Peds - Respiratory Flashcards
Egophany
o normal findings
o consolidative findings
Normal E –> A
Consolidation E –> E
Age for relatively reliable PFTs
greater than 8 years
FEV1 - normal is at least what number?
At least 80%
What does hyper-resonance indicate?
air trapping
What do these stand for?
FVC
FEV1
TLC
Forced Vital Capacity
Forced Expiratory Volume in 1 sec
Total Lung Capacity
OBSTRUCTIVE pulmonary disease -
o FVC
o FEV1
o FEV1/FVC ratio
o TLC
FVC - decreased or normal
FEV1 - decreased
FEV1/FVC ratio - decreased
TLC - normal or increased
RESTRICTIVE pulmonary disease -
o FVC
o FEV1
o FEV1/FVC ratio
o TLC
FVC - decreased
FEV1 - decreased or normal
FEV1/FVC ratio - normal
TLC - decreased
These normal breath sounds are harsh and sound like air is being blown through a pipe.
Tracheal
These normal sounds are loud and high in pitch with a short pause between inspiration and expiration; expiratory sounds last longer than inspiratory sounds.
Bronchial
These normal breath sounds are softer than bronchial sounds, but have a tubular quality. The sounds are about equal during inspiration and expiration
Bronchovesicular
These normal breath sounds are soft, blowing, or rustling sounds; normally heard throughout most of the lung fields and heard throughout inspiration, continue without pause through expiration and then fade away.
Vesicular
Viral disease of the lower respiratory tract where inflammation causes obstruction of the small respiratory airways.
Bronchiolitis
“bronchitis in little people”
Bronchiolitis - typical age
less than 3 years
Bronchiolitis - typical pathogen
RSV (50%)
Bronchiolitis - signs and symptoms (4)
o URI symptoms lasting several days
o increasing respiratory distress
o moderate fever
o palpable liver and spleen (hyperinflated lungs)
Bronchiolitis - xray findings
hyperinflated lungs
may have scattered consolidation
Prevention of RSV in high-risk infants
Synagis monthly during RSV season
High-risk for Synagis purposes (2)
o chronic lung disease under age 2
o preemie
Remodeling in asthma (3)
o thickening of epithelial basement membrane
o indicates severe stage
o permanent change
Asthma - ominous signs (4)
o absent breath sounds
o pulsus paradoxus
o inability to maintain recumbancy
o cyanosis
Asthma - diagnostics
o bloodwork
o PFTs
o other
o slight WBC increase, eosinophilia
o PFTs –> obstructive findings vv FEV1
o no radiograph unless r/o
Asthma - indications for hospitalization (2)
peak flow less than 60 L/min AND
no improvement with inhaled therapy
Asthma - frequency of monitoring
every 2 - 4 weeks for at least 3 months - until control is acheived
more frequently if more severe
Asthma - when can therapy be stepped-down?
After 3 months of good control
return in 2 weeks for recheck
Pneumonia - percentage caused by virus
70-80 %
Community-acquired Pneumonia - ABT
o preschool
o school age
preschool -
1st - amoxicillin
2nd - amoxicillin/clavulanate or macrolide
school age -
1st - macrolide
2nd - amoxicillin, or amoxicillin/clavulanate
Community-acquired Pneumonia -
which organisms does amoxicillin target?
S. pneumoniae
H. influenzae
(most likely bacterial causes of pneumonia in children)
An autosomal recessive disorder characterized by recurrent bronchial infection, progressive obstructive pulmonary disease, and pancreatic insufficiency with intestinal malabsorption.
Cystic Fibrosis (CF)
CF - selected sypmtoms (3)
viscous meconium
steatorrhea
salt-tasting skin
CF -
gold standard
Gold standard = pilocarpine iontophoresis sweat test
CF - PFTs reveal obstructive or restrictive pattern?
PFTs –> obstructive pattern
CF - blood worm reveals:
hyponatremia
hypochloremia
CF - chest radiograph
cystic lesions
atelectasis
Cromolyn
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