Pediatric Pulmonology Flashcards
what is the pathophysiology behind bronchiolitis
common, acute lower respiratory tract infection that primarily affects the small airways and causes inflammation
what is the MC population for bronchiolitis
under 2 years old
what is the MCC of bronchiolitis
RSV
what is the presentation of bronchiolitis
- URI symptoms
- lower respiratory symptoms
how do you diagnose bronchiolitis
clinically
what is the treatment of bronchiolitis
- hydration
- relief of nasal congestion
what are the indications for hospitalization of bronchiolitis
- increased respiratory effort
- hypoxemia
- toxic appearance
- dehydration
what are triggers for asthma
- virus
- allergies
- stress
- exercise
- weather
what is the presentation of asthma
- cough
- chest tightness
- SOB
- difficulty breathing
- signs of atopy
how do you diagnose asthma
spirometry
what spirometry results indicate asthma
- 85% predicted FEV/FVC
- increase in 12% of either FEV1 or FVC following neb treatment
generalized treatment for asthma
start with ICS and SABA then you can add LABA later
what are the classifications for asthma
- 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
How do you differentiate well controlled, not well controlled, and very poorly controlled asthma
- 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
what is the etiology of croup
parainfluenza
what is the clinical presentation of croup
- barking cough
- inspiratory stridor
management of mild croup
supportive
management of moderate to severe croup
dexamethasone and racemic epinephrine and observe for 3-4 hours
what organs are affected by CF
- lungs
- upper respiratory
- sweat glands
- pancreas
- intestines
- liver
- reproductive tract
How is CF typically caught
- newborn screening
- meconium ileus
- respiratory symptoms
- FTT
what are the typical GI issues for CF
- rectal prolapse
- volvulus
- meconium
What are the typical respiratory issues for CF
- chronic sinusitis
- nasal polyps
- persistent cough
what are the typical pancreas issues for CF
- abnormal electrolyte secretions
- decreased pancreatic enzymes
- diabetes
- pancreatitis
what are the typical GU issues for CF
- infertility
- reduced testicular size
- abnormal menstrual cycles
How is CF typically diagnosed
sweat chloride test
what are the indications for the sweat chloride test
- two weeks old and weight >2kg
- positive screening of newborn
- meconium ileus
- siblings of patients with CF
How do you interpret a sweat chloride test
- <30: normal
- 40-60: borderline
- > 60: positive
What is the treatment for CF
- airway clearance
- inhaled bronchodilators
- chest physiotherapy
- pancreatic enzymes
- vaccinations
how do you treat an acute exacerbation of CF
- sputum culture
- at least 1 abx to cover each pathogen that is cultured and 2 for pseudomonas
what is hyaline membrane disease
- deficiency in surfactant
what is the clinical presentation of hyaline membrane disease
-prematurity
-tachypnea
-nasal flaring
-diminished breath sounds
-cyanosis
-grunting
when does hyaline membrane disease occur?
minutes to hours after a premature birth
what is the treatment of hyaline membrane disease
- nasal CPAP
- surfactant replacement
how do you prevent hyaline membrane disease
- prenatal administration of a single course of steroids to women who are in premature labor
what is the presentation of foreign body aspiration
- coughing
- choking
- wheezing
- cyanosis
- drooling
- stridor
how do you distinguish between laryngotracheal vs bronchial foreign body
- laryngotracheal: stridor, hoarseness, complete apnea
- bronchial: unilateral wheezing and decreased breath sounds
how do you treat a foreign body aspiration
- under age 1: hard back blows
- over age 1: abdominal thrusts/heimlich maneuver
How would you tell whether a coin is in the trachea or the esophagus
Xray showing…
* circle on AP/PA = esophagus
* circle on lateral = trachea
what confirms the diagnoses for airway foreign bodies
bronchoscopy
what is the MCC of lobar pneumonia
strep pneumo
what is the MC location of pneumonia for each organism
- strep pneumo: RLL
- klebiella: upper lobes
- legionella: lower lung fields
what is the appearance of lobular/bronchopneumonia
- central bronchi involved
- asymmetrical
- patchy appearance
what is interstitial pneumonia
results from edema and inflammatory cellular infiltrate into the interstitial tissue of the lung and fibrosis
what is the interstitial space of the lungs
the space between the air sacs and small blood vessels that surround the air sacs. This space contains connective tissue and fluid.
what is the appearance of interstitial pneumonia on a chest xray
- ground glass appearing
- bilateral and symmetrical
what is aspiration pneumonia
pneumonia that develops following the inhalation of oropharyngeal secretions, gastric contents or colonized organisms
what is the MC site of aspiration pneumonia in alcoholics
RUL due to typically aspirating in the prone position
what is ventilator associated pneumonia
pneumonia that develops 48 hours or longer after mechanical ventilation
what are s/s of community acquired pneumonia
- fever
- dyspnea
- chills
- cough with sputum production
- crackles and rales
- dull to percussion
how do you diagnose community acquired pneumonia
chest Xray
how do you determine if pneumonia needs inpatient or outpatient care
- PSI
- CURB 65
what is the CURB 65
- 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
what is the outpatient treatment of community acquired pneumonia
- no comorbs: amoxicillin or azithromycin
- comorbs: (azithromycin + augmentin) OR (levo alone)
what is the inpatient treatment of community acquired pneumonia
- Non ICU: (Levo alone) OR (rocephin + azithromycin)
- ICU: (Rocephin + azithromycin) OR (rocephin + levo)
what is the presentation of klebsiella pneumonia
- red current jelly sputum
- ground glass opacities
what is the presentation of staph pneumonia
- low grade fever
- sputum production
- empyema or pleural effusions on cxr
what is the treatment of staph pneumonia
clindamycin
what is the presentation of viral pneumonia
- fever
- chills
- nonproductive cough
- tachypnea
what is the treatment of viral pneumonia
supportive
what is the presentation of pneumocystis jiroveci pneumonia
- fever
- dry cough
- elevated LDH
- diffuse, bilateral infiltrates on cxr
- ground glass opacities
what is the treatment of pneumocystis jiroveci pneumonia
bactrim
