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Clin Medicine > Newman > Flashcards

Newman Flashcards

1
Q

Respiratorty distress in children

A

Ok

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2
Q

Most emergencies in kids

A

Are respiratory

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3
Q

Untreated respiratory distress

A

Cardiac arrest, cardiopulmonary failure

So want to intervene before it gets to that point
-bag or intubate

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4
Q

Cardiac arrest in kids

A

Usually due to progressive respiratory failrue->bradycardia, hypotension, cardiac arrest

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5
Q

What caues cardiopulm arrest in kids

A

Respiratory failure, cardiac failure, trauma, infection blah blah

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6
Q

At door what see

A

Appearance, breathing, circulation

The pediatric triangle

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7
Q

Flaring, gasping, dyspnea, pale, cyanotic, mottling pale, doesn’t always mean poor circulation, can be cold)

A

Nostrils flare indication of respiratory distress

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8
Q

Somnolent, lethargic, not moving, not interacting

A

Severe hypoxia, hypercarbia, Andorra respiratory fatigue

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9
Q

If haven’t intervened and HR goes down

A

Dwindle

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10
Q

If incosable by mom or nurse or if kid don’t want to be touched

A

Bad sign

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11
Q

Take note of all the info before you

A

Examine

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12
Q

Kid grunt

A

Effort to keep airway open longer

RSV season

Progressive-closing glottis to keep airway open

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13
Q

Slow, irregular respiratory pattern int he setting of respiratory distress is

A

Ominous sign

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14
Q

Body position in respiratory distress

A

Lean forward try to expand intrathoracici volume

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15
Q

Stridor

A

Croup, foreign body, inspiratory Barky cough

Narrow larynx or trachea

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16
Q

Wheezing

A

Squeaking noise by air in narrow tracheobronchial airway

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17
Q

Rales

A

Crackles, air passing through narrowed bronchi

-air through fluid, pneumonia

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18
Q

HR changes

A

Up with respi compromise then lose ability to compensate(hypoxia sets in) get bradycardia

Always O2 sat

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19
Q

Normal O2 sat

A

95 or higher

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20
Q

Hypercarbia

A

In resp distress co2 goes up, pH goes down , acidic , body hates this

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21
Q

Severely upper airway obstruction

A

Foreign body-doodling cant cough

Angioedema, epiglottis

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22
Q

Tension pneumothorax

A

Intervening can be lifesaving

Causes shift of mediastinal to side away from air leak, compresses the heart and good lunge

Can’t see lung markings

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23
Q

Signs of tension pneumothorax

A

Heart drop, sat droppping , respiratory distress

Put needle in and swoooooosh

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24
Q

Cardiac tamponade

A

Blood, serous fluid, air fill pericardial sack with life threatening compromise of venous return and cardiac stroke volume

Lupus with pericarditis, post op

Rare in kids

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25
Q

Becks triad of cardiac tamponade

A

Jugular venous distention, muffled cardiac sounds, hypotension (1/3 with cardiac tamponade)

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26
Q

Reropharyngeal and peritonsillar abscess

A

Sore throat, difficulty swallowing and oral pain, swelling

Hoarse voice

Can obstruct airway

Base of uvula shifted away from inflammation think peritonsilar absence

Retropharyngeal-of pharynx pushed up towards you

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27
Q

Croup

A

Acute laryngotracheobronchitis
Most common cause of infectious airway obstruction in kids 6 -36 months

Usually parainfluenza virus, or allergiv(less common)tracheitis is most often a secondary bacterial infection to croup kids
STRIDOR-CROUP

October to March
Vocal cord

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28
Q

Bronchiolitis

A

RSV
Wheeze
Less than 2
No treat-just supportive can wheeze forever

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29
Q

Mycoplasma viral

A

Can cause lobar pneumia and pleural effusions

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30
Q

Asthma

A

Inflammation, edema, bronchospasm, mucus

Triggers: infection, exercise, environmental irritants, stress GERD

Sudden worsening

Sudden changes can be due toalveolar disease and/atelectasis

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31
Q

Highest risk group for asthma for sudden death from asthma

A

Adolescence-teens , they don’t want to carrry medicine

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32
Q

Bronchioles

A

Asthma

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33
Q

Asthma cxr

A

Perihilar junkiness , bronchioles, rest of lungs kind of streaky,

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34
Q

CXR asthma attack

A

Lung expansion bilateral flattening of diaphragm

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35
Q

What most commonly causes anaphylaxis in kids

A

Food or meds
Life threatening, lips tingle, throat close,

*epinephrine !!!!!!!!!!!!!! Drug of choice

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36
Q

Foreign body resp distress

A

Sudden dramatic choking

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37
Q

Trachea body

A

Coughing, choking when FB is first ingested

Stridor, drooling choking if upper airway obstructed

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38
Q

Past carina where is foreign body

A

Right mainstem bronchus

Lower foreign body-cough, choking with first ingested

Delayed symptoms..recurrent pneumonia, chronic cough

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39
Q

Esophagus foreign body

A

Drooling swallowing problems

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40
Q

40% foreign bodies

A

No one knows there, no one saw it

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41
Q

Age group at risk for foreign body aspiration

A

1.5-3

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42
Q

Choking hazard

A

Button batteries if into trachea or esophagus within four hours corrode the mucosa and get tracheoesophageal fistula

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43
Q

How get foreign body out of trachea

A

Bronchoscopy

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44
Q

What happens when something gets in right mainstem bronchus

A

Ballvalve, air trapped, inspiratory and expiratory film can see!!!!!!

