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Pediatric Heart > Asthma > Flashcards

Asthma Flashcards

1
Q

Chronic respiratory condition characterized by wheezing, coughing, distress, and bronchospasm

A

Asthma

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2
Q

Pathophysiology of Asthma

A

Immune/allergic reaction (inflammation) in the basement membrane that causes permanent changes (airway remodeling)

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3
Q

Asthma can cause episodes of ____, ____, ____, ______. These episodes are reversible either spontaneously or with treatment.

A

wheezing, chest tightness, breathlessness, nighttime or early morning cough

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4
Q

Who is most likely to have asthma (location, race)

A

Low income, minority (black, American Indian, and some hispanic), inner city, children

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5
Q

Other chronic lung disease, CF, obesity (exercise intolerance), CV disease and immunodeficiency disorders are co morbidities of what?

A

Asthma

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6
Q

Asthma can cause smooth muscle dysfunction that leads to _______, bronchial ______, _______ of lung cells, and inflammatory mediator release

A

bronchospasm, hyperreactivity, hypertrophy/hyplerplasia of lung cells

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7
Q

Asthma can also lead to _____ ________, which causes inflammatory cell infiltration, mucosal edema, _____ damage, and basement membrane ______

A

airway inflammation; epithelial; thickening

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8
Q

So triggers lead to a immunohistopathologic response meaning:

A

shedding of epithelium and collagen deposition under basement membrane
-Edema occurs and mast cells are activated and then inflammatory cell infiltration occurs

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9
Q

Inflammation in asthma then leads to _____ and evolves into wheezing ____ _____, and cough

A

bronchospasm/constriction; chest tightness

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10
Q

_____ ______ occurs due to persistent inflammation that leads irreversible changes
such as abnormal airway diameter (caliber), decreased airflow

A

Airway remodeling

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11
Q

Triggers lead to airway inflammation, leading to ____ production, airway ____tightening, and swollen ___ ___, which leads to narrowing of breathing passages then ___, ___ and ______

A

mucous production, airway muscle tightening, and swollen bronchial membranes; wheezing, coughing, and SOB

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12
Q

Common asthma triggers include

A

Infections, viral respiratory illness (rhino/enterovisrus, parainfluenza, RSV, metapneumovirus), seasonal allergens, pets, cigarrette smoke, weather changes

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13
Q

Rule of 2’s (2 SABA canisters/years, 2 doses of SABA/wee, 2 nocturnal awakenings/month, 2 unscheduled visits/year, 2 PO steriod bursts/year)

A

Helps determine the need to add controller therapy in asthma (step 1 to STEP 2)

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14
Q

Medications: Reliever (Fast acting)
Taken as needed for rapid, short term relief
It is used to ____ or ____ an asthma attack.
Examples include albuerol or Xopenex ( less tachycardia than albuterol so consider in kids with heart issues)
Anticholinergic (Ipratropium or Atrovent) or Corticosteriods (systemic)

A

prevent or treat

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15
Q 
Corticosteroids 
\_\_\_mg/kg per dose BID or 2-4mg/kg/day
Liquid prednisone (poor taste) 15mg/5ml
Pills (adult daily mac is \_\_\_\_\_mg) 
Oral dissolving tablets but insurance may be an issue
A

1-2

60

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16
Q

Controller Medications are taken _____ to control chronic symjpmtoms and prevent asthma attacks

A

Regularly

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17
Q

The most important type of medication for people with asthma is _______

A

controller medications

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18
Q

Controller medications are not _____, and one option during an exacerbation is doubling dose of _____ instead of giving steroids.

A

systemic; ICS

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19
Q

Example of a controller medication s______

A

Inhaled corticosteroids which are anti-inflammatory, most effective and commonly used for long term control; reduce swelling and tightening in airways, but can take several days/weeks to reach max. benefit

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20
Q

Inhaled corticosteroid examples

A

Fluticasone (Flovent), Beclomethasone (Qvar), Ciclesonide (Alvesco), Flunisolide (Aerobid)
Nebulizer (bedside (Pumicort), or even Mometasone.

  • insurance helps determine.
  • encourage kids rinse mouth out
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21
Q

LABA: _____ that opens up narrowed airways and reduces ____. They last for at least ___ hours and can control moderate to severe asthma and _____symptoms.

