Pulm Flashcards
development
90% alv dev after birth. incr until 8yo
obstructive defect
2/2 to decr airflow through narrowed airway: asthma, bronchiolitis, foreign body aspiration
restrictive defects
2/2 decr lung V (air filling alveoli) ex: pul edema, scoliosis, pul fibrosis, respiratory M weakness
PE
inspiratory stridor- extrathoracic obstruction~ croup and larygnomalacia (layrngeal cartiage soften and collapse into airway especially in supine)
expiratory wheezing: intrathoracic obstruction, asthma, bronchiolitis
crackles or rales- parenchymal disease- pneumonia and pul edema
incr second heart sound- elevated pul P,
eczema, digital clubbing
epiglottitis: define, epi, etio, P, labs, CXR, Dx, Tx
acute inflm and edema of epiglottis, arytenoids and aryepiglottic folds
2-7yo M=F
etio: haemophilus influenzae type B (HIB) but rare bc vaccine. grou A beta hemolytic strep
P: abrupt onset of rapidly progressive upper airway obstruction w/o prodrome. May have high fever, toxic, muffled speech, quiet stridor, dysphagia with drooling, sitting forward in tripod position with neck hyperextension. complete airway obstruction with respiratory arrest may occur suddenly
Labs: leukocytosis with left shift. 90% pos blood culture
CXR: thumbprint on lateral
Dx: cherry red swollen epiglottis
tx: emergency, nasotracheal intubation, antibiotics-2/3 cephalosporen. rifampin if HIB. prophylax unionized contacts
laryngotracheobronchitis (croup)
inflm and edema of subglottic larynx, trachea, bronchi.
epi: 2 types: viral croup (most common cause of stridor, 3mo-3yo F>M, fall/winter), spasmodic croup (year round preschool)
etio: viral- parainfluenza. spasmodic- HS rxn
P:
1) viral: URI prodrome then inspiratory stridor worse at night and with agitation, barky cough, hoarse voice, possible wheezing, steeple sign
2) spasmodic: a night, recur and resolve w/o tx
D: clinical
tx: cool mist, systemic corticosteroid if stridor at rest (dexamethasone), racemic epi and hospitalization if respiratory distress, beta2 agonist with wheezing,
supraepiglotic D features
quiet stridor, no cough, muffled voice, dysphagia or drooling, high fever, to, neck extended tripod
subepiglotic D features
loud stridor, barky cough, hoarse, no dysphagia, variable fever, no tox unles tracheitis, normal posture
bronchiolitis
inflm of bronchioles due to virus
epi: most common lei in F, nov-aril, worse if have chronic lung disease or
pneumonia, etio
infection and inflm of parenchyma
etio: dep on age. viruses most common cause in all age. 0-3mo- congenital - syphilis, too, CMV, intrapartum like GBS, post part like RSV, afebrile- chlaydia trachoma’s, ureaplasma urelyticum, CMV, PCP
3-5mo: virus like adenovirus, influenza a/b
bacteria- strep pneumonia
>6yo: mycoplasma pneumoniae, chlamydia pneumonia
virus: adenovirus, influenza, parainfluenca. bacteria- s pneumoniae
pneumonia dx and tx
viral: URI sx then fever cough dyspnea, PE- tachypnia, wheezin, rales or distress, dx- intersitial infiltrates on CXR and WBC 20K, lobar consolidation on CXR. tx: antibiotics
chlamydia trachomatis: most common cause of afebrile pneumonia at 1-3mo, staccato type cough, hx of conjunctivitis, dx- eosinophilia and CXR- interstitial infiltrates. culture or direct fluorescent ab. tx- erythromycin or azithromycin
mycoplasma pneumoniae- sx: fever, chill, nonproductive cough 3-4wk, HA, widespread rales, dx- pos cold agglutinins nonspecific, CXR vary, igM for mycoplasma incr. tx: azy/erythromycin
pertussis
whooping cough. bordetella pertussis
severe risk when
asthma
most common chronic pediatric disease. 50% sx by 1, 90% by 5. 30-50% remission by puberty
CXR: hyperinflmation, peribronchial thickening, pathy atelectasis
PFT: incr lung V and decr expiratory flow rate
acute wheezing dd
astham ,HS rxn, broncholitis, pneumonia, FBA, acute aspiration of stomach contents, enviro irritants
cromolyn Na and nedocromil NA
anti0inflm prophylaxis by inhibit activation of inflm mediators. no effect on acute sx but prevent exacerbation of asthma
anti-cholinergic v asthma
atropine or ipratropium bromid (astrovent).. 2nd line bronchodilators. decr airway vagal tone and block reflex bronchoconstriction
leukotriene modifiers
montelukast. oral antiinflm agents for long term ctrl of mild persistent asthma
CF sx
altered exocrine gland secretion
etio: auto recessive chromosome 7
abn CFTR protein
P: chornic progressive pul insufficiency, pancreatic insuf, high sweat electrolytes.
1) meconium ileus at birth in 20%
2) recurrent chronic respiraotry sx, steatorrhea, FTT
3> respiratory sign and sx- chronic productive cough, dyspnea, hyperinflation, crackles, wheezing, digital clubbing, PFT-decr respiratory flow rate, decr lung V
4) pneumonia with ss aureus then P aeruginosa
5) pum complications- hemoptysis, penumothorax, astham ,nasal polyps, precurrent pneumonia, pul fibrosis, cor pulmonale, respiratory fialure
6) pancreatic insuf in 90%
CF dx
1+ pheno, pos fx, inr immunoreactive trypsinogen on newborn screen
lab: abn CFTR, sweat chloride>60, or t CF mut, or characteristic ion transport abn
CF management
antibiotics, pul toilet, bronchodialtors, pancreatic enzyme replacement, oxygen, antiinflm, lung transplant,
chronic lung disease
oxygen dependency beyond 28d of life. most common in premie with respiratory distress syndrome
etio: follow acute lung injury then secondary lung injury by oxidants and proteases, then healing of lung tissue is abn - tissue fibrosis, chronic airflow limits, decr compliance, obstructive+ restrictive disease
P: decr ocygenation, hypercarbia, intermittent tachypanea, freq respiratory infection
CXR: hyperinflation, atelectasis, linear or cystic radiodensities
incr caloric needs and delayed growth and dev
tx: sup O2, bronchodilators, diuretics, anti inflm, optimize caloric intake , prevent infection, ID complications like subglottic stenosis, reflux
prog- incr risk of sudden death
apnea of infancy
unexplained cessation of breathing for 20s. respiratory pause may be central (no respiratory effort), obstructive (unsuccesful effort), or both
short central apnea
ALTE: apparent life threatening event.
combo of apnea, color change, change in M tone, chokign or gaggin. recovery only after stimulation or resuscitation
DD; sz d, breath holding spells,incr in ICP by trauma bleeding tumor etc,Cardiac (bradycardia 2/2 congenital heart block of long QT –> apnea. or CHD, tof), pulm (upper aieway obsturction, most common is RSV, pertussis, LRI), intracranial mass, sepsis, metabolic, arrhythmia, abn central ctrl, munchausen, trauma, GI (GERD, swallow abn, tracheoesophaeal fistula)
SIDS
sudden death in
