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Pediatric studying torture > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Parts of lower respiratory tract

A

Trachea, right and left lungs, bronci, bronchioles, and the alveoli

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2
Q

What side of the lungs do FBs tend to get stuck in?

A

Right side because it is shorter and wider than the left bronchus. It forms a smaller angle away from the trachea

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3
Q

Tracheal breath sounds

A

Heard over the trachea

Harsh and sound like air is being blown through a pipe

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4
Q

Bronchial breath sounds

A

Over large airways in the 2nd and 3rd intercostal spaces
Tubular and hollow sounding
Loud and high in pitch with a short pause between inspiration and expiration
Expiatory sounds last longer than inspiratory sounds

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5
Q

Bronchovesicular sounds

A

Heard best in the posterior chest between the scapulae and in the center of chest
Tubular quality
Equal during inspiration and expiration

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6
Q

Vesicular sounds

A

Soft blowing, or rustling normally heard throughout most of the lung field
Heard throughout inspiration, continue without pause through expiration and fade away about 1/3rd of the way through expiration

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7
Q

Upper respiratory tract sounds

A

Snoring, noisy breathing, stridor, musical or wheezing breath sounds

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8
Q

Lower respiratory

A

Fine crackles, coarse crackles, rhoncus, pleural fiction rub, wheezing, and bronchial breath sounds

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9
Q

Intermittent, nonmusical, short or rattling sounds best heard on mind to late inspiration and occasionally on expiration

A

Fine crackles

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10
Q

Fine crackles likely cause

A

Pnx and interstitial lung disease

Unaffected by coughing

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11
Q

Course crackles–what do they sound like

A

Nonmusical, short and explosive and heard on early inspiration and throughout expiration.
Intermittent bubbling or brief popping sounds that are longer in duration than fine crackles

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12
Q

Nonmusical, short and explosive and heard on early inspiration and throughout expiration.
Intermittent bubbling or brief popping sounds that are longer in duration than fine crackles

A

Course crackles

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13
Q

Fine crackles

A

Intermittent, nonmusical, short or rattling sounds best heard on mind to late inspiration and occasionally on expiration

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14
Q

Affected by cough and are more common during inspiration, indicate intermittent airway opening and may be related to secretions

A

Course crackles

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15
Q

Dyskinetic cilia syndrome presents as

A

recurrent sinusitis and pnx

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16
Q

Situs inversus

A

a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions

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17
Q

Situs inversus + Dyskinetic cilia syndrome

A

Kartagener’s syndrome

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18
Q

Transient tachypnea tx

A

give oxygen

CPAP

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19
Q

Poorly compliant lung due to deficiency of surfactant

A

respiratory distress syndrome in newborn

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20
Q

Tachypnea, grunting, nasal flare, chest retraction, cyanosis in newborn

A

respiratory distress syndrome in newborn

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21
Q

Diffuse ground glass appearance with air bronchograms

A

respiratory distress syndrome in newborn

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22
Q

Prevention of transient tachypnea

A

Give mom cortiocosteroid 48 hours before delivery

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23
Q

Baby @ risk for meconium aspiration syndrome

A

Post term infant or SGA

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24
Q

Tachypnea and cyanosis in a post term infant or SGA

A

Tachypnea and cyanosis

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25
Q

What to look for if kid has recurrent resp infections

A

Immunodeficiency, primary ciliary dyskinesia, or CF

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26
Q

S P U R

A

Severe infection
Persistent infection and poor recovery
Unusual organisms
Recurrent infection

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27
Q

When to consider child for CF or ciliary dysk or immunod diff

A
  1. 4 or more new ear infections in 1 year
  2. 2 or more serious sinus infections
  3. 2 or more pnx in 1 year
  4. persistent oral candidiasis
  5. FTT
  6. 2 or more deep seeded skin abscesses
  7. 2 or more months on antibiotics w/o improvement
  8. fam hx of immunodef
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28
Q

Rising PaCO2

A

ominous sign

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29
Q

Positions to get chest radiographs

A

Posteroanterior and lateral positions

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30
Q

Definition of throat infection

A

Temp >38.3c, cervical lymphadenopathy with tonsillar exudate or a positive GABHS culture

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31
Q

Indications for tonsillectomy and adenoidectomy

A

more than 7 throat infections in the past year

More than 5 episodes of throat infection the the past 2 years or 3 episodes per year for the past 3 years

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32
Q

Initial low grade fever with clear rhinitis changing by day 3 to purulent discharge to a slow resolution with clear nasal discharge by 10th day

