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peds special pops > ped pulm test 2 > Flashcards

ped pulm test 2 Flashcards

1
Q

at what weeks of life is a baby highest risk for RDS (respiratory distress syndrome)

A

<28 weeks = 60 to 80%

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2
Q

increased risk for RDS

A

Infants of Diabetic Mothers
Multifetal pregnancies
C-section
Family History

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3
Q

Primary Cause –

A

Surfactant Deficiency

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4
Q

signs of RDS

A 
Signs within minutes of birth:
Tachypnea
Grunting
Intercostal and subcostal retractions
Nasal flaring
Duskiness
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5
Q

PE findings in RDS

A

Diminished breath sounds

Falling blood pressure

Pallor

Progresses to, Apnea and
Mixed resp/metab acidosis

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6
Q

how to DX RDS

A

Clinical Course
CXR – ground glass appearance
ABG

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7
Q

RDS prevention

A

Beta methasone 48 hours prior to delivery between 23 – 34 weeks

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8
Q

t/f beta methasone Should be administered at 23 – 34 weeks gestation if increased risk of preterm delivery in next 7 days

A

true

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9
Q

RDS tx

A

Careful and frequent monitoring

Warm humidified O2 to keep arterial levels between 55 – 70 (sats >90%)

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10
Q

when do you give surfactant in RDS

A

If intubation (or CPAP) needed at birth after initial stabilization infants

with hypoxic respiratory failure attributable to secondary surfactant deficiency

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11
Q

Inflammation of the bronchioles – usually caused by an acute viral infection

Most common lower respiratory tract infection in infants and children <2yo

A

Bronchiolitis

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12
Q

common causative agents in bronchiolitis

A

RSV

Adenovirus, human metapneumovirus, influenza, parainfluenza

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13
Q

how to dx bronchiolitis

A

Based on history and physical exam

Routine lab and radiologic studies not recommended

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14
Q

bronchiolitis upper resp presentation

A

uri, runny nose

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15
Q

bronchiolitis lower resp presentation

A

Cough

Tachypnea

Increased Respiratory Effort

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16
Q

other bronchiolitis findings

A

Apnea in very young infants

Elevated RR – earliest and most sensitive sign

Tachycardia
Due to dehydration and hypoxemia

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17
Q

Illness severity – determined by ?

A

RR, work of breathing, hypoxia

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18
Q

what days are the peak of bronchiolitis

A

3 and 4

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19
Q

bronchiolitis cxr findings

A

hyperinflation, atelectasis, infiltrates,

does not correlate with disease severity or guide management

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20
Q

who do you check for sepsis if they have a fever?

A

< 60 day olds

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21
Q

management of bronchiolitis

A

hydration

o2

broncho dilators/steroids (not typical)

nasal suction

rivavirin (sever)

influenza antivirals

22
Q

leading cause of infant death (viral)

A

RSV

23
Q

who is RSV most sever in

A

children with cardiovascular disease,

infants born prematurely

infants with chronic lung disease

premature <6 mo old

24
Q

RSV testing

A

rapid antigen

does not alter tx

25
Q

common RSV complications

A

otitis media

Bacterial pneumonia

26
Q

drug used to prevent RSV

A

synagis (big money)

27
Q

when can you use synagis

A

born at less than 29 weeks

born at less than 32 weeks with O2 requirement for at least 28 days after birth (Chronic Lung Disease

Infants less than 24 months of age with CLD still requiring medical intervention

28
Q

one of most common causes of ed visits

A

asthma

29
Q

common onset of asthma

A

prior to 6 yr

30
Q

what does asthma look like

A

Intermittent dry coughing and expiratory wheezing
SOB and chest tightness in older children
Symptoms worse at night

31
Q

asthma triggers

A 
Physical exertion
Hyperventilation (laughing)
Cold or dry air
Airways irritants
Inhaled allergens
32
Q

asthma PE findings

A

Expiratory wheezing, prolonged expiratory phase
Decreased Breath Sounds (regional hypoinflation due to airways obstruction)
Retractions, accessory muscle use

33
Q

barky cough, hoarseness, inspiratory stridor

A

croup

34
Q

happen before croup

A

URI symptoms for 1 – 3 days before the symptoms of upper airway obstruction

35
Q

age of croup onset

A

Occurs in 3 month – 5 years of age, peak in second year of life

36
Q

what “bug” causes croup

A

parainfluenza viruses

Also: influenza, RSV, adenovirus

37
Q

clinical sign on x ray of croup

A

steeple sign

38
Q

how do we manage croup

A

Usually managed at home
Cool mist
Steamy bathroom for exacerbations

39
Q

how do we manage croup in the hospital

A

Nebulized racemic epinephrine

Corticosteroids

40
Q

when do we hospitalize for croup

A 
Progressive stridor
Severe stridor at rest
Respiratory distress
Hypoxia
Cyanosis
Depressed mental status
41
Q

Acute, fulminating course of high fever, sore throat, dyspnea, rapidly progressing respiratory obstruction

A

epiglottitis

42
Q

what vaccine lowers the risk of epiglottits

A

HiB

43
Q

what currently causes epiglottits

A

due to Streptococcus pyogenes, Streptococcus pneumoniae, and Staphylococcus aureus

44
Q

what do you see with epiglottitis

A

“cherry-red” swollen epiglottitis

drooling

tripod

fast onset

45
Q

management of epiglottits

A

intubate
Oxygen
Culture blood, epiglottis

46
Q

abx for epiglottitis

A

Ceftriaxone, cefixime or combo of ampicillin and sulbactam

47
Q

street names for pertussis

A

Whooping cough

Bordetella pertussis

48
Q

what are the stages of pertussis

A

6 week course

  • Catarrhal
  • Paroxysmal
  • Convalescent
49
Q

what pertussis looks like

A

cough especially in the absence of fever, malaise, myalgia, exanthema or sore throat

50
Q

how to dx pertussis

A

Leukocytosis with absolute lymphocytosis

Culture is gold standard, but do not wait on results to treat

Reportable disease

51
Q

tx of pertussis

A

Erythromycin or azythromycin

52
Q

who do we hospitalize with pertussis

A

Infants under 3 months of age

3- 6 months with severe paroxysms

Premature infants or children with cardiac, pulmonary, muscular or neurologic disorders

peds special pops (8 decks)

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