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Clin Med IV - Pediatrics > Pediatric Pulmonology > Flashcards

Pediatric Pulmonology Flashcards

1
Q

What happens in acute epiglottitis?

A

Inflammation of supraglottic region (epiglottis, vallecula, arythenoids, aryepiglottic folds)

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2
Q

Acute epiglottitis typically occurs in kids age ____. Why?

A

<6mo. Not fully immunized

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3
Q

Acute epiglottitis is typically caused by what organisms (3)

A
  • S. pyogenes (strep throat)
  • Stre. pneumonia
  • Staph
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4
Q

Presentation of epiglottitis

A
  • Mild sore throat and fever → rapidly turns into respiratory distress
  • Drooling, tripoding (impending doom)
  • Stridoer (late finding)
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5
Q

Dx epiglottitis

A

Clinical suspicion - pts tend to deteriorate before imaging can be done

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6
Q

If you were doubtful of epiglottitis and just needed to rule it out, what diagnostics/imaging could you get? What would you see if it was positive?

A
  • Lateral neck film → thumb print sign

- Direct visualization via intubation/endoscopy

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7
Q

Management of epiglottitis

A
  • Anesthesia STAT for intubation → if office setting, call EMS then ED to have anesthesia on standby
  • Keep child calm/quiet
  • O2, IV access if tolerated
  • IV ceftriaxone or cefotaxime
  • INTUBATION for 2-3 days while abx take effect
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8
Q

Is epiglottitis contagious?

A

No BUT the causative organism is

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9
Q

Your pedi pt has epiglottitis, should mom be worried about it spreading to the rest of the fam?

A

Epiglottitis isn’t contagious but causative organism is → consider rifampin ppx if non-immunized/immunocompromised or <6mo without complete HIB vaccine

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10
Q

What happens in croup?

A

Inflammation of subglottis region (trachea, larynx)

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11
Q

Etiology of croup

A

Parainfluenza 1-3 virus

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12
Q

Common age of croup pts

A

3mo-5yo

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13
Q

When do you usually see croup?

A

Spring/fall

10pm-4am

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14
Q

What is pathognomonic for croup?

A

Barking cough

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15
Q

Presentation of croup

A
  • Days 0-2 → URI sx’s (rhinorrhea, low-grade fever, +/- cough/pharyngitis)
  • Days 0-5 → barking cough +/- stridor
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16
Q

How long does croup usually last?

A

5-7 days

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17
Q

Croup tends to worsen on days ________

A

2-3

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18
Q

Diagnosis of croup

A

Clinical dx

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19
Q

Tx mild-moderate croup (i.e. no stridor)

A
  • IV dexamethasone (Decadron) given PO
  • Cold night air
  • Humidified air
  • NO abx
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20
Q

Dosing for dexamethasone (Decadron) for croup pt

A

IV solution given PO

0.6mg/kg x1 → max 10-12mg

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21
Q

Tx mod-severe croup (i.e. stridor)

A
  • Emergency Department
  • IV dexamethasone (Decadron) given PO
  • Racemic Epi via neubilizer prn
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22
Q

If racemic epi doesn’t work for croup, what should you consider?

A
  • Continuous racemic epi after 2nd dose
  • IM epi
  • Consider transfer to ICU
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23
Q

What happens in bronchiolitis?

A

Inflammation of lower respiratory tract with secretions into inflamed bronchial tree

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24
Q

Pts at greatest risk for morbidity/mortality with bronchiolitis

A
  • <2mo

- Cardiopulmonary disease → preemies, asthmatic, immunocompromised

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25
Q

Etiology of bronchiolitis

A

RSV (>50%)

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26
Q

Presentation of bronchiolitis

A
  • Begins with URI (rhinorrhea, congestion, low-grade fever)

- Wheezing

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27
Q

When is bronchiolitis commonly seen?

