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SD- Pediatrics > Pulm Lecture > Flashcards

Pulm Lecture Flashcards

1
Q

Larger head
Smaller mandible, small neck
Large tongue, posteriorly placed
Tonsils and adenoids present
Smaller airways
Less rigid throacic cage
Increased metabolick rate
Increased O2 demand

A

Differences of pediatric respiratory system

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2
Q

Tachycardia
Retractions- intercostal and sternal
Grunting, nasal flaring
Head bobbing
Abnormal breathing
Tripod position

A

Pediatric respiratory distress

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3
Q

Laryngotracheobronchitis, AKA

A

Croup

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4
Q

Pathophys: parainfluenza, affects the larynx
causes subglottic edema, airflow obstruction

Affects ages 6 mos to 3 years
males>females
Fall, early winter MC

A

Croup

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5
Q

“Seal, barky” cough
Inspiratory stridor
Respiratory distress (retractions), low O2 stats, cynosis, sometimes low grade fever

coughing fits at night (due to increased edema)

A

Croup

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6
Q

Diagnosis:

Clinical diagnosis
Steeple sign on CXR

A

Croup

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7
Q

Tx:
Single dose of Decadron
Moist vs cool air, tylenol for fever

A

Croup

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8
Q

Bacterial infection with H. influenza
Affects the epiglottis with cellulitis/edema
causes airway obstruction

affects kids 4-7 yo
decreased incidence due to HiB vaccination

A

Epiglottitis

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9
Q

Rapid onset, severe distress within hours
High fever, difficulty swallowing or sore throat
drooling, stridor
No cough*
TRIPOD POSITION

A

Epiglottitis

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10
Q

DO NOT ATTEMPT TO VISUALIZE AIRWAY

lateral soft tissue neck X ray shows thumb sign

**this is a medical emergency!!

A

Epiglottitis

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11
Q

Tx:

Antipyretics for fever
IV antibiotics (Rocephin)
Secure airway- may need to intubate
A

Epiglottitis

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12
Q

Acute respiratory infection caused by influenza A or B
Present winter months, community outbreaks
Vaccine for prevention (do not give if pt has egg allergy)
Affects adults and children

s/s: myalgias, fever, chills, runny nose, HA, sore throat

Dx: PCR nasal swab

Tx: antipyretcs, tamiflu within 48 hours of sxs

A

Influenza

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13
Q

AKA Bronchiolitis (inflamed bronchial tubes)
RNA paramyxovirus
Causes air trapping
Seasonal airbreaks (mostly during winter)

children under 2 (peak incidence at 6 mos)

A

Respiratory Syncytial Virus (RSV)

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14
Q

S/S:

Recent URI exposure, increase in nasal congestion, cough
gradual onset of respiratory distress
fever, poor feeding, expiratory wheezing
“junky” lung sounds, retractions, tachypnea, low O2 sat

A

RSV

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15
Q

Dx:
Nasal swab
hyperinflation on CXR

Tx:
Supportive tx, self-limited

A

RSV

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16
Q

“whooping cough”
All ages of children

3 stages:

  1. catarrhal stage: 1-2 weeks, URI symptoms, fever, cough, runny nose
  2. paroxysmal stage: 1-6 weeks, post tussive vomiting, inspiratory whoop
  3. convalescent stage: 2-3 weeks, cough lessens
A

Pertussis

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17
Q

Which stage of pertussis lasts 1-6 weeks and consists of:
post-tussive vomiting
inspiratory whoop

A

Paroxysmal stage

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18
Q

What stage of pertussis lasts 1-2 weeks and consists of:
URI symptoms
Fever
Cough
Runny nose

A

Catarrhal stage

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19
Q

Which stage of pertussis is the recovery stage that lasts 2-3 weeks, cough lessens

A

Convalescent stage

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20
Q

Dx: culture/PCR nasal swab

Tx: macrolide antibiotics (Azithro, Clarithro)
**treat all family members***

A

Pertussis

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21
Q

Infection of the lower respiratory tract
MC pathogens: strep pneumonia, H.influezae, mycoplasma

A

Pneumonia

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22
Q

S/S:

Fever, cough
rapid breathing/tachypnea
dypnea
low oxygen sat
lethargy
focal crackles/rales on ausculation

A

Pneumonia

23
Q

Dx:
CXR shows consolidation, “round appearing”
CBC shows WBC > 15k

Tx:
Amoxicillin (1st choice)
or Macrolide (Azithro)

A

Pneumonia

24
Q

Pneumonia in a child with….

Oxygen sat <92%
RR >70 in infant or >50 in child
Intermittent apnea or grunting
Dehydration
Family unreliable

A

Admit!

25
Q

When should a child follow up with a pediatrician after a pneumonia dx?

