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PCM III final > Resp. CIS > Flashcards

Resp. CIS Flashcards

1
Q

common cause of wheezing in kids

A

Viral infections

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2
Q

What time of day is more suggestive of asthma?

A

coughin that’s worse in the middle of the night (midnight to 3 AM)

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3
Q

What are some risks for developing asthma?

A
  • RSV infection prior to 6 months of age

- patient hx or family hx of any atopy(allergic rhinitis or eczema)

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4
Q

What are some example of common triggers for asthma?

A 
virus
allergies
exercise
cold air
cigarette smoke exposure
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5
Q

What are common findings on a CXR in a child with asthma or reactive airway disease (RAD)

A

Atelectasis
Hyperinflation of both lungs
Perihilar thickening

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6
Q

What is capillary refill like in a child

A

if at 2 sec… concerning

  • > 2 sec is terrible
  • healthy kids’ cap refill nearly instantaneously!
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7
Q

What is the best way to obtain blood gases in a peds patient and what are the caveats of ordering blood gases in a peds patient?

A
  • use capillary blood gases in children
  • quicker and less distressing than arterial gas
  • can’t use PaO2 from them
  • ONLY USEFUL FOR pH and CO2
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8
Q

Where should a pediatric patient with asthma exacerbation be admitted?

A

needs to go to PICU due to significant risk for decompensation

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9
Q

Options for mainanence IVF in children?

A

1/2 NS in >1yo or 1/4 NS in <1 yo

  • NS is reserved for bolusing
  • in peds usually potassium is added to IVF
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10
Q

When is it approptiate to intubate an asthmatic patient and what are potential treatments to add prior to intubation

A
  • “EVERY ATTEMPT SHOULD BE MADE TO MAINTAIN THE KID’S RESPIRATORY STATUS IN THE PICU
  • ADD terbutalin drip, Mg, Theophylline, subcu epinephrine, heliox, IN ORDER TO NOT INTUBATE AN ASTHMATIC
  • You intubate them, they get worse and then they die
  • The time to intubate an asthmatic kid is somewhere between irritable and obtunded (them, not you)
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11
Q

Why do you no want to intubate asthmatics?

A

“they can’t exhale, so you force breaths in with the vent, they get fuller and fuller until they either get bilateral pneumothorax or acute right heart collapse and die”

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12
Q

Which population of asthmatics has the highest mortality?

A

Adolescents- because they don’t carry their rescue inhaler with them

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13
Q

What are some signs of respiratory distress in a respiratory patient?

A
  • inspiratory and expiratory wheezing
  • nasal flaring and tachypnea
  • subcostal, intercostal, and suprasternal retractions
  • stridor
  • sniffing or tripod positioning
  • decreased air movement
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14
Q

What are some treatment considerations for peds asthma?

A

-Albuterol nebulizer or inhaler
-inhaled corticosteroids
-oral corticosteroid
oxygen (put this on first if hypoxic)

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15
Q

CF shoud be in the idfferential, what would indicate concern for it and how would you test for it?

A
  • poor height and weight
  • clubbing
  • foul-smelling stools (evidence of malabsorption)
  • recurrent pneumonia
  • edema
  • failure to thrive
  • test with SWEAT CHLORIDE TEST*
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16
Q

SUDDEN stridor in a child makes you think of what?

A

foreign body aspiration

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17
Q

O2 options to consider

A

NC up to 5 L, simple face mask at 5-6 L, NRB at 10-15 L/min, bag valve mask, Bipap, intubation

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18
Q

What is GTPAL in regards to obstetrical hx taking?

A 
Gravidity= number of total preggos
Term births= devlieries 38wks or more
Preterm births= <38 weeks
Abortions=... abortions
Living children
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19
Q

What is a “total hysterectomy”?

A

take uterus and ovaries, usually but not always they take the cervix too

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20
Q

What can causes be of S2 splitting during cardiac exam?

A
  • physiologic on inspiration
  • persistent spliting dureing inspirationa nd expiration can be sensitive and specific screening for : heart disease in adults, the most likely cause being RBBB, and RV pressure overload situations such as acute massive PE is also a cause
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21
Q

What can be heard on pulmonary exam of a patient with a PE, 53% of the time?

A

rales

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22
Q

What is an invasive but highly accurate way of measuring blood pressure constantly?

A

arterial line (excellent in pts with any type of shock)

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23
Q

What labs should we consider checking for inherited thrombophilia?

A

Activated ptnC/ Factor V leiden, homocysteine level, functional assays of antithrombin III/ ptn C/ Ptn S, antiphospholipid antibodies

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24
Q

What is the most ocmmon findings on an EKG in a patient with a PE?

A

nonspecific ST-T wave abnormalities and sinus tachycardia

25
Q

What is the gold standard imaging choice for PE?

A 
CT angiogram (CTA) of the chest (PE Protocol)
-need to consider the stability of your patient before taking them to radiology
26
Q

What acan be seen on EKG that is indicative of PE?

A

S1 Q3 T3
-S in lead 1
Q in lead 3
-and an inverted T wav in lead 3

27
Q

What is tPA

A

recombinant rissue type pasminogen activator… “clot buster

  • binds to fibrin, which increases its affinitiy for plasminogen and enhances plasminogenactivation
  • systemic thrombolysis preferred as more widespread availability and can give it rapidly as compared to taking to cath lab for angiogram and direct injection to clot itself
28
Q

Are hormones pro-thrombotic?

