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Pediatric: HEENT, PULM, ID > Pediatric- HEENT and Pulm > Flashcards

Pediatric- HEENT and Pulm Flashcards

1
Q

what s/s will Orbital cellulitis have

A 
Fever
proptosis (displacement of body part) 
Restriction of extraocular movements
Swelling 
redness
on eye lid
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2
Q

Treatment for Orbital cellulitis

A

DONT WAIT

IV Vancomycin, Clindamycin, Cefotaxime

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3
Q

What is the most common organism found in Orbital cellulitis

A

Secondary to sinus infection - Ethmoid *
* Strep pneumonia
H. influenza
Staph aureus

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4
Q

If treatment is delayed with Orbital cellulitis what the most dangerous side effect?

A

**Optic nerve damage

spread of infection to sinuses, meninges and brain

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5
Q

What care must be given if you suspect Orbital cellulitis?

A

Emergent referral to ophthalmologist

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6
Q

What has decreased the incidence of Orbital Cellulitis

A

Pneumococcal vaccine

*Strep pneumoniae most common cause

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7
Q

What are the most common causes of orbital cellulitis

A
  1. Sinus infection *
  2. dental infection
  3. bacteremia
  4. Dacrocystitis
  5. Facial infections
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8
Q

What age group is orbital cellulitis most common in?

A

7-12 years old

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9
Q

what is the best imaging for Orbital cellulitis?

what will it show?

A

CT - infection of the fat and ocular muscles

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10
Q

What is the difference between Postseptal cellulitis and preseptal cellulitis

A

Postseptal- emergency- vision changes, pain when they move their eye
s. pneumo cause - child was sick with sinus then swollen eye
Preseptal- infection of the eyelid - periocular tissues
no vision changes and no ocular movement pain

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11
Q

What is the most common organism is viral conjunctivitis?

A

Adenovirus

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12
Q

What is the most common source someone obtained a viral conjunctivitis from?

A

most common swimming pool
direct contact
*highly contagious

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13
Q

What are some physical exam findings of viral conjunctivitis

A 
fever
pharyngitis
perauricular lymphadenopathy
*often in both eyes
copious watery discharge 
mucoid discharge
punctate staining on slit lamp
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14
Q

key symptoms of this diagnosis- punctuate staining on slit lamp, mucoid/water eye discharge

A

viral conjunctivitis

*Red eyes ! (ciliary injection)

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15
Q

Treatment for viral conjunctivitis

A

cool compresses
artificial tears
antihistamines for itching/redness - olopatadine

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16
Q

key terms for this diagnosis- red eyes, fever, pharyngitis, cobblestone mucosa on upper eyelid with itching tearing may have photophbia and vision loss

A

Allergic Conjunctivitis

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17
Q

Treatment for Allergic Conjunctivitis

A
  • ->Antihistamines
  • ->H1 blockers
  • ->topical steroid- long term
    1. Olopatadine
    2. Patanol- antihistamine/mast cell
    3. pheniramine/naphazoline - Naphcon A - antihisamine
    4. Emedastine
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18
Q

What is the most common organism for Bacterial conjunctivitis ?
how is it transmitted?

A

Staph
Strep
Haemophilus
-Transmitted direct contact and autoinoculation

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19
Q

What are the S/S of Bacterial conjunctivitis

A

purulent discharge
eyelid crusting
no visual changes * (viral can have visual changes)
mild eye pain
no ciliary injection** eye is not RED ** (viral is red)

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20
Q

what is needed to detect corneal abrasions?

A

Fluorescein staining

rule out in conjunctivitis

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21
Q

Treatment for Bacterial conjunctivitis

A

Topical Erythromycin

If contacts cover pseudomonas- fluroquine OR Tobrex

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22
Q

What is the treatment for Gonoccoccal conjunctivitis

A

Admit - optho emergency
IV ceftriaxone for 5 days
can add a topical

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23
Q

What is the treatment for Chlamydia conjunctivitis

A

Admit- optho emergency
IV Azithromycin for 5 days
can add topical

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24
Q

How do you treat neonatorium bacterial conjunctivitis

A

AgNO3 - silver nitrate
day 2-5 gonococcal
day 5-7 chlamydia
7-11 HSV

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25
Q

What is Strabismus?

