
>60% <60%
LUNG FUNCTION
>5YEARS
FEV1% PREDICTED >80%
FEV1/FVC RATIO >80% >75 <75%
RISK EXACERBATIONS <2TIMES /YEAR >2TIMES /YEAR
45. Step: Step1 Step2 Step3 Step4 Step5 Step6
0-4y P SABA prn Low ICS Medium ICS Medium ICS +
LABA or LTRA
High ICS
+LABA or LTRA
High ICS
+LABA or
LTRA+steroids
A LTRA
5-11y P SABA prn Low ICS Medium ICS or
Low dose ICS +
LABA, LTRA
Medium
ICS+LABA or
LTRA
High ICS
+LABA or LTRA
High ICS
+LABA or
LTRA+steroids
A LTRA theophylline theophylline theophylline theophylline
>12y P SABA prn Low ICS Medium ICS or
Low dose ICS
+LABA or LTRA
Medium
ICS+LABA or
LTRA
High ICS
+LABA or LTRA
High ICS
+LABA or
LTRA+steroids
A or LTRA Theophylline,
Zileuton
Theophylline,
Zileuton
Omalizumab Omalizumab
100 genetic loci have been identified
high-affinity IgE receptors
T-cell antigen receptor
interleukin-4 gene
Other : ADAM-33 , B agonist receptor polymorphism
Bronchoconstriction and Bronchopspasm
Recruitment of immune cells which cause epithelial cell damage
The most common symptoms that arouse a suspicion of asthma are intermittent and repetitive episodes of cough and noisy breathing or wheezing triggered by respiratory infections, allergen or irritant exposure, exercise, or play, with symptoms often awakening the child at night
Nonspecific symptoms may include self-imposed limitation of physical activities, genera
Recurrent “croup” in an older child or frequent “clinical pneumonias” or “bronchitis” may also alert the pediatrician to consider evaluating for possible asthmal fatigue, and difficulty keeping up with peers
Birth: Congenital diaphragmatic hernias( neonatal), Bronchopulmonary dysplasia(Neonate)
Early infancy: Vascular rings
Early Childhood: Bronchiolitis , FBA
Adolescents: Atypical pneumoniae and asthma
New-onset: Previously healthy infant: bronchiolitis , incontext of urticaria , stridor: anaphylaxis
Recurrent: URTI: Viral induced wheeze, Feeds: GERD, Atopy: asthma
Episodic: viral induced wheeze, Persistent: Congenital airway abnormality: tracheomalacia, mediastinial mass
Both: asthma
Control: Recurrent wheeze is difficult to control Severe asthma or Cystic Fibrosis or anatomic abnormality
Recurrent pneumoniae: immunodeficiency or Cystic fibrosis or ciliary dyskinesia
Neurodegenerative : Swallowing dysfunction
Antenatal: Congenital diaphragmatic hernia
Preterm: intubated? BPD
FH: Atopy: Asthma
GE: DML: allergy
Clubbing: CF
Weight and Height: Chronic disorders: CF, Immunodeficiency HC: Neurodegenerative disease
Temp: Pneumoniae,
Urticaria: anaphylaxis
Eczema: AR
Boggy: AR
Rhinorrhea: VIW
PolypS: CF
NDD: swallowing dysfuntion
Local : FBA
Localized: FBA, Endobronchial mass
Generalized: Asthma
Inspiratory: obstruction: FBA, Expiratory: Edema asthma, VIW, irritants
PFTs: diagnostic, Reversibility, Hyperreactivity,
CXR:
If its new onset, worsening wheezing
Hyperinflation: generalized: Asthma, CF, Bronchiolitis, Localized: FBA
Cardiomegaly, Mediastinial masses
radioallergosorbent test: Asthma to identify triggers sometime in difficult to treat cases
Barium: TEF, GERD, vascular rings
FVC = forced vital capacity = volume exhaled after maximal inspiration through to maximal expiration
FEV1 = forced expiratory volume in 1 sec
FEV1/FVC = ratio = percent exhaled within first second
FEF25-75 = forced expiratory flow: the % exhaled between 25%-75%
PEFR = peak expiratory flow rate: highest at first because of mechanical advantage and traction of airways; also a measure of effort
AGE GENDER HEIGHT RACE
exercise challenges, methacholine, cold air, and most recently, mannitol challenges performed only when the determination of asthma is difficult despite routine evaluation.
Clinical diagnosis
< 5 years , in whom PFTs cant be performed
Recurrent: cough or wheeze
And inclusion of FH or personal history of atopy
So you don’t do PFTs to confirm
Ciliary dyskinesia or cystic fibrosis: Symptoms and signs that are not consistent with chronicity of asthma, including failure to thrive, cyanosis, and clubbing, should alert the pediatrician to alternative diagnoses such as ciliary dyskinesia or cystic fibrosis.
Foreign body aspiration : A baseline chest radiograph may help exclude other conditions that mimic asthma
Vascular ring: barium swallow
Immune dysregulation : White cell count and differential and quantitative immunoglobulins.
