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Peds-Final > Pulmonology & Atopy > Flashcards

Pulmonology & Atopy Flashcards

1
Q

what is the MC reason for pediatric hospitalization?

A

respiratory dz

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2
Q

hallmark airway noise for upper airway obstruction

A

stridor

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3
Q

hallmark distinction of lower airway obstruction

A

wheezing

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4
Q

air trapping & prolonged expiratory phase can occur in?

A

either upper or lower obstruction

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5
Q

ventilation & oxygenation occur_________from one another

A

independent

processes compromise each function differently

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6
Q

ventilation & oxygenation both may be affected by what?

A

severe obstruction

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7
Q

respiratory rate in infant

A

24-38

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8
Q

respiratory rate 1-3 yo

A

22-30

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9
Q

respiratory rate 4-6 yo

A

20-24

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10
Q

respiratory rate 7-14 yo

A

16-24

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11
Q

respiratory rate 14-18 yo

A

14-20

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12
Q

you want to always count respiratory rate for how long?

A

60 seconds

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13
Q

what is the most sensitive sign of pneumonia in CH?

A

tachypnea

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14
Q

continuous sound caused by turbulent flow in narrow airways

A

wheezing

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15
Q

fine, interrupted sounds that suggest pulmonary parenchymal dz

A

rales (crackles)

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16
Q

course, interrupted sounds that suggest large airway dz

A

rhonchi

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17
Q

predominately inspiratory, monophasic noise

A

stridor

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18
Q

expiratory stridor

A

pretty rare

means there’s most likely an obstruction in larger thoracic part

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19
Q

children mount a progressive effort w/ worsening compromise in respiratory distress how?

A

tachypnea
labored breathing
positioning

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20
Q

what will you see in labored breathing?

A

retractions
nasal flaring
grunting

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21
Q

retractions include?

A

abdominal (“subcostal”)
intercostal
supraclavicular

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22
Q

grunting is an attempt to?

A

maintain area for gas exchange by providing extra end expiratory pressure

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23
Q

positioning

A

upright
tripodding
sniffing positon

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24
Q

upright positioning

A

gravity aids diaphragmatic contraction

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25
Q

tripodding

A

allows more efficient scalene & intercostal work

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26
Q

sniffing position

A

opens upper airway

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27
Q

what is a good screening test for parenchymal or pleural dz?

A

plain chest film

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28
Q

a plain chest film is a poor test of?

A

pulmonary function

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29
Q

what is the best plain chest film in respiratory distress?

A

upright film at limit of inspiration

  • often difficult in small children, may require repeat of film
  • radiography tech often forgets to compensate for child size when determining exposure
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30
Q

if you have a prolonged expiration you have?

A

an obstruction

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31
Q

ventilation is used to do what?

A

get CO2 out

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32
Q

mild obstruction effects what?

A

ventilation

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33
Q

what test is good to measure pulmonary function?

A

arterial blood gas- esp. useful if serial measurements allow description of trends

  • cap blood gas easier to obtain, but pO2 less helpful
  • no utility of pO2 in venous blood gases
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34
Q

ABG worrying findings include?

A

respiratory acidosis
hypoxemia
uncompensated acidosis

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35
Q

rising pCO2 over 45 mmHg

A

respiratory acidosis

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36
Q

rales (crackles) sound like what?

A

crumpled seran wrap un-crumpling

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37
Q

decreasing pO2 less than 85 mmHg

A

hypoxemia

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38
Q

acidemia

A

uncompensated acidosis

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39
Q

stridor DDx

A 
laryngeal papillomatosis
laryngeal trauma
larygomalacia
viral croup
epglottitis
bacterial tracheitis
anaphylaxia
vocal cord paralysis/ dysfunction
FB
subglottic stenosis
retropharyngeal abscess
congenital anomalies
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40
Q

congenital anomalies include

A

Pierre-Robin sequence
neuromuscular dz
hemangioma

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41
Q

a respiratory illness (inflammation of larynx & surrounding airways) that manifests in young children

A

croup

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42
Q

signs of croup

A

hoarse voice
dry, barking cough
inspiratory stridor

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43
Q

croup is most commonly what type of infxn

A

viral- fever & cough

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44
Q

viral croup typically occurs before the age of?