A

common cold

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33
Q

Agents of common cold

A

Rhinoviruses like parainfluenza, rsv, coronavirus, human metapneumovirus

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34
Q

How common cold is spread

A

direct inhalation of sneeze, nasal blowing, inoculation via fingers from nasal secretions, fomites

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35
Q

Risk factors for getting sick

A

Mental stress, lack of sleep, high basal lvls of catecholamines, infrequent exercise, smoking, low vitamin C

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36
Q

Nasal congestion, cough, sneezing, rhinorrhea, fever, hoarseness, and pharyngitis. Prominent nasal symptoms

A

Common cold, should go away by 10 days. Vomiting and diarrhea are uncommon

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37
Q

Gradual onset, prominent nasal symptoms, dysphagia/sore throat, mild cough, low grade fever in young kids

A

common cold

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38
Q

PE of red nasal mucosa with secretions of various colors, mildly erythematous throat, anterior cervical lymphadenopathy with freely moveable nodes <2cm.

A

Common cold

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39
Q

Pertussis patho

A

primary disease or reinfection

caused by gram neg bacillus, bordetella pertussis or b parapertussis

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40
Q

Pertussis transmission

A

aerosol dropletfrom coughing

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41
Q

Pertussis incubation

A

7-`10 days but can go to 21

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42
Q

Prolonged cough for 6-10 weeks

A

think Pertussis

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43
Q

Catarrhal phaes of Pertussis

A
  1. non specific complaints
  2. upper respiratory infection similar to common cold
  3. Mild but worsening cough, coryza, sneezing, and low grade fever 101f 38.3c
  4. 1-2 weeks
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44
Q

Paroxysmal phase

A
  1. absent or minimal fever
  2. persistent staccato or rapid firing cough, paroxysmal cough w inspiratory whoop
  3. Paroxysms can be several times per hour w vomit
  4. Cyanosis, sweating, prostration, and exhaustion after coughing
  5. disturbed sleep
  6. 2-4 weeks
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45
Q

Convalescent phase

A
  1. Symptoms wane over a variable period that can last months
  2. Waning of paroxysmal coughing eps
  3. 3 weeks to six months
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46
Q

Pertussis symptoms in kids less than 6 months

A 
apnea w seizures
cough w/o whoop
tachypnea
poor feeding
leukocytosis w marked lymphocytosis
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47
Q

Pertussis diagnostic

A

Culture for B pertussis is gold stnd. Collect from nasopharynx w a dacron or calcium alginate fiber tipped swab into a special transport medium
PCR
CBC w leukocytosis and lymphocytosis can be seen in infants but usu not adolescents

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48
Q

Pertussis tx infants younger than 6mos

A

Azithromycin 10mg/kg in a single dose for 5 days for infants from birth to 6mos

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49
Q

Pertussis tx infants older than 6 months

A

azithromycin 10mg/kg/day on day 1 then a single dose of 5mg/kg/day on days 2-5

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50
Q

Pertussis tx kids >1mo

A

Clarithromycin 15mg/kg/day bid for 7 days

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51
Q

Pertussis tx all ages >1mo

A

erythromycin can cause pyloric stenosis if younger

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52
Q

What not to give with pertussis

A

corticosteroid

albuterol

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53
Q

Croup patho

A

Inflammatory disease of the larynx, trachea, and bronchi

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54
Q

Croup presentation

A

Brassy, barking cough, with varying degrees of inspiratory stridor, hoarseness, and resp distress

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55
Q

Brassy, barking cough, with varying degrees of inspiratory stridor, hoarseness, and resp distress

A

Croup

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56
Q

Most common agents of croup and season when it is active

A

parainfluenza type 1 (sometimes 2)

Outbreaks in fall for kids 1-6

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57
Q

Most common type of croup in kids 6-36months

A

viral

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58
Q

Croup incubation

A

2 to 4 days

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59
Q

Croup communicability

A

1 week before onset of disease

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60
Q

How long does croup last

A

5 days

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61
Q

Barking cough, inspiratory stridor with dyspnea w symptoms being worse at night

A

croup

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62
Q

Steeple sign on xray

A

croup

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63
Q

Diagnostic test for croup

A

chest radiography of soft tissues, showing sublglottic narrowing ‘steeple sign’

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64
Q

rapidly progressive disease n kids 3weeks to 16 years with high fever and inflammatory cell infiltration of the larynx, trachea, and bronchi

A

Bacterial tracheitis

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65
Q

Bacterial tracheitis agent

A

Stap. M catarrhalis

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66
Q

Bacterial croup specific symptoms

A

Pus within the trachea and lower airways

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67
Q

Croup treatment non med

A

humidified air, cold air can be helpful

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68
Q

Croup treatment med

A

nebulized epi
cortico steroids–dexamethasone .5-2mg/kg/dose q8hr for 1-2 days
racemic epi
hydration is important

69
Q

When to hospitalize for croup

A

when respiratory rate is between 70-90 bpm
stridor at rest
temp higher than 102.2f (39c)

70
Q

hx of missing dtap vaccine + whooping, postussive vomiting, afebrile

A

pertussis

71
Q

coryza

A

catarrhal inflammation of the mucous membrane in the nose, caused especially by a cold or by hay fever.

