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Peds: Growth and Development > Resp > Flashcards

Resp Flashcards

1
Q

Define croup syndrome

A
  1. Croup describes acute inflammatory diseases of the larynx (acute stridor), to include:
    A. Viral croup (laryngotracheobronchitis)
    B. Epiglottitis (supraglottitis)
    C. Bacterial tracheitis
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2
Q

Describe croup

A
  1. Infectious process
  2. Severe inflammation & obstruction of upper airway
  3. Can progress to total airway obstruction: steeple sign
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3
Q

What is the pathophys of croup

A
  1. Infectious organism invades laryngeal mucosa
  2. Leads to inflammation, edema, epithelial necrosis & shedding
  3. Leads to cough &/or stridor
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4
Q

Describe viral croup

A
  1. Generally affects younger children in fall & early winter
  2. Inflammation of entire airway, especially subglottic space
    A. Can cause upper airway obstruction
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5
Q

What are the sxs of croup?

A
  1. URI sx’s
  2. +/- fever
  3. Nasal flaring
  4. Retractions
  5. Barky cough
  6. Stridor
  7. Tachypnea
  8. Tachycardia
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6
Q

What is the etiology of croup?

A 
1. Viruses (70%)
A. Parainfluenza 
B. Adenovirus 
C. RSV
D. Influenza
2. Bacteria (20%)
A. H. flu
B. B. pertussis
C. Diphtheria
3. Allergies
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7
Q

What is the ddx for croup? Prognosis?

A 
1. DDx
A. Angioneurotic edema
B. Laryngeal foreign body
C. Esophageal foreign body
D. Retropharyngeal abscess
E. Differs from epiglottitis:
-Cough 
-No drooling
2. Prognosis
A. Uneventful course that will improve w/in a few days
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8
Q

What will be seen on a neck xray for a pt with croup?

A

“Steeple sign” on neck X-ray

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9
Q

What is the treatment for mild croup?

A
  1. Barking cough & no stridor at rest
    A. Supportive therapy w/ oral hydration & minimal handling
    B. Cool air
    C. Steamy shower
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10
Q

What is the treatment for moderate croup?

A
  1. Barking cough w/ stridor at rest
    A. Oxygen if desaturation
    B. Nebulized racemic epinephrine (2.25% solution; 0.05 mL/kg diluted in sterile saline) – rapid onset w/in 10-30 min.
    C. Dexamethasone 0.6 mg/kg IM one dose or oral
    D. Budesonide 2-4mg, inhaled – onset w/in 2 hours
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11
Q

What are indications for hospitalization with croup?

A
  1. less than 1 yo
  2. resp > 50 /min
  3. Cyanosis
  4. Long distance travel
  5. 2nd trip to ER
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12
Q

What is the prognosis for croup?

A
  1. After treatment, symptoms should resolve w/in 3 hours, then can be safely discharged
  2. Recurrent nebulized epinephrine needed, then hospitalization required
  3. Respiratory distress persists intubation is required
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13
Q

Describe epiglottitis

A
  1. Inflammation of the epiglottis
  2. Can interfere w/ breathing, & constitutes a medical emergency
  3. With the advent of the HIB vaccine, the incidence of epiglottitis has decreased, but not eliminated
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14
Q

What causes epiglottitis?

A
  1. Haemophilus influenzae (most common) if not immunized
  2. Neisseria meningitides
  3. Streptococcus species
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15
Q

What is the ddx for epiglottitis?

A
  1. Angioneurotic edema
  2. Laryngeal foreign body
  3. Esophageal foreign body
  4. Retropharyngeal abscess
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16
Q

What are the sxs of epiglottitis?

A
  1. Sudden onset high fever
  2. Dysphagia
  3. Drooling
  4. Muffled voice
  5. Inspiratory retractions
  6. Cyanosis
  7. Stridor
  8. “Sniff-dog” position
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17
Q

What imaging is used for epiglottitis?