A

within 24-48 hours

26
Q

Viral or bacteria pneumonia?:

Gradual onset
Recent URI symptoms
CXR shows interstitial infiltrates

A

Viral pneumonia

27
Q

Genetic-multi systemic disease. avg survival is 38 years

abnormality in the cystic fibrosis transmembrane conductance regulator (CFTR)

abnormalities of salt and water transport across epithelial surfaces affecting the lungs and GI system

*MUCUS RETENTION

A

Cystic fibrosis

28
Q

Pancreas dysfunction: calorie malabsorption bc pancreas becomes obstructed

Lung disease: cycle of mucus retention, injection and inflammation

A

Cystic fibrosis

29
Q

S/S:

Positive newborn screen (elevated ImmunoReactive Trypsinogen)
Failure to pass meconium at birth, or bowel obstruction at birth

Recurrent respiratory infections! (thick mucus, wheezing, cough)
greasy, foul smelling stools that float

99% of males are sterile
clubbing of fingers

A

Cystic fibrosis

30
Q

Dx: positive sweat test > 60 mEq/L

Tx: mucus thinners, airways clearance (chest PT), inhalers, lung transplant, frequent abx, supplemental pancreas enzymes, etc

A

Cystic fibrosis

31
Q

Lower airway hypersensitivity to:
allergies, irritants, exercise, infection

chronic airway inflammatory disorder affecting mast cells, eosinophils, lymphocytes

inflammation –>bronchospasm –>bronchial edema –>increased mucus

A

Asthma

32
Q

S/S:

Episodic dry cough
wheezing
respiratory distress (nasal flaring, retractions)
reucrrent symptoms, presence of triggers (exercise, cold air, allergens)
associated with nasal polyps and atopic dermatitis

A

Asthma

33
Q

Dx:

PFTs
Spirometry shows < FEV1:FVC ratio
Spirometry pre and post bronchodilator with a 12% improvement of FEV1

CXR shows hyperinflation
Methacholine challenge- causes bronchoconstriction

A

Asthma

34
Q

Tx:

Bronchodilators
Beta2 agonists
Inhaled steroids

A

Asthma

35
Q

SIDS occurs during sleep in what age group?

A

less than 1 yo

peaks 2-4 months

36
Q

Exposure to cigarette smoke
Maternal age under 20
Prematurity and low birth weight
Prone sleeping position (“back is best”)
Soft bedding (no pillows, toys, blankets in crib)
Overheating
Bed sharing not recommended under 3 months old

A

Risk factors for SIDS

37
Q

Siblings of SIDS victim increases risk _____ fold

A

5-6 fold

38
Q

Room sharing
Breast feeding
Use of pacifier during sleep
Place infant on back to sleep

A

Methods to reduce SIDS

39
Q

Hyaline membrane disease is a deficinecy in…

A

Surfactant

40
Q

Asthma symptoms less than 2 days a week is what classification?

A

Intermittent

41
Q

symptoms >2 times a week, but not daily
night time awakenings 3-4 times a month
use SABA >2 times a week, not daily

what classification of asthma?

A

Mild persistent asthma

42
Q

Symptoms daily
Awaken >1 time a week but not daily
Use SABA daily

what classification of asthma?

A

Moderate persistent asthma

43
Q

Symptoms daily throughout the day
Awaken at night ~7 times a week
Used SABA several times a day

what classification of asthma?

A

Severe persistent

44
Q

Step 1 for asthma treatment?

A

SABA PRN (ie albuterol)

45
Q

Step 2 asthma tx?

A

Low dose inhaled glucocorticoids

(step 3 would be medium dose inhaled glucocorticoids)

46
Q

Failed therapy of asthma with medium dose inhaled glucocorticoids alone, what is the next time?

A

Add a LABA

47
Q

______ maintains alveoli stability and inflation

*if deficient, no inspiratory pressure to inflate alveolar units, causing atelectasis

A

surfactant

48
Q

What population is hyaline membrane disease seen in?

A

Premature infants! (under 37 weeks)

49
Q

Signs of respiratory distress a few hours after birth
Cyanosis, hypoxemia

CXR shows ground glass appearance

Tx: Corticosteroids (during labor)
Surfactant

A

Hyaline membrane disease

50
Q

What tx is used in Hyaline Membrane Dz because it induces the formation of surfactant in the fetal lung

A

Corticosteroids (give during labor)

51
Q

S/S:

upper airway: stridor, choking, cough, cyanosis, not phonating
if complete obstruction, no cough or choking

lower airway: unilateral wheezing, recurrent pneumonia, cough

Dx with CXR

A

Foreign body aspiration

52
Q

Should you do a blind finger sweep with finger in the oral cavity?

A

NO

53
Q

Tx:

Infant: back blows, chest thrusts
Child: abdominal thrusts

A

Foreign body aspiration

SD- Pediatrics (11 decks)

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