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Pediatrics Rotation > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

When does the bronchial tree develop

A

16 weeks

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2
Q

when does 90 percent of alveolar development occur

A

after birth

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3
Q

how many lobes are in the right and left lung

A

right: 3 lobes
left: 2 lobes

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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

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5
Q

What happens to pulmonary vascular resistance after birth

A

decreases

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6
Q

obstructive lung problems

A

secondary to decreased airflow through narrowed airways

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7
Q

Restrictive lung problems

A

secondary to pulmonary processes that decrease lung volume

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8
Q

what does an inspiratory stridor suggest

A

extra-thoracic obstruction

  • croup
  • laryngomalacia
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9
Q

Laryngomalacia

A

softening and weakness of laryngeal cartilage that collapses into the airway
- especially in supine position

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10
Q

Expiratory wheezing suggests

A

intra-thoracic obstruction

  • asthma
  • bronchiolitis
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11
Q

what would be an indication for laryngoscopy and bronhoscopy

A

persistent pneumonia, cough, stridor, or wheezing

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12
Q

most common disorder in children 2-7 years of age

A

epiglottitis

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13
Q

Epiglottitis

A

acute inflammation and edema of epiglottis, arytenoids and aryepiglottic folds

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14
Q

causes of epiglotitts

A
  1. Haemophilus influenzae type B

2. Group A Beta-hemolytic streptococcus

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15
Q

clinical feature of epiglotittis

A

Abrupt onset and rapidly progressive

  • high fever
  • muffled speech
  • dysphagia and drooling
  • sitting forward in tripod position
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16
Q

lab study for epiglottitis

A
  • leukocytosis to the left

- positive blood culture

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17
Q

radiograph of neck for epiglottitis

A

“thumbprint” sign

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18
Q

is epiglottitis a medical emergency? what do you do?

A

yes

  • provide O2
  • controlled nasotracheal intubation ( done my expert)
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19
Q

another name for croup

A

Laryngotracheobronchitis

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20
Q

croup

A

inflammation and edema of subglottic larynx

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21
Q

what are 2 forms of croup and which one is more common

A
  • viral: common

- spasmodic

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22
Q

viral cause of croup

A

Parainfluenza

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23
Q

what causes spasmodic croup

A

hypersensitivity reaction

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24
Q

symptoms of croup

A

prodrome: upper respiratory infection

actual disease: inspiratory stridor, barky cough

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25
Q

when is stridor worse in croup

A

at night and with agitation

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26
Q

A-P radiograph of neck for croup

A

“steeple sign”

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27
Q

Management of croup when

  1. supportive care
  2. children with stridor at rest
  3. children with respiratory distress
A
  1. cool mist and fluids
  2. systemic corticosteroids
  3. racemic epinephrine aerosols
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28
Q

bacterial tracheitis

A

acute inflammation of trachea

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29
Q

what causes bacterial tracheitis

A 
Staphylococcus aureus (60)
Steptrococcus
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30
Q

most common lower respiratory tract infection

A

bronchiolitis

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31
Q

Bronchiolitis

A

inflammation of bronchioles

- viral infection: inflammatory bronchiolar obstruction

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32
Q

what age range usually gets bronchiolitis

A

up to 2 years

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33
Q

during what time of year is bronchiolitis occur

A

november to April

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34
Q

most common cause of bronchiolitis

A

RSV

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35
Q

clinical feature of RSV

A
  1. onset is gradual
  2. progression: tachypnea, fine rales, wheezing
    spleen and liver may appear enlarged
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36
Q

what does chest X-ray show for RSV

A
  • hyperinflation
  • patchy infiltrates
  • atelectasis
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37
Q

when should a child improve with RSV

A

within 2 weeks

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38
Q

what is a complication of RSV

A

apnea

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39
Q

primary management of RSV

A

supportive

hand washing

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40
Q

what can be given prophylactically to prevent RSV? how?

A

Palivizumab (RSV monoclonal antibody)

- monthly intramuscular injection

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41
Q

pneumonia

A

infection and inflammation of lung parenchyma

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42
Q

most common cause of pneumonia in all age groups for pneumonia

A

viruses

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43
Q

how is viral pneumonia diagnosed

A
  • interstitial infiltrates on CXR
  • WBC less than 20,000,
  • lymphocytes predominate
44
Q

difference between symptoms of viral pneumonia and bacterial pneumonia

A

bacterial: more rapid onset
Viral: upper respiratory symptoms

45
Q

Diagnosis for bacterial pneumonia

A
  • WBC greater than 20,00
  • neutrophil dominant
  • lobar consolidation on CXR
46
Q

common cause of afebrile pneumonia at 1-3 months of age

A

Chlamydia trachomatis

47
Q

symptoms of Chlamydia trachomatis

A

staccato-type cough

48
Q

Diagnosis for chlamydia trachomatis

A
  • eosinophilia on CXR

- interstitial infiltrates

49
Q

management for chlamydia trachomatis

A

Erythromycin or Azithromycin

50
Q

most common cause of pneumonia in older children and adolescents

A

mycoplasma pneumoniae

51
Q

Diagnosis for Mycoplasma pneumoniae

A
  1. positive cold agglutinins ( not specific)

2. elevation of IgM titers (specific)

52
Q

management of Mycoplasma pneumoniae

A

erythromycin

53
Q

who is at the most risk for severe pertussis

A

younger than 6 months

54
Q

major source of pertussis

A

adolescents and adults who immunity has waned

55
Q

3 stages of pertussis

A
  1. catarrhal
  2. paroxysmal
  3. Convalescent
56
Q

how long and describe catarrhal stage

A
  • upper respiratory symptoms

1-2 weeks

57
Q

how long and describe paroxysmal stage

A

forceful cough
- 2-4 weeks
whoop: inspiratory gasp heard at the very end of a coughing fit
post-tussive vomiting

