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Peds EOR > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

What is acute bronchiolitis caused by?

A

RSV - commonly in fall and winter months

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2
Q

Who does acute bronchiolitis present in?

A

infants and young children

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3
Q

What are the symptoms of acute bronchiolitis?

A

tachypnea, respiratory distress, wheezing

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4
Q

How is acute bronchiolitis diagnosed?

A

nasal washing for RSV culture and antigen assay

-CXR = normal

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5
Q

What is the treatment of acute bronchiolitis?

A
  • hospitalization if O2 situation <95-96%, age <3 months, RR > 70, nasal flaring, retractions, or atelectasis on CXR
  • supportive = humidified O2, antipyretics, beta-agonist, nebulized racemic epinephrin, and steroids
  • the only treatment demonstrated to improve bronchiolitis is oxygen
  • ribavirin is given if sever lung or heart disease and in immunocompromised patients
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6
Q

What is given prophylaxis for acute bronchiolitis for special populations?

A

palivizumab - once per month for 5 months beginning in November (immunocompromised, premature infants, neuromuscular disorders)

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7
Q

What is asthma?

A

a chronic, reversible inflammatory airway disease with recurrent attacks of breathlessness and wheezing

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8
Q

How is asthma diagnosed and monitor?

A

with peak flow

  • spirometry with pre and post-therapy (albuterol inhalation) readings
  • decreased FEV1/FVC (75-80%)
  • > 10% increase of FEV1 with bronchodilator therapy
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9
Q

What are the findings of spirometry for asthma?

A
  • decreased FEV1 to FVC ratio <80% (you would expect the amount of air exhaled during the first second (FEV1) to be the greatest amount)
  • in asthma, since there is an obstruction (inflammation) you will have a decreased FEV1 and therefore a reduced FEV1 to FVC ration
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10
Q

What is the treatment of mild intermittent asthma?

A

(<2x/week or <2 night/month) - SABA prn

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11
Q

What is the treatment of mild persistent asthma?

A

(>2x per week or 3-4 night/month) - low dose ICS daily

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12
Q

What is the treatment of moderate persistent asthma?

A

(daily sx or >1 night/week)

  • low dose ICS + LABA daily
  • medium dose ICS + LABA daily
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13
Q

What is the treatment of severe persistent asthma?

A

(sx severo times/day + nightly)

  • high dose ICS + LABA daily
  • hight dose ICS + LABA + oral steroids
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14
Q

What is the treatment for acute asthma?

A

oxygen, nebulized SABA< ipratropium bromide, and oral steroids

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15
Q

What is croup?

A

an infection of the upper airway, which obstructs breathing and causes a characteristic barking cough

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16
Q

What is croup caused by?

A

parainfluenza virus

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17
Q

Who is croup common in?

A

children 6 months - 3 years, fall and early winton months

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18
Q

What are the sings and symptoms of croup?

A
  • baring cough and stridor

- steeple sign on PA CXR (narrowing trachea in the subglottic region)

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19
Q

What is the treatment of croup?

A
  • supportive (air humidifier), antipyretics

- severe: IV fluids and nebulized racemic epinephrine, steroids

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20
Q

What is cystic fibrosis?

A

an autosomal recessive mutation in the CFTR gene

-abnormally thick mucus, difficultly clearing mucus

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21
Q

What is the presentation of cystic fibrosis?

A

recurrent repertory infections (especially pseudomonas), steatorrhea

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22
Q

How is cystic fibrosis diagnosed?

A

quantitive sweat chloride test

-CXR may revel hyperinflation, mucus plugging, and focal atelectasis

23
Q

What is the treatment of cystic fibrosis?

A
  • maintenance: chest physiotherapy, high-fat diet, supplement fat-soluble vitamins (A,D,E,K)
  • acute exacerbations: antibiotics
24
Q

When does a foreign body aspiration occur?

A
  • when a foreign body enters the airways and causes chocking
  • objects can enter the esophagus through the mouth, or enter the trachea through the mouth or nose
25
Q

What most often is the foreign body?

A

food and can be life-threatening, 80% in mainstream or lobar bronchus right > left

26
Q

What are the risk factors of a foreign body?

A

institutionalization, advanced age, poor dentition, alcohol, sedative use

27
Q

What is the presentation of a foreign body?

A
  • depends on the location of obstruction

- inspiratory stridor (if high in the airway) or wheezing and decreased breath sounds (if low in the airways)

28
Q

What does the CXR of a foreign body show?

A

expiratory radiograph may reveal regional hyperinflation of the affected side
-ABG - necessary for appropriately evaluating ventilation, may be useful for following the progression of respiratory failure when it is a concern

29
Q

What is the treatment for a foreign body?

A
  • remove foreign body with bronchoscope

- rigid bronchoscopy preferred in children while flexible is diagnostic and therapeutic in adults

30
Q

What are the complications of foreign body?

A

pneumonia, acute respiratory distress syndrome, asphyxia

31
Q

What is the presentation of a nasal foreign body?

