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Summer Disciplines 2 > Peds pulm > Flashcards

Peds pulm Flashcards

1
Q

Describe Crackles

A

scratchy, bubbly noises, esp on inspo

2/2 Re-opening of airways closed on previous expiration

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2
Q

Possible causes of crackles include

A

bronchiolitis, pulmonary edema, pneumonia, asthma

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3
Q

Describe wheezes

A

continuous high pitched musical sounds, esp. on Expo

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4
Q

Possible causes of wheezes include

A

asthma, bronchiolitis, FB

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5
Q

Describe rhonchi

A

continuous low pitched snoring sounds

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6
Q

Possible causes of rhonchi include

A

PNA, CF

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7
Q

Describe stridor

A

high pitched, harsh blowing, esp on inspo

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8
Q

Possible causes of stridor include

A

croup, vocal cord dysfunction, laryngomalacia, subglottic stenosis, allergic rxn

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9
Q

What are Sx of viral croup

A

Inspiratory stridor
Hoarseness
*Seal-Like, barking cough
-URI Sx, nasal congestion, afebrile

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10
Q

What causes viral croup

A

MC: Parainfluenza Virus Type 1

also RSV, and adenovirus

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11
Q

A life threatening effect of viral croup is

A

Subglottic narrowing, which can cause respiratory distress if it becomes severe enough

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12
Q

When does viral croup occur

A

fall and winter

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13
Q

What is the Westley croup score

A

Mild: 2 or less
Moderate: 3-7
Severe: 8+

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14
Q

These are signs of imminent respiratory failure

A 
fatigue and listlessness 
marked retractions 
decreased/absent breast sounds 
depressed LOC 
Tachycardia out of proportion of fever 
cyanosis or pallor
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15
Q

How do you diagnose croup

A

Clinically; if retractions are present, croup is mod-severe

On XR: “Steeple Sign”**

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16
Q

How do you manage croup

A

Mild: cool mist (supportive)
Mod:Dexamethasone 0.6 mg/kg (alt. Prednisolone); Nebulized racemic epinephrine in ED
Severe: airway support, corticosteroid, nebulized epi. +/- admit

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17
Q

If severe croup is admitted, when can you d/c them

A

if normal color, no stridor, nl LOC, tolerating PO fluids, reliable caregivers

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18
Q

What causes epiglottitis

A

Haemophilus influenza B

But not so common now thanks to the HIB vaccine! (can rarely happen if immunized)

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19
Q

What are Sx of epiglottitis

A 
sudden onset high fever 
inspirator retractions
rapid onset stridor, muffled voice 
**Dysphagia, Drooling, Distress** 
*Tri-pod posturing*
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20
Q

What should you NEVER use in a child with epiglottitis

A

a tongue blade!

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21
Q

How do you diagnose epiglottitis

A

Clinically!

But radiograph will show “Thumb Sign” *

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22
Q

How do you manage epiglottitis

A

Airway support (ET tube if possible)
blood and epiglottis cultures, then IV abx
Corticosteroids are controversial

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23
Q

What abx do you use for epiglottitis

A

(Empiric therapy covering H. flu, PRSP, MRSA, beta hemolytic strep)
*Third gen cephalosporin + Vancomycin

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24
Q

What is bronchiolitis

A

LRI affecting small airways in patients <2 y/o (MC 2-6 mo.)

