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Pediatric Secretes (TEXTBOOK) > PULMONOLOGY > Flashcards

PULMONOLOGY Flashcards

1
Q

How common is allergic rhinitis?

A

Very common… b/t 10-40% of children experience rhinitis as the most common manifestation of allergic disease

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2
Q

What features on PE suggest chronic allergic rhinitis? (7)

A

1- congestion
2-“allergic facies” : open mouth, midface hypoplasia
3- “allergic salute”: nasal crease on bridge of nose from chronic upward rubbing of nose with palm
4- diminished sense of taste/smell
5- allergic “shiners” (dark circles under eyes)
6- increased infraorbital folds
7- cobblestoning of conjunctiva/posterior oropharynx

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3
Q

List the major risk factors for allergic rhinitis

A

1- +FMHx
2- heavy maternal cigarette smoking during first year of life
3- early introduction of solid foods
4- individuals born during pollen season
5- higher serum IgE levels (>100 IU/mL before age 6)
6- atopic dermatitis (eczema)

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4
Q

How does the time of year help identify the potential cause of allergic rhinitis?

A
  • Tree pollen: onset of growing season
  • Grass pollen: onset of growing season (after trees)
  • Weed pollen: late-summer pollen peak (most common in north/central america = ragweed)
  • Fungal: span growing season
  • Household animal allergens (dust mites/indoor fungi): increase when windows//doors closed -i.e. colder months, or in areas of high humidity
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5
Q

Which variables affect allergy skin testing? (5)

A
  1. Test Site (reactivity order = forearmspecific than> intradermal)
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6
Q

What is RAST? When is it indicated?

A

“radioallergosorbent test”
=in vitro lab test to quantify the pt’s allergen-specific IgE
(RAST antigen binds to the allergen of interest)

indicated in pts w/ severe skin disorders or risk of severe rxn to skin testing

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7
Q

What are the Pros and Cons of In vitro vs. skin testing for allergies?

A

In vitro:

  • no risk anaphylaxis
  • more $$$

Skin testing:

  • less $
  • more sensitive
  • results available immediately
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8
Q

What are the Tx recommendations for children w/ chronic allergic rhinitis?

A
  • change/control environment to avoid allergen
  • pharmacotherapy: antihistamines, LTRAs, intranasal steroids, topical cromolyn
  • immunotherapy: for pts sub-optimally controlled by 1st 2 measures OR w/ severe sxs
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9
Q

List the major indoor allergens (4)

A
  • dust mites
  • mold
  • animal dander
  • cockroach
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10
Q

How to get rid of cat allergen at home?

A
  • remove upholstered furniture, carpet, etc.
  • get new bedding covers + plastic mattress cover
  • limit cat’s roaming areas, esp in bdrm
  • high efficiency air filter
  • ?felinectomy
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11
Q

List the allergy testing methods in order of sensitivity

A

intradermal > epicutaneous (skin prick) > RAST

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12
Q

What are key questions during Hx taking to Dx allergic rhinitis?

A

FMHx
Environmental Hx
Assoc Sxs

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13
Q

How to decrease house dust mite levels at home?

A
  • replace mattress and pillow casings (plastic)
  • wash bedding q 1-2 wks in hot water
  • get rid of stuffed animals, books, and other sources of HDM in bdrm
  • dust hard surfaces and vacuum carpets regularly
  • reduce indoor humidity (<45%)
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14
Q

When is immunotherapy indicated? When is it contraindicated?

A
  • in some pts to Tx hymenoptera venom sensitivity to prevent life-threatening rxns (bees, wasps, etc)
  • for IgE-mediated diseases when avoidance and meds have sub-optimal results

DO NOT give to pt w/ unstable asthma w/ FEV1 <70%

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15
Q

How common is exercise-induced bronchospasm in children w/ allergic rhinitis?

A

up to 40% of kids with AR (but no asthma) had abN PFTs in response to exercise

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16
Q

At what age do asthma sxs usually present?

A

50% cases occur before age 3, ~100% before age 7

often sxs are incorrectly attributed to recurrent pneumonia or “wheezing bronchitis”

17
Q

How many children have wheezing episodes <3 y/o? Of those, how many go on to develop chronic asthma?

A

1/3

40% develop persistent wheezing

18
Q

What are the RFs of developing chronic asthma in childhood?

A 
\+FMHx
increased IgE levels
Atopic dermatitis
Allergic Rhinitis (not associated w/ colds)
\+second hand smoke exposure
19
Q

What Hx points are suggestive of an allergic basis for asthma?

A
  • seasonal sxs congruent w/ rhinitis (suggests pollen)
  • sxs worse when visiting family w/pets (animal dander)
  • wheexing when carpets are vacuumed or bed is made (mites)
  • sxs develop in damp basements or barns (molds)
20
Q

How common is exercise-induced bronchospasm (EIB)?