A
  1. Lateral neck x-ray

A. Classic “thumbprint” sign

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18
Q

How is epiglottitis treated?

A
  1. Once diagnosis made, immediate intubation is needed
  2. Cultures of epiglottis & blood should be taken
    IV antibiotics
    A. Ceftriaxone 50-75 mg/kg every 12 hours
  3. Extubation w/in 24-48 hours after visualization of improved epiglottis
  4. Switch to oral antibiotics for a total of 10 days of treatment
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19
Q

What is the prognosis of epiglottitis?

A
  1. Prompt recognition & appropriate treatment result in rapid resolution
  2. Recurrence is unusual
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20
Q

What is Laryngomalacia?

A

Condition where epiglottis is underdeveloped in a newborn and the cartilage cannot perform its job. Persistent stridor, dxed with larynoscopy, will be outgrow by age 2-3. worse when laying down, better when sitting up

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21
Q

What are the clinical findings for fb aspiration?

A
  1. Sudden onset of coughing, wheezing, or respiratory distress
  2. Decreased breath sounds or localized wheezing
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22
Q

What are the dx studies for fb aspiration?

A
  1. Chest x-ray can be normal up to 25% of the time

2. Inspiratory & forced expiratory CXR should be obtained

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23
Q

How is fb aspiration treated?

A
  1. Admission to hospital is required
  2. Rigid bronchoscopy under general anesthesia
  3. Clear related mucus & bronchospasms
    A. After removal, ß-adrenergic nebulization treatments begin
    B. Chest physiotherapy
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24
Q

What organisms cause CAP?

A
  1. Strep pneumoniae (most common)
  2. Haemophilus influenzae
  3. Chlamydia pneumoniae
  4. Bordetella pertussis
  5. Mycoplasma pneumoniae
  6. Legionella pneumophila
  7. Staphylococcal pneumoniae
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25
Q

What are the clinical findings for CAP?

A
  1. Fever >39°C
  2. Tachypnea
  3. Cough
  4. Crackles
  5. Decreased breath sounds
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26
Q

What are the lab test results for CAP?

A
  1. Elevated WBC w/ left shift
  2. Blood cultures
  3. Low WBC (
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27
Q

What complications are possible from CAP?

A
  1. Staphylococcal
  2. Pneumococcal
    A. Empyema
  3. Strep pneumonia
  4. Haemophilus influenzae
    A. Meningitis
    B. Otitis media
    C. Sinusitis
    D. septicemia
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28
Q

How is CAP treated in a kid less than 5 yo?

A
  1. Amoxil 80-100 mg/kg/d in divided doses
  2. Ceclor (cefaclor) 20 mg/kg/d in 3 divided doses
  3. Zithromax (azithromycin) 10mg/kg day 1, 5 mg/kg days 2-4
  4. Careful outpatient f/u w/in 1 - 5 days
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29
Q

How is CAP treated in a kid >5yo?

A

Zithromax (azithromycin) 10mg/kg day 1, 5 mg/kg days 2-4

30
Q

When should a pt with CAP be admitted?

A 
1. Age
A. less than 3 months
2. Severity of illness
3. Suspected organism
4. Parent compliance
31
Q

What causes viral pneumonia?

A
  1. RSV
  2. Parainfluenza (1, 2, & 3) viruses
  3. Influenza (A & B)
  4. Human metopneumovirus
32
Q

What are the clinical findings for viral pneumonia?

A
  1. URI precedes onset
  2. Cough
  3. Wheezing
  4. Stridor
  5. Tachypnea
  6. Retractions
  7. Grunting
  8. Nasal flaring
33
Q

What are the wbc in CAP?

A

Normal to slightly elevated

Not useful to determine between viral or bacterial infection

34
Q

What are the rapid viral methods for viral pneumonia?

A

Fluorescent antibody tests
Enzyme-linked immunosorbent assay
Polymerase chain reaction (PCR)

35
Q

What are the cxr results for viral pneumonia?