72
Q

Patho of bronchiolitis

A

inflammation, necrosis and edema of the respiratory epithelial cells in the lining of small airways as well as copious mucus production

73
Q

URI symptoms of 2-3 days that progresses to lower respiratory symptoms that last as long as 10 days

A

bronchiolitis

74
Q

Ages for bronchiolitis

A

infancy to 2 years

75
Q

When is the postnatal nadir in maternal immunoglobulins

A

2-3 months

76
Q

Severe bronchiolitis symptoms

A

cyanosis, air hunger, retractions, nasal flaring, respiratory distress and apnea

77
Q

cyanosis, air hunger, retractions, nasal flaring, respiratory distress and apnea

A

Severe bronchiolitis

78
Q

bronchiolitis infectious agent

A

RSV

79
Q

bronchiolitis (rsv) incubation

A

2-8 days

80
Q

When does bronchiolitis occur (months)

A

Nov-March (winter)

81
Q

Cough, coryza, and rhinorrhea, over 2-3 days then a progression to cough, coryza, and rhinorrhea
Gradual progression of resp distress marked by noisy, raspy, breathing, w audible wheezing
Low grade temp

A

bronchiolitis

82
Q

bronchiolitis symptoms

A

Cough, coryza, and rhinorrhea, over 2-3 days then a progression to cough, coryza, and rhinorrhea
Gradual progression of resp distress marked by noisy, raspy, breathing, w audible wheezing
Low grade temp

83
Q

bronchiolitis diagnostic

A

based on history and physical, routine use of chest radiographs isn’t recommended

84
Q

bronchiolitis tx

A

bronchodilators and use of epi is not recommended, don’t really need to do anything really. O2 if oxygen less than 90%,
Fluid intake and nasal suctioning
Kids younger than 2 should be hospitalized

85
Q

Inpatient management of bronchiolitis

A

heated hummidified high flow o2 via nc

hypertonic nebulized saline

86
Q

What is one of the most common causes of fatal aspiration

A

hot dogs

87
Q

rapid onset of hoarseness and development of a chronic croupy cough with aphonia

A

laryngeal foreign body

88
Q

FB diagnositic

A

radiograph in expiratory or lateral decubitus

89
Q

High risk foods for FB ingestion

A

whole acrrots, nuts, popcorn, hot dogs

90
Q

Bronchitis patho

A

inflammation of the bronchioles. usu proceeded by a viral infection that damages the large airways like the trachea and destroys ciliated epithelium

91
Q

Bronchitis agents

A

influenza, rsv, adenovirus. P aeruginosa is most common agent in kids w CF

92
Q

bronchitis infection period

A

winter and lasts 2-3 weeks

93
Q

productive cough that lasts for more than 3 months

A

chronic Bronchitis

94
Q

Phase 1 findings of bronchitis

A

URI for 3-4 days with a dry hacking cough with sputum production

95
Q

URI for 3-4 days with a dry hacking cough with sputum production

A

Phase 1 findings of bronchiti

96
Q

Phase 2 findings of bronchitis

A

low substernal discomfort or burning chest pain aggravated by coughing

97
Q

Phase 3 findings of bronchitis

A

Dry harsh brassy cough that becomes productive.

98
Q

Bronchitis management

A

analgesia
hydration
Bc most causes are viral, antibiotics usu not given
Do not give bronchodilators or cough suppressants.
can give inhaler if chronic cough

99
Q

Valley fever/ coccidioidomycosis

A

fungal spore that can cause a primary pulmonary infection when inhaled

100
Q

Fatigue, weight loss, couch and headache, chest pain, bone pain, erythema multiforme, in kid from southwestern us

A

Valley fever/ coccidioidomycosis

101
Q

Valley fever/ coccidioidomycosis diagnostic

A

IgM by enzyme immunoassasy EIA tests

102
Q

Valley fever/ coccidioidomycosis management

A

treat high risk kids who are immune supressed

Tx=fluconazole or itraconazole for 3 to 6 months

103
Q

Valley fever/ coccidioidomycosis when to hospitalize

A

when it doesnt respond to high dose oral fluconazole and involves CNS. may require IV amphotericin B