A

Late fall and throughout winter

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28
Q

Bronchiolitis worsens on day______

A

2-5

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29
Q

Bronchiolitis usually lasts _____

A

10-12 days

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30
Q

Prognosis of bronchiolitis

A

40% will have wheezing again

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31
Q

Diagnostics involved with bronchiolitis

A
  • NO CBC
  • CXR if 1st episode of wheezing ever or considering PNA
  • Nasal washings for RSV PCR if <2mo, risk factors, hospitalization, or requested
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32
Q

Tx bronchiolitis

A
  • +/- bronchodilators, cool mist
  • PO steroids (dexamethasone, prednisolone)
  • NO abx
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33
Q

Should you hospitalize pts with bronchiolitis?

A

Yes if:

  • O2 required
  • Apneic episodes
  • Preemie <12wo
  • <12wo and signs of resp. distress or days 1-3 of illness
  • Underlying cardiopulmonary dz/risk factors
  • Parent unable to care for child at home
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34
Q

Tx for inpatient bronchiolitis

A
  • O2 → SpO2 >94%, high flow O2 if <92% on O2
  • Consider CPAP, no chest PT
  • PICU if intubation needed or expected
35
Q

Tx for outpatient bronchiolitis

A
  • Fluids
  • Tylenol/motrin
  • ED if worsens, tachypnea w/o fever, or resp. distress
36
Q

What is Synergis?

A

IM vaccine ppx for certain pts during RSV season

37
Q

Who might need Synergis?

A
  • 0-12mo → preemi <12wo, chronic lung dz, neuro dz, CHD, CF, heart transplant, immunocompromised
  • 12-24mo → chronic lung dz needing O2, heart transplant during RSV season, immunocompromised, some CF pts
38
Q

All pedi asthma pts should use ______

A

spacer

39
Q

When can you officially diagnose asthma in kids?

A

Age 4-6 when methacholine challenge can be administered

40
Q

Presentation of asthma in kids

A
  • Cough (could be only sx)
  • Wheezing
  • Breathlessness, chest tightness, chest pain
41
Q

Kids with asthma usually have ______

A

Other atopic illnesses (e.g. atopic dermatitis, food allergies, allergic rhinitis)

42
Q

Dx asthma

A

Improvement of >8% of FEV1 with bronchodilator

43
Q

Tx asthma in kids

A
  • Mild (intermittent) → SABA

- Persistent → ICS (low-high dose) +/- adjuncts, consult pedi pulmonologist

44
Q

Etiology of pertussis

A

Bortadella pertussis (95% US cases) → G- coccobacillus that colonizes ciliated epithelium

45
Q

Transmission of pertussis

A

Spread via respiratory droplets → nearly 100% contagious to non-immunized close contacts

46
Q

Is there a vaccine for pertussis?

A

Yes, it’s extremely effective but immunity wanes after 5 yrs and disappears by 12 yrs (booster)

47
Q

Incubation period of pertussis

A

3-12 days

48
Q

3 stages of pertussis. During which one is pt most contagious?

A
  • Catarrhal stage → most contagious
  • Paroxysmal stage
  • Convalescent stage
49
Q

How long does catarrhal stage of pertussis last?

A

1-2 weeks

50
Q

What happens in catarrhal stage of pertussis?

A

URI sx’s - rhinorrhea, sneezing, low-grade fever, mild cough

51
Q

How long does paroxysmal stage of pertussis last

A

1-6 weeks, up to 10 weeks

52
Q

What happens in paroxysmal stage of pertussis?

A

Paroxysm of numerous rapid coughs, followed by whooping cough → pt may be in resp. distress, protruding tongue, purple face, bulging/watery eyes, post-tussive emesis/exhausion

53
Q

What is pathognomonic for pertussis?

A

Whooping cough

54
Q

What happens in convalescent stage of pertussis?

A

Paroxysms may recur when pt suffers subsequent respiratory infections → may last for months

55
Q

Dx pertussis

A

Nasopharyngeal swab BUT if highly suspicious, treat b/c takes days to weeks

56
Q

Tx pertussis

A

Azithromycin

57
Q

Partial vs. complete airway obstruction

A 
Partial = stridor
Complete = silence
58
Q

80% FB aspirations involve pts age _____

A

<3 yo

59
Q

Most common FBs aspirated by infants/toddlers

A

*Peanuts (50%)
*Nuts
*Popcorn
*Hot dogs
Coins, toys, batteries, seeds

60
Q

Most common FBs aspirated by older kids

A

Nonfood items - coins, paper clips, pen caps, coins

61
Q

FBs that lead to fatal aspiration

A
  • Balloons
  • Balls
  • Marbles
  • Toys
  • Strong/round/unbreakable
62
Q

Location of FB aspiration in kids

A

Proximal mainstem bronchus - no preference over R vs. L b/c similar size/angle

63
Q

Highest morbidity/mortality d/t FB aspiration occurs with ______ . Why?

