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Respiratory Flashcards

1
Q

Respiratory Assessment

-1- of -2-

A
  1. Type and location

2. breath sounds

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2
Q

Respiratory Assessment - Transmitted voice sounds

-1-: auscultate while patient says -2-; if more of a long -3-, possible -4-

A
  1. Egophony
  2. “EEE”
  3. “AAA”
  4. consolidation
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3
Q

Respiratory Assessment - Transmitted voice sounds

Bronchophony: -1- chest wall; ask pt to say -2- repeatedly; -3- auscultation = -4-

A
  1. Hold stethoscope at
  2. “99”
  3. clear, distinct
  4. abnormal (consolidation)
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4
Q

Respiratory Assessment - Transmitted voice sounds

-1-: auscultate as patient -2-; if -3- and distinct, -4-

A
  1. Whisper pectoriloquy
  2. whispers, “1, 2, 3”;
  3. clear
  4. possible consolidation
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5
Q

Respiratory Assessment
> -1- if -2- of age and -3-
> Inspect -4-

A
  1. PFTs
  2. greater than 8 years
  3. cooperative
  4. work of breathing (nasal flaring, intercostal or supraclavicular contractions, grunting, head bobbing)
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6
Q

Respiratory Assessment - Obstructive Disease

Characterized by -1- rates; -2- within -3- or -4-

A
  1. reduced airflow
  2. lung volumes
  3. normal range
  4. larger
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7
Q

Respiratory Assessment - Obstructive Disease

Typical of a child -1- (air trapping) which results in decreased rates and FEV1 (e.g., -2-, -3-, -4-)

A
  1. having trouble exhaling (Obstructive, breathing Out)
  2. asthma
  3. chronic bronchiolitis
  4. cystic fibrosis
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8
Q

Respiratory Assessment - Restrictive Disease
> characterized by -1- and -2-
> Typical of a child that has -3-, thus affecting the -4- (e.g., -5-)

A
  1. reduced volumes
  2. expiratory flow rates
  3. trouble inhaling air
  4. volume
  5. pneumonia
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9
Q

Bronchiolitis
Def: a disease of the lower respiratory tract that causes -1- leading to obstruction of the -2-
> Typically noted among children -3- of age

A
  1. inflammation
  2. small respiratory airways
  3. < 3 years
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10
Q

Bronchiolitis

> Most cases result from a -1- (e.g., -2-, -3-, -4-, -5-, among others)

A
  1. viral infection
  2. RSV
  3. rhinovirus
  4. parainfluenza
  5. adenovirus
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11
Q

Bronchiolitis - S/S
> -1- symptoms lasting for several days
> moderate fever: -2-

A
  1. URI

2. 102F (38.9C)

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12
Q

Bronchiolitis - S/S

Gradual development of -1- (e.g., -2-, -3-, -4-, cyanosis, prolonged expiration)

A
  1. respiratory distress
  2. nasal flaring
  3. grunting
  4. intercostal retractions
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13
Q

Bronchiolitis - S/S
Respiratory Distress
> -1- (-2-)
> -3-

A
  1. Tachypnea
  2. 60-80/minute
  3. non-productive cough
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14
Q 
Bronchiolitis - S/S
Respiratory Distress
> -1-
> progressive -2-
> -3-
A
  1. paroxysmal wheezing
  2. stridor
  3. cyanosis
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15
Q

Bronchiolitis - S/S

Palpable -1- (-2- due to -3-)

A
  1. liver & spleen
  2. pushed down
  3. hyperinflated lungs
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16
Q

Bronchiolitis - Lab/Dx
> -1- with -2-; may have scattered areas of consolidation
> -3- of nasal washing may be -4- (-5-)

A
  1. CXR
  2. hyperinflated lungs
  3. immunofluorescence assay (IFA)
  4. positive for RSV
  5. or flu
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17
Q

Bronchiolitis - Mgmt
> Infants with mild distress can be treated as outpatients with -1-
> -2- in -3- infants with -4- IM every -5- during RSV season

A
  1. supportive care
  2. Prevention of RSV
  3. high-risk
  4. palivizumab (Synagis)
  5. month
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18
Q

Bronchiolitis - Mgmt
> The -1- for those who -2- Synagis includes the following:
» -3- of age with -4- treated w/in -5-

