Repiratory Flashcards
____ causes 80-90% of childhood respiratory infections.
Viruses
what is stridor?
upper airway
what is a wheeze
lower airway
what is caused by cough?
acute , paroxysmal, chronic
what is rhonchi?
low not on musical scale, fluid in big airways
what are crackles/rales?
fluid or atelectasis in small airways
what shows work of breathing?
retractions, grunting
what does barium swallow show?
TrachealEsoh Fistual, GER, vascular rings
what does CT show?
parenchymal changes , lung interstitium, Masses
what does MRI show?
Subtle abnormalities and vascular rings- not as helpful
what do laryngoscopy and bronchoscopy?
look for obstructions and malacia, foreign bodies
what is the mainstay study for pulmonary?
CXR
what is malacia? who is it seen in?
softening, younger kids
what are ways for O2 to be given? what sat do you wanna reach
Oxygen – Nasal Cannula , blended(air tank and o2 tank) O2 for SaO2 > 90%
what is CPT?
chest physiotherapy to loosen secretions
where s upper airway and what noise do you hear….
supraglottic= extrathoracic
Stridor
Structure / function / infection
what is lower airway and what do you hear in lower airway…
Lower Airways = subglottic = intrathoracic
Wheezing
Structure /Function / infection
what is an acute Upper airway obs cause stridor?
infection – croup , epiglottitis
what is structure airway obstruction cause stridor?
laryngomalacia, subglottic stenosis
what is a fxnl upper airway obs cause stridor?
vocal cord paralysis by recurrent laryngeal n.
what are risk factors of stridor?
Difficult delivery, ductal ligationPDA, intubation, infection, FB
what imp hx things should we know for stridor?
sx at rest? Or with agitation, feeding, positional (snore?), Other sx of infection?
what is the mainstay study for stridor?
CXR
what is stridor?
inspiratory deep wheeze
what is Croup? what does it cause?
Acute inflammatory disease of the larynx - common
Acute Inspiratory Stridor
when do you get Croup and who gets it?
Fall and early winter, younger children(6mo-3yr
what is # 1 that causes Croup? others?
Parainfluenza (RSV, influenza, adenovirus, roseola,mycoplasm pneumoniae)
what are symptoms of croup?
Edema in subglottic space
Prodrome URI followed by barking cough
Fever low grade or none usually
what do we see on xray for Croup
Xray with subglottic narrowing and normal epiglottis
how do you we test for croup?
Viral swab for respiratory viruses
how do we treat croup? mild? if at rest?
– mild cases – supportive. (+/- mist)
Stridor at rest -> O2, racemicepi neb, dexamethasone 0.6mg/kg IM x1, (possibly oral dex x 1dose)
“Go outside in the cold air “
If croup symptoms resolve within ____ and there is no stridor at rest – can go home
3 hrs
what if we need to do recurrent nebs for croup?
If recurrent nebs (Q 20 min > 1-2 hrs) needed, hospitalize.
when do most get better from croup?
Most children have uneventful course and improve within a few days.
what does a viral resp panel test? 9
Influenza A virus Influenza B virus Respiratory syncytial virus Human metapneumovirus Parainfluenza virus type 1 Parainfluenza virus type 2 Parainfluenza virus type 3 Adenovirus Streptococcus pneumoniae
what is bacterial tracheitis
croup - Invasion of bacteria into mucosa of pt with viral croup
what bacteria cause bacterial tracheitis
Staph Aureus ( H flu, S. pyogenes, Morax cat)
what are symotoms of bacterial tracheitis
Inflammatory edema, purulent secretions,
High fever, toxic, severe obstruction
Severe life threatening from of laryngotracheobronchitis
how do you treat bacterial tracheitis
Hospitalization and monitoring, suctioning, hydration. IV ABX for Staph Aureus. More likely to need intubation.
what are symptoms of epiglottis
Inspiratory stridor
Resp distress
Drooling
Sudden onset
what are causes of epiglottis
Hflu type B ( deceased incidince since HiB immunization) – now GAS , and Staph A
what should you do first for epiglottis?
intubate
what does cxr show in epiglottis
Lateral neck xrays. “Thumb sign”
Get xray before touching pt if you suspect this
what is the most common cause of stridor in infants?
