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Pediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Assessment of Respiratory System

A

PQRST
P- promoting, preventing, precipitating, palliating factors
Q- quality or quantity
R- region or radiation
S- severity, setting, simultaneous, similar illnesses in past
T- temporal factors

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2
Q

PQRST: P

A
  • Contacts: those with similar illness
  • Prevention: medications, supplements, handwashing
    -Progression: increasing or decreasing in severity
    -Treatment: what has been used?
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3
Q

PQRST: Q

A

quality or quanitity
- How severe are the symptoms?

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4
Q

PQRST: R

A

region or radiation
- Complaints of chest pain?

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5
Q

PQRST: S

A

-Key signs/symptoms/associated symptoms
-Similar illnesses

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6
Q

PQRST: T

A

temporal factors
- When did illness begin?
- Acute or insidious onset?
- How long?

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7
Q

Indications for tonsillectomy and adenoidectomy

A
  • > 7 throat infections/past year
  • > 5 throat infections/past 2 years
  • > 3 throat infections/past 3 years
  • recurrent peritonsllar abscess
  • periodic fever with aphthous ulcers/adenopathy
  • obstructive sleep apnea
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8
Q

What is pharyngitis?

A

inflammation of mucosal lining of throat - tonsils, pharynx, uvula, soft palate, nasopharynx

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9
Q

Viral sources of pharyngitis

A
  1. EBV
  2. HSV
  3. CMV
  4. enterovirus
  5. influenza
  6. parainfluenza
  7. HIV
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10
Q

Bacterial source of pharyngitis

A

group B strep

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11
Q

Clinical findings of acute viral pharyngitis

A
  1. pain
  2. myalgia/arthralgia
  3. fever
  4. sore throat/dysphagia
  5. rhinitis, cough, hoarseness, stomatitis
  6. gradual onset
  7. erythema tonsils/pharynx
  8. reactive cervical lymphadenopathy
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12
Q

Virus-Specific Findings of Pharyngitis: EBV

A

exudate on tonsils, soft palate

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13
Q

Virus-Specific Findings of Pharyngitis: adenovirus

A

follicular pattern on pharynx

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14
Q

Virus-Specific Findings of Pharyngitis: enterovirus

A

vesicles/ulcers on tonsils

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15
Q

Virus-Specific Findings of Pharyngitis: HSV

A

ulcers anteriorly/marked adenopathy

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16
Q

Virus-Specific Findings of Pharyngitis: parainfluenza/RSV

A

more lower tract disease

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17
Q

Diagnostic Studies for acute viral pharyngitis, tonsillitis, or tonsillopharyngitis

A
  1. RADT/culture
  2. GABHS screen if indicated: rare <3 years
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18
Q

Management of acute viral pharyngitis, tonsillitis, or tonsillopharyngitis

A
  1. supportive care
  2. adequate fluid intake
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19
Q

Clinical Findings for acute bacterial pharyngitis, tonsillitis, or tonsillopharyngitis

A
  • 5 to 13 yo most common
  • abrupt onset without nasal symptoms
  • arthralgia, myalgia, HA
  • moderate high fever, malaise
  • prominent sore throat, dysphagia
  • nausea, abd discomfort, vomitting
  • common in late winter/early spring
  • petechiae on soft palate/pharynx, swollen beefy red uvula
  • yellow, blood tinged exudate
  • tender enlarged anterior cervical lymph nodes
  • bad breath
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20
Q

Diagnostic Studies for acute bacterial pharyngitis, tonsillitis, or tonsillopharyngitis

A
  1. RADT
  2. ASO not useful for acute infections
  3. STI testing if indicated
  4. If mononucleosis suspected: CBC, heterophile, antibody testing
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21
Q

Management of for acute bacterial pharyngitis, tonsillitis, or tonsillopharyngitis

A
  1. antibiotics in symptomatic child only
  2. supportive care
  3. NO steroids
  4. return to school when on antibiotics for 24 hours
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22
Q

PANDAS

A

a rare complication of acute bacterial pharyngitis, tonsillitis, or tonsillopharyngitis

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23
Q

5 Criteria to diagnose PANDAS

A
  1. OCD or tic disorder
  2. Perpubertal onset
  3. Abrupt onset; relapsing/remitting course
  4. Clear association with GABHS
  5. Neurologic abnormalities
24
Q

What is rhinosinusitis?

A

inflammation/edema of mucous membranes in sinuses - bacterial invasion

25
Q

Clinical Findings for Rhinosinusitis

A
  • duration determines classification
  • acute presentation: high fever, purulent nasal discharge
  • HA, bad breath, fatigue
  • facial pain, congestion, post nasal drip
26
Q

Management of Rhinosinusitis

A
  • refer chronic/recurrent to ENT
  • treat with antibiotics if URI lasts > 10 days with purulent discharge, cough, or worsening fever
  • NO decongestants
  • NO antihistamines
  • NO topical steroids
  • NO saline irrigation
  • analgesics
27
Q

Clinical Findings of Nasal Foreign Body

A
  • persistent/recurrent unilateral purulent discharge
  • foul odor, epistaxis, obstruction, mouth breathing
28
Q

What is croup?

