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EOR - Pediatrics (Alice copy + Seth's) > Pulmonology additional (Seth's Additional info) (12%) > Flashcards

Pulmonology additional (Seth's Additional info) (12%) Flashcards

1
Q

Leading cause of infant hospitalization

A

Bronchiolitis

2 months - 2 years

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2
Q

MCC of acute bronchilolitis

A

RSV

Respiratory Syncytial Virus

in the winter, spring, and sorta fall

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3
Q

what is acute bronchilitis inflammation of?

A

Bronchioles

smallest air passages

Defined as a clinical syndrome of respiratory distress in children under 2 years of age

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4
Q

MC age of acute bronchilits

A

2 months - 2 years

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5
Q

desribed the symptom evolution of bronchiolitis

A

upper respiratory symptoms, followed by the acute onset of wheezing, crackles, hyperinflation, and tachypnea

Resulting in acute inflammation of airways

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6
Q

PE of bronchiloitis
RR ()
Prolonged ()
Cough
() wheeze
otitis media

A

RR increased
Prolonged expiration
Cough
expiratory wheeze
otitis media

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7
Q

t/f first line dx of bronchilitis is imaging showing inflammed airways

A

FALSE

clinically typically, xray only sometimes

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8
Q

Treatment of acute bronchilitis

A

Supportive and hydration

f/u patient in 2 days if outpatient

if hypoxia/apnea/ect consider hospitalization

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9
Q

which (rarely used) antiviral has a good treatment response for bronchilitis

A

Ribavirin

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10
Q

what pulm medications should be AVOIDED with bronchilitis?

A

Bronchodilators (albuterol)
Systemic glucocorticoids

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11
Q

MC lethal genetic disease in the US

A

Cystic fibrosis :(

Median survival 47 years

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12
Q

inheritance pattern of CF

A

Autosomal recessive

Spells CAR

Seen in caucasians mostly

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13
Q

Overview of CF
(obstructive/restrictive) disease that leads to progressive respiratory failure and death

A

Obstructive

secrections get in the way

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14
Q

Chromsome # that contains CF gene and is defected in CF

A

Chromosome 7

Cystic Fibrosis averages 7 letters each

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15
Q

What does the CF gene on chromosome 7 typically code for

A

epithelial chloride channel (CF transmembrane conductance regulator protein)—(CFTR)

found on MANY organs

This in turn leads to problems in salt and water movement across cell membranes resulting in abnormally thick secretions in various organs

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16
Q

Early symptoms that key you into CF shortly after birth

A

Meconium ileus
Respirtory symptoms
FTT

if meconium ileus assume CF until confirmed with sweat tests and genotyping

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17
Q

Meconium ileus is obstruction of bowel by meconium in newborn infant that occurs at this anatomic site ().

virtually diagnostic of CF

A

terminal ileum

in the name!

think crohn’s I guess

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18
Q

What age do kiddos typically get diagnosed with CF?

A

Upon heel prick while in hospital

early diagnoses

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19
Q

what is the overview of upper respiratory, lower respiratory, GI, and pancreas symptoms

for CF

A

GI: volvulus, poor hydration, rectal prolapse
UR: Chronic sinusitis, nasal polyps, persistent cough
LR: infections, pneomothrax, right-sided heart failure (from pulm congestion)
Pancreas = abnormal electrolyte secretions, destruction of acini cells (leading to decreased pancreatic enzymes and pancreatic insuffiency in 85%+ of CF patients), DM, pancreatitis, malabsorbtion of fat soluble vit (DAKE), FTT

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20
Q

Electrolyte abn sometimes seen in CF and why

A

metabolic alkalosis

d/t losing electrolytes

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21
Q

Although typically initially dx with a heel stick, what is the gs dx of CF?

A

Sweat chloride test

Collection of sweat with pilocarpine iontophoresis

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22
Q

what is a borderline sweat-chloride test for CF?

above = dx
below = normal

A

40-60 mmol/L

50 +/- 10
think of sweat being 5 letters (so 50)

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23
Q

What do you do after you get 60+ sweat chloride test?

