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peds resp Flashcards

1
Q

why would infant be cyanotic

A

amniotic fluid in lung

cong. heart disease

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2
Q

why would infant be cyanotic

A

amniotic fluid in lung

cong. heart disease

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3
Q

cong. heart vs respiratory cyanosis: how to tell the difference

A

listen for murmurs

-single S2: worrisome

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4
Q

baby PMI

A

right side hypertrophy, so right shifted–>just left of sternal border (vs. mid clavicular line in adults)

  • ensure not situs inversus
  • ensure no tension pneumothorax (R: right hyper expands, shift left of PMI, vis versa)
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5
Q

baby PMI

A

right side hypertrophy, so right shifted–>just left of sternal border (vs. mid clavicular line in adults)

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6
Q

cong. heart vs respiratory cyanosis: how to tell the difference

A

listen for murmurs

-single S2: worrisome

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7
Q

palpate this before listening to lungs/heart

A

PMI

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8
Q

baby PMI

A

right side hypertrophy, so right shifted–>just left of sternal border (vs. mid clavicular line in adults)

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9
Q

check pre-ductal (PDA) pulse ox

A

right arm: if lower no mixing??

postductal : leg or left arm

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10
Q

cardiac pre vs. post O2

A

pH: 7.44
CO2: 20
O2: 50

pH: 7.44
CO2: 20
O2: 54
not much change! problem with ductus, still not getting O2

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11
Q

lung problem: CO2 levels and hyperoxia test

A

retained CO2 (elevated)
dec. O2
hyperoxia test PaO2>150 mmHg
retracting, gasping, grunting, crackles, rhonchi, rales

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12
Q

heart problem: CO2 levels and hyperoxia test

A

normal or dec. CO2
dec. O2
PaO2 50-150 mmHg
quiet tachypnea
norm.

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13
Q

resp pre vs post O2

A

pH: 7.2
CO2: 70
O2: 50

pH: 7.2
CO2: 66
O2: 160

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14
Q

cardiac pre vs. post O2

A

pH: 7.44
CO2: 20
O2: 50

pH: 7.44
CO2: 20
O2: 54

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15
Q

oxyhood

A

can be given instead of mask/intubation

*if CO2 is not a problem

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16
Q

transient tachypnea of the newborn

A

typ. term baby
mult. deliveries, C sec
respiratory problem
some retained fluid
check CBC

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17
Q

ddx for trans. tachypnea of newborn (“blue baby”)

A

meconium in utero: thick pea soup–>meconium aspirates: would intubate (ET tube, meconium aspirator) may need to bag them
-fluid in lungs–>chemical pneumonitis (bile acid)–>tachypnea
“meconium staining”
rare for premies, mostly term: think inf. w/ listeria if premie

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18
Q

chorioamnioitis orgs

A

group B. Strep, E. coli, listeria

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19
Q

meconium does not have

A

bacteria?

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20
Q

pneumothorax

A

seen on CXR: free air, pushes heart to opposite side

may occur from meconium aspiration

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21
Q

mom had fever while baby in utero, baby has foul smell

A

chorioamnionitis
can dev. into pneumonia
baby comes out w. flu, tachypnic

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22
Q

chorioamnioitis orgs

A

group B. Strep, E. coli, listeria

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23
Q

premature risk w/ O2 deficiency

A 
surfactant deficiency
37 wks
inc. work of breathing
grunting
inc. resp. rate
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24
Q

phys. signs of resp. distress

A

Nasal flaring: causes marked reduction in nasal resistance…can reduce lung resistance, and decrease work of breathing
Retractions: disturbance in lung and chest wall mechanics: intercostal, subcostal and suprasternal muscles
Cyanosis: clinically apparent when at least 5gm/100ml of hgb becomes unsaturated
cardiac baby would NOT grunt

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25
Q

common pulm. causes

A 
Retained Fetal Lung Liquid Syndrome (RFLLS or also known as Transient Tachypnea of newborn or TTN)*
Respiratory Distress Syndrome
Meconium Aspiration Syndrome
Pneumonia
Air leak*
most likely for premie
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26
Q

non-pulm causes RD

A

Cardiac: ie: cyanotic congenital heart disease
Infection : sepsis
Metabolic Disorders: ie Hypoglycemia, inborn errors of metabolism
CNS disorders: ie: meningitis, seizure, obstructed hydrocephalus
Other: ie Anemia, polycythemia, asphyxia
“panting like a dog”
not retractions

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27
Q

CXR for surf. deficiency

A 
air bronchograms
wet lungs
"ground glass"
higher surface tension
(with 100% O2, O2 would inc., CO2 would still be elevated)
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28
Q

can give babies CPaP?

A

yes, can also intubate but use oxyhood if not as bad

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29
Q

what lung cells respond to surfactant

A

type 2 alveolar cells

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30
Q

can give exogenous surfactant?