Peak November-April

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25
What causes bronchiolitis
RSV** | also rhinovirus
26
Who is high risk for contracting bronchiolitis
``` Born <37 wks <12 weeks old Chronic pulm disease congenital heart dz immunodeficient congenital airway defects neurologic disease ```
27
How do Sx of bronchiolitis present
URI Sx for 2-3 days LRI Sx on day 3-5 Sx resolve over 2-3 weeks
28
What are Sx of bronchiolitis
``` Shallow, rapid breathing, nasal flaring Irritable Poor feeding vomiting wheezing and crackles cough, tachypnea, labored breathing, hypoxia ```
29
How do you diagnose bronchiolitis
Clinically! based on Sx, age, and time of year | Can also do an RSV nasopharyngeal swab
30
How do you manage bronchiolitis
O2 (keep them >90-92%) Maintain hydration Nasal suctioning +/- mechanical ventilation if severe
31
What is not routinely recommended in the treatment of bronchiolitis
Albuterol and epi | Hypotonic saline SVN (small volume nebulizer)
32
What is the #1 cause of LRI in children <1
RSV! Respiratory Syncitical Virus | Causes >70% of bronchiolitis cases, peak Jan-Feb
33
What patients are high risk for contracting RSV
``` <6 mo old Preemie Second hand smoke exposure* Respiratory disease congenital heart disease immunodeficient ```
34
Sx of RSV include
Wheezing and tachypnea AFTER URI Sx Low grade fever Crackles, prolonged expiration, wheezing, retractions Congestion w/ LOTS of mucus
35
On XR what will RSV look like
Hyperinflation, peribronchial thickening
36
How do you diagnose RSV infection
Clinically! Age <12, Season, Sx of RSV Rapid assay (nasal swab, done in hospital) CXR to dx secondary PNA if indicated
37
How do you treat RSV
Fluids, respiratory support (O2) Ribavirin (antiviral for Hep C and RSV) IF immunocompromised Palivizumab (Synagis) as prophylaxis ONLY
38
What is the prognosis of RSV
30-40% oh RSV hospitalized pts will wheeze later in childhood RSV in infancy can lead to asthma
39
What is Infant Respiratory Distress syndrome
MCC of respiratory distress in pre-term infants | Deficient surfactant production + Surfactant inactivation 2/2 protein leaking into airspaces
40
What is the role of surfactant normally
Reduce surface tension allowing alveolar expansion= alveoli won't collapse
41
If you are deficient in surfactant what can happen
Alveolar collapse during expiration, atelectasis, decreased gas exchange, hypoxia, V/Q mismatch Lung inflammation causing pulmonary edema
42
RF for surfactant deficiency are
Premature birth (highest if <28 weeks) Maternal DM AMA FHx
43
Sx of IRDS are
Respiratory distress at birth Hypoxemia on ABG Ground Glass on CXR** (atelectasis) Diminished air movement despite vigorous respiratory effort
44
How do you treat IRDS
Supplemental O2, nasal CPAP, early intubation | Steroids, surfactant replacement (Beractant-Survanta)
45
RF for peds PNA are
``` congenital heart dz bronchopulmonary dysplasia CF second hand smoke No vaccinations (Prevnar, PCV 13) Asthma sickle cell dz NM disorders GERD Immunodeficiency ```
46
Sx of peds PNA include
Fever, cough, preceding URI | Infants: poor feeding, irritable, restless
47
What causes afebrile PNA of infancy
Chlamydia* and other maternal infx Occurs mostly at 2 weeks-3 months (n CXR will see hyperinflation w/ interstitial process)
48
On PE of PNA you will note
``` tachypnea, tachycardia, +/- fever Retractions *Grunting (imminent resp failure) Decreased O2 sat Crackles, Rhonchi, decreased air movement +.- ill appearance ```
49
What are the causes of PNA by age
1-3 mo: Viral (RSV) 3-12 mo: Viral (RSV) 2-5 yr: Viral (parainfluenza, influenza) 5-18 yr: Bacterial (strep pneumo, atypical bacteria)
50
What is the MCC of bacterial PNA in all ages
Strep pneumo!!
51
What work up should you get if you suspect pneumonia
A/P and lateral CXR Blood cultures if toxic and need admission Sputum cultures if severe
52
On PNA CXR you will se
Air space disease/Consolidation in lobar distribution (bacterial PNA) Interstitial/peribronchial infiltrates (viral PNA)
53
How do you treat peds PNA
<3-6 mo. or hypoxemic: Admit! <5 y/o: Amoxicillin high dose (90mg/kg) BID x 10 days >5 y/o: Same as above (Amoxicillin) Susp atypical: Macrolide (Azithromycin) **Close follow up!!**
54
Atypical causes of bacterial PNA are
Mycoplasma pneumo | Chlamydia pneumo
55
What is pertussis
Whooping cough! caused by Bordatella pertussis
56
How is pertussis spread
Respiratory droplets | Incubation 7-10 days
57
Complications in infants/young kids of Pertussis include
Hypoxia Apnea PNA Seizures
58
What are the 3 phases of whooping cough
(1) Catarrhal: URI Sx and fever x 1-2 wks (2) Paroxysmal: Inspiratory whoop, post-tussive emesis, persistent cough x 2-6 weeks (3) Convalescent: cough gradually resolves over wks-mo
59
How do you diagnose pertussis
**Gold: PCR and nasal cultures +/- serology CBC (leukocytosis, mostly lymphocytes) (CXR is usually normal)
60
How do you treat Pertussis
Macrolide or Bactrim Prophylaxis for household (immunized or not!) Hospitalize if: low O2 sat, decreased feeding, respiratory distress, cyanosis, apnea

Summer Disciplines 2 (8 decks)

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