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Pediatric EOR exam > Pediatric Pulmonology > Flashcards

Pediatric Pulmonology Flashcards

1
Q

what is the pathophysiology behind bronchiolitis

A

common, acute lower respiratory tract infection that primarily affects the small airways and causes inflammation

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2
Q

what is the MC population for bronchiolitis

A

under 2 years old

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3
Q

what is the MCC of bronchiolitis

A

RSV

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4
Q

what is the presentation of bronchiolitis

A
  • URI symptoms
  • lower respiratory symptoms
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5
Q

how do you diagnose bronchiolitis

A

clinically

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6
Q

what is the treatment of bronchiolitis

A
  • hydration
  • relief of nasal congestion
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7
Q

what are the indications for hospitalization of bronchiolitis

A
  • increased respiratory effort
  • hypoxemia
  • toxic appearance
  • dehydration
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8
Q

what are triggers for asthma

A
  • virus
  • allergies
  • stress
  • exercise
  • weather
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9
Q

what is the presentation of asthma

A
  • cough
  • chest tightness
  • SOB
  • difficulty breathing
  • signs of atopy
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10
Q

how do you diagnose asthma

A

spirometry

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11
Q

what spirometry results indicate asthma

A
  • 85% predicted FEV/FVC
  • increase in 12% of either FEV1 or FVC following neb treatment
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12
Q

generalized treatment for asthma

A

start with ICS and SABA then you can add LABA later

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13
Q

what are the classifications for asthma

A
  • mild intermittent: 2 or fewer days per week with no nighttime symptoms
  • mild persistent: 2 or more days per week and nighttime symptoms 3-4 times per month
  • moderate persistent: daily symptoms and nighttime awakening 2 nights per week
  • severe persistent: symptoms throughout the day and nighttime awakenings nightly
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14
Q

How do you differentiate well controlled, not well controlled, and very poorly controlled asthma

A
  • well controlled: symptoms < 2 days per week
  • not well controlled: symptoms > 2 days per week or multiple times a night
  • very poorly controlled: symptoms persist throughout the day
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15
Q

what is the etiology of croup

A

parainfluenza

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16
Q

what is the clinical presentation of croup

A
  • barking cough
  • inspiratory stridor
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17
Q

management of mild croup

A

supportive

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18
Q

management of moderate to severe croup

A

dexamethasone and racemic epinephrine and observe for 3-4 hours

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19
Q

what organs are affected by CF

A
  • lungs
  • upper respiratory
  • sweat glands
  • pancreas
  • intestines
  • liver
  • reproductive tract
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20
Q

How is CF typically caught

A
  • newborn screening
  • meconium ileus
  • respiratory symptoms
  • FTT
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21
Q

what are the typical GI issues for CF

A
  • rectal prolapse
  • volvulus
  • meconium
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22
Q

What are the typical respiratory issues for CF

A
  • chronic sinusitis
  • nasal polyps
  • persistent cough
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23
Q

what are the typical pancreas issues for CF

A
  • abnormal electrolyte secretions
  • decreased pancreatic enzymes
  • diabetes
  • pancreatitis
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24
Q

what are the typical GU issues for CF

A
  • infertility
  • reduced testicular size
  • abnormal menstrual cycles
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25
Q

How is CF typically diagnosed

A

sweat chloride test

26
Q

what are the indications for the sweat chloride test

A
  • two weeks old and weight >2kg
  • positive screening of newborn
  • meconium ileus
  • siblings of patients with CF
27
Q

How do you interpret a sweat chloride test

A
  • <30: normal
  • 40-60: borderline
  • > 60: positive
28
Q

What is the treatment for CF

A
  • airway clearance
  • inhaled bronchodilators
  • chest physiotherapy
  • pancreatic enzymes
  • vaccinations
29
Q

how do you treat an acute exacerbation of CF

A
  • sputum culture
  • at least 1 abx to cover each pathogen that is cultured and 2 for pseudomonas
30
Q

what is hyaline membrane disease

A
  • deficiency in surfactant
31
Q

what is the clinical presentation of hyaline membrane disease

A

-prematurity
-tachypnea
-nasal flaring
-diminished breath sounds
-cyanosis
-grunting

32
Q

when does hyaline membrane disease occur?