A

bronchodilators; swelling; 12; nighttime

*Salmerrol (Serevent) or Foradil

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22
Q

Combination inhalers can increase the risk for __________ and contain both a corticosteroid and long acting beta agonist

A

Severe asthma attacks

*Advir, Symbicort, Dulera)

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23
Q 
Leukotrine modifiers (Antagonists) block the effect of leukotrienes which are: \_\_\_\_\_\_\_, \_\_\_\_\_\_ released by \_\_\_\_ cells,
These medications help prevent symptoms for \_\_\_\_hours
A

immune system chemicals that cause atopy symptoms and are released by mast cells. They help prevent symptoms for up to 24 hr.

*Montelukast (Sinfugulair)
1-5m=4mg, 6-14 = 5mg, >14 = 10mg
SE: nighttime terrors/hallucinations

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24
Q

Can use antihistamines, Leukotrine Antagonists, allergy shots, or omalizumab for _____

A

allergy-mediated symptoms

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25
Q

Spacers can help pt. with _________ and ________

A

difficulty using an inhaler/can reduce SE from medication.

*less thrush

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26
Q 
If well controlled for 3-6m
Improved spirometry
Improved hx. and time of year is when they are not triggerd
improved peak flow, 
what should you do?
A

Step Down

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27
Q

Acute exacerbation of asthma symptoms:

A

tachypnea, low 02 saturations, wheezing, retractions, tracheal tugging, breathlessness at rest, hunched forward, speaks in words vs. sentences, agitation, low peak flow (less than 60% of normal)

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28
Q

Acute exacerbation concerns

A

early tx. has better outcomes

identify pt. at risk for death

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29
Q

In an acute asthma attack:

A

SABA (you can double neb treatment or do an hour long neb tx.), oxygen, corticosteroid,
If there is concurrent illness present, give antibiotics

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30
Q

Azrithomycin has ______ effects that have actions on macrophages, COX-inhibitory effects

A

anti-inflammatory

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31
Q

Cystic Fibrosis is cause by abnormalities in the _____ protein that’s produced by mutations in the _____ gene

A

CFRT

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32
Q

CF presentation in utero

A

increased echogenicity on ultrasound

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33
Q

Newborn CF manifestations

A

Meconium ileus; delayed stool passage; jaundice

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34
Q

Infant and Children

A

Malabsorptive stools, rectal prolapse, failure to thrive, intusseption

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35
Q

CF presentation (Gastrointestinal)

A

Malabsorption of fat, protein, CHD, fat soluable vitamins, malabsorptive stools, FTT (but have a voracious appetite), recurrent abdominal pain, pancreatitis.
(hepatobiliary) electrolyte imbalance/abnormal liver enzymes

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36
Q

Respiratory CF presentation

A

Chronic cough (mucous production), Respiratory infections (recurrent), persistent and recurrent wheeze, prolonged symptoms of bronchiolittis, recurrent/chronic rhinosinusitis, bronchlectasis , finger clubbing

37
Q

CF dx.

A

newborn screening; sweat test >60 mEq, malabsorptive studies, vitamin E, stool pancreatic elastase (<100)

38
Q

Pneumonia
Effects_____ respiratory tractParticularly the ______ Lobar, interstitial, bronchial
Many viruses progress to secondary bacterial infection

A

lower; parenchyma

39
Q

Pneumonia associated symptoms

A

Fever, cough, increased respiratory effort, dehydration, +/- wheezing

40
Q

____, hypoxia, and____ are signs of worsening ____

A

nasal flaring; retrations; worsening pneumonia

41
Q

Gold standard for diagnosing pneumonia

A

Crest X-ray (infiltrates/consolidation

42
Q

Viral pneumonia is more common in _________. Symptoms include ___, _____, and tachypnea. We treat symptomatically and by ____, ____, _____, monitor and if suspecting possible bacterial thick about azithromycin

A

children; cough, fever; increasing water, isolation, and treating fever

43
Q

Bacterial Pneumonia can be a ____ of vial pneumonia and is associated with ________. tx. includes ______, which is safest in neonates but if _____ or _______, give azithromycin. If influenza, use _______

A

secondary complication; influenza A. Amoxicillin; walking pneumonia or community acquired; Tamiflu

44
Q

Bronchitis is associated with inflammation in the ____ airways vs. bronchiolitis in the ______

A

large; small

45
Q

Bronchitis is associated with ___ and ____vs. bronchiolitis which is associated with ______

A

pharygitis and laryngitis; copious mucous secretion and upper wairway symptoms that move into lower airway

