Pulmonary Flashcards
1
Q
Parts of lower respiratory tract
A
Trachea, right and left lungs, bronci, bronchioles, and the alveoli
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
3
Q
Tracheal breath sounds
A
Heard over the trachea
Harsh and sound like air is being blown through a pipe
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
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
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
7
Q
Upper respiratory tract sounds
A
Snoring, noisy breathing, stridor, musical or wheezing breath sounds
8
Q
Lower respiratory
A
Fine crackles, coarse crackles, rhoncus, pleural fiction rub, wheezing, and bronchial breath sounds
9
Q
Intermittent, nonmusical, short or rattling sounds best heard on mind to late inspiration and occasionally on expiration
A
Fine crackles
10
Q
Fine crackles likely cause
A
Pnx and interstitial lung disease
Unaffected by coughing
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
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
13
Q
Fine crackles
A
Intermittent, nonmusical, short or rattling sounds best heard on mind to late inspiration and occasionally on expiration
14
Q
Affected by cough and are more common during inspiration, indicate intermittent airway opening and may be related to secretions
A
Course crackles
15
Q
Dyskinetic cilia syndrome presents as
A
recurrent sinusitis and pnx
16
Q
Situs inversus
A
a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions
17
Q
Situs inversus + Dyskinetic cilia syndrome
A
Kartagener’s syndrome
18
Q
Transient tachypnea tx
A
give oxygen
CPAP
19
Q
Poorly compliant lung due to deficiency of surfactant
A
respiratory distress syndrome in newborn
20
Q
Tachypnea, grunting, nasal flare, chest retraction, cyanosis in newborn
A
respiratory distress syndrome in newborn
21
Q
Diffuse ground glass appearance with air bronchograms
A
respiratory distress syndrome in newborn
22
Q
Prevention of transient tachypnea
A
Give mom cortiocosteroid 48 hours before delivery
23
Q
Baby @ risk for meconium aspiration syndrome
A
Post term infant or SGA
24
Q
Tachypnea and cyanosis in a post term infant or SGA
A
Tachypnea and cyanosis
25
What to look for if kid has recurrent resp infections
Immunodeficiency, primary ciliary dyskinesia, or CF
26
S P U R
Severe infection
Persistent infection and poor recovery
Unusual organisms
Recurrent infection
27
When to consider child for CF or ciliary dysk or immunod diff
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
28
Rising PaCO2
ominous sign
29
Positions to get chest radiographs
Posteroanterior and lateral positions
30
Definition of throat infection
Temp >38.3c, cervical lymphadenopathy with tonsillar exudate or a positive GABHS culture
31
Indications for tonsillectomy and adenoidectomy
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
32
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
common cold
33
Agents of common cold
Rhinoviruses like parainfluenza, rsv, coronavirus, human metapneumovirus
34
How common cold is spread
direct inhalation of sneeze, nasal blowing, inoculation via fingers from nasal secretions, fomites
35
Risk factors for getting sick
Mental stress, lack of sleep, high basal lvls of catecholamines, infrequent exercise, smoking, low vitamin C
36
Nasal congestion, cough, sneezing, rhinorrhea, fever, hoarseness, and pharyngitis. Prominent nasal symptoms
Common cold, should go away by 10 days. Vomiting and diarrhea are uncommon
37
Gradual onset, prominent nasal symptoms, dysphagia/sore throat, mild cough, low grade fever in young kids
common cold
38
PE of red nasal mucosa with secretions of various colors, mildly erythematous throat, anterior cervical lymphadenopathy with freely moveable nodes <2cm.
