Peds respiratory Flashcards
1
Q
etiology of viral croup
A
parainfluenza virus or RSV
2
Q
clinical presentation
- hoarseness
- inspiratory stridor (subglottic narrowing)
- cough: barking “seal-like”
A
croup
3
Q
steeple sign is associated with what condition
A
croup
- refers to tapering of the upper trachea on a frontal chest radiograph reminiscent of a church steeple.
4
Q
managemant of moderate croup
A
- corticosteroids (Dexamethasone)
- nebulized racemic epinephrine
5
Q
managemant of severe croup
A
- airway support
- admit
6
Q
etiology of epiglottitis
A
bacterial: H. Influenza
* incidence greatly reduced in peds as result of Hib vaccine
7
Q
what are the 3 D’s of epiglottitis
A
- dysphagia
- drooling
- distress
8
Q
clinical presentation
- rapid onset
- high fever, sore throat
- dsyphagia
- drooling
- distress
- tri-pod
A
epiglottitis
9
Q
what is important to remember when examining a possible epiglottitis
A
do not use a tongue blade
10
Q
thumb sign is associated with what condition
A
- epiglottitis
- enlarged epiglottis protruding from anterior wall of hypopharynx
11
Q
management of epiglottitis
A
- airway support (ET tube if possible)
- Abx: ceftriaxone
12
Q
what is tracheomalacia
A
- floppy trachea- abnormal collapse due to inadequate supporting cartilage
13
Q
- clinical presentation
- recurrent harsh, barking cough or stridor during expiration
- aggravated by respiratory tract infections and agitation
A
tracheomalacia
14
Q
treatment of tracheomalacia
A
- spontaneous improvement: cartilage becomes stronger as child grows
- CPAP
15
Q
clinical presentation
- abrupt onset of cough
- inspiratory/expiratory stridor
- unilateral wheezing
- possible absence of cough or breathing
A
foreign body aspiration
16
Q
foreign body aspiration, objects typically end up in?
A
R mainstem bronchus
17
Q
diagnostic and curative of foreign body aspiration
A
bronchoscopy
18
Q
bacterial pathogen of pertussis (whooping cough)
A
Bordatella pertussis
19
Q
the “cough of one-hundred days”
A
pertussis (whooping cough)
20
Q
name the 3 phases of pertussis (whooping cough)
A
-
Catarrhal
- URI, fever
- 1-2 weeks
-
Paroxysmal
- persistant paroxysmal cough, inspiratory whooping
- 2-6 weeks
-
convalescent
- cough gradually resolves
- weeks-months
21
Q
gold standard diagnosis of pertussis (whooping cough)
A
nasopharyngeal swab/aspirate: nasal culture
22
Q
treatment of pertussis (whooping cough)
A
- Abx: Macrolid preferred
- hospitilize if respiratory distress, age < 4 mo
23
Q
what is the most common cause of lower respiratory tract infection in children < 1 yo
A
respiratory syncytial virus (RSV)
24
Q
respiratory syncytial virus (RSV) peaks in what months
A
- Nov-April (peaks Jan/Feb)
25
high risk patients for respiratory syncytial virus (RSV)
* infants \< 6 mo and preemies
* 2nd hand smoke exposure
* respiratory disease or congenital heart disease
* immunodeficiency
26
complications of respiratory syncytial virus (RSV)
* _bronchiolitis_
* PNA
* acute respiratory failure
27
prevention (prophylaxis) of respiratory syncytial virus (RSV)
* Palivizumab
* monthly injection
* for high risk children \<2 yo
28
etiology of bronchiolitis
* **RSV** #1
* rhinovirus
29
clinical presentation
* 2-3 days of URI sx followed by development of low grade fever, cough, and expiratory wheeze
* respiratory distress (tachypnea, retractions, nasal flarring)
bronchiolitis
30
diagnosis of bronchiolitis
* clinical
* \*\*RSV nasopharyngeal swab is available
31
managment of bronchiolitis
* anticipatory guidance
* hospitilization if severe
* \*inhaled bronchodilators do not improve overal outcomes
32
what is the most common fatal autosomal recessive disease in the US
cystic fibrosis
33
what is cystic fibrosis
* abnormal trans-membrane chloride transport -\> thick, viscous secretions in the lungs
* multi-system disease
34
clinical presentation
* persistant, productive cough
* hyperinflation on CXR
cystic fibrosis
35
diagnosis of cystic fibrosis
* sweat chloride testing \>60 meq/L
36
managment of cystic fibrosis
* Abx
* chest physiotherapy
* mucolytics, steroids, bronchodilators
37
what is bronchiectasis
* abnormal dilation of bronchi
* obstructive pattern
38
presentation of bronchiectasis
chronic cough with sputum (r/o cystic fibrosis)