A

misalignment of eyes - 4% of population

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26
Q

What are all the types of Strabismus

A
  1. Esotropia - IN horizontal
  2. Exotropia - OUT horizontal
  3. Hyoptropia - DOWN vertical
  4. Hypertopia -UP vertical
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27
Q

What are the causes of Strabismus

A
  1. cranial nerves - III, IV , VI (3, 4, 6)- weaken or palsy
  2. eye muscles
  3. brain- cerebral palsy, downs
  4. Strokes
  5. Trauma
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28
Q

What are some symptoms of Strabismus

A

Amblyopia - lazy eye
diplopia- double vision
cataracts

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29
Q

What will you find on physical exam with Strabismus

A

cover/uncover exam- eye can drift

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30
Q

What is Bruckner’s test

A

Bruckner testing can be helpful in observing strabismus. When doing the Bruckner test, fundus reflex is one characteristic to pay close attention to. A patient with a strabismus may show an increased light reflex in the deviated eye. Using your occluder, occlude the non-deviated eye as if you were doing a unilateral cover test, and you may be able to observe a change in fundus reflex of the deviated eye. The reflex may change from a brighter white to a duller red. Why? The macula is usually the most heavily pigmented area of the retina; therefore, once the deviated eye takes up fixation upon unilateral occlusion, the reflex will assume a duller appearance

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31
Q

What is the diagnosis- loss of red light reflex in one eye

A

Retinal blastoma

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32
Q

Treatment for Strabismus

A

Glasses
Eye muscle exercises
ocular surgery

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33
Q

What is the most common infection of the middle respiratory tract?

A

Laryngotracheobrochitis - Croup

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34
Q

What is the most common cause of Laryngotracheobrochitis

A

aka croup
Parainfluenza
RSV

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35
Q

What causes the stridor?

Describe stridor

A

Croup

the walls of the subglottic airway are drawn together during INSPIRATION

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36
Q

what is the Patho behind Laryngotracheobrochitis

A

inflammation and edema of laryngotracheal airway
kids already have a smaller airway to being with
this will lead to increased airway resistance and increased work of breathing during INSPIRATION (Stridor)

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37
Q

Laryngotracheobrochitis is commonly seen in whom? what time of year?

A

6 months to 3 years

Peaks in the Fall early winter time

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38
Q

Key symptoms should make you think what diagnosis-
Stridor- inspratory, barky seal-like cough, hoarseness, increase work of breathing, retractions +/-
nasal flaring, often starts out like cold symptoms (or out of the blew no pre-warning symptoms)

A

Laryngotracheobrochitis- CROUP !

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39
Q

What Physical exam findings will you see with CROUP?

if diagnosis is unclear what is the next step?

A

lungs are usually clear *
usually clinical dx
AP neck x-ray- steeple sign narrowing of the subglottic region

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40
Q

What is the best imaging for Croup

what are the best labs?

A

X-ray AP steeple sign narrowing of the subglottic region

viral PCR or culture

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41
Q

What is the treatment for mild Croup

A

mild- no stridor at rest
symptomatic - humid air, fever reduction, fluids, cool mist humidifier
ONE dose Dexamethasone 0.6mg/kg in office

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42
Q

What is the treatment for moderate-severe Croup

A

Stridor at rest & retractions
try keeping the child calm to minimize labored breathing
Dexamethasone 0.6mg/kg - oral, IV or IM
If severe = Racemic aerosolized epinephrine by nebulizer (q 20 min)
*observe for 3-4 hours and decided to admit or not
*monitor for rebound effect
* worsening as drug clears
-Humidifed air
- antipyretics, fluids

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43
Q

How often can you give Racemic Epinephrine with Croup

A

If severe = Racemic aerosolized epinephrine by nebulizer - can repeat every 20min for 1-2 hours
peak effect- 10-30 minutes
fades within 60-90minutes

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44
Q

When should you admit a patient with Croup?

