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PEDS final > Peds respiratory > Flashcards

Peds respiratory Flashcards

1
Q

etiology of viral croup

A

parainfluenza virus or RSV

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2
Q

clinical presentation

  • hoarseness
  • inspiratory stridor (subglottic narrowing)
  • cough: barking “seal-like”
A

croup

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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.
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4
Q

managemant of moderate croup

A
  • corticosteroids (Dexamethasone)
  • nebulized racemic epinephrine
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5
Q

managemant of severe croup

A
  • airway support
  • admit
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6
Q

etiology of epiglottitis

A

bacterial: H. Influenza
* incidence greatly reduced in peds as result of Hib vaccine

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7
Q

what are the 3 D’s of epiglottitis

A
  • dysphagia
  • drooling
  • distress
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8
Q

clinical presentation

  • rapid onset
  • high fever, sore throat
  • dsyphagia
  • drooling
  • distress
  • tri-pod
A

epiglottitis

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9
Q

what is important to remember when examining a possible epiglottitis

A

do not use a tongue blade

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10
Q

thumb sign is associated with what condition

A
  • epiglottitis
  • enlarged epiglottis protruding from anterior wall of hypopharynx
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11
Q

management of epiglottitis

A
  1. airway support (ET tube if possible)
  2. Abx: ceftriaxone
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12
Q

what is tracheomalacia

A
  • floppy trachea- abnormal collapse due to inadequate supporting cartilage
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13
Q
  • clinical presentation
    • recurrent harsh, barking cough or stridor during expiration
    • aggravated by respiratory tract infections and agitation
A

tracheomalacia

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14
Q

treatment of tracheomalacia

A
  • spontaneous improvement: cartilage becomes stronger as child grows
  • CPAP
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15
Q

clinical presentation

  • abrupt onset of cough
  • inspiratory/expiratory stridor
  • unilateral wheezing
  • possible absence of cough or breathing
A

foreign body aspiration

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16
Q

foreign body aspiration, objects typically end up in?

A

R mainstem bronchus

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17
Q

diagnostic and curative of foreign body aspiration

A

bronchoscopy

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18
Q

bacterial pathogen of pertussis (whooping cough)

A

Bordatella pertussis

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19
Q

the “cough of one-hundred days”

A

pertussis (whooping cough)

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20
Q

name the 3 phases of pertussis (whooping cough)

A
  1. Catarrhal
    1. URI, fever
    2. 1-2 weeks
  2. Paroxysmal
    1. persistant paroxysmal cough, inspiratory whooping
    2. 2-6 weeks
  3. convalescent
    1. cough gradually resolves
    2. weeks-months
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21
Q

gold standard diagnosis of pertussis (whooping cough)

A

nasopharyngeal swab/aspirate: nasal culture

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22
Q

treatment of pertussis (whooping cough)

A
  • Abx: Macrolid preferred
  • hospitilize if respiratory distress, age < 4 mo
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23
Q

what is the most common cause of lower respiratory tract infection in children < 1 yo

A

respiratory syncytial virus (RSV)

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24
Q

respiratory syncytial virus (RSV) peaks in what months

A
  • Nov-April (peaks Jan/Feb)
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25
Q

high risk patients for respiratory syncytial virus (RSV)

A
  • infants < 6 mo and preemies
  • 2nd hand smoke exposure
  • respiratory disease or congenital heart disease
  • immunodeficiency
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26
Q

complications of respiratory syncytial virus (RSV)

A
  • bronchiolitis
  • PNA
  • acute respiratory failure
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27
Q

prevention (prophylaxis) of respiratory syncytial virus (RSV)

A
  • Palivizumab
    • monthly injection
    • for high risk children <2 yo
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28
Q

etiology of bronchiolitis

A
  • RSV #1
  • rhinovirus
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29
Q

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)
A

bronchiolitis

30
Q

diagnosis of bronchiolitis

A
  • clinical
  • **RSV nasopharyngeal swab is available
31
Q

managment of bronchiolitis

A
  • anticipatory guidance
  • hospitilization if severe
  • *inhaled bronchodilators do not improve overal outcomes
32
Q

what is the most common fatal autosomal recessive disease in the US

A

cystic fibrosis

33
Q

what is cystic fibrosis

A
  • abnormal trans-membrane chloride transport -> thick, viscous secretions in the lungs
  • multi-system disease
34
Q

clinical presentation

  • persistant, productive cough
  • hyperinflation on CXR
A

cystic fibrosis

35
Q

diagnosis of cystic fibrosis

A
  • sweat chloride testing >60 meq/L
36
Q

managment of cystic fibrosis

A
  • Abx
  • chest physiotherapy
  • mucolytics, steroids, bronchodilators
37
Q

what is bronchiectasis

A
  • abnormal dilation of bronchi
  • obstructive pattern
38
Q

presentation of bronchiectasis

A

chronic cough with sputum (r/o cystic fibrosis)