A
  1. criteria
  2. should receive
  3. < 2 years
  4. chronic lung disease
  5. 6 months of RSV season
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19
Q 
Bronchiolitis - Mgmt - Synagis criteria
> -1- during the first year of life
> Infants between -2- may be treated if -3- are present: 
>> exposure to -4-
>> -5- impairments
A
  1. Premature infant (<32 weeks gestation)
  2. 33 and 35 weeks gestation
  3. certain risk factors
  4. high URI populations/environmental irritants
  5. mechanical or neuromuscular
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20
Q 
Asthma - Pathophys
> -1-
> Mucosal -2- and hyperemia
> -3- and -4- by -5-
> thickening of epithelial basement membrane: -6-
A
  1. hypertrophy of smooth muscle
  2. edema
  3. acute inflammation
  4. plugging of airways
  5. thick, viscid mucus
  6. remodeling
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21
Q 
Asthma - Causes
> Most common -1- are encountered indoors, so you need -2-
>> -3-
>> -4-
>> -5-
A
  1. allergens
  2. a detailed history
  3. pets
  4. dust mites
  5. cockroaches
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22
Q

Asthma - Causes
> Allergens
» Indoor -1-
> -2-

A
  1. molds

2. exercise

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23
Q 
Asthma - Causes
> Airway irritants
>> -1-
>> -2-
>> -3- or -4-
>> -5-
A
  1. cigarettes
  2. air pollution
  3. paints
  4. sealants
  5. cleaning agents
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24
Q 
Asthma - Causes
> Airway irritants
>> -1-
>> -2-
>> -3-
A
  1. cold air
  2. medications
  3. respiratory infections
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25
Asthma - S/S > Respiratory -1- > -2- or -3- in sentences > -4-
1. distress at rest 2. difficulty catching breath 3. speaking 4. diaphoresis
26
``` Asthma - S/S > Use of -1- > -2- may be -3- > Chest -4- > -5- ```
1. accessory muscles 2. nighttime symptoms 3. common 4. Chest Tightness 5. HYPERRESONANCE
27
Asthma - Ominous signs > -1- --> -2- > -3-
1. absent breath sounds 2. ED 3. Cyanosis
28
Asthma - Lab/Dx > -1- reveal -2- that are typical of -3- > A -4- in unnecessary unless used to -5-
1. PFTs 2. abnormalities 3. obstructive dysfunction 4. CXR 5. r/o other conditions (infection)
29
``` Asthma - Classification of Severity (age 5-11) > SABA Rescue Inhaler Use >> Mod Persistent: -1- >> Severe persistent: -2- >Activity Level >> Severe Persistent: -3- > Lung Function >> Intermittent: -4- >> Moderate persistent: -5- ```
1. Daily 2. > 1/day 3. **Extremely Limited** 4. >80% FEV1 p during exacerbations (otherwise normal) 5. 60-80% FEV1p
30
``` Asthma - Classification of Severity (age 5-11) > Intermittent >> SABA Rescue inhaler use: -1- > Mild Persistent >> Symptoms: -2- > Severe Persistent >> Symptoms: -3- >> Nighttime Awakenings: -4- >> Lung Functioning: -5- ```
1. 2- d/wk (Rule of 2s) 2. >2d/wk 3. throughout the day 4. frequently, *sometimes nightly* 5. FEV1 < 60% predicted
31
``` Asthma - Classification of Severity (age 5-11) > Intermittent >> Symptoms: -1- > Mild Persistent >> Nighttime awakenings: -2- >> SABA Rescue inhaler use: -3- >> Activity level: -4- > Moderate persistent >> Activity level: -5- ```
1. 2- d/wk (Rule of 2s) 2. 3-4/month 3. >2 d/wk, not daily 4. minor limitation 5. Some limitation
32
``` Asthma - Classification of Severity (age 5-11) > Intermittent >> Nighttime awakenings: -1- >> Activity level: -2- > Mild Persistent >> Lung Function: -3- > Moderate persistent >> Symptoms: -4- >> Nighttime awakenings: -5- ```
1. 2- /month (Rule of 2s) 2. No impairment 3. FEV1 >80% predicted (never normal) 4. Daily (in waves) 5. >1/wk, not nightly
33
Asthma - Mgmt NHLBI/NAEPP Asthma Guidelines > Focus on...
...achieving and maintaining control (keeping up activity)
34
Asthma - Mgmt - Asthma Control | > -1- is/are part of the preferred treatment plan for -2- across all age groups; closely monitor growth
1. Inhaled corticosteroids | 2. persistent asthma
35
Asthma - Mgmt - Asthma Control | > Moderate to severe persistent asthma (-1-): -2- in -3- as a -4- and -5-
