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pulmonology > Peds pulmonary diseases > Flashcards

Peds pulmonary diseases Flashcards

1
Q

What is Croup? (laryngotracheobronchitis)

  • usual cause?
  • most common age?
A
  • infection causing inflammation of the larynx, trachea, and bronchi
  • usually caused by parainfluenza virus
  • also by RSV, influenza virus, and adenovirus
  • 6 months to 3 years
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2
Q

Wha are the key features of Croup?

A
  • URI sxs with BARKING dry cough and stridor (upper airway, heard upon inspiration), low grade fever or may be absent
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3
Q

DDx of Croup?

A
  • think about epoglottitis
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4
Q

How do you differentiate between Croup and Epiglottitis?

A
  • Croup: child might be in distress but won’t be toxic, will have barking cough
  • epiglottitis: will be toxic, ill appearing, can’t swallow, child will be stoic, focused on breathing (caused by H flu), will have high fever
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5
Q

When do you tx child with croup w/ steroids?

A

in clinic setting, during the day when the cough isn’t so prominent (you know it will get worse at night)
- dexamethasone 0.6 mg/kg one dose

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6
Q

When should you hospitalize pt with croup?

A
  • when they are not responding to tx
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7
Q

Tx options for croup

A
  • generally steroids
  • if barking cough and no stridor at rest: supportive therapy, hydration, minimal handling, mist therapy, cold air
  • if stridor at rest: O2, neb racemic epi
  • if sxs resolve within 3 hours of steroid and epi use, can be safely d/c
  • hospitalize if recurrent epi txs are required or if respiratory distress persists
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8
Q

Epiglottitis?

A
  • true medical emergency!!!

- most commonly due to H flu Type B

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9
Q

Presentation of Epiglottitis?

A 
- SUDDEN onset:
fever
dysphagia
DROOLING
muffled hot potato voice
inspiratory retractions
soft stridor
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10
Q

What should you do when pt comes in with epiglottitis?

A
  • don’t examine pt
  • get a STAT soft tissue lateral portable x ray of neck and prepare to intubate immediately
  • Call in ped anesthesia team ASAP
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11
Q

Hallmark sign of Epiglottitis on XR? Looking in throat?

A
  • thumb sign - enlarged epiglottitis

- looking in oropharynx: cherry red spot

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12
Q

6 mo old girl presents with fever, worsening cough, and rapid breathing, rhinorrhea, increased rate of breathing (during winter)
- becoming more irritable, refusing bottle
- attends daycare
- grunting, chest intercostal retractions, wheezing audible in all fields, 88% on RA
- CXR show bilateral interstitial infiltrates and hyperaeration with mild consolidation at bases
What is the dx?
Tx?

A
  • RSV (bronchiolitis) -respiratory synctial virus

- supportive care: O2, fluids

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13
Q

Pathology of bronchiolitis?

A
  • inflammatory process of smaller lower airways, usually caused by RSV
  • can progress to respiratory failure and is potentially fatal
  • infants with congenital heart disease, chronic lung disease, immunodeficiences at risk for severe disease and poorer outcomes
  • mucus is stuck in bronchioles, can’t cough it out
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14
Q

Presentation of bronchiolitis (RSV)

A
  • usually fever, URI sxs, accompanied with tachypnea and wheezing
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15
Q

Other causes of Bronchiolitis?

A
  • adenovirus

- parainfluenza virus

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16
Q

Who should recieve palivizumab (synagis)?

A
  • premature babies

- it is a IM monocolonal Ab that provides passive prophylaxis against RSV

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17
Q

What is Ribavirin? Who gets this?

A
  • synthetic nucleoside analog with activity against RSV, usually reserved for severely ill or immunocompromised pt, given by inhalation
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18
Q

Presentation of Bronchitis? lab work up?

A
  • URI sxs with cough and malaise
  • coarse bronchial sounds
  • WBC will be normal, CXR clea, most the time it is viral
  • ** the presence of mucopurulent sputum doesn’t imply a bacterial infection so abx aren’t helpful
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19
Q

Most pneumonia cases in children viral or bacterial?

A
  • viral
20
Q

Presentation of viral pneumonia?

A
  • prodrome of rhinorrhea, cough, low grade fever, and pharyngitis
  • not a sudden presentation like bacterial
  • won’t see a lot of consolidation on CXR
21
Q

Presentation of bacterial pneumonia?

A
  • more abrupt sxs, will have high fever, cough, chest pain and shaking chills
  • vitals will be bad
  • babies usually quit feeding, inspiratory retraction
  • but it has a wide spectrum of presentation because of broad spectrum of disease
  • some cases: tachypnea only sign of underlying pneumonia
    may have elevated WBC
  • CXR: much more variable than with adults, don’t see classic lobar consolidation
22
Q

Tx considerations for pneumonia?

A
  • abx: if you think it is bacterial
  • bronchodilators: if wheezing
  • fluids, O2: if less than 95%?
  • hospitalize if you think condition is severe
23
Q

What is Pertussis or whooping cough caused by? Why is it making a comeback? Who do we worry about getting perttussis?

A
  • caused by bordetella pertussis
  • highly communicable disease, making a comeback because less people are vaccinating and vaccination not always effective, and many people lose immunity over time
  • Worry about babies getting pertussis - infection isn’t what kills but the respiratory distress from coughing does
24
Q

How long does pertussis last?

A
  • 4-12 weeks
25
Q

Presentation of Pertussis?