39
Q

treatment of bronchiectasis

A
  • Abx
  • pulmonary drainage
  • possible bronchodilators
40
Q

PNA

A
  • infection of lung parenchyma
  • consolidation of the alveolar spaces
41
Q

causes of PNA in age group: 1-3 months

A
  • viral
    • RSV
42
Q

causes of PNA in age group: 3-12 months

A
  • viral
    • RSV
43
Q

causes of PNA in age group: 2-5 years

A
  • viral
    • RSV
    • Parainfluenza
    • influenza
44
Q

causes of PNA in age group: 5-18 years

A
  • bacterial
    • S. Pneumoniae
    • Atypicals: mycoplasma and chlamydia pneumoniae
45
Q

Most common bacterial pathogens causes pneumonia in age group: 1 month-5 years

A
  • S. pneumonia
  • H. influenza
  • atypicals
46
Q

Most common bacterial pathogens causes pneumonia in age group: 5-18 years

A
  • Atypicals
  • S. pneumonia
47
Q

symptoms of PNA in infants

A
  • may be subtle
    • poor feeding
    • irritability
    • restlessness
48
Q

clinical presentation

  • tachypnea
  • tachycardia
  • fever (not always)
  • decreased O2 sat
  • increased work of breathing
  • lungs: crackles, rhonchi
A

pneumonia

49
Q

if you hear wheezing in a patient with pna, it is associated more with what etiology

A

atypical bacteria and viruses

50
Q

outpatient treatment of pneumonia in infant/preschool age

A
  • Amoxicillin
  • alternative: 2rd/3rd gen cephalosporin, clindamycin
51
Q

outpatient treatment of pneumonia in school age

A
  • amoxicillin
  • consider azithromycin for atypical pahtogen coverage (alternative: doxycycline)
52
Q

pneumonia inpatient treatment

A
  • ampicillin/sulbactam
  • cefuroxime
  • ceftriaxone
53
Q

infants factors that show they need to be hospitilized for pna

A
  • apnea/grunting
  • spO2 < or = 92%
  • poor feeding
  • RR > 70 breaths/min
54
Q

factors in older children that show they need to be hospitilized for pna

A
  • grunting
  • inability to tolerate PO
  • spO2 < or = 92%
  • RR > 50 breaths/min
55
Q

Infant respiratory distress syndrome or “haline membrane disease” is?

A
  • deficiency of surfactant at birth
    • leads to alveolar collapse during respiration, decreased gas exchange -> hypoxia
56
Q

clinical presentation

  • symptoms begin within minutes of birth
  • signs of respiratory distress
    • tachypnea
    • chest wall retractions
    • expiratory grunting
    • cyanosis
A

Infant respiratory distress syndrome

57
Q

a CXR showing diffuse bilat atelecatsis with ground-glass appearance is associated with what condition

A

Infant respiratory distress syndrome

58
Q

treatment of Infant respiratory distress syndrome

A
  • O2 given via CPAP
  • ET tube
  • exogenous surfactant
59
Q

preventative treatment of Infant respiratory distress syndrome

A
  • antenatal glucocorticoid (dexamethasone or betamethasone)
    • hastens lung maturity
    • given to mothers expected to deliver before 32-34 weeks
60
Q

presentation

  • chronic airway inflammation
  • hyper-responsiveness
  • reversible obstruction
A

asthma

61
Q

clinical presentation

  • intermittent or chronic
    • cough
    • wheezing
    • dyspnea
    • chest tightness
  • triggers
A

asthma

62
Q

Dx of asthma using spirometry

A
  • pulmonary function tests
    • spirometry: children > 5 yo
      • FEV1/FVC ratio decreased (obstructive)
      • increase in FEV1 > 12% and > 200 ml following bronchdilator use : reversible
63
Q

asthma treatment

A
  • short acting bronchodilators (SABA) orn
  • inhaled corticosteroids
  • long acting bronchodilators (LABA)
    • shoud NOT be used without an inhaled corticosteroid
  • leukotriene antagonist
  • oral steroids
64
Q

Does treatment of asthma need more than a rescue inhaler?

A

Rules of two

  • more than 2 x/week
  • more than 2x/month at night
  • more than 2x/year to refill
65
Q

one plus one rule for treatment of asthma

A
  • dispense one albuterol inhaler and give one refill
  • *make sure patient is consistently taking inhaled corticosteroid
66
Q

what is vocal cord dysfunction

A
  • inappropriate vocal cord motion
    • causes partial airway obstruction; often misdiagnosed as asthma
67
Q

clinical presentation

  • inspiratory stridor
  • cough
  • choking sensation or throat tightness
  • tiggers: exercise, irritants, rhinosinusitis, GERD
A

vocal cord dysfunction

68
Q

treatment of vocal cord dysfunction

A
  • reassurance
  • breathing maneuvers
  • avoidance of triggers
  • speech therapy
69
Q

major risk factors of obstructive sleep apnea

A
  • adenotonsillar hypertrophy
  • obestiy
70
Q

dx of obstructive sleep apnea

A

sleep study

71
Q

treatment of obstructive sleep apnea

A
  • adenoidectomy with possible tonsillectomy or CPAP

PEDS final (3 decks)

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