Lecture 10/29-Resp Flashcards
main organisms that causes croup
Parainfluenza virus
also RSV
main cause of epiglottitis
H. influenza
what sound is caused by an upper airway obstruction
stridor
what sound is due to fluid or atelectasis in small airways
crackles/ rales
what sound means fluid in big airways (low note)
Rhonchi
little alveoli are popping open
crackles
what are signs of work of breathing
grunting
retractions
seen more infants due to lack of fixed chest
mainstay for test for respiratory dz?
chest x-ray
used to see if there is a structure obstruction the trachea. Also good for trachealesophageal fistula (TEF), GER, vascular rings.
barium swallow
what helps to look for malacias, foreign bodies.
Laryngoscopy and bronchoscopy
test to look for RSV, influenza, parainfluenza.
Viral swab (panel)
what are 2 infections of the upper airway
Croup
Epiglottis
Structural problems with upper airway obstruction
Laryngomalacia subglottic stenosis (from intubation)
Functional problems with the upper airway
Vocal cord paralysis
some risk factors of upper airway problems
Difficult delivery ductal ligation (PDA) intubation foreign body infection
when in the year is croup common?
fall and early winter
what age group is croup common in
6 mo- 3 year
what presents with a prodrome URI followed by a barking cough and possibly a low grade fever
Croup
what will the xray with croup show?
subglottic narrowing and normal epiglottis
what testing do you do for croup?
Viral swab for respiratory virus
what sign do you see on x-ray with croup?
Steeple sign from laryngeal edema
subglottic narrowing
tx for croup
Supportive “go outside in cold air” vasoconstriction
Nebulizers (racemic epi neb)
dexamethasone
if a kid shows up in the ER with croup, what must they have achieved to be able to go home?
Not stridor at rest within 3 hours
not recurrent nebs needed (if so- hospitalize)
what viruses are in a viral panel?
Influenza A an B RSV human metapneumovirus parainfluenza 1,2,3 Adenovirus Strep pneumo
what is the invasion of bacteria into the mucosa of a patient with viral croup. Will have purulent secretions with high fever and severe obstruction.
Croup- Bacterial tracheitis
how do you tx croup- bacterial tracheitis
Hospitlization
Suctioning, hydration
IV ABX for staph aureus
probably intubated
Inspiratory stridor with sudden onset and drooling. Will be tripoding and flaring nares
Epiglottis
Tx for epiglotitis
emergency- need to intubate
what causes epiglotitis if someone is immunized (usually)
Group A Strep and Staph Aureus
What will the x-rays look like on epiglottitis?
Thumb sign on lateral x-ray (shows thickened tissue of epiglottitis)
Underdeveloped cartilaginous structures
Most common cause of stridor in infants
Laryngomalacia
when will a child usually outgrow laryngomalacia?
improves with age, resolves by 2 years of age
when is laryngomalacia worse?
Supine
Activity (feedings)
how do you diagnose laryngomalacia?
laryngoscopy and bronchoscopy
vessels coming off the heart are compressing the upper tracheal
vascular ring or sling
Congenital or from intubation
Mild to severe with serious obstruction of airway
Stridor after extubation
Suspect in Pt with recurrent croup
Subglottic stenosis
Tx for subglottitic stenosis?
Surgical correction- plasty
if there is a progressive wheeze what should you suspect?
CF
bronciolitis obliterans
What can be a lower or upper airway disorder?
tracheomalacia or vascular ring
how do you treat a severe tracheomalacia?
Tracheostomy
what are some txs for lower resp tract infections
beta adrenergic nebs
CPT
most common organisms for bronchiolitis?
RSV
Cough, coryza, rhinorrhea… over 3-7 days to noisy raspy breathing and audible wheeze
Bronchiolitis
what is the leading cause of hospitalization of infants?
bronchiolitis
when does RSV peak?
late winter from November to March
How do you dx RSV?
viral swab
what may the CXR show with bronchiolitis?
may be normal or show
peribronchial cuffing
increased intestitial markings
hyperinflation
what is the monoclonal antibody given every month to help prevent at risk infants?
Synagis (palivizumab)
symptoms in infants are fever, prominent runny nose, and congestion, coupled with wheezing. Duration of 1-2 weeks
RSV
are viral or bacterial pneumonias more common in children?
Viral
What is the most common bacterial pneumonia
Strep pneumo
what are atypicals that cause pneumonia?
