Pulmonology Flashcards
1
Q
When does the bronchial tree develop
A
16 weeks
2
Q
when does 90 percent of alveolar development occur
A
after birth
3
Q
how many lobes are in the right and left lung
A
right: 3 lobes
left: 2 lobes
4
Q
what is the mechanics of the lungs and chest wall of an infant compared to an older child
A
lung: more compliant (stiffer)
chest: less compliant
5
Q
What happens to pulmonary vascular resistance after birth
A
decreases
6
Q
obstructive lung problems
A
secondary to decreased airflow through narrowed airways
7
Q
Restrictive lung problems
A
secondary to pulmonary processes that decrease lung volume
8
Q
what does an inspiratory stridor suggest
A
extra-thoracic obstruction
- croup
- laryngomalacia
9
Q
Laryngomalacia
A
softening and weakness of laryngeal cartilage that collapses into the airway
- especially in supine position
10
Q
Expiratory wheezing suggests
A
intra-thoracic obstruction
- asthma
- bronchiolitis
11
Q
what would be an indication for laryngoscopy and bronhoscopy
A
persistent pneumonia, cough, stridor, or wheezing
12
Q
most common disorder in children 2-7 years of age
A
epiglottitis
13
Q
Epiglottitis
A
acute inflammation and edema of epiglottis, arytenoids and aryepiglottic folds
14
Q
causes of epiglotitts
A
- Haemophilus influenzae type B
2. Group A Beta-hemolytic streptococcus
15
Q
clinical feature of epiglotittis
A
Abrupt onset and rapidly progressive
- high fever
- muffled speech
- dysphagia and drooling
- sitting forward in tripod position
16
Q
lab study for epiglottitis
A
- leukocytosis to the left
- positive blood culture
17
Q
radiograph of neck for epiglottitis
A
“thumbprint” sign
18
Q
is epiglottitis a medical emergency? what do you do?
A
yes
- provide O2
- controlled nasotracheal intubation ( done my expert)
19
Q
another name for croup
A
Laryngotracheobronchitis
20
Q
croup
A
inflammation and edema of subglottic larynx
21
Q
what are 2 forms of croup and which one is more common
A
- viral: common
- spasmodic
22
Q
viral cause of croup
A
Parainfluenza
23
Q
what causes spasmodic croup
A
hypersensitivity reaction
24
Q
symptoms of croup
A
prodrome: upper respiratory infection
actual disease: inspiratory stridor, barky cough
25
when is stridor worse in croup
at night and with agitation
26
A-P radiograph of neck for croup
"steeple sign"
27
Management of croup when
1. supportive care
2. children with stridor at rest
3. children with respiratory distress
1. cool mist and fluids
2. systemic corticosteroids
3. racemic epinephrine aerosols
28
bacterial tracheitis
acute inflammation of trachea
29
what causes bacterial tracheitis
```
Staphylococcus aureus (60)
Steptrococcus
```
30
most common lower respiratory tract infection
bronchiolitis
31
Bronchiolitis
inflammation of bronchioles
| - viral infection: inflammatory bronchiolar obstruction
32
what age range usually gets bronchiolitis
up to 2 years
33
during what time of year is bronchiolitis occur
november to April
34
most common cause of bronchiolitis
RSV
35
clinical feature of RSV
1. onset is gradual
2. progression: tachypnea, fine rales, wheezing
spleen and liver may appear enlarged
36
what does chest X-ray show for RSV
- hyperinflation
- patchy infiltrates
- atelectasis
37
when should a child improve with RSV
within 2 weeks
38
what is a complication of RSV
apnea
39
primary management of RSV
supportive
| hand washing
40
what can be given prophylactically to prevent RSV? how?
Palivizumab (RSV monoclonal antibody)
| - monthly intramuscular injection
41
pneumonia
infection and inflammation of lung parenchyma
42
most common cause of pneumonia in all age groups for pneumonia
viruses
43
how is viral pneumonia diagnosed
- interstitial infiltrates on CXR
- WBC less than 20,000,
- lymphocytes predominate
44
difference between symptoms of viral pneumonia and bacterial pneumonia
bacterial: more rapid onset
Viral: upper respiratory symptoms
45
Diagnosis for bacterial pneumonia
- WBC greater than 20,00
- neutrophil dominant
- lobar consolidation on CXR
46
common cause of afebrile pneumonia at 1-3 months of age
Chlamydia trachomatis
47
symptoms of Chlamydia trachomatis
staccato-type cough
48
Diagnosis for chlamydia trachomatis
- eosinophilia on CXR
| - interstitial infiltrates
49
management for chlamydia trachomatis
Erythromycin or Azithromycin
50
most common cause of pneumonia in older children and adolescents
mycoplasma pneumoniae
51
Diagnosis for Mycoplasma pneumoniae
1. positive cold agglutinins ( not specific)
| 2. elevation of IgM titers (specific)
52
management of Mycoplasma pneumoniae
erythromycin
53
who is at the most risk for severe pertussis
younger than 6 months
54
major source of pertussis
adolescents and adults who immunity has waned
55
3 stages of pertussis
1. catarrhal
2. paroxysmal
3. Convalescent
56
how long and describe catarrhal stage
- upper respiratory symptoms
| 1-2 weeks
57
how long and describe paroxysmal stage
forceful cough
- 2-4 weeks
whoop: inspiratory gasp heard at the very end of a coughing fit
post-tussive vomiting
58
how long and describe convalescent phase
recovery
| weeks to months
59
what does CBC show for pertussis
lymphocytosis
60
what confirms diagnosis for pertussis
- culture
- direct fluorescent antibody tests
both taken from nose
61
what is given to all patients with pertussis to prevent spread
erythromycin
62
most common chronic pediatric disease
Asthma
63
Asthma
- smooth muscle bronchoconstriction
- airway mucosal edema
- increased secretions with mucous plugging
- eventually wall remodeling
- production of inflammatory mediators
64
chest x ray of asthma
- hyperinflation
- peribronchial thickening
- patchy atelectasis
65
pulmonary function testing for asthma
- increased lung volume
| - decreased expiratory flow rates
66
What classes of drugs are used for asthma
1. Sympathomimetics
2. Cromolyn sodium and nedocromil sodium
3. corticosteroids
4. anticholinergic agents
5. Leukotriene modifiers
6. Methylxanthines
67
What sympathomimetics are used for asthma? what types are there?
