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Peds Exam 2 > Lecture 7 - Pulmonary > Flashcards

Lecture 7 - Pulmonary Flashcards

1
Q

Bronchiolitis

A

Viral etiology: RSV, influenza, parainfluenza, metapneumovirus

Presentation: 
apnea (especially <4 months of age) 
copious rhionrrhea
cough/wheeze 
\+/- fever

Dx: does NOT require Xray
specific cause can be confirmed by antigen detection testing or PCR
RSV is MC

Tx: supportive care

  • nasal suctioning, hydration, sup O2
  • trial of B2 agonist or recemic epi
  • nebulized 3% hypertonic saline

Why screen for RSV? avoid unnecessary ABX use

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2
Q

What are the pathogens causing bronchiolitis?

A

Viral etiology: RSV, influenza, parainfluenza, metapneumovirus

RSV MC cause

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3
Q

What is the clinical presentation of bronchiolitis?

A

apnea (especially <4 months of age)
copious rhionrrhea
cough/wheeze
+/- fever

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4
Q

How do you dx bronchiolitis?

A

does NOT require Xray
specific cause can be confirmed by antigen detection testing or PCR
RSV is MC

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5
Q

What is the treatment of bronchiolitis?

A

supportive care

  • nasal suctioning, hydration, sup O2
  • trial of B2 agonist or recemic epi
  • nebulized 3% hypertonic saline

Why screen for RSV? avoid unnecessary ABX use

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6
Q

Sequelae of bronchiolitis?

A

obstruction of upper.lower airways can lead to respiratory failure in infants
higher risk in premature and younger infants
can be mitigated with monthly palivizumab (Synagis)

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7
Q

When do pts with bronchiolitis need to be hospitalized?

A

presents with apnea
unable to maintain oral intake
hypoxemia (<90%)
concern for impending respiratory failure

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8
Q

What is the RSV prophylaxis?

A

palivizumab (synagis)

IgG monoclonal antibody

administered monthly during RSV season

Recommended:
infants born <29 weeks gestation, younger than 12 months at onset of RSV season

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9
Q

Who gets Palvizumab?

A

Synagis
RSV prophylaxis

Recommended:
infants born <29 weeks gestation, younger than 12 months at onset of RSV season

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10
Q

Impending Respiratory Failure in Infants can be caused by?

A

upper or lower airway obstruction
sepsis
hypotonia

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11
Q

How do pts with impending respiratory failure in infants present?

A

increased accessory muscle use
inability to coordinate feeding
decreased arousability
hypoxemia/hypercarbia

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12
Q

Pertussis clinical presentation

A

incubation period 7-10 days

stages:
- catarrhal: cough and rhinorrhea (1-2 weeks)
- paroxysmal: paraoxysms, inspiratory whoop, post-tussive emesis (2-8 weeks)
- convalescent: gradual waning of sxs (weeks to months)

fever generally absent

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13
Q

What are the stages of pertussis?

A
  • catarrhal: cough and rhinorrhea (1-2 weeks)
  • paroxysmal: paraoxysms, inspiratory whoop, post-tussive emesis (2-8 weeks)
  • convalescent: gradual waning of sxs (weeks to months)
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14
Q

How do you dx pertussis?

A

PCR
Culture
DFA - direct fluorescent antibody)
Serology

Clinically:
-paroxysmal cough, post tussive emesis, whoop

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15
Q

What is the treatment for pertussis?

A

Macrolides
-azithromycin (5 days)
Alternative: erythromycin (14 days), clarithromycin (7days), TMP-SMX (14 days)

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16
Q

During which phase of pertussis, if treated with a macrolide, will ameliorate the cough?

A

catarrhal

17
Q

What are some potential complications of pertussis?

A 
hospitalization 
apnea
PNA
seizure 
death
18
Q

What/who is the most common source of infection of pertussis?

A

sibling

followed by mother

19
Q

What is the first sign of PNA in infants?

A

apnea

20
Q

How do neonates with PNA present?

A

fever or hypoxia only

21
Q

How do children with PNA present?

A 
fever 
chills
tachypnea
cough
malaise
retractions
apprehension
22
Q

How does viral PNA differ in presentation from bacterial PNA?

A

viral - cough, wheezing, URI sx

Bacteria - high fever, chills, cough, dyspnea, focal lung findings

Atypical - tachypnea, cough, crackles on auscultation

23
Q

What is the MC PNA causing pathogen in neonates?

A

GBS

24
Q

What is the MC PNA causing pathogen in 1-3 months old?

A

febrile - RSV

afebrile - chlamydia, mycoplasma, bordetella pertussis

25
Q

Asthma

A

a chronic inflammatory disorder of the airways that causes variable and reversible recurrent episodes of airway obstruction

26
Q

What is the theory behind asthma?

A

early life (even in utero) exposures greatly determine future risk

nutrition 
allergen exposure 
endotoxin 
pollutants 
microbiome 
psychosocial factors
27
Q

How do you dx asthma?

A

episodic sxs of airflow obstruction or airway hyper-responsiveness are present

prove that it’s reversible by:
increased FEV1 of >200mL and 12% from baseline after inhalation of a short acting B2 agonist

28
Q

When do you do spirometry testing for children with suspected asthma?

A

at the initial assessment
after treatment is initiated and sxs have stabilized
during periods of progressive or prolonged loss of asthma control
at least every 1-2 years; more frequently depending on response to therapy

29
Q

Decreased FVC

A

restrictive process

30
Q

Decreased FEV1

A

airflow limitation/obstruction

31
Q

Exercise Induced Bronchospasm

A

doesn’t occur in everyone with asthma

1st line treatment:
-pre-treatment - 2 puffs albuterol with spacer at least 15 minutes before exercise

if sxs still occur you don NOT need to wait 4 hours before using albuterol again

32
Q

Classifications of asthma

A

look at the chart in the slides

33
Q

What is the first step in asthma management in children 0-4 years old?

A

SABA PRN

Step 2:
Low Dose ICS

Step 3:
medium dose ICU

Steph 4:
MEdium dose ICS and LABA

34
Q

What do you use to determine initiation and adjustment of medications?

A

severity determines how you initiate medications

control determines how you adjust medications

35
Q

What is the preferred agent for initiating controller therapy?

A

ICS

inhaled corticosteroids

36
Q

Green, Yellow, Red Zones

A

Look back at the slides for this one

37
Q

What are the highest risks of severe asthmas exacerbations?

A

poor asthma control
higher disease severity
prior hospitalizations
non-adherence to therapy

38
Q

Status asthmaticus

A

no response to repetitive or continuous administration of short acting inhaled B2 agonist

Peds Exam 2 (11 decks)

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