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Pediatrics Module > Peds Pulm > Flashcards

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
Q

uncontrolled vs controlled asthma

A

uncontrolled - every 4 weeks

controlled - every 3-6 months

26
Q

If using LABA for asthma, then patient must also be on ________.

A

ICS

27
Q

New onset of wheezing in < 2 month old infant born premature?

A

Bronchiolitis

28
Q

Recurrent wheezing and coughing in small for age child who has been seen multiple times for pneumonia and sinus infections.

A

cystic fibrosis

29
Q

AAP Bronchiolitis treatment

A
  • supplemental oxygen if sat < 90%
  • bronchodilator therapy (don’t continue if no response)
  • light nasal suction and saline drops
30
Q

Common infection of bronchiolitis

A

RSV

31
Q

AAP Guideline prevention of bronchiolitis

A

hand washing, alcohol-based rubs, avoid smoke exposure, infants should be breastfed, Palivizumab for high risk (chronic lung dz, premature, congenital heart dz)

32
Q

Defect in gene responsible for Cystic Fibrosis (CFTR protein) causes what?

A
  • increased salty secretions from sweat glands

- dehydration and thickening of mucus, more adherent to bacteria

33
Q

When to screen for elevated sweat chloride?

A

any child with nasal polyps, pseudomonas pneumonia, and rectal prolapse

34
Q

Cystic fibrosis treatment

A

pancreatic enzyme supplements
mucolytics
abx (Cipro)
multi-vitamins

35
Q

Pulmonary exam of pneumonia

A

crackles, decreased breath sounds, wheezing

36
Q

Bacteria that cause pneumonia in neonates

A

Group B strep
Listeria
G- rods (E. coli, Klebsiella)

37
Q

How to treat bacterial pneumonia in neonates?

A

parental ampicillin and gentamicin, +/- Cefotaxime

admit immediately if febrile!!!

38
Q

How is wheezing of pneumonia different than asthma?

A

pneumonia more focal; asthma diffuse

39
Q

Bacteria that cause pneumonia in 1 mon to 5 yrs old

A

strep pneumo, H-flu

40
Q

Bacteria that cause pneumonia in children over 5 yo

A

Mycoplasma, step pneumo

41
Q

Viruses that cause pneumonia in neonates and children

A

RSV, influenza A/B

42
Q

Viral pneumonia most common, except when patient what age?

A

< 3 months old

43
Q

Bacterial pneumonia treatment

A

Admit if < 4-6 months or toxic-appearing

IV cefuroxime/cefotax
High dose amoxicillin

+5 yo: macrolide for mycoplasma

44
Q

Treatment for cough in children < 6 yo

A

NO cough suppressants

supportive: humidified air, suction, nasal saline

45
Q

When to admit bronchiolitis?

A 
diminished breath sounds
< 90% sats
inability to clear secretions
severe retractions/flaring
\+ 70 bpm
risk factors (premature, < 24 mon)

Pediatrics Module (15 decks)

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