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Pediatric EOR > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Lower respiratory tract infection of the small airways leading to mucus plugging and peripheral airway narrowing and variable obstruction

A

RSV - Acute bronchiolitis

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2
Q

Most common cause of acute bronchiolitis

A

RSV - respiratory syncytial virus

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3
Q

Most common age group affected by RSV

A

< 6 mo (especially around 2 months)

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4
Q

Risk factors for RSV

A

Cigarette exposure
Lack of breastfeeding
Premature crowded conditions

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5
Q

Complications of RSV

A

Otitis media - most common acute

Asthma - most common later in life

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6
Q

Fever, URI symptoms for 1-2 days followed by respiratory distress (wheezing, tachypnea, nasal flaring, cyanosis, retractions)

A

RSV - acute bronchiolitis

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7
Q

Diagnosis of RSV / acute bronchiolitis

A

CXR - hyperinflation, peribronchial cuffing
Nasal washings using monoclonal Ab testing
Pulse ox

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8
Q

Best predictor of disease in children with RSV

A

Pulse ox < 96% - admit

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9
Q

Management of RSV

A

Supportive: O2 mainstay
Albuterol, racemic epi if albuterol not effective
Ribavirin if severe

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10
Q

Prevention of RSV

A

Palivizumab prophylaxis in high risk groups

Hand washing preventative

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11
Q

Inflammation most commonly secondary to acute viral infxn of the upper airway leading to subglottic larynx/trachea swelling

A

Laryngotracheitis (croup)

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12
Q

Signs/symptoms of laryngotracheitis (croup)

A
  1. Barking cough (seal-like, harsh)
  2. Stridor (both inspiratory and expiratory)
  3. Hoarseness
  4. Dyspnea (especially worse at night)
  5. +/- preceding URI sx
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13
Q

Diagnosis of laryngotracheitis (croup)

A
  1. Clinical

2. Frontal cervical radiograph - steeple sign

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14
Q

Steeple Sign

A

Laryngotracheitis (croup)

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15
Q

Management of mild croup (no stridor at rest, no respiratory distress)

A

Cool humidified air mist, hydration
Dexamethasone
Supplemental oxygen if < 92%

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16
Q

Management of moderate croup (stridor at rest with mild-mod retractions)

A

Dexamethasone PO or IM +/- nebulized epinephrine

Should be observed 3-4 hours

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17
Q

Management of severe croup (stridor at rest with marked retractions)

A

Dexamethasone + nebulized epinephrine and hospitalization

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18
Q

Most common cause of CAP

A

Streptococcus pneumoniae

Haemophilus influenzae

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19
Q

Klebsiella pneumonia is seen in ___________ and is associated with _________

A

Alcoholics

Cavitary lesions

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20
Q

Most common viral cause of pneumonia in infants/small children

A

RSV Parainfluenza

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21
Q

Most common viral cause of pneumonia in adults

A

Influenza

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22
Q

Most common causes of hospital acquired pneumonia

A

Pseudomonas
E. coli
Klebsiella
Staph aureus (MRSA)

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23
Q

When to hospitalize for pneumonia

A

Multilobar
Neutropenia
Comorbidities

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24
Q

Still considered community acquired if pt develops pneumonia within __________ of initial hospital admission

A

48 hours

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25
Q

Physical exam signs of pneumonia

A

Dullness on percussion
Egophony
Increased tactile fremitus
Inspiratory rales (crackles)

26
Q

Mycoplasma pneumonia (atypical) is associated with

A

Bullous myringitis

27
Q

Legionella pneumonia is associated with

A

GI symptoms

Increased LFTs

28
Q

Diagnosis of pneumonia

A
  1. CXR/CT

2. Sputum culture (gram stain)

29
Q

Rusty (blood-tinged sputum in pneumonia)

A

Strep pneumoniae

30
Q

Currant jelly sputum in pneumonia

A

Klebsiella

31
Q

Management of CAP outpatient

A

Macrolide or doxycycline

32
Q

Management of CAP inpatient

A

B lactam + macrolide or doxycycline OR fluoroquinolone

33
Q

Management of HAP

A

B lactam + AG or FQ

34
Q

Reverse hyperirritability of the tracheobronchial tree, leading to airway inflammation and bronchoconstriction