Positive test for CF

A

Genetic testing + therapy

can also get fecal elastase, pancreatic elastase-1 absent in 80% with CF

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24
Q

Tx of CF respiratory

A
  1. Follow with CF foundation
  2. Every 3 months
  3. Pulmozyme (mucolytic to decrease viscosity of purulent CF sputum)
  4. Hypertonic saline
  5. Bronchodilators
  6. Chest phsyio
  7. ABX for infections
  8. CFTR modulators
  9. Vaccines
25
Q

Tx of CF GI

A
  1. Pancreatic enzyme supplementation combined with high calorie, high protein, high fat diet
  2. Daily vitamins
  3. Caloric supplements
  4. G-tube placement and supplemental feedings in FTT
26
Q

Tx of acute exacerbation of CF

increased sputum, increased cough, DOE, fatigue, decreased apetite, fever, increased nasal congestion

A
  1. systemic ABX
  2. Sputum cultures
  3. 1 abx to target microbe grown on culture and 2 for pseodomonas
27
Q

What is hyaline membrane disease AKA?

A

Infant respiratory distress syndrome

28
Q

1 RF associated with hyaline membrane disease

A

Preterm

DM moms with term babies sometimes as well, but not nearly as common

Approximately 50% of infants born between 26 and 28 weeks gestation develop RDS, drops to 20 - 30% at 30 - 32 weeks

29
Q

Pathophys of hyaline membrane disease

A
  1. Deficiency in pulmonary surfactant d/t prematurity
  2. Leads to noncompliant, stiff lungs
  3. Amount of pressure needed to open alveoli is increased, leading to atelectasis at end expiration
  4. Leads to a ventilation/perfusion mismatch, hypoxemia, hypercarbia, and persistent HTN
30
Q

When do the manifestations of hyaline membrane disease (IRDS) typically present by?

A

min-hours after birth

31
Q

s/s of hyaline membrane disease (IRDS)

A
  1. Premature infant
  2. Tachypnea
  3. Intercostal retractions
  4. Expiratory grunting
  5. Diminished breath sounds
  6. Cyanosis
  7. Progressively worsening
32
Q

Dx and classic CXR finding of hyaline membrane disease (IRDS)

A

Clinically + cxr, pulse ox, ABG
diffuse ground-glass appearance

33
Q

Treatment of hyaline membrane disease
(what O2 delivery is used?)

A

Multidisciplanary + Nasal CPAP (initial preferred intervention) and surfactant replacement

34
Q

What might you give to prevent hyaline membrane disease (IRDS) and when?

A

Prenatal administration of a single course of steroids to women in preterm labor or at risk of delivery within the next 7 days between 24 - 34 weeks gestation

35
Q

Asthma is a reversible (obstructive/restrictive) disease

A

obstructive

36
Q

The pathogenesis of asthma involves

Inflammatory cell infiltration with ___
____ hyperplasia
Plugging of ___ airways with thick mucus
Hypertrophy of ____ muscle
Airway _____
___ cell activation

A

Inflammatory cell infiltration with eosonophils
Goblet cell hyperplasia
Plugging of small airways with thick mucus
Hypertrophy of smooth muscle
Airway edema
Mast cell activation

37
Q

strongest RF for asthma

A

atopy

but lots of others as well

38
Q

MC age range that marks the beginning of asthma

A

< 5 yo

77% of asthma begins in children <5 years old

39
Q

What is the difference between extrinsic and intrinsic asthma and which is most common?

A

Extrinisic = allergic (MC)
Intrinsic = anything other than allergies

40
Q

Overall common s/s of asthma

A
  1. Cough
  2. Chest tightness
  3. SOB/dyspnea
  4. difficulty breathing
  5. Episodic wheezing with expiration, hyperexpansion of thorax, use of accessory muscles.
  6. Decreased tactile fremitus (sometimes)
  7. Increased nasal secretions
  8. Atopy
  9. Hunched shoulders to breathe
  10. Percusion is normal to hyperresonant
41
Q

Other than clinical suspicion, what is the main diagnostic tool for asthma and what does it show (in general).

A

Spirometry

Shows reversibility with bronchodilator + obstruction

Reduced FEV1/FVC and increased FEV1 after bronchodilator therapy

42
Q

Explain the steps to diagnosing asthma for patients 5-18 yo with a obstructive pattern

A
  1. FEV1/FVC is < 85% of predicted
  2. if FVC < 80% predicted = obstructive (A); if FVC > 80% predicted = mixed (B).
  3. (A) For obstructive administer brochodilater, which shows increase in FEV1 of > 12% = reversible condition = asthma (if not increased by 12% consider alternative diagnosis)
  4. (B) For mixed, adminster bronchodilator, which shows FVC > 80% = likely COPD

obstrutive reversible is needed for dx

43
Q

If spirometry is nondiagnostic, but you still are highly sus of asthma, what can you do?

what is a positive result?

