1. Respiratory approach

2. Approach to chronic cough
Definition
Hints in history
a- nature of cough
b- diurnal variation
c- associated symptoms
d. exacerbating factors and relieving factors
e- associated symptoms
f- family history

3. Cough in asthma
A- usually dry
B- more at night
C- respond to bronchodilators
D- associated with wheeze
E- symptom- free periods

4. Examination:
Signs indicating chronic serious lower respiratory tract disease:
A- failure to thrive
B- clubbing of fingers
C- chest deformity

5. Other signs to look for
A- signs of allergy
B- nasal polyps
C- signs of immunodeficiency
E- lymph nodes
F- cardiac murmurs
E-organomegaly
F- skin rashes

6. Investigation
A- CBC
B- LFT
E- CXR, Sinus and previous Xrays
F- Sweat chloride test
E- Immune screen
F- PH monitoring
G- PFT and bronchoscopy

7. 6 months old with chronic cough, sweat chloride 70, 75 in 2 occasions, lymphocytes counts 400, 450 in 2 occasions:
What results u believe in?
What's the diagnosis?

8. 2 years old with recurrent admissions due to patchy pneumonias, manifested by cough, wheeze. Good response to nebulizer, negative blood cultures.
A- is it recurrent bacterial pneumonia
B- indication for further investigation
C- is it bronchial asthma

9. Bronchial asthma suspect in all the followings:
A- chronic cough, chronic bronchitis
B- recurrent pneumonias without bacteriological proof
C- unequivocal response to ventolin nebulizer

10. Bronchial asthma:
A- definition:
B- other diagnosis mimicking asthma
C- most important history:
Diurnal variation and seasonal
Exacerbating factors
Relieving factors
Associated other atopic features

11. symptom-free periods
Parental history of asthma
Environmental

12. Attack of asthma
Interventional medication:
Systemic steroids
Ventolin administration +/- anticholinergic
Mg sulphate
Adrenaline

13. Asthma attack
Indication for admission:
Dehydration
O2 sat <92 after treatment
Apnea
Convulsion
Previous Icu admission
Respiratory distress interfering with eating and activity

14. Asthma attack:
Discharge:
Able to have oral intake
No use of accessory muscle
O2 sat>92
Discharge on steroid for 3-5 days and Ventolin inhaler and controllers

15. Asthma:controllers:
Steroid inhalers: availables:
Beclomathasone(clenil)
Budesonide( pulmicort)
Fluticasone(flexetide)
Combination: Symbicort, Seretide,
Theophylline, Antileucotreines

16. What to follow:
Growth parameter
Cataract
Asthma control: sleep and activity disturbances, use of ventolin, acute care visits

17. Recurrent pneumonia Definition Most popular causes in children:
Cystic fibrosis
PCD
Immunedeficiency
Recurrent aspiration( CP patients)

18. pneumonias Indications to look for underlying cause: Severe Persistent
Unusual organisms
Recurrent

19. Cystic fibrosis Definition Systems involved: respiratory, killing GI
Reproductive system

20. CF Other manifestations:
Hypotonic, hypoelectrolytemic dehydration with alkalosis( infants, recurrent)
Syndrome of Anemia, edema and Anemia
Neonatal cholestasis

21. CF
Diagnosis:
Sweat chloride
Gene mutation
Nasal potential difference

22. CF Treatment: respiratory: Antibiotics the cornerstone of treating CF
GI: enzyme replacement, vitamins, diet
Liver disease
complications

23. Airmay obsrtruction Cardinal sign: Stridor Classification
Acute( toxic and notoxic) and chronic
Congenital or aquired

24. Clinical manifestation
Stridor : ( Inspiratory stridor )
- Harsh sound produced by vibration of upper airway structure
- Indicates upper airway obstruction
Hoarseness: Indicates involvement of vocal cords
Respiratory distress / suprasternal retraction

25. stridors Toxic : - Acute epiglotitis - Bacterial tracheitis
-Retropharyngeal abcess and retrotonsillar abcess(quinze)
Nontoxic:
Croup
Foreign body

26. CROUP (also termed laryngotracheitis or laryngotracheobronchitis):
Is a respiratory condition, that is usually triggered by an acute viral infection of the upper airway.
The infection leads to swelling inside larynx and trachea but may also extend to the bronchi produces the classical symptoms of a "barking" cough, stridor, and hoarseness.