CLIPP 12

Question 1

can kids without asthma have wheezing with cold sx?is wheezing always associated with asthma?

Answer 1

yes - but may be more likely to develop asthma later on, no

Question 2

3 characteristics of astham

Answer 2

airway inflammation, mucus hypersecretion, reversible airflow obstruction due to revesible bronchoconstriciton

Question 3

asthma sx in kids

Answer 3

often wheezing or coughing responsive to beta-agonists (bronchodilators) and steroids

Question 4

peds asthma dx

Answer 4

A child with symptoms of asthma who responds to therapy for asthma and has no other identifiable cause for wheezing has asthma by definition, regardless of age.

Question 5

RAD vs asthma

Answer 5

many kids w wheezing early in life don’t wheeze beyond age 2-3yo so docs call them RAD bc they don’t want to stick them w/ an asthma dx for life if they have hyperresosibness of asthma but not quite definite asthma. controversial.

Question 6

normal 10 month old RR

Answer 6

30

Question 7

how can blood gas be used in asthma

Answer 7

As a child begins to tire and can no longer maintain adequate ventilation, the PCO2 may normalize and even become elevated despite continued normal oxygenation.
Thus, blood gas analysis can be helpful in distinguishing compensated from uncompensated asthma, and in predicting impending respiratory failure.

Question 8

5 signs of resp distress

Answer 8

head bobbing, nasal flaring, grunting, retractions, paradoxical breathing

Question 9

head bobbing

Answer 9

pt head bobs up and down due to accessory muscle use

Question 10

nasal flaring

Answer 10

nares enlarge in inspiration to try to increase air entry

Question 11

gruntign

Answer 11

glottis closes w/ expiration, helps infants generate positive pressure to stent airways open

Question 12

retractions

Answer 12

inspiratory depression of soft tissue in relation to cartilaginous or bony thorax

Question 13

paradoxical breathing

Answer 13

asynchrony of chest and abdominal wall motion during respiration (chest wall draws in during inspiration instead of moving outward with the same motion as the abdominal wall)

Question 14

clue to worst resp distress

Answer 14

paradoxical breahting - force of diaphragm exceeds ability of chest wall muscles to expand in inspiration

Question 15

important connection between resp muscle fatigue and resp distress

Answer 15

respiratory muscle fatigue will reduce the signs of respiratory distress even though a patient’s condition is in fact deteriorating.

Question 16

hypopnea vs hyperpnea

Answer 16

hyper - increased depth, that, if occurring in situation w/o resp distress , could imply things like non pulmonary like acidosis , fever or panic attack
hypopnea - less TV thus can result in hypo vent regardless of RR

Question 17

tx of resp distress in hypoxemic pt who depends on hypoxemia to stim resp drive

Answer 17

still give o2, but only as much as they need for maintaining reasonable saturation, and monitor

Question 18

4 of most common and 3 less common causes ofcough/wheezing in kid

Answer 18

bronchiolitis, asthma, fb, gerd

tachomalasia, extrinsic compression like vascular ring, CF

Question 19

wet vs dry coufh

Answer 19

wet -bronchiectasis, viral, post nasal drip, gerd

dry - chonic ashtmia

Question 20

cough with liquids

Answer 20

suggests aspiration

Question 21

dysphagia w liquid/solid

Answer 21

narrowing of posterior oropharyx or esophagus

Question 22

barky cough

Answer 22

croup - laryngeotrachoebronchitis due to virus most often parainfluenza that starts w/ vague uri sx and progresses to some degree of airway obstruction and inspiratory stridor.

Question 23

wheeze vs stridor

Answer 23

stridor most likely to be inspiratory while wheeze often expiatory but if severe, can have both in either
-strdor mor likely in croup

Question 24

what resp disorder are partially or non immunized kids more prone to

Answer 24

pertussis

Question 25

pertussis course and complications and vaccine efficacy

Answer 25

catarrhal: 1-2 weeks, uri sx paroxysmal: 4-6 weeks, forceful whooping cough tho infants don't get whoop due to relatively weaker inspiratory effort resolution/convalescent stage: episodic cough can peristn for months but overall severity/freq drops -efficacy is 70-90%, immunity wanes so get reimmunzied as teen

Question 26

something to consider in pt w/ chronic cough or hard to control astham

Answer 26

secondhand smoke exposure

Question 27

2 key findings in epiglottitis presentation

Answer 27

severe rsep distress and stirodr

Question 28

typically when does chlamryida teach. passed down from mother present in baby

Answer 28

within first 6 months

Question 29

course that wheezing can take

Answer 29

initally w expiratation, then biphasis, then can disappear if obstruct nsevere

Question 30

poly vs monophonic wheeze

Answer 30

Polyphonic wheeze is characterized by multiple pitches and is typical of asthma; monophonic wheeze is characterized by only a single pitch and is typical of focal airway obstruction.