A
  • persistent foul-smelling purulent unilateral nasal discharge in a young child without other respiratory symptoms should raise suspicion for a retained nasal foreign body
  • even without a history of witnessed foreign body insertion
32
Q

What is the treatment of a nasal foreign body?

A

prior to removal consider using oxymetazoline drops to shrink the mucous membrane

33
Q

What are the precautions of foreign body in ear?

A
  • aggressive flushing can cause perforation of the tympanic membrane, so caution is advised while irrigating
  • after each flush, it is prudent to recheck the external canal for retained foreign body (FB) fragments, which can occur with an insect
  • irrigation of the external ear can be uncomfortable for the child consider treating with topical pain agents such as benzocaine-anti-pyrene
  • insects must be immobilized prior to removal, drown insects with mineral oil or viscous lidocaine before attempting removal
  • removal of foreign body which requires direct visualization prior to removal either via warm irrigation with a syringe or instruments like an alligator forceps
34
Q

What are the characteristics of ocular foreign body?

A
  • metallic foreign bodies may leave a rust ring

- if you can’t remove the foreign body easily then refer to the ophthalmologist

35
Q

What is the dx of ocular foreign body?

A

full inspection of lids, conjunctiva, and cornea - slit-lamp examination will assist in identification and removal
-X-ray or CT of may be necessary if there is any evidence of penetration of the globe

36
Q

What is the tx of ocular foreign body?

A
  • if the corneal foreign body is detected, an attempt can be made to remove it by irrigation after the instillation of topical anesthetic
  • this is particularly helpful in the case of multiple superficial foreign bodies (sand)
  • an attempt can then be made to remove the foreign body with a swab, using direct visualization
  • intraocular foreign bodies require immediate surgical removal by an ophthalmologist
  • systemic and topical antimicrobials (effective against Bacillus cereus if the injury involved contamination with soil or vegetation) are indicated
37
Q

What is a rust ring?

A

after removal of foreign body containing iron, there is often a residual rust ring and reactive infiltrate

  • patients with rust ring should be treated as patients with corneal abrasions
  • rust ring itself is not harmful and will usually reabsorb gradually
38
Q

Who does hyaline membrane disease affect?

A

premature infants

39
Q

When does hyaline membrane disease occur?

A

when infants are born before the lungs are producing adequate amounts of surfactant

  • surfactant helps to prevent the lungs from collapsing
  • as the airways collapse, infants will struggle most and more to breathe until they become acidotic and multisite organ failure begins
40
Q

What is the most common cause of respiratory disease in preterm infant?

A

preterm infant

41
Q

What causes hyaline membrane disease?

A

a deficiency in surfactant resulting in poor lung compliance and atelectasis

42
Q

How is hyaline membrane disease dx?

A

CXR will demonstrate diffuse bilateral atelectasis causing a “ground glass appearance” and air bronchograms

43
Q

What is the tx of hyaline membrane disease?

A

given antenatal steroid pithing 24-48 hours of birth - betamethasone IM x2

  • artificial surfactant can be given through the endotracheal tube
  • mechanical ventilation with positive pressure
44
Q

What is the most common cause of viral pneumonia?

A
  • kids = RSV (comes on fast)

- Adults = flu

45
Q

How is viral pneumonia dx?

A

CXR = bilateral interstitial infiltrates

-rapid antigen testing for flu, RSV nasal swab, cold agglutinin titer negative

46
Q

What is the tx of viral pneumonia?

A

flu with Tamil (A and B) if sx’s began <48 hours

-symptomatic tx = beta 2 agonists, fluids, rest

47
Q

What are the signs and symptoms of bacterial pneumonia?

A

fever, dyspnea, tachycardia, tachypnea, cough, +/- sputum

48
Q

How is bacterial pneumonia dx?

A

patchy, segmental lobar, multiobar consolidation

-blood cultures x2, sputum gram statin

49
Q

What is the tx of bacterial pneumonia?

A 
outpatient = doxy, macrolides
inpatient = ceftriaxone + azithromycin/respiratory FQs
50
Q

What is the MC cause of lower respiratory tract infection in children worldwide?

A

respiratory syncytial virus

-virtually all children get it by age 3

51
Q

What is the leading cause of pneumonia and bronchiolitis?

A

respiratory syncytial virus

52
Q

What are the symptoms fo respiratory syncytial virus?

A

Rhinorrhea, wheezing/coughing that persists for months, low-grade fever, nasal flaring/retractions, nail bed cyanosis

53
Q

How is respiratory syncytial virus dx?

A

nasal washing, RSV antigen test, CXR can show diffuse infiltrates

54
Q

What is the treatment of respiratory syncytial virus?

A
  • indications for hospitalization = tachypnea with feeding difficulties, visible retractions, oxygen desaturation <95-96%
  • supportive measures include albuterol via nebulizer, antipyretics and humidified oxygen, steroids (controversial), resolves in 5-7 days
  • vaccine for children with lung issues or born premature/immunocompromised at birth should get Synagis prophylaxis (palivizumab) = once per month for five months beginning in November

Peds EOR (12 decks)

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