A

Bronchoprovocation testing with inhaled methacholine, histamine, or mannitol

worsens breathing d/t causing contraction/narrowing if hyperresponive

Patients breathe in increasing amounts of methacholine and perform spirometry after each dose

Increased airway hyperresponsiveness with a ≥ 20% decrease in FEV1 up to 16 mg/mL max dose

others include exercise challenge, peal flow meters, chest xray (especially with status asthmaticus to r/o other dx), skin testing, sputum for eosinophils

44
Q

what testing can you use for exercise and cold-induced asthma?

A

Provocative testing

In these tests, your doctor measures your airway obstruction before and after you perform vigorous physical activity or take several breaths of cold air

45
Q

ABG findings of asthma commonly show (2)

A
  1. Hypoxemia
  2. Hypercarbia with decompensation
46
Q

Sputum sample of asthma sometimes shows:

() of small airways
Thick, mucoid sputum
and what other 2 classic findings?

A

casts of small airways
Thick, mucoid sputum
Curschmann’s spirals (from shed epithelium)
Charcot-Leyden crystals (crystalloids with galectin-10)

47
Q

What is mild intermittent asthma?
_ days a week
_ night awakenings
_ FEV1/FVC
() exacerbations requiring glucocortidoids per year

A

<= 2 days a week
<= 2 night awakenings per month
< 2 SABAs per week

No interfence with normal activites
Normal FEV1/FVC

0-1 exacerbations (< 2 basically)

Rule of 2s

48
Q

how often does some1 with moderate persistent asthma need a SABA?

A

Daily

FEV1 between 60-80% of predicted and FEV1/FVC below normal

49
Q

FEV1 of severe asthma

A

60% or less

FEV1/FVC below normal

50
Q

6 steps of asthma treatment

A
  1. SABA + low dose ICS when symptomatic OR low dose ICS daily
  2. SABA + low dose ICS
  3. SABA + low dose ICS + **LABA ** OR medium dose ICS alone
  4. SABA + medium dose ICS AND LABA
  5. SABA + high dose ICS + LABA (or montelukast)
  6. SABA + high dose ICS + oral steroids + LABA (or montelukast); consider monoclonal antibody
51
Q

How often should patients with asthma f/u?

A

every 1-6 months depending on severity

52
Q

when might you consider step down therapy for asthma?

A

if stable for 3 months

53
Q

Your patient is dx with asthma - they can use this assessment tool at home to keep an “asthma diary” of how they are doing

A

Peak flow meter

54
Q

t/f Peak flower meters consider height, weight, and age to measure normal values

A

FALSE

NOT weight, but height and age are a factor

55
Q

What are the 4 factors used to predict normal values of peak flow monitors?

A
  1. Height
  2. Age
  3. Sex
  4. Ethnicity sorta (AA and hispanic americans are approx 10% lower)
56
Q

What are the different colors of a peak flow monitor and what is the “caution” zone color and range?

A

Green, yellow, red

yellow = caution (50-80% predicted) follow treatment plan

below this = Bronchodilator therapy should be started immediately and clinician should be contacted

57
Q

When to refer a pt with asthma to a pulmonologist or allergist

A
  1. Experienced a life threatening attack
  2. Hospitalized for attack
  3. > 2 rounds of oral corticosteroids needed
  4. Over 5 yo requiring step 4 care or higher
  5. Under 5 yo and requiring step 3 care or higher
  6. Unresponsive to treatment after 3-6 months
  7. Candidate for allergen immunotherapy
58
Q

When would you take a SABA for exercise induced asthma/bronchospasm?

A

15-30 min prior to exercise

59
Q

Cough variant asthma is treated the same as other forms, but is characterized by:

Cough lasting ()
Cough is (productive/nonproductive)
Cough typically occurs at this hour ()

A

Cough lasting (> 3 weeks)
Cough is (nonproductive)
Cough typically occurs at this hour (night)

EOR - Pediatrics (Alice copy + Seth's) (23 decks)

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