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Clin Med IV Exam III > Pediatric pulmonolgy > Flashcards

Pediatric pulmonolgy Flashcards

1
Q

Epiglottitis

A

acute inflammation in the supraglottic region

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2
Q

Who gets epiglottitis

A

typically kids <6 months

rare in the US

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3
Q

Why type of kids are at risk for epiglottitis

A

they are not fully immunized

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4
Q

What causes epiglottitis?

A
  • strep pyogenes
  • strep pneuo
  • staph
  • H flu (less likely in pedi)
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5
Q

Clinical presentation of epiglottitis

A

Rapid onset

  • muffled voice
  • drooling!
  • pain
  • labored breathing
  • tripodding
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6
Q

What is the tripod position

A
  • neck hyperextended
  • mouth opened
  • chin up sniffing
  • leaning forward
  • outstretched arms
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7
Q

Late findings of epiglottitis

A
  • air hunger
  • stridor
  • restlessness

Pre apnea–> coma–> death

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8
Q

Diagnosis of epiglottitis is what

A

Clinical suspicion!!!!

can do xray–> look for thumbprint sign

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9
Q

If you have clinical suspicion of epiglottitis–>

A

ANESTHESIA

if in office, call ED and EMS

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10
Q

What do you do before anesthesia arrives in a child with epiglottitis

A
  • keep patient calm and quiet
  • O2 if tolerated
  • establish 2 lines if tolerated
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11
Q

Treatment of epiglottitis

A
  • intubation
  • IV abx (ceftriaxone, cefotaxime)
  • supportive care
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12
Q

Is epiglottitis contagious

A

NO!

but if unimmunized or immunosuppressed family contacts consider ppx (rifampin)

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13
Q

What is croup

A

subglottic inflammation of the larynx and trachea

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14
Q

Etiology of croup

A

typically viral

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15
Q

Who gets croup

A
  • children 3 months to 5 years (2 is peak)

- males slightly more often than females

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16
Q

When is croup typically seen

A
  • in fall and spring

- between 10pm and 4am

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17
Q

Virus that causes croup

A
  • parainfluenza 1,2,3
  • influenza A or B
  • adenovirus, RSV
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18
Q

Symptoms of croup. When do they occur?

A

day 0-2

  • rhinorrhea
  • low grade temp
  • +/- cough
  • +/- pharyngitis

Day 0-5

  • barking cough
  • +/- stridor
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19
Q

How long does it take croup to resolve

A

5-7 days

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20
Q

When does the course of croup worsen

A

day 2 and 3 of the barking cough

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21
Q

Diagnosis of croup?

A

clinical diagnosis!!

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22
Q

When do you do outpatient treatment for child with croup? What is it?

A

mild or moderate croup- no stridor

Decadron (IV solution given orally)

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23
Q

Treatment for moderate to severe croup

A
  • decadron
  • racemic EPI by neb
  • watch for 2 to 3 hours and watch for recurrence
  • if you need to give another dose consider admission
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24
Q

At home mild croup treatment

A
  • cold night air
  • humidified air
  • breathe air from air conditioning or freezer
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25
Q

Resolution of croup

A

within 5 to 7 days

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26
Q

What is bacterial tracheitis

A

bacterial infection of the trachea that can cause complete respiratory failure by blockage of the trachea with swelling and purulent drainage

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27
Q

Bronchiolitis

A

inflammation of the lower respiratory tract

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28
Q

Who gets bronchiolitis

A

kids less than 2 years old

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29
Q

Which kids with bronchiolitis are at the greatest risk for morbidity/mortality

A
  • kids with underlying cardiopulmonary disease

- kids <2 months are at risk for respiratory compromise

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30
Q

What causes bronchiolitis

A
  • > 50% caused by RSV
  • viral–> parainfluenza and adenovirus
  • Bacterial–> mycoplasma
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31
Q

What causes the symptoms seen in bronchiolitis

A

inflammation fo the bronchioles, secretions into the inflamed bronchial tree

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32
Q

What is the typical presentation of bronchiolitis

A
  • begins with URI (copious clear rhinorrhea, congestion, low grade fever)
  • wheezing +/- crackles
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33
Q

When is bronchiolitis most commonly seen

A

late fall throughout winter

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34
Q

How is bronchiolitis spread

A

respiratory droplets

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35
Q

Vitals in child with bronchiolitis

A
  • fever (up to 102)
  • tachycardia
  • tachypnea
  • respiratory distress
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36
Q

Lung sounds in bronchiolitis

A
  • wheezing

- rhonci or fine rales

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37
Q

If decreased breath sounds in bronchiolitis patients–>

A

BAD

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38
Q

When do you preform a nasal washing to do a PCR for RSV

A
  • pt <2 to 3 months or has underlying risk factors
  • if you will hospitalize pt
  • if youre in the ED and the pcp or hospitalist asks you!
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39
Q

When should you do a CXR in pt with suspected bronchiolitis

A

if it is first episode of wheezing ever–> look for foreign body

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40
Q

Treatment for bronchiolitis

A
  • albuterol
  • cool mist
  • PO steriods (decadron, prednisolone)
  • supportive treatment (fluids, tylenol)
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41
Q