A

age < 6 months
if strior is still present at rest
if rebound effect after multiple treatments od Dexamethasone
oxygen requirments
oral intake
care giver understanding and abilty to return if needed
Recurrent Emergency Department visits in 24 hours

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45
Q

What part of the body does Croup occur?

A

Larynx
Sub-glottis
Trachea
that is why its called Laryngotracheitis

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46
Q

What part of the lungs does Bronchiolitis effect?

A

Lower respiratory tract infection affecting small airways (bronchioles)

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47
Q

What is the Patho of Bronchiolitis

A

small airways are inflamed and increase mucous production and occasionally bronchospasm leads to symptoms. can lead to airway obstruction or atelectasis

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48
Q

What is the most common cause of Bronchiolitis

A 
Respiratory syncytial virus - RSV 
rhinovirus 
parainfluenza 
influenza 
adenovirus
*uncommon mycoplasma pneumonia
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49
Q

Bronchiolitis commonly infections whom?

what time of year is common

A

first 2 years of life is common and peaks 2-6 months

peaks December through march

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50
Q

Key symptoms for this diagnosis - history of 1-3 day is URI, low grade fever, cough, noisy breathing or wheezing, nasal flaring, hypoxia <95%, tachypnea >70,
lethargy +/- , dehydrated +/-

A

Bronchiolitis

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51
Q

X-ray is not usually indicated in Bronchiolitis

but when do you need to order it?

A
  1. infant < 3 months
  2. fever > 38 (100.4)
  3. suspect secondary infection
  4. severe illness
  5. hyperinflation
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52
Q

What is the best imaging for Bronchiolitis

what will it show ?

A

x-ray
hyperinflated lungs due to air trapping peribronchial cuffing due to bronchial wall thickening and peribronchial opacification.
minimal focal areas of atelectasis

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53
Q

What is the treatment for Bronchiolitis

when should you admit?

A 
supportive care &amp; monitoring 
nasal suctioning 
O2 
IV fluids if needed 
admit if- moderate to severe respiratory distress, hypoxemia, apnea, inability to tolerate oral feedings, inadequate care at home
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54
Q

What is the prognosis of Bronchiolitis

what can you tell mom to expect?

A

most improve within a few days then gradually resolve in 1-2 weeks
can persist to have bronchial hyperactivity

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55
Q

Children who were hospitalized for RSV as an infant tend to have higher rates of what ?

A

Asthma

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56
Q

What vaccine can you give to prevent Bronchiolitis?
who do you give it to?
How much?

A

Synagis - Palivizumab
it is a RSV specific monoclonal Ab
-passive prophylasis
- one dose just prior to RSV season (nov)
- 15mg/kg IM once per month for max of 5 doses
max interval between doses if 35 days
- infants < 1 years old with chornic lung diesase, prematurity or hemodynamically significant congenital heart disease

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57
Q

What is prevention for Bronchiolitis?

A

Syngis - Palivizumab

Influenza vaccine

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58
Q

What are two types of chronic Bronchiolitits

A
  1. Bronchiolitis obliterans (constrictive)

2. Cryptogenic organizing pneumonia )COP

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59
Q

What is Bronchiolitis obliterans (constrictive)

A

Type of bronchiolitis that causes a crhonic inflammation and fibrosis of bronchioles causing collapse and obliteration of bronchioles. Granulation tissue in the bronchiole lumen causes obstrutive lung disease

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60
Q

If the CT scan shows Mosaic pattern on the chest what is the diangosis?

A

Bronchiolitis obliterans - constrictive

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61
Q

Bronchiolitis obliterans (constrictive) is common in whom?

