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RESP 5017 > 17. Lower Airway Disorders > Flashcards

17. Lower Airway Disorders Flashcards

1
Q
  1. Is bronchiolitis viral or bacterial? Upper or lower respiratory tract infection?
  2. Characterized by ________ of _____ airways caused by…. (3 things)
A
  1. Viral, lower resp tract infection
  2. Obstruction of small airways caused by:
    - Acute inflammation
    - Edema and necrosis of the epithelial cells
    - Increased mucus production
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2
Q
  1. What virus is bronchiolitis usually caused by, and what is it often called because of this?
  2. Other viruses that can cause bronchiolitis? (hint: 4)
  3. How common is an infection with multiple viruses?
A
  1. Respiratory syncytial virus (RSV) is responsible for most cases of bronchiolitis, so it is often called RSV
  2. Influenza, rhinovirus, adenovirus, parainfluenza
  3. 10-30% of all cases
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3
Q

What possible anatomic alterations of the lungs can occur with Bronchiolitis? (Hint: 6 of them)

A
  1. Inflammation and swelling of the peripheral airways
  2. Excessive airway secretions
  3. Sloughing of necrotic airway epithelium
  4. Partial airway obstruction and alveolar hyperinflation
  5. Complete airway obstruction and atelectasis
  6. Consolidation
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4
Q
  1. When does RSV season usually occur during the year, and how long does it last?
  2. What age group is this common in?
  3. In the first year of life, what is bronchiolitis the most common cause for?
A
  1. Between Nov-Jan, persists for 4-5 months
  2. Common during first 2 years of life
  3. Admission to hospital
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5
Q

What is the difference between droplet transmission and direct/indirect contact?
Infection occurs when particles touch the ___,___, and ___.

A
  1. Droplet - transmitted when droplets containing the virus are coughed or sneezed into the air
    Direct/indirect contact - spread from direct/indirect contact with droplets
  2. Nose, mouth, or eyes
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6
Q

How is bronchiolitis diagnosed?
How does bronchiolitis usually present?
What may there be/not be history of exposure to?

A
  1. History and physical exam
  2. First episode of wheezing before the age of 12 months
  3. There may or may not be history of exposure to an individual with a viral URTI
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7
Q
  1. Bronchiolitis S&S begins with a ___ to ____ day viral prodrome of..? (3 things)
  2. It then progresses to variable degree of resp. distress (9 possible things)
A
  1. 2 to 3 days, 3 signs: Fever, cough, rhinorrhea
  2. Tachypnea, tachycardia, wheeze or crackles, grunting, nasal flaring, tracheal tug, retractions, abdominal breathing, hypoxia, apnea
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8
Q
  1. What are the differential diagnosis for wheezing in young children? (hint: 6 things)
  2. Are diagnostic tests indicated for children with mild bronchiolitis?
A
  1. Viral bronchiolitis, asthma, other pulm. infections, croup, foreign body aspiration, allergic reaction
  2. No
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9
Q

What would you see on a bronchiolitis CXR? (Hint: 4 possible)

A

Streaky peribronchial opacities, patchy hyperinflation, areas of atelectasis (common in RUL), consolidation if pneumonitis present

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10
Q
  1. Do nasopharyngeal swabs help with patient outcomes with respiratory viruses? When are they recommended?
  2. What tests can be done in severe cases?
  3. Which test is most definitive and why? What does the more definitive test require?
A
  1. No, they don’t change patient outcome. Recommended in unsure cases, withdrawal of unnecessary antibiotics, severely ill
  2. Antigen assay tests, called RSV enzyme immunoassay (RSV-EIA), or a RIDP by polymerase chain reaction (PCR)
  3. RIDP by PCR is more definitive, it identifies RSV plus other resp. viruses (rhinovirus, influenza, parainfluenza etc), however it requires a nasopharyngeal aspirate or lavage sample
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11
Q
  1. How does bronchiolitis present? (wide or narrows S&S? mild or serious?)
  2. How long does it take for symptoms to develop of bronchiolitis/RSV once infected? How long does it last?
  3. How long are infected individuals contagious for?
A
  1. May present with wide range of symptoms and severity, from mild URTI to impending resp failure
  2. 4-6 days to develop symptoms, lasts 1-2 weeks
  3. up to 8 days
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12
Q

Which groups of infants/children are at higher risk for SEVERE bronchiolitis? (hint: 4 of them)

A
  • Premature infants (<35 wks)
  • < 3 months of age at presentation
  • Hemodynamically significant cardiopulmonary disease
  • Immunodeficiency
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13
Q

What are the guidelines for admitting a child with bronchiolitis to the hospital? (Hint: 6 requirements)