Common cold
39
Pertussis patho
primary disease or reinfection
| caused by gram neg bacillus, bordetella pertussis or b parapertussis
40
Pertussis transmission
aerosol dropletfrom coughing
41
Pertussis incubation
7-`10 days but can go to 21
42
Prolonged cough for 6-10 weeks
think Pertussis
43
Catarrhal phaes of Pertussis
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
44
Paroxysmal phase
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
45
Convalescent phase
1. Symptoms wane over a variable period that can last months
2. Waning of paroxysmal coughing eps
3. 3 weeks to six months
46
Pertussis symptoms in kids less than 6 months
```
apnea w seizures
cough w/o whoop
tachypnea
poor feeding
leukocytosis w marked lymphocytosis
```
47
Pertussis diagnostic
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
48
Pertussis tx infants younger than 6mos
Azithromycin 10mg/kg in a single dose for 5 days for infants from birth to 6mos
49
Pertussis tx infants older than 6 months
azithromycin 10mg/kg/day on day 1 then a single dose of 5mg/kg/day on days 2-5
50
Pertussis tx kids >1mo
Clarithromycin 15mg/kg/day bid for 7 days
51
Pertussis tx all ages >1mo
erythromycin can cause pyloric stenosis if younger
52
What not to give with pertussis
corticosteroid
| albuterol
53
Croup patho
Inflammatory disease of the larynx, trachea, and bronchi
54
Croup presentation
Brassy, barking cough, with varying degrees of inspiratory stridor, hoarseness, and resp distress
55
Brassy, barking cough, with varying degrees of inspiratory stridor, hoarseness, and resp distress
Croup
56
Most common agents of croup and season when it is active
parainfluenza type 1 (sometimes 2)
| Outbreaks in fall for kids 1-6
57
Most common type of croup in kids 6-36months
viral
58
Croup incubation
2 to 4 days
59
Croup communicability
1 week before onset of disease
60
How long does croup last
5 days
61
Barking cough, inspiratory stridor with dyspnea w symptoms being worse at night
croup
62
Steeple sign on xray
croup
63
Diagnostic test for croup
chest radiography of soft tissues, showing sublglottic narrowing 'steeple sign'
64
rapidly progressive disease n kids 3weeks to 16 years with high fever and inflammatory cell infiltration of the larynx, trachea, and bronchi
Bacterial tracheitis
65
Bacterial tracheitis agent
Stap. M catarrhalis
66
Bacterial croup specific symptoms
Pus within the trachea and lower airways
67
Croup treatment non med
humidified air, cold air can be helpful
68
Croup treatment med
nebulized epi
cortico steroids--dexamethasone .5-2mg/kg/dose q8hr for 1-2 days
racemic epi
hydration is important
69
When to hospitalize for croup
when respiratory rate is between 70-90 bpm
stridor at rest
temp higher than 102.2f (39c)
70
hx of missing dtap vaccine + whooping, postussive vomiting, afebrile
pertussis
71
coryza
catarrhal inflammation of the mucous membrane in the nose, caused especially by a cold or by hay fever.
72
Patho of bronchiolitis
inflammation, necrosis and edema of the respiratory epithelial cells in the lining of small airways as well as copious mucus production
73
URI symptoms of 2-3 days that progresses to lower respiratory symptoms that last as long as 10 days
bronchiolitis
74
Ages for bronchiolitis
infancy to 2 years
75
When is the postnatal nadir in maternal immunoglobulins
2-3 months
76
Severe bronchiolitis symptoms
cyanosis, air hunger, retractions, nasal flaring, respiratory distress and apnea
77
cyanosis, air hunger, retractions, nasal flaring, respiratory distress and apnea
Severe bronchiolitis
78
bronchiolitis infectious agent
RSV
79
bronchiolitis (rsv) incubation
2-8 days
80
When does bronchiolitis occur (months)
Nov-March (winter)
81
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
bronchiolitis
82
bronchiolitis symptoms
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
bronchiolitis diagnostic
based on history and physical, routine use of chest radiographs isn't recommended
84
bronchiolitis tx
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
Inpatient management of bronchiolitis
heated hummidified high flow o2 via nc
| hypertonic nebulized saline
86
What is one of the most common causes of fatal aspiration
hot dogs
87
rapid onset of hoarseness and development of a chronic croupy cough with aphonia
laryngeal foreign body
88
FB diagnositic
radiograph in expiratory or lateral decubitus
89
High risk foods for FB ingestion
whole acrrots, nuts, popcorn, hot dogs
90
Bronchitis patho
inflammation of the bronchioles. usu proceeded by a viral infection that damages the large airways like the trachea and destroys ciliated epithelium
91
Bronchitis agents
influenza, rsv, adenovirus. P aeruginosa is most common agent in kids w CF
92
bronchitis infection period
winter and lasts 2-3 weeks
93
productive cough that lasts for more than 3 months
chronic Bronchitis
94
Phase 1 findings of bronchitis
URI for 3-4 days with a dry hacking cough with sputum production
95
URI for 3-4 days with a dry hacking cough with sputum production
Phase 1 findings of bronchiti
96
Phase 2 findings of bronchitis
low substernal discomfort or burning chest pain aggravated by coughing
97
Phase 3 findings of bronchitis
Dry harsh brassy cough that becomes productive.
