Pulm part 1 Flashcards
Peak age incidence of acute bronchiolitis
Occurs almost exclusively during the first 2 yrs of life
Peak age at 2-6 mos
What is a primary cause of acute bronchiolitis?
RSV
Presentation of acute bronchiolitis
Progressive respiratory illness similar to the common cold with cough and rhinorrhea
Progresses to noisy, raspy breathing and audible wheezing
Low-grade fever accompanied by irritability
PE of acute bronchiolitis
Prolongation of the expiratory phase of breathing Nasal flaring Intercostal retractions Suprasternal retractions Diffuse wheezes and crackles
Workup of acute bronchiolitis
Pulse oximetry
Frequent, regular assessments and cardiorespiratory monitoring of infants
Tx of acute bronchiolitis
Respiratory monitoring Control of fever Hydration Upper airway suctioning Oxygen administration
Indications for hospitalization in acute bronchiolitis
Moderate to marked respiratory distress Hypoxemia Apnea Inability to tolerate oral feeding Lack of appropriate care at home
MCC of croup
Parainfluenza viruses
RSV
Most common age of croup
6 mos-3 yrs
Presentation of croup
Harsh cough, described as barky or brassy Hoarseness Inspiratory stridor Low-grade fever Respiratory distress
PE of croup
Signs of upper airway obstruction may be present, such as:
Labored breathing
Marked suprasternal, intercostal and subcostal retractions
Wheezing may be present
Imaging of croup
AP radiographs of the neck show steeple sign
Tx of croup
Oral or IM dexamethasone
Racemic epi for significant airway compromise
Hospitalization for children with stridor at rest
Common organisms of bacterial pneumonia in neonates
Group B strep
E. coli
Other Gram-neg bacilli
S. pneumoniae
Common organisms of bacterial pneumonia in 1-3 mos: afebrile
S. pneumoniae
H. influenzae
Common organisms of bacterial pneumonia in 1-3 mos: febrile
C. trachomatis
M. hominis
U. urealyticum
B. pertussis
Common organisms of bacterial pneumonia in 3 mos-5 yrs
S. pneumoniae
H. influenzae
Common organisms of bacterial pneumonia in 5-18 yrs
M. pneumoniae
S. pneumoniae
C. pneumoniae
S/sx of bacterial pneumonia
Neonates may have fever or hypoxia only Fever Chills Tachypnea Cough Malaise Pruritic CP Retractions and apprehension
PE of bacterial pneumonia
Higher fever Auscultatory findings of lung consolidation Poor diaphragmatic excursion Dullness to percussion Localized crackles, rhonchi and wheezes
Labs of bacterial pneumonia
WBC elevated
BCx for hospitalized children
Mild eosinophilia in infants with C. trachomatis
Cold agglutinins present in Mycoplasma PCR
Tuberculin skin test if suspected
Thoracentesis with pleural effusion or empyema
Frontal and lateral radiographs
S/sx of asthma
Coughing
Wheezing
Shortness of breath or rapid breathing
Chest tightness
Exacerbating factors of asthma
Viral infections Exposure to allergens and irritants Exercise Emotions Change in weather/humidity
What sx can aggravate asthma?
Rhinosinusitis
Gastroesophageal reflux
NSAIDs
Presentation of acute asthma episodes
Tachypnea Tachycardia Cough Wheezing Prolonged expiratory phase As attack progresses: Cyanosis Diminished air movement Retractions Agitation Inability to speak Tripod position Diaphoresis Pulsus paradoxus
Workup of asthma
Spirometry
Therapeutic trial of controller medications
Allergy skin testing for persistent asthma
CXR
What are the key components of the optimal tx of asthma?
Environmental control
Pharmacologic therapy
Pt education
Step 1 tx of asthma for 0-4 yoa
SABA PRN
Step 2 tx of asthma for 0-4 yoa: preferred
Low-dose ICS
Step 2 tx of asthma for 0-4 yoa: alternative
Cromolyn or Montelukast
Step 3 tx of asthma for 0-4 yoa
Medium-dose ICS
Step 4 tx of asthma for 0-4 yoa
Medium-dose ICS +
LABA or Montelukast
Step 5 tx of asthma for 0-4 yoa
High-dose ICS +
LABA or Montelukast
Step 6 tx of asthma for 0-4 yoa
HIgh-dose ICS +
LABA or Montelukast +
Oral corticosteroids
Step 1 tx of asthma for 5-11 yoa
SABA PRN
Step 2 tx of asthma for 5-11 yoa: preferred
Low-dose ICS
Step 2 tx of asthma for 5-11 yoa: alternative
Cromolyn LTRA Nedocromil or Theophylline
Step 3 tx of asthma for 5-11 yoa
Low-dose ICS +
LABA, LTRA, or Theophylline
OR
Medium-dose ICS
Step 4 tx of asthma for 5-11 yoa: preferred
Medium-dose ICS +
LABA
Step 4 tx of asthma for 5-11 yoa: alternative
Medium-dose ICS +
LTRA or Theophylline
Step 5 tx of asthma for 5-11 yoa: preferred
High-dose ICS +
LABA
Step 5 tx of asthma for 5-11 yoa: alternative
High-dose ICS +
LTRA or Theophylline
Step 6 tx of asthma for 5-11 yoa: preferred
High-dose ICS +
LABA +
Oral corticosteroids
Step 6 tx of asthma for 5-11 yoa: alternative
High-dose ICS +
LTRA or Theophylline +
Oral corticosteroids
