Pulmonary Flashcards
Examples of obstructive versus restrictive defects?
Asthma, bronchiolitis, foreign body aspiration
Pulmonary edema, scoliosis, pulmonary fibrosis, respiratory muscle weakness
Bronchial tree develops when? Sufficient air sacs/vasculature for viability when? Alveoli increase in number until?
16 weeks; 27 weeks; eight years
Differential for inspiratory strider?
Expiratory wheezing?
Crackles/rales?
Extrathoracic obstruction – croup, laryngomalacia
Intrathoracic obstruction – asthma, bronchiolitis
Parenchymal disease – pneumonia, pulmonary edema
Epiglottitis – Ddx? causes? Features? Laboratory studies? Radiographic findings?
Croup, bacterial tracheitis, retropharyngeal abscess
H. influenzae type B, GABHS
- Rapidly progressive airway obstruction without prodrome
- Muffled speech, drooling
Leukocytosis with a left shift and positive blood culture
Thumb sign
Supraglottic versus subglottic disorders – examples?
- Strider?
- Cough?
- Voice?
- Drooling?
- Fever?
- Toxicity?
- Posture?
Epiglottitis, retropharyngeal abscess versus tracheitis, croup
- Quiet versus loud
- None versus Barky
- Muffled versus hoarse
- Yes versus no
- High versus low/high
- Yes versus no (unless tracheitis)
- Tripod versus normal
Epiglottitis secondary to H. influenzae – prophylaxis for who? Drugs?
Rifampin for unimmunized children under four
Viral croup – causes? Non-viral cause? Clinical features? Radiologic findings? Management?
Parainfluenza, RSV, adenovirus, influenza; Mycoplasma
- Prodrome
- Inspiratory Strider, barky cough, horse voice
Steeple sign (subglottic narrowing) on x-ray
- Cool mist/food
- Corticosteroids if stridor at rest
- Racemic epinephrine if respiratory distress
- Beta agonist if wheezing
Spasmodic croup – cause? Symptoms? Management?
Hypersensitivity reaction
- Stridor at night
- Recurrs and resolves without treatment
- Cool mist/food
- Corticosteroids if stridor at rest
- Racemic epinephrine if respiratory distress
- Beta agonist if wheezing
Bacterial tracheitis – causes? Clinical features? Management?
Staph aureus, streptococcus, nontypeable H. influenzae
Abrupt onset with high fever, toxicity, and pus in the trachea
Anti-staphylococcal antibiotics
Bronchiolitis – age of typical patient? Causes? Clinical features? CXR? Management?
Children under two
RSV >parainfluenza, adenovirus, rhinovirus, influenza, Mycoplasma
- Gradual onset with URI symptoms
- Progression to tachypnea, Respiratory distress, apnea, hepatosplenomegaly
CXR shows hyperinflation with air trapping, patchy infiltrates, atelectasis
- Primarily supportive
- Nebulized bronchodilators, steroids, racemic epinephrine
- Aerosolized ribavirin
- Palivizumab - RSV monoclonal antibody
Causes of pneumonia: Most common in all age groups? 1. 0 to 3 months 2. Three months to five years 3. 6+ years
Viruses
- Congenital infections, postpartum infections (respiratory viruses), afebrile pneumonitis
- Viruses, strep pneumonia/staph aureus/HIB
- Mycoplasma, chlamydia, viruses and bacteria
Diagnosis of viral pneumonia?
Interstitial infiltrates on chest x-ray and WBC >20 with lymphocytic predominance
Common cause of afebrile pneumonia at 1 to 3 months? Clinical features? Management?
Chlamydia
Staccato type cough, eosinophilia
Erythromycin, azithromycin
Causes of recurrent pulmonary infiltrates in single lobe of lung?
- Intraluminal obstruction – foreign body, tumor, mucous plug
- Extraluminal obstruction – lymph node, malignancy
- Structural abnormalities – bronchial stenosis, bronchiectasis, congenital abnormalities,
Causes of recurrent pulmonary infiltrates in multiple lobes?
- Aspiration
- Mucociliary clearance dysfunction – CF, Kartagener’s
- Bronchopulmonary dysplasia – chronic lung disease
- Asthma
- Immunodeficiency
- Misc - Congenital heart disease, alpha-1-antitrypsin deficiency, sickle cell, hypersensitivity pneumonitis
Stages of pertussis?
- Catarrhal – URI symptoms
- Paroxysmal – forceful cough with inspiratory whoop (And possible post-tested vomiting)
- Convalescent – Recovery stage, where paroxysmal cough slowly improves
Characteristics findings in pertussis? Diagnosis?
- Whooping cough
- Lymphocytosis
Culture/direct fluorescent antibody test
Chest x-ray findings of asthma?
- Hyperinflation
- Peribronchial thickening
- Patchy atelectasis
Wheezing – differential?
- Asthma
- Hypersensitivity reaction
- Bronchiolitis
- Pneumonia
- Aspiration
- Environmental irritants
Theophylline – drug class? Why not used anymore?
Methylxanthine; narrow toxic-therapeutic ratio
Classic hallmarks of cystic fibrosis? Structural abnormality? Sinopulmonary infections – bugs?
Finding at birth?
Nutritional deficiency?
Acid/base status?
- Lungs - Chronic progressive pulmonary insufficiency
- Pancreas - Pancreatic insufficiency
- Skin - High sweat electrolytes
Also see:
- Chronic sinopulmonary disease – nasal polyps, staph aureus/pseudomonas infection
- G.I. – meconium ileus, pancreatic insufficiency, chronic hepatic disease
- Nutritional – fat-soluble vitamin deficiencies (decreased pancreatic enzymes)
- Metabolic – hypoNa/Cl/K metabolic alkalosis
Diagnosis of cystic fibrosis?
- Laboratory evidence – sweat chlorine over 60 OR two CF mutations OR ion transport abnormality across nasal epithelium
- One or more phenotypic features OR +family hx OR Immunoreactive trypsinogen on newborn screen
Chronic lung disease – definition? Commonly occurs in? Causes? Clinical features? ABG findings?Chest x-ray? Management?
Oxygen dependency beyond 28 days of life
Children with hyaline membrane disease or surfactant deficiency syndrome
- Acute injury – meconium aspiration, infection, mechanical ventilation
- Oxidants or proteases
- Abnormally healed lung – fibrosis
Low PaO2, high PaCO2
CXR – hyperinflation, atelectasis, cystic radiodensity
Supplemental oxygen, bronchodilators/diuretics, immunization,
Apnea of infancy/prematurity? Periodic breathing?
ALTE?
Cessation of breathing for more than 20 seconds
Breathing pattern with 3+ respiratory pauses lasting over 3 seconds each with less than 20 seconds of normal respiration in between
Apnea, color change, choking, gagging – recovery only with resuscitation
Risk factors – SIDS?
- Belly sleeping
- Soft bedding, over bundling
- Prematurity
- Lack of breast-feeding
- Maternal smoking, drug
