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Pediatrics > Repiratory > Flashcards

Repiratory Flashcards

1
Q

____ causes 80-90% of childhood respiratory infections.

A

Viruses

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2
Q

what is stridor?

A

upper airway

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3
Q

what is a wheeze

A

lower airway

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4
Q

what is caused by cough?

A

acute , paroxysmal, chronic

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5
Q

what is rhonchi?

A

low not on musical scale, fluid in big airways

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6
Q

what are crackles/rales?

A

fluid or atelectasis in small airways

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7
Q

what shows work of breathing?

A

retractions, grunting

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8
Q

what does barium swallow show?

A

TrachealEsoh Fistual, GER, vascular rings

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9
Q

what does CT show?

A

parenchymal changes , lung interstitium, Masses

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10
Q

what does MRI show?

A

Subtle abnormalities and vascular rings- not as helpful

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11
Q

what do laryngoscopy and bronchoscopy?

A

look for obstructions and malacia, foreign bodies

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12
Q

what is the mainstay study for pulmonary?

A

CXR

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13
Q

what is malacia? who is it seen in?

A

softening, younger kids

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14
Q

what are ways for O2 to be given? what sat do you wanna reach

A

Oxygen – Nasal Cannula , blended(air tank and o2 tank) O2 for SaO2 > 90%

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15
Q

what is CPT?

A

chest physiotherapy to loosen secretions

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16
Q

where s upper airway and what noise do you hear….

A

supraglottic= extrathoracic
Stridor
Structure / function / infection

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17
Q

what is lower airway and what do you hear in lower airway…

A

Lower Airways = subglottic = intrathoracic
Wheezing
Structure /Function / infection

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18
Q

what is an acute Upper airway obs cause stridor?

A

infection – croup , epiglottitis

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19
Q

what is structure airway obstruction cause stridor?

A

laryngomalacia, subglottic stenosis

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20
Q

what is a fxnl upper airway obs cause stridor?

A

vocal cord paralysis by recurrent laryngeal n.

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21
Q

what are risk factors of stridor?

A

Difficult delivery, ductal ligationPDA, intubation, infection, FB

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22
Q

what imp hx things should we know for stridor?

A

sx at rest? Or with agitation, feeding, positional (snore?), Other sx of infection?

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23
Q

what is the mainstay study for stridor?

A

CXR

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24
Q

what is stridor?

A

inspiratory deep wheeze

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25
Q

what is Croup? what does it cause?

A

Acute inflammatory disease of the larynx - common

Acute Inspiratory Stridor

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26
Q

when do you get Croup and who gets it?

A

Fall and early winter, younger children(6mo-3yr

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27
Q

what is # 1 that causes Croup? others?

A

Parainfluenza (RSV, influenza, adenovirus, roseola,mycoplasm pneumoniae)

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28
Q

what are symptoms of croup?

A

Edema in subglottic space
Prodrome URI followed by barking cough
Fever low grade or none usually

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29
Q

what do we see on xray for Croup

A

Xray with subglottic narrowing and normal epiglottis

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30
Q

how do you we test for croup?

A

Viral swab for respiratory viruses

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31
Q

how do we treat croup? mild? if at rest?

A

– 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 “

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32
Q

If croup symptoms resolve within ____ and there is no stridor at rest – can go home

A

3 hrs

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33
Q

what if we need to do recurrent nebs for croup?

A

If recurrent nebs (Q 20 min > 1-2 hrs) needed, hospitalize.

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34
Q

when do most get better from croup?

A

Most children have uneventful course and improve within a few days.

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35
Q

what does a viral resp panel test? 9

A 
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
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36
Q

what is bacterial tracheitis

A

croup - Invasion of bacteria into mucosa of pt with viral croup

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37
Q

what bacteria cause bacterial tracheitis

A

Staph Aureus ( H flu, S. pyogenes, Morax cat)

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38
Q

what are symotoms of bacterial tracheitis

A

Inflammatory edema, purulent secretions,

High fever, toxic, severe obstruction
Severe life threatening from of laryngotracheobronchitis

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39
Q

how do you treat bacterial tracheitis

A

Hospitalization and monitoring, suctioning, hydration. IV ABX for Staph Aureus. More likely to need intubation.

