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PEDS 7500 > CLIPP 12 > Flashcards

CLIPP 12 Flashcards

1
Q

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

A

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

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2
Q

3 characteristics of astham

A

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

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3
Q

asthma sx in kids

A

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

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4
Q

peds asthma dx

A

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.

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5
Q

RAD vs asthma

A

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.

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6
Q

normal 10 month old RR

A

30

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7
Q

how can blood gas be used in asthma

A

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.

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8
Q

5 signs of resp distress

A

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

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9
Q

head bobbing

A

pt head bobs up and down due to accessory muscle use

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10
Q

nasal flaring

A

nares enlarge in inspiration to try to increase air entry

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11
Q

gruntign

A

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

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12
Q

retractions

A

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

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13
Q

paradoxical breathing

A

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)

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14
Q

clue to worst resp distress

A

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

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15
Q

important connection between resp muscle fatigue and resp distress

A

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

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16
Q

hypopnea vs hyperpnea

A

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

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17
Q

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

A

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

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18
Q

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

A

bronchiolitis, asthma, fb, gerd

tachomalasia, extrinsic compression like vascular ring, CF

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19
Q

wet vs dry coufh

A

wet -bronchiectasis, viral, post nasal drip, gerd

dry - chonic ashtmia

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20
Q

cough with liquids

A

suggests aspiration

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21
Q

dysphagia w liquid/solid

A

narrowing of posterior oropharyx or esophagus

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22
Q

barky cough

A

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.

23
Q

wheeze vs stridor

A

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

24
Q

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

A

pertussis

25
Q

pertussis course and complications and vaccine efficacy

A

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

26
Q

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

A

secondhand smoke exposure

27
Q

2 key findings in epiglottitis presentation

A

severe rsep distress and stirodr

28
Q

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

A

within first 6 months

29
Q

course that wheezing can take

A

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

30
Q

poly vs monophonic wheeze

A

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.

31
Q

rhonchi

A

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

32
Q

crackles

A

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.

33
Q

air entry

A

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.

34
Q

Bronchial breath sounds

A

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

35
Q

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

A

consider FB aspiration

36
Q

good initial tests in FB aspiration wrokup

A

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

37
Q

rigid vs flex bronhc

A

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

38
Q

most common cause of infant wheezing

A

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.

39
Q

cxr bronchoiolitis

A

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

40
Q

pneumonia is due to

A

inflammation of the lung parenchyma.

41
Q

most common cause of pneumonia in kids is

A

virual -adeno, rsv, parainflu, influ

42
Q

viral vs bacterial pneumonia on cxr

A

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.

43
Q

lab findings pna

A

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.

44
Q

X-ray saying hyperinflation of L lung not right

A

FB in L lung

45
Q

causes of asymm wheeze

A

FB»> or mucus plug from bronchiolitis or ashtam

46
Q

film findings in R sided FB obstruction

A 
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.
47
Q

xr findings in partial vs complete FB obstruction

A

parital = ball vale effect, hyperinflation of affected side

complete - atelecatasis or volume loss and elev of hemidiaphragm or mediastinal shift toward affected side

48
Q

what determines local tissue reaction to aspirated fb

A

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

49
Q

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

A

pneumonai

50
Q

bordatella vs bartonella

A

cough vs cats!!

51
Q

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

A

seen in forceful whooping cough

52
Q

azithromycin, clarithromycin, and erythromycin

A

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

53
Q

epiglttiss presntation

A

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

PEDS 7500 (32 decks)

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