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Clin Med Peds > Peds Pulmonary 2 > Flashcards

Peds Pulmonary 2 Flashcards

1
Q

breath sound for partial airway obstruction?

A

stridor

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2
Q

breath sound for complete airway obstruction?

A

no sound/silence -> NO AIRWAY

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3
Q

80% of FBA episodes occur at what age?

A

< 3 y/o

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4
Q

what do kids most commonly aspirate?

A

peanuts, nuts, popcorn, hot dogs

food is M/C in infants and toddlers

non-food is M/C in older kids

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5
Q

what causes FATAL aspiration?

A

Balloons, anything unbreakable

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6
Q

in kids, what is the most common location for foreign body to get stuck?

A

proximal mainstay bronchus (before the branch), R = L

can be in larynx if large enough

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7
Q

why is larynx foreign body associated with higher morbidity/mortality?

A

b/c if it’s in the larynx you’re not moving an air at all vs if in right or left bronchi still have air moving from side that isn’t blocked

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8
Q

when should you suspect FB aspiration in kids?

A
  • chocking (witnessed event)
  • wheezing
  • formerly speaking and won’t speak
  • coughing w/out URI sx’s
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9
Q

when do kids usually present with FBA?

A

within 24hrs of FBA (can have chronic FBA as well)

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10
Q

sx’s of acute and life threatening FBA

A
  • respiratory distress
  • cyanosis
  • AMS
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11
Q

sx’s of less acute (chronic) and not emergently life threatening FBA

A

CLASSIC TRIAD

  • wheezing
  • decreased air entry especially regionally
  • cough
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12
Q

dx of FBA

A

HISTORY IS KEY

May also need X-rays (if radiopaque object)

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13
Q

what will you see on x-ray for FBA?

A

swelling on lateral neck film

air trapping distal to PARTIAL obstruction on expiratory CXR

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14
Q

what is dx tool and tx if hx, PE, x-rays lead to suggestion of FBA?

A

Bronchoscopy

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15
Q

what are complications of FBA removal?

A
  • dislodgement or breakage with advancement into bronchioles or lungs
  • infection by FB that’s in too long -> requires abx
  • inflammation -> may require steroid burst
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16
Q

how do you prevent FBA in kids?

A

EDUCATE THE PARENTS!!!

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17
Q

what is Cystic Fibrosis (CF)?

A

Genetic disruption (mutation) of the CHLORIDE CHANNEL

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18
Q

viscous secretions in what organs in CF?

A

Lungs, Pancreas, Liver, Intestine, Reproductive tract

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19
Q

Respiratory sx’s of CF

A
  • Persistant productive cough

- Hyperinflation of lungs on CXR

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20
Q

Respiratory tract colonized with what bacteria in CF?

A

Staph aureus and H. flu in childhood

can get pseudomonas pneumonia and then get colonized with pseudomonas (pseudomonas found in CF adult pts)

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21
Q

Sinus sx’s of CF

A

Panopacification of sinuses by the age of 8 months

Nasal polyps

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22
Q

Pancreas sx’s of CF

A

Pancreas becomes thickened, so it doesn’t produce enough digestive enzymes -> malabsorption -> failure to thrive, electrolyte abnl, anemia

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23
Q

what is a pathognomonic clinical feature of CF?

A

meconium ileus

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24
Q

what other clinical features do you see in CF?

A

Infertility

biliary issues, clubbing of fingers and toes, recurrent DVT, nephrolithiasis and neprhocalcinosis

depression, drug abuse both (d/t having chronic disease)

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25
Q

why are males and females with CF infertile?

A

95% of males w/CF d/t absent vas deferens or poorly develop Wolffian structures

up to 20% of females are infertile due to amenorrhea secondary to malabsorption and tenacious cervical mucous

26
Q

how do you dx CF? what about newborns?

A

Clinical sxs of CF in at least 1 organ system

Evidence of CFTR dysfunction by any of these tests:
-sweat chloride elevated (>60mmol/L) on 2 occasions

In newborns, don’t need any organ system involvement

27
Q

why do patients need to meet both criteria for dx of CF?

A

b/c there are other CFTR related d/o’s that will NOT be CF

ex: chronic rhinosinusitis, idiopathic bronchiectasis, etc.

28
Q

what is classic CF?

A
  • disease in 1 or >1 organ system

- Pt has elevated sweat chloride (>60mmol/L)

29
Q

what is non-classic CF?

A
  • meet disease criteria in 1 or more organ systems with normal or borderline sweat test results
  • requires DNA analysis for dx
30
Q

what is the most common form of CF diagnosed in adults or older adolescents?

A

non-classic CF

diagnosed in them d/t milder physical findings

31
Q

what is the most likely chief complaint leading to dx of CF in infants and children? examples?

A

respiratory sx’s

Ex: persistant or chronic URI, wheezing of unclear etiology or recalcitrant

32
Q

with what respiratory sx’s should suspicion in setting of no CF dx be raised?