46
Q

Bronchitis can be acute, chronic, viral or bacterial wheras bronchiolitis is ______ usually

A

acute

47
Q

both bronchitis and bronchioltis are more prominent in the _____

A

Winter

48
Q

Bronchitis can be treated with:

A

Cough suppressants in adults or expectorants in kids (Mucinex) and bronchodilators

49
Q

Bronchiolitis is most common lower respiratory infection in kids ages ________

A

1 month to 2ys

50
Q

Bronchiolitis is caused by 5 viruses (name them) and has the symptoms of edema and necrosis of lining in small airways, ___ mucous production, and _____

A

RSV, adenovirus, influenza, para influenza, human metapneumovirus

51
Q

___ is the most common agent for bronchiolitis with the greatest incidence between ____ and March. 90% of kids are infected in the first 2 years of life

A

RSV; December

52
Q

RSV’s incubation period is _ to _ days. It is transmitted by _____ contact, _____ ____ droplets, and can survive for ___ on hands and fomites

A

4-6; direct contact (nasopharyngeal or ocular mucous membranes, large aerosol droplets; hours

53
Q

RSV Risk factors include

A

premature birth (less than 37w), young child (6-12 weeks), development of apneic episodes, hemodynamically significant heart disease, chronic lung disease, immunocpromised, non-breastfed

54
Q

RSV symptoms: _____ is the presenting symptom in 20% of infants admitted to the hospital, significant _____, tachypea (over ____ RR), wheezing, coughing, crackles, nasal flaring, use of accessory muscles, and 50-75% also have ______

A

Apnea; rhinitis; 70; Acute otitis media

55
Q

RSV dx.

A

Clinical features; virologic nasopharyngeal testing; pulse oximetry <90, chest X-ray (r/o pneumonia) , CBC

56
Q

RSV management incudes: supportive nutrition/hydration. Insert an IV PRN ; Pulse oxyden PO is _____, antibiotics only is ____ present. Suction the nares

A

<90%; AOM

57
Q

___ should not routinely be used for RSH (modest short term improvement), _____ not okay if <24m, ____ only used in immosuppressed patients with RSV, and if _____ and on Synagis they may continue

A

Bronchodilators; Corticosteriods; premature

58
Q

RSV is worse on day ___

A

4

59
Q

____ is also known as ____ or ____ and is cause by the bacterium ______ _______

A

Pertussis; Bordetella pertussis

60
Q

symptoms of Pertussis include a ______ _______ cough that is accompanied by an ____ whoop and patients may often have a ___ worsening or subsequent encounter ; reportable to local health department

A

prolonged paroxysmal; inspiratory; second

61
Q

Pertussis mode of transmission is ___ to ____ by ____ ____ or ___ contact with sections from respiratory tract. 80% have a secondary attack rate, and older adults and kids are a source for infants and young children. Kids ______m are at greatest risk for complications and death

A

<12m

62
Q

Incubation for pertussis ____ days. Most infectious period is during the catarrhal stage or ______w ____ cough and first ___ weeks ____ cough onset.

Duration is _____ or ___ in adolescents

A

7-10 days; 3 weeks before cough or 2 weeks after cough onset.
Duration is 6-10w or 10+ in adolescents

63
Q

Pertussis is dx. without labs if patient has COUGH LASTING ____ WEEKS WITHOUT LIKELY DX. AND 1 OF THE FOLLOWING:

A

> 2; paroxysm of cough, inspiratory whop, post tussive vomitting, apnea without or without cyanosis (if <1y)

64
Q

Cough that is not improving, rhinorrhea with steady watery mucous, apnea, seizures, cyanosis, vomitting, or poor weight gain; ____ (WBC > 20,000) with lymphocytosis ( ____% lymphoctyes), pneumonia, subconjunctival hemorrhage, sleep disturbance, or

A

leukocytosis; 50%

65
Q

Labs for Pertussis

A

CBC with Diff (WBC/lymphocytes are directly related to severity in infants) , Chest X-ray )could be normal/r/o pneumonia), PCR and culture if <4 or PCR and serology is ?4 ( IgG is >1 if vaccinated)

66
Q

Syncope, rib fractures, incontinence, sleep disturbance, (pneumonia, seizures, encephalopathy in infants) and death (unvaccinated infants) are complications of

A

Pertussis

67
Q

If child is < ____m, in respiratory distress, may have PNA, unable to feed, cyanotic or apnea with or without cough, or has a seizure, send them to the _____