58
Q

how long and describe convalescent phase

A

recovery

weeks to months

59
Q

what does CBC show for pertussis

A

lymphocytosis

60
Q

what confirms diagnosis for pertussis

A
  • culture
  • direct fluorescent antibody tests
    both taken from nose
61
Q

what is given to all patients with pertussis to prevent spread

A

erythromycin

62
Q

most common chronic pediatric disease

A

Asthma

63
Q

Asthma

A
  • smooth muscle bronchoconstriction
  • airway mucosal edema
  • increased secretions with mucous plugging
  • eventually wall remodeling
  • production of inflammatory mediators
64
Q

chest x ray of asthma

A
  • hyperinflation
  • peribronchial thickening
  • patchy atelectasis
65
Q

pulmonary function testing for asthma

A
  • increased lung volume

- decreased expiratory flow rates

66
Q

What classes of drugs are used for asthma

A
  1. Sympathomimetics
  2. Cromolyn sodium and nedocromil sodium
  3. corticosteroids
  4. anticholinergic agents
  5. Leukotriene modifiers
  6. Methylxanthines
67
Q

What sympathomimetics are used for asthma? what types are there?

A

Beta2 agonists: short and long acting bronchodialators

68
Q

when is short acting beta 2 agonist used

A
  • frist line for exacerbations

- prevention of exercise-induced symptoms

69
Q

how is persistent (more severe than intermittent) treated

A

beta2 agonist in addition of anti-inflammatory medication

70
Q

Cromolyn sodium and Nedocromil sodium

A

anti-inflammatory prophylaxis

- no effect on acute symptoms

71
Q

Most effective anti-inflammaotry agent for asthma

A

corticosteroids

72
Q

how do anticholinergic agents work

A
  • second line bronchodilators

- decrease airway vagal tone

73
Q

type of drug Leukotriene modifiers

A

oral anti-inflammatory agents

74
Q

type of drug Methylxanthines

A

bronchodilators

75
Q

why is Methylxanthines controversial use in asthma patients

A

narrow-toxic therapeutic ration

76
Q

intermittent asthma

A

daytime symptoms 2 or less/ week

nighttime symptoms 2 or less/ month

77
Q

Mild persistent asthma

A

daytime symptoms 2 more/ week
nighttime symptoms 2more/ month
FEV1 less than 80

78
Q

Moderate persistent asthma

A

daily symptoms
nighttime symptoms 1 more/week
FEV1 60-80
Daily use of inhaled short-acting B2-agonist

79
Q

Severe persistent

A

Continuous symptoms
frequent nighttime symptoms
limited physical activity
FEV1 less than 60

80
Q

Management for intermittent asthma

A
  • No daily medication
  • Short-acting B2-agonist for symptom relief
  • no anti-inflammatory agents
81
Q

Mild persistent asthma management

A
  • Short-acting B2-agonist for symptom relief

- low dose inhaled corticosteroid or comolyn sodium or leukotriene modifier

82
Q

management of moderate persistent asthma

A
  • Short-acting B2-agonist for symptom relief
  • medium dose of inhaled corticosteroids
    OR
  • low-dose of inhaled corticosteroid
  • long acting inhaled B2-agonist
83
Q

Management of Severe persistent asthma

A
  • Short-acting B2-agonist for symptom relief
  • High-dose inhaled corticosteroid and long-acting B2-agonist
  • long-term systemic corticosteroids, if needed
84
Q

Cystic fibrosis

A

altered content of exocrine gland secretions

85
Q

genetics of cystic fibrosis

A

autosomal recessive

chromosome 7

86
Q

pathophysiology of cystic fibrosis

A
  • abnormal ion-channel regulator (CFTR) protein

- abnormal mucus production in airway

87
Q

what can be present at birth for cystic fibrosis

A

meconium ileus

88
Q

common presenting features of cystic fibrosis

A
  • recurrent or chronic respiratory symptoms
  • steatorrhea
  • failure to thrive
89
Q

pulmonary function test for cystic fibrosis

A
  • decrease respiratory flow rates

- decrease lung volume

90
Q

most likely colonized bacteria in cystic fibrosis

A
  1. staphylococcus aureus

2. pseudomonas aeruginosa

91
Q

common pulmonary complication of cystic fibrosis

A

nasal polyps

recurrent pneumonia

92
Q

chronic lung disease

A

oxygen dependency beyond 28 days

93
Q

who most likely gets chronic lung disease

A

children born prematurely who suffered from respiratory distress syndrome

94
Q

respiratory distress syndrome

A

hyaline membrane disease or surfactant deficiency syndrome

95
Q

chronic lung disease follows what protocall

A

acute lung injury

96
Q

what causes secondary lung injury in chronic lung disease and acute lung injury

A

oxidants and proteases

97
Q

how does the lung heal in chronic lung disease

A

typically abnormal

98
Q

what is ABG testing for chronic lung disease

A

diminished oxygen

hypercarbia

99
Q

how are objects that remain in the airway removed

A

bronchoscopy

100
Q

which bronchus do foreign objects usually go into

A

right bronchus

101
Q

apnea of infancy

A

cessation of breathing for greater than 20 seconds

102
Q

what is normal central apnea ?

A

less than 15 seconds is normal

103
Q

symptoms of bronchiolitis

A

lower respiratory tract infection

104
Q

child comes in with ALTE, what do you do

A

attempt to identify underlying cause

105
Q

Diagnosis for chlamydia trachomatis is suggested by what

A

presence of elevated eosinophils on complete blood count

Pediatrics Rotation (19 decks)

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