pulmo functioning Flashcards
Pneumonia
- inflammation of pulmonary tissue/consolidation of alveolar spaces
- types: pneumonitis (interstitum), lobar, broncopneumonia, atypical
community->4 months- 5 yo: viral ( RSV infants, PIV, IV, …)
- <4 months and >5 yo: bacterial (s.penumoniae @ all ages, myocoplasma @ > 5yo group, chlamydia in very young..)
- afebrile types: chlamydia and mycoplasma hominis
- atypical: chalmydophilus and m.pneumonia
- in immunocompromised: think about fungal, TB, CMV, pneumocystis and gram neg bacteria
clinical/examination:
- fever, cough, dyspnea
- fever very specific (if no fever, think about ..)
- dullness to percussion
- bronchial breathing (louder, high pitched, cracking, wheezing- more suggestive of viral or myoplasma), conjunctivitis-suggestive of chlamydia
- neonates may just have hypoxia or fever
- -viral: less fever, mucosal congestion and URT infection*
- -bacterial: fever more pronounced, cough, dyspnea,cough*
- shallow breathing or hyperinflation therefoew low diagphragm and liver
- effusion/empyema may be present - should be analysed
- CRP, leukocyte/(neutrophil-bacteria) (lympocytes- viral) count in CBC.
- CXR/ culture only in hospitalised patients, recurrant pneumonia, immunocompromised and refractive to therapy
Treatment:
- most community aquired is viral so supportive
- strep.b/HIB: Amoxicillin PO/ Ampicillin IV, ceftriaxone IV/linezolid PO
- mycoplasma: azithromycin
- c.trachomatis: macrolide
Complications and DD:
- bronciectasis, effusion/empyema, lung abscess
- asthma,CF, HF,…
VQ
- VQ mismatch happen when either pulm.blood flow is poor or when ventilation doesn’t work well
- ventilation problems: problems with V : alveoli with edema or blood (pneumonia) in it then ventilation doesn’t work well
- blood flow problems: problems with Q: BF not arriving to alveoli
Otitis externa
- swimmer’s ear
- movement pinna/tragus causes pain
- cause pseudomonas/pools/summer months/tympanostomy tubes
- culture if think pseudomonas/ABiogram
- TT topical FQ ciprofloxacin
- DD: OM with tympanic perf
CF
- aut rec genetic mutation of CFTR which is a cholride channel on apical surface of epithelial cells
- maintains secretion content (in CF, no secretion of Cl- so less secretion of H20 so thickened mucus), skin Cl- not reabsorbed in cftr channel so Na not absorbed- salty sweat.
diagnositic test:
- neonatal screening most are diagnosed: IRT in blood high
- sweat scholride test >60mEq/L
- Genetic testing to confirm
Present with:
- fat malabsorption ( most born with exocrine insufficiency) leading to FTT, hypoalbuminemia, statorrhea
- cholestatic jaundice (liver disease from back up from cholestasis)
- chronic resp. problems
- bacterial colonisation with staoh and pseudomonas and bronchial damage bronchiectasis
- clubbing
Complications
_-_asperogillus allergic bronchopulmonary (HS rxn to asperogillus)
- chronic sinusitis with polyps
- bronchial artery damage :hemoptysis
- meconium ileus, volvulus, pancreatitis,…
- infertility
- hyponatremia and hypochloremia (sweat glands) therefore metabolic alkalosis
Treatment:
- multifactorial
Pulmonary: physiotherapy, nebulisers, vibrational vests, AB for infections with monitoring of flora
- pancreatic enzymes (lipases ans proteases) titrated to fat consumption
- fat soluble enzyme replacements
- watch diet make sure enough fiber, keep eating fats even if steatorrhea, laxatives if ileus in older patients, surgery if meconium ileus
- new treatments for some mutations modify CFTR channel
Bronchiolitis
- bronchioles affected infection
- fill mucus
- RSV most common cause/ common 50% of children by age 2
- presents with cough and fever, feeding difficulties, irritability, wheezing, crackles, tachypnea, tachycardia,…
- usually mild but can increase asthma risk
- TT supportive PO hydration, aspirin, 02
- unless high risk groups; give IV IgRSV
- hospitilise if decompensating
Pharyngitis
- strep. pyogenes: rapid, very sore throat and fever, sometimes classic scarlet fever symptoms. sometimes tonsillitis
- viral like adenovirus: more gradual onset, rhinorrhea, cough, diarrhea.
- coxackie virus: heprangina: sudden onset fever, V+, headache, malaise, classic small papular vesicle on soft palate, uvula then ulcerate when burst.
- HSV: stomatitis, gingivitis, pharyngitis.
