| What in medical history do we need to consider when it comes to respiratory system and cardiovascular? | Respiratory system:
Cough
Dyspnoe
Pain in chest
Apnoe
Hematoptysis
Cyanosis
Cardiovascular system:
Dyspnoe
Oedemas
Cyanosis |
| What do we need to consider during physical examination when it comes to respiratory and cardiovascular system? | Respiratory system:
Tachypnoe/bradypnoe
Dyspnoe
Cyanosis
Patologic sounds upon auscultation
Abnormalities on auscultation
Cardiovascular system:
Tachycardia /bradycardiaMurmurs
Arrhytmias
Abnormal apex beat |
| What is cough? | Cough- sudden expulsion of air -protective reflexphysiologically removing particles from airway ,
incidental cough- normal phenomenon
• Recurent coughing- sign of disease
• Most frequently manifestation of upper or lower
respiratory airways |
| What 3 types of cough do we have? | Dry cough- usually upper respiratory tract infections
• Productive cough-usually lower respiratory tract
infection( bronchitis, pneumonia)
• Acute caugh( <3 weeks, usually infections), persistent( 3-
8 weeks), chronic ( >8weeks) |
| Causes of acute cough | • Infections
• Asthma
• Choking
• Forein body in airways
• Pneumothorax |
| Causes of chronic cough | • Cystic fibrosis
• Gastro-esophageal reflux
• Tuberculosis
• Bronchiectases( CF, immune deficiencies)
• Impression on airways( tumor-lymphoma, vascular ring)
• Foreign body in Airways
• Reccurent aspiration due to oesophago-tracheal fistula• Chronic interstitial lung diseases
• Chronic sinusitis |
| Signs of dyspnoea: | -use of accessory respiratory muscles,
-nasal flaring,
-grunting,
-subcostal retraction
- excessive movements of diaphragm
Abnormal respiratory rate( bradypnoe, tachypnoe) may
accompany dyspnoea |
| Most frequent causes of dyspnoe- respiratory system
diseases | Respiratory dyspnoea
• Inspiratory: upper airway( throat,larynx, trachea)
• Expiratory : lower airway- bronchi
• Mixed dyspnoea: alveoli |
| Types of dyspnoea | Respiratory dyspnea – due to respiratory tract pathology,
• Cardiac dyspnea – cardiac failure
• Metabolic dyspnea – usually due to acidosis
• Anaemic dyspnea – due to dysfunction or low number of red blood cells
• Neurognic dyspnea – secondary to neurologic system impairmen
• Inspiratory dyspnea – laryngitis, larynospasm, laryngeal oedema ( anaphylaxis), foreign body in larynx
• Expiratory dyspnea- asthma, wheezy bronchitis,
bronchiolitis
• Mixed dyspnea- pneumonia, pleuritis, pneumothorax |
| Pain in chest, what is it and what causes it? | Contrary to adults, children most often suffer from non-cardiac causes
of chest pain (e.g. a heart attack practically does not occur in
children).
Causes
• Pleuritis
• Emphysema
• Pulmonary embolism
• Myocarditis
• Pericarditis
• Acute pancreatitis
• Psychogenic causes (after exclusion of organic causes !!!) |
| Apnoe, what is it and what causes it? | Blockage of airflow in respiratory tract
Causes
• Hypertrophy of tonsils
• Decreased muscle tone
• Obesity
• May appear also in healthy individuals
Affective apnea- preceded by strong emotions |
| What types of apnoe do we have? | • Central- immaturity of medullar respiratory centre, decreased
sensitivity to hypercapnia, mainly in premature infants
• Obstructive- obstruction of upper respiratory airways, non-efectiverespiratory movements, obstructive sleep apnoea is an indication for
laryngologic consutation |
| Hemoptysis | Rare symptom in children
Mostly originate from throat/nose
• Nasophrygeal infection
• tonsilitis
From lower respiratory tract
• bronchiectases ( cystic fibrosis, immune deficiencies)
• pulmonary abscess
• tuberculosis
• vasculitis |
| What is cyanosis and what types do we have? | Definition- bluish discoloration, especially of the skin and mucous membranes, due to excessive concentration of deoxygenated hemoglobin in capilary blood -> 5 g/dl
Cyanosis classification
• Central- decreased saturation of oxegen saturation of hemoglobin in arterial blood, predominantly visible on lips, tongue and oral cavity.