When should a patient with bronchiolitis be hospitilized

A

-if hypoxic
awake <91-93%
asleep <91%

  • apneic episodes
  • premie <12 weeks
  • NB to 12 weeks and any suggestion of resp distress
  • underlying cariopulm disease
  • parents unable to care for child

ANY CHILD THAT IS WORRISOME

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42
Q

Inpatient bronchiolitis treatment

A
  • oxygen support
  • consider CPAP or high flow O2
  • intubation if impending respiratory failure
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43
Q

What is the course of bronchiolitis

A
  • gets worse days 2 to 5

- last for 10 to 12

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44
Q

RVS vaccine prophylaxis

A

Synergis

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45
Q

Pediatric asthma–>

A

spacers! spacers! spacers!

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46
Q

Does wheezing always equal asthma

A

NOPE

47
Q

Making the diagnosis of asthma

A
  1. demonstration of variable episodic expiratroy airflow limitation that is reversible
  2. exclusion of other reasons for the finding
48
Q

If a child presents with first time wheezing can you say they have asthma

A

NO, reactive airway disease

49
Q

Symptoms of asthma

A
  • dry cough
  • wheezing
  • possible breathlessness, chest tightness, chest pain
50
Q

Symptoms pattern with asthma

A
  • intermittant w/ asxs at baseline
  • chronic with periods of worsening
  • worse in the morning (“morning dipping”)
51
Q

Asthma triggers

A
  • seasonal allergies
  • houshold allergies
  • URIs
  • exercise
  • weather
  • stress
  • perfumes, hair spray, cleaning products, paint
52
Q

Atopic illness?

A
  • asthma
  • atopic dermatitis
  • food allergies
  • allergic rhinitis
53
Q

What causes pertussis

A
  • bortadella pertussis–> epidemic pertussis

- para pertussis–> sporadic pertussis

54
Q

What is bortadella pertussis

A

gram negative coccobaccilus that colonizes the ciliated epithelium

55
Q

How is pertussis spread

A

through the air by infection droplets from respiratory mucous membrane

*highly contagious

56
Q

How long is the incubation period for pertussis

A

3-12 days

57
Q

Stages of pertussis

A
  • catarrhal stage
  • paroxysmal stage
  • conval
58
Q

What stage of pertussis is most contagious

A

catarrhal stage

59
Q

What classifies each stage of pertussis? How long does it last?

A

Catarrhal stage: 1 to 2 weeks: runny nose, sneezing, low grade fever and mild cough

Paroxysmal stage: 1 to 6 weeks: burst of numerous, rapid coughs followed by a long inhaling effort characterized by a high pitched whoop

Convalescent stage: can last for months: paroxysms may recur whenever the patient suffers any subsequent respiratory infection

60
Q

Children or infants with paroxysms may have what types of thing

A
  • respiratory distress
  • tongue protruding
  • face turning purple
  • eye bugling
  • watery eyes
  • post tussive emesis and exhaustion
61
Q

Pertussis in adolescents and adults

A
  • typically milder
  • persistent cough similar to that found in other URIs
  • have the cough in paroxysms without or without he “whoop”
62
Q

Diagnosis of pertussis

A

Clinical!–> if suspiscious, treat and watch for results

can do nasopharygneal swab

63
Q

Treatment of pertussis

A

Zithromax 10mg/kg on day 1 then 5mg/kg days 2-5

supportive care

64
Q

Mild complications of pertussis

A
  • ear infection
  • loss of appetitis
  • dehydration
  • pneumonia
  • rib fracture
65
Q

More severe complications of pertussis

A

if hypoxic from paroxysm–> encephalopathy and seizures

66
Q

Are there usually complications of pertussis

A

nope!

67
Q

Partial airway obstruction=

A

stridor

68
Q

Airway obstruction=

A

silence

69
Q

No airway=___=___=___

A

no airway =no oxygenation= no ventilation= tissue death

70
Q

Most FBA in infants and toddlers

A

food–> peanuts

71
Q

What causes fatal aspiration

A
  • balloons
  • balls
  • marbles
  • toys

anything strong, round and unbreakable

72
Q

Where does the FB lodge in kids

A

proximal mainstem bronchus

73
Q

When should you suspect a FB aspiration in a kid

A
  • witnessed choking event
  • wheezing
  • formerly speaking and wont speak
  • coughing without URI symptoms
74
Q

Acute and life threatening foreign body aspiration has what symptoms

A
  • respiratory distress
  • cyanosis
  • altered mental status
75
Q

Symptoms of less acute and not emergent life threatening FBA

A

Classic triad!