98
Bronchitis management
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
Valley fever/ coccidioidomycosis
fungal spore that can cause a primary pulmonary infection when inhaled
100
Fatigue, weight loss, couch and headache, chest pain, bone pain, erythema multiforme, in kid from southwestern us
Valley fever/ coccidioidomycosis
101
Valley fever/ coccidioidomycosis diagnostic
IgM by enzyme immunoassasy EIA tests
102
Valley fever/ coccidioidomycosis management
treat high risk kids who are immune supressed
| Tx=fluconazole or itraconazole for 3 to 6 months
103
Valley fever/ coccidioidomycosis when to hospitalize
when it doesnt respond to high dose oral fluconazole and involves CNS. may require IV amphotericin B
104
Valley fever/ coccidioidomycosis prevention
avoid areas where there is aerosolized spores from dust (avoid contruction sites, or where there are soil disturbances) think mexico, central/south america
105
What is pnx
lower resp tract infection associated with fever, respiratory symptoms involving lung parenchyma
106
pnx that involves the infection of the alveolar space that results in consolidation
lobar pnx ('typical pnx')
107
atypical pnx
pnx patterns of consolidation that are not localized
108
Interstitial pnx
cellular infiltrates that attack the interstitium that makes up the cell walls of the alveoli, sacs, ducts, and bronchioles. Typical of viral infection
109
Pneumonitis
lung inflammation that may be associated with consolidation.
110
risk factors for pnx in childhood
male, lower se class, lack of breastfeeding, poor nutrition, exposure to cig smoke, alcohol and drug use, gerd
111
leading agent of pnx
s pneumoniae except in newborns
112
atypical agents of pnx
m pneumo, chlamydia, mycoplasma pnx--most common cause of pnx in kids >5 through young adulthood
113
M pneumonia incubation period
2-3 weeks
114
wheezing in a kid over 5 without a history of wheeze
atypical pnx. usually a mild to self limited disease
115
Newborn pnx through genital tract
C trachomatis from mother to infant during birth
116
Fever and cough in all age groups
tachypnea and inc work of breathing before coughing
Cough, hypoxia, nasal flaring, rales, retractions, rhonchus lung sounds
hallmark of pnx (fever+cough)
117
Lung sounds in pnx
Cough, hypoxia, nasal flaring, rales, retractions, rhonchus lung sounds
118
lobar pnx symptoms
fever, cough, decreased breath sounds
119
pnx in newborns presentation
presents within 1st 3 days of life with respiratory distress, apnea, tachycardia, poor perfusion, no fever and subtle physical findings
120
presents within 1st 3 days of life with respiratory distress, apnea, tachycardia, poor perfusion, no fever and subtle physical findings
pnx in newborns presentation
121
Abrupt high fever, with temps >103.3 chills, cough, and dyspnea in childhood and adolescence
bacterial pnx
122
restlessness, shaking chills, apprehension, sob, malaise, pleuritic chest pain
pnx
123
tachypnea > 60bpm in infants less than 2 months old
pnx -- tachypnea may be the only sign
124
tachycardia, air hunger, cyanosis
pnx in kids <1
125
fine crackles, dullness, diminished breath sounds
pnx
126
fever hypoxia lethargy
pnx
127
pnx position of comfort
fetal position on the side to improve air exchange
128
pnx diagnositc
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
management of pnx
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
out pt antibiotic treatment of pnx 2 months to 3 months if chlamydia suspected
azithromycin for 5 days
131
out pt antibiotic treatment of pnx 3 months to 18 years old
amoxicillin 80 to 100 mg/kg/day divided every 6 to 8 hours for 10 days
132
if C pneumonia or M pneumonia suspected tx
azithromycin 12 mg/kg/day qd for 5 days
133
Influenza related pnx tx
Oseltamivir (tamiflu)
| Zanamivir (relenza) in kids > 7
134
Inpatient tx of pnx in neonates
ampicillin and cefotaxime, ceftriaxone, or genatmicin
135
Inpatient tx of pnx in fully immunized infant or school aged kid with community acquired pnx
Ampicillin or penicillin g
136
complications of pnx
meningitis, cns abscess, endocarditis, pericarditis, osteomyelitis, septic arthritis
137
what to give if there are high rates of penicillin resistance to s pneumoniae
3rd gen ceph such as ceftriaxone or cefotaxime
138
what to give if s aureus is suspected cause of pnx
clindamycin/vanc
139
CF inheritance pattern
autosomal recessive
140
CF patho
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
Where does cf have the most negative effects
lungs, pancreas, biliary tree, intestens, vas deferens, sweat glans and exocrine glands
142
CF lung symptoms
severe chronic lung disease in kids.
