Pulmonology (Alice) (12%) Flashcards
acute bronchiolitis in peds is mc caused by
RSV
3 sx of acute bronchiolitis
tachypnea
respiratory distress
wheezing
dx for acute bronchiolitis
nasal wash culture and assay
CXR findings of acute bronchiolitis
normal bro!
only tx that improves sx of bronchiolitis
O2
indications for hospitalization w. RSV infxn (6)
O2 sat 95-96%
< 3 mo old
RR > 70
nasal flaring
retractions
atelectasis on CXR
med NOT recommended for bronchiolitis in previously well kiddos
systemic steroids
med for RSV if kid has severe lung/heart dz or is immunocompromised
ribavarin
prophylaxis for RSV for high risk kiddos (immunocompromised, lung dz, premature, neuromuscular d.o)
palivizumab
2 PMH findings associated w. asthma
eczema
seasonal rhinitis
spirometry findings of asthma (2)
FEV1:FVC < 80%
FEV increase > 10% after bronchodilator
tx for asthma
tx for acute asthma attack (3)
O2
nebulized SABA/SAMA
steroids
what is this showing
steeple sign -> croup
narrowing of the trachea in the subglottic region
croup is caused by _ virus
and is mc in _ year olds
parainfluenza
3-6 mo
tx for croup
supportive
severe: IVF, nebulized racemic epi, steroids
growth retadation
recurrant PNA
chronic diarrhea/steatorrhea
cystic fibrosis
PE findings of CF
scattered ronchi bilat
dullness to percussion
mild hepatomegaly
mild LE edema
3 CXR findings of CF
focal atelectasis
mucus plugging
hyperinflation
dx for CF
sweat chloride test
CF is an autosomal recessive mutation in the _ gene
CFTR
CF is associated w. recurrant respiratory infxns caused by
pseudomonas
management of CF
chest physiotherapy
high fat diet
fat soluble vitamin supplements
exacerbations: abx
mcc of foreign body aspiration
food
5 rf for foreign body aspiration
institutionalization
advanced age
poor dentition
etoh
sedatives
mc location for aspiration
mainstem
right lobar bronchus
3 PE findings of foreign body aspiration
foul smelling nasal d.c
inspiratory stridor
wheezing
+/- decreased breath sounds
CXR finding of foreign body aspiration
expiratory film: hyperinflation of affected side
_ is necessary for appropriately evaluating/monitoring ventilation
ABG
what type of bronchoscopy is preferred in peds
rigid
what should you consider administering prior to removal of a nasal foreign body object
oxymetazoline drops -> shrinks mucous membrane
2 topical pain agents useful when flushing foreign body in ear
benzocaine
anti-pyrene
what 2 substances can be used to immobilize buggies in the ear prior to removal
viscous lidocaine
mineral oil
what is this showing
rust ring -> metallic foreign body
management of intraocular foreign bodies (3)
topical anesthetic
topical vs systemic abx
immediate ophtho referral
what pathogen are you worried about w. eye injuries associated w. soil/vegetation
bacillus cereus
dz that affects premature infants that are born before the lungs produce adequate amounts of surfactant
hyaline membrane dz
mcc of respiratory distress in preterm infants
hyaline membrane dz
CXR findings of hyaline membrane dz
diffuse bilat atelectasis -> ground glass appearance
rf for hyaline membrane dz
infants < 30 weeks gestation at birth
what 3 antenatal tx can help with hyaline membrane dz
-antenatal betamethasone IM x 2 w.in 24-48 hr of birth
-artificial surfactant thru endotracheal tube
-PEEP
mcc cause PNA in peds vs adults
peds: RSV
adults: flu
CXR finding associated w. viral PNA
bilateral interstitial infiltrates
management of viral PNA
tamiflu w.in 48 hr
SABA
fluids
what makes you think viral PNA vs bacterial
rapid onset
milder sx
4 sx of bacterial PNA
fever
dyspnea
tachycardia/pnea
+/- sputum
CXR findings of bacterial PNA
patchy, segmental lobar, multilobar consolidation
dx for bacterial PNA (2)
blood cultures x 2
sputum gram stain
outpt vs inpt tx for bacterial PNA
outpt: doxy, macrolides
inpt: ceftriaxone + azithro/FQ
RSV is the mcc of _ in peds (2)
bronchiolitis
PNA
