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X Pediatrics Final > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is croup/laryngotracheobronchitis?

A

Inflammation of the larynx and subglottic airway

Kids 6-36 mos old

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2
Q

What is most common etiology of croup?

A

Parainfluenza virus type 1

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3
Q

Presentation of croup

A

Barking cough (seal-like), hoarseness, inspiratory stridor (because of subglottic narrowing), stuffy nose (coryza)

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4
Q

What will you see on an X-ray in croup?

A

Steeple sign (useful when dx is unclear)

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5
Q

Different levels of croup

A

Mild: no stridor at rest
Moderate: stridor and some retractions
Severe: stridor, retractions and agitation

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6
Q

Management of moderate group

A

Corticosteroids (dexamethasone .6 mg/kg PO/IM or IV)

Can also use nebulized racemic epi (observe for 3-4 hrs)

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7
Q

Why is epiglottitis an emergency?

A

It can lead to life-threatening airway obstruction

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8
Q

What is the etiology of epiglottitis?

A

Bacterial: H. flu type B is most common in kids

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9
Q

Presentation of epiglottitis

A

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

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10
Q

What will you see on the x-ray for epiglottitis?

A

Thumb sign (need direct laryngoscopy for definitive dx)

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11
Q

Management of epiglottitis

A

Airway management!

3rd gen cephalosporin (ceftriaxone)

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12
Q

What is tracheomalacia?

A

Floppy trachea and abnormal collapse due to inadequate supporting cartilage

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13
Q

Presentation of tracheomalacia

A

Recurrent hard, barking cough and stridor (typically expiration)

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14
Q

When is the peak incidence of foreign body aspiration?

A

12-24 mos

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15
Q

When should you suspect a foreign body aspiration?

A

Abrupt onset of cough (followed by tachypnea and stridor), choking, wheezing or cyanosis in previously healthy kid

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16
Q

How do you diagnose FBA is no object seen on CXR?

A

Perform rigid bronchoscopy (diagnostic and curative)

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17
Q

What can happen to a kid who did not have proper management of FBA?

A

Pneumonia

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18
Q

What bacterial pathogen causes pertussis?

A

Bordatella pertussis (also causes bronchitis)

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19
Q

What is a catch phrase for pertussis?

A

Cough of 100 days

It has 3 distinct phases of sxs

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20
Q

What are the phases of pertussis?

A

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

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21
Q

What is the gold standard diagnosis of pertussis?

A

Nasal culture

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22
Q

Management of pertussis

A

Supportive care and abx (macrolides like azithro or clarithro or maybe bactrim)
Might need to hospitalize

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23
Q

What is bronchiolitis?

A

Lower respiratory tract infection affecting small airways in kids < 2

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24
Q

Most common etiology of bronchiolitis?

A

Viral- RSV

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25
Q

Presentation of bronchiolitis?

A

Low grade fever, cough, respiratory distress (tachypnea, retractions, wheezing, crackles)
Usually have URI sxs 1-3 days before

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26
Q

What might you see on a CXR for bronchiolitis?

A

Peribronchial thickening

27
Q

Management of non-severe bronchiolitis

A

Anticipatory guidance and follow up in 1-2 days (hydrate, nasal suctioning etc)

28
Q

Management of severe bronchiolitis

A

ER or hospital admission

29
Q

When is RSV seen most?

A

November-April but peaks Jan/Feb

30
Q

Presentation of RSV

A

Primary infection of infants/young kids (URI sxs, LRT infection, apnea)
Secondary infection in older kids (URI sxs)

31
Q

Management or RSV

A

Mostly just supportive care (fluid, respiratory support-bronchodilators and steroids not recommendeD)

32
Q

What are important ways to prevent RSV?

A

Wash hands and avoid ppl with it (prophylaxis with palivizumab)

33
Q

What causes cystic fibrosis?

A

Abnormal trans membrane chloride transport

most common fatal autosomal recessive disease in US

34
Q

Presentation of CF

A

Meconium ileus in some, respiratory sxs (persistent/productive cough) and FTT

35
Q

How do you diagnose CF?

