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