Laryngomalacia
what is Laryngomalacia
Underdeveloped cartilaginous structures
when is Laryngomalacia worse
when supine activity infection and during feedings
when dose Laryngomalacia improve?
Improves with age and resolves by 2 years.
Vocal Cord paralysis is from?
Congenital or trauma/injury
what are symptoms of Vocal Cord paralysis
Hoarseness, aspiration and high pitched stridor
what is subglottic stenosis from?
Congenital or from intubation - Mild to severe with serious obstruction of airway
wat are symptoms of subglottic stenosis? this t might have recurrent___?
Stridor after extubation
Suspect in Pt with recurrent croup
what does vascular ring cause? and is from?
stridor or wheeze Airway compression (PDA, abberant inominant artery)
what is the common symptom of lower airway?
is wheeze
what is acute lower airway d/o?
asthma, bronchiolitis , foreign body
what is chronic lower airway d/o
tracheomalacia , vascular ring
how can vascular ring and tracheomalacia be both wheeze and stridor
it can occur in any area
what is recurrent lower airway d/o?
asthma
what is progressive lower airway d/o
– CF or bronchiolitis obliterans
what hx do we wanna know about lower airway d/o?
Age of pt, cough, sputum , response to bronchodialators, sx with positional changes, other organs involved
what PE do we want to get for lower airway d/o
VS and growth, cyanosis, pallor, barrel chest, retractions, clubbing
what studies should we get for lower airway d/o?
CXR, sweat test, PFT in older children
what is Tracheomalacia
Tracheomalacia / bronchomalacia – inadequate cartilaginous support of airway. Excessive collapse in expiration
how can you get Tracheomalacia
Congenital or aquired
what are sx of Tracheomalacia
Coarse wheezing, cough, stridor,
Sx present over 1st few months of life
Worsens with infection
when does it resolve?
Resolves as child grows
if Tracheomalacia is severe?
tracheostomy
where does a foreign body lodge in URT
Usually lodge supraglottic and triggering protective laryngospasm
what is the onset of foreign body lodge in URT
Abrupt onset – partial or complete – NO blind finger sweeps
how do you treat child <1 with foreign body lodge in URT
1 turn over onto their chest and 5 measured back blows between the shoulder blades, followed by 5 chest compressions if needed – repeat
how do you treat child over 1 with foreign body lodge in URT
Heimlich maneuver (abdominal thrusts)
how does lower resp tract foreign body present?
Sudden cough, wheeze of respiratory distress
what are symptoms of lower resp tract foreign body
Suspect in pt with chronic wheeze, pneumonias, asymmetric chest sounds
how do we work up and treat lower resp tract foreign body
CXR – nl up to 25% of time.
Abnl = hyperinflation with air trapping
Flexible/Rigid bronchoscopy
Beta adrenergic nebs and CPT
what causes bronchiolitis?
RSV
what is leading cause of hospitalization in infants?
bronchiolitis
when do children get bronchiolitis
Approximately 50% of children experience bronchiolitis during the first 2 years of life, with a peak age at 2 to 6 months
what are symptoms of bronchiolitis
Cough, coryza, rhinorrhea… over 3-7 days to noise raspy breathing and audible wheeze
in young infants bronchiolitis may present with…
apnea
how is bronchiolitis spread?
Spread by secretions – very contagious
what are other causes of bronchiolitis?