A
  • onset is insidious, starts as URI sxs and slight fever may be present, cough is initially irritating but not paroxysmal
  • after about 2 weeks: cough becomes paroxysmal with classic whoop (stage lasts 2-4 weeks)
  • cough can be so harsh that it can cause vomiting
26
Q

What are the guidelines for dx pertussis?

A
  • ask about immunization status
  • classic presentation than you should suspect pertussis
  • cough for more than 2 weeks, suspect pertussis
  • nasal swab for culture (Bordet-Gengou culture medium)
    or
  • nasal swab for PCR more sensitive: sent to state lab, results in 3-7 days
27
Q

Tx for pertussis?

A
  • erythromycin for 14 days
  • azithro for 5-7 days
  • usually tx awaiting lab results if hx of known exposure
  • will not shorten course of cough unless given in early phase but it will prevent transmission (must tell this to pt)
28
Q

Pearls for Bronchiolitis

A
  • usually caused by RSV

- peaks at 6 mos of age, generally fever with marked tachypnea and wheezing, highly contagious and seasonal

29
Q

Difference b/t bronchitis and pneumonia in peds?

- tx pneumonia?

A
  • viral bronchitis: URI sxs and coarse bronchial sounds and usually no fever
  • with bacterial pneumonia: acute onset of fever, productive cough, SOB w/o URI sxs and with fine crackles, not coarse breath sounds
  • pneumonia is usually viral but difficult to distinguish from bacterial pneumonia so usually tx with abx
30
Q

2 yo boy presents with persistent “hacking” cough (6 mo), dx with asthma 4 months ago, cough gets worse with each cold, and he vomits occassionaly. Smaller than most children his age (in 3rd percentile)
- Repeated URI infections after being dx with RSV bronchiolitis
- ** born at home, UTD on immunizations
- had formula intolerance - stools frothy and bulky - not digesting fat
PE: slight increased AP diameter of chest, diffuse wheezes, and crackles
most likely Dx?

A
  • Cystic fibrosis
  • do sweat chloride test - 90 mEq/L (anything above 60 is abnormal)
  • failure to thrive because lungs are full of mucus, huge metabolic disruption and all intake is going towards breathing, also losing fats because of pancreas
31
Q

How should you tx CF pneumonia?

A
  • combo of abx: amino glycoside tobramycin (cover pseudomonas) and antipseudomonal PCN - piper or ticarcillin
  • also neb bronchodilators, O2 prn, chest physiotherapy, mucolytics, and maybe steroids
32
Q

What should you be worried about when Rx tobramycin?

A
  • ototoxicity

- nephrotoxicity

33
Q

Can you use cipro on this 2 yo child?

A

No, worried about arthopathy (joints) and osteochondrosis

34
Q

Common findings in CF population?

A

recurring sinusitis
mucus secretions
nasal polyps

35
Q

Cystic fibrosis pathology?

A
  • autosomal recessive inheritance
  • 1/6000 CAUCASIAN births
  • carrier rate: 1 in 32 adults
  • disease of exocrine gland system (reach an epithelia surface and assoc with external secrteion, whereas endocrine - secretes directly into bloodstream): defective chloride channel results in highly viscous secretions
  • theory: decrease in chloride secretion leads to relative dehydration and abnormal mucociliary clearance
36
Q

Clinical features of CF?

A 
respiratory insufficiency: excessive mucus
- pulmonary fibrosis
- obstruction
- frequent infections
- chronic sinusitis
pancreatic insufficiency:
- malabsorption of fats anf proteins: steatorrhea, meconium illeus
- failure to thrive
- rectal prolapse
- intussuseption (currant jelly stool)
37
Q

Dx tests for CF?

A
  • IRT assay
  • DNA assay
  • sweat chloride test (newborns)
  • typical pulmonary features
  • typical GI features
    • family hx
38
Q

Tx options for CF?

A 
- pulmonary:
bronchodilators
mucolytics (acetylcysteine)
steroids
abx (always has to cover pseudomonas)
- pancreatic:
pancreatic enzyme supplements
vitamin supplements
high caloric high protein diet
39
Q

Survival rate for CF? Often dx when?

A
  • primary morbidity is from progressive obstructive lung disease
  • pancreatic enzyme replacement meds have increased survival - now 37 yo
  • often dx in hospital at birth because of meconium ileus, signs also include abdominal dissension, and thick sticky meconium
  • also dx with presenting during infancy with failure to thrive, respiratory compromise
40
Q

What is cause of respiratory distress syndrome of the newborn?

A
  • common in preterm infants
  • from deficiency in pulmonarry surfactant
  • cause of major morbidity/mortality in preterm infants
  • lungs aren’t allowed to fully develop if preterm because of lack of surfactant (surfactant isn’t produced until 3rd trimester)
  • greatest risk: 28 weeks and lower
41
Q

Pathophys of Respiratory distress syndrome of newborn?

A
  • surfactant deficiency
  • inflammation
  • pulmonary edema
  • decrease in pulmonary fxn
  • hypoxemia
42
Q

Clinical manifestations of respiratory distress syndrome?

A
  • tachypnea
  • nasal flaring
  • expiratory grunting
  • accessory muscle breathing
  • cyanosis
43
Q

Clinical course of respiratory distress?

A

progresses over 48-72 hours

  • marked diuresis
  • tx greatly improves pulmonary fxn
44
Q

Dx respiratory distress?

A
  • clinical picture of premie
    CXR: air bronchograms, ground glass opacities
    ABGs
    hyponatremia (because of water retention - inflammation)
45
Q

Tx of respiratory distress?

A
  • give O2, maybe CPAP

- surfactant replacement therapy given through ET tube

pulmonology (20 decks)

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