Pulmonology Flashcards
What is Mild Persistent asthma?
- Sxs >2 times a week, but not every day
- Waking up 3-4 times a night/ month
- FEV >80%
- Variability of 20-30%
What is the recommended tx for Mild Persistent asthma?
- Daily low dose inhaled corticosteroid
- SA B2 agonist PRN
Which of the following can NOT be used to tx Mild Persistent asthma?
A. Flovent
B. Pulmicort
C. Qvar
D. Prednisone
D. Prednisone–systemic po steroid
A 12 y/o male patient is having daily sxs of his asthma, which are not continual. He states he is waking up 5-6 times a month at night. What would you expect his FEV to be?
- FEV 60-80%
- Variability >30%
- Moderate Persistent
A 14 y/o female patient is having asthma attacks every day at school, but they do not last throughout the day. She states she is waking up 7-8 times a month at night. What is the best management for this patient?
- Moderate dose of inhaled corticosteroid
- MAY add on a LA B2 agonist OR leukotriene modulator
- SA B2 agonist PRN
- Moderate persistant
A 15 y/o female patient is having daily asthma attacks that seem to last all day. She reports waking up frequently in the night. What would you expect her FEV to be?
- FEV <60%
- Variability >30%
- Severe Persistent
A 15 y/o female patient is having daily asthma attacks that seem to last all day. She reports waking up frequently in the night. What would be the best management for this patient?
- High dose of inhaled steroids
- WITH a LA B2 agonist OR a leukotriene modulator
- SA B2 agonist PRN
- Severe Persistent
How do you treat Severe Acute asthma?
A short burst of oral steroids then taper
How can you tell if a patient’s asthma is managed/controlled?
- Rule of 2’s
- Has has an urgent care visit
- Awakens at night with sxs
- Increased need for SA B2 agonist
- Uses more than 1 canister of B2 agonist/month
What is the Rule of 2’s?
- Using 2 canisters of B2 agonists/year
- Using 2 doses of B2 agonists/week
- Having 2 nocturnal awakenings/month
- Having 2 unscheduled visits/year
- Needing 2 prednisone bursts/year
How is Peak Flow useful?
-Useful when the spirometry is negative OR at home usage for the family
What Peak Flow result would indicate poorly controlled asthma?
If there is greater than 20% difference between the AM and PM peak flow
What is the Green Zone for Peak flow?
> 80% of the patients best
-signifies the asthma is well controlled
What is the Yellow Zone for Peak flow?
<80% but >50% of the patients best
- if this happens, have the patient take a dose of their rescue inhaler and repeat
- On repeat, there should be a 20% + improvement
- Medications may beed to be evaluated
What is the Red Zone for Peak flow?
<50% of the patients personal best
-if this happens, have the patient use their rescue inhaler, and call drs office, or go to the ER
When do you schedule f/u for patients just starting tx or who require a step up in tx to achieve/regain control?
2-6 weeks
2 weeks to a month and a half
When do you schedule f/u for patients after control is achieved?
1-6 month intervals-consider a 3 month f/u if considering a step down
If control is not achieved in 3-6 months, what is the appropriate next step?
Referral
When a child has a foreign body, how can you tell if it is upper or lower based on clinical sxs?
Upper: Coughing and strider
Lower: Coughing and wheezing with unilateral decreased breath sounds, with retractions/accessory muscle use
With a high suspicion of a foreign body, what is the study of choice?
Rigid bronchoscopy: allows for removal at the time of visualization
Which of the following is NOT true regarding Cystic Fibrosis?
- CF is autosomal dominant
- It is an abnormality of the CF conducting regulator that affects chloride channels effecting movement of salt across the cell
- Children often present with FTT
- Confirmation of CF dx is done with a Pilocarpine sweat test
- is NOT true: CF is autosomal recessive
Note: >60 mmol for the Pilocarpine sweat test
What is the CF “quad” seen in children? (You made up “quad”)
- Meconium ileus*
- Later have FTT WITH foul smelling stools
- GERD
- Clubbing
What bacteria becomes predominant in CF patients?
Pseudomonas aeruginosa
What is the leading cause of death in pre-term infants?