A 
Post lung transplant rejections 
inhalation
 injuries - silo filler's disease
drug reactions 
RA
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62
Q

inital treatment for Bronchiolitis obliterans (constrictive)?
definitive?

A

High dose steroid and imunosuppression

definitive- lung transplant

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63
Q

What is Crytogenic organizing pneumonia COP

what is the treatment?

A

Common after pneumonia infection
persistent alveolar exudes causing inflammation and scarring *Fibrosis of the bronchioles and alveoli resembling pneumonia on a CXR but does not respond to antibiotics.
Steroids

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64
Q

Pathology of Acute epiglottis

A

inflammation of the epiglottis - thin flap at the base of the tongue which prevents food from going into the trachea. Swelling of the epiglottis can interfere with breathing

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65
Q

What is the most common cause of Acute Epiglottis

A

Haemophilus influenza type B - HiB
Streptococcua pneumonia
staphlococcus aureus
GABHS

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66
Q

What are s/s of Acute Epiglottis

A 
3' D's 
Dysphagia 
Drooling
Distress 
fevers, odynophagia, *inspiration stridor, *Tripoding, leaning forward with elbow on lap
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67
Q

How do you diagnosis Epiglottis ? What are the results?

A

if high suspicion- DO NOT ATTEMPT TO LOOK IN THEIR THROAT with tongue depressor !
Laparoscopy - Definitive = Cherry red epiglottis

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68
Q

Key terms for this diagnosis- Lateral cervical x-ray shows a thumb sign
what other common s/s

A

Acute epiglottis

difficulty swallowing, drooling, distress and tripoding

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69
Q

Treatment for Acute Epiglottis

A
  1. keep the child comfortable position and keep clam
  2. dexamethason to reduce airway inflammation
  3. tracheal intubations to protect airway
  4. 2nd or 3rd gen cephalosporin + penicillin to cover staph
70
Q

what is the most common organism that causes Pertussis

A

it is a highly contagious infection secondary to Gram neg bordetella pertussis

71
Q

What phases will Pertussis go through?

A
  1. Catarrhal - URI 1-2 weeks
  2. Paroxysmal - Severe coughing fits, post cough emesis
  3. Convalescent - resolving 6 weeks
72
Q

This phase of pertussis- cold like symptoms for 1-2 weeks

A

Catarrhal

73
Q

This phase of pertussis- severe coughing fits that come in paroxysms. Has an inspiratory whooping sound with cough fit

A

Paroxysmal phase

74
Q

This phase of pertussis- cough and emesis is decreasing but cough still present up to 6 weeks

A

Convalescent phase

75
Q

How do you diagnosis Pertussis

A

Nasopharyngeal swab - do in the first 3 weeks

Severe Lymphocytosis* 60-80% lymphs

76
Q

Treatment of Pertussis

A
  1. supportive! antibiotics have no effect on duration or severity of illness
    * decreaes contagiousness
  2. Macrolides - Erythromycin or Bactrim
77
Q

what is the most common complication of of pertussis

A

pneumonia
encephalopathy
otitis media
sinusitis

78
Q

What is Hyaline membrane disease also know as

A

Infant respiratory Distress Syndrome

IRDS

79
Q

What is the diagnosis- present in premature infants secondary to insufficiency of surfactant production and lung structural immaturity

A

Hyaline membrane disease - Infant respiratory Distress Syndrome
IRDS

80
Q

A decrease in surfacnt production can lead to what problems in the lungs?

A

Atelectasis and decrease in perfusion and ventilation
decrease lung compliance
-hyaline membrane disease or IRDS

81
Q

What is the most common cause of death in the first month of life?

A

Hyaline membrane disease or IRDS

82
Q

Hyaline membrane disease or IRDS
is most common in whom?
what are risk factors?

A

Common in white males * TWICE AS COMMON
c-section deliveries (under stress and release coristol)
perinatal infections
multiple births - especially premature
maternal diabetes- high insulin levels delays surfactant production

83
Q

What are symptoms of Hyaline membrane disease?

