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EOR Pediatrics > Chapter 8: Pulmonology > Flashcards

Chapter 8: Pulmonology Flashcards

1
Q

Most common cause of congenital stridor

A

Laryngomalacia

large floppy epiglottis or floppy arytenoid cartilages

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2
Q

Tx of Laryngomalacia

A

usually resolves w/ growth over the first 1-3 years

-most only need to be followed

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3
Q

Children who present in first year w/ persistent stridor and or hoarseness most likely have?

A

Vocal Cord paralysis or laryngeal papillomatosis

-most only need to be followed

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4
Q

Presentation of OSA

A
  • restless sleep with frequent position changes
  • irregular snoring
  • daytime somnolence
  • poor growth
  • behavioral problems
  • enuresis
  • poor academic performance
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5
Q

Study of choice for OSA

A

polysomnography

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6
Q

Tx of OSA

A

First: try to normalize airway anatomy by removing enlarged tonsils and/or adenoids (if indicated)
If that doesn’t work: CPAP is indicated

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7
Q

Two major LOWER airway obstructive diseases in childhood

A

1) Asthma
2) Cystic Fibrosis
3) Primary ciliary dyskinesia (rare)
* *most patients with asthma wheeze but not all patients who wheeze have asthma**

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8
Q

Risk Factors for Asthma

A
  • genetic predisposition
  • atopy
  • cigarette smoke exposure
  • living in urban areas in poverty
  • African American race
  • Puerto Rican ethnicity
  • Upper respiratory tract infections w/ certain viruses (rhinovirus, RSV) at critical times in early life
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9
Q

What is cough variant asthma?

A

Relatively uncommon

  • produces a chronic cough that may be triggered by exercise or noted primarily at night during sleep
  • wheezing may or may not be present
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10
Q

Patients w/ persistent asthma should have PFTs how often?

A

at least once a year

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11
Q

What do baseline CXR look like in asthma?

A

Mild hyperinflation and/or increased bronchial markings

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12
Q

Obstructive PFTs =

A

find it

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13
Q

Restrictive PFTs=

A

find it

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14
Q

Mainstays of medical treatment of asthma

A
  • inhaled corticosteroids
  • leukotriene receptor antagonists
  • short acting B2 agonists
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15
Q

What is tx of exercise induced asthma?

A

-use SABA 5-20 minutes before vigorous activity

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16
Q

Most effective treatment for chronic asthma?

A

Inhaled corticosteroid treatment

17
Q

Theophylline

A

has fallen out of favor as a first line treatment option

18
Q

Patients >12 w/ severe allergic asthma that remains poorly controlled with use of inhaled corticosteroids and leukotriene receptor antagonists and LABS may benefit from treatment w/?

A

-Omalizumab an injectable monoclonal antibody directed against IgE
(expensive; must be given q2-4 wks)

19
Q

Other tx for severe obstruction

A
  • Ipratropium (anticholinergic)
  • SubQ epinephrine
  • Terbutaline
20
Q

Factors that increase risk of death from asthma

A
  • noncompliance
  • poor recognition of symptoms
  • delay in treatment
  • history of intubation
  • AA race
  • steroid dependence
21
Q

Pathogenesis of Cystic Fibrosis

A
  • autosomal recessively inherited multi system disease characterized by disordered exocrine gland function
  • *most common in caucasians 1/3500**
  • average life expectancy is mid to late 30s
22
Q

Nasal polyps

A

should prompt further testing for CF

23
Q

What bugs usually colonize patients w/ CF?

A

Early childhood = s. aureus and h. influx
Later = p. aeruginosa (90% acquire and it is rarely eradicated)
Particularly ominous = burkholderia cepacia (accelerated pulmonary deterioration and early death)

24
Q

Most common manifestation of untreated CF in infants and children

A

failure to thrive

25
Q

Meconium ileus is pathognomonic for

A 
Cystic fibrosis
(neonatal intestinal obstruction in the absence of anatomic abnormalities)
26
Q

Classic diagnostic findings of CF

A
  • elevated sweat chloride concnetration
  • pancreatic insufficiency
  • chronic pulmonary disease
27
Q

Initial diagnostic study of choice

A

-sweat chloride test

level >60 is is generally considered abnormal

28
Q

Tx of CF

A

1) most fundamental = maintain effective airway clearance
-chest PT, vigorous exercise, frequent couging
-Recominbinant human deoxyribonuclease admin via neb breaks down thick complexes
-Alternate months of inhaled tobramycin maybe indicated for patient infected w/ Pseudomonas
(frequently bacterial infections have to be treated w/ IV abx)
2) Maintain Near normal growth
-Pancreatic enzyme replacement
-fat soluble vitamin replacement
-high calorie/high protein diets
(maintenance above 25th%ile = best prognosis)
3) may develop insulin deficiency

29
Q

Complications of CF

A

1) Hemopthysis

2) Spontaneous Pneumothorax

30
Q

Primary ciliary dyskinesia

A

-symptoms are similar to CF or asthma
-Dx is made by demonstration of abnormal ciliary beat under light microscopy or characteristic US changes in samples of ciliated cells obtained from scrapings of the nasal or bronchial epithelium
TX: similar to the pulmonary tx of CF but not same risk of p.aeuroginosa infection

31
Q

Tracheomalacia presentation

A

(common cause of expiratory airway obstruction)
-si-widening of posterior membranous portion of the trachea w/ dynamic collapse during exhalation (severe) or forced expiration (less severe)
HARSH, BRASSY, CROUPY COUGH (often misdiagnosed as having recurrent croup)

32
Q

What makes you think tracheomalacia vs asthma?

A
  • *wheezing of tracheomalacia is made worse by bronchodilator**
  • often misdiagnosed as severe asthma
33
Q

Tx of tracheomalacia

A

most require no intervention

-there are surgical procedures to help some children

34
Q

List some examples of restrictive lung disease

A
  • pectus excavatum
  • pectus carinatum
  • severe scoliosis
  • marked obesity
  • any lesion that occupies intrathoracic space
  • pulmonary hemosiderosis
35
Q

Symptoms of restrictive lung disease

A
  • exercise intolerance
  • tachypnea
  • eventual dyspnea
36
Q

Define apnea

A

cessation of breathing for longer than 20 seconds or pauses of any duration tha are associated w/ color changes, hypotonia, decreased responsiveness or bradycardia

37
Q

Apnea is: diagnosis or sign?

A

Sign that is potentially dangerous that requires aggressive evaluation to define the underlying cause

38
Q

What is ALTE?

A

Apparent life threatening event

  • this is how apnea may come to medical attention
  • cause is not found in about 50%
  • when no treatable cause is found infant may be placed on a him monitor that senses chest movement, heart rate and sounds alarm when child may be apneic or bradycardic
39
Q

Apnea and SIDS

A

Apnea of infancy does not increase the risk of an infant dying from SIDS.
this may be why home monitors have never been proven to decrease the likelihood of SIDS

EOR Pediatrics (16 decks)

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