Infant Respiratory Distress Syndrome/Hyaline Membrane Disease
(IRDS)
What are the 3 main causes for Hyaline membrane disease?
- Developmental insufficiency of of pulmonary surfactant production and structural maturity in the lungs
- Neonatal infection
- Genetic problem with the production of surfactant associated proteins
What are the risks of developing IRDS?
Risks decrease with advancing gestational age:
- 50% chance with infants born at 26-26 weeks
- 25% chance with infants born at 30-31 weeks
- More frequent with children born to diabetic mothers
- the second born of premature twins
You are performing a newborn exam on a 26-week infant in the hospital. Vital signs reveal tachypnea, tachycardia and high CO2. On PE, you notice nasal flaring, grunting, and some cyanosis. What would you expect to see on a chest x ray?
“Bell shaped chest”
-IRDS
You are performing a newborn exam on a 26-week infant in the hospital. Vital signs reveal tachypnea, tachycardia and high CO2. On PE, you notice nasal flaring, grunting, and some cyanosis. What is the most appropriate management?
PREVENTION is the best tx: in premature births, giving mother steroids can increase rate of surfactant production
- O2 via CPAP and surfactant
- Infant may need ET tube and ventilation
What is Acute Bronchiolitis?
Nonspecific inflammation of the bronchioles
A 1 year old infant is seen in the clinic. Vital signs reveal an increased RR. On PE, you hear rhonchi and wheezing; you see retractions while the patient is breathing. Parents say their child has had a cough for about 2-3 days. What is the most common cause of this child’s condition?
Usually caused by RSV or Adenovirus
A 1 year old infant is seen in the clinic. Vital signs reveal an increased RR. On PE, you hear rhonchi and wheezing; you see retractions while the patient is breathing. Parents say their child has had a fever, cough, and runny nose for about 2-3 days. What is the most appropriate treatment for this patient?
Supportive: Albuterol and O2; cool mist humidifier
- RSV is self limiting
- If there is a pneumonia –> treat
- Steroids may be used in severe cases
What is the MCC of pneumonia in children <2 y/o?
Viral:
- RSV
- Parainfluenza
- Influenza A/B
- Human metapneumovirus
What is the difference between a pneumonia CXR and a bronchiolitis CXR?
Pneumonia: perihilar streaking, increased interstitial markings, peribronchial cuffing
Bronchiolitis: “patchy pneumonia”? and HYPERINFLATION
What is the MC bacterial cause of pneumonia in neonates?
- Group B strep***
2. Chlamydia
What is the MC bacterial cause of pneumonia in children older than neonate age?
- Strep pneumo***
- Hib
- M. cat
- Staph
- Klebsiella
- E. coli
What are the following findings consistent of:
- Increased vocal fremitus
- Dullness to percussion
- Tachypnea
- Tachycardia
- Fever with productive cough* (part of hx)
Bacterial pneumonia
What is the most appropriate tx for bacterial pneumonia for a <4 wk old infant?
-admission for Gentamicin and Ampicillin
What is the most appropriate tx for bacterial pneumonia for a 3months to 5 yrs old child?
-Amoxicillin 50-90 mg/kg/d x 7-10 days
What is the most appropriate tx for bacterial pneumonia for a child >5y/o?
-Amoxicillin, Macrolide, or Penicillin G can all be effective based on the pathogen
What is “lobar consolidation” consistent with on CXR?
bacterial pneumonia
What CXR finding is the classic hallmark of Croup?
Steeple sign = Supraglottic narrowing
A 4 year old child is seen in the office with a balky, seal cough. You notice stridor while the child is breathing. Vital signs reveal a low grade 99 degrees fever. What is the most likely cause of this condition?
- Croup
- Parainfluenza virus***
A 4 year old child is seen in the office with a balky, seal cough. You notice stridor while the child is breathing at rest. Vital signs reveal a low grade 99 degrees fever. What is the most appropriate tx for this child?
- Supportive therapy
- Hydration and O2
- Nebulized racemic epinephrine***–used when pt has resting stridor
- Glucocorticoids like Dexamethasone