Mycoplasma pneumonia
chlamydial pneumonia
URI prodrome + wheezing and stridor +/-fever
Myalgia, malaise, headache
Viral pneumonia
what causes viral pneumonia?
RSV
parainfluenza
influenza A and B
Human metapneumovirus
what will you see on CXR with viral pneumonia?
Perihilar streaking
increased interstitial markings or patchy bronchopneumonia
what virus can cause necrotizing pneumonia?
Adenovirus
what will there be an elevation of (cell wise) with viral pneumonia?
lymphocytes
Tx for viral pneumonia?
Supportive
hospital at risk patients (asthma, RSV, CHD)
Present with Fever, chills, cough, dyspnea. Rales or decreased breath sounds
bacterial pnuemonia
what cells will be elevated for bacterial pneumonia?
neutrophils
tx for bacterial pneumonia?
Amoxicillin
augmentin
erythromycin
cerfuroxime
when does bacterial pneumonia occur (season)?
anytime of year
when are viral pneumonias more common (season)
fall and winter
More common causes of pneumonia in ages 1-5?
RSV in infants
Parainfluenza viruses
influenza viruses
adenoviruses
Most common causes of pneumonia >5 years?
Mycoplasma pneumoniae
streptococcus penumoniae
most common cause of bacteria for pneumonia in kids >5?
mycoplasma pneumoniae
how do you tx mycoplasma pneumoniae?
Erythromycin
in teenagers what is almost always the cause of pneumonia?
Mycoplasma penumoniae
what 2 immuniztions have helped prevent penumonia in children?
Prevnar (PCV13)
Hib
What organism causes pertussis?
Bordetella pertusis
peak age for pertussis?
<4 months of age
When is pertussis immunized?
2, 4, 6, 12-15 moths and 4-6 years
when does pertussis peak?
July-October (via cough)
3 stages of pertussis?
Catarrhal
Paroxysmal
Convalescent
what stage is a URI 1-2 weeks for pertussis?
Catarrhal
what is the stage of pertussis that is a dry cough 1-2 weeks?
Convalescent
what is the stage of pertussis with Staccato cough with inspiratory whoop and post tussive vomiting 2-4 weeks
paroxysmal
how do you dx pertussis?
NP swab
tx for pertussis?
Erythromycin /azithromycin
who else should you tx if someone is infected with pertussis?
family members
Adolescents present with prolonged bronchitis, persistent non-productive cough – often begins as a URI.
Don’t whoop but may have paroxysms
Cough can last weeks to months
Pertussis
chronic progressive disease that can present with protein and fat malabsorption (failure to thrive, hypoalbuminemia, steatorrhea), liver disease (cholestatic jaundice), or chronic respiratory infection
Cystic fibrosis
dx of CF
sweat test (elevated sweat chloride >60 mEq/L)
what will you find on PE of a CF patient?
digital clubbing
chronic sinusitis
nasal polyposis
tx for CF
manage infections
pancreatic enzyme replacement
ADEK vitamins
what may an infant present with that suggest CF?
meconium ileus
non functioning pulmonary tissue that does not communicate with tracheobronchial tree. Blood supply from anomalous blood supply
Pulmonary Sequestration
decreased in alveolar number and airways
Pulmonary hypoplasia
what can cause pulmonary hypoplasia?
diagphramtic hernia
achondroplasia
Congenital cystic lung dz. have large airspaces.
CCAM (Congenital Cystic Adenomatoid Malformation)
tx for CCAM and pulmonary sequestration
remove the defective part of the lung
elevation of part or all of diaphragm
diaphragm muscle is weak and stretched up
Enventration
depression of sternum/ anterior chest wall
Pectus Excavatum
protrusion of sternum/ anterior chest wall – more common in males,
Pectus Carinatum
what alveolar cells form the structure of an alveolar wall
Type I cells
What alveolar cells secrete surfactant?
Type II cells
Due to a surfactant deficiency
Respiratory Distress Syndrome (RDS)
what is another term for RDS?
bronchopulmonary dysplasia
what are infants with RDS at risk for?
pulmonary HTN
reactive airway dz
chronic lung dz is considered when an infant needs oxygen when?
at 28 days
What is an ALTE?
Apparent LIfe Threatening Events in infancy
what are some ALTEs?
apnea color change decreased muscle tone emesis choking gagging
when doe most deaths with SIDS occur?
2-4 months and between midnight and 8 am in winter
What is SIDS?
Sudden Death of infant < 1yr old that remains unexplained
what is the risks for SIDS?
male low birth weight smoking teen mom drug addicted mom
