Pediatric Pulmonology Flashcards
What is chronic inflammatory disorder that produces airway hyperresponsiveness, airflow limitation and persistent respiratory symtpoms
Asthma
what is the strongest predisposing factor for asthma
atopy
what is the first line medication treatment for asthma
short-acting beta agonist as needed
What is status asthmaticus
medical emergency that requires careful evaluation and agressive therapy - asthma attack refratory to treatment
what is the mainstay of medical therapy for status asthmaticus
frequent administration of beta-agonists inhalations, combined with early corticosteroid use
IV magnesium can be used as an adjunctive measure
THeohylline may be also used as an adjunctive measure
may hae to consider mechanical ventilation
what is the leading cause of death in children with asthma
hypoxia
what are the indications for ICU admission with status asthmaticus
altered sensorium
use of continuous inhaled beta-agonist therapy
exhaustion
markedly decreased air entry
rising PCO2 despite treatment
prescence of high-risk factors for a severe attack
fialure to improve despite adequate therapy
What is cystic fibrosis
autosomal recessive inherited disorder
progressive dysfunction of ion channel responsible for movement of water and salt through epithelail cells
thick viscous mucus builds up, ccompromises host defenses
what is the classic presentation of CF
toddler to small child with bronchiectasis, pancreatic insufficiency, growth delays (aka failure to thrive) and infertility
what is the pulmonary presentation of CF
persistent cough, productive due to hypersecretion
pulmonary inflam, obstruction
wheezing, dyspnea
recurrent infection
what is the liver presentation with CF
hepatic insufficiency
prolonged neonatal jaundice
what is the pancreatic presentation with CF
pancreatic insufficiency
steatorrhea
malabsorption
pnacreatitis
exocrine hypersecretion
how is CF diagnosed/worked up
newborn screen may include immunoreactice trypsin (IRT) measurement, elevated with CF
sweat chloride test
confirmation via genetic testing (definitive)
what is the gold standard for diagnosis of CF
sweat chloride testing
what is the treatment of pneumonia
broad spectrum abx for severely ill pts
oral abx for less severe (cefuroxime, amox, augmentin, macrolide)
what is the most common pneumonia in children
viral
usually URI precedes penumonia
what is the treatment of viral pneumonia
supportive, hospitalization only if respiraotry distress
consider Ribivirin or Tamiflu if indicated
what is the treatment for FB aspiration
bronchoscopy to remove object
followed by inpt monitoring, nubulized albuterol and/or chest physiotherapy
what is the treatment of a <6 month old with acute bronchiolitis
hospitalation
fluids, supportive care
what is the most common cause of acute bronchiolitis
RSV
what is the catarrhal stage of pertussis
URI symtpoms (fever, fatigue, rhinorrhea, conjunctival injection), duration ~1-2 weeks; most infectious stage of illness
what is the paroxysmal stage of pertussus
repeated coughs, followed by forceful inspiration creating characteristic “whoop”; fever comes and goes; post tussive vomitting common
duration 1-6 weeks, up to 10 weeks
what is the convalescent stage of pertussus
residual cough persists for weeks to months, usually triggered by exposure to another URI and irritant
what is the treatment of pertussis
abx may help in catarrhal stage
erythromycin 40-50mg/kg/day - gold standard
zithromax
supportive care
what is the treatment of pertussis in pts < 1 year old
hospitalized regardless of symptoms
what is the treatment of neonates with pertussis
admit to ICU as life trheatening cardiopulmonary complications and arrest can occur unexpectedly
what is the prevention of pertussis
immunization: DTaP/Tdap
chemoprophylaxis with macrolides for close contacts, esp <20 yo