A

Asthma

35
Q

Most common chronic childhood disease

A

Asthma

36
Q

Samter’s Triad

A
  1. Asthma
  2. Nasal polyps
  3. ASA/NSAID allergy
37
Q

Classic triad of asthma

A
  1. Dyspnea
  2. Wheezing
  3. Coughing (esp at night)
38
Q

Prolonged expiration with wheezing, hyperresonance to percussion

A

Asthma

39
Q

Diagnosis of asthma

A
  1. PFT - gold standard (reversible obstruction)
  2. Bronchoprovocation- methacholine challenge
  3. Peak Flow Rate - best for assessing severity
  4. Pulse Ox
  5. ABG
  6. CXR
40
Q

Admission criteria for asthma

A

PEFR < 50% predicted
ER visit within 3 days of exacerbation
Status asthmaticus
Post treatment failure AMS

41
Q

Adjuncts for asthma management

A

IV magnesium - indicated in severe asthma

Omalizumab - used in severe, uncontrolled asthma

42
Q

Diagnosis of foreign body aspiration

A
  1. Bronchoscopy - allows for removal

2. CXR

43
Q

Disease of premature infants secondary to insufficiency of surfactant production and lung structural immaturity

A

Infant respiratory distress syndrome (hyaline membrane disease)

44
Q

Infant respiratory distress syndrome (hyaline membrane disease) leads to

A

Atelectasis and perfusion without ventilation

45
Q

Most common single cause of death in first month of life

A

Hyaline membrane disease (infant respiratory distress syndrome)

46
Q

Surfactant production begins around ________ weeks. By _____ weeks, enough surfactant is produced

A

24-28 weeks

35 weeks

47
Q

Risk factors for hyaline membrane disease (IRDS)

A

Caucasian
Male
Cesarean delivery (cortisol production - stress)
Perinatal infection
Multiple births
Maternal diabetes (high insulin delays surfactant production)

48
Q

Signs/symptoms of hyaline membrane disease (IRDS)

A 
Presents shortly postpartum with respiratory distress
Tachypnea
Tachycardia
Chest wall retractions
Expiratory grunting
Nasal flaring
Cyanosis
49
Q

Diagnosis of hyaline membrane disease (IRDS)

A
  1. CXR - reticular ground-glass opacities + air bronchograms
  2. ABG - hypoxia
  3. Post mortem histopathology - waxy appearing layers lining collapsed alveoli
50
Q

Management of hyaline membrane disease (IRDS)

A

Exogenous surfactant given to open alveoli (via endotracheal tube).
CPAP

51
Q

Prevention of hyaline membrane disease (IRDS)

A

Corticosteroids given to mature lungs if premature delivery expected (24-36 weeks)

52
Q

Irreversible bronchial dilation secondary to transmural inflammation of medium-sized bronchi

A

Cystic fibrosis (bronchiectasis)

53
Q

Most common cause of bronchiectasis if not due to cystic fibrosis

A

H influenza

54
Q

Most common cause of bronchiectasis if due to cystic fibrosis

A

Pseudomonas

55
Q

Most common cause of bronchiectasis in US

A

Cystic fibrosis

56
Q

Daily chronic cough with thick, mucopurulent, foul-smelling sputum, pleuritic chest pain, patient’s often develop pneumonia

A

Cystic fibrosis

57
Q

Most common cause of massive hemoptysis

A

Cystic fibrosis

Acute bronchitis and lung carcinoma most common causes of hemoptysis in general

58
Q

Physical exam with cystic fibrosis

A

Persistent crackles at the bases common

Wheezing, rhonchi, clubbing

59
Q

Diagnosis of cystic fibrosis

A
  1. CT scan - study of choice (tram-track appearance), mucopurulent plugs
  2. PFT - obstructive pattern
  3. CXR
  4. Sputum culture
  5. Bronchoscopy
60
Q

Management of cystic fibrosis

A

Antibiotics cornerstone of tx
Empiric (ampicillin, amoxicillin, TMP-SMX)
Bronchodilators, anti-inflammatory agents
Surgery

Pediatric EOR (10 decks)

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