Question 31

rhonchi

Answer 31

Coarse, low-pitched rattling sounds heard best in expiration. . Rhonchi are coarse, low-pitched, rattling sounds due to secretions and airway narrowing and are typically heard in the setting of bronchitis or pneumonia. Thought to be due to secretions and narrowing of airways

Question 32

crackles

Answer 32

Finer breath sounds heard on inspiration. Associated with either fluid in the alveoli or with opening and closing of stiff alveoli (as in interstitial disease). Sometimes described as either coarse or fine. (Coarse crackles are usually thought to be associated with purulent secretions in the alveoli as with pneumonia; fine crackles are often associated with pulmonary edema or interstitial lung disease.

Question 33

air entry

Answer 33

The amount of air entry should be noted during every lung exam. Decreased air entry can be a sign of consolidation, atelectasis, pneumothorax, pleural effusion or airway obstruction.

Question 34

Bronchial breath sounds

Answer 34

Lower in pitch and more hollow-sounding than normal breath sounds. Caused by air moving through areas of consolidated lung.

Question 35

asymmetric breath sounds, cogh, tachypneia, and focal (one sided) wheeze esp w/o fever

Answer 35

consider FB aspiration

Question 36

good initial tests in FB aspiration wrokup

Answer 36

pa and lateral cxr and bilat decubitus or inspir/expir films -for bilat decubitus, look for asymmetric deflation of dependent lung -both should deflate but if one doesn't, suggest obstruction. for expire/inspir films, loo for asymm expiration deflation

Question 37

rigid vs flex bronhc

Answer 37

rigid - only thru mouth , can examine large airways, forceps pass thru flex - mouth or nose, can look at more distal smaller airways, forceps don't pass

Question 38

most common cause of infant wheezing

Answer 38

bronchiolitis- bronchiolar obstruction due to edema, mucus, and cellular debris. Respiratory syncytial virus (RSV) is the most common cause, but other viruses such as influenza and parainfluenza may cause bronchiolitis as well.

Question 39

cxr bronchoiolitis

Answer 39

Chest radiographs may show hyperinflation, increased interstitial markings, peribronchial cuffing, and scattered atelectasis from bronchial obstruction.

Question 40

pneumonia is due to

Answer 40

inflammation of the lung parenchyma.

Question 41

most common cause of pneumonia in kids is

Answer 41

virual -adeno, rsv, parainflu, influ

Question 42

viral vs bacterial pneumonia on cxr

Answer 42

Findings of viral pneumonia on chest x-ray are variable and may show diffuse or patchy interstitial infiltrates, hyperinflation and small pleural effusions. Chest x-rays in bacterial pneumonia typically show air-space disease with lobar or segmental consolidation and air bronchograms.

Question 43

lab findings pna

Answer 43

viral pneumonia, peripheral white blood cell counts tend to be normal or only slightly elevated. Viral antigen testing of respiratory secretions may be helpful in making the diagnosis but is usually not necessary. In bacterial pneumonia, peripheral white blood cell counts are usually elevated and have a neutrophilic predominance.

Question 44

X-ray saying hyperinflation of L lung not right

Answer 44

FB in L lung

Question 45

causes of asymm wheeze

Answer 45

FB>>> or mucus plug from bronchiolitis or ashtam

Question 46

film findings in R sided FB obstruction

Answer 46

``` PA film (with the child in a sitting position): Right hemidiaphragm is flattened, suggesting unilateral hyperexpansion on the right. Right decubitus: With child on her right side, the mediastinal structures remain in the midline, rather than shifting towards the right lung due to gravity, further demonstrating the fixed hyperinflation of the right lung. Left decubitus: With child on her left side, the mediastinal structures shift towards the left lung as expected. ```

Question 47

xr findings in partial vs complete FB obstruction

Answer 47

parital = ball vale effect, hyperinflation of affected side | complete - atelecatasis or volume loss and elev of hemidiaphragm or mediastinal shift toward affected side

Question 48

what determines local tissue reaction to aspirated fb

Answer 48

compassion of the fb - fatty things cause more pneuonitis, batteries etc erode

Question 49

what concern is there after a fb aspiration (not the immediate life or death choking but after that)

Answer 49

pneumonai

Question 50

bordatella vs bartonella

Answer 50

cough vs cats!!

Question 51

conjunctival hemorrhages and pneumothoraces from the increased intrathoracic and intracranial pressures from Valsalva

Answer 51

seen in forceful whooping cough

Question 52

azithromycin, clarithromycin, and erythromycin

Answer 52

tx choices for whooping cough - given in P phase will not alter course but lowers transmissibility

Question 53

epiglttiss presntation

Answer 53

appear toxic and sit in the “sniffing position” (sitting, leaning forward, neck hyperextended, chin protruding). A “thumb sign