• Peripheral- decreased perfusion of periphery, visible on peripheral parts of body |
| What dieses can cyanosis be a symptom of in respiratory and cardiovascular systems? | Diseases of respiratory tract( respiratory failure)
• Foreign body of trachea, larynx
• Choanal atresia
• Epiglottitis
• Bronchiolitis
• Severe asthma attack
• End stage of cystic fibrosis
Diseases of cardiovascular system
• Cyanotic cardiac defect (ie. Falot syndrome)
• Cardiogenic shock
• In all the mentioned condiotions exept cardiogenic shock central
cyanosis |
| Tachypnoe/bradypnoe | • Abnormal( too high/too law respiratory ratein relations to
age
Normal respiratory rate
• newborn 40-60/min
• infant 30-50/min
• 1-5 years 26-40/min
• 6-8 years 18-30/min
• older 14-20/min
• Most frequently accompanies dyspnoe |
| Auscultation abnormalities over lungs- pathologic sounds | Rhonci and wheezes- come from bronchi as a result of
their obturation due to oedema and mucus
overproduction, usually present on expiration
Crepitations, crackles – audible when air comes back
into atelectatic vessicles (atelectasis, inflammation) best heard at the top of inspiration, typical for pneumonia
Pleural friction- best heard at the end of inspiration and
the beginning of expiration in pleuritis without exudate. |
| Auscultation abnormalities over lungs- pathologic sounds 2 | Patologic bronchial sound if present over lungs, not in the
typical location- lobar pneumonia
• Prolonged expiration- obstruction of bronchi , wheezy
bronchitis, bronchiolitis
• Prolonged inspiration – narrowing of larynx, laryngitis |
| Percussion abnormalities | • Dull pecussion sound –presence of fluid in pleura (
pleuritis) airless fragment of lung( atelectasis), diffuse
pneumonia ( loban pneumonia)
• Hyperresonant sound – emphysema
• Tympanic sound - pneumothorax |
| Vocal fremitus abnormalities | Absent or decreased- pnaumothorax, presence of fluid in pleural cavity
Increased- over an airless part of lung- lobar pneumonia |
| Tachycardia | • Heart rate above the normal range in relation to age.
May be physiologically present. In many pathologies.
Compensative mechanism
• 1 month – 100-180
• 2-6 month – 100-140
•6-12 month – 100-120
•2-6 years – 90-110
•7-10 years – 80-100
•11-14 years – 70-90 |
| What types of tachycardia do we have? | Sinusal
• fever, stress, anxiety
• hipotension
• anaemia
• conditions presenting with hypoxia, respiratory failure
• severe infections
• hyperthyroidism,
• cardiac failure, medications/stimulants
• dehydration, shock
Extra sinusal- cardiologic diseases |
| Bradycardia | • Bradycardia- heart rate lower than norm in relation to age
The most common causes
• Apnoe and bradycardia of premature infants
• Arrhytmias and conduction disturbances
• Increased intracranial pressure
• Medications |
| Arrhythmia | Respiratory arrhythmia- physiologic in children, increasedheart rate on inspiration, dissapaers , when a child stops
to breathe
Arhythmias- cardiologic diseases |
| How do we divide cardiac murmurs? | Cardiac ( systolic, diastolic, systo-diastolic )
• Organic causes - cardiac defects
• Functional – cardiac enlargment, hyperkinetic circulation
• Innocent murmurs
Extracardiac (pericardial friction) |
| Characteristics of innocent murmurs | • Loudness 1-3/6 Levine’s scale
• Without any heart failure.