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40
Q

what are symptoms of epiglottis

A

Inspiratory stridor
Resp distress
Drooling
Sudden onset

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41
Q

what are causes of epiglottis

A

Hflu type B ( deceased incidince since HiB immunization) – now GAS , and Staph A

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42
Q

what should you do first for epiglottis?

A

intubate

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43
Q

what does cxr show in epiglottis

A

Lateral neck xrays. “Thumb sign”

Get xray before touching pt if you suspect this

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44
Q

what is the most common cause of stridor in infants?

A

Laryngomalacia

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45
Q

what is Laryngomalacia

A

Underdeveloped cartilaginous structures

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46
Q

when is Laryngomalacia worse

A

when supine activity infection and during feedings

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47
Q

when dose Laryngomalacia improve?

A

Improves with age and resolves by 2 years.

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48
Q

Vocal Cord paralysis is from?

A

Congenital or trauma/injury

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49
Q

what are symptoms of Vocal Cord paralysis

A

Hoarseness, aspiration and high pitched stridor

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50
Q

what is subglottic stenosis from?

A

Congenital or from intubation - Mild to severe with serious obstruction of airway

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51
Q

wat are symptoms of subglottic stenosis? this t might have recurrent___?

A

Stridor after extubation

Suspect in Pt with recurrent croup

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52
Q

what does vascular ring cause? and is from?

A 
stridor or wheeze
Airway compression (PDA, abberant inominant artery)
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53
Q

what is the common symptom of lower airway?

A

is wheeze

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54
Q

what is acute lower airway d/o?

A

asthma, bronchiolitis , foreign body

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55
Q

what is chronic lower airway d/o

A

tracheomalacia , vascular ring

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56
Q

how can vascular ring and tracheomalacia be both wheeze and stridor

A

it can occur in any area

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57
Q

what is recurrent lower airway d/o?

A

asthma

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58
Q

what is progressive lower airway d/o

A

– CF or bronchiolitis obliterans

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59
Q

what hx do we wanna know about lower airway d/o?

A

Age of pt, cough, sputum , response to bronchodialators, sx with positional changes, other organs involved

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60
Q

what PE do we want to get for lower airway d/o

A

VS and growth, cyanosis, pallor, barrel chest, retractions, clubbing

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61
Q

what studies should we get for lower airway d/o?

A

CXR, sweat test, PFT in older children

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62
Q

what is Tracheomalacia

A

Tracheomalacia / bronchomalacia – inadequate cartilaginous support of airway. Excessive collapse in expiration

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63
Q

how can you get Tracheomalacia

A

Congenital or aquired

64
Q

what are sx of Tracheomalacia

A

Coarse wheezing, cough, stridor,
Sx present over 1st few months of life
Worsens with infection

65
Q

when does it resolve?

A

Resolves as child grows

66
Q

if Tracheomalacia is severe?

A

tracheostomy

67
Q

where does a foreign body lodge in URT

A

Usually lodge supraglottic and triggering protective laryngospasm

68
Q

what is the onset of foreign body lodge in URT

A

Abrupt onset – partial or complete – NO blind finger sweeps

69
Q

how do you treat child <1 with foreign body lodge in URT

A

1 turn over onto their chest and 5 measured back blows between the shoulder blades, followed by 5 chest compressions if needed – repeat

70
Q

how do you treat child over 1 with foreign body lodge in URT

A

Heimlich maneuver (abdominal thrusts)

71
Q

how does lower resp tract foreign body present?

A

Sudden cough, wheeze of respiratory distress

72
Q

what are symptoms of lower resp tract foreign body

A

Suspect in pt with chronic wheeze, pneumonias, asymmetric chest sounds

73
Q

how do we work up and treat lower resp tract foreign body

A

CXR – nl up to 25% of time.
Abnl = hyperinflation with air trapping
Flexible/Rigid bronchoscopy
Beta adrenergic nebs and CPT

74
Q

what causes bronchiolitis?

A

RSV

75
Q

what is leading cause of hospitalization in infants?

A

bronchiolitis

76
Q

when do children get bronchiolitis

A

Approximately 50% of children experience bronchiolitis during the first 2 years of life, with a peak age at 2 to 6 months

77
Q

what are symptoms of bronchiolitis

A

Cough, coryza, rhinorrhea… over 3-7 days to noise raspy breathing and audible wheeze

78
Q

in young infants bronchiolitis may present with…

A

apnea

79
Q

how is bronchiolitis spread?