A
  1. Perihilar streaking
  2. Increased interstitial markings
  3. Peribronchial cuffing
  4. Patchy bronchopneumonia
36
Q

What complications can arise from viral pneumonia?

A

Bacterial tracheitis
Bronchiolitis obliterans
Chronic respiratory failure
Asthma

37
Q

How is viral pneumonia treated?

A

1 Supportive care

  1. Hospitalization if severely ill
  2. Antibiotics maybe started as very hard to distinguish between viral and bacterial pneumonia
  3. Uneventful recovery in most children
38
Q

What is hte most common cause of serious acute respiratory illness in infants and young children?

A
  1. Bronchiolitis

2. Applies to children

39
Q

What organisms cause bronchiolitis?

A
  1. RSV (most common)
  2. Parainfluenza
  3. Human metopneumovirus
  4. Influenza
  5. Adenovirus
40
Q

What are the sxs for bronchiolitis?

A
  1. 1-2 days of fever, rhinorrhea, & cough
  2. Followed by wheezing or crackles, tachypnea, hypoxia, and respiratory distress
  3. Shallow breathing
  4. Nasal flaring, cyanosis, retractions & rales can be present
  5. Prolongation of expiratory phases is noted w/ wheezing
  6. Sometimes apnea is seen
41
Q

How is bronchiolitis dxed?

A
  1. Viral nasal wash
    2.WBC
    A Normal
    B. Mild lymphocytosis
42
Q

What complications can arise form bronchiolitis?

A

Super-infection

Streptococcus pneumoniae leading to pneumonia

43
Q

What are the ddx for bronchiolitis?

A

Pneumonia
Asthma
CHF

44
Q

How is bronchiolitis prevented?

A

Proper handwashing

Reduce exposure to environmental factors

45
Q

How is bronchiolitis treated?

A
  1. Most can be treated as outpatient w/supportive measures

2. Infants

46
Q

What is the prognosis for bronchiolitis?

A
  1. Very good in most infants
  2. Improved supportive care and Palivizumab (Synagis) injection has decrease high-risk infant mortality
    A. Tx RSV in high risk pt
    B. Monthly IM dose during season
    C. 15 mg/kg , max 3-5 dose
47
Q

Define bronchiectasis

A

Permanent dilation of bronchi resulting from airway obstruction by retained mucus secretions or inflammation in response to chronic/repeated infection

48
Q

What causes bronchiectasis?

A

Occurs either from preceding illness (severe pneumonia or foreign body aspiration) or from an underlying systemic disorder (CF, PCD, chronic aspiration, or immunodeficiency)

49
Q

What causes bronchiectasis?

A
  1. Streptococcus pneumoniae
  2. Staph aureus
  3. Haemophilus influenzae
  4. Pseudomonas aeruginosa
50
Q

What are the sxs of bronchiectasis?

A
  1. Chronic cough
  2. Purulent sputum
  3. Fever
  4. Weight loss
  5. Recurrent respiratory infections
  6. Dyspnea on exertion
  7. Finger clubbing
  8. Rales, rhonchi, decrease air entry is noted
51
Q

What is the ddx for bronchiectasis?

A

Foreign body aspiration

Allergic bronchopulmonary aspergillosis

52
Q

How is bronchiectasis dxed?

A
  1. CXR
    A. Increased bronchovascular markings or atelectasis
  2. High-resolution CT scan of the lungs
    A. Best to determine the extent of the disease
  3. PFT
    A. Airflow obstruction
    B. Air trapping
53
Q

How is bronchiectasis treated?

A
  1. Aggressive antibiotic therapy during pulmonary exacerbations
    2 Routine airway clearance
  2. Surgical removal of lung affected that is showing poor response to medical treatment
54
Q

What is the prognosis for bronchiectasis?