- EBV: mono
Clinical/exam:-
- rapid antigen test strep: detects strep antigens
- throat culture gold standard
- mono: atypical lympocytes on smear
Treatment:
- preventing RF: start AB within 9 days of start of illness if + strep, scarlet fever or sibling of +.
- cephalosporin/penicillin
- acyclovir for HSV
Inspiration
Quiet breathing: diaphragm
Hevy breathing disease or exercise: intercostals, scalene and SCM
LUNG VOLUMES
- tidal volume: amount air with each relaxed inspiration
- FRC: amount of air left in lungs at end of each expiration (keeps 02 provision during expiration)
- Residual volume: amount of air left in lungs at end of MAXIMAL expiration
- TLC: amount air in lungs after maximal inspiration
VC: difference between TLC and RV= amount of air that can be expelled from lungs (bc would be TLC but small amount left even after max exhalation which is RV)
-
Airway resistances
- higher flow rates in lagrer bronchi increases resistance
- lower flow rates lowers resistance in smaller bronchioles
- laryngomalacia and croup increase upper airway resistance
- asthma, brochiolitis and CF increase lower airway resistance
Lung compliance
- how well lungs can expan under pressure
- difference between pressure in alveoli and pressure in pleural cavity= transpulmonary pressure, in normal conditions is +
- decreased lung compliance by factors that produce resistance to distention of alveoli
Restrictive disease: 02 can’t get in- anything that causes lungs not to expand as much so fibrosis, amyloidosis, lobar pneumonia, pulomonary edema,…
Obstructive: C02 can’t get out- large inflated lungs, can’t exhale : Copd, asthma
Bronchitis
- acute bronchitis: infl of mucous membranes bronchi
- usually viral
- malaise, rhionorrhea, cough productive, fever,…
DD: asthma, pneumonia
TT: analgesics, humidifier, antipyretics, …
nb: as usual, don’t use antihistamines or decongestants in under 6yo
Otitis media
- middle ear effusion or inflammation
- bacterial,viral, eustacian tube dysfunction
- peaks in winter
- predisposing factors: eustaican tube dysfunction in Downs, UPRTI, adenoid hypertrophy (incubates infections), immunosupression
- if bacterial: s.pneumoniae, H.influenza, Moraxella, S.aureus,
- If viral: RSV, influenza, parainfluenza, adenovirus
Clinical: presents with fever , otalgia and conductive hearing loss, ortorrhea if perf
Exam: hyperemia, bulging and or pus of tympanic membrane, loss of landmarks can’t see malleus
WATCHFUL WAITING- 48-72 h if child not very young, no long term illness, not Downs syn, mild clinical
Give ibuprofen 10mg/kg/d or acetominophen
If not or if deteriorates- 1st line: penicillin 75mg/kg/d, 2nd line cephalosporins
URTI with stridor- what to look out for?
- croup
- epiglottitis
CROUP: subglottic laryngitis (under glottic area)
- <6 yo, winter and autumn
- parainfluenza 75%
- prodrome of rhinorrhea, pharyngitis, cough
- then barking cough, stridor, worse at night
- Diagnose with presentation
TT with dexamethasone PO, if doesn’t work or moderate to severe add nebulised epinephrine
EPIGLOTTITIS: supraglottic laryngitis
- quite rare
- HiB cause
- fever, rapid progression, 4 D’s: drooling, dysphonia, dysphagia and distress TT with intubation, AB, prevent with HIB vaccine
Pertussis
whooping cough
- B.pertussis
- cough, cyanosis, apnea
- distinctive paroxysmal stage: sudden outburts coughing with loss of breath
TT: azithromycin
Asthma
- inflammatory cells causing HS reactions to allergens
- most common chronic diasease of childhood in developed countries
- obstructive lung disese - difficulty expiring and taking air in
Presents with:
- rhinorrhea
- cough
- wheezing
- chest pain
Clinical:
- frequency and aggravating facvtors, allergies, family history
- attack: tachypnea, tachycardia, cyanosis, agitation, pulsus paradoxus
Tests:
- spirometry to evaluate diagnosis and severity
- allergy skin testing to evaluate HS, but not during acute phase (tree, grass, pollen., dust)
- CXR
DD: some
- CF ( sweat test and other symptoms)
- epiglotittis (check throat)
- asthma (atopy and allergy)
- rhinitis ( nasal symptoms as well as cough),…
- infections (blood test, other symptoms)
TT:
- environmental control
- education
- prophylaxis virus’ (vaccine)
- stepwise therapy depending on severity and need
- inhaled corticosteroids for long term control, montelukast, b2 agonists -salmeterol, omalizumab
- for quick control- short actinng b2 agonists like albuterol, anticholinergic bronchodilator , oral prednisone
- eg: child >5 yo: moderate persistant asthma, give inhaled CS and long acting B agonists- monitor and change accordingly.
