Respiratory Flashcards
What is croup/laryngotracheobronchitis?
Inflammation of the larynx and subglottic airway
Kids 6-36 mos old
What is most common etiology of croup?
Parainfluenza virus type 1
Presentation of croup
Barking cough (seal-like), hoarseness, inspiratory stridor (because of subglottic narrowing), stuffy nose (coryza)
What will you see on an X-ray in croup?
Steeple sign (useful when dx is unclear)
Different levels of croup
Mild: no stridor at rest
Moderate: stridor and some retractions
Severe: stridor, retractions and agitation
Management of moderate group
Corticosteroids (dexamethasone .6 mg/kg PO/IM or IV)
Can also use nebulized racemic epi (observe for 3-4 hrs)
Why is epiglottitis an emergency?
It can lead to life-threatening airway obstruction
What is the etiology of epiglottitis?
Bacterial: H. flu type B is most common in kids
Presentation of epiglottitis
Sudden onset of high fever (>38.5 C-101.3 F) and sore throat
3Ds (dysphagia, drooling and distress-tripod or sniffing positions)
Hot potato voice
What will you see on the x-ray for epiglottitis?
Thumb sign (need direct laryngoscopy for definitive dx)
Management of epiglottitis
Airway management!
3rd gen cephalosporin (ceftriaxone)
What is tracheomalacia?
Floppy trachea and abnormal collapse due to inadequate supporting cartilage
Presentation of tracheomalacia
Recurrent hard, barking cough and stridor (typically expiration)
When is the peak incidence of foreign body aspiration?
12-24 mos
When should you suspect a foreign body aspiration?
Abrupt onset of cough (followed by tachypnea and stridor), choking, wheezing or cyanosis in previously healthy kid
How do you diagnose FBA is no object seen on CXR?
Perform rigid bronchoscopy (diagnostic and curative)
What can happen to a kid who did not have proper management of FBA?
Pneumonia
What bacterial pathogen causes pertussis?
Bordatella pertussis (also causes bronchitis)
What is a catch phrase for pertussis?
Cough of 100 days
It has 3 distinct phases of sxs
What are the phases of pertussis?
Catarrhal: URI sxs and low fever- 1-2 wks
Paroxysmal: persistent cough, inspiratory whoop, post-tussive emesis- 2-6 wks
Convalescent (recovering): cough gradually resolves- wks to months
What is the gold standard diagnosis of pertussis?
Nasal culture
Management of pertussis
Supportive care and abx (macrolides like azithro or clarithro or maybe bactrim)
Might need to hospitalize
What is bronchiolitis?
Lower respiratory tract infection affecting small airways in kids < 2
Most common etiology of bronchiolitis?
Viral- RSV
Presentation of bronchiolitis?
Low grade fever, cough, respiratory distress (tachypnea, retractions, wheezing, crackles)
Usually have URI sxs 1-3 days before
What might you see on a CXR for bronchiolitis?
Peribronchial thickening
Management of non-severe bronchiolitis
Anticipatory guidance and follow up in 1-2 days (hydrate, nasal suctioning etc)
Management of severe bronchiolitis
ER or hospital admission
When is RSV seen most?
November-April but peaks Jan/Feb
Presentation of RSV
Primary infection of infants/young kids (URI sxs, LRT infection, apnea)
Secondary infection in older kids (URI sxs)
Management or RSV
Mostly just supportive care (fluid, respiratory support-bronchodilators and steroids not recommendeD)
What are important ways to prevent RSV?
Wash hands and avoid ppl with it (prophylaxis with palivizumab)
What causes cystic fibrosis?
Abnormal trans membrane chloride transport
most common fatal autosomal recessive disease in US
Presentation of CF
Meconium ileus in some, respiratory sxs (persistent/productive cough) and FTT
How do you diagnose CF?
Sweat chloride testing > 60 meq/L
What is the most common cause of bronchiectasis
CF in kids
Abnormal dilation and distortion of bronchial tree btw
Sxs of bronchiectasis
Chronic cough with purulent sputum
What tests can you do to see bronchiectasis?
PFTS: obstructive pattern
CXR: dilated, thickened airways (tram tracks or ring shadows)
Tx for bronchiectasis
Abx, clear airway, mucolytics, bronchodilators, immunizations
What is pneumonia associated with?
Fever, respiratory sxs and evidence of parenchymal involvement (PE or infiltrates on CXR)
What are the causes of pneumonia by age?
<5 is viral usually and 5-18 is atypical bacteria usually
Most common causes of bacterial pneumonia by age
<5 is S. pneumonia and over 5 is atypicals (mycoplasma pneumonia-see extrapulmonary manifestations or chlamydophila pneum)
Presentation of CAP
Varies but usually fever and cough (tachypnea and recent URI) with chest pain and SOB
What other sxs might you see in neonates or young infants in CAP?
Poor feeding and restlessness
Afebrile pneumona in infancy (2 wks-3 mos from chlamydia)
What is the kids general appearance in CAP?
Ill appearing, grunting showing imminent respiratory failure
What will you hear in lungs with CAP?
Crackles and pulmonary consolidation
How you treat influenza pneumonia?
Neuraminidase inhibitor
Outpatient tx of suspected bacterial pneumonia
6 mo- 5 yrs: amoxicillin 90 mg
Over 5:
Atypical bacteria (macrolide or doxy)
Typical is still amoxicillin
When should you hospitalize a kid for CAP?
Under 6 mos, sp02 under 90, dehydration, toxic appearing, fail outpt tx
What is infant respiratory distress syndrome (hyaline membrane disease)?
Deficiency of surfactant at birth causing alveolar collapse
Risks: preemie
Presentation of infant respiratory distress syndrome
Within minutes of birth
Tachypnea, chest wall retractions, expiratory grunting, nasal flaring, cyanosis
What lab findings will you see with infant respiratory distress syndrome
CXR: diffuse bilateral atelectasis with ground-glass appearance
Tx for infant respiratory distress syndrome
O2 given with small amount of CPA
Fluids
Endotracheal tube
Exogenous surfactant
How can you prevent infant respiratory distress syndrome?
Antenatal glucocorticoid like dexamethasone or betamethasone
Given to moms in preterm labor up to 34 wks gestation
What is asthma?
Chronic airway inflammation, hyper responsiveness and reversible obstruction
What is spirometry used for?
Diagnosis of asthma and used to monitor disease progression and response to therapy (children over 5)
What is the diagnostic criteria for asthma?
Spirometry showing:
FEV1/FVC ratio decreased (obstructive pattern)
Increase in FEV1 > 12% and >200 ml following bronchodilator use (reversible obstruction)
Asthma tx
Stepwise approach based on age and classification
Short acting bronchodilators (SABA) prn
Inhaled corticosteroids
Long acting bronchodilators (must have inhaled steroid too)
Leukotriene antagonists
Oral steroid
How do you decide if asthma needs more than just rescue bronchodilator?
Use rule of 2 to decide if pt needs 2 meds for asthma
What is the rule of 2s?
Need more than rescue inhaler if using SABA
More than 2 times/wk
More than 2 times/month at night
More than 2 times per year to refill
Sxs of vocal cord dysfunction
Inspiratory stridor, cough, choking sensation or throat tightness
Tx for vocal cord dysfunction
Reassurance, breathing maneuvers, avoid triggers and speech therapy
Will not improve with albuterol
Tx of obstructive sleep apnea
Adenoidectomy with possible tonsillectomy or CPAP
