Pediatric respiratory issues and disorders Flashcards
Egophany
E->A during auscultation indicated PNA
what age can you start PFTs
at age 8 if cooperative
obstructive lung disease characteristics
characterized by reduced airflow rates; lung volumes within normal range or larger
Typical of a child having trouble exhaling air (air trapping) which results in decreased rated and FEV1 (asthma, bronchiolitis, cystic fibrosis)
restrictive lung disease characteristics
characterized by reduced volumes and expiratory flow rates. Typical of a child that has trouble inhaling air, thus affecting the volume (PNA)
Bronchiolitis definition
A disease of the lower respiratory tract that causes inflammation leading to obstruction of the small respiratory airways. noted in children
s/sx of bronchiolitis
URI symptoms lasting for several days, moderate fever of 102F, gradual development of respiratory distress (nasal flaring, grunting, cyanosis, prolonged expiration) Tachypnea (60-80 bpm) non productive cough paroxysmal wheezing progressive stridor restlessness; changes in mental status cyanosis palpable liver and spleen (pushed down due to hyperinflation)
chest xray presentation for bronchiolitis
hyper inflated lungs, may have scattered areas of consolidation
Management of bronchiolitis
infants with mild distress can be treated as outpatients with supportive care
Prevention of high risk infants with (palivizumab) SYNAGIS IM monthly
Intermittent asthma- sx, nighttime awakenings, rescue inhaler use, interference with normal activity, lung function
80% predicted and normal between exacerbations
Mild persistent asthma- sx, nighttime awakenings, rescue inhaler use, interference with normal activity, lung function
> 2 days/ week
Nighttime awakenings 3-4/month
rescue inhaler use >2 days/week but not daily
interference with normal activity- minot limitation
Lung function is FEV1>80% of predicted
Moderate persistent asthma- sx, nighttime awakenings, rescue inhaler use, interference with normal activity, lung function
symptoms are daily, nighttime awakening are more than once per week but not nightly
rescue inhaler use is daily
some limitation and interference with normal activity
FEV1 60%-80% predicted
Severe persistent asthma- sx, nighttime awakenings, rescue inhaler use, interference with normal activity, lung function
Symptoms throughout the day, nightly awakenings, rescue inhaler use several times per day, extremely limited interference with normal activity, and lung function less than 60% of predicted
treatment in intermittent asthma
step 1- SABA + PRN for all age groups
Treatment in mild persistent asthma
Step 2- Low dose ICS. Alternative: Cromolyn or monteukast
Treatment for 0-4 yo with moderate or severe asthma
Refer beyond mild persistent
Step 3- medium dose ICS option and consider short course of oral systemic corticosteroids
treatment for moderate persistent asthma fort he 5-11 yo
step 3: Medium dose ICS option and consider short course of oral systemic corticosteroids
treatment for the severe persistent asthma in the 5 -11yo
Step 3: Medium dose OR
step 5 ICS option and consider short course or oral systemic corticosteroids
How long to see patient back after initiating or changing asthma medications? How long before you can try to decrease ICS?
Bring back in 2 weeks for follow-up. Wait for 3 months of controlled before decreasing the ICH, then recheck in 2 weeks
FEV1/FVC values for intermittent, mild persistent, moderate persistent, severe persistent
intermittent: >85%
mild persistent: FEV1/FVC: >80%
Moderate persistent: FEV1/FVC: 75%-80%
Severe persistent: FEV1/ FVC:
FEV1 values for intermittent, mild persistent, moderate persistent, severe persistent
Intermittent: >80%
mild persistent: >80%
Moderate persistent: 60-80%
Severe persistent:
What age do you not consider lung function for asthma
0-4 years
Most common agent of PNA in newborns
Group B strep, chlamydia, E.coli
most common agent of PNA in infants and young children
RSN and H. Influenzae, strep pneumoniae (community aquired)
most common agent of PNA in preschool through young adulthood
Strep pneumoniae, mycoplasma, chlamydia
how much % of PNA is viral?
70%-80%
Radiograph for H. Influenzae
Lobar consolidation
Radiograph for S. Pneumonaie
lobar consolidation
Radiograph for Klebsiella
lobar consolidation
CXR for pneumocystis
diffuse interstitial, alveolar, apical or upper lobe infiltrates
radiograph for E.Coli
Patchy infiltrates, pleural effusion
Radiograph for staphylococcus
Patchy infiltrates
Radiograph for Pseudomonas
Patchy infiltrates
TX for CAP S. Pneomoniae
PCN
TX for CAP M. Catarrhalis (walking PNA)
macrocodes such as azithromycin (zithromax)
TX for CAP H. Influenze
Amoxicillin or cephalosporin
TX for viral PNA
supportive measures: hydration and antipyretics
ANX if secondary infection
Humidified o2 and chest physiotherapy
Bronchodilators
Cystic fibrosis definition
a autosomal recessive disorder that causes a defect in epithelial chloride transport resting in dehydrated, thick secretions leading to chronic multi system disorder affecting the respiratory tract, GI, hepatobiliary and reproductive tracts
s/sx of cystic fibrosis
viscid meconium or ileus in newborns, recurrent URI, large, liquid bulky, foul stool (steatorrhea) salt-tasting skin chronic cough rhinorrhea hepatosplenomegaly fat-soluble vitamin deficiencies FTT Delayed pubery infertility
labs for cystic fibrosis
pilocarpine sweat test, PFTs with obstructive patter, hyponatremic hypochloremic dehydration (alkalosis)
Chest radiograph: cystic lesions, atelectasis
s/sx of croup
clear lungs, barking cough, low grade fever, recent uri, dyspnea
steeples sign (narrowing of the trachea) on radiograph is indicative of
croup