1. 4+ years old 2. ICS w/ formoterol 3. a single inhaler 4. daily controller 5. reliever therapy
36
Asthma - Mgmt - Asthma Control | > When -1-, combination therapy is recommended and -2- are the preferred agents to combine with ICS in patients -3-
1. stepping up treatment 2. Long-acting beta-2 adrenergic agonists (LABAs, like Advair) 3. > 12 years of age
37
Asthma - Mgmt - Asthma Control > mgmt guidelines by three distinct age groupiongs: -1-, -2-, and -3- years of age >> With consideration for: -4- and -5-
1. 0-4 2. 5-11 3. 12+ years 4. current impairment 5. future risk
38
Asthma - Mgmt - Asthma Control > More -1- >> initially -2- until -3- >> If -3-, -4- and follow up -5-
1. frequent monitoring 2. every 2-4 weeks 3. control is achieved 4. uncontrolled 5. escalate treatment steps 6. every 2 wks-
39
``` Asthma - Mgmt - Asthma Control > Severe Persistent >> Lung Function >>> 0-4: -1- >> Systemic Corticosteroid Use >>> 5-11: -2- >> Recommended Step >>> 0-4: -3- > Mild Persistent >> Recommended Step: -4- ```
1. N/A (Lung function not tested in this age group, any severity) 2. Risk relative to FEV1 (lower prediction percentage, higher risk) 3. Step 3 (Med ICS! + sys corticosteroids?); REFER (moderate too) 4. Step 2 (add Low-Dose ICS alternative: Cromolyn or montelukast)
40
``` Asthma - Mgmt - Asthma Control > Intermittent >> FEV1/FVC: -1- >> Systemic Corticosteroid Use: -2- >> Recommended Step: -3- > Severe Persistent >> Systemic Corticosteroid Use >>> 0-4 years: -4- >> Recommended Step >>> 5-11: -5- ```
1. > 85% 2. < 2/year 3. Step 1: SABA+PRN for both age groups 4. 2+ uses in 6 months; high-risk children: 4+ >1-day wheezing episodes in a year 5. step 3: Med dose ICS; OR Step 5 ICS + sys corticosteroids?
41
``` Asthma - Mgmt - Asthma Control > FEV1/FVC >> Mild Persistent: -1- >> Moderate: -2- >> Severe: -3- > Recommended Step >> Moderate: -4- ```
1. > 80% 2. 75-80% 3. < 75% 4. Step 3: Med dose ICS + sys corticosteroids?
42
Pneumonia | Def: Inflammation of the -1- as microorganisms gain access by -2-, inhalation, or hematogenous dissemination
1. lower respiratory tract | 2. aspiration
43
PNA Etiologies by Cohort > -1-: GABHS, -3- (-4-); -5-
1. Newborns 3. chlamydia 4. GABHS & chlamydia are transferred vertically 5. E. Coli
44
PNA Etiologies by Cohort > Children < 6 years: -2-, -3-, -4-, (-5-)
2. RSV 3. H. influenzae 4. s. pneumoniae 5. CAP
45
PNA Etiologies by Cohort -1- through -2-: -3-, -4-, -5-
1. Preschool 2. young adulthood 3. S. pneumoniae 4. mycoplasma 5. chlamydia
46
PNA Etiologies by Cohort > -1-: -2- or -3- > Depending on age group, -4- of all PNAs are -5-
1. immunocompromised or malnourished 2. (P. jirovecii PNA) PJP 3. fungi 4. 50 - 80% 5. viral
47
``` PNA S/S > -1- > -2- > -3- on physical exam > -4- oxygenation in severe distress > -5- ```
1. fever 2. shaking chills 3. lung consolidation 4. pulse-ox: decreased 5. Egophony: EEE to AAA (evidence of consolidation)
48
``` PNA Lab/Dx > Infiltrates by CXR >> patchy infiltrates w/ -5- >> lobar consolidation w/ -6- > -2- is common with -3- PNA > -4-: may be warranted if cough is productive (age dependent) ```
2. increased WBC 3. bacterial 4. sputum culture 5. E. Coli 6. S. Pneumoniae
49
``` PNA Mgmt of CAP > Pharm Tx r/t etiology >> -1-: -2- >> -3- such as -4- for -5- ```
1. amoxicillin 2. s. pnuemoniae 3. macrolides 4. azithromycin 5. m. pneumoniae
50
PNA Mgmt of CAP > Pharm Tx r/t etiology >> -1- or -2-: -3-
1. Amoxicillin 2. 3rd gen cephalosporin 3. H. influenzae
51
``` PNA Mgmt of CAP > -1- PNA >> Supportive measures: -2- >> -3- only if -4- are present ```
1. Viral 2. hydration and antipyretics 3. ABX 4. secondary bacterial infections
52
``` PNA Mgmt of CAP > Viral PNA >> Humidified -1- and -2- (at the -3-) >> -4- to improve -5- ```
1. oxygen 2. chest physiotherapy 3. hospital 4. bronchodilators 5. airway clearance
53
PNA Mgmt of CAP > Supportive measures: -1-
1. force fluids
54
Cystic Fibrosis | -1- with a -2- mutation, which produces a -3- in -4- resulting in -5-
