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End of Rotation: Pediatrics > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

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A

Acute Epiglottitis

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2
Q

What is epiglotittis?

A
  • Severe, acute, life threatening infection of the epiglottis.
  • Suspect in unvaccinated children
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3
Q

What causes epiglotittis?

A
  • It may be viral or bacterial in origin.
  • Haemophilus influenza type B
  • The wide spread administration of H. influenza type B (HiB) vaccine has decreased the incidence of epiglottitis in children. More adults however, have not been immunized; therefore, the incidence of HiB-induced epiglottitis has increased in this population. The most common etiologies in adults include Group A Strep, S. pneumonia, H. parainfluenza, and S. aureus.
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4
Q

What are the signs and symptoms of epiglotittis?

A
  • Sudden onset of high fever, respiratory distress, severe dysphagia, drooling (3 D’s) and muffled voice (“hot potato” voice) is characteristic.
  • Examination may reveal mild stridor with little or no coughing; patients usually sit up right with their necks extended (tri-pod or sniffing position; chin thrust forward)
  • Tachycardia is a constant feature
  • High fever is usually the first symptom
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5
Q

How is epiglotittis diagnosed?

A
  • Direct visualization of the epiglottis is diagnostic, but manipulation may initiate sudden, fatal airway obstruction in children. This is less common in adults.
  • Laryngoscopy- swollen, cherry-red epiglottis
  • Once the airway is secured obtain a CBC and blood and sputum cultures.
  • A lateral neck X-ray shows a swollen epiglottis. (Thumb print sign)
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6
Q

How is epiglotittis treated?

A
  • True medical emergency- potentially lethal airway obstruction
  • Secure airway, do not move or upset the child unless ready to manage the airway.
  • Administer broad spectrum, second or third generation cephalosporin such as cefodaxime or ceftriazone for 7-10 days. Dexamethasone may also be indicated to reduce inflammation.
  • Maintenance of the airway is the focus of treatment.
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7
Q

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A

Croup

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8
Q

What is croup?

A
  • Also known as acute viral laryngotracheobronchitis, (inflammation of the larynx and trachea) which more commonly affects children aged 6 mo-5yrs (in the fall or early winter) – viral infection of the upper respiratory tract
  • Croup is the most common infectious cause of acute airway obstruction.
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9
Q

What causes croup?

A
  • Most common cause is parainfluenza virus types 1 & 2. RSV, adenovirus, influenza and rhinovirus are also implicated.
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10
Q

What are the signs and symptoms of croup?

A
  • Harsh, barking, seal-like cough with retractions and nasal flaring; inspiratory stridor; hoarseness; aphonia; low-grade fever; and rhinorrhea.
  • Most cases are mild and last 3-7 days
  • Symptoms are worse at night and typically worse on second day of illness
  • Most common cause of stridor in children is croup
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11
Q

How is croup diagnosed?

A
  • The diagnosis is usually clinical
  • Posterior anterior (PA) neck film may show subglottic narrowing (steeples sign). The lateral neck film will differentiate croup from epiglottitis.
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12
Q

How is croup treated?

A
  • Mild croup does not generally require treatment. Patients should be well hydrated. Minimum observation of child brought in with croup is 3 hours.
  • Corticosteroids, humidified air or oxygen, and nebulized epinephrine may also be recommended.
  • If no stridor- supportive, reassurance, avoid agitation
  • If stridor present- racemic epinephrine, IM dexamethasone, inhaled bubesonide
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13
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A

Pertussis

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14
Q

What is pertussis?

A
  • Pertussis toxin is a virulence protein that causes lymphocytosis and systemic manifestations
  • Aerosol droplet transmission
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15
Q

What causes pertussis?

A
  • Whooping cough- caused by gram-negative bacteria, Bordetella pertussis. Highly contagious acute respiratory illness predominately affecting children < 10 year old. It is classified as a prolonged cough illness.
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16
Q

What are the signs and symptoms of pertussis?

A
  • Incubation period 1-2 weeks
  • Three stages: catarrhal, paroxysmal and convalescent
  • Duration is 6 weeks
  • Symptoms include inspiratory whoop, paroxysmal cough, post tussive emesis; symptoms in adolescents and adults are no specific and diagnosis may not be considered.
  • Suspect pertussis is paroxysmal cough with color change
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17
Q

How is pertussis diagnosed?

