Lecture 5 Respiratory HEENT

Question 1

infant respiratory system

Answer 1

obligate nose breathers
shorter trachea
immature lungs
immature respiratory muscles = belly breathing

Question 2

infant trachea

Answer 2

• diameter triples between birth and 3 years

Question 3

effects of short infant trachea

Answer 3

• less warming and humidifying of air
• easier for microbes to access lungs

Question 4

alveoli maturation

Answer 4

• mature around 8-9 years
• 9x more alveoli in late childhood than at birth

Question 5

lung maturation

Answer 5

lungs are fully mature at 20-25 years

Question 6

why do children have more respirations per minute than adults?

Answer 6

• children need to breathe more often to meet metabolic demands
• children have higher proportion of anatomical dead space than adults

Question 7

infant thorax

Answer 7

• rounder than adults
• more cartilaginous and pliable
• faster respiratory rate

Question 8

optimal positioning for pediatric airway

Answer 8

rolled towel under shoulder to counter neck flexion because babies have big heads

Question 9

physical respiratory exam

Answer 9

• lung auscultation
• nasal flaring
• grunting
• retractions
• respiratory rate
• skin assessment

Question 10

where do retractions occur?

Answer 10

• intercostal
• suprasternal
• clavicular
• subcostal

Question 11

what vaccines lower risk for respiratory infection?

Answer 11

• Hib
• Influenza
• Measles
• Pertussis
• Pneumococcus
• Varicella

Question 12

how many respiratory infections is normal for child attending daycare?

Answer 12

6-8 per year

Question 13

How common is upper respiratory tract infection for infants?

Answer 13

can have 10 per season, may be followed by otitis media

Question 14

lower airway infections

Answer 14

RSV (bronchiolitis)
Pneumonia (Viral or Bacterial)
Aspiration Pneumonia

Question 15

How should pneumonia be diagnosed?

Answer 15

Chest x-ray

Question 16

Bacterial Pneumonia

Answer 16

More severe
Fever
Rapid and shallow breathing
Chest pain
Crackles

Question 17

Viral pneumonia

Answer 17

Follows viral URI
Less severe
Low fever
Malaise
Non-productive cough
wheeze and crackles on auscultation

Question 18

Croup

Answer 18

• swelling and edema constricting the larynx
• barking cough
• inspiratory stridor
• common for 6mo-3yo
  can be caused by parainfluenza, flu, RSV

Question 19

Epiglottitis

Answer 19

• Mostly caused by Hib
• Stridor
• Dysphagia
• Drooling
• High fever
• Tripod positioning

Question 20

Otitis Media

Answer 20

• after recurrent respiratory infections
• most often 6 mo - 2 yr
• eustachian tube more horizontal and difficult to drain
• pain control and antibiotics

Question 21

pneumothorax

Answer 21

• air in between the pleura
• traumatic or spontaneous

Question 22

what populations get pneumothorax more often?

Answer 22

• more common in male children
• more common in tall thin young adults

Question 23

pneumothorax presentation

Answer 23

• chest pain
• diminished breath sounds on affected side
• hyper resonant percussion
• tachypnea
• cyanosis

Question 24

Pertussis

Answer 24

cough lasting 6 - 10 weeks

Question 25

pertussis complications

Answer 25

- vomiting from coughing so hard - sleep apnea <6 months - contagious for 2 weeks after coughing begins

Question 26

pertussis treatment

Answer 26

- nasopharyngeal swab - antibiotics ASAP - 50% of infants hospitalized for supportive care

Question 27

catarrhal stage of pertussis

Answer 27

7-10 days rhinitis, low fever, mild cough

Question 28

paroxysmal stage of pertussis

Answer 28

1-6 weeks persistent cough, cyanosis, vomiting, exhaustion

Question 29

convalescent stage of pertussis

Answer 29

7-10 days less persistent cough

Question 30

influenza s/sx

Answer 30

high fever headache chills cough sore throat muscle pain fatigue

Question 31

influenza vaccine age

Answer 31

6 months and older

Question 32

tamiflu

Answer 32

given within 2 days of symptom onset or exposure

Question 33

Preventing spread of RSV

Answer 33

droplet and contact precautions hand washing

Question 34

RSV pathophysiology

Answer 34

- Replicates in nasopharynx - infects epithelium of bronchioles and alveoli

Question 35

RSV clinical manifestations

Answer 35

fever cough tachypnea retractions wheezing crackles

Question 36

RSV treatment

Answer 36

oxygen fluids ventilation immunoglobulin

Question 37

what age group gets strep the most?

Answer 37

5-15 years

Question 38

strep throat timeline

Answer 38

2-5 day incubation 3-5 day duration

Question 39

clinical manifestations of strep throat

Answer 39

sudden sore throat fever and chills abdominal pain loss of appetite headache N/V swollen

Question 40

strep throat pathophysiology

Answer 40

group a strep colonizes epithelial cells of the throat and skin, cause inflammatory response

Question 41

physical exam strep throat

Answer 41

red swollen tonsils white patches on tonsils petechiae on palate swollen lymph nodes

Question 42

strep throat test

Answer 42

rapid test - 15 minutes throat culture - 2 days

Question 43

treatment for strep throat

Answer 43

- penicillin - erythromycin for people with penicillin allergies - 10 days of antibiotics - no longer contagious after 24 hours with treatment

Question 44

patient education for strep throat

Answer 44

- throw away toothbrushes - continue antibiotics for full course

Question 45

complications of strep throat

Answer 45

- rheumatic fever - scarlet fever - abscesses of the tonsils, throat - otitis media - post strep glomerulonephritis