A

IRDS

Shortly after birth infant has respirator distress = tachypnea, nasal flaring, cyanosis, chest wall retractions, apnea

84
Q

what is the best diagnostic test for Hyaline membrane disease. What will it show?

A

CXR- bilateral diffuse reticular ground glass opacities + air bronchograms from atelectasis
poor expansion
domed diaphragms
Histology- waxy appearing layers lining the collapsed alveoli

85
Q

Treatment for Hyaline membrane disease - IRDS

A

Endotracheal tube: Exogenous surfactant given to open alveoli
CPAP
IV fluids

86
Q

How do you prevent Hyaline membrane disease - IRDS

A

If you suspect a premature delivery- give steroids

between 24-36 weeks

87
Q

What re the most common types of Influenza outbreaks

how does it spread?

A

A and B during the fall and winter

Spreads via airborne respiratory secretions

88
Q

Which type of influenza is associated with more severe

extensive outbreaks

A

A

89
Q

What are the most common symtoms of influenza

A

URI
Pharyngitis
pneumonia
abrupt onset of fever, headaches, chills, malaise, myalgias most common in legs and lumbosacral area

90
Q

What are contraindications to Trivalent influenza vaccine

A

eggs
gelatin
thimerosal allergies

91
Q

What are the two types of influenza vaccines

A
  1. trivalent

2. live attenuate - healthy 5-49 years

92
Q

What are contraindications to live attenuated influenza vaccine

A

> 50 years old

Pregnant

93
Q

Treatment for Influenza

A 
best if started with in 48 hours of onset  (3-5 days) 
Neuraminidase inhibitors
1. Oseltamivir (tamiflu)
   Zanamivir (relenza) 
2. Acetaminophen or salicylates
94
Q

What medication is a diskhaler used for the treatment of influenza

A

Zanamivir (relenza)

95
Q

What is this normal breath sound-
Loud high-pitched sounds heard over the trachea and larynx/manubrium
Expiration is longer than inspiration

A

Bronchial

96
Q

What is this normal breath sound-
Medium pitched heard over the primary bronchus and posterioly between the scapula
Expiration is equal to inspiration

A

Bronchovesicular

97
Q

What is this normal breath sound-
Soft gentle sounds over all the areas
Inspiration > expiration

A

Vesicular

98
Q

What is normal pulmonary capillary wedge pressure

A

8-10mmHg

99
Q

what type of breathing is this- deep, rapid, continuous respirations, as a results of metabolic acidosis, deep breaths and no expiratory pause and no expiratory between inhalation and exhalation

A

Kussmaul’s Respiration

100
Q

What type of breathing is- cyclic breathing in response to hypercapnia.. Smooth increases in respiratioins and the gradual decrease in respirations with a period of apnea 15-60 seconds. Due to decreased brain blood flow slowing impulses to the respiratory center

A

Cheyne Stokes

101
Q

What type of inherited disorder is Cystic fibrosis ?

A

Autosomal recessive

102
Q

What gene is the cause of cystic fibrosis

What does it cause?

A

Cystic Fibrosis Trnsmembrane Receptor protein- CFTR
The defect prevents chloride transport and water movement leads to buildup of thick, viscous, mucous in lungs, pancrease, liver, intestines and reproductive tracts then leads to obstructive lung disease and exocrine gland dysfunction

103
Q

Cystic fibrosis is most common in which race?

what is the survival age?