A
  • PCR (poor sensitivity) or culture of nasopharyngeal secretion.
  • No single serologic test is diagnostic for pertussis
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18
Q

What is the treatment for pertussis?

A
  • Goal is to decrease the spread of the organism. Antibiotics do not affect illness in paroxysmal stage, which is toxin mediated
  • Macrolides (Azithromycin)
  • Isolation until 5 days of therapy
  • There is a risk of hypertrophic pyloric stenosis in infants younger than 6 weeks treated with oral erythromycin
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19
Q

What is the vaccine for pertussis?

A

Dtap

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20
Q

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A

Cystic Fibrosis

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21
Q

What is cystic fibrosis?

A

An Autosomal recessive disorder causing mutation on chromosome 7, which normally regulates and participates in transport of Cl- across epithelial cell and intracellular membranes.

Cystic Fibrosis is the most common cause of severe chronic lung disease in young adults and the most common fatal hereditary disorder of whites in the US.

22
Q

What causes cystic fibrosis?

A

CF is caused by abnormalities in a membrane chloride channel that results in altered chloride transport and water flux across the apical surface of epithelial cells.

23
Q

What are the signs and symptoms of CF?

A

Clinical Findings:
Cystic fibrosis should be suspected in a young adult with a history of chronic lung disease (especially bronchiectasis), pancreatitis, or infertility. Cough, sputum production decreased exercise tolerance and recurrent hemoptysis are typical complaints. Patients with CF are often malnourished with a low body mass index.

Physical Exam Findings:
Digital clubbing, increased AP diameter, hyper-resonance to percussion, and apical crackles are common physical exam findings.

24
Q

How is CF diagnosed?

A

The quantitative pilocarpine iontophoresis sweat test reveals elevated sodium and chloride levels (>60 mEq/L) in the sweat of patients with CF. Genetic testing is also used in the diagnosis of CF.

25
Q

What is the treatment for CF?

A
  • Non-pharmacologic- mucus, mobilization, pulmonary rehabilitization, O2 therapy, vaccinations
  • Pharmacologic treatment- bronchodilators, recombinant human deoxyribonuclease antibiotics, glucocorticoids, azithromycin.
26
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A

Pneumonia

27
Q

What is pneumonia?

A
  • Inflammation of the lung parenchyma
28
Q

What causes pneumonia?

A
  • Viruses: RSV, influenza, parainfluenza, adenovirus

- Bacteria: less common, but more severe- S. pneumoniae, S. pyrogenes, S. aureus, H. influenzae type B, M. pneumoniae

29
Q

What are the signs and symptoms of pneumonia?

A
  • Tachypnea, dyspnea
  • Fever and feeding difficulty (infant)
  • Productive cough, chest pain (children)
  • The most reliable sign of pneumonia is tachypnea
  • Consider pneumonia in children with neck stiffness or acute abdominal pain
30
Q

How is pneumonia diagnosed?

A
  • Chest x-ray
    • Viral (hyperinflation, perihilar infiltrate, hilar adenopathy, and atelectasis)
    • Bacterial (alveolar consolidation)
    • Mycoplasma (interstitial infiltrates)
    • Tuberculosis (hilar adenopathy)
    • Pneumonocystitis (reticulonodular infiltrates)
  • Round pulmonary infiltrate on x-ray; think S. pneumoniae pneumonia
  • In young children auscultation may be normal with impressive x-ray findings
  • Blood culture (positive in 10-30% of bacterial infiltrates)
31
Q

What is the treatment for pneumonia?

A
  • Inpatient:
    • 1-3 months old- macrolide (pneumonitis syndrome) or third generation cephalosporin
    • 3 months or older- third generation cephalosporin
  • Outpatient:
    • Patients should have normal O2 saturation and be able to take oral fluids in order to be outpatients
    • Amoxicillin or erythromycin
32
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A

ARDS

33
Q

What is ARDS?

A

ARDS denotes acute hypoxemic respiratory failure following a systemic or pulmonary insult with out evidence of heart failure.

