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Pediatrics > Respiratory/Cardiology > Flashcards

Respiratory/Cardiology Flashcards

1
Q 
prodrome URI
hoarseness
inspiratory stridor
cough (barking, "seal-like")
often starts at night and is worse at night

etiology: parainfluenza virus (sometimes RSV too)
6mo-3yo most common

A

Viral Croup

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2
Q

Viral Croup diagnostics and treatment

A

steeple sign on radiography

mild = no stridor at rest
–> supportive care, cool mist
moderate = stridor + mild retractions
–> corticosteroids (dexamethasone), nebulizer racemic epinephrine
severe = stridor, retractions and labored
–> airway support and admit

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3
Q 
rapid onset
fever, sore throat
dysphagia, drooling, distress (3 D's)
tripod/sniffing posture
"hot potato" voice

etiology: H. influenza type B (bacterial)
Hib vaccine has greatly reduced incidence

A

Epiglottitis

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4
Q

Epiglottitis diagnostics and treatment

A

thumb sign on radiography

EMERGENCY –> can lead to life-threatening airway obstruction
DO NOT USE TONGUE BLADE

airway support - ET tube if possible
ceftriaxone

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5
Q

recurrent harsh, barking cough
stridor

floppy trachea during expiration due to inadequate supporting cartilage
aggravated by respiratory tract infections and agitation

A

Tracheomalacia

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6
Q

Tracheomalacia treatment

A

6mo-1yo cartilage becomes stronger and sxs usually resolve

if severe = CPAP

*some crania-facial abnormalities can lead to tracheomalacia

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7
Q

Foreign Body Aspiration

A

suspect if abrupt onset cough, choking, wheezing
potential stridor if caught in upper airways
12-24mo peak incidence
commonly food, paperclips, coins, balloons (most fatal)

*can potential go down right main bronchus because angle

CXR and BRONCOSCOPY (treatment)

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8
Q

“cough of 100 days”
prolonged bronchitis
complications: apnea, pneumonia, seizures and death

bacterial - B. pertussis

A

Pertussis (Whooping Cough)

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9
Q

Pertussis (Whooping Cough) phases

A
  1. catarrhal = URI sxs, fever (1-2wks)
  2. paroxysmal = persistent cough, inspiratory “whooping”, emesis (2-6wks)
  3. convalescent = cough gradually resolves (wks-mos)

*adults won’t always present with these 3 phases

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10
Q

Pertussis (Whooping Cough) diagnostics and treatment

A

nasopharyngeal swab/aspirate = gold standard
CBC = leukocytosis (bacterial)
CXR = normal or segmental atelectasis

treat with macrolides (erythro/azithro)
hospitalize if: respiratory distress, cyanosis/apnea, inability to feed or less than 4mo old

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11
Q 
cough
conjunctivitis
nasal congestion
fever
apnea

*most common cause of lower respiratory tract infection in children less than 1yo

A

Respiratory Syncytial Virus (RSV)

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12
Q

Respiratory Syncytial Virus (RSV) diagnostics and treatment

A

complications: bronchiolitis, bronchospasm, acute respiratory failure

Dx with nasopharyngeal culture

hand washing
avoid contact with RSV-infected
prophylaxis with palivizumab = monthly injection during season in high risk patients less than 2yo

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13
Q 
2-3 days URI sxs then:
low grade fever
cough
expiratory wheezing
respiratory distress = tachypnea, retractions, nasal flaring

etiology: RSV #1, rhinovirus
peaks 2-6mo old
Nov-Apr

A

Bronchiolitis

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14
Q

Bronchiolitis diagnostics and treatment

A

clinically based on sxs, age, time of year
RSV nasopharyngeal swab in the ERs

anticipatory guidance:
– 1-2 wks
– nasal secretions (suctioning helps)
– seek help if increased respiratory distress
hospitalization for supportive measures (i.e.. hydration and oxygenation)

*inhaled bronchodilators DO NOT improve overall outcomes

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15
Q

persistent, productive cough
50% of children with “failure to thrive” are diagnosed with this condition

avg age of survival is 30yo
*most common fatal autosomal recessive disease in US
abnormal trans-membrane Cl- transport
multi-system disease

A

Cystic Fibrosis

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16
Q

Cystic Fibrosis diagnostics and treatment

A

CXR = hyperinflation
*sweat chloride test >60 meq/L

abx
chest physiotherapy
mucolytics, steroids, bronchodilators

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17
Q

chronic cough with sputum
abnormal dilation of bronchi
PFT show obstructive pattern

*CF is #1 cause
walls of bronchi become damaged/weakened over time

A

Bronchiectasis

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18
Q

Bronchiectasis treatment

A

abx
pulmonary drainage
possible bronchodilators

19
Q

fever, cough
myalgia, HA, malaise
pleuritic chest pain or abdominal pain
sxs may be subtle in infants: poor feeding, irritability, restlessness

*tachypnea
tachycardia
decreased O2 saturation
cradles/rales, rhonchi
grunting = imminent respiratory failure

consolidation of alveolar spaces –> infection of lung and parenchyma
*leading COD in children

A

Pneumonia

20
Q

Pneumonia etiologies

A

fungal = newborn - 1mo
–> inclusion conjunctivitis if Chlamydia infection

viral = 1-12mo (RSV #1), 2-5yo (RSV, parainfluenza, influenza)

bacterial = 5-18yo (S. pneumoniae mostly, older = atypical bacteria)