A

white - caucasians
Northen europeans
1 in 3,000
median age of survival 36.8 years

104
Q

What are the top s/s of Cystic Fibrosis

A
  • Young with brochiectasis
  • pancreatic insufficiency
  • growth delays
  • infertility
  • full term infant with meconium ileus at birth (meconium is thicker than ususally and causes an obstruction)
  • Pancreatic insufficiency - steatorrhea, bulky pale/foul smelling stool, *Vitamin deficiency A, D, E, K
  • Recurrent pulmonary infections- Pseudomonas, Staph aureus, productive cough, dyspnea, chest pain, chronic sinusitis
105
Q

What is the inital test done for Cystic Fibrosis

A

Sweat chloride test with pilocarpine >60mmol/L on TWO occasions
(pilocarpine is a cholinergic drug that increases sweat)

106
Q

What is the most common cause of bronchiectasis in the untied states

A

Cystic Fibrosis

107
Q

What will a CXR of Cystic Fibrosis show?

A

if infected with Bronchiectasis
hyperinflation of the lungs
CT- medial/proximal airway dilation lacking tapering and thick walls “tram-track” appearance
Signet ring sign* - pulmonary artery with dialted bronchus

108
Q

What would be common to find on sputum cultures with cystic fibrosis

A

pseudomonas aeruginosa
Haemophilus influenza
staph aureus

109
Q

what would a Pulmonary function test show with Cystic Fibrosis

A

Obstructive - irreversible

110
Q

Treatment for Cystic Fibrosis

A
  1. Airway clearance- bronchodilators, mucolytics, antibiotics, decongestants
  2. pancreatic enzyme replacement- Vitamin A,D,E & K supplments
  3. Lung and pancreatic transplantation
111
Q

What will PFT’s show with Obstructive disorders?

A

increased lung volumes
hyperinflation- High TLC, RV, FRC
obstruction- decrease FEV1, FVC As

112
Q

Asthma
Bronchiectasis
Cystic fibrosis
All these are what type of lung disorder

A

Obstructive disorders

113
Q

what is the patho of Bronchiectasis

A

Inflamed medium bronchi leads to dilation causing

  1. destruction of muscular and elastic tissues of the bronchial wall
  2. collapse of airways from inflammation
  3. obstruction of airflow
  4. impaired clearance of mucous = lung infections
114
Q

What are common organisms that are present in Bronchiectasis

A

MC cause is Cystic fibrosis
H influenza
Pseudomonas* most common with CF
M. Catarrhalis

115
Q

What are s/s of Bronchiectasis

A

Chronic cough that is daily with thick mucopurulent foul smelling sputum
hemoptysis (erosion of bronchial arteries) *massive amounts
Presistent crackles at the bases
clubbing, wheezing, rhonchi

116
Q

What will a CT of Bronchiectasis show?

A 
airway dilation
lack tapering of bronchi 
bronchial wall thickening  *tram-track 
mucopurulent plugs
Signet ring sign
117
Q

What are Signet rings?

A

Dilated pulmonary arteries

118
Q

What pathogen is most commonly found in a cystic fibrosis patient with bronchiectasis

A

** Pseudomonas

119
Q

what is the treatment for Bronchiectasis with Aspergillus

A
  • thick brown sputum
    Corticosteroids + Itraconazole
    if sxatic aspergilloma = Surgical
120
Q

Treatment for Bronchiectasis

A 
Antibiotics - empiric = ampicillin, amoxicillin 
pseudomonal coverage = fluoroquinolone 
*antibitic cycling may be used 
Mucus managment 
Chest physiotherapy 
broncodilators 
anti-inflammatory 
surgery 
embolization for bleeding 
transplant
121
Q

What is a reversible hyperirritability of the tracheobronchial tree resulting in broncoconstriction and inflammation

A

Asthma

122
Q

What is the atopy most common predisposing factors

A
  1. Asthma
  2. Nasal polyps
  3. ASA/NSAID allergy
  4. Eczema
123
Q

What does bronchoconstriction in asthma lead to?

A

airway narrows because of smooth muscle contrction, edema and thick mucous secretions.
the constrictions lead to air trapping causing obstructioin and decrease in expiratory air flow and increase airway resistance = increased work of breathing

124
Q

What types of cells lead to inflammation responds in asthma?