A

yes

-Her hormone replacement therapy of Premarin is pro-thrombotic and a risk factor

29
Q

What is Factor V Leiden (FVL)?

A

mutant form of coagulation factor V

  • renders factor V insensitive to the actions of activated Ptn C, a natural anticoagulant
  • increased risk of venous thromboembolism
  • extrememly common
30
Q

What is Virchow’s triad?

A
  • a major theory delineating the pathogenesis of VTE
  • alterations in blood flow
  • vascular endothelial injury
  • Alterations in the constituents of the blood
31
Q

What are some risk factors for VTE?

A
  • FVL
  • Ptn S or C deficiency
  • malignancy
  • pregnancy or oral contraceptives
  • paroxysmal nocturnal hemoglobinuria
32
Q

What is Wells Criteria?

A
  • clinical assessment for pulmonary embolism
  • you get points for stuff
  • gives you probability for PE
  • > 6 is bad, between 6 and 2 is aight, 2 is golden
33
Q

In the modified wells criteria, what is the magic number for if we are going to have a PE or not?

A

4

34
Q

What are some absolute contraindications to fibrinolytic therapy?

A
  • prior intracranial hemorrahe
  • active bleeding
  • pretty much anything up in the brain
  • suspected aortic dissection
  • trauma
  • ischemic stroke within 3 months
35
Q

What are some relative contraindications for fibrinolytic therapy?

A

hx of chronic, severe, poorly controlled htn

  • pregnancy
  • active peptic ulcer
  • diabetic retinopathy
36
Q

What are the types of shock?

A

Hypovolemic= high systemic vascular resistance

  • Cardiogenic= high preload, low pump funciton, high afterload, <65% tissue perfusion
  • Distributive= low afterload, >65% tissue perfusion
  • Pericardial tamponade= high pre and afterload bc low pump function, <65% tissue perfusion
  • Tension pneumothorax= high afterload, >65% tissue perfusion
37
Q

What is MAP?

A

Mean arterial pressure

  • diastolic BP+ (systolic-diastolic/3)
  • > 65= good perfusion to all organs
  • <65= hypotension/hypoperfusion
38
Q

How do you Dx Nontuberculosis Mycobacterial infection- NTM (Kansaii)

A

sputum Cx and molecular diagnostics

39
Q

Dx TB fungal infection

A

Cx results, regional exposure

40
Q

Lung cancer dx:

A

histopathology

41
Q

Lymphoma dx:

A

histopathology

42
Q

> 5 mm induration on PPD

-What makes this result considered positive?

A
  • HIV
  • Close contact with actively infected person
  • CXR with fibrotic changes consistent with TB
  • Immunosuppression
43
Q

> 10 mm induration on PPD

-What makes this result considered positive?

A
  • silicosis, DM, CRF w/ dialysis, malignancies….anything that would increase risk of reactivation
  • children <4
  • from country with high prevalence
  • Residents/employees in high risk setting: jail, healthcare facilities, mycobacterium labs, homeless shelters
44
Q

> 15 mm induration on PPD

-what makes this result considered positive?

A

Healthy individual >4 with low likelihood of true TB infecion

45
Q

Anergy, nothing on PPD

-what does this mean?

A

no rxn secondary to immune unresponsiveness

46
Q

What are some signs and symptoms that are associated with active pulmonary TB?

A

-fever
-night sweat
-cough
weight loss
lymphadenopathy

47
Q

What do we do for the workup and dx of TB?

A

Sputum culture (SCx)
Sputum staining: RA initially then Zeihl neelsen to confirm
-PPD skin test (mantoux)
-IFN gamma release assay: used for dx of LATENT TB… indicates there has been a cellular response to TB
-CXR: CAVITARY LESIONS IN APICES OF LUNGS
-NAAT: nucleic acid amplification test

48
Q

What is the indication for IGRA?

A

individuals who have recieved a BCG vaccination and those witha positive PPD in whom latent TB is suspected

49
Q

What is the 4 drug standard therapy for TB?

A
  • isoniazid (INH)
  • Rifampin
  • Pyazinamide
  • Ethambutol
50
Q

Side effect of INH

A

Hepatitis, N/V, peripheral neuropathy (give pt. Vitamin B6), rash

51
Q

Side effect of Rifampin

A

-Red/orange body fluids, N/V, rash, hepatitis, Steven-Johnson’s syndrome

52
Q

Side effect of Pyrazinamide

A

Urticaria, hyperuricemia/gout, hepatitis, joint aches

53
Q

side effect of ethambutol

A

optic neuritis, color-blindness

54
Q

Clinical diagnosis of active TB

A
  • clinical symptoms (bloody cough… etc.)
  • assess risk factors (close contact, immigrants, IV drugs… etc)
  • order radiography
  • Sputum culture
55
Q

Do you delay treatment if clinical diagnosis and awaiting culture?

A

no

-For active TB, start the four drug therapy (INH, rifampin, pyrazinamide, ethambutol)

56
Q

Latent TB considerations

A
  • clinically silent but can become active

- Get screening PPD

57
Q

if there’s no history of BCG vaccination, what do you do along with the PPD?

A

Check CXR to make sure there is no Active TB

-if negative, treat as latent TB with 9 months of INH

58
Q

If there is a hx of BCG vaccine, what do you do along with PPD skin testing?

A
  • Check CXR and IGRA
  • if CXR is negative and IGRA positive, treat as latent TB with 9 months of INH
  • if they are both negative, there is no active or latent TB, positive PPD was from BCG vaccine and there is NO TREATMENT NEEDED!

PCM III final (4 decks)

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