A
  • chronic productive cough
  • recurrent URIs or LRIs
  • hyperinflation on CXR
  • PFTs c/w obstructive disease
33
Q

how are 50% of CF cases diagnosed?

A

by newborn screening with heel stick dry blood sample

34
Q

how is newborn screened for CF? when must it be done? confirmation?

A

heel stick dry blood sample

measure levels of immunoreactive trypsin (IRT)

must be done before 8 weeks of life

a lot of false positives and negatives, so positive must be confirmed by DNA or sweat test

35
Q

what is the primary test for dx of CF?

A

sweat test

36
Q

how is the CF sweat test done?

A

by applying pilocarpine iontophoresis and determining the chloride concentration in the resulting sweat chemically

37
Q

when is the CF sweat test done?

A

if asymptomatic positive newborn screen, after 2 weeks of life and >2 kg

if meconium ileus after DOL 2

38
Q

when is DNA testing for CF done? how is it done?

A

on all pts w/intermediate (possible) sweat test result

also done for prognostic and epidemiological interest on all CF pts

23 common mutations screened

pts should have 2 mutations to be considered positive for CF

39
Q

main tx for CF?

A

Tezacaftor/Ivacaftor for >6 y/o (improves lung fxn by 4%)

Ivacaftor for >6 y/o

Azithromycin PO for ppx use and anti-inflammatory effects (>6 y/o)

Bronchodilators (albuterol daily use)

40
Q

what meds enhance airway secretion clearance for CF?

A

DNASE

Inhaled Hypertonic Saline (>6 y/o)

41
Q

so what do CF pts inhale for rx?

A

Albuterol -> Hypertonic Saline -> Chest PT -> DNASE -> abx

DON’T MIX!!!

42
Q

what are other CF pulmonary tx’s?

A

STEROIDS
-chronic PO, short-term, or inhaled

OXYGEN, BiPAP, IMMUNIZATIONS

43
Q

what immunizations are recommended for CF?

A

influenza, pneumococcal, palivizumab for RSV ppx if age appropriate

44
Q

what tx must you consider if CF is a multi system disease?

A

lung transplant

45
Q

use of chronic PO steroids in CF not recommended in…

A

kids 6-18 y/o d/t adrs

46
Q

use of short-term PO steroids no more than…

A

5 days

47
Q

use of inhaled steroids if…

A

chronic asthma like sx’s or aspergillosis ONLY

48
Q

what is RDS in preterm infants?

A

Respiratory distress syndrome

aka Hyaline Membrane Disease

49
Q

increased risk of RDS in infants born below…

A

30 weeks

50
Q

when does formation of alveoli begin in babies?

A

at 24 weeks

51
Q

93% of RDS infants at what age?

A

<28 weeks

52
Q

what is the etiology of RDS in preterm infants?

A

born too early, so have Surfactant Deficiency (quantity and quality deficient) -> atelectasis -> V/Q mismatch -> Pulmonary Inflammatory Response -> Potential Lung Injury and Pulmonary Edema

53
Q

what else complicates the issue of poor surfactant in preterm infants?

A

increased risk of PDA and foramen ovale b/c premature -> extra pulmonary shunting -> increased hypoxemia

54
Q

sx’s of RDS?

A
  • tachypnea, nasal flaring
  • grunting-expiratory
  • retractions
  • cyanosis, pallor
  • decreased breath sounds (may be developing pulmonary edema)
  • peripheral pulses diminished
  • peripheral edema
  • poor urine output (b/c of renal failure)
55
Q

dx of RDS

A

history and PE

56
Q

what imaging for RDS? what can you see on it?

A

CXR

  • airbronchograms (air trapped w/in bronchi)
  • low lung volume
  • ground glass appearance
  • pneumothorax
57
Q

what are interventions to prevent RDS in preterm infants?

A

Antenatal corticosteroids (given to mom before 34 weeks of delivery to promote development of surfactant for babies)

Exogenous surfactant (natural preferred by endotracheal tube w/in 30-60 min of life)

Assisted Ventilation

58
Q

good things about mechanical ventilation in RDS?

A
  • PEEP corrects atelectasis and gives route for exogenous surfactant administration
  • this improves arterial oxygenation
59
Q

bad things about mechanical ventilation in RDS?

A
  • trauma by volume and pressure
  • O2 toxicity
  • intervention can lead to bronchopulmonary dysplasia (BPD)
  • intubation injury
60
Q

possible new ventilation tx’s for RDS?

A

nasal CPAP, nasal intermittent positive pressure ventilation

61
Q

what is NOT advocated for as tx for RDS?

A

nitrous oxide, ECMO

62
Q

other considerations in RDs therapy?

A
  • thermoregulation
  • fluid management
  • CV management
  • nutritional support

Clin Med Peds (10 decks)

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