1. **AUTOSOMAL RECESSIVE** disorder 2. chromosome 7, long arm 3. defect 4. epithelial chloride transport 5. Dehydrated, thick secretions
55
CF | A chronic multisystem disorder affecting the -1-, -2-, -3-, and -4-
1. Respiratory 2. GI 3. hepatobiliary 4. reproductive tracts
56
CF | Characterized by -1-, progressive -2-, and pancreatic insufficiency w/ intestinal -3-
1. recurrent infections 2. obstructive lung disease 3. malabsorption
57
CF > Most common in the -1- > Life expectancy -2-
1. caucasian population | 2. 30+ years (improving)
58
CF - S/S > Viscid -1- (or -1- -2-) in -3- > Recurrent -4- > Large, liquid, bulky, foul stool (-5-)
1. meconium 2. ileus 3. newborns 4. respiratory infections 5. steatorrhea
59
``` CF - S/S > -1- skin > -2- deficiencies > -3- to -4- > -5- ```
1. Salt-tasting 2. fat-soluble vitamin 3 & 4. FTT 5. infertility
60
``` CF - Lab/Dx > Pilocarpine iontophoresis (-1-) > -2-: obstructive pattern > -3- (alkalosis) > -4-: cystic lesions, atelectasis ```
1. sweat test 2. PFTs 3. Hyponatremic, Hypochloremic, dehydration 4. CXR
61
``` CF - Mgmt Referral for spec mgmt > -1- > -2- > anti-inflammatory control (i.e., -3-) > -4- > -5- support ```
1. respiratory secretion care 2. chest PT 3. steroids 4. nutritional status (ADEK) 5. psychosocial
62
Pertussis | Def: AKA -1-; contagious respiratory illness cause by -2-; can cause serous complicatoins in -3- (-4-)
1. whooping cough 2. b. pertussis 3. infants & young children 4. before the first & second Dtap (2&4 months)
63
``` Pertussis - S/S -1- last for 1-2 weeks > -2- nose > -3- > Mild, -4- ```
1. early symptoms 2. runny 3. low-grade fever 4. occasional cough
64
Pertussis - S/S -1- symptoms can last for 10+ wks > -2- followed by a -3- sound
1. late-stage 2. paroxysms 3. "whoop"
65
Pertussis - Dx | ... test
PCR
66
Pertussis - Tx > Abx (-1-), within -2- of -3- > Do not -4-
1. az-/clarithromycin 2. first 3 weeks 3. infection 4. use cough medications (they don't help)
67
Pertussis - Tx | -1- to avoid -2- and small, frequent -3- to prevent -4-
1. Fluids 2. dehydration 3. meals 4. vomiting
68
Respiratory syncytial virus (RSV) is the -1- of bronchiolitis and pneumonia in children -2- of age. For children under 6 months, -3-. In developed countries, the fatality rate is -4-, with deaths attributable to respiratory arrest/failure or -5-.
1. most common etiology 2. under 1 year 3. 1-2% require hospitalization 4. <1% 5. severe **dehydration**/electrolyte disturbances
69
RSV Bronchiolitis -1- are seen in children with comorbidities such as -2- and immunodeficiency, as well as in those with complex medical needs. In infants -3- of age, RSV infection may result in symptoms of irritability, -4-, lethargy, and/or apnea with or without fever.
1. Higher mortality rates 2. congenital heart disease 3. under six months 4. poor feeding
70
RSV Bronchiolitis In -1-, rhinorrhea and decreased appetite may appear -2- days before cough, often followed by sneezing, fever, and sometimes -3-.
1. older infants/young children 2. one to three 3. wheezing
71
RSV Bronchiolitis Paroxysms of coughing may trigger -1-, that along with poor oral intake and tachypnea, increase the -2-. Therefore, the -3- of an infant with bronchiolitis needs to be carefully monitored. Typically an infant with a good -3- will have -4- wet diapers -5-.
1. vomiting 2. risk of dehydration 3. hydration status 4. at least 6 5. per 24 hours
72
RSV Bronchiolitis The first -1- hours after the onset of cough are the most critical. The child can be -2- but gradually improves over a period of several days. -3- is expected for more than -4- and a fever of up to 102˚ F (38.9˚ C) is common in the -5- of illness, which further contributes to the risk of dehydration.
1. 48 to 72 2. ill-appearing 3. Wheezing 4. 5 days 5. first 3-7 days
73
RSV Bronchiolitis | Coughing commonly continues for -1- and may cause the infant to -2-, also affecting the infant’s -3-.
1. 2-3 weeks 2. vomit on occasion 3. hydration

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