A

6 yo

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45
Q

viral croup can occur any time of year, but most commonly occurs when?

A

late fall & winter

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46
Q

viral croup symptoms are typically worse?

A

at night

2nd & 3rd night usually the worst

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47
Q

what type of virus is most commonly the cause of viral croup?

A

parainfluenza viruses

but also: influenza A & B, adenovirus, RSV (respiratory syncytial virus)

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48
Q

DDx for croup

A

airway FB
angioneurotic edema (anaphylaxis)
retropharyngeal abscess
bacterial tracheitis (common airway pathogens, also M. pneumoniae & Candida spp.)
in unimmunized pt: acute epiglottitis (Hib), laryngeal dipheria

49
Q

screen all pts w/ stridor for what?

A

immunizations
recent choking/ FB spiration
food allergies

50
Q

Dx of viral croup

A

based on clinical findings
plain films only useful if atypical presentation
pulse ox usually nml unless severe case
visualization of epiglottis not usually indicated unless concern for epiglottis (drooling, toxic-appearing)

51
Q

what type of sign will you see on CXR in viral croup?

A

steeple sign

52
Q

tx of viral croup

A

cool mist
systemic corticosteroids
nebulized racemic epinephrine
severe cases: endotracheal intubation, helium-oxygen mixture

53
Q

cool mist for croup

A

home shower “steam”
car ride w/ windows down
cool water humidifiers

54
Q

systemic corticosteroids for croup

A

onset of action is several hrs after dose

no demonstrable benefit for more than 2 daily doses of dexamethasone

55
Q

cystic fibrosis occurs d/t a defect in what?

A

cystic fibrosis transmembrane conductance regulator resulting in a deficiency in chloride ion transport, causing abnormal fluid secretion

autosomal recessive

56
Q

secretions & mucus in cystic fibrosis has what type of quality to it?

A

thick & tenacious

57
Q

cystic fibrosis is most prevalent in who?

A

northern Europeans

58
Q

cystic fibrosis involves multiple organ systems, including?

A

chronic pulmonary dz & exocrine pancreatic insufficiency

59
Q

Dx cystic fibrosis

A

newborn genetic screening
FH
sweat chloride- functional test, most sensitive
DNA testing- less sensitive, can only screen for known mutations

60
Q

red flags in cystic fibrosis

A 
meconium ileus & chronic constipation
prolonged jaundice (biliary obstruction)
FTT
signs of malabsorption (bulky, foul smelling stools, greasy/oily stools)
recurrent lung dz
61
Q

complications of cystic fibrosis

A 
chronic recurrent & indolent pneumonias
recurrent infxns contribute to airway & lung parenchymal changes (bronchiectasis, asthma)
systemic & inhaled Abx therapy
airway clearance measures
pancreatic enzyme replacement
62
Q

define obstructive sleep apnea

A

spectrum of d/o’s where obstruction of airflow results in increased respiratory effort & frequent sleep arousal, incrased respiratory effort, hypoventilation, & (sometimes) hypoxemia

63
Q

obstructive sleep apnea may progress to

A 
cor pulmonale (pulmonary vascular-source right heart dz)
pulmonary HTN
64
Q

sleeping difficulties in obstructive sleep apnea

A

frequent sleep arousals
increased sleeptime respiratory effort
daytime hypersomnolence impairing school performance (CH<adults)
snoring- common in pediatric population, 15% of CH have habitual snoring on hx)

65
Q

what type of S&S might be present in children w/ obstructive sleep apnea

A

“allergic shiners”
maxillary expansion- related to chronic nasal obstruction
allergic rhinitis
tonsillar & adenoidal hypertrophy

66
Q

a polysomnography can be used to Dx what?

