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Lung Clin Med > Newman Pediatric Respiratory > Flashcards

Newman Pediatric Respiratory Flashcards

1
Q

RED FLAG:

Sudden onset of symptoms children with choking/gagging, asymmetric wheezing

A

Possible DX: Foreign body

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2
Q

Red Flag: Coughing and choking when eating or drinking

A

Possible DDX

  1. Oropharyngeal dysphagia with aspiration
  2. tracheo- esophageal fistula
  3. GERD
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3
Q

Poor growth and low body mass index

A
  1. Cystic fibrosis

2. immunodeficiency

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4
Q

Family history of sterile males

A
  1. Cystic fibrosis

2. immotile cilia syndrome

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5
Q

Red Flags:

  • Chronic rhinorrhea and recurrent sinus infections
  • Family hx of sterile males
A
  1. Cystic fibrosis

2. immotile cilia syndrome

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6
Q

Acute onset of SOB, tightness in chest/throat, feeling of choking, noisy breathing, hoarse voice without history of asthma in teenager

A

Vocal cord dysfunction

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7
Q

Chronic wet productive cough

A

Bronchiectasis

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8
Q

Chronic episodes of pneumonia

A

Immunodeficiency

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9
Q

Red Flag: Wheezing associated with viral illness

A

Poss DDX:

  1. Reactive airway disease
  2. bronchiolitis
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10
Q

DDX for Wheezing in Infants

A
  1. GERD
  2. Congenital abnormalities
  3. CF
  4. Infections
  5. ciliary dyskinesia
  6. Immunodeficiency
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11
Q

DDX for wheezing in preschool age

A
  1. Asthma
  2. CF
  3. GERD
  4. FBA
  5. Infections/ post infectious
  6. Immunodeficiency
  7. Congenital abnormality
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12
Q

DDX for wheezing in school age child

A
  1. Asthma
  2. Vocal cord dysfunction
  3. CF
  4. Infections/post infectious
  5. a-1 antitrypsin deficienct
  6. FBA
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13
Q

Abnormal closing of the vocal cords making it hard to move air in and out of the lungs

A

VCD = Vocal Cord Dysfunction (also called paradoxical vocal fold motion disorder

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14
Q

What is often confused with asthma?

A

VCD = Vocal Cord Dysfunction (also called paradoxical vocal fold motion disorder

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15
Q

Sx of Vocal Cord Dysfunction

A

SOB or difficulty getting air into or out of lungs
• Tightness in the throat or chest
• Frequent cough or throat clearing
• Feeling of choking or suffocation
• Noisy breathing (stridor, gasping, raspy sounds or wheezing)
• Hoarse voice

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16
Q
  • GERD
  • Post-nasal drip
  • URI
  • Exercise
  • Strong odors or fumes
  • Tobacco smoke
  • Strong emotions and stress

are triggers for what?

A

Vocal cord Dysfunction

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17
Q

Who is at risk for vocal cord dysphasia?

A

• High achieving adolescents can be prone to this (F>M)

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18
Q

What is tx of vocal cord dysphagia?

A
  • Learning techniques that control the vocal cords -often taught by speech therapist or psychologist
  • Stress management
  • Control or avoidance of triggers
19
Q

How is asthma classified?

A
  1. Impairment (symptoms)

2. Risk (# of exacerbations requiring steroids)

20
Q

Signs that Respiratory arrest is imminent?

A
  1. Breathless and mute at rest
  2. cannot speak
  3. drowsy or confused
  4. RR >30/min
  5. Cannot recline
  6. paradoxical thoracoabdominal movement
  7. no wheexing
  8. bradycardia
  9. absent pulses paradoxus
21
Q

What would functional assessment show when respiratory arrest is imminent? (FEV1, PaO2, PCO2, SaO2)

A
  1. FEV1<25%
  2. PaO2 <60, cyanosis possible
  3. PCO2>42
  4. SaO2<90%
22
Q

How do you treat an acute asthma exacerbation?

A
  1. Albuterol + impratropium (anticholinergic)
  2. Steroids
  3. Oxygen
23
Q

What is Cystic fibrosis gene?

A
  • CTFR encodes for a protein that functions as a cAMP regulated Chloride channel across epithelial cells on mucous surfaces
24
Q

What chromosome is cystic fibrosis gene

A
  • Autosomal Recessive

- chromosome 7

25
Q

Cystic fibrosis is a disease of what gland>

A
  • Exocrie gland function –> involves many organ systems
  • Chronic resp infections
  • pancreatic enzyme insufficiency
26
Q

What contributes to the penetrance and variability of CTFR expression?