A 
T lymphocytes
Neutrophils 
Eosinophils
Cytokines = leukotrines 
Histamine releasing from mast cells * IgE mediated
125
Q

What is causes the airway hyper-reactivity in asthma?

A

Early - IgE
later T-Cell
Extrinsic- allergic triggers pollen, mold, dust
Intrinsic- nonallergic triggers - infections, drugs, occupations, exercises, emotions, cold air

126
Q

Key symptoms for this diagnosis- Dyspnea, wheezing and coughing at night*

A

Asthma

127
Q

What are some clues to know how well the asthma is controlled?

A
  1. Steroid use
  2. previous intubations, ICU, hospital admissions
    (>2 times a year or >3 times in one month)
  3. How often waking up at night coughing
128
Q

Is Asthma an inspirational or expirational wheeze ?

A

proonged expirational wheeze with hyperresonance

decreased breath sounds

129
Q

What is Status asthmaticus defined as?

A
  1. inability to speak in full sentances
  2. Peak expiratory flow <40% predicted
  3. altered mental status
  4. pulses paradoxus (inspration SBP drops >10
  5. tripod position
  6. silent chest ! no air exchange
130
Q

What is the best way to objectively asses severity and patients response in the ED in Asthma ?

A

Pea kExpiratory Flow Rate- PEFR

> 15% from inital response shows responding to treatment

131
Q

What level of Po2 would indicative of respiratory distress in an infant or child?

A

<90%

132
Q

What is the gold standard to diagnosis asthma ?

A

Pulmonary function test - RV, TLC, RV/TLC ratio

133
Q

What will the pulmonary function test show with asthma
RV?
TLC?
RV/TLC?

A

Increase residual volume - RV
Increased Total lung capacity
Increased RV/TLC ratio

134
Q

what if the PFT are normal ? what is the next step?

A

Induce bronchospasm/bronchodilator test using medication and measure the FEV1

135
Q

What drugs are used in the Bronchoprovocation testing for asthma?
what is positive?

A
  1. Metacholine
    + is >20 % drop in the FEV 1
  2. bronchodilator
    + is an increase >12% in FEV1
136
Q

Exercise induced asthma test is positive when?

A

> 15% drop in FEV1

while exercising of course

137
Q

What would an ABG show in Asthma attack?

A

Respiratory Alkalosis

138
Q

What peak expiration flow would you admit the patient with?

A 
<50% predicted 
= < 15% inital value 
200cc 
FEV < 1L 
ER visit with in 3 days of exacerbation 
altered mental status
139
Q

What peak expiration flow can you discharge a patient with?

A

> 70% predicted
15% initial
clear lungs with good air movement
will follow up in 24-72 hours

140
Q

What is first line asthma treatment for acute attack?

A

Albuterol - proventil
Terbutaline
Epinephrine
levalbuterol

141
Q

What is the MOA for a Short acting beta agonist

A 
Bronchodilator - especial peripheral 
decreases bronchospasm 
inhibits the release of bronchospastic mediators 
increases ciliary movement 
decreases edema
142
Q

How are SABA’s given

how often?

A

Nebulizers most common in ED

q 20 minutes x3 doses

143
Q

What are side effects of SABA’s

A

albuterol- tachycardia, arrhythmias, muscle tremor, CNA stimulation

144
Q

What Anticholinergic is used for treatment of asthma?

A

Ipratropium- atrovent

145
Q

MOA for what drug- Central bronchodilator that inhibits vagal medicated bronchoconstriction and inhibits nasal mucosal secretions

A

Anticholinergics- Ipratropium

146
Q

What are side effects of Ipratropium

A 
anticholinergic- 
thirst, blurred vision
dry mouth
urinary retention
dysphagia
acute glaucoma
147
Q

What anti-inflammatory is used in mod-severe asthma attacks?

A

Prednisone
Methprednisone
Prednisolone

148
Q

What is the onset of action of oral and IV steroids in asthma?

