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PEDS > Pulmonology-Notes > Flashcards

Pulmonology-Notes Flashcards

1
Q

In neonates, what EKG finding may accompany hypoxia?

A

bradycardia

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2
Q

What is the best non-invasive way to determine pulmonary function? Best invasive way?

A

Non-invasive way: FVC

Invasive way: Arterial PO2

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3
Q

What is the ddx of wheezing?

A 
asthma
bronchiolitis
cystic fibrosis
tracheomalacia
foreign body aspiration
CHF
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4
Q

T/F Hilar lymphadenopathy can be normal in kiddos

A

False. Never normal, no matter the age.

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5
Q

What is the ddx for hilar lymphadenopathy?

A

Malignant: lymphoma, mets
Infectious: TB, histoplasmosis
Inflammation: sarcoidosis (would be bilateral)

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6
Q

What are the causative agents for bronchiolitis?

A

RSV
parainfluenza
human metapneumovirus
adenovirus

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7
Q

What is the presentation of bronchiolitis?

A

wheezing & crackles
coughing
rhinorrhea
tachypnea

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8
Q

What is the detailed mechanism behind bronchiolitis?

A

upper and lower resp infection

upper: nasal congestion, rhinorrhea
lower: edema, epithelial cell necrosis, bronchospasm, increased mucous (atelectasis, hyperinflation)

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9
Q

What is the workup for bronchiolitis?

A

Rapid RSV and influenza tests

CXR: see lung hyperinflation, peribronchial thickening, increased interstitial markings

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10
Q

What is the treatment for bronchiolitis?

A

supplemental O2
racemic epi PRN
hypertonic saline (decreases mucous)
high risk: palivizumab (prophylaxis)

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11
Q

What is the pathophysiology of bronchopulmonary dysplasia?

A

decreased number of alveoli (larger)
decreased vascular growth
decreased surfactant and antioxidant capacity

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12
Q

What is a part of the presentation of bronchopulmonary dysplasia?

A 
a kiddo who needed oxygen for the first 28 days
chronic resp symptoms
preterm birth (
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13
Q

What are the possible complications of bronchopulmonary dysplasia?

A 
URI can lead to episodic respiratory distress
pulmonary HTN
R heart failure
Asthma
Exercise intolerance
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14
Q

What is the treatment for bronchopulmonary dysplasia?

A

supplemental oxygen
diuretics for pulmonary edema
albuterol if wheezing.

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15
Q

What is ALTE?

A

apparent life threatening event
episode of apnea
decreased muscle tone
choking/gagging.

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16
Q

What are the possible causes of ALTE?

A 
GERD
idiopathic
infections
cardiac
laryngospasm
seizures
hypoxemia
prematurity
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17
Q

What is the ddx for inspiratory stridor?

A 
laryngomalacia
tracheomalacia
croup
laryngospasm
epiglottis
subglottic stenosis
vascular rings
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18
Q

What is the ddx for expiratory stridor?

A

tracheomalacia
bronchomalacia
subglottic stenosis?

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19
Q

What is the fancy name for broup

A

laryngotracheobronchitis

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20
Q

What is laryngomalacia?

A

floppy larynx
age 4-8mo
infantile inspiratory stridor

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21
Q

What is something that helps laryngomalacia?

A

worsens in supine position

BETTER on BELLY (not working against gravity)

22
Q

What is the workup for laryngomalacia?

A

flexible laryngoscopy
resolves by 1 year
no real treatment, but supraglottoplasty if there is FTT with it.

23
Q

What is tracheomalacia?

A

floppy cartilage, trachea can collapse
positive intrathoracic pressure obstructs expiration
expiratory stridor with wheeze

24
Q

What is the workup and treatment for tracheomalacia?

A

workup: CXR to r/o mass
nasal CPAP
tracheostomy

25
Q

What are the causes of croup? workup? treatment?

A 
parainfluenza
influenza
adenovirus
metapneumovirus
diphtheria/measles in unvaccinated kids
CXR-steeple sign (subglottic narrowing)
dexamethasone
racemic epi O2
26
Q

What is epiglottitis?

A

inflammation of epiglottis

  1. Hib
  2. staph and strep
27
Q

What is the presentation and workup of epiglottitis?

A 
high fever
sore throat
inspiratory stridor
drooling with dysphagia
muffled voice (hot potato)
hyperextended noice
CXR: thumbprint
sometimes see AMS
28
Q

Which antibiotics are indicated in epiglottitis?

