Peds Pulm Flashcards

1
Q

Of the pulm diseases that cause respiratory distress at birth, which disease is most likely to occur in newborns who are: premature, term, post term?

A

premature: ARDS
term: Transient tachypnea
post term: meconium aspiration

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2
Q

What causes ARDS?

A

prematurity results in impaired lung surfactant synthesis -> hypoxemia

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3
Q

CXR of ARDS

A

low lung volume, ground glass appearance (diffuse atelectasis), air bronchograms

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4
Q

delayed clearance of fetal lung fluid causes __________.

A

transient tachypnea in newborns (TTN)

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5
Q

CXR shows hazy bilateral perihilar streaking and ABG normal

A

TTN

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6
Q

Pathophysiology of meconium aspiration

A

meconium passed while still in utero and aspirated

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7
Q

What is meconium?

A

newborn’s first stool; dark green tarry stool normally passed after birth

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8
Q

What conditions does the meconium not passed within 24 hrs of birth?

A

Hirschsprung

Cystic fibrosis

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9
Q

Post term newborn delivered with green nail and skin staining. Why?

A

baby passed meconium before delivery; risk of aspiration

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10
Q

TTN treatment

A

self-resolves in 0-3 days

  • nasal cannula
  • O2 hood; CPAP
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11
Q

When should abx be added to treatment of newborn respiratory distress?

A

if pneumonia suspected

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12
Q

Which newborn respiratory distress condition presents with only mild sxs of quiet tachypnea w/o retractions?

A

TTN

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13
Q

Meconium aspiration syndrome treatment

A
  • suction trachea ASAP to prevent aspiration (if no meconium do not repeat)
  • gentle ventilation
  • surfactant and nitric oxide for hypoxia
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14
Q

How can ARDS be prevented?

A

antenatal corticosteroids

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15
Q

ARDS management

A

Keep O2 sat 80-90%

Give surfactant and nitric oxide

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16
Q

Prognosis of newborns with ARDS

A

40% mortality

Many that survive will develop chronic lung disease

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17
Q

High alert for _________ with meconium aspiration as it is a common complication.

A

pneumothorax

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18
Q

Pulmonary findings suggesting asthma

A

wheezing, prolonged expiratory phase, hyper-expansion, cough worse at night

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19
Q

Atopy

A

genetic tendency to develop classic allergic diseases - atopic dermatitis, allergic rhinitis, and asthma

20
Q

spirometry results of asthma patient

A
decreased FEV1 (expiratory volume in 1 sec)
normal FVC

improve with use of bronchodilator (reversible)

21
Q

Chronic treatment of asthma

A

Mild intermittent: SABA (Albuterol)

Mild persistent: add daily low dose ICS (beclomethasone)

Moderate persistent: increase to medium dose ICS, add LABA (Salmeterol)

Severe persistent: increase to high dose ICS, add systemic steroids

22
Q

How are acute exacerbations of asthma treated?

A

SABA (Albuterol)

23
Q

If patient is unresponsive to Albuterol treatment x 3 and O2 sats still < 92%, then…

A

Supplemental oxygen
Racemic epinephrine
Admit

24
Q

What factors increase risk of asthma in infant?

A
Parental asthma
Eczema
Allergic rhinitis
Wheezing apart from colds
Eosinophilia >4%
Food allergen sensitization
25
uncontrolled vs controlled asthma
uncontrolled - every 4 weeks | controlled - every 3-6 months
26
If using LABA for asthma, then patient must also be on ________.
ICS
27
New onset of wheezing in < 2 month old infant born premature?
Bronchiolitis
28
Recurrent wheezing and coughing in small for age child who has been seen multiple times for pneumonia and sinus infections.
cystic fibrosis
29
AAP Bronchiolitis treatment
- supplemental oxygen if sat < 90% - bronchodilator therapy (don't continue if no response) - light nasal suction and saline drops
30
Common infection of bronchiolitis
RSV
31
AAP Guideline prevention of bronchiolitis
hand washing, alcohol-based rubs, avoid smoke exposure, infants should be breastfed, Palivizumab for high risk (chronic lung dz, premature, congenital heart dz)
32
Defect in gene responsible for Cystic Fibrosis (CFTR protein) causes what?
- increased salty secretions from sweat glands | - dehydration and thickening of mucus, more adherent to bacteria
33
When to screen for elevated sweat chloride?
any child with nasal polyps, pseudomonas pneumonia, and rectal prolapse
34
Cystic fibrosis treatment
pancreatic enzyme supplements mucolytics abx (Cipro) multi-vitamins
35
Pulmonary exam of pneumonia
crackles, decreased breath sounds, wheezing
36
Bacteria that cause pneumonia in neonates
Group B strep Listeria G- rods (E. coli, Klebsiella)
37
How to treat bacterial pneumonia in neonates?
parental ampicillin and gentamicin, +/- Cefotaxime admit immediately if febrile!!!
38
How is wheezing of pneumonia different than asthma?
pneumonia more focal; asthma diffuse
39
Bacteria that cause pneumonia in 1 mon to 5 yrs old
strep pneumo, H-flu
40
Bacteria that cause pneumonia in children over 5 yo
Mycoplasma, step pneumo
41
Viruses that cause pneumonia in neonates and children
RSV, influenza A/B
42
Viral pneumonia most common, except when patient what age?
< 3 months old
43
Bacterial pneumonia treatment
Admit if < 4-6 months or toxic-appearing IV cefuroxime/cefotax High dose amoxicillin +5 yo: macrolide for mycoplasma
44
Treatment for cough in children < 6 yo
NO cough suppressants supportive: humidified air, suction, nasal saline
45
When to admit bronchiolitis?
``` diminished breath sounds < 90% sats inability to clear secretions severe retractions/flaring + 70 bpm risk factors (premature, < 24 mon) ```