Put it together with ingestion and think right mainstem bronchus

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45
Q

Congenital or acquired CNS disesase

A

Neuromuscular delay-respiratory distress usually from chronic hypoventilation, infectious, trauma, medication, cerebral palsy

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46
Q

Reckless cell disease

A

Acute chest syndome-> sudden onset respiratory distress and chest pain, new infiltrates on cxr, fever

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47
Q

Sickle cell

A

If see kid with new infiltrate on x ray and have fever and resp distress think acute chest syndrome……..ACUTE CHEST SYNDROME
Hostpital antibiotics, oxygen, and pain control

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48
Q

Asthma is ___

A

Reversible

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49
Q

Diagnose asthma

A

Reversibility either spontaneously or with bronchodilator therapy

Limitation of airflow on pulmonary function testing or positive broncho-privation challenge
-methacholine challenge

Cough at night, cough exercising-make sure bronchospasm is part of differential

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50
Q

Asthma

A

Tightening smooth muscle that lines airway

Obstruction/inflammation

Mucus plugs

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51
Q

Exposure to allergen with asthma

A

Triggers it!! Mast cells are involved-mast cells produce leukotrienes (smooth msucle constrictors)

52
Q

Leukotriene

A

Smooth msucle constrictor

53
Q

If lot of allergies

A

Eosinophil up

54
Q

Asthma path in prolonged status asthmaticus

A

Curshmann spirals and Charcot laymen crystals

55
Q

Airway remodel asthma

A

Then airway, fibrosis, hypertrophy, may contribute to irreversible

56
Q

Atopy FAMILY HISTORY so important

A

Strongest predisposing factory

Exposure to inhaled allergens

  • dust mites
  • cockroaches
  • seasonal polllen
57
Q

Asthma and family history

A

YES very likely

58
Q

Copd vs asthma with tratment

A

Fev1 FEV1/FVC return with therapy
NO with cops
Asthma it can

59
Q

Copd airflow limitation

A

Partially reversible

60
Q

Asthma airflow lmitation

A

Reversible

61
Q

Asthma key indicators cough

A

Worse at night, exercising-bronchospasm

Usually early in life

62
Q

Asthma vs copd age of presentation

A

Kid asthma

Copd older

63
Q

Obstructive spirometers

A

Swooping, see screen shot

Give b2 agonist improved rule

Prolonged inspiratory phase

64
Q

Vocal cord dysfunction

A

Truncated inspiratory loop

Get abnormal closure of vocal cords, usually on inspiration, exercise triggers,

Treating for asthma and nothing work, flattened inspiratory flow

65
Q

Sound like asthma look like asthma

A

Do spiroemtry, and get truncated inspiratory loop vocal cord dysfunction treated with behavioral techniques

66
Q

Obstructive vs restrictive spirometry

A

See screen shot

67
Q

Treat asthma

A

SABA sort acting beta 2 agonist
-albuterol, levabuterol

Relaxes smooth msucles, airway open,

68
Q

Steroids for asthma

A

Cut down inflammation

69
Q

What is your rescue medicine for asthma

A

B2 agonist

70
Q

Long term treat asthma

A

Inhaled corticosteroids

Leukotriene modifiers

71
Q

If need albuterol more than 2 x a week

A

ICS sometimes LABA-but not to be used alone use after try ICS or in conjunction,

72
Q

Leukotriene modifiers

A

Released by mast cells

Lukasts and leukotriene receptor antagonists

73
Q

Signs and symptoms of child in impending respiratory failure/arrest

A

Breathlessness, cant talk bc breathing so hard, not crying not making noise, seem drowsy, RR>30, unable to recline, use of accessory muscles, abdomen goes up when breath out PARADOXICAL MOVEMENT

Right before cardiac arrest have baby with alt hese signs HR up at first, in resp distress then go down as tire

HR down-really close to arresting

74
Q

Most arrest of kids

A

Respiratory

75
Q

Goal of verge of cardiac arrest or failure

A

Stabilize respiration

76
Q

Intermittent asthma

A

<2 days/week symptoms

Nighttime awakening<2x a month

Use albuterol <3 days a week (or equal)