Beta2 agonists: short and long acting bronchodialators
68
when is short acting beta 2 agonist used
- frist line for exacerbations
| - prevention of exercise-induced symptoms
69
how is persistent (more severe than intermittent) treated
beta2 agonist in addition of anti-inflammatory medication
70
Cromolyn sodium and Nedocromil sodium
anti-inflammatory prophylaxis
| - no effect on acute symptoms
71
Most effective anti-inflammaotry agent for asthma
corticosteroids
72
how do anticholinergic agents work
- second line bronchodilators
| - decrease airway vagal tone
73
type of drug Leukotriene modifiers
oral anti-inflammatory agents
74
type of drug Methylxanthines
bronchodilators
75
why is Methylxanthines controversial use in asthma patients
narrow-toxic therapeutic ration
76
intermittent asthma
daytime symptoms 2 or less/ week
| nighttime symptoms 2 or less/ month
77
Mild persistent asthma
daytime symptoms 2 more/ week
nighttime symptoms 2more/ month
FEV1 less than 80
78
Moderate persistent asthma
daily symptoms
nighttime symptoms 1 more/week
FEV1 60-80
Daily use of inhaled short-acting B2-agonist
79
Severe persistent
Continuous symptoms
frequent nighttime symptoms
limited physical activity
FEV1 less than 60
80
Management for intermittent asthma
- No daily medication
- Short-acting B2-agonist for symptom relief
- no anti-inflammatory agents
81
Mild persistent asthma management
- Short-acting B2-agonist for symptom relief
| - low dose inhaled corticosteroid or comolyn sodium or leukotriene modifier
82
management of moderate persistent asthma
- Short-acting B2-agonist for symptom relief
- medium dose of inhaled corticosteroids
OR
- low-dose of inhaled corticosteroid
- long acting inhaled B2-agonist
83
Management of Severe persistent asthma
- Short-acting B2-agonist for symptom relief
- High-dose inhaled corticosteroid and long-acting B2-agonist
- long-term systemic corticosteroids, if needed
84
Cystic fibrosis
altered content of exocrine gland secretions
85
genetics of cystic fibrosis
autosomal recessive
| chromosome 7
86
pathophysiology of cystic fibrosis
- abnormal ion-channel regulator (CFTR) protein
| - abnormal mucus production in airway
87
what can be present at birth for cystic fibrosis
meconium ileus
88
common presenting features of cystic fibrosis
- recurrent or chronic respiratory symptoms
- steatorrhea
- failure to thrive
89
pulmonary function test for cystic fibrosis
- decrease respiratory flow rates
| - decrease lung volume
90
most likely colonized bacteria in cystic fibrosis
1. staphylococcus aureus
| 2. pseudomonas aeruginosa
91
common pulmonary complication of cystic fibrosis
nasal polyps
| recurrent pneumonia
92
chronic lung disease
oxygen dependency beyond 28 days
93
who most likely gets chronic lung disease
children born prematurely who suffered from respiratory distress syndrome
94
respiratory distress syndrome
hyaline membrane disease or surfactant deficiency syndrome
95
chronic lung disease follows what protocall
acute lung injury
96
what causes secondary lung injury in chronic lung disease and acute lung injury
oxidants and proteases
97
how does the lung heal in chronic lung disease
typically abnormal
98
what is ABG testing for chronic lung disease
diminished oxygen
| hypercarbia
99
how are objects that remain in the airway removed
bronchoscopy
100
which bronchus do foreign objects usually go into
right bronchus
101
apnea of infancy
cessation of breathing for greater than 20 seconds
102
what is normal central apnea ?
less than 15 seconds is normal
103
symptoms of bronchiolitis
lower respiratory tract infection
104
child comes in with ALTE, what do you do
attempt to identify underlying cause
105
Diagnosis for chlamydia trachomatis is suggested by what
presence of elevated eosinophils on complete blood count
