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CKPeds > Respi > Flashcards

Respi Flashcards

1
Q

upper respiratory infection 1–3 days, then barking

cough, hoarseness, inspiratory stridor; worse at night, gradual resolution over 1 week

A

Croup

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2
Q

SIgn of Croup on Xray

A

(steeple sign if an x-ray is performed

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3
Q

MC infective agents in Acute Epiglotitis

A

– Haemophilus influenzae type B (HiB) no longer number one (vaccine success)
– Now combination of Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus
aureus, Mycoplasma

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4
Q

Signs of Acute Epiglotitis

A

– Toxic-appearing, difficulty swallowing, drooling, sniffing-position
– Stridor is a late finding (near-complete obstruction)

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5
Q

Dx of acute epiglotiis

A

Clinical first (do nothing to upset child), controlled visualization (laryngoscopy) of cherry-red, swollen epiglottis; x-ray not needed (thumb sign if x-ray is performed) followed by immediate intubation

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6
Q

Etilogy of croup vs epiglottitis

Croup ________

Epiglottitis_______

A

Parainfluenza 1,2,3

S. aureus
• S. pneumonia, S. pyogenes
• H. influenza type

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7
Q

Best accurate test of croup vs epiglottitis

Croup ________

Epiglottitis_______

A

• PCR for virus • Not needed clinically

C and S from tracheal aspirate

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8
Q

Definitive Treatment croup vs epiglottitis

Croup ________

Epiglottitis_______

A

Parenteral steroid
––Most common-single dose IM
Dexamethasone →
––Observation

• Airway (tracheostomy
if needed) + broadspectrum
antibiotics
• Then per sensitivities

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9
Q

Most common laryngeal airway anomaly and is the most frequent cause of stridor in infants and children

A

Laryngomalacia

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10
Q

Onset of Laryngomalacia

A

Starts in first 2 weeks of life, and symptoms increase up to 6 months of life; typically exacerbated by any exertion

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11
Q
  • Second most common cause of stridor

* Common presentation—recurrent/persistent croup, i.e., stridor (no difference supine vs. prone position

A

Congenital Subglottic Stenosis

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12
Q
  • Third most common cause of stridor

* May be acquired after surgery from congenital heart defects or tracheoesophageal fistula (TEF) repair

A

Vocal Cord Paralysis

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13
Q

Associations of Vocal Cord Paralysis

A

Often associated with meningomyelocele, Chiari malformation, hydrocephalus

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14
Q

Dx of Vocal Cord Paralysis

A

Diagnosis—flexible bronchoscopy

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15
Q

Age MC for FBI

A

Most seen in children age 3–4 years

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16
Q

• Most common foreign body is______

A

peanuts

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17
Q

Diagnosis of FBI

A

—Chest x-ray reveals airtrapping (ball-valve mechanism). Bronchoscopy for definite diagnosis

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18
Q

Therapy of FBI—removal by _______

A

rigid bronchoscopy

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19
Q

Infective agents for Bronchiolitis

A

respiratory syncytial virus (RSV) (50%), parainfluenza, adenovirus, Mycoplasma, other viruses

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20
Q

Pathophysio of Bronchiolitis

A

Inflammation of the small airways (inflammatory obstruction: edema, mucus, and cellular debris) → (bilateral) obstruction → air-trapping and overinflation

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21
Q

Bronchiolitis

_______may be more prominent early in young infants.

A

Apnea

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22
Q

Dx of Bronchiolitis

Chest x-ray (not routine)—

A

hyperinflation with patchy atelectasis (may look like early

pneumonia)

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23
Q

______ not routinely used; may prevent need for mechanical ventilation in severe cases

A

Ribavirin

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24
Q

Prevention of Bronchiolitis

A

Prevention—monoclonal antibody to RSV F protein (preferred: palivizumab) in high-risk patients only

25
Q

Pneumonia:

______ are predominant cause in infants and children age <5 years

A

Viruses

26
Q

VIran Pneumonia Pathogens

° Major pathogen—______
° Others—parainfluenza, influenza, adenovirus

A

RSV

27
Q

Nonviral causes more common in children _____

A

> 5 years

28
Q

MC bacterial etilogies of Pnx

A

S. pneumoniae most common with focal infiltrate in children of all ages

29
Q

° 1–3 months of age, with insidious onset
° Staccato cough
° Peripheral eosinophilia