ARDS is the most severe form of acute lung injury and is characterized by an acute onset with in one week of a known clinical insult, bilateral radiographic pulmonary infiltrates, respiratory failure not fully explained by heart failure or volume overload, and a PaO2/FIO2 ratio < 300mm Hg.

Three clinical settings/risk factors account for 75% of ARDS cases: sepsis syndrome (the single most important), severe multiple trauma, and aspiration of gastric contents.

34
Q

What causes ARDS?

A

Although the mechanism of lung injury varies with the cause, damage to capillary endothelial cells and alveolar epithelial cells are common to ARDS regardless of cause. Damage to these cells causes increased vascular permeability and decreased production and activity of surfactant; these abnormalities lead to interstitial and alveolar pulmonary edema, alveolar collapse and hypoxemia.

35
Q

What are the signs and symptoms of ARDS?

A

Clinical Findings:
ARDS is marked by rapid onset of profound dyspnea that usually occurs 12-48 hours after the initiating even.

Physical Exam Findings:
Labored breathing, tachypnea, intercostal retractions, and crackles are noted on physical examination. Physical exam also can note frothy red/pink sputum. Most patients are cyanotic with increasingly severe hypoxemia that is refractory to administration of oxygen. Multi-organ failure is common.

36
Q

How is ARDS diagnosed?

A

Chest radiography shows diffuse or patchy bilateral infiltrates that rapidly become confluent (air bronchograms); these characteristically spare the costophrenic angles.  

37
Q

How is ARDS treated?

A

Treatment of ARDS must include identification and specific treatment of the underlying precipitating and secondary conditions. Meticulous supportive care must then be provided to compensate for the severe dysfunction of the respiratory system and to prevent complications. Treatment of hypoxia associated with ARDS requires tracheal intubation and positive pressure mechanical ventilation.

38
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A

Hyaline Membrane Disease

39
Q

What is Hyaline Membrane Disease?

A

Hyaline membrane disease is the most common cause of respiratory disease in the preterm infant. It is caused by a deficiency of surfactant.

40
Q

What are the signs and symptoms of Hyaline Membrane Disease?

A

Clinical Findings:

The infant will demonstrate typical signs of respiratory distress.

41
Q

How is Hyaline Membrane Disease diagnosed?

A

CXR demonstrates air bronchograms, diffuse bilateral atelectasis causing ground glass appearance, and doming of the diaphragm.

42
Q

What is the treatment for Hyaline Membrane Disease?

A

Synchronized intermittent mandatory ventilation should be used. Administration of exogenous surfactants can be used in the delivery room as prophylaxis or as a rescue in established hyaline membrane disease.

43
Q

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A

Aspiration of a foreign body

44
Q

What are the signs and symptoms for an Aspiration of a foreign body?

A

An episode of choking and coughing or unexplained wheezing or hemoptysis should raise the suspicion of foreign body aspiration. Asphyxia may result from the aspiration of obstructing material.

45
Q

What is the treatment for an Aspiration of a foreign body?

A
  • Expiratory radiography may reveal regional hyperinflation caused by a check valve effect.
  • Bronchoscopy may help to establish the diagnosis but also can be the treatment of choice for the removal of the object.
46
Q

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A

Bronchitis

47
Q

What is bronchitis?

A
  • Infection of conductive airways of lung
48
Q

What causes bronchitis?

A

Etiology:

  • Viruses: Influenza A and B, adenovirus, parainfluenza, rhinovirus, RSV, coxsackievirus
  • Bacteria: Bordetella pertussis, M. pneumonia, Chlamydia pneumonia, S. pneumonia
49
Q

What are the signs and symptoms of bronchitis?

A
  • Acute productive cough (<1 week); most common symptom of chronic bronchitis
  • Rhinitis
  • Myalgia
  • Fever
  • No evidence of sinusitis, pneumonia, or chronic pulmonary disease
  • Normal arterial oxygenation
50
Q

How is bronchitis treated?

A
  • Mostly self limited
  • Bronchodilators may help
  • Antibiotics for high risk patients
51
Q

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A

RSV

52
Q

What causes bronchiolitis?

A
  • RSV causes more than 50% of cases of bronchiolitis

End of Rotation: Pediatrics (12 decks)

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