A

Sweat chloride testing > 60 meq/L

36
Q

What is the most common cause of bronchiectasis

A

CF in kids

Abnormal dilation and distortion of bronchial tree btw

37
Q

Sxs of bronchiectasis

A

Chronic cough with purulent sputum

38
Q

What tests can you do to see bronchiectasis?

A

PFTS: obstructive pattern
CXR: dilated, thickened airways (tram tracks or ring shadows)

39
Q

Tx for bronchiectasis

A

Abx, clear airway, mucolytics, bronchodilators, immunizations

40
Q

What is pneumonia associated with?

A

Fever, respiratory sxs and evidence of parenchymal involvement (PE or infiltrates on CXR)

41
Q

What are the causes of pneumonia by age?

A

<5 is viral usually and 5-18 is atypical bacteria usually

42
Q

Most common causes of bacterial pneumonia by age

A

<5 is S. pneumonia and over 5 is atypicals (mycoplasma pneumonia-see extrapulmonary manifestations or chlamydophila pneum)

43
Q

Presentation of CAP

A

Varies but usually fever and cough (tachypnea and recent URI) with chest pain and SOB

44
Q

What other sxs might you see in neonates or young infants in CAP?

A

Poor feeding and restlessness

Afebrile pneumona in infancy (2 wks-3 mos from chlamydia)

45
Q

What is the kids general appearance in CAP?

A

Ill appearing, grunting showing imminent respiratory failure

46
Q

What will you hear in lungs with CAP?

A

Crackles and pulmonary consolidation

47
Q

How you treat influenza pneumonia?

A

Neuraminidase inhibitor

48
Q

Outpatient tx of suspected bacterial pneumonia

A

6 mo- 5 yrs: amoxicillin 90 mg
Over 5:
Atypical bacteria (macrolide or doxy)
Typical is still amoxicillin

49
Q

When should you hospitalize a kid for CAP?

A

Under 6 mos, sp02 under 90, dehydration, toxic appearing, fail outpt tx

50
Q

What is infant respiratory distress syndrome (hyaline membrane disease)?

A

Deficiency of surfactant at birth causing alveolar collapse

Risks: preemie

51
Q

Presentation of infant respiratory distress syndrome

A

Within minutes of birth

Tachypnea, chest wall retractions, expiratory grunting, nasal flaring, cyanosis

52
Q

What lab findings will you see with infant respiratory distress syndrome

A

CXR: diffuse bilateral atelectasis with ground-glass appearance

53
Q

Tx for infant respiratory distress syndrome

A

O2 given with small amount of CPA
Fluids
Endotracheal tube
Exogenous surfactant

54
Q

How can you prevent infant respiratory distress syndrome?

A

Antenatal glucocorticoid like dexamethasone or betamethasone

Given to moms in preterm labor up to 34 wks gestation

55
Q

What is asthma?

A

Chronic airway inflammation, hyper responsiveness and reversible obstruction

56
Q

What is spirometry used for?

A

Diagnosis of asthma and used to monitor disease progression and response to therapy (children over 5)

57
Q

What is the diagnostic criteria for asthma?

A

Spirometry showing:
FEV1/FVC ratio decreased (obstructive pattern)
Increase in FEV1 > 12% and >200 ml following bronchodilator use (reversible obstruction)

58
Q

Asthma tx

A

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

59
Q

How do you decide if asthma needs more than just rescue bronchodilator?

A

Use rule of 2 to decide if pt needs 2 meds for asthma

60
Q

What is the rule of 2s?

A

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

61
Q

Sxs of vocal cord dysfunction

A

Inspiratory stridor, cough, choking sensation or throat tightness

62
Q

Tx for vocal cord dysfunction

A

Reassurance, breathing maneuvers, avoid triggers and speech therapy
Will not improve with albuterol

63
Q

Tx of obstructive sleep apnea

A

Adenoidectomy with possible tonsillectomy or CPAP

X Pediatrics Final (3 decks)

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