A

Yes, down trachea via intubation, tip them around, let ventilator blow into lungs, get better quickly

31
Q

complication of surfactant

A

pulmonary hemorrhage, calculate amount need to be given

32
Q

Sweat chloride test

A

The most discriminatory test for CF and is the gold standard
-IRT/DNA method can detect single CFTR (cystic fibrosis transmembrane conductance regulator) gene
(But child with single gene may not have CF)

33
Q

what lung cells respond to surfactant

A

type 2 alveolar cells

34
Q

meconium ileus

A

poor weight gain
**(buzzword for CF)
elevated IRT

35
Q

IRT: immunoreactive trypsinogen

A

meas. fraction of pancreatic enzymes normally rel. in low conc.
if elevated, suspect pancr. dysfunc, CF

36
Q

Sweat chloride test

A

The most discriminatory test for CF and is the gold standard
-IRT/DNA method can detect single CFTR (cystic fibrosis transmembrane conductance regulator) gene, i.e. + for carrier (But child with single gene may not have CF)
>60 is dx
40-60 intdeterminant (>30)
-newborns don’t sweat much

37
Q

CF can result in…

A 
chronic sinopulmonary disease and pancreatic insufficiency
Chronic cough
Decreased appetite/failure to thrive
Weight loss
Dyspnea
Increased sputum production
Rectal prolapse
pseudomonas infection
38
Q

CF inheritance

A

autosomal recessive

chromosome 7

39
Q

CF affects

A
  • Peribronchial cuffing
  • Tram lines (bronchial line shadows)
  • Recurrent infiltrates
  • Fibrosis
  • Pulmonary blebs and bullae
40
Q

CF also affects

A

vas deferens

nasal polyps

41
Q

In managing a child with CF, which of the following is the most appropriate choice?

a. Pulmonary therapies including bronchodilators and mucolytics
b. Macrolides for suspected bacterial infections
c. Pancreatic enzymes only for those with pancreatitis
d. Avoidance of live vaccines

A

all except d.

will put on macrolides later, pseudomonas is a big dog

42
Q

CF complications

A 
Recurrent pneumonia
Recurrent sinusitis
Hemoptysis
Pneumothorax
Respiratory failure
Nasal polyps
43
Q

Which of the following is the LEAST likely to be a complication of CF?

a. Hemoptysis
b. Pneumothorax
c. Pancreatic cancer
d. Male infertility
e. Cirrhosis
A

pancreatic ca

44
Q

Which of the following is usually clinically diagnostic of CF in neonate?

A

meconium ileus (1/5)

45
Q

macrolide tx

A

give during cataharral stage, ameliorate, but after cough, have no effect on course but limit spread

46
Q

CF tx

A 
Oxygen
Empiric antibiotic therapy
Bronchodilators
Support of ventilation
Support nutrition with pancreatic enzymes/GI
Treat complications:
Pneumothorax
Hemoptysis
Diabetes (usually as teens)
47
Q

what dx studies for CF?

A

lymphocytes on CBC (70%), elevated WBC

48
Q

CF colonization

A

S aureus, nontypeable H influenzae, gram-negative bacilli
P aeruginosa becomes predominant organism by 10 years of age.
Antibiotic therapy continued for 2 to 3 weeks and may be given on an inpatient service combined with home IV therapy

49
Q

macrolide tx

A

give during cataharral stage, ameliorate, but after cough, have no effect on course but limit spread

50
Q

how to prevent pertussis

A

infant DTaP
adult TdaP
pregnant: TdaP + flu shot–>passive imm. to baby

51
Q

more wheezing bac or viral?

A

viral

52
Q

most common cause of bronchiolitis

A

RSV

collect via saline tube on ice

53
Q

other causes of bronchiolitis

A

hMPV, adenovirus, influenza, hit kids

54
Q

peribronchial cuffing

A

“donut” rings around bronchi

55
Q

other CXR findings bronchiolitis

A

air expansion, air in subQ tissuses (crackly), hyperinflation

56
Q

bronchiolitis

A

don’t need steroids, albuterol; but can try

sev. may need to be intubated(premies, CV probe)

57
Q

RSV ppx

A

Palivizumab (MoAb IM)
criteria: typ. premies on O2
$$

58
Q

bronchiolitis: complications

A 
Apnea (most common in premature infants and young term infants)
Pneumonia
Atelectasis
Dehydration
Respiratory failure
Bacterial superinfection
Air leaks
59
Q

Ribavirin

A

don’t use much
give in a hood
ppx and supp. care is better

60
Q

placenta previa or abruption can result in

A

fetal anema or hypovolemia–>resp. distress

61
Q

poorly controlled DM can result in fetal

A

hypoglycemia, polycythemia, rel. surfactant deficiency

62
Q

polyhydramimnios can cause

A

tracheoesophageal fistula

63
Q

oligohydramnios can be a sign of

A

hypoplastic lungs

64
Q

triple screen

A

a-fetoprotein, hCG, estradiol

65
Q

during prey, lung epi is mostly

A

secretory membrane; chloride pump cause influx of Cl and H2O from interstitial into alv space

66
Q

just before delivery, fluid begins to clear

A

alv. space about 2-3 days before labor onset, pulm. epi becomes an absorbing membrane

67
Q

fetal RR

A

60 implies resp. distress)

68
Q

prior to delivery, if notice lecithin:sphingomeylin ratio is

A

implies fetal lung is immature

-give mom steroids (betamethason >2 days before)

69
Q

acute onset
fever
CP
grunting

A

BACTERIAL
most common: S. pneumo
-localized lobar pneumonia

70
Q

pneumonia diagnostics

A

CXR

CBC: high WBCs, left shift

71
Q

pneumonia: bac or viral?

A

viral more common, bac higher mortality/morbidity

72
Q

leading cause of bac CAP

A
  1. S. pneumo
  2. S. aureus
  3. GAS
73
Q

pneumonia vs. effusion

A

pneumo: rhonchi, wheezes, rales
eff: not as much, dec. breath sounds, egonphony

74
Q

Mycoplasma pneumonia

A

(teens)
“walking pneumonia”
tx: macrolide
neg. Gs

CSI (75 decks)

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