Human metapneumovirus, Parainfluenza, influenza, adenovirus,
when you get bronchiolitis
late winter months from November through March.
what has high morbidity with bronchiolitis
underlying med conditions ie CLD, CF, CHD, immunodeficiency.
how do you dx bronchiolitis?
viral swab
what may show on cxr of bronchiolitis?
normal or wet appearing – peribronchial cuffing, increased intestitial markings, hyperinflation
what kid of virus is RSV
RNA-Unstable in the environment, survives only a few hours on surfaces. Killed by soap and water
who gets RSV most often?
Most common cause of bronchiolitis and pneumonia in children < 1 yr
what are symptoms of RSV
Characteristically, the symptoms in infants are fever, prominent runny nose, and congestion, coupled with wheezing. The duration of these symptoms is 1 to 2 weeks.
what is the vaccine for RSV
Synagis (palivizumab) – monoclonal antibody. Q month during season in at risk infants (typically < 2 yrs of age)
1 cause of pneumonia in children?
viral
what causes bact pneumonia most often?
strep pneumo
symptoms of Viral Pneumonia?
URI prodrome + wheezing and stridor +/-fever
Myalgia, malaise, headache
what is walking pneumonia -
Viral Pneumonia
what causes Viral Pneumonia?
RSV , parainfluenza , influenza A and B, human metapneumovirus
do labs show with Viral Pneumonia
WBC often normal or mild elevation of lymphocytes
CXR – perihilar streaking, increased interstitial markings or patchy bronchopneumonia
what viral pneumo can cause narcotizing pneumonia?
adenovirus
how and when does pt appear with Viral Pneumonia
Pt appear less toxic – more often fall and winter
how do we tx Viral Pneumonia
Therapy is supportive. Identify at risk pt (BPD, asthma, RSV, CHD) for hospitalization (antibiotics commonly started)
what is the symptoms of bacterial pneumonia
fever, chills, cough, dyspnea. Rales or decreased breath sounds
Infants may have few or nonspecific findings on history and PE
what will labs show for bacterial pneumonia? blood and radiology?
Increased WBC (or decreased) , increased neutrophils
CXR (AP and LAT) define bacterial pneumonia
Patchy infiltrates, atelectasis, hilaradenopathy, pleural effusions. Possibly complete lobar consolidation in infants
Clinical condition improves before xray
what is the cause of bacterial pneumonia
strep pneumo
how do you treat bacterial pneumonia?
Amox, augmentin, Erythromycin Cefuroxime
what are the mainstay labs for bacterial pneumonia?
CXR and CBC
when does bacterial pneumonia occur?
anytime of the year
1-5 yrs ,Most common causes of pneumo are
resp syncytial virus (RSV) in infants , respiratory viruses (RSV, parainfluenza viruses, influenza viruses, adenoviruses)
> 5 yrs most common cause of pneumonia
is Mycoplasma pneumoniae
on xray of bacterial pneumonia…
will have a lot more dense white streaky areas….
Streptococcus pneumoniae is…
most common cause of bacterial pneumonia
Lobar pneumonia,
6 yr old,
high fever, cough, chest pain
most common patho and how do you treat?
strep pneumonia, amox
how do you treat mycoplasma pneumonia?
erythromycin
12 yr old
Cough, fever, wheeze
Bilateral, perihilar, peribronchial thickening and shaggy infiltrates
… what is it
Diffuse viral bronchopneumonia
14yr old with malaise, dry cough, mild shortness of breath x 1 week Xray findings No focal infiltrates Increased interstitial markings what is the organism? tx?
Mycoplasm pneumoniae - erythromycin
Which immunizations have impacted the causal organisms of pneumonia in children?
Prevnar ( 13 types of strep pneumonia)
HiB
what is pertussis?
Whooping Cough due to Bordetella pertussis
what is the pk incidence of pertussis
<4mo
when do you immunize for pertussis
2,4,6,12-15mo and 4-6 yr
when does pertussis occur
July – October (via cough)
Incubation 6 days – most contageous
what are the symptoms stages of pertussis?
