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P3.2 > Respiratory CIS > Flashcards

Respiratory CIS Flashcards

1
Q

most common cause of wheezing in kids

A

-viral infