CLIPP 13 Flashcards
chronic cough in kids duration
> 4 w
6 yo RR
12-20
acute complaints is what hour timeframe
<72h, and likely d/t infection or precipitating event like trauma
dry cough
environmental irritant, asthma, fungal infection
barking cough
croup, subglottic disease or foreign body
brassy or honky cough
habitual cough, tracheitis
paroxysmal cough
pertussis, Chlamydia, mycoplasma, foreign body
worse at night cough
asthma, sinusitis, allergies - can result in post nasal drip–>nocturnal cough
cough disappears at night
habitual cough
cough w/ gag or choke
gastroesophageal reflux
what can lobar pna in lower quadrants mimic
APPY
dysphonia or hoarseness could be due to
laryngeal irrutaiton due to gerd orchronic rhintiis
serious condition presenting w wheeze and cough that mimics asthma or bornchitis
infectious myocarditits
headaches plus a cough
sinusitis often
heritable cough things
ashtma, immunodef, cf
a dx to consider w/ male sterility
primary ciliary dyskinesia
sx and radiology findings in peds pulm tb
sx are few to none compared to radiology findings which include a primary complex (large size of hilar LAD) with sequence going from hilar LAD to hyperinflation and atelectasis
PPD TST test positivity markers
A test is considered positive if it is: > 5 mm in high-risk children, > 10 mm in moderate-risk children and > 15 mm in low-risk children.
common asthma trigger
URI
peds bronchitis findigns and tx
sputum production, cough equal at day and ngith with no change in sx based on night or cold air or workout
-does not require abx tx
atypical pna presenation
cough can persist for 8-12weeks, worse in cold air/workout, , URI sx, abnl breath sounds,
habit cough
A habit cough is caused by habitual perpetuation of cough begun with a viral upper respiratory infection.
Continued coughing irritates the airway further, leading to a stronger stimulation to cough.
The cough is typically very loud, short, dry, brassy and spasmodic.
A habit cough is unchanged by exercise or cold air and classically resolves during sleep.
what is one of the most important distinguishing characteristics of a sinusitits
persisting ssx w/o improvement as viral URI tends to improve over the course of a week or so.
pale edematous turbinates aka and seen in
boggy, nasal allergies , can be concurrent w/ sinusitis
cobblestoning is
lymphoid hyperplasia of posterior pharynx due to chronic PND and most often seen in kids w/ chronic allergic rhinitis
in which types of pt are nasal polyps often seen
cf, astham, aspirin sensitive
3 criterion in dx sinusitis
Persistence of bilateral nasal discharge of any quality or daytime cough, or both, lasting for more than 10 days without significant improvement (unilateral symptoms suggest a nasal foreign body), OR
Worsening after initial improvement (“double-sickening”) OR
High fever and purulent nasal discharge for more than 3 days.
1st line tx for sinusitis
amox w or w/o clav
wheezing is the sound of
airflow thru narrow airways
accessory muscles of respiration
inspiratory contraction of SCM at rest = severe resp distress
hyperrres vs dullness
hyper = air dull = lobar consolidatin or atelec
egophany
ee–>ay sound, due to lobar consolidation aka airless lung
I:E ratio
full inspiration time to full expiration time, normally 1:2, or 1:# but in obstruction, expiration is prolonged thus ratio down
2 ways in which crackles and ronchi differ
crackles inspiratory, discontinuous
ronchi expiratory, continous
ronchi due to
mucous, secretion in airway
atopy defn and causes
Atopy is defined as the genetic predisposition for the development of an IgE-mediated response to common aeroallergens, leading to the development of allergic rhinitis, asthma, and atopic dermatitis (eczema).
- due to genetics and environ
the 3 most common indoor aeroallergens that sensitize people are
house dust mites, animal dander, cockroaches
most specific way of determine presence or absence of reversible airway obstruction
spirometry before and after bronchodil therapy if at least 5-6yo
Bronchoprovocation with methacholine, histamine or exercise challenge
reserved for pts w normalish spiro but still suspected ashtam
overreliance on SABA
using 1 cannister/motnh even if not using it every day
pathophysi of asthma
biphasis
- lasts 1 h - allergen triggers, mast cells and eos release PG and leukotirenes –>permeability, hyper secretion, bronchoconstriction
- 2-3h later - worst by 4-8h, resolves by 24h, neuts eos lymphocyte infiltratio–>hyperplaia of bronchial smooth musc
common ics in asthma and what to monitor for
budesonide, beclamethasone, fluticasone - monitor for htn, growth delay, glucose, cataracts
who should be on ICS
any pt w/ persistent asthma - mild , mod , or severe
In well controlled asthma, SABA should not be required more than __ x per week
2
what is cromolyn sodium
an inhaled NSAID
who is at rsk for severe varicella infection
kids on inhaled or systemic steroid
PF meter
air exhaled in L/s, is effort dependent so poor effort = poor # and poor results
exercise induced brochospoasm
haracterized by severe bouts of bronchospasm triggered only by exercise or cold air; may also be a marker for poorly controlled asthma.
cough variant ashtam
presents only w/ cough
non productive nocturnal cough
cough variant asthma is one possib
AAP based on
daily sx and peak flow readings
f/u intervals for asthma
q2-6 weeks til asthma is stabile then 1-6 month intervalsq
most approp way to use peak flow
use kids personal best -avg of 14 days of values when control is good
what is peak flow not good for
dx - use oft isntead
intermitent astham
fewer than 2 d/week or 2 NIGHTS/month
moderate astham
dialy sx w/more than one NIGHT/week
mild persis astham
3-6d/w and 3-4NIGHTS/month