39
treatment of bronchiectasis
* Abx
* pulmonary drainage
* possible bronchodilators
40
PNA
* infection of lung parenchyma
* consolidation of the alveolar spaces
41
causes of PNA in age group: 1-3 months
* viral
* RSV
42
causes of PNA in age group: 3-12 months
* viral
* RSV
43
causes of PNA in age group: 2-5 years
* viral
* RSV
* Parainfluenza
* influenza
44
causes of PNA in age group: 5-18 years
* bacterial
* S. Pneumoniae
* Atypicals: mycoplasma and chlamydia pneumoniae
45
Most common bacterial pathogens causes pneumonia in age group: 1 month-5 years
* **S. pneumonia**
* H. influenza
* atypicals
46
Most common bacterial pathogens causes pneumonia in age group: 5-18 years
* Atypicals
* S. pneumonia
47
symptoms of PNA in infants
* may be subtle
* poor feeding
* irritability
* restlessness
48
clinical presentation
* **tachypnea**
* tachycardia
* fever (not always)
* decreased O2 sat
* increased work of breathing
* lungs: crackles, rhonchi
pneumonia
49
if you hear wheezing in a patient with pna, it is associated more with what etiology
atypical bacteria and viruses
50
outpatient treatment of pneumonia in infant/preschool age
* **Amoxicillin**
* alternative: 2rd/3rd gen cephalosporin, clindamycin
51
outpatient treatment of pneumonia in school age
* amoxicillin
* consider azithromycin for atypical pahtogen coverage (alternative: doxycycline)
52
pneumonia inpatient treatment
* ampicillin/sulbactam
* cefuroxime
* ceftriaxone
53
infants factors that show they need to be hospitilized for pna
* apnea/grunting
* spO2 \< or = 92%
* poor feeding
* RR \> 70 breaths/min
54
factors in older children that show they need to be hospitilized for pna
* grunting
* inability to tolerate PO
* spO2 \< or = 92%
* RR \> 50 breaths/min
55
Infant respiratory distress syndrome or "haline membrane disease" is?
* deficiency of surfactant at birth
* leads to alveolar collapse during respiration, decreased gas exchange -\> hypoxia
56
clinical presentation
* symptoms begin within minutes of birth
* signs of respiratory distress
* tachypnea
* chest wall retractions
* expiratory grunting
* cyanosis
Infant respiratory distress syndrome
57
a CXR showing diffuse bilat atelecatsis with ground-glass appearance is associated with what condition
Infant respiratory distress syndrome
58
treatment of Infant respiratory distress syndrome
* O2 given via CPAP
* ET tube
* exogenous surfactant
59
preventative treatment of Infant respiratory distress syndrome
* antenatal glucocorticoid (dexamethasone or betamethasone)
* hastens lung maturity
* given to mothers expected to deliver before 32-34 weeks
60
presentation
* chronic airway **inflammation**
* **hyper-responsiveness**
* **reversible obstruction**
asthma
61
clinical presentation
* intermittent or chronic
* cough
* wheezing
* dyspnea
* chest tightness
* triggers
asthma
62
Dx of asthma using spirometry
* pulmonary function tests
* spirometry: children \> 5 yo
* FEV1/FVC ratio decreased (obstructive)
* increase in FEV1 \> 12% and \> 200 ml following bronchdilator use : _reversible_
63
asthma treatment
* short acting bronchodilators (SABA) orn
* inhaled corticosteroids
* long acting bronchodilators (LABA)
* shoud NOT be used without an inhaled corticosteroid
* leukotriene antagonist
* oral steroids
64
Does treatment of asthma need more than a rescue inhaler?
**Rules of two**
* more than 2 x/week
* more than 2x/month at night
* more than 2x/year to refill
65
one plus one rule for treatment of asthma
* dispense one albuterol inhaler and give one refill
* \*make sure patient is consistently taking inhaled corticosteroid
66
what is vocal cord dysfunction
* inappropriate vocal cord motion
* causes partial airway obstruction; often misdiagnosed as asthma
67
clinical presentation
* inspiratory stridor
* cough
* choking sensation or throat tightness
* tiggers: exercise, irritants, rhinosinusitis, GERD
vocal cord dysfunction
68
treatment of vocal cord dysfunction
* reassurance
* breathing maneuvers
* avoidance of triggers
* speech therapy
69
major risk factors of obstructive sleep apnea
* adenotonsillar hypertrophy
* obestiy
70
dx of obstructive sleep apnea
sleep study
71
treatment of obstructive sleep apnea
* adenoidectomy with possible tonsillectomy or CPAP