21
Q

Pneumonia diagnostics and treatment

A

radiography not needed
blood cultures if toxic
sputum if severe

treat empirically first
respiratory support
close f/u and admit

outpatient = amoxicillin (no abx if viral)

  • -> 2/3 ceph or clindamycin as second options for infant/preschool
  • -> azithromycin as second option for school age

inpatient = ampicillin/sulbactam
cefuroxime
ceftriaxone

22
Q

Pneumonia hospitalization

A 
Infants/Older children:
apnea/grunting
poor feeding
SpO2 less than 92%
infants = RR >70 breaths per minute
older children = RR >50 breaths per minute

*comorbidities, f/u not possible or family unable to care for child

23
Q

sxs begin within minutes of birth
respiratory distress = tachypnea, retractions, grunting, cyanosis, nasal flaring

deficiency of surfactant at birth = hypoxia as alveoli collapse
predisposing factors: preemie, fam hx, DM mother

acute diseases lasts 2-3 days but can progress to ventilatory failure

A

Infant Respiratory Distress Syndrome (RDS)

24
Q

Infant Respiratory Distress Syndrome (RDS) diagnostics and treatment

A

arterial blood gas = hypoxemia
CXR = diffuse bilateral atelectasis
–> *ground glass appearance

O2 with CPAP
exogenous surfactant (given via ET tube)
IV fluids

prevention with antenatal glucocorticoid for mother

  • -> dexamethasone or betamethasone
  • -> hastens lung maturity in those expected to deliver in less than 32-34 weeks
25
Q

cough (intermittent or chronic)
wheezing
dyspnea
chest tightness

RSV is a risk factor
allergic triad

chronic airway inflammation, hyper-responsiveness and reversible obstruction

A

Asthma

26
Q

Asthma diagnostics and treatment

A

spirometry (also used to monitor disease)
–> measures lung volumes and flow rates in children >5yo via trained hospital staff
FEV1/FVC ratio decreases (obstructive)

stepwise approach to treatment:
short-acting bronchodilators (SABA) PRN (aka rescue inhaler)
inhaled corticosteroids (preventive and prophylactic)
LABA (with inhaled corticosteroids)
leukotriene antagonists
oral steroids

27
Q

choking sensation/throat tightness
inspiratory stridor
cough

triggered by exercise, irritants, GERD or rhino sinusitis

inappropriate vocal cord motion = partial airway obstruction

A

Vocal Cord Dysfunction

28
Q

Vocal Cord Dysfunction treatment

A

*often misdiagnosed as asthma

reassurance
*speech therapy
breathing maneuvers
avoid triggers

29
Q

habitual snoring, gasping or apnea
2-3% children
risk: obesity and adenotonsillar hypertrophy

Dx: sleep study
Tx: adenoidectomy with possible tonsillectomy or CPAP

A

Obstructive Sleep Apnea

30
Q

5 T’s of Cyanotic CHD

A 
Tetralogy of Fallot
Truncus Arteriosus
Transposition
Tricuspid atresia
Total anomalous pulmonary venous return (TAPVR)
31
Q

most common of all congenital heart defects
most common in Down Syndrome patients

large:
failure to thrive/poor growth
tachypnea
hepatomegaly
GERD
A

VSD

32
Q

VSD Treatment

A

diuretics

ACE inhibitors +/- digoxin (lowers LVP)

33
Q

most common type is secundum

usually asymptomatic because not much extra blood flow

A

ASD

34
Q

ASD treatment

A

elective closure 2-5yo surgical or transcatheter

*never leave open in young girl approaching puberty

35
Q

Atrio-ventricular septal defect (AVSD)

A 
most common prenatal dx of CHD
complete = large VSD and ASD
CHF
pulmonary HTN
*repair in infancy
36
Q

continuous “machinery” murmur can be heard front and back
enlarged RA, RV, LV
increased pulse pressure

A

Patent Ductus Arterioles (PDA)

37
Q

PDA treatment

A

indomethacin may help closure

*many preemies have immature lungs which can make PDA dx difficult

38
Q

Cyanotic CHD signs

A 
check both UE and LE saturations
arterial pulses (absent, delayed, bounding)
*anemic baby may not look cyanotic because they don't have enough Hb to show it

need more than 5g/dL deoxygenated Hb to look cyanotic

39
Q

Tetralogy of Fallot

A

RV output tract obstruction (cause of TET spells)
RV hypertrophy
VSD
overriding aorta

*fix by 3-6mo or sooner if blue

40
Q

failure to separate aorta and pulmonary artery causing a large VSD

requires operation in first 2 weeks of life

A

Truncus Arteriosus

41
Q

prostaglandins (PGE) started to keep ductus open
*BLUE BABY think PGE

aorta comes off RV and pulmonary artery comes off LV

A

Transposition

42
Q

TAPVR

A

veins migrate from lungs to meet heart and form back of LA, but if lost, they form a CONFLUENCE

supra cardiac = repair in first 6mo of life
infra cardiac = usually obstructed –> EMERGENT
–> very sick with wet lungs, cyanosis and pulmonary HTN

43
Q

proximal HTN
presents as extremis (near point of death)
irritability, tachypnea, poor feeding, CHF
decreased of absent femoral pulses
older children and teens may present with unexplained HTN
associated with Turner’s syndrome

when ductus is closed, muscle can also impinge on aorta causing LV failure

A

Coarctation of Aorta

44
Q

Coarctation of Aorta diagnostics

A

CXR = rib notching (takes several years to develop)
*CT angiogram or MRA becoming GOLD STD

just need ECHO in infants for surgery

Pediatrics (3 decks)

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