A

4-8 hours

will decrease relapse and reverses the late pathophysiology

149
Q

What are side effects of systemic corticosteroids?

A 
Immunosuppression
hyperglycemia
fluid retention
osteoprosis * 
cataracts 
Growth delay*
150
Q

Becloethasone
flunisolide
triamcinolone
are all what class of medications?

A

Inhaled corticosteroids

151
Q

Ipratropium is what class of medicaiton?

A

Anticholinergic

152
Q

Albuterol
terbutaline
epinephrine
are all what class of medications

A

B2 agonists - short acting - SABA

153
Q

What is the drug of choice for long term persistent asthma ?

A

Inhaled corticosteroids - ICS
Becloethasone
flunisolide
triamcinolone

154
Q

What are side effects of of inhaled corticosteroids?

A

Thrush *

use a spacer and rise the mouth

155
Q

Salmeterol
symbicort
advair diskus
are all what class of meciations?

A

Inhaled corticosteroids

156
Q

what do you add on to persistent asthma that is not controlled with ICS alone?

A

long acting B2 agonist - LABA

157
Q

If a patient is on ICS and LABA what is the next step if controlled?

A

if controlled >3 months

step down off LABA

158
Q

Cromoly
Nedocromil
are all what class of medicaitons
-what are they used for?

A

Mast cell modifier

used for inhibits acute phase response to cold air, exercise, sulfites

159
Q

Montelukast
Zafirlukast
Zileuton
-are all what class of medications?

A

Leukotriene Modified

160
Q

Leukotriene modifiers are used for what ?

A

asthmatics with allergic rhinitis

aspirin induced asthma

161
Q

What medication is used in asthma that is a bronchodilator that improves respiratory muscle endurance

A

Theopphylline

162
Q

What are side effects of Theophylline?

A

nervousness, nausea, vomiting, anorexia, headache, numerous drug interactions

  • Narrow TI- toxicity causes arrhythmia and seizures
  • need higher dose in smokers
163
Q

What medications are used in severe asthma?

A

IV magnesium
Ketamine
Heliox
Omalizumab - severe uncontrolled asthma

164
Q

When are intermittent symptoms of asthma occurring?

  • How often are they using a rescue inhaler
  • How often are they waking up from coughing?
  • How often does it effect activity?
  • Lung function levels?
A 
<2 times a day and <2 a week 
using albuterol <2 times a day or <2 times a week
waking up at night less than 2 a month 
Does not effect activity
FEV1 >80%
165
Q

When are MILD symptoms of asthma occurring?

  • How often are they using a rescue inhaler
  • How often are they waking up from coughing?
  • How often does it effect activity?
  • Lung function levels?
A 
> 2 days a week 
but not daily 
using albuterol >2 times a day or week 
waking up at night 3-4 times a month 
has minor effect in activity
FEV1 >80%
166
Q

When are MODERATE symptoms of asthma occurring?

  • How often are they using a rescue inhaler
  • How often are they waking up from coughing?
  • How often does it effect activity?
  • Lung function levels?
A

Daily
using albuterol daily
waking up at night more than 1 a week - not every night
has some limitation in activity

167
Q

When are SEVERE symptoms of asthma occurring?

  • How often are they using a rescue inhaler
  • How often are they waking up from coughing?
  • How often does it effect activity?
  • Lung function levels?
A 
Throughout the day
Several times a day 
using albuterol several times a day 
waking up every night coughing 
extremely limited in activity 
FEV1 <60%
168
Q

What is the treatment intermittent asthma

A

Albuterol as needed

169
Q

what is the treatment for mild asthma

A

Albuterol

ICS low dose

170
Q

what is the treatment for moderate asthma

A 
Abluterol 
ICS low dose + long acting 
OR 
ICS bump up dose 
OR 
Leukotrine
171
Q

what is the treatment for severe asthma

A

Albuterol
ICS high dose + long acting
can add Omalizumab

Pediatric: HEENT, PULM, ID (4 decks)

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