No interference in normal activity

Normal spirometry

77
Q

When someone goes to persistent to intermittent

A

When not intermittent

78
Q

Risk asthma severity

A

How many times in last year have had exacerbation that required oral or iv corticosteroids

79
Q

1 and symptoms less than 2

A

Intermittent

80
Q

If hospital 2 or more times and need steroids

A

Persistent category

81
Q

Ass soon as one impairment markers is hit

A

Persistent and need long term controller

82
Q

Initial treatment

A

SABA

83
Q

Wheeze

A

Can be asthma can be other

84
Q

Educate parents on asthma

A

Yes please

85
Q

If on ICS

A

You are persistent

86
Q

Acute exacerbation treat

A

O2
SABA
Oral steroid-if asthma attack that haven’t been able to pop out of with albuterol at home

87
Q

If choking 2 yo

A

Think foreign body do x ray

88
Q

14 yo girl high achiever athlete, cant breath when run not responding to asthma treatment

A

Vocal cord dysfunction

89
Q

Kid with no thromboembolism except exercise

A

Recommend Saba before exercise

-if use before every time still intermittent asthma

90
Q

5 yo new diagnosis of asthma can give all prescriptions and parents hesitant about ICS

A

Need to educate about side effects less effects than other

91
Q

ICS risk

A

Thrush, rinse mouth out with water after you use it

92
Q

Salty skin

A

CF

93
Q

CF who is it high in

A

Ashkan AZt jews

94
Q

CF

A

AR

CFTR encodes a chloride channel in epithelial cells on mucosal surfaces

Long arm chromosome 7

Most common mutation 3 nucleotides

Exocrine gland function

95
Q

CF resp

A

Thick mucous in lung, chronic infections, colonized with bacteria

96
Q

Ethnic distribution CF

A

Askanazi Jew 1/24

97
Q

Inheritance CF

A

AR

98
Q

Dad and mom carrier what percentage of kids will have no disease or no carrier

A

25%

50% carriers

25% have it

99
Q

What happen with bad gene

A

Decreased Cl secretions

Increased reabsorption of Na and water , less water in mucus thicker

100
Q

Does cf present same way in everyone

A

Poor penetrance NO

101
Q

Env causes of CF

A

May effect penetrance

102
Q

Most commmon presentation CF

A

Chronic and progressive lung disease

Exocrine pancreatic insuffiency

103
Q

Why doesn’t CF present same

A

Modifier genes, env factors, nutrition

104
Q

When most commonly see intestinal blockage

A

In nursery…muconium ileus

105
Q

Clincial presentation baby

A

Lungs normal just after birth
a repeating cycle of infection and neutrophilic inflammation
-staph aureus and nontrpable HI
-pseudomonas aeruginosa is usually isolated from the respiratory sectretions
-not good

So usually meconium ileus is when suspect

New born screens-screens for sickle cell, CF, …

106
Q

CF

A

Pseudomonas

107
Q

Presence of bacteria in secretions for so long is ___ but as get older it is _____

A

Aureus younger

Pseudomonas eventually

108
Q

Lung __ inflated with CF

A

Hyper

Air trapping and lungs big and diaphragma flat

109
Q

Spirometry exhalation Curve in obstructive

A

Scoop

110
Q

Most common cause of death CF

A

Respiratory death

111
Q

Cf x ray

A

Expanded lung field flattened diaphragm, hazy and junky

Junk in upper lobes more

Hyperaeration in submediastinal area

112
Q

Clubbing with cf

A

Ya

113
Q

GI

A

Neonatal in nursery meconium ileus-not pooping when 36 hours old

Do newborn screen

114
Q

If no poop 36-48 hours

A

CF, hershprungs

115
Q

Older more stools

A

Malabsorption

116
Q

Pancreas and CF

A

95% insuffiency

Pancreatic enzymes are prevented from reaching gut (reduced water content of secretions, precipitation of proteins, plugging of ductules and acini_
=fat soluble vit ADEK
-malabsorption of fat-steatorhea
Carb, protein

Failrue to thrive, foul smelling poop
History of jaundice or GI tract bleeding as a result of hepatobiliary involvement

117
Q

What supplene ta CF patient

A

ADEK

118
Q

Liver

A

Jaundice ductules plugged

119
Q

Diabetes

A

8-12% get

120
Q

Anything with a duct

A

Can be effected by CF

121
Q

Most men with CF

A

Azospermic secondary to agenesis of the vas deferens

122
Q

CF what have more of

A

Prolapsed rectum,

NASAL POLYPS

123
Q

Criteria for diagnosis CF

A

Positive new born screening test, next step…perform confirmatory test

Plus positive cl test of sweat
-have more Cl in sweat , more cl and na stays in ductal lumen

124
Q

Positive newborn screen and elevated sweat chloridex2

A

CF

125
Q

Test for immunoreactive trypsinogen

A

Elevated in kids with CF

——-this is the screening in all states

Clin Medicine (28 decks)

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