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Rotation 1: Pediatrics > Pulmonary (12%) > Flashcards

Pulmonary (12%) Flashcards

1
Q

What infectious organism most commonly causes PNA in an immunocompromised patient/a patient with structural abnormalities (i.e. cystic fibrosis, bronchiectasis)?

A

Pseudomonas aeruginosa

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2
Q
A
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3
Q

On PE of a pt with pleural effusion, what should be observed with percussion?

Fremitus?

Breath sounds?

A

Dullness

Decreased

Decreased breath sounds

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4
Q

Are foreign body aspirations more common on the right or left side? Why?

A

Right side: due to wider, shorter, more vertical right mainstem bronchus

Position may also influence location

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5
Q

What are some examples of medications that can be used for long term/chronic control of asthma?

Which is the drug of choice?

Which is best for cold air/exercise?

Which is best for allergic rhinitis/ASA induced asthma?

A

Inhaled corticosteroids {drug of choice for long term, persistent}: Beclomethasone, Flunisolide, Triamcinolone

Longa Acting B2 Agonists (LABA) {bronchodilator}: Salmeterol, Formoterol

Mast Cell Modifiers {good for cold air and exercse}: Cromolyn, Nedocromil

Leukotrine modifiers/receptor antagonists (LTRA) {good for allergic rhinitis/ASA induced asthma}: Montelukast, Zafirlukast, Zileuton

Theophylline

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6
Q

______ is a risk factor for developing asthma

A

Atopy

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7
Q

What infectious orgnaism is most commonly responsible post-viral infxn (i.e. influenza) PNA?

A

Staphylococcus aureus

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8
Q

In regards to timeline/timeframe, what is the difference between hospital acquired vs community acquired PNA in a pt who is admitted?

A

If developed PNA within 48 hours of admission, PNA is CAP

If developed PNA >48 hours post-admission, the PNA is hospital acquired

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9
Q

What is the clinical course of IRDS with or without tx?

A

2-3 days

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10
Q

_____ ______ leads to decreased fat absorption which in turn leads to steatorrhea, bulky (pale/dark), foul-smelling stools, weight loss, and Vitamin ____, ____, _____, ____ deficiency in a patient with CF.

A

Pancreatic insufficiency

pale

A, D, E & K

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11
Q

What abx therapy is recommended as 1st line for patients with CAP, ICU?

A

Beta lactam + macrolide

OR

Beta lactam + Broad spectrum FQ

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12
Q

What is the mainstay of tx fro acute bronchiolitis?

A

Supportive, humidified O2 is the mainstay of tx

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13
Q

What is the recommended course of managment for CF?

A

Airway clearance tx with bronchodilators, mucolytics, abx, and decongestants

Pancreatic enzyme replacement and supplementation of fat soluble vitamins (A,D,E & K)

Lung and pancreatic transplantation

Immunizations: pneumococcal, influenza

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14
Q

What abx therapy is recommended as 1st line for patients with hospital acquired PNA?

A

Anti pseudomonal Beta Lactam and anti-pseudomonal AG or FQ

(Anti-Pseudomonal B-lactams: Piperacillin/tazobactam (Zosyn), Cefepime (Maxipime); lmipenem (Primaxin), Meropenem (Merrem), Ceftazidime)

+Vacomycin if suspect MRSA

Add Levofloxacin or Azithromycin if Legionella is suspected

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15
Q

Gastric aspiration of a foreign body may cause what condition?

A

Acute Respiratory Distress Syndrome (ARDS)

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16
Q

What is Samter’s triad?

A

Asthma

Nasal Polyps

ASA/NSAID allergy

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17
Q

If a pt presents c/o fever, URI sx x1-2 days, and respiratory distress, what should be at the top of your DDx?

A

Acute bronchiolitis

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18
Q

Patients with CF are infertile ____% of the time

A

95%

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19
Q

In a pt with croup, what is seen on frontal cervical XR?

A

Steeple sign (subglottic narrowing of trachea), in 50% of pts

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20
Q

On PE of a pt with PNA, what should be observed with percussion?