104
Q

Valley fever/ coccidioidomycosis prevention

A

avoid areas where there is aerosolized spores from dust (avoid contruction sites, or where there are soil disturbances) think mexico, central/south america

105
Q

What is pnx

A

lower resp tract infection associated with fever, respiratory symptoms involving lung parenchyma

106
Q

pnx that involves the infection of the alveolar space that results in consolidation

A

lobar pnx (‘typical pnx’)

107
Q

atypical pnx

A

pnx patterns of consolidation that are not localized

108
Q

Interstitial pnx

A

cellular infiltrates that attack the interstitium that makes up the cell walls of the alveoli, sacs, ducts, and bronchioles. Typical of viral infection

109
Q

Pneumonitis

A

lung inflammation that may be associated with consolidation.

110
Q

risk factors for pnx in childhood

A

male, lower se class, lack of breastfeeding, poor nutrition, exposure to cig smoke, alcohol and drug use, gerd

111
Q

leading agent of pnx

A

s pneumoniae except in newborns

112
Q

atypical agents of pnx

A

m pneumo, chlamydia, mycoplasma pnx–most common cause of pnx in kids >5 through young adulthood

113
Q

M pneumonia incubation period

A

2-3 weeks

114
Q

wheezing in a kid over 5 without a history of wheeze

A

atypical pnx. usually a mild to self limited disease

115
Q

Newborn pnx through genital tract

A

C trachomatis from mother to infant during birth

116
Q

Fever and cough in all age groups
tachypnea and inc work of breathing before coughing
Cough, hypoxia, nasal flaring, rales, retractions, rhonchus lung sounds

A

hallmark of pnx (fever+cough)

117
Q

Lung sounds in pnx

A

Cough, hypoxia, nasal flaring, rales, retractions, rhonchus lung sounds

118
Q

lobar pnx symptoms

A

fever, cough, decreased breath sounds

119
Q

pnx in newborns presentation

A

presents within 1st 3 days of life with respiratory distress, apnea, tachycardia, poor perfusion, no fever and subtle physical findings

120
Q

presents within 1st 3 days of life with respiratory distress, apnea, tachycardia, poor perfusion, no fever and subtle physical findings

A

pnx in newborns presentation

121
Q

Abrupt high fever, with temps >103.3 chills, cough, and dyspnea in childhood and adolescence

A

bacterial pnx

122
Q

restlessness, shaking chills, apprehension, sob, malaise, pleuritic chest pain

A

pnx

123
Q

tachypnea > 60bpm in infants less than 2 months old

A

pnx – tachypnea may be the only sign

124
Q

tachycardia, air hunger, cyanosis

A

pnx in kids <1

125
Q

fine crackles, dullness, diminished breath sounds

A

pnx

126
Q

fever hypoxia lethargy

A

pnx

127
Q

pnx position of comfort

A

fetal position on the side to improve air exchange

128
Q

pnx diagnositc

A

xray in kid >3months who does not improve after 72 hours on standard treatment. f/u films not needed on kids with uneventful recovery. blood cultures not used in out pt. culture in severely sick kids. rapid viral tests are helpful. CBC not needed in out pt.

129
Q

management of pnx

A

supportive with antipyretics, hydration, and rest.
use antibiotics if suspected bacterial infection
Serious cases may need hospitalization for resp therapy with intubation/humidified o2

130
Q

out pt antibiotic treatment of pnx 2 months to 3 months if chlamydia suspected

A

azithromycin for 5 days

131
Q

out pt antibiotic treatment of pnx 3 months to 18 years old

A

amoxicillin 80 to 100 mg/kg/day divided every 6 to 8 hours for 10 days

132
Q

if C pneumonia or M pneumonia suspected tx

A

azithromycin 12 mg/kg/day qd for 5 days

133
Q

Influenza related pnx tx

A

Oseltamivir (tamiflu)

Zanamivir (relenza) in kids > 7

134
Q

Inpatient tx of pnx in neonates

A

ampicillin and cefotaxime, ceftriaxone, or genatmicin

135
Q

Inpatient tx of pnx in fully immunized infant or school aged kid with community acquired pnx

A

Ampicillin or penicillin g

136
Q

complications of pnx

A

meningitis, cns abscess, endocarditis, pericarditis, osteomyelitis, septic arthritis

137
Q

what to give if there are high rates of penicillin resistance to s pneumoniae

A

3rd gen ceph such as ceftriaxone or cefotaxime

138
Q

what to give if s aureus is suspected cause of pnx

A

clindamycin/vanc

139
Q

CF inheritance pattern

A

autosomal recessive

140
Q

CF patho

A

mutated CF trasmembrane conductance regulator protein that is expressed in epithelial cells and blood cells leading to defective ion transport leading to defective mucous clearance. The obstruction leads to inflammation and infection.

