Respi Flashcards
upper respiratory infection 1–3 days, then barking
cough, hoarseness, inspiratory stridor; worse at night, gradual resolution over 1 week
Croup
SIgn of Croup on Xray
(steeple sign if an x-ray is performed
MC infective agents in Acute Epiglotitis
– Haemophilus influenzae type B (HiB) no longer number one (vaccine success)
– Now combination of Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus
aureus, Mycoplasma
Signs of Acute Epiglotitis
– Toxic-appearing, difficulty swallowing, drooling, sniffing-position
– Stridor is a late finding (near-complete obstruction)
Dx of acute epiglotiis
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
Etilogy of croup vs epiglottitis
Croup ________
Epiglottitis_______
Parainfluenza 1,2,3
S. aureus
• S. pneumonia, S. pyogenes
• H. influenza type
Best accurate test of croup vs epiglottitis
Croup ________
Epiglottitis_______
• PCR for virus • Not needed clinically
C and S from tracheal aspirate
Definitive Treatment croup vs epiglottitis
Croup ________
Epiglottitis_______
Parenteral steroid
––Most common-single dose IM
Dexamethasone →
––Observation
• Airway (tracheostomy
if needed) + broadspectrum
antibiotics
• Then per sensitivities
Most common laryngeal airway anomaly and is the most frequent cause of stridor in infants and children
Laryngomalacia
Onset of Laryngomalacia
Starts in first 2 weeks of life, and symptoms increase up to 6 months of life; typically exacerbated by any exertion
- Second most common cause of stridor
* Common presentation—recurrent/persistent croup, i.e., stridor (no difference supine vs. prone position
Congenital Subglottic Stenosis
- Third most common cause of stridor
* May be acquired after surgery from congenital heart defects or tracheoesophageal fistula (TEF) repair
Vocal Cord Paralysis
Associations of Vocal Cord Paralysis
Often associated with meningomyelocele, Chiari malformation, hydrocephalus
Dx of Vocal Cord Paralysis
Diagnosis—flexible bronchoscopy
Age MC for FBI
Most seen in children age 3–4 years
• Most common foreign body is______
peanuts
Diagnosis of FBI
—Chest x-ray reveals airtrapping (ball-valve mechanism). Bronchoscopy for definite diagnosis
Therapy of FBI—removal by _______
rigid bronchoscopy
Infective agents for Bronchiolitis
respiratory syncytial virus (RSV) (50%), parainfluenza, adenovirus, Mycoplasma, other viruses
Pathophysio of Bronchiolitis
Inflammation of the small airways (inflammatory obstruction: edema, mucus, and cellular debris) → (bilateral) obstruction → air-trapping and overinflation
Bronchiolitis
_______may be more prominent early in young infants.
Apnea
Dx of Bronchiolitis
Chest x-ray (not routine)—
hyperinflation with patchy atelectasis (may look like early
pneumonia)
______ not routinely used; may prevent need for mechanical ventilation in severe cases
Ribavirin
Prevention of Bronchiolitis
Prevention—monoclonal antibody to RSV F protein (preferred: palivizumab) in high-risk patients only
Pneumonia:
______ are predominant cause in infants and children age <5 years
Viruses
VIran Pneumonia Pathogens
° Major pathogen—______
° Others—parainfluenza, influenza, adenovirus
RSV
Nonviral causes more common in children _____
> 5 years
MC bacterial etilogies of Pnx
S. pneumoniae most common with focal infiltrate in children of all ages
° 1–3 months of age, with insidious onset
° Staccato cough
° Peripheral eosinophilia
Chlamydia trachomatis pneumonia:
Xray of viral Pneumonia
hyperinflation with bilateral interstitial infiltrates and peribronchial cuffing
Xray of Pneumococcal Pneumonia
confluent lobar consolidation
What organism
unilateral or bilateral lower-lobe interstitial pneumonia; looks worse than presentation
Mycoplasma
CBC of Chlamydia
Chlamydia—eosinophilia
Abx for Hospitalized pneumonia—
parenteral cefuroxime (if S. aureus suspected, add vancomycin or clindamycin
Abx for Chlamydophila or Mycoplasma—
erythromycin or other macrolide
See table for pneumonia
okay
- 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
CF
Pathogenic findings of CF
dysfunction of epithelialized surfaces; obstruction and
infection of airways; maldigestion
Autosomal recessive; _____ most prevalent among northern and central Europeans
CF gene
CF gene mutations occur at a single locus on long arm of
chromosome 7.
Pathogenesis of CF
Membranes of CF epithelial cells unable to secrete Cl– in response to cyclic adenosine monophosphate–mediated signals
Result of the pathogenesis of CF
Failure to clear mucous secretions; paucity of water in mucous secretions
________—usually first presentation of pts with CF
Intestinal tract
CF: 10% of newborns with ______
meconium ileus
Presentation of CF because of _________
is frequent, bulky, greasy stools and failure-to-thrive.
pancreatic exocrine insufficiency
Vitamin insufficiency of pancreatic exocrine insufficiency
ADEK
Sweating patterns of CF
° Excessive loss of salt → salt depletion, especially with hot weather or
gastroenteritis (serum–hypochloremic alkalosis)
° Salty taste of skin
Diagnosis of CF
Any of the following:
1
2
3
Plus Any of the Following
1
2
3
- 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
What is the best test for CF
Sweat test (best test):
° Difficult in first weeks of life
° Confirm positive results
° Diagnosis: >60 mEq/
Other diagnostics if sweat test is negative
° Pancreatic function—72-hour fecal fat collection, stool for trypsin, pancreozymin-
secretin stimulation, serum immunoreactive trypsinogen (↑ in neonates)
PFT of pts with CF
° By 5 years—obstructive pulmonary disease
° Then restrictive (fibrosis)
Microbiologic test for pts with CF
finding in sputum of S. aureus first, followed by P. aeruginosa (mucoid forms) is virtually diagnostic (also B. cepacia, but is usually late finding)
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
T
Aerosolozed Abx used in CF
Aerosolized antibiotics—tobramycin
Tx of hospitalized CF patients
° Typical 14-day treatment
° Two-drug regimens to cover pseudomonas, e.g., piperacillin plus tobramycin
or ceftazidime
sudden death of an infant, unexplained by history or by thorough postmortem examination including autopsy, investigation of death scene, and review of medical history;
Sudden Unexplained Infant Death Syndrome (SUIDS
Autopsy findings of SIDS
infections; congenital anomaly; unintentional injury; traumatic child abuse; other natural causes
Non-modifiable RF for SIDS
° 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