A
  1. Underlying cause
  2. Severity
  3. Extent of lung involvement
  4. Response to medical management
55
Q

Describe pertussis

A
  1. Highly communicable infection

2. 50% of children

56
Q

What causes pertussis?

A

Pathogen – Bordetella pertussis

Gm (-) coccobacillus

57
Q

What is the pathophys of pertussis?

A
  1. Incubation period averages 7-14 days
  2. Invades mucosa of the nasopharynx, trachea, bronchi, & bronchioles
  3. Increases secretion of mucus
  4. Disease can last up to 6 weeks
  5. Transmission by aspiration
58
Q

What are the 3 stages of pertussis?

A
  1. Catarrhal (1-2 weeks)
  2. Paroxysmal Coughing (2-4 weeks)
  3. Convalescence (1-2 weeks)
59
Q

What are the sxs of the catarrhal stage?

A
  1. Sneezing
  2. Coryza
  3. Irritating cough
  4. Fever is rare
60
Q

What are the sxs of the Paroxysmal Coughing stage?

A
  1. Paroxysmal cough ending in loud inspiration “whoop”
  2. 10-30 consecutive coughs causing exhaustion
  3. Vomiting from gag reflex
  4. Gradually improves
61
Q

What are the sxs of the Convalescence stage?

A

Usually begin within 4 weeks
Decrease paroxysmal coughing
Vomiting decreases
Patient looking and feeling better

62
Q

What are the lab findings for pertussis?

A
  1. WBC 20,000-30,000 w/ 70%-80% lymphocytes
  2. Nasoparyngeal swabs are (+) in 80%-90% of cases in the catarrhal & early paroxysmal stages
    CXR
  3. Thickened bronchi and “shaggy” heart border
63
Q

What are the ddx for pertussis?

A
  1. Bacterial Pneumonia
  2. Tuberculous Pneumonia
  3. Chlamydial Pneumonia
  4. Viral Pneumonia
  5. Cystic Fibrosis
  6. Foreign Body Aspiration
64
Q

What are the complications for pertussis?

A
  1. Bronchopneumonia
  2. Atelectasis
  3. Otitis media
  4. Chronic Bronchiectasis
  5. Apnea
  6. Sudden Death
  7. Seizure
65
Q

How is pertussis prevented?

A 
DTaP in early infancy
Booster dose (Tdap) between 11 & 18 years & q 10 yr
66
Q

How is pertussis treated?

A
  1. **Azithromycin (10 mg/kg qd x 5 days birth-6 mo)
  2. Erythromycin > 1 mo age (40-50 mg/kg/day in 4 divided doses for 14 days)
  3. Clarithromycin > 1 mo (15 mg/kg/d in 2 in 2 divided doses x 7 d
  4. Post-exposure prophylaxis
    A. Treat all household contacts, even if immunizations are UTD
67
Q

What is the prognosis for pertussis?

A
  1. Good w/ appropriate Tx

2. Poor in infants

68
Q

Describe SIDS

A
  1. Sudden death of an infant
69
Q

What is the incidence of SIDS?

A
  1. Incidence 2 in 1,000 live births before education to reduce prone sleeping w/ the “Back to Sleep” campaign
    to 1 in 1,000 live births since
  2. New evidence shows in sudden unexpected deaths of infants (SUDI) due to accidental suffocation & unsafe sleep surfaces
70
Q

When do most sids deaths occur?

A
  1. Most deaths occur between 2-4 months

2. Most deaths occur between midnight & 8 am, when parent is asleep

71
Q

What are the risk factors for SIDS?

A
  1. More common among ethnic & racial minorities & socio-economically disadvantaged populations
  2. Risk ratio - 3:2 male to female
  3. Highest risk:
    A. Low birth weight
    B. Teenage or drug-addicted mothers
    C. Multiparity
    D. Crowded living conditions
    E. Maternal smoking
    F. (+) FH of SIDS

Peds: Growth and Development (13 decks)

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