Pulm Flashcards
What is the most common casue of acute bronchiolitis and when does it typically present
Most often caused by RSV - commonly in fall and winter months
How is Acute Bronchiolitis diagnosed
Nasal washing for RSV culture and antigen assay
CXR = normal
what is the treatment for Acute Bronchiolitis
Oxygen
+ supportive
when should a patient be hospitalized with Acute Bronchiolitis
if O2 saturation < 95-96%
Less than 3 months old
>70 years old
nasal flaring
retractions
atelectasis on CXR
what is a reversible inflammatory airway disease with recurrent attacks of breathlessness and wheezing
Asthma
what tool is used to diagnose and monitor asthma
Peak flow spirometry
What is Intermitten asthma
and what is the treatment
less than 2x/week or < 2 night symtpoms/month
- SABA PRN
What is Mild persistent asthma
and how is it treated
more than 2x/week or 3-4 night symptoms/month
- Low dose ICS daily
What is moderate persistent asthma
and how is it treated
daily symptoms or more than 1 nightly episode/week
- Low dose ICS + LABA daily
- Medium dose ICS + LABA daily
What is severe persistent asthma
and how is it treated
Symptoms several tiems per day and nightly
- High dose ICS + LABA daily
- High dose ICS + LABA + oral steroids daily
What is the acute treatment for asthma
oxygen, nebulized SABA, ipratropium bromide and oral corticosteroids
what is an infection of the upper airway that obstructs breathing and causes a barking cough
croup
what pathogen causes Croup
Parainfluenza virus
what is seen on AP CXR in Croup
Steeple sign
(narrowing of the trachea in subglottic region)
What is the treatment for Croup
Supportive (air humidifier) and antipyretics
What is cystic fibrosis
autosomal recessive mutation in the CFTR gene causing abnormally thick mucus, causing difficulty to clear the mucus
what is the presentation of CF
recurrent respiratory infections (esp. Pseudomonas), Steatorrhea
What is steatorrhea
excretion of abnormal quantities of fat with feces due to reduced absoprtion of fat by intestines
How is CF diagnosed?
Quantitiative sweat chloride test
- CXR may reveal hyperinflation, mucus plugging and focal atelectasis
what is the treatment of CF
maintenance and acute exacerbatiosn
Maintenance: chest physiotherapy, hight-fat diet, supplement fat-soluble vitamins (A, D, E, K).
Acute exacerbations: antibiotics
what are risk factors for foreign body aspiration
institutionalization
advanced ageg
poor dentitition
alcohol
sedative use
what test is required to appropriatly assess ventilation
ABG
what is the presentation of nasal foreign body
persistent foul-smelling purulent unilateral nasal discharge in a young child without respiratory symtpoms
What can be used with nasal foreign bodies to shrink the mucous membrane prior to removal of the FB
Oxymetazoline drops
how are ocular foreign bodies diagnosed
full inspection of lids, conjunctiva and cornea
Slit lamp exam will assist in ID and removal
What is hyaline membrane disease
when infants are born before the lungs are producing adequate amounts of surfactant
What causes hyaline membrane disease
prematuraty
deficiency in sufactant resulting in poor lung compliance an dn atelectasis
what is the presentation of hyaline membrane disease on CXR
diffuse bilateral atelectasis causing a “ground glass appearance”
What is the treatment of hyaline membrane disease
antenatal steroid within 24-48 hours of birth (Betamethasone IM x 2)
- artificial surfactant can be given via endotracheal tube
- mechanical ventilation with postivie pressure
What is the common viral cause for pneumonia in kids
RSV: comes on fast
What is the common viral cause of pneumonia in adults
influenza
how are viral pneumonias diagnosed
CXR: bilateral insterstitisl infiltrates
-rapid antigen testing for flu, RSV nasal swab
what is the treatment for viral pneuomnia
flu - tamiflu if sxs began <48hours
symptomatic tx: BEta2 agonists, fluid and rest
what is the presntation of bacterial pneumonia
fever, dyspnea, tachycardia, tachypnea, cough, +/- sputum
how is bacterial pneumonia diagnosed
CXR: patchy, segmental, lobar, mulitlobar consolidation
Blood culutres x2, sputum gram stain
what is the outpatient treatment for bacterial pneumonia
Doxycycline
Macrolides
what is the inpatient treatment for bacterial pneumonia
Ceftriazone + azithromycin/respiratory FQs
what is the most common cause of lower respiratory tract infection in children worldwide
RSV (respiratory synctial virus)
what is the presentation of RSV
rhinorrhea, wheezing/coughing that persists for months, lowgrade fever, nasal flaring/retractions, nail bed cyanosis
what are indications for hospitalization with RSV
tachypnea with feeding difficulties
visible retractions
oxygen desaturation < 95-96%
who are RSV vaccinations approved for
individuals 60+ years and older
what is the preventative management for infants and younger children with RSV
- 1 dose Nirsevimab for all infants younger than 8 months born during/entering their first RSV seaso
- 1 dose Nirsevimab for infants/children 8-19months who are at increased risk for severe RRSV disease and entering their second RSV season
what is the prophylaxis for RSV
Palivizumab (Synagis) - FDA approved for children at high risk for severe RSV