| chronic dry, frequent cough and sputum production to resp failure, bronchitis and bronchiolitis frequently
143
GI symptoms in infancy for kid with cf
meconium ileus, pancreatic insufficiency, rectal prolapse, FTT, edema with hypoproteinemia, thick fat ladden stools (steatorrhea) intsussception, poor fat absorption
144
Distal intestinal obstructive sndrome
occurs when viscous fecal matter causes blockage in distal intestine and presents with abd pain and distention (kids with cf)
145
CF diagnostic gold standard
pilocarpine iontophoresis sweat test
146
When to order sweat test
when kid has 1 of more clinical features like chronic sinopulmonary disease, GI and nutritional abnormnalities, salt loss syndrome, chronic metabolic alkalosis
147
Diagnosis of CF guidelines
[] 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
CF management
optimize lung functioning by controlling airway infections and increasing clearance.
149
CF airway management
Inhaled dornase alfa (recombinant human deoxyribonuclease) or hypertonic saline.
Ivacaftor in pts with 1 G551D mutation
150
Pnx thorax presentation
Acute onset of chest pain and dsypnea
151
Pnx thorax diagnosis
xray
152
Pnx thorax treatment
observation and discontinuation of positive pressure
153
Cystic fibrosis diabetes mellitus
result of fatty infilltration and destruction of islet cells. at age 10 oral glucose tolerance test done annually to screen
154
The lower ribs and sternum bow inwards on the ant chest wall
pectus excavatum
155
pectus excavatum complications
smaller anteroposterior diamter can lead to decrease in cardiac stroke volume and output
156
Pectus carinatum
bowing of the sternum (pigeon chest) gets worse during adolescence.
157
diagnostic test for pectus
chest radiography
158
pectus tx
surgery if psychological and physical impairment of pc or pe
159
xray finding of bronchiolitis
hyper inflation with a flattened diaphragm
160
normal breath sounds
inspiration > expiration
161
intermittent asthma symptoms
symptoms less than 2 days a week, brief exacerbations
| tx only when symptoms occur (saba)
162
mild persistent asthma symptoms
symptoms > 2 weeks a week but <1x exacerbatopm
| tx low dose steroid inhalers daily (flovent/singulair) + Saba
163
moderate persistent asthma symptoms
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
severe persistent asthma symptoms
continuous symptoms, uses SABA multiple times per day, freq exacerbations, limited physical activity
Tx: high dose corticosteroids + long acting b2 agoinist (advair).
165
S and symptoms of BPD
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
what are b2 agonist and when is it used
short acting=albuterol used to stop asthma symptoms
| se=tachy, palpitations, dec k, inc glucose
167
what are mast cell stabilizers and when are they used
inhibit degranulation of mast cells.
Cromolyn
can be used before exercise
SE=bad taste, dry mouth, pharyngitis
168
What are leukotriene modifers and when are they used
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
2 week history of worsening cough and mediastinal shift on xray most likely dx
pleural effusion