Fremitus?

Breath sounds?

A

Dullness to percussion

Increased tactile fremitus

Bronchial breath sounds, EGOPHANY

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21
Q

What test is the single best predictor of dz in children w/ acute bronchiolitis?

A

Pulse ox (<96% admit to hospital)

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22
Q

What infectious organism should be suspected in a patient with PNA and comorbid HIV or was a recent transplant recipient?

A

CMV

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23
Q

Cystic fibrosis is an autosomal (recessive/dominant) inherited d/o of defective Cystic Fibrosis Transmembrane Receptor (CFTR) protein, which prevents _______ transport (water movement out of the cell), which leads to buildup of thick, viscous, mucus in what organs?

CF is a(n) (restrictive/obstructive) lung disease and (endocrine/exocrine) gland dysfunction.

A

recessive

chloride

lungs, pancreas, liver, intestines, and reproductive tracts

obstructive

exocrine (ex. pancreatic insufficiency)

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24
Q

What time of year is acute bronchiolitis most common in?

A

Fall and spring

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25
Q

What are three examples of atypical organisms that can cause PNA?

A

Chlamydophila

Mycoplasma

Legionella

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26
Q

Suspect CF if a full term infant who presents with a ____ _____

What is this due to?

What else may a pt present with if they have CF?

A

meconium ileus (due to obstruction of intestine with meconium)

Children may present with failure to thrive

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27
Q

Aspiration PNA is usually caused by what infectious organism?

Most commonly presents in what lobe?

A

Anaerobes

R lower lobe

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28
Q

What infectious organism causes PNA and is known to cause severe illness in ETOHics, debilitated pts, pts with chronic illness, and is associated with cavitary lesions?

A

Klebsiella pneumoniae

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29
Q

If a pt’s sputum is foul-smelling, what infectious organism should be suspected to be the cause of the pt’s PNA?

A

Anaerobes

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30
Q

What are the three main components of asthma pathophysiology?

A

Airway hyperreactivity: Extrinsic (Allergic), Intrinsic (Idiosyncratic)

Bronchoconstriction

Inflammation

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31
Q

When will a pt present with IRDS?

What will they present with?

A

Shortly postpartum

respiratory distress (tachypnea, tachycardia, chest wall retractions, expiratory grunting, nasal flaring, cyanosis)

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32
Q

What is another name for infant respiratory distress syndrome (IRDS)?

A

Hyaline membrane dz

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33
Q

On PE of a pt with PTX or obstructive lung dz, what should be observed with percussion?

Fremitus?

Breath sounds?

A

Hyperresonance

Decreased

Decreased breath sounds

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34
Q

If a CXR shows upper lobe (especially R upper lobe) w/ bulging fissure and cavitations, what infectious organism should be suspected to be the cause of the pt’s PNA?

A

Klebsiella

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35
Q

If a pt’s sputum is described as “currant jelly”, what infectious organism should be suspected to be the cause of the pt’s PNA?

A

Klebsiella

36
Q

The PCV13 Pneumococcal conjugate vaccine is administered to children at what ages?

A

2, 4, 6, 12-15 months of age

37
Q

If a pt’s sputum is green, what infectious organism should be suspected to be the cause of the pt’s PNA?

A

H. Flu, pseudomonas

38
Q

What is the most common cause of viral PNA in children and infants?

A

RSV and parainfluenza

39
Q

What abx therapy is recommended as 1st line for patients with CAP, inpatient?

A

Beta lactam + macrolide (or doxycycline)

OR

broad spectrum FQ

40
Q

What is the most common acute complication of acute bronchiolitis?

What is the most common complication seen later in life?

A

otitis media with S. pneumoniae

asthma

41
Q

In what situations would a child be given the PPSV23 Pneumococcal Polysaccharide vaccine (Pneumovax)

A

If they have a chronic dz

42
Q

What is the most common cause of community acquired PNA?

A

Streptococcus pneumoniae

43
Q

What is the 2nd most common cause of CAP?

A

Haemophilus influenzae

44
Q

What is the primary test done in the dx of a pt with CF?