Catarrhal : URI 1-2 weeks
Paroxysmal : Staccato cough with inspiratory whoop and post tussive vomiting 2-4 weeks
Convalescent: Dry cough 1-2 weeks
how do you work up pertussis
Culture from NP Swab gold standard
how do you treat pertussis?
Treatment Erythromycin /azithromycin– treat family
how do adolescents present with pertussis
Adolescents present with prolonged bronchitis, persistent non-productive cough – often begins as a URI.
Don’t whoop but may have paroxysms
Cough can last weeks to months
how ma infants present with pertussis
apnea
what is CF?
chronic progressive disease Abnormally thick secretions due to problems of salt and water movement across cell membranes
how does CF present?
present with protein and fat malabsorption (failure to thrive, hypoalbuminemia, steatorrhea), liver disease (cholestatic jaundice), or chronic respiratory infection
what does CF affect?
Affect airways, biliary tree, intestines, sweat ducts, pancreatic ducts, vas deferens
what should make you suspicious for CF?
MECONIUM ILEUS – so thick and hard and stuck
Severe intestinal obstruction from inspissation of tenacious meconium in terminal ileum
In infancy – Failure to thrive
Frequent bulky foul smelling greasy stools
Protein and fat malabsorption
Frequent pneumonias / bronchitis
Staph aureus and Hflu_ pseudomonas
NASAL POLYPS
how do you dx CF?
sweat test
what is shown on PE of CF
digital clubbing , chronic sinusitis, nasal polyposis
what should ppl with CF supplement?
Pancreatic enzyme replacement
ADEK
what are 3 congenital malformations of respiratory?
Pulmonary hypoplasia
Sequestration
CCAM
what has decreased in alveolar number and airways
Lack of space , achondroplasia or CDH (1:2200)
Low amniotic fluid
Low amount of fetal breathing
pulm hypoplasia
what has non functioning pulmonary tissue that does not ommunicate with tracheobronchial tree. Blood supply from anomalous blood supply
pulm sequestration
what is 95% congenital cystic lung disease, R=L
has cystic tissues on CXR .
CCAM
what are 2 problems with diaphragm?
Eventration and CDH
what is elevation of part or all of diaphram
Striated muscle replaced with connective tissues
Congenital , acquiried
If large, paradoxical movement of diaphram
eventration
how do we treat evantration
surgery
what is Herniation of abdominal contents into chest
CDH
how do we treat CDH?
Surgery
Intubate – OG tube to decompress stomache and intestines
what is Pectus Excavatum
depression of sternum/ anterior chest wall
what is pectus carinatum? more common in?
protrusion of sternum/ anterior chest wall – more common in males,
what has….poor air entry, or poor diaphram excursion.
may be found by Recurrent pneumonia, hypoventilation , resp failure
NM disease
in alveloi what are type I cells
form the structure of an alveolar wall
in alveoli type II cells secrete?
surfactant
what is RDS? who gets? how do you treat?
= surfactant deficiency
< 35 weeks
Can give surfactant via ETT (endotracheal tube
what is “Chronic Lung disease” or PMD?
from RDS
Sequellae of sufactant deficiency / prematurity
30% in infants < 1000g at birth.
if you still need O2 at 28 days what do you have?
chronic lung disease
what causes chronic lung disease?
Early lung injury with inflammation fibrotic tissue and vascular remodeling
what are they at risk for with chronic lung disease?
Pulm HTN and reactive airway disease
what is ALTE?
Apparent Life threatening Events in Infancy
how does ALTE present?
Apnea / color change / decreased muscle tone / emesis/ choking/ gagging
what is the most freq cause of ALTE?
GER and laryngomalactia most common (50%)
what is ALTE associated with?
SIDS
what is ALTE thought to relate to?
immaturity
what is SIDS
Sudden Death of infant < 1yr old that remains unexplained
who are the most deaths of SIDS in
Most deaths in < 6 mo
what are risk factors of SIDS
3:2 males to females
Lowbirthweight, smoking, teenage mother, drug addicted mother
