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Peds Rotation > Pulm part 1 > Flashcards

Pulm part 1 Flashcards

1
Q

Peak age incidence of acute bronchiolitis

A

Occurs almost exclusively during the first 2 yrs of life

Peak age at 2-6 mos

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2
Q

What is a primary cause of acute bronchiolitis?

A

RSV

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3
Q

Presentation of acute bronchiolitis

A

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

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4
Q

PE of acute bronchiolitis

A 
Prolongation of the expiratory phase of breathing
Nasal flaring
Intercostal retractions
Suprasternal retractions
Diffuse wheezes and crackles
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5
Q

Workup of acute bronchiolitis

A

Pulse oximetry

Frequent, regular assessments and cardiorespiratory monitoring of infants

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6
Q

Tx of acute bronchiolitis

A 
Respiratory monitoring
Control of fever
Hydration
Upper airway suctioning
Oxygen administration
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7
Q

Indications for hospitalization in acute bronchiolitis

A 
Moderate to marked respiratory distress
Hypoxemia
Apnea
Inability to tolerate oral feeding
Lack of appropriate care at home
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8
Q

MCC of croup

A

Parainfluenza viruses

RSV

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9
Q

Most common age of croup

A

6 mos-3 yrs

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10
Q

Presentation of croup

A 
Harsh cough, described as barky or brassy
Hoarseness
Inspiratory stridor
Low-grade fever
Respiratory distress
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11
Q

PE of croup

A

Signs of upper airway obstruction may be present, such as:
Labored breathing
Marked suprasternal, intercostal and subcostal retractions
Wheezing may be present

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12
Q

Imaging of croup

A

AP radiographs of the neck show steeple sign

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13
Q

Tx of croup

A

Oral or IM dexamethasone
Racemic epi for significant airway compromise
Hospitalization for children with stridor at rest

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14
Q

Common organisms of bacterial pneumonia in neonates

A

Group B strep
E. coli
Other Gram-neg bacilli
S. pneumoniae

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15
Q

Common organisms of bacterial pneumonia in 1-3 mos: afebrile

A

S. pneumoniae

H. influenzae

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16
Q

Common organisms of bacterial pneumonia in 1-3 mos: febrile

A

C. trachomatis
M. hominis
U. urealyticum
B. pertussis

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17
Q

Common organisms of bacterial pneumonia in 3 mos-5 yrs

A

S. pneumoniae

H. influenzae

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18
Q

Common organisms of bacterial pneumonia in 5-18 yrs

A

M. pneumoniae
S. pneumoniae
C. pneumoniae

19
Q

S/sx of bacterial pneumonia

A 
Neonates may have fever or hypoxia only
Fever
Chills
Tachypnea
Cough
Malaise
Pruritic CP
Retractions and apprehension
20
Q

PE of bacterial pneumonia

A 
Higher fever
Auscultatory findings of lung consolidation
Poor diaphragmatic excursion
Dullness to percussion
Localized crackles, rhonchi and wheezes
21
Q

Labs of bacterial pneumonia

A

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

22
Q

S/sx of asthma

A

Coughing
Wheezing
Shortness of breath or rapid breathing
Chest tightness

23
Q

Exacerbating factors of asthma

A 
Viral infections
Exposure to allergens and irritants
Exercise
Emotions
Change in weather/humidity
24
Q

What sx can aggravate asthma?

A

Rhinosinusitis
Gastroesophageal reflux
NSAIDs

25
Q

Presentation of acute asthma episodes

A 
Tachypnea
Tachycardia
Cough
Wheezing
Prolonged expiratory phase 
As attack progresses:
Cyanosis
Diminished air movement
Retractions
Agitation
Inability to speak
Tripod position
Diaphoresis
Pulsus paradoxus
26
Q

Workup of asthma

A

Spirometry
Therapeutic trial of controller medications
Allergy skin testing for persistent asthma
CXR

27
Q

What are the key components of the optimal tx of asthma?

A

Environmental control
Pharmacologic therapy
Pt education

28
Q

Step 1 tx of asthma for 0-4 yoa

A

SABA PRN

29
Q

Step 2 tx of asthma for 0-4 yoa: preferred

A

Low-dose ICS

30
Q

Step 2 tx of asthma for 0-4 yoa: alternative

A

Cromolyn or Montelukast

31
Q

Step 3 tx of asthma for 0-4 yoa

A

Medium-dose ICS

32
Q

Step 4 tx of asthma for 0-4 yoa

A

Medium-dose ICS +

LABA or Montelukast

33
Q

Step 5 tx of asthma for 0-4 yoa

A

High-dose ICS +

LABA or Montelukast

34
Q

Step 6 tx of asthma for 0-4 yoa

A

HIgh-dose ICS +
LABA or Montelukast +
Oral corticosteroids

35
Q

Step 1 tx of asthma for 5-11 yoa

A

SABA PRN

36
Q

Step 2 tx of asthma for 5-11 yoa: preferred

A

Low-dose ICS

37
Q

Step 2 tx of asthma for 5-11 yoa: alternative

A 
Cromolyn 
LTRA
Nedocromil
or
Theophylline
38
Q

Step 3 tx of asthma for 5-11 yoa

A

Low-dose ICS +
LABA, LTRA, or Theophylline
OR
Medium-dose ICS

39
Q

Step 4 tx of asthma for 5-11 yoa: preferred

A

Medium-dose ICS +

LABA

40
Q

Step 4 tx of asthma for 5-11 yoa: alternative

A

Medium-dose ICS +

LTRA or Theophylline

41
Q

Step 5 tx of asthma for 5-11 yoa: preferred

A

High-dose ICS +

LABA

42
Q

Step 5 tx of asthma for 5-11 yoa: alternative

A

High-dose ICS +

LTRA or Theophylline

43
Q

Step 6 tx of asthma for 5-11 yoa: preferred

A

High-dose ICS +
LABA +
Oral corticosteroids

44
Q

Step 6 tx of asthma for 5-11 yoa: alternative

A

High-dose ICS +
LTRA or Theophylline +
Oral corticosteroids

Peds Rotation (12 decks)

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