What would be seen on CXR of a pt with CF?

PFTs?

What is the definitive test for dx, especially if sweat test is -?

What organisms most commonly grow on sputum Cx?

A

ELEVATED SWEAT CHLORIDE TEST: ~60 mmol/L on two occasions after administration of Pilocarpine (Pilocarpine is a cholinergic drug that induces sweating)

CXR: bronchiectasis (CF MC cause ofbronchiectasis in US) {tram track appearance, signet ring sign}; hyperinflation of the lungs

PFTs: obstructive (often irreversible), May be a mixed with a restrictive pattern

DNA analysis: definitive test (especially if sweat testing is -)

Sputum cx: often grow Pseudomonas aeruginosa, Haemophilus injluenzae, or Staph aureus.

45
Q

What is the most common viral cause of PNA in adults?

A

Influenza

46
Q

What is asthma caused by?

A

Reversible hyperirritability of the tracheobronchial tree which leads to airway inflammation and bronchoconstriction

47
Q

What is the most common chronic childhood disease?

A

Asthma

48
Q

When does surfactant production begin in a neonate?

When is enough surfactant produced?

A

24-28 weeks

By 35 weeks

49
Q

What is the MC cause of atypical/walking PNA?

A

Mycoplasma pneumoniae

50
Q

What are two ways to dx a pt with an aspirated foreign body?

Which one provides direct visualization and ability to remove FB?

A

Bronchoscopy provides direct visualization and ability to remove FB

CXR (regional hyperinflation)

(<em>photo shows aspirated dental crown!</em>)

51
Q

What abx therapy is recommended as 1st line for patients with aspiration PNA (anaerobes)?

A

Clindamycin or Metronidazole or Augmentin

52
Q

What are some examples of medications that can be used as an adjunct to traditional asthma management?

A

IV Magnesium (bronchodiliator)

Heliox

Ketamine

Omalizumab (anti-IgE antibody, used in severe uncontrolled asthma)

53
Q

When is Ribavirin Rx’d to patients with Acute bronchiolitis?

A

Ribavirin ± administered if severe lung or heart dz or in immunosuppressed patients

54
Q

What is the recommended tx for IRDS?

A

Exogenous surfactant given to open alveoli

CPAP

55
Q

Acute bronchiolitis is a (lower/upper) respiratory tract infxn of the (small/large) airways, that leads to the proliferation/necrosis of the bronchiolar epithelium, which produces obstruction from the sloughed epithelium, increased mucus plugging, and submucosal edema leading to ____ ____ ______ and variable obstruction.

A

lower

small

peripheral airway narrowing

56
Q

What is the stepwise approach to tx of asthma?

When is step down recommended?

A

Step down recommended if pt has controlled sx for >3 months

57
Q

What infectious agent is the most common cause of croup?

A

Parainfluenza virus type 1

Can also be caused by adenovirus, RSV, and rhinovirus

58
Q

What is the best way to prevent acute bronchiolitis?

A

hand washing!

59
Q

Croup is caused by inflammation to the (lower/upper) airway, whcih leads to swelling of the ______, resulting in stridor, ______, and what kind of cough?

A

upper airway

trachea

hoarseness

“BARKING” cough

60
Q

If a pt’s sputum is rusty (blood-colored), what infectious organism should be suspected to be the cause of the pt’s PNA?

A

Strep pneumoniae

61
Q

What will be noted on pulmonary examination of a child with asthma?

A

Prolonged expiration with wheezing and hyperresonace

62
Q

What infectious organism causes PNA that is not transmitted person to person, but rather is associated with outbreaks related to CONTAMINATED WATER SUPPLIES (air conditioners, cooling towers, etc)?

A

Legionella pneumoniae

63
Q

What fungal etiology should be suspected in a pt with PNA who is immunocompromised?

A

Pneumocystis jirovechi (carinii) {PCP}

64
Q

What is the best and most objective way to assess asthma exacerbation severity and patient response in the ED?