At home, ___ and ___. ___ aren’t recommended

A

HOSPITAL

Nutrition/fluids; cough suppressants

68
Q

Antimicrobial therapy may be given to kids with pertussis if given within ___ days of symptom onset because it can shorten duration and decrease transmission, espically if

A

7; 6

tx. includes azithromycin, erythromycin, clarirothymic, and TMP-SMX

69
Q

T or F: Treat close contacts pending PCR and isolate the patient for 5 days after giving antibiotics or 21 days if no antibiotics

A

T

70
Q

laryngotracheitis or laryngotracheobronchitis typically effects ____m to ____y

A

Croup; 3m-3y

71
Q

Croup is _____; most common causes : Parainfluenza, adenovirus, RSV.

Leads to _____ and _____ of larynx and subglottic area & decreased mobility of the ______ ______

A

viral;

inflammation and infection; vocal chords

72
Q

Croup is ______, beginning with nasal irritation, coryza, and congestion. Generally progresses over ___ to ___ hours to include fever, _____, ___ cough, and stridor
Respiration distress ___ as upper airway obstruction becomes more severe.

A

gradual; 12-48; hoarseness, barking; increases

73
Q

Cough resolves in ___ days, other symptoms may persist for ____ and gradually return to normal

A

3; 7

- deviations in course suggest different diagnosis

74
Q

occasional barking cough, no stridor at rest, mild to no suprasternal retractions

A

Mild croup disease

75
Q

Moderate Croup disease:

A

____cough, ____audible stridor at __, and retractions _____

76
Q

Severe Croup presents as ____ cough, inspiratory/expiratory ______, retractions, cyanosis, lethargy, distress, and agitation

A

frequent; stridor

77
Q

Croup dx.

A

Clinical presentation, A/P neck x-ray will show subglottic _____ (steeple), CBC might show ______

78
Q

Croup management at home;

A

humidity, cool air mist, steam from bathroom, exposure to outdoor cool air, adequate hydration, fever reducation, and oral fluids

79
Q

Outpatient management of Croup;

A

Glucocorticoids: single dose of oral or IM dexamethasone (0.6mg/kg)
Prednisolone (2mg/kg per day for three days)

80
Q

Tell parents to seek medical attention:

A

Stridor at rest, difficulty breathing, pallor or cyanosis, suprasternal retractions, severe coughing spells, drooling, difficulty swallowing, fatigue, worsening course, fever >38.5 and prolonged symptoms greater than 7 days

81
Q

Severe Croup management

A

Send to ER; Nebulized Racemic epinephrine (NOT GIVEN OUTPATIENT), dexamethasone (+/- prednisolone for 3 days)

82
Q

Moderate/severe croup with persistent or deteriorating respiratory distress after treatment with racemic epinephrine and corticosteroids (In ER or office)
Severe croup with poor air entry, altered consciousness, or impending respiratory failure
Dehydration
Significant respiratory compromise
Signs of respiratory failure
”Toxic” appearance or clinical picture suggesting serious secondary bacterial infection
Need for supplemental oxygen
Severe dehydration

A

Hospitalization Indications

83
Q

____ is an acute inflammation of the ___, cartilaginous structure covered with mucous membrane, and pharyngeal structures

A

epiglottitis; epiglottis

84
Q

Epiglottitis affects kids _ through __ and is caused by ____, S. pneumoniae, H parainfluenzae, S. aureus, and beta hemolytic streptococci

A

2-7; HIB

85
Q

Epiglottitis Manifestations: There is a tyriad of ____, dysphagia,____; also high ___, ___positioning, dyspnea, inspiratory stridor, accessory muscle use, ____ voice, and ___ cough

A

drooling; distress/ high fever; tripod positioning; muffled; brassy

CALL 911

86
Q

Epiglottitis Dx.

A

Lateral neck is enlarged, edematous epiglottis, Laryngoscopy (direct inspection of epiglottis under controlled circumstances), leukocytosis, and + blood cultures for staph/strep.

87
Q

Epiglottits management

A

ER HOSPITALIZATION
-Secure airway with intubation or cricothyroidotomy, sit child upright, humidifed oxygen, no tongue blades, IV antibiotics (ROCEPHIN)

88
Q

If a child is younger than 5, they cannot have a ___ infection

A

sinus

Pediatric Heart (3 decks)

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