A

Spread by secretions – very contagious

80
Q

what are other causes of bronchiolitis?

A

Human metapneumovirus, Parainfluenza, influenza, adenovirus,

81
Q

when you get bronchiolitis

A

late winter months from November through March.

82
Q

what has high morbidity with bronchiolitis

A

underlying med conditions ie CLD, CF, CHD, immunodeficiency.

83
Q

how do you dx bronchiolitis?

A

viral swab

84
Q

what may show on cxr of bronchiolitis?

A

normal or wet appearing – peribronchial cuffing, increased intestitial markings, hyperinflation

85
Q

what kid of virus is RSV

A

RNA-Unstable in the environment, survives only a few hours on surfaces. Killed by soap and water

86
Q

who gets RSV most often?

A

Most common cause of bronchiolitis and pneumonia in children < 1 yr

87
Q

what are symptoms of RSV

A

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.

88
Q

what is the vaccine for RSV

A

Synagis (palivizumab) – monoclonal antibody. Q month during season in at risk infants (typically < 2 yrs of age)

89
Q

1 cause of pneumonia in children?

A

viral

90
Q

what causes bact pneumonia most often?

A

strep pneumo

91
Q

symptoms of Viral Pneumonia?

A

URI prodrome + wheezing and stridor +/-fever

Myalgia, malaise, headache

92
Q

what is walking pneumonia -

A

Viral Pneumonia

93
Q

what causes Viral Pneumonia?

A

RSV , parainfluenza , influenza A and B, human metapneumovirus

94
Q

do labs show with Viral Pneumonia

A

WBC often normal or mild elevation of lymphocytes

CXR – perihilar streaking, increased interstitial markings or patchy bronchopneumonia

95
Q

what viral pneumo can cause narcotizing pneumonia?

A

adenovirus

96
Q

how and when does pt appear with Viral Pneumonia

A

Pt appear less toxic – more often fall and winter

97
Q

how do we tx Viral Pneumonia

A

Therapy is supportive. Identify at risk pt (BPD, asthma, RSV, CHD) for hospitalization (antibiotics commonly started)

98
Q

what is the symptoms of bacterial pneumonia

A

fever, chills, cough, dyspnea. Rales or decreased breath sounds
Infants may have few or nonspecific findings on history and PE

99
Q

what will labs show for bacterial pneumonia? blood and radiology?

A

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

100
Q

what is the cause of bacterial pneumonia

A

strep pneumo

101
Q

how do you treat bacterial pneumonia?

A

Amox, augmentin, Erythromycin Cefuroxime

102
Q

what are the mainstay labs for bacterial pneumonia?

A

CXR and CBC

103
Q

when does bacterial pneumonia occur?

A

anytime of the year

104
Q

1-5 yrs ,Most common causes of pneumo are

A

resp syncytial virus (RSV) in infants , respiratory viruses (RSV, parainfluenza viruses, influenza viruses, adenoviruses)

105
Q

> 5 yrs most common cause of pneumonia

A

is Mycoplasma pneumoniae

106
Q

on xray of bacterial pneumonia…

A

will have a lot more dense white streaky areas….

107
Q

Streptococcus pneumoniae is…

A

most common cause of bacterial pneumonia

108
Q

Lobar pneumonia,
6 yr old,
high fever, cough, chest pain
most common patho and how do you treat?

A

strep pneumonia, amox

109
Q

how do you treat mycoplasma pneumonia?

A

erythromycin

110
Q

12 yr old
Cough, fever, wheeze

Bilateral, perihilar, peribronchial thickening and shaggy infiltrates
… what is it

A

Diffuse viral bronchopneumonia

111
Q 
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?
A

Mycoplasm pneumoniae - erythromycin

112
Q

Which immunizations have impacted the causal organisms of pneumonia in children?

A

Prevnar ( 13 types of strep pneumonia)

HiB

113
Q

what is pertussis?

A

Whooping Cough due to Bordetella pertussis

114
Q

what is the pk incidence of pertussis

A

<4mo

115
Q

when do you immunize for pertussis

A

2,4,6,12-15mo and 4-6 yr

116
Q

when does pertussis occur

A

July – October (via cough)

Incubation 6 days – most contageous

117
Q

what are the symptoms stages of pertussis?