A

Acute, inflammatory disease of larynx, trachea, bronchi

29
Q

Clinical Findings of Croup

A
  • brassy, barking cough
  • stridor
  • URI with acute onset of hoarse, barking cough
  • mild to severe laryngeal obstruction, stridor
  • symptoms worse at night
  • epiglottis appears normal
  • prolonged inspiration
  • wheezing/rales if lower airway involvement
  • fever
  • slight dyspnea
30
Q

Diagnostic Studies for croup

A
  • clinical diagnoses
  • subglottic narrowing on radiograph
31
Q

Management of Croup

A
  • humidified air
  • nebulized epinephrine
  • corticosteroids
  • NO cold medicines
  • bronchodilators
  • O2 if sat below 92%
  • heliox for severe croup
32
Q

Indications/Treatment for Hospitalization for Croup

A
  • RR 70-90
  • temp higher than 102.2
  • racemic epi in conjunction with steroids
  • hydration & IV fluids
33
Q

What is epiglottitis?

A

inflammation of epiglottis by H. influenzae type B, usually from 1-5 years

34
Q

Clinical Findings of Epiglottitis

A
  • abrupt onset of fever
  • severe sore throat
  • dyspnea
  • inspiratory distress without stridor
  • drooling, aphonia, high fever
  • rapidly progressive resp obstruction
  • severe retractions
  • hyperextension of neck
35
Q

Diagnostic Studies for Epiglottitis

A
  1. blood cultures
  2. lateral neck radiograph before physical exam with provider capable of intubation present
36
Q

Management of Epiglottitis

A
  • acute otolaryngologic emergency
  • establish airway; start antimicrobials IV
  • resp support (O2)
37
Q

Prevention of Epiglottitis

A

flu vaccine

38
Q

What is bronchiolitis?

A

Inflammation, necrosis, edema of resp epithelial cells in small airways
* Viral illness, primarily RSV

39
Q

Clinical Findings of Bronchiolitis

A
  • URI symptoms
  • gradual development of resp distress
  • low grade to moderate fever
  • decreased appetite
  • coryza, conjunctivitis, pharyngitis, otitis media
  • tachypnea, retractions
  • wheezing, crackles
40
Q

Management of Bronchiolitis

A
  • no bronchodilators
  • nebulized hypertonic saline for hospitalized infants
  • no antibiotics
  • supportive care: hydration, antipyretics
  • O2 if low sat
  • nasal suctioning, avoid deep airway suctioning
41
Q

Prevention of Bronchiolitis

A
  • Palivizumab for high risk infants
  • educate parents about limiting exposure
42
Q

Laryngeal FB

A
  • rapid onset of hoarseness/chronic croupy cough
  • unilateral wheezing, recurrent pneumonia
43
Q

Tracheal FB

A
  • brassy cough hoarseness, dyspnea, cyanosis
  • homophonic wheeze
44
Q

Bronchial FB

A
  • most in right lung
  • blood streaked sputum
  • initial episode of coughing, gagging, choking
  • limited chest expansion, decreased vocal fremitus, atelectasis
  • crackles, rhonchi, wheezes
45
Q

Management of FB aspiration

A
  • Refer to pulm for bronchoscopy
  • Treat secondary lung infections, bronchospasms
46
Q

What is bronchitis?

A
  • nonspecific inflammation of bronchioles
  • Caused by influenza, RSV, adenovirus, or parainfluenza
47
Q

Clinical Findings of Bronchitis

A
  • dry, hacking cough
  • low substernal discomfort, burning chest pain
  • fam hx of asthma, CF, atopy, infections, irritants
  • hx of prematurity, GERD
  • variable rhinitis
  • low grade or no fever
  • nasophayngeal infection, conjunctivitis
  • coarse breath sounds, rhonchi, rales
48
Q

Management of Bronchitis

A
  • supportive care
  • analgesia, hydration
  • antivirals if influenza
  • NO cough suppressants
  • NO bronchodilators
    ** Chronic bronchitis may require steroids or bronchodilators
49
Q

Personal History Nonbacterial and Bacterial Pneumonia: Neonate

A
  • hx of group B strep or C. trachomatis infection in mother
  • prenatal drug use/ lack of prenatal care
  • C. trachomatous
50
Q

Personal History Nonbacterial and Bacterial Pneumonia: infant

A
  • slower onset of resp symptoms
  • determine mother’s HIV status or exposure to TB
51
Q

Personal History Nonbacterial and Bacterial Pneumonia: Child/Adolescent

A
  • immunization, travel history, TB status
  • sick contacts
  • possible FB
  • hx of mild URI
  • abrupt high fever
  • restlessness, shaking chills, apprehension, SOB, malaise, pleuritic chest pain
52
Q

Physical Examination of Nonbacterial and Bacterial Pneumonia

A
  • resp distress
  • apena, tachycardia
  • nasal flaring, grunting, retractions
  • tachypnea, air hunger, cyanosis
  • fine crackles, dullness, diminished breath sounds
53
Q

Clinical Findings Specific to Bacterial Pneumonia

A
  • fever, hypoxia, lethargy
  • splinting affected side, tachypnea, retractions
  • pleural effusion
54
Q

Clinical Findings Specific to Viral Pneumonia

A
  • wheezing
  • downward displacement of liver/spleen
55
Q

Clinical Findings Specific to Atypical Pneumonia

A
  • repetitive staccato cough - C. trachomatis
56
Q
A

Pediatrics (12 decks)

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