  • wheezing
  • decreased air entry especially regionally
  • cough
76
Q

Diagnosis of FBA

A

History!
Bronchoscopy is diagnostic tool and treatment

+/- xray

77
Q

When do you do a flexible bronchoscopy for diagnosis of FBA

A
  • chronic or recurrent pneumonia
  • chronic cough
  • can remove object
78
Q

When do you use a rigid bronchoscopy for diagnosis of FBA

A

-if you suspect a non emergent FBA

  • anesthesia required
  • less risk of dislodgement
79
Q

Complications of FBA removal

A
  • dislodgement or breakage w/ advancement into bronchioles or lings
  • infection if fb is in too long
  • inflammation
80
Q

What is cystic fibrosis in its simplest form

A

genetically driven disruption of the chloride channel

81
Q

Which protein affected in CF? What does that protein typically do

A

CFTR protein–> complex chloride channel and regulatory protein found in exocrine tissue

82
Q

CF causes viscous secretions where

A
  • lungs
  • intestine
  • pancreas
  • liver
  • reproductive tract
83
Q

What happens to sw3eat gland secretions in CF

A

increased salt content

84
Q

Respiratory features of CF

A
  • persistant productive cough
  • hyperinflation of lungs on cxr
  • PFTs consistent with obstructive airway disease
85
Q

Progressive respiratory symptoms of CS

A
  • chronic bronchitis
  • bronchiectasis
  • increase cough/sputum-tachypnea
  • malaise
  • anorexia and weight loss
  • clubbing
86
Q

What colonizes in the lungs of CF patients

A
  • staph aureus
  • h flu
  • pseudomonas
87
Q

Extrapulmonary clinical features of CF

A
  • panopacification of sinuses

- nasal polyposis

88
Q

Pancreatic features of CF

A
  • exocrine function typically insufficient
  • insufficient digestive enzymes–>malabsorption–> FTT, electrolye abnl, anemia

+/-glucose intolerance or CF related DM

89
Q

What is an important early clinical feature of CF

A

meconium ileus and distal ileal obstruction in newborns

Distal intestinal obstructive syndrome–> seen in sicker CF patients

90
Q

Billiary issues for CF

A
  • focal billiary cirrhosis caused by impissated bile
  • hepatomegaly
  • aymptomatic liver disease
  • cholelithiasis
91
Q

Muscluoskeletal manifestations of CF

A
  • reduced bone mineral content
  • hypertrophic osteoarthropaathy
  • clubbing of fingers and toes
92
Q

What is needed to make diagnosis of CF

A
  • clinical sxs in at least one organ system
  • evidence of CFTR dysfunction on any one of the following tests (sweat chloride, presense of 2 disease causing mutation, abnormal nasal potential difference)
93
Q

Classic CF

A
  • disease in or or more organ systems

- pt has elevated sweat chloride

94
Q

Non-classic CF

A
  • meet disease criteria in one or more organ systems with normal or borderline sweat test
  • requires DNA analysis for dx
  • more common in adults and older adolescents–> milder
95
Q

Clinical features that make you suspicious of CF

A
  • chronic reproductive cough
  • recurrent upper and lower resp infections
  • hyperinflation on CXR
  • PFTs that show obstructive disease
96
Q

Newborn screening for CF

A

measure levels of immunoreactive trypsin on dried blood sample

confimred by DNA or sweat tsting

97
Q

Primary test for dx of CF?

A

sweat test

98
Q

How is a sweat test done

A

by applying pilocarpine iontophoresis and determining the chloride concentration in the resulting sweat chemically

99
Q

When is a sweat test done

A

if positive new born screen

meconium ileus after DOL 2

100
Q

When is molecular dx done for CF

A

on all pts w/ intermediate sweat test results

prognostic and epidemiologic interest

101
Q

How many mutations are screened when testing for CF

A

23

pt has to have at least 2 to be considered positive for CF

102
Q

Infants at risk for RDS

A

born before 30 weeks

103
Q

When does formation of alveoli begin

A

24 weeks

104
Q

The majority of RDS infants are born before when

A

28 weeks

105
Q

Etiology of RDS

A

surfactant deficiency–> atelectasis–> V/Q mismatch–> pulmonary inflammatory response–> potential lung injury and pulmonary edema

106
Q

Clinical manifestation of RDS

A
  • tachypnea
  • nasal flaring
  • expiatory grunting
  • retractions
  • cyanosis/pallor
  • decreased breath sounds
  • diminished peripheral pulses
  • peripheral edema
  • poor urine output
107
Q

ARD on chest xray

A
  • airbronchograms
  • low lung volume
  • ground glass appearance
  • pneumothorax
108
Q

Ways to prevent RDS

A
  • antenatal corticosteriods
  • exogenous surfactant
  • assisted ventilation
109
Q

Who gets antenatal corticosteriods

A

pregnant women at risk of delivery before 34 weeks

110
Q

When is eogenous surfactant given to infants

A

preterm infants with resp distress/apnea/ fail cpap

given through ET tube

111
Q

Positives of mechanical ventilation in ADS babies

A
  • PEEP corrects atelectasis and give route for exogenous surfactant
  • improves arterial oxygenation
112
Q

Negative to mechanical ventilation in ADS babies

A
  • traums by volume adn pressure
  • oxygen toxicity
  • intervention can lead to BPD
  • intubation injury
113
Q

New ventilation for RDS?

A
  • nasal CPAP

- NIPPV

114
Q

Other things to think about for RDS babies

A
  • thermoregulation
  • fluid management
  • cardiovascular management
  • nutritional support

Clin Med IV Exam III (8 decks)

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