A

minutes to hours after a premature birth

33
Q

what is the treatment of hyaline membrane disease

A
  • nasal CPAP
  • surfactant replacement
34
Q

how do you prevent hyaline membrane disease

A
  • prenatal administration of a single course of steroids to women who are in premature labor
35
Q

what is the presentation of foreign body aspiration

A
  • coughing
  • choking
  • wheezing
  • cyanosis
  • drooling
  • stridor
36
Q

how do you distinguish between laryngotracheal vs bronchial foreign body

A
  • laryngotracheal: stridor, hoarseness, complete apnea
  • bronchial: unilateral wheezing and decreased breath sounds
37
Q

how do you treat a foreign body aspiration

A
  • under age 1: hard back blows
  • over age 1: abdominal thrusts/heimlich maneuver
38
Q

How would you tell whether a coin is in the trachea or the esophagus

A

Xray showing…
* circle on AP/PA = esophagus
* circle on lateral = trachea

39
Q

what confirms the diagnoses for airway foreign bodies

A

bronchoscopy

40
Q

what is the MCC of lobar pneumonia

A

strep pneumo

41
Q

what is the MC location of pneumonia for each organism

A
  • strep pneumo: RLL
  • klebiella: upper lobes
  • legionella: lower lung fields
42
Q

what is the appearance of lobular/bronchopneumonia

A
  • central bronchi involved
  • asymmetrical
  • patchy appearance
43
Q

what is interstitial pneumonia

A

results from edema and inflammatory cellular infiltrate into the interstitial tissue of the lung and fibrosis

43
Q

what is the interstitial space of the lungs

A

the space between the air sacs and small blood vessels that surround the air sacs. This space contains connective tissue and fluid.

44
Q

what is the appearance of interstitial pneumonia on a chest xray

A
  • ground glass appearing
  • bilateral and symmetrical
45
Q

what is aspiration pneumonia

A

pneumonia that develops following the inhalation of oropharyngeal secretions, gastric contents or colonized organisms

46
Q

what is the MC site of aspiration pneumonia in alcoholics

A

RUL due to typically aspirating in the prone position

47
Q

what is ventilator associated pneumonia

A

pneumonia that develops 48 hours or longer after mechanical ventilation

48
Q

what are s/s of community acquired pneumonia

A
  • fever
  • dyspnea
  • chills
  • cough with sputum production
  • crackles and rales
  • dull to percussion
49
Q

how do you diagnose community acquired pneumonia

A

chest Xray

50
Q

how do you determine if pneumonia needs inpatient or outpatient care

A
  • PSI
  • CURB 65
51
Q

what is the CURB 65

A
  • Confusion
  • BUN >19
  • RR >30
  • BP <90/60
  • > 65 y/o

one or less indicated patient can be treated outpatient. Greater than 1 risk = hospitalization

52
Q

what is the outpatient treatment of community acquired pneumonia

A
  • no comorbs: amoxicillin or azithromycin
  • comorbs: (azithromycin + augmentin) OR (levo alone)
53
Q

what is the inpatient treatment of community acquired pneumonia

A
  • Non ICU: (Levo alone) OR (rocephin + azithromycin)
  • ICU: (Rocephin + azithromycin) OR (rocephin + levo)
54
Q

what is the presentation of klebsiella pneumonia

A
  • red current jelly sputum
  • ground glass opacities
55
Q

what is the presentation of staph pneumonia

A
  • low grade fever
  • sputum production
  • empyema or pleural effusions on cxr
56
Q

what is the treatment of staph pneumonia

A

clindamycin

57
Q

what is the presentation of viral pneumonia

A
  • fever
  • chills
  • nonproductive cough
  • tachypnea
58
Q

what is the treatment of viral pneumonia

A

supportive

59
Q

what is the presentation of pneumocystis jiroveci pneumonia

A
  • fever
  • dry cough
  • elevated LDH
  • diffuse, bilateral infiltrates on cxr
  • ground glass opacities
60
Q

what is the treatment of pneumocystis jiroveci pneumonia

A

bactrim

Pediatric EOR exam (20 decks)

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