A

obstructive sleep apnea
it monitors oxygenation & ventilation during sleep
gas challenges to determine source of apnea (central vs. obstructive)

67
Q

besides a polysomnography, what else can be used to Dx obstructive sleep apnea?

A

lateral neck film to evaluate airway

EKG to screen for right ventricular hypertrophy

68
Q

how can you medically manage obstructive sleep apnea temporarily

A

tx allerigic rhinitis

tx tonsillitis

69
Q

surgical mgnt of obstructive sleep apnea

A

tonsillectomy & adenoidectomy

palatouvuloplasty (less common)

70
Q

DDx for wheezing

A 
pneumonia
aspiration
laryngotracheomalacia
vascular rings
airway stenoisis/Web
paratracheal adenopathy
mediastinal mass
airway FB
BPD/BOOP
CF
vocal cord paralysis
vocal cord dysfunction
cardiovascular dz (CHF)
asthma
71
Q

what is the MCC of acute hospital admissions for infants < 2yo during the winter months

A

bronchiolitis

72
Q

MCC of bronchiolitis?

A

RSV (respiratory syncytial virus)
infects ~ 1/3 of all CH q yr
immunity is NOT long lasting

73
Q

other causes of bronchiolitis?

A

influenza
parainfluenza
adenovirus

74
Q

if you have infection & inflammation of the lower airways you have?

A

bronchiolitis

75
Q

obstruction in bronchiolitis results from what?

A

edema, mucus plugging

76
Q

early findings of bronchiolitis

A

similar to typical URI- fever, rhinorrhea, cough

77
Q

later findings in bronchiolitis

A

signify lower airway dz- lower airway secretions, tachypnea

78
Q

lab tests that may be useful in Dx bronchiolitis

A

RSV & influenza enzyme immunoassay- may be useful for cohorting if performed rapidly
CXR- hyperinflation, atelectasis, multifocal ( & often shifting) infiltrates
CBC- commonly nml, may show mild lymphocytosis consistent w/ viral illness

79
Q

prevention of bronchiolitis

A

hand washing
RSV IVIG- palivizumab, given to high-risk groups during RSV season each year
*RSV infects at a high rate

80
Q

Tx of bronchiolitis

A

no curative therapy

supportive care- O2, IV fluids/freq. feedings, pulmonary toilet

81
Q

what is a pulmonary toilet?

A

nasal suction, airway clearance, positioning

82
Q

what is the MC chronic dz of CH?

A

asthma

*despite technologic advances, morbidity has increased

83
Q

what population of people have a disproportionate amt of dz burden for asthma?

A

African-Americans

84
Q

airway hyperresponsiveness to triggers resulting in excess inflammation is what?

85
Q

the processes that narrow the lumen of the airway in dz of excess inflammation (asthma) are

A 
inflammatory cell infiltration
mucus plugging
shedding of airway epithelium
mast cell activation
bronchoconstriction
86
Q

widespread small airway constriction & obstruction impairs air movnt in asthma, particulary during?

A

exhalation

87
Q

in asthma, what is evident on exam & chest plain films?

A

air trapping

88
Q

in asthma,_____________ is reduced as pt must inspire again before exhaling sufficient volume

A

tidal volume

89
Q

Asthma S&S

A

baseline sx’s may be very subtle & clinically hard to dx

there may be mild, moderate, & severe asthma exacterbation

90
Q

mild asthma exacerbation S&S

A

cough
wheeze
exercise intolerance
chest congestion

91
Q

moderate asthma exacerbation S&S

A

dyspnea
chest tightness
labored breathing

92
Q

sever asthma exacerbation S&S

A

mental status changes
may become paradoxically unlabored when entering respiratory failure
cyanosis
pulsus paradoxus

93
Q

you may have hypoxia in asthma with what?

