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Pediatrics > Peds Respiratory > Flashcards

Peds Respiratory Flashcards

1
Q

what is the strongest identifiable factor for asthma?

A

atopy

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2
Q

4 yr old pt presents w/ wheezing, coughing at night, shortness of breath, and chest tightness. he reports tiring more easily than his peers and has had hx of recurrent bronchitis, pneumonia or croup. what do you suspect?

A

asthma

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3
Q

on exam, you find wheezing upon expiration, prolonged expiratory phase, diminished breath sounds, retractions, use of accessory muscles, cyanosis, and agitation/lethargy. what do you suspect?

A

asthma

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4
Q

what are differential diagnoses for asthma?

A

bronchiolitis, pneumonia, croup, pertussis, foreign body aspiration (unilateral wheezing), CF, vocal cord dysfunction (stridor, no shortness of breath)

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5
Q

pt has decreased peak expiratory flow rate. what do you suspect?

A

asthma

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6
Q

on spirometry, pt’s FEV and FEF are diminished. RV, functional residual capacity, and TLC are increased. vital capacity is decreased. what do you suspect?

A

asthma

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7
Q

pt’s symptoms improve w/ bronchodilator therapy. is this definitive for asthma?

A

yes

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8
Q

on chest x-ray, you find bilateral hyperinflation, flattened diaphragm, and patchy atelactasis (collapsed areas). what do you suspect?

A

asthma

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9
Q

if asthma is not improving at night w/ tx, what could be going on?

A

GERD

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10
Q

if asthma is not improving despite tx, what could be going on?

A

sinusitis

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11
Q

how should parents be educated in regards to asthma?

A

avoid allergens and tobacco smoke
use air purifier, hardwood floors, consider immunotherapy
give pt written action plan
develop baseline peak flow for child

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12
Q

what are fast acting beta 2 adrenergic agonist meds for acute asthma?

A

albuterol, levalbuterol

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13
Q

if pt is using albuterol >2x/wk, what does this signify?

A

suboptimal asthma control

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14
Q

what is an anticholinergic asthma med that may be used in combo w/ or as an alternative to albuterol?

A 
ipratropium bromide (atrovent) 
slow acting
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15
Q

what are anti-inflammatory agents used for treating chronic asthma?

A

inhaled corticosteroids
fluticasone, budesonide
MDI, discus, aerosol

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16
Q

what is the leukotriene receptor antagonist used for treating chronic asthma?

A

montelukast (singulair)

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17
Q

what are combination agents used for treating chronic asthma?

A

fluticasone + salmeterol, budesonide + formoteral

18
Q

child is having asthma symptoms <2x/wk, night waking <2x/month, albuterol use <2x/wk, no activity limitation, and FEV1 >80%. what is the recommended tx?

A

mild intermittent asthma
no daily meds needed
rescue PRN

19
Q

child is experiencing asthma symptoms >2x/wk, night waking 3-4x/month, albuterol use >2x/wk, minor activity limitation, and FEV1 >80%. what is the recommended tx?

A

mild persistant asthma

low dose inhaled corticosteroid, then albuterol PRN

20
Q

child is having asthma symptoms daily, night waking >1x/wk, albuterol use daily, some activity limitation, and FEV1 60-80%. what is the recommended tx?

A

moderate persistant asthma

medium dose inhaled corticosteroid w/ or w/o long-acting B2-agonist/leukotriene inhibitor

21
Q

child is having asthma symptoms continuously, frequent night waking, albuterol use more than once per day, extreme activity limitation, and FEV1 <60%. what is the recommended tx?

A

severe persistent asthma

high dose inhaled corticosteroid PLUS long-acting B2-agonist/leukotriene inhibitor

22
Q

how should exercise-induced asthma be treated?

A

albuterol 15 min prior
don’t limit exercise
if response suboptimal, add montelukast 2 hrs prior

23
Q

4-6 wk old infant presents w/ inspiratory stridor and noisy breathing. PE is normal aside from inspiratory sounds above the sternal notch. what do you suspect?

A

laryngomalacia

24
Q

how do you tx laryngomalacia?

A

time, typically resolves by age 2

25
Q

what should you be worried about if a child >2 yrs of age presents w/ laryngomalacia?

A

OSA or tonsilar hypertrophy

26
Q

what is laryngomalacia?

A

most common cause of noisy breathing in infancy. The laryngeal structure is malformed and floppy, causing the tissues to fall over the airway opening and partially block it

27
Q

what is cystic fibrosis?

A

most common lethal genetic disease in U.S.
body produces thick and sticky mucus that can clog the lungs and pancreas, leading to chronic lung infections and scarring

28
Q

infant is born w/ meconium ileus (thick meconium throughout large colon), bulky, greasy, foul-smelling stools and abdominal distention. what do you suspect?

A

cystic fibrosis

29
Q

respiratory illness before 1 yr of life is cause for concern of what?

A

CF

30
Q

infant presents with FTT due to chronic diarrhea/steatorrhea. what do you suspect?

A

CF

31
Q

infant presents w/ cough, tachypnea, rales, wheezing and hx of recurrent pneumonia/respiratory infections. what do you suspect?

A

CF

32
Q

how do you treat CF?

A 
abx: ceftazadime + tobramycin 
bronchodilators
chest physical therapy 
lung transplant for end-stage disease 
pancreatic enzyme supplementation 
high kcal diet
33
Q

what are causes of OSA in children?

A

tonsilar/adenoid hypertrophy, obesity, neuromuscular disorders, down syndrome, sickle cell disease

34
Q

pt has hx of hyperactivity, irritability, inattention, HA, fatigue, hx of poor growth, hx of awakenings/falling out of bed, nightmares, and enuresis. what do you suspect?

A

OSA

35
Q

Upon HEENT exam, you find cranio-facial abnormalities, mouth breathing, nasal pitched voice, large tongue/tonsil size and short thick neck. you also find scoliosis/chest wall abnormalities and elevated BP. What do you suspect?

A

OSA

36
Q

what is the tx for OSA in children?

A

adenotonsilectomy
wt loss if obese
CPAP if above interventions fail
fluticasone may help

37
Q

when do SIDS deaths peak?

A

2 months of age (majority between birth-6 months)

38
Q

what are risk factors for SIDS?

A

MALE, non-white, family hx of SIDS, tobacco smoke, mother <20 yrs old, RSV season, LOW BIRTH WEIGHT, sharing a bed, sleeping prone, overheating, failing oto-acoustic emission test on right ear

39
Q

what are ways to prevent SIDS?

A 
sleep supine or side-wedged
don't over bundle
simple bedding, sleep in same room 
breast feeding
avoid tobacco in home
RSV prevention (synagis) in appropriate premature infants
40
Q

what are signs of impending respiratory failure in an asthmatic?

A

agitation or lethargy

Pediatrics (7 decks)

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