Pulmonology Flashcards
what are common etiologies of bronchiolitis?
viral - RSV, influenza, parainfluenza, metapneumovirus
what is the presentation of bronchiolitis?
apnea (esp. in 4 months of age -RSV)
copious rhinorrhea
cough/wheeze
fever
how do you diagnose bronchiolitis?
PE findings and history
x-ray unecessary
specific cause can be confirmed by antigen testing or PCR?
what’s the most common cause of bronchiolitis?
RSV
how do you manage bronchiolitis?
supportive care - nasal suction, hydration, supplemental O2 if sats<90% on room air
meds - trial of beta 2 agonist or racemic epinephrine (works, keep it up), nebulized 3% hypertonic saline
no benefit to chest PT
screen for RSV to avoid abx and isolate infants in hospitals
what are the sequelae of bronchiolitis?
obstruction of the u and l respiratory tract that can lead to respiratory failure
- highest risk in premies and those with lung disease
- give these babies Synagis
What is Synagis?
Palivizumab
IgG monoclonal Ab
<29 weeks gestation, younger than a year at onset of RSV season
chronic lung dz less than 24 years
*consider in immunocompromised, CV disease, neuromuscular disease
what are the causes of respiratory failure in infants?
upper airway ob
lower airway ob
sepsis
hypotonia
what presentations in infants is concerning for impending respiratory failure?
inreased accessory muscle use
inability to coordinate feeding (poop out)
decreased arousability
hypoxemia/hypercarbia
*normal PCO2 with marked tachypnea very poor sign
what are the three phases of pertussis and the clinical features of each?
- catarrhal: cough and rhinorrhea (1-2 weeks)
- paroxysmal: fits of coughing, inspiratory whoop, post-tussive emesis (2-8 weeks)
- convalescent - gradual waning of symptoms (weeks to months)
Generally, NO FEVER
what is the incubation period for pertussis?
7-10 days
how is diagnosis of pertussis made?
clinical - paroxysmal cough, whoop, post-tussive emesis
lymphocytosis is a clue
PCR and culture
what is the treatment for pertussis?
macrolides
azithromycin (5 days)
preferred in young, pregnant women
alternatives: erythromycin (14 days), clarithromycin (7 days), TMP-SMX (14 days)
*prevents spread and limits cough in catrarrhal
what are the complications of pertussis?
abx don’t do much
hospitalization
apnea
2ndary pneumonia
seizure
death
what is the most common source in infant pertussis?
family members
one of the reasons we have been moving to immunizing mother during pregnancy
what are the clinical manifestations of pneumonia by age?
neonates - fever or hypoxia only
young infants - apnea may be first sign
children - fever, chills, tachypnea, cough, malaise, retractions, apprehension
which type of pneumonia usually presents with high fever, chills, and focal findings?
bacterial
what type of pneumonia presents with diffuse crackles?
atypical
what are the most common causative organisms for pneumonia by age?
in longstanding asthma, what may occur?
remodeling of the airway that can lead to incomplete reversability
what’s a common clinical sign of childhood asthma?
post-tussive emesis (night or early morning)
when do peds usually diagnose with asthma?
after recurrent episodes
usually 4
partially reversible measured by spirometry increase of FEV 1 > 200 mL AND 12% from baseline after SABA admin.
using metered dose inhaler without a spacer can cause loss of up to how much of the medicine?
60%
how often should children have spirometry once the asthma is under control?
every 1-2 years
what’s an unusual asthma trigger?
essential oil infusers
what percentage of children with asthma have an allergic phenotype?
60-80%
what happens during exercise induced bronchospasm?
airway dries out, and bronchospasm ensues from inflammation
what do you need to know to determine asthma severity?
symptoms
nighttime awakenings
SABA use for rescue
interference with normal activities
PFTs
what is the preferred approach to initiate controller therapy in pediatric asthma?
inhaled cortiocosteroids if already on SABA
add LABA to ICS if not well controlled
leukotriene alternative (good for allergic)
what are the components of an asthma action plan?
green - daily regimen
yellow - acute loss of asthma control (nip exacerbation in the bud)
red - ER
what are the highest risks for severe asthma exacerbations?
poor asthma control
higher disease severity
prior hospitalizations/intubations
non-adherence to therapy
what is status asthmaticus?
no response to reptitive or continuous administration of SABA
what are third tier therapies for asthma?
IV ketamine
inhaled anesthetics
ECMO
what are 2nd tier asthma exacterbation treatments?
IV magnesium
aminophylline
salbutamol
non-invasive ventilation
heliox
what are 1st tier asthma exacerbation treatments?
inhaled Beta agonists
inhaled anti-cholinergics
systemic corticosteroids