A

significant airway compromise, or w/ significant atelectasis

94
Q

what might you see on chest plain films in asthma

A

lung hyperinflation
atelectasis related to airway plugging
peribronchial thickening/cuffing

95
Q

pulmonary function testing in asthma

A

reveal small airway dz
methacholine challenge
FEV1 reduced, FEV25-75 reduced
improvement w/ administration of B-agonist

96
Q

tx of acute asthma exacerbation

A

systemic corticosteroids
B2-agonist
ipratropium
supportive care (oxygen, hydration)

97
Q

systemic corticosteroids in athma

A

mainstay of therapy
impairs new inflammation
inflammation present in airways needs time to “burn out”

98
Q

B2-agonist in asthma

A

albuterol- briefly impairs small airway smooth muscle bronchoconstriction

99
Q

ipratropium

A

inhaled atropine analog (anticholinergic) for large airway dilation

100
Q

severe cases of asthma exacerbation may require what tx

A

parenteral B2-agonist (terbutaline)
parenteral epinephrine, magnesium, theophylline
mechanical ventilation generally avoided, but if necessary: ketamine + halothane anesthesia w/ helium-oxygen mixture

101
Q

ketamine + halothane anesthesia w/ helium-oxygen mixture can be used for?

A

mechanical ventilation in sever cases of asthma

102
Q

chronic asthma tx

A

education
medications
environment modification
reduction of exacerbating factors

103
Q

medications used in chronic asthma tx

A

inhaled corticosteroids
long-acting B2-agonist- assoc. w/ increased risk of death
leukotriene modifiers
mast cell stabilizers (cromolyn)

104
Q

environment modification in chronic asthma tx

A

Hepa filters
smoking
dust mite ctrl
pets

105
Q

reduction of exacerbating factors in chronic asthma tx

A

ID triggers & find ways to avoid
tx of reflux, sinusitis, allergic rhinitis
stress redcution
influenza vaccine

106
Q

larger tx goals in asthma

A

anti-inflammatory agents
individualized mngt plans
reduction of risks must be ongoing
early dx & vigilant monitoring w/ utilization of latest tx modalities

107
Q

atopic dermatitis

A

acute followed by chronic, superficial inflammation of the skin

108
Q

atopic dermatitis may first present w/ ?

A

acute edema
erythema
oozing & crusting

109
Q

usual progression of atopic dermatitis

A

infancy- cheeks, scalp, trunk
childhood- flexural areas
adolescence- occurs frequently in hands

110
Q

hints to diagnosing atopic dermatitis

A 
generalized dry skin
accentuation of skin markings on palms & soles
Dennie-Morgan lines
fissures at base of earlobe
hx of atopy
111
Q

symmetric depression folds just beneath the eyelids are what?

A

Dennie-Morgan lines

seen in atopic dermatitis

112
Q

hx of atopy includes what?

A 
asthma
allergic rhinitis (hay fever)
113
Q

treating atopic dermatitis

A

emollients to moisturize
topical corticosteroids- apply under emollients
anti-histamines for itching
alternatives

114
Q

emollients for atopic dermatitis

A

apply w/in 10 min of bathing (after drying)
Vaseline is oil-based
Aquaphor is water-based

115
Q

alternative tx for atopic dermatitis includes what?

A

tacrolimus
Abx to decrease bacterial superinfxn
Domeboro (acetic acid w/ aluminum acetate) soaks
sun exposure promotes malanin production

116
Q

allergic rhinitis

A 
seasonal or episododic
boggy nasal mucosa w/ clear to thin white nasal secretions
allergic shiners are frequent
nasal congestion/obstruction
may contribute to OSA
117
Q

the “allergic salute” creates what?

A

transverse nasal crease

118
Q

you want to screen for what in allergic rhinitis?

A

overuse of OTC nasal sprays that cause rhinitis medicamentosa (rebound rhinitis)

119
Q

treating allergic rhinitis

A

typically nasal steroids
also: leukotriene inhibitiors, antihistamines
incidental tx- change environment

Peds-Final (10 decks)

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