141
Q

Where does cf have the most negative effects

A

lungs, pancreas, biliary tree, intestens, vas deferens, sweat glans and exocrine glands

142
Q

CF lung symptoms

A

severe chronic lung disease in kids.

chronic dry, frequent cough and sputum production to resp failure, bronchitis and bronchiolitis frequently

143
Q

GI symptoms in infancy for kid with cf

A

meconium ileus, pancreatic insufficiency, rectal prolapse, FTT, edema with hypoproteinemia, thick fat ladden stools (steatorrhea) intsussception, poor fat absorption

144
Q

Distal intestinal obstructive sndrome

A

occurs when viscous fecal matter causes blockage in distal intestine and presents with abd pain and distention (kids with cf)

145
Q

CF diagnostic gold standard

A

pilocarpine iontophoresis sweat test

146
Q

When to order sweat test

A

when kid has 1 of more clinical features like chronic sinopulmonary disease, GI and nutritional abnormnalities, salt loss syndrome, chronic metabolic alkalosis

147
Q

Diagnosis of CF guidelines

A

[] of sweat is > 60 mmol/L
[] of sweat is 30-59 mmol/L in infants less than 6 months or 40-59 if older
The child has 2 CFTR mutations

148
Q

CF management

A

optimize lung functioning by controlling airway infections and increasing clearance.

149
Q

CF airway management

A

Inhaled dornase alfa (recombinant human deoxyribonuclease) or hypertonic saline.
Ivacaftor in pts with 1 G551D mutation

150
Q

Pnx thorax presentation

A

Acute onset of chest pain and dsypnea

151
Q

Pnx thorax diagnosis

A

xray

152
Q

Pnx thorax treatment

A

observation and discontinuation of positive pressure

153
Q

Cystic fibrosis diabetes mellitus

A

result of fatty infilltration and destruction of islet cells. at age 10 oral glucose tolerance test done annually to screen

154
Q

The lower ribs and sternum bow inwards on the ant chest wall

A

pectus excavatum

155
Q

pectus excavatum complications

A

smaller anteroposterior diamter can lead to decrease in cardiac stroke volume and output

156
Q

Pectus carinatum

A

bowing of the sternum (pigeon chest) gets worse during adolescence.

157
Q

diagnostic test for pectus

A

chest radiography

158
Q

pectus tx

A

surgery if psychological and physical impairment of pc or pe

159
Q

xray finding of bronchiolitis

A

hyper inflation with a flattened diaphragm

160
Q

normal breath sounds

A

inspiration > expiration

161
Q

intermittent asthma symptoms

A

symptoms less than 2 days a week, brief exacerbations

tx only when symptoms occur (saba)

162
Q

mild persistent asthma symptoms

A

symptoms > 2 weeks a week but <1x exacerbatopm

tx low dose steroid inhalers daily (flovent/singulair) + Saba

163
Q

moderate persistent asthma symptoms

A

daily symptoms, exacerbations that are long and severely affect activity level.
tx medium dose inhaled steroid and long acting b2 agoinst (singular or theophylline +saba)

164
Q

severe persistent asthma symptoms

A

continuous symptoms, uses SABA multiple times per day, freq exacerbations, limited physical activity
Tx: high dose corticosteroids + long acting b2 agoinist (advair).

165
Q

S and symptoms of BPD

A

infants need o2 at 36 weeks or greater
high incidence of bpd in lbw infants
resp distress (cough/wheeze), poor growth, cyanotic episodes, fluid over loading
tx: supplemental o2 and fluids, bronchodilators, diuretics, synagis

166
Q

what are b2 agonist and when is it used

A

short acting=albuterol used to stop asthma symptoms

se=tachy, palpitations, dec k, inc glucose

167
Q

what are mast cell stabilizers and when are they used

A

inhibit degranulation of mast cells.
Cromolyn
can be used before exercise
SE=bad taste, dry mouth, pharyngitis

168
Q

What are leukotriene modifers and when are they used

A

block leukotriene synthesis to prevent allergy response, broncho constriction and mucous production
Montelukast
used to prevent allergic rhinitis
SE=headache, n/abd pain/infection

169
Q

2 week history of worsening cough and mediastinal shift on xray most likely dx

A

pleural effusion

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