A

Catarrhal : URI 1-2 weeks
Paroxysmal : Staccato cough with inspiratory whoop and post tussive vomiting 2-4 weeks
Convalescent: Dry cough 1-2 weeks

118
Q

how do you work up pertussis

A

Culture from NP Swab gold standard

119
Q

how do you treat pertussis?

A

Treatment Erythromycin /azithromycin– treat family

120
Q

how do adolescents present with pertussis

A

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

121
Q

how ma infants present with pertussis

A

apnea

122
Q

what is CF?

A

chronic progressive disease Abnormally thick secretions due to problems of salt and water movement across cell membranes

123
Q

how does CF present?

A

present with protein and fat malabsorption (failure to thrive, hypoalbuminemia, steatorrhea), liver disease (cholestatic jaundice), or chronic respiratory infection

124
Q

what does CF affect?

A

Affect airways, biliary tree, intestines, sweat ducts, pancreatic ducts, vas deferens

125
Q

what should make you suspicious for CF?

A

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

126
Q

how do you dx CF?

A

sweat test

127
Q

what is shown on PE of CF

A

digital clubbing , chronic sinusitis, nasal polyposis

128
Q

what should ppl with CF supplement?

A

Pancreatic enzyme replacement

ADEK

129
Q

what are 3 congenital malformations of respiratory?

A

Pulmonary hypoplasia
Sequestration
CCAM

130
Q

what has decreased in alveolar number and airways
Lack of space , achondroplasia or CDH (1:2200)
Low amniotic fluid
Low amount of fetal breathing

A

pulm hypoplasia

131
Q

what has non functioning pulmonary tissue that does not ommunicate with tracheobronchial tree. Blood supply from anomalous blood supply

A

pulm sequestration

132
Q

what is 95% congenital cystic lung disease, R=L

has cystic tissues on CXR .

A

CCAM

133
Q

what are 2 problems with diaphragm?

A

Eventration and CDH

134
Q

what is elevation of part or all of diaphram
Striated muscle replaced with connective tissues
Congenital , acquiried
If large, paradoxical movement of diaphram

A

eventration

135
Q

how do we treat evantration

A

surgery

136
Q

what is Herniation of abdominal contents into chest

A

CDH

137
Q

how do we treat CDH?

A

Surgery

Intubate – OG tube to decompress stomache and intestines

138
Q

what is Pectus Excavatum

A

depression of sternum/ anterior chest wall

139
Q

what is pectus carinatum? more common in?

A

protrusion of sternum/ anterior chest wall – more common in males,

140
Q

what has….poor air entry, or poor diaphram excursion.

may be found by Recurrent pneumonia, hypoventilation , resp failure

A

NM disease

141
Q

in alveloi what are type I cells

A

form the structure of an alveolar wall

142
Q

in alveoli type II cells secrete?

A

surfactant

143
Q

what is RDS? who gets? how do you treat?

A

= surfactant deficiency
< 35 weeks
Can give surfactant via ETT (endotracheal tube

144
Q

what is “Chronic Lung disease” or PMD?

A

from RDS
Sequellae of sufactant deficiency / prematurity
30% in infants < 1000g at birth.

145
Q

if you still need O2 at 28 days what do you have?

A

chronic lung disease

146
Q

what causes chronic lung disease?

A

Early lung injury with inflammation  fibrotic tissue and vascular remodeling

147
Q

what are they at risk for with chronic lung disease?

A

Pulm HTN and reactive airway disease

148
Q

what is ALTE?

A

Apparent Life threatening Events in Infancy

149
Q

how does ALTE present?

A

Apnea / color change / decreased muscle tone / emesis/ choking/ gagging

150
Q

what is the most freq cause of ALTE?

A

GER and laryngomalactia most common (50%)

151
Q

what is ALTE associated with?

A

SIDS

152
Q

what is ALTE thought to relate to?

A

immaturity

153
Q

what is SIDS

A

Sudden Death of infant < 1yr old that remains unexplained

154
Q

who are the most deaths of SIDS in

A

Most deaths in < 6 mo

155
Q

what are risk factors of SIDS

A

3:2 males to females

Lowbirthweight, smoking, teenage mother, drug addicted mother

Pediatrics (9 decks)

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