A

Peak Expiratory Flow Rate

65
Q

What are some examples of quick relief medications for acute exacerbations of asthma?

1st line?

Most effective and fastest?

A

B2 Agonists (SABA) {bronchodilators}: 1st line tx, most effective and fastest {2-5 min} [Albuterol]

Anticholinergics (Antimuscarinics) {central bronchodilators}: [Ipratropium]

Corticosteroids {antiinflammatory}: [Prednisone, Methylprednisolone]

66
Q

Elderly pts with PNA may not present with respiratory sx, fever, or increased WBC, but instead may present with ______

A

AMS/depressed mental fxning

67
Q

What are some potential risk factors for being born with hyaline membrane disease?

(i.e. race? sex? type of delivery? maternal conditions? what else?)

A

Caucasian, males (2x MC), C-section delivery (infant stress during delivery causes cortisol production in infant), perinatal infxns, multiple births (especially if premature), maternal DM (high insulin delays surfactant production)

68
Q

Patients with CF typically have recurrent respiratory infections, due to infectious organisms _________ and ____ _____

A

Pseudomonas and Staph aureus

69
Q

What is the most common cause of acute bronchiolitis?

A

RSV

70
Q

What is the classic triad of asthma?

A

Dyspnea

Wheezing

Cough (especially at night)

71
Q

What abx therapy is recommended as 1st line for patients with CAP, outpatient?

A

Macrolide or Doxycycline

+FQ if pt has comorbidities

72
Q

How to manage mild croup?

Moderate?

Severe?

A

Mild (no stridor at rest, no respiratory distress): cool humidifier, hydration, dexamethsone provides significant relief

Moderate (stridor at rest with mild to moderate retractions): Dexamethasone PO or IM, +/- Nebulized epinephrine; observer 3-4 hour, d/c home if improved

Severe (stridor at rest with marked retractions): Dexamethasone and nebulized epinephrine and hospitalization

73
Q

What is the gold standard diagnostic study for asthma?

The finding?

A

Pulmonary function test

reversible obstruction

74
Q

What is the most common single cause of death in the 1st month of life?

A

Infant respiratory distress syndrome (hyaline membrane dz)

75
Q

If a pt presents with severe asthma and/or status asthmaticus, what will be noted on PE?

A

inability to speak in full sentences

PEFR <40% predicted

altered mental status (ominous)

pulsus paradoxus (inspiratory JSBP>10)

cyanosis, “tripod” position, “silent chest” (no air exchange), tachycardia, severe tachypnea

76
Q

When should you hospitalize a pt with PNA?

A

mulitlobar PNA, (+) neutropenia, or have comorbidities that may complicate treatment

77
Q

What is IRDS/Hylaine membrane dz?

What is it due to?

A

dz of premature infants secondary to insufficient surfactant production

78
Q

What fungal organism should be suspected in a pt with PNA who is from the Ohio/Mississippi River basin and who may have also come into contact with bird/bat droppings?

A

Histoplasma capsulatum

79
Q

There is an increased incidence of CF in patients of what race/descent?

What is the avg life expectancy of a pt with CF?

A

Northern europeans, caucasian

36.8 years

80
Q

What will be seen on CXR in a pt with IRDS?

A

bilateral diffuse reticular ground-glass opacities + air bronchograms

domed diaphragms

81
Q

What condition is described below?

“young with bronchiectasis, pancreatic insufficiency, growth delays, and infertility”

A

Cystic fibrosis (CF)

82
Q

Acute bronchiolitis is most commonly seen in patients aged ____-____ after ____ infxn

A

2 months - 2 years

viral infxn (i.e. RSV, adenovirus)

83
Q

_______ are given to infants to help mature lungs if premature delivery expected (between 24 - 36 weeks)

A

Corticosteroids

84
Q

CF may also lead to developing what other chronic conditions?

A

Pancreatitis, CF-induced Diabetes Mellitus, Biliary disease

85
Q

In a pt with IRDS, there is a ____% survival rate w/ tx and normal return of lung fxn w/in ____

A

90%

1 month

Rotation 1: Pediatrics (13 decks)

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