A

very common
Significant sxs (cough, CT, SOB, wheeze) noted after exercise in:
- 80% kids w/ asthma
- 40% kids w/ atopy

21
Q

How is EIB Dx’d?

A

Peak flow rate of FEV1 drops 15% after 6 min of vigorous exercise (w/ greatest reduction at 5-10 min)
- if found, 2 puffs beta2-agonist should be given to reverse bronchospasm

22
Q

What is the mechanism that leads to airway obstruction during an acute asthma attack?
What happens in chronic cases?

A
  • airway inflammation (including edema)
  • bronchospasm
  • increased mucous production

chronic inflammation: leads to remodelling of airways

23
Q

ALL THAT WHEEZES IS NOT ASTHMA. What are the other noninfectious causes?

A
  • Aspiration pneumonitis
    (esp in infant w/ neurological impairment, GERD, sxs of cough/choke/gaging w/feeding…if clear assoc w/ feeding = ?tracheoesophageal fistula)
  • Bronchiolitis obliterans
    (chronic wheezing often after adenoviral infection)
  • Bronchopulmonary dysplasia
    (esp if needed prolonged O2 therapy/vent. as neonate)
  • Ciliary dyskinesia
    (esp if recurrent otits media, sinusitis, or situs inversus present)
  • Congenital malformations
    (ex. trachiobronchial anom’s, trachiomalacial anom’s, lung cysts, mediastinal lesions)
  • Cystic fibrosis
    (if recurrent wheeze, FTT, chronic D, recurr. resp infections)
  • Congenital cardiac anomalies
    (esp right to left shunts)
  • Foreign-body aspiration
    (if assoc w/ acute choking episode in infant <6mo/o)
  • Vascular rings, slings, or compression
24
Q

S/S of Mild asthma attack

A
  • PEFR = 70-90%
  • Resting Resp rate = N - 30% above mean
  • Alertness = N
  • Dyspnea = None - mild, speaks full sentences
  • Accessory muscle use = None - mild intercostal retractions
  • Colour = good
  • Auscultation = end exp. wheeze
  • O2 sat = >95%
  • PCO2 = <35
25
Q

S/S of Moderate Asthma Attack

A
  • PEFR = 50-70% predicted
  • Resting Resp rate = N - 30% above mean
  • Alertness = N
  • Dyspnea = moderate, speaks in full-partial phrases, infants cry softer + diff feeding/suckling
  • Accessory muscle use = moderate (intercostals, tracheosternal, sternocleidomastoid, chest hyperinflation)
  • Colour = pale
  • Auscultation = constant wheeze
  • O2 sat = 90-95%
  • PCO2 = <40
26
Q

S/S of Severe Asthma Attack

A
  • PEFR = <50% predicted
  • Resting Resp rate = >50% above mean
  • Alertness = ?decreased
  • Dyspnea = severe, only single words/short phrases; infants: soft cry, stop feeding/suckling
  • Accessory muscle use = severe retractions + nasal flaring + chest hyperinflation
  • Colour = ?cyanotic
  • Auscultation = decrease/inaudible breath sounds
  • O2 sat = <90%
  • PCO2 = >40
27
Q

Should you order CXR in a child w/ first time wheeze?

A

Only if:

  • PE suggest Dx other than asthma
  • marked asymmetry of breath sounds
  • suspect pneumonia
  • suspect foreign-body aspiration
  • hypoxemia or marked distress
  • older child w/o FMHx of asthma or atopy
  • suspect CHF
  • Hx trauma (burns, scalds, blunt/penetrating injury)
28
Q

What are the findings on arterial blood gas (ABG) sampling during an asthma attack?
(most common?)

A

most common = hypocapnia (low CO2) d/t hyperventilation

hypoxemia (unless pt being treated w/ O2)

29
Q

What does the finding of hypercapnia on ABGs during an asthma attack a sign of? What should you do?

A

=serious sign that the child is tiring or becoming severely obstructed

this should prompt reevaluation + consider admission to high-acuity unit

30
Q

What are indications for hospital admissions for pts w/ asthma?

A

AFTER therapy in ER, admit if:

  • dec’d LOC
  • incomplete response w/ moderate retractions, wheezing, peak flow <60%, pulsus paradoxus >15 mmHg, SaO2 <90%, pCO2 >42
  • breath sounds significantly diminished
  • evidence of dehydration
  • pneumothorax (PTX)
  • residual sxs + hx of severe attacks involving prolonged hospital stay (esp if was intubated)
  • parental unreliability
31
Q

When is it better to use nebulizers vs. MDIs?

A

Nebulizers - infants <2yrs

MDIs (+ spacer) - everyone else

32
Q

List the possible acute SEs of albuterol or other beta2-agonists

A
  • General: hypoxemia, tachyphylaxis
  • Renal: hypokalemia
  • CV: tachy, palpitations, PVCs, Afib
  • Neuro: HA, irritability, insomnia, tremor, weakness
  • GI: N, heartburn, V

Pediatric Secretes (TEXTBOOK) (6 decks)

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