A

ceftriaxone for hib coverage

vancomycin for staph and strep coverage

29
Q

Aside from epiglottitis what else can produce a hyperextended neck? excessive drooling?

A

excessive drooling: tracheoesophageal fistula

hyperextended neck vascular rings

30
Q

When do vascular rings present? What is the presentation?

A

before age 1
stridor, wheezing, cough, dysphagia, difficulty breathing
improves with neck extension

31
Q

What is the workup for vascular rings?

A

barium contrast esophogram
bronchoscopy
CT

32
Q

T/F Stridor improves in the prone position for laryngomalacia.

A

False. it improves with hyperextended neck

prone position helps laryngomalacia

33
Q

What is the pathophysiology of asthma?

A

airway hyper-responsiveness th2, igE mediated
get obstruction
bronchospasm
rhonchi are from increased secretions
get inflammation–>fibrosis–>SM hypertrophy
decreased FEV1/FVC
spiral shaped mucous plugs (Curshmann spirals)
eosinophil derived crystals (Charcot-Leyden Crystals)

34
Q

Which symptoms, nighttime awakenings, # times use rescue inhaler, exacerbations requiring oral steroids…
fit with intermittent asthma?

A

symptoms:

35
Q

Which symptoms, nighttime awakenings, # times use rescue inhaler, exacerbations requiring oral steroids…
fit with mild asthma?

A 
symptoms: >2d/wk, not daily
rescue inhaler: >2d/wk, not daily
nighttime awakenings: 1-2/mo
minor limitation on activities
~4/yr steroid exacerbations
36
Q

Which symptoms, nighttime awakenings, # times use rescue inhaler, exacerbations requiring oral steroids…
fit with moderate asthma?

A

daily symptoms and need for rescue inhaler
nighttime awakenings: 3-4X/mo
some limitation on activity
~4/yr steroid exacerbations

37
Q

Which symptoms, nighttime awakenings, # times use rescue inhaler, exacerbations requiring oral steroids…
fit with severe asthma?

A

all day symptoms and >1X/d need for rescue inhaler
>1X/wk nighttime awakenings
extremely limited activity level
~4/yr steroid exacerbations

38
Q

If Albuterol PRN isn’t working…what is the next step?

A

Low dose steroid (fluticasone, budesonide, beclamethasone)

+ Albuterol PRN

39
Q

If low dose steroid + Albuterol PRN isn’t working…what is the next step?

A

Low dose steroid + LABA + montelukast + albuterol PRN

40
Q

If low dose steroid + LABA + montelukast + albuterol prn isn’t working…what is the next step

A

change the low dose steroid to a medium or high dose steroid

41
Q

What are the LABAs?

A 
formeterol (faster acting)
and salmeterol (20 min until action onset)
42
Q

What are some possible causes of asthma exacerbations?

A 
rhinovirus
RSV
HMV
influenza
mycoplasma
chlamydia
fungi
tree
weed
grass
pollen
animal exposures
chemical exposures
airway pollutants
43
Q

What is the workup for an asthma exacerbation?

A

peak flow

44
Q

What defines status asthmaticus?

A

an attack SO bad that there is no response to bronchodilators

45
Q

What is the treatment for an asthma exacerbation?

A

albuterol q1h nebulizer
ipratropium nebulized
methylprednisolone PO

if no response: magnesium sulfate
if no response: terbutaline
if no response: intubation

46
Q

What is aspirin exacerbated respiratory disease?

A

happens in patients with asthma and chronic rhinosinusitis who are on aspirin
difficulty breathing, chest tightness

47
Q

What is bronchiectasis?

A

obstructive lung dx-permanent dilation of bronchioles and bronchi, get air trapping
necrotizing chronic inflammation
lots of sputum, recurrent resp infections

48
Q

What is a possible cause of bronchiectasis?

A

cystic fibrosis

49
Q

What are some multisystemic presentations for cystic fibrosis?

A 
bronchiectasis
meconium ileus (failure to pass w/i first 24 hours)
pancreatic insufficiency, DM
chronic rhinosinusitis
nasal polyposis
fatty liver
50
Q

How do you diagnose pancreatic insufficiency?

A

CCK-secretin stimulation
measure bicarb (decreased)
bentiromide test (will decrease PABA in pts with steatorrhea)]
quantitative fecal fat excretion

51
Q

What is the treatment for the respiratory symptoms of Cystic fibrosis?

A

antibiotics
albuterol
DNAse mucolytic
chest physiotherapy

PEDS (14 decks)

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