A

Laryngeal FB - blocks R and L airways

64
Q

Classic triad of FB aspiration

A
  • Wheezing
  • Cough
  • Decreased air entry regionally
65
Q

What’s one of the most important ways of diagnosing FB aspiration?

A

History

66
Q

Sure, history is important in diagnosing FB aspiration. But what’s the official way of diagnosing it?

A

Bronchoscopy → diagnosis + treatment

67
Q

What may you see on radiograph of FB aspiration?

A
  • FB if radiopaque
  • Subglottic density/swelling
  • Air trapping distal to partial obstruction
  • Atelectasis if complete obstruction
  • Late = consolidation d/t infection, abscess, bronchiectasis
68
Q

What happens in cystic fibrosis?

A

Mutation in CFTR protein → dysfunctional Cl- channel in exocrine tissues

69
Q

Epidemiology of cystic fibrosis

A

Caucasians

70
Q

What is pathognomonic for cystic fibrosis?

A

Meconium ileus

71
Q

Respiratory signs of cystic fibrosis

A
  • Persistent productive cough
  • Recurrent URI/LRI
  • Obstructive airway dz findings → hyperinflation on CXR, PFTs
  • Colonization with S. aureus and H. flu in childhood; Pseudomonas in adulthood
72
Q

Reproductive effect of cystic fibrosis

A

95% males are infertile (and up to 20% females)

73
Q

What organ systems are involved in cystic fibrosis?

A
  • Pulmonary
  • Sinuses
  • Pancreas
  • Liver
  • Intestines
  • Reproductive tract
  • Kidneys
  • Bone
74
Q

Dx cystic fibrosis

A
  • Newborn screening via heel stick → high rate of false positives (see below)
  • Chloride sweat test
  • Molecular DNA testing if sweat test inconclusive → 2 mutations = dx
  • Nasal potential difference if above inconclusive
75
Q

When is newborn screening for CF via heel stick performed?

A

Well before 8wo b/c trypsin levels fall

76
Q

When is chloride sweat test performed?

A
  • Asymptomatic positive heel stick
  • After 2wo and >2kg
  • Meconium ileus after day 2
77
Q

When is molecular DNA testing done for CF?

A
  • Inconclusive sweat test

- All CF pts for prognosis and epidemiologic interest

78
Q

Infants and children with CF usually present with ________

A

Respiratory sx’s - chronic URI, wheezing of unclear etiology

79
Q

Tx for CF

A
  • Expansive list b/c multisystem
  • Ivacaftor → CFTR modulator
  • Specific sequence of inhaled Rx: albuterol → hypertonic saline → chest PT → Dnase → azithromycin
  • Steroids (PO or inhaled)
  • Supportive → O2, BiPAP, immunizations
  • Lung transplant (but remember, multisystem dz)
80
Q

Respiratory distress syndrome usually occur in what pts?

A

<28wo GA

81
Q

Pathophysiology of respiratory distress syndrome

A

Prematurity = surfactant deficiency, incr. risk of PDA and foramen ovale

82
Q

Dx respiratory distress syndrome

A

Clinical diagnosis

83
Q

What might you see on CXR of respiratory distress syndrome

A
  • Airbronchograms
  • Low lung volume
  • Ground glass appearance
  • Pneumothorax
84
Q

Prevention of Respiratory Distress Syndrome

A
  • Antenatal corticosteroids for pregnant pts at risk for delivery at <34wks GA
  • Exogenous surfactant within first 30-60 min. of life for <30wks GA with resp. distress
  • Assisted ventilation w/ PEEP
  • Thermoregulation, fluids, CV management, nutrition support

Clin Med IV - Pediatrics (2 decks)

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