GERD: Symptoms sometimes related to eating, vomiting
Clinical,An upper gastrointestinal series
SABA: nil to 1 time a week
Activity: work, sport
Exacerbations: <2 a year
Adverse effect: minimise and reduce the dose as much as possible
Spirometry: A baseline spirometry should also be performed once a year during follow-up evaluations
Assessment of asthma control should not be based solely on individual single measurements and limited interactions
Asthma control represents the degree to which manifestations of asthma
are minimized and the goals of therapy are met, and should be used as a guide to either maintain or
adjust therapy.
Responsiveness refers to the ease with which prescribed therapy achieves asthma control
the degree of control can change over time; thus, constant review of symptoms and treatment every 1 to 6 months is helpful
Apart from the assessment of severity and control, the predisposition to risk for exacerbations should also be kept in mind.
For instance, a child with intermittent asthma may not need daily controller medication based on the initial assessment of severity,
but the child may still have an unexpectedly severe exacerbation triggered by, for example, a viral infection
Asthma severity index and asthma control index basically contains the following parameters. Aim is to bring the symptoms to the intermittent range of asthma severity and Spirometry results to normal physiologic
1. Basic facts about asthma
Differences between normal and asthmatic airway, preferably using models
Links between airways inflammation, hyperreactivity, and bronchoconstriction
2. Environmental exposures
Comorbid conditions
4. Also provide asthma plan for school
Meds: taste, dosing schedule, difficulties with devices, side effects, and expense
medication regimens tends to be suboptimal
Patient:; misperception of disease severity, misunderstanding instructions
Physician; failure to monitor patients regularly, and incorrect medication and dosage
1. Put your mattresses and pillows in special allergen-proof covers.
Remove all animal products from bedding (e.g. feather pillows and down comforters).
Wash your bedding every week in hot water
2. Keep the bathroom dry by using an exhaust fan or dehumidifier.
Clean sinks, tubs and showers often with a bleach solution (1 part bleach, 3 parts water).
Limit house plants as they are sources of dampness and mold.
3. During allergy season, use air conditioning instead of opening the windows at home and in the car.
hange the air conditioner filter monthly.
Shower or bathe after being outdoors
4. Keep pets outside, if possible.
Keep them off the furniture.
Keep pets out of the bedrooms.
Bathe your pets weekl
5. Some medications, such as aspirin or beta blockers
6. These chemicals are found in wine, beer, shrimp, dried fruit and processed potatoes, and can cause breathing difficulty for many people with asthma.
7. Smoking and secondhand smoke irritate the lungs. Do not use wood burning stoves or fireplaces and avoid campfires
8. Perfumes, sprays and cleaning products
9. Strong emotions, such as anger and anxiety, can lead to changes in breathing that can cause asthma symptoms or make them worse
10. Take your asthma medicine as prescribed. Warm up by exercising slowly at first. Limit exercise if you are ill or if the weather is cold and dry.
relief medication for quick relief of acute symptoms and exacerbations
controller medication for long-term control of the underlying pathophysiologic mechanism of asthma
inhaled corticosteroids (ICS), combination ICS and long-acting β-agonists (ICS-LABA), leukotriene receptor antagonists (LTRA),
5 y step 2-4 consider allergen immunotherapy
SABA > 2 d / week should alert
SABA:Excessive reliance on quick relievers has been associated with increased risk for death or worsening asthma.
ipratropium: This agent decreases vagal tone (resulting in bronchodilation)
Steroids: These drugs have broad anti-inflammatory effects and are usually used as a short 3- to 5-day course to gain initial control of asthma and to speed resolution of moderate or severe persistent exacerbation
1. Inhaled corticosteroids are recommended as the first-line treatment for most types of persistent asthma.
inhibition of inflammatory cytokines and upregulation of β2-receptor responsiveness.
improve pulmonary function, reduce the need for quick-relief medications,
2. are not intended for treating acute exacerbations or as monotherapy for persistent asthma
up to 12 hours
The FDA also specifies that LABAs should be discontinued when asthma control is achieved,
and asthma should be maintained with controllers such as ICS
3. montelukast > 6mand zafirlukast,>5y that block LTD4 receptors, Zileuton >12y
4. they need to be administered frequently (4 times a day) and are not as efficacious as ICS or leukotriene antagonists
5. omalizumab : is an anti-IgE humanized monoclonal antibody that binds circulating IgE, thereby binding the high-affinity receptor and preventing IgE-mediated allergic responses and inflammatory cascade
6. administered every 2 to 4 weeks subcutaneously
Issues to consider include the drug delivery device, dose level, formulation of the preparation, bioavailability, potency of the inhaled corticosteroid, and deposition either in the pulmonary system or in the gastrointestinal system
Allergy shots work like a vaccine. Your body responds to injected amounts of a particular allergen, given in gradually increasing doses, by develop resistance to allergen
Of great concern is that many of these fatal outcomes occur in children viewed as having mild disease..
Risk of death increase with Prior admissions to an intensive care unit, Prior intubation for asthma and sometimes when they have Difficulty perceiving airflow obstruction or its severity, Use of more than 1 canister per month