A
  1. Signs of severe resp distress (undrawing, grunting)
  2. Supplemental O2 needed to keep sats above 90%
  3. Dehydration or history of poor fluid intake
  4. Cyanosis or history of apnea
  5. Infant at high risk for severe disease
  6. Family unable to cope
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14
Q

What is recommended for the treatment of bronchiolitis? (Hint: 3)
What has equivocal evidence? (Hint: 2)
Not routinely recommended? (Name a few, but there are 7)

A
  1. Oxygen, hydration, heated humidified HFNC
  2. Nasal suctioning, epi nebulization
  3. Bronchodilators, 3% hypertonic saline neb, oral/inhaled corticosteroids, antivirals, antibiotics, chest physio, cool mist or saline therapy
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15
Q

What type of oxygen administration device should you use for bronchiolitis patients?

A

Nasal prongs, blow by, HFNC

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16
Q
  1. Why is the HFNC beneficial? (6 things)
  2. What type of bronchiolitis cases should we use this in?
  3. How much flow should be used?
A
  1. Reduction of upper wait way headspace resulting in increased O2 and decreased CO2, decreases insp. resistance, decreased WOB, increased humidity to thin secretions, dynamic airway pressure to decrease air trapping and stent swollen airways, decreased RR
  2. Moderate to severe cases
  3. 2 L/kg/min
17
Q
  1. What does nebulized epi do to the vasculature?
  2. What is the dose for an infant < 1 year, and a child > 1 year?
  3. What do you need to be aware of, and how long should you monitor for? Side effects?
A
  1. Vasoconstriction, reducing edema
  2. infant: 2.5 ml 1:1000, child: 5 ml 1:1000
  3. Rebound! Monitor for 2 hours post rx, possible tachycardia
18
Q

Bronchiolitis presents with a _____ that is clinical similar to _____.
Are the airways constricted in bronchiolitis? Or are they just obstructed?
Are bronchodilators recommended? Can a trial be done?

A
  1. Wheeze, asthma
  2. No, they are obstructed by edema and secretions
  3. No, but a trial of them can be done
19
Q

Why is hypothesized about 3% hypertonic saline nebulized?

Is it routinely recommended? Can a trial be done?

A
  1. Hypothesized that hypertonic saline increases mucociliary clearance and rehydrates the airway surface
  2. No, but a trial can be done
20
Q
  1. What medication is used for the prophylaxis of bronchiolitis?
  2. What type of medication is this? What does it prevent against, and in what patient population?
  3. How often is the med given, and in what form?
A
  1. Palivizumab (Synagis)
  2. Immunoglobulin prophylaxis, preventative measure against RSV infection in high risk infants
  3. IM injection, given every 30 days during RSV season
21
Q
  1. What is the definition of paediatric asthma?

2. What is it usually associated with?

A
  1. Inflammatory disorder of the airways, characterized by paroxysmal or persistent symptoms such as dyspnea, chest tightness, wheezing, sputum production, and cough
  2. Associated with variable airflow limitation and airway hyper responsiveness to endogenous and exogenous stimuli
22
Q

How is paediatric asthma diagnosed in preschoolers? (< 6 years) (Hint: 3 things)
What can heighten the suspicion of asthma? (2 things)

A
  1. S&S of airflow obstruction, reversibility of airflow obstruction (improvement with meds), no evidence of alternative diagnoses
  2. Personal atopy (eczema, food allergy,) and family history of asthma
23
Q

How is paediatric asthma diagnosed in older children? (Hint: 7 possibilities)

A

Medical history, physical exam, PFTs (spirometry showing reversibility, PEF variability, positive methacholine/exercise challenge), exhaled NO, sputum cell counts

24
Q
  1. How do you know is a childs airflow limitation is reversible during spirometry?
  2. What about PEF?
  3. Positive methacholine challenge?
  4. Exercise challenge?
A
  1. Less than LLN based on age, sex, height, ethnicity, AND >/= 12% change in FEV1
  2. > /= 20% (increase after bronchodilator)
  3. PC20 < 4 mg/mL (4-16 borderline, > 16 is negative)
  4. > /= 10-15% decrease in FEV1 post-exercise
25
Q

What is well controlled asthma defined as? Here are the categories:

  1. Daytime symptoms
  2. Nighttime symptoms
  3. Physical activity
  4. Exacerbations
  5. Absence from work or school due to asthma
  6. Need for reliever (SABA or bud/form)
  7. FEV1 or PEF
  8. PEF diurnal variation
  9. Sputum eosinophils
A
  1. < 2 days/wk
  2. < 1 night/wk and mild
  3. Normal
  4. Mild and infrequent
  5. None
  6. = 2 doses per week
  7. > /= 90% personal best
  8. < 10-15%
  9. < 2-3%

RESP 5017 (19 decks)

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