• Proper development
• Mainly systolic
• Position dependent |
| Apex beat abnormalities | Diffuse,high, abnormally located: cardiac defects,
cardiac failure,cardiomyopathies |
| Skin colour abnormalites | - Palor
• Redness
• Icterus
• Cyanosis |
| Causes of palor | Anaemia- palor best visible on lips, auricles, conjunctiva
• Infections
• Dehydration
• Low blood pressure- syncope
• Shock |
| Causes of redness | Fever
• Overheating
• Carbon monoxide intoxication
• Neonates in first days of life- skin physiologically redpolicytemia
• Local redness for example over inflammed lymphnode or
joint |
| Causes of icterus | The most common causes !!!!
• Physiologic jaundice in 60% !!!! of full term neonates
• Breast milk jaundice
Blood and liver diseases as causes of jaundice will be
discussed next year |
| Patomechanisms of physiologic jaundice | Immaturity of the liver- decreased conjugation with
glucuronic acid
• Increased destruction of erythrocytes( presence of fetal
hemoglobin,)
• Increased enterohepatic circulation of bilirubin |
| Criteria of physiologic jaundice | • Unconjugated bilirubin
• Not in the first day of life
• Not longer than 10 days ( ful term newborns),14 days
premature neonates
• Level lower than 15 mg% (artificial feeding) i 17 mg% (
brest feeding)
• The daily increase lower than 5 mg% , less than 0,3 mg%
per hour
• No pathologic symptoms present |
| Breast milk jaundice | components of breast milk hinder
bilirubin conjugation
• early ( 2-3 day) late(7 day)
• unconjugated bilirubin
• therapeutic-diagnostic trial- the decrease in bilirubin
level after stopping breast feeding for 24-48 h or feedingwith previusly heated breast milk
• needs to be differentiated with pathologic jaundices |
| oedema patomechanism | • Decreased oncotic pressure : (hypoalbuminemia)
• Increase blood vessels permeability
• Venous stasis
• Lymph stasis |
| Main causes of oedemas | Cardiac failure
• Renal failure
• Liver failure
• Nephrotic syndrome
• Allergy |
| Primary skin lesions | macule
• papule
• vesicle
• blister
• pustule
• wheal
• nodule |
| Secondary skin leasions | • crust
• erosion
• scale
• lichenication
• scar
• excoriation |
| Macule | most common category
erythematous due to blood vessels dilatation
upon pressing dissapear if its macular rash
upon pressing do not dissapear if its hemorrhagic rash
- fever and measles
- allergic rash allergy to drugs
- in Schoenlein Henoch disease
- hemorrhagic rash in meningococcal sepsis
- cafe au lait |
| Papule | - diper dermititis |
| Vesicle | chickenpox (vesicular rash)
wheal |
| Pustule | acne |
| Lichenication | atopic dermatitis |
| Excoriations | atopic dermititis |
| Scale | seborrhoic dermatitis |
| During the examination of lymph nodes the following elements have to be assessed | size
location
number
single/cluster
consistency- hard, soft, firm
mobile/fixed
Tenderness
appearence of the skin over lymphnode:
normal/inflammed |
| The following groups of lymph nodes have to be palpated | • occipital
• retroauricular
• nuchal
• preauricular
• cervical
• submadibular
• axilar
• supraclavicular
• inguinal |
| Lymphadenopathy, the most important causes | Lymphadenitis- painful lymph nodes
• Reactive lymphadenopathy due to infection in the region of lymph
node: submandibular lymphadenopathy in tonsilitis or labial heres
• General infections( rubella- occipital lymphadenopathy, glandular
fever- cervical lymphadenopathy)
• Hematologic malignancies:
-General lymphadenopathy- lymphoblastic leukemia
-Single lymphnode or cluster- lymphoma
• Non- infectious disease – Kawasaki disease |
| Nerons neck | lynphadenopathy in glandular fever caused by Epstein Bar virus (mononucleosis) |
| Hodgkin lymphoma | lymphadenopathy, cancer |
