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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
Q

What causes bronchiolitis

A

RSV**

also rhinovirus

26
Q

Who is high risk for contracting bronchiolitis

A 
Born <37 wks
<12 weeks old 
Chronic pulm disease 
congenital heart dz 
immunodeficient 
congenital airway defects 
neurologic disease
27
Q

How do Sx of bronchiolitis present

A

URI Sx for 2-3 days
LRI Sx on day 3-5
Sx resolve over 2-3 weeks

28
Q

What are Sx of bronchiolitis

A 
Shallow, rapid breathing, nasal flaring 
Irritable 
Poor feeding 
vomiting 
wheezing and crackles 
cough, tachypnea, labored breathing, hypoxia
29
Q

How do you diagnose bronchiolitis

A

Clinically! based on Sx, age, and time of year

Can also do an RSV nasopharyngeal swab

30
Q

How do you manage bronchiolitis

A

O2 (keep them >90-92%)
Maintain hydration
Nasal suctioning
+/- mechanical ventilation if severe

31
Q

What is not routinely recommended in the treatment of bronchiolitis

A

Albuterol and epi

Hypotonic saline SVN (small volume nebulizer)

32
Q

What is the #1 cause of LRI in children <1

A

RSV! Respiratory Syncitical Virus

Causes >70% of bronchiolitis cases, peak Jan-Feb

33
Q

What patients are high risk for contracting RSV

A 
<6 mo old 
Preemie 
Second hand smoke exposure*
Respiratory disease
congenital heart disease 
immunodeficient
34
Q

Sx of RSV include

A

Wheezing and tachypnea AFTER URI Sx
Low grade fever
Crackles, prolonged expiration, wheezing, retractions
Congestion w/ LOTS of mucus

35
Q

On XR what will RSV look like

A

Hyperinflation, peribronchial thickening

36
Q

How do you diagnose RSV infection

A

Clinically! Age <12, Season, Sx of RSV
Rapid assay (nasal swab, done in hospital)
CXR to dx secondary PNA if indicated

37
Q

How do you treat RSV

A

Fluids, respiratory support (O2)
Ribavirin (antiviral for Hep C and RSV) IF immunocompromised
Palivizumab (Synagis) as prophylaxis ONLY

38
Q

What is the prognosis of RSV

A

30-40% oh RSV hospitalized pts will wheeze later in childhood
RSV in infancy can lead to asthma

39
Q

What is Infant Respiratory Distress syndrome

A

MCC of respiratory distress in pre-term infants

Deficient surfactant production + Surfactant inactivation 2/2 protein leaking into airspaces

40
Q

What is the role of surfactant normally

A

Reduce surface tension allowing alveolar expansion= alveoli won’t collapse

41
Q

If you are deficient in surfactant what can happen

A

Alveolar collapse during expiration, atelectasis, decreased gas exchange, hypoxia, V/Q mismatch
Lung inflammation causing pulmonary edema

42
Q

RF for surfactant deficiency are

A

Premature birth (highest if <28 weeks)
Maternal DM
AMA
FHx

43
Q

Sx of IRDS are

A

Respiratory distress at birth
Hypoxemia on ABG
Ground Glass on CXR** (atelectasis)
Diminished air movement despite vigorous respiratory effort

44
Q

How do you treat IRDS

A

Supplemental O2, nasal CPAP, early intubation

Steroids, surfactant replacement (Beractant-Survanta)

45
Q

RF for peds PNA are

A 
congenital heart dz 
bronchopulmonary dysplasia 
CF
second hand smoke 
No vaccinations (Prevnar, PCV 13)
Asthma
sickle cell dz
NM disorders 
GERD 
Immunodeficiency
46
Q

Sx of peds PNA include

A

Fever, cough, preceding URI

Infants: poor feeding, irritable, restless

47
Q

What causes afebrile PNA of infancy

A

Chlamydia* and other maternal infx
Occurs mostly at 2 weeks-3 months
(n CXR will see hyperinflation w/ interstitial process)

48
Q

On PE of PNA you will note

A 
tachypnea, tachycardia, +/- fever
Retractions 
*Grunting (imminent resp failure) 
Decreased O2 sat 
Crackles, Rhonchi, decreased air movement 
\+.- ill appearance
49
Q

What are the causes of PNA by age

A

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
Q

What is the MCC of bacterial PNA in all ages

A

Strep pneumo!!

51
Q

What work up should you get if you suspect pneumonia

A

A/P and lateral CXR
Blood cultures if toxic and need admission
Sputum cultures if severe

52
Q

On PNA CXR you will se

A

Air space disease/Consolidation in lobar distribution (bacterial PNA)
Interstitial/peribronchial infiltrates (viral PNA)

53
Q

How do you treat peds PNA

A

<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
Q

Atypical causes of bacterial PNA are

A

Mycoplasma pneumo

Chlamydia pneumo

55
Q

What is pertussis

A

Whooping cough! caused by Bordatella pertussis

56
Q

How is pertussis spread

A

Respiratory droplets

Incubation 7-10 days

57
Q

Complications in infants/young kids of Pertussis include

A

Hypoxia
Apnea
PNA
Seizures

58
Q

What are the 3 phases of whooping cough

A

(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
Q

How do you diagnose pertussis

A

**Gold: PCR and nasal cultures
+/- serology
CBC (leukocytosis, mostly lymphocytes)
(CXR is usually normal)

60
Q

How do you treat Pertussis

A

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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