A

Chlamydia trachomatis pneumonia:

30
Q

Xray of viral Pneumonia

A

hyperinflation with bilateral interstitial infiltrates and peribronchial cuffing

31
Q

Xray of Pneumococcal Pneumonia

A

confluent lobar consolidation

32
Q

What organism

unilateral or bilateral lower-lobe interstitial pneumonia; looks worse than presentation

A

Mycoplasma

33
Q

CBC of Chlamydia

A

Chlamydia—eosinophilia

34
Q

Abx for Hospitalized pneumonia—

A

parenteral cefuroxime (if S. aureus suspected, add vancomycin or clindamycin

35
Q

Abx for Chlamydophila or Mycoplasma—

A

erythromycin or other macrolide

36
Q

See table for pneumonia

A

okay

37
Q
  • Most common life-limiting recessive trait among whites

* Major cause of severe chronic lung disease and most common cause of exocrine pancreatic deficiency in children

A

CF

38
Q

Pathogenic findings of CF

A

dysfunction of epithelialized surfaces; obstruction and

infection of airways; maldigestion

39
Q

Autosomal recessive; _____ most prevalent among northern and central Europeans

A

CF gene

40
Q

CF gene mutations occur at a single locus on long arm of

A

chromosome 7.

41
Q

Pathogenesis of CF

A

Membranes of CF epithelial cells unable to secrete Cl– in response to cyclic adenosine monophosphate–mediated signals

42
Q

Result of the pathogenesis of CF

A

Failure to clear mucous secretions; paucity of water in mucous secretions

43
Q

________—usually first presentation of pts with CF

A

Intestinal tract

44
Q

CF: 10% of newborns with ______

A

meconium ileus

45
Q

Presentation of CF because of _________

is frequent, bulky, greasy stools and failure-to-thrive.

A

pancreatic exocrine insufficiency

46
Q

Vitamin insufficiency of pancreatic exocrine insufficiency

A

ADEK

47
Q

Sweating patterns of CF

A

° Excessive loss of salt → salt depletion, especially with hot weather or
gastroenteritis (serum–hypochloremic alkalosis)
° Salty taste of skin

48
Q

Diagnosis of CF

Any of the following:

1
2
3

Plus Any of the Following

1
2
3

A
  • Typical clinical features
  • History of a sibling with CF
  • Positive newborn screen
  • Two increased sweat chlorides on 2 separate days
  • Identification of 2 CF mutations (homozygous)
  • Increased nasal potential difference
49
Q

What is the best test for CF

A

Sweat test (best test):
° Difficult in first weeks of life
° Confirm positive results
° Diagnosis: >60 mEq/

50
Q

Other diagnostics if sweat test is negative

A

° Pancreatic function—72-hour fecal fat collection, stool for trypsin, pancreozymin-
secretin stimulation, serum immunoreactive trypsinogen (↑ in neonates)

51
Q

PFT of pts with CF

A

° By 5 years—obstructive pulmonary disease

° Then restrictive (fibrosis)

52
Q

Microbiologic test for pts with CF

A

finding in sputum of S. aureus first, followed by P. aeruginosa (mucoid forms) is virtually diagnostic (also B. cepacia, but is usually late finding)

53
Q

T or F

NBS in CF

determination of immunoreactive trypsinogen in blood
spots and then confirmation with sweat or DNA testing; does not improve pulmonary and therefore long-term outcome

A

T

54
Q

Aerosolozed Abx used in CF

A

Aerosolized antibiotics—tobramycin

55
Q

Tx of hospitalized CF patients

A

° Typical 14-day treatment
° Two-drug regimens to cover pseudomonas, e.g., piperacillin plus tobramycin
or ceftazidime

56
Q

sudden death of an infant, unexplained by history or by thorough postmortem examination including autopsy, investigation of death scene, and review of medical history;

A

Sudden Unexplained Infant Death Syndrome (SUIDS

57
Q

Autopsy findings of SIDS

A

infections; congenital anomaly; unintentional injury; traumatic child abuse; other natural causes

58
Q

Non-modifiable RF for SIDS

A 
° Low socioeconomic status
° African American and Native American
° Highest at 2–4 months of age; most by 6 months
° Highest in winter, midnight to 9 a.m.
° Males > females

CKPeds (20 decks)

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