Lecture 7: Pulmonology

Question 1

What is the etiology of bronchiolitis?

MC cause?

Answer 1

Viral

MC cause = RSV

Question 2

4 main manif of bronchiolitis?

Answer 2

1. apnea
2. Copious rhinorrhea
3. cough/wheezing
4. highly contagious

Question 3

how does RSV cause apnea

Answer 3

RSV blunts respiratory response

Question 4

+/-

1. Fever
2. Nasal secretions/flaring
3. wheezes, crackles
4. retractions
5. prolonged expiratory phase

Answer 4

PE findings for bronchiolitis

Question 5

Is an XR needed to Dx bronchiolitis?

Tests used to determine specific cause of bronchiolitis?

Answer 5

NO (based on hx/PE)

Cause determined by antigen testing or PCR

Question 6

Main type of Tx for bronchiolitis?

What drugs can be trialed in bronchiolitis for effectivness?

Tx to mobile secretions?

Answer 6

Supportive
(nasal suctioning, hydration, supp O2)

Trial of beta2 agonist or racemic epi

mobilze secretions: Nebulized 3% hypertonic saline

Question 7

Main sequelae of bronchiolitis?

• Cause?
• groups at most risk?
• how to mitigate?

Answer 7

Respiratory failure

• d/t obstruction of airways
• high risk = premature infants, preexisting airway/ lung dz
• give monthly Palivizumab (ppx) during RSV season

Question 8

1. apneic
2. cant maintain PO intake/hydration
3. Hypoxemia
4. concern for impending resp failure
5. premature infants

Answer 8

consider hospitalization for bronchiolitis

Question 9

1. infants < 29 gestation
2. < 12 mo at onset of RSV season
3. chronic lung dz of prematurity < 24 mo & need medical therapy w/in 6 mo RSV season

Answer 9

recommend Tx w/Palivizumab

Question 10

3 scenarios that can cause impending resp failure

Answer 10

1. upper or lower airway obstruction
2. sepsis
3. Hypotonia

Question 11

1. incr accessory muscle use/tachypnea
2. inability to coordinate feeding
3. decr arousability
4. hypoxemia/hypercarbia

what is most worrisome

Answer 11

Presentation of impending resp failure

most worrisome = normal PCO2 w/marked tachypnea

Question 12

3 stages of pertussis

Answer 12

1. Catarrhal
2. Paroxysmal
3. Convalescent

Question 13

Sxs of Catarrhal stage of pertussis

Answer 13

cough and rhinorrhea

Question 14

Sxs of Paroxysmal stage of pertussis

Answer 14

1. coughing fits
2. inspiratory whoop
3. post-tussive emesis

Question 15

Sxs of Convalescent stage of pertussis

- time pd?

Answer 15

waning of Sxs

- wks to months –> called 100 day cough

Question 16

What can be a/w pertussis?

What is not seen w/pertussis?

Answer 16

perioral cyanosis

NOT typical = fever

Question 17

4 main ways to Dx pertussis (other than clinically)

Note: DFA and serology NOT recommended

Answer 17

1. PCR
2. Culture
3. CBC
4. XR

Question 18

What is seen w/pertussis on CBC and XR

Answer 18

CBC –> incr WBCs

XR –> perihilar infiltrates, segmental lung atelectasis

Question 19

Major Tx for Pertussis & how long?

- when is this tx preferred?

Answer 19

Azithromycin x 5 days
- preferred < 1 mo or pregnancy

Note: alt = erthro/clarithromycin, Bactrim

Question 20

Benefits of Tx Pertussis?

Answer 20

limit spread, Ameliorate cough if given in catarrhal stage

Question 21

5 complications a/w pertussis

Answer 21

1. high rates hospitalization (premies)
2. apnea
3. PNA
4. Seizures
5. death

Question 22

MC source of inf for pertussis

Edu for grandparents ?

Answer 22

sibling

grandparents need pertussis booster to be around kids

Question 23

What is only manif of PNA in neonates?

What is often 1st sign of PNA in infants?

Answer 23

neonates: fever or hypoxia
infants: apnea

Question 24

Difference b/t viral, bacterial, Atypical PNA?

*see notes for pathogens by age

Answer 24

viral –> URI sxs
bacterial –> higher fever, focal consolidation
atypical –> crackles on auscultation

Question 25

3 main features of asthma

Answer 25

1. chronic, reversible, recurrent episodes of airway obstruction
2. airway hyper-responsiveness
3. +/- airway remodeling

Question 26

What is required for Dx of asthma (2)

Answer 26

1. Recurrence ( > 4 episodes)

2. measurement of airflow obstruction

Question 27

How is airflow obstruction measured?

What is considered Diagnostic result for asthma?

Answer 27

airflow obstruction –> spirometry

Diagnostic = airflow obstruction that improves w/bronchodilator (b2 agonist) –> incr FEV1

Question 28

What is seen on spirometry that is consistent w/asthma

Answer 28

Scooping of FEF

Question 29

Main Tx for asthma in peds

Answer 29

MDI inhaler w/SPACER

Question 30

What do most children w/asthma also have, what does this predict

Answer 30

allergies

+ IgE to inhalant allergens predicts persis asthma and imroved response to inhaled CCS

Question 31

How is exercise induced asthma different from reg asthma

Answer 31

• doesnt occur in everyone w/asthma

- NOT inflam –> steroids not useful

Question 32

What is pre-Tx for exercise induced asthma

what if Sxs continue

Answer 32

1. 2 puffs of albuterol 15 min before exercise

2. do 2-4 more puffs immed

Question 33

When is asthma considered well controlled?

v. poorly controlled?

Answer 33

well controlled = Sx < 2x /wk

v. poorly controlled = Sxs thruout day

Question 34

What is 1st line med for asthma

what is the preferred med for initiating controller therapy

Answer 34

1st line = SABA PRN

initiating controller therapy = ICS

Question 35

What is status asthmaticus

Answer 35

NO response to repetitive/contin admin of SABAkk

Question 36

1st tier Tx for asthma exacerbations (3)

Answer 36

1. inhaled beta agonist
2. inhaled anti-cholinergic
3. systemic CCS

Question 37

Beta agonist toxicity

• does dose matter?
• common Sx?
• MC in?

Answer 37

• Dose matters (toxicity = dose dep)
• Sx = HoTN
• MC in kids on continous nebulizer