A
  1. Non genetic factors
    - environment - air quality
    - level of care
    - nutritional status
    - age of onset of lung infection
  2. Modifier genes that interact with CFTR to influence disease severity
    - Reduced MLB2 ass with increased rates of CF-related bronchiectasis
27
Q

What organisms contribute to the repeating cycle of infection and neutrophilic inflammation on the clinical presentation of CF?

A
  1. S. Aureaus and Haemophylus influenza are common during early childhood (first 10 years)
  2. Pseudomonas in most patient secretions 20s-30s
28
Q

Dx of CF requires

A

ONE OF
1. one or more phenotype presentation (chronic pulmonary disease, chronic sinusitis, GI/nutritional abnormalities, salt loss syndrome, obstructive azoospermia)

  1. Hx of CF in sibling
  2. Positive newborn screen test (immunoreactive trypsinogen)

PLUS AT LEAST ONE OF

  1. elevated sweat chloride concentration
  2. 2 mutations known to cause CF on separate alleles
  3. Abnormal post nasal potential differences test
29
Q

What are the 3 components of cardiopulmonary arrest in children?

A
  1. Respiratory (O2)
  2. Cardiac (pump, perfusion, BP)
  3. Circulatory volume (perfusion, BP)
30
Q

What is the cause of most pediatric cardiopulmonary arrests?

A

Respiratory

31
Q

What is the pediatric assessment triangle to assess for CP arrest?

A
  1. Appearance ( abnormal tone look cry or gaze, decreased interaction)
  2. Breathing (Abnormal sound/positioning, retraction, flaring, apnea/gasping
  3. Circulation (pillow, mottling, cyanosis
32
Q

ABCDE of pediatric CP arrest assessment

A 
Airway
Breathing
Circulation
Disability (depressed consciousness, unresponsiveness)
Exposure ( hypothermia, bleeding, shock)
33
Q

What is the most common cause of infectious airway obstruction in kids ages 6-36 month

A

croup (acute laryngotracheobronchitis)

34
Q

IF you are given the following, what illness should you think?

  1. Most often viral (parainfluenza virus) less often allergic.
  2. Tracheitis is most often a secondary bacterial infection to this(kids are febrile, really sick)
  3. Stridor􏰂 think this!
A

CROUP

35
Q

What causes epiglottis?

A

H. Flu type B

36
Q

Is there a vaccine for H. Flu?

A

yes, for HIB that has nearly eliminated HIB meningitis and epiglottis

37
Q

What is caused by

  1. RSV, influenza, parainfluenza, adenovirus
  2. Children less than 2
  3. Characterized by URI sx –> progressive cough –> wheezing/atelectasis
A

Bronchiolitis

38
Q

Characterized by inflammation, edema, bronchospasm, mucus

  • Triggers include: infection, exercise, environmental irritants, stress, GERD…..
  • Can result in sudden worsening
  • Sudden changes can be due to alveolar disease and/or atelectasis.
  • Wheeze, prolonged expiratory phase
A

Asthma

39
Q

Wha is most common caused by food or medications and shows:

  • Retropharyngeal/laryngeal edema can be life threatening.
  • Symptoms are often sudden and associated with facial edema and urticaria
  • Bronchospasm in lower airways common
  • If an allergy is reported…ALWAYS ASK WHAT HAPPENS WHEN EXPOSED TO THE ALLERGEN
A

Anaphylaxis

40
Q

How do you treat Anaphylaxis?

A

Epinephrine
oxygen
steroids

41
Q

How does pneumonia present in NEWBORN? what causes it?

A
  • tachypnea, retractions, grunting, hypoxemia

- Group B strep, listeria monocytogenes, gram-neg rods

42
Q

How does pneumonia present in INFANTS/CHILDREN? What causes it?

A

Cough, tachypnea, retractions, hypoxemia, congestion, fever, irritability, decreased feeding

• Viruses most common cause, if bacterial…Streptococcus pneumonia is most common

43
Q

How does pneumonia present in ADOLESCENTS? What causes it?

A

• Similar symptoms (may c/o headache,
pleuritic chest pain, abd pain)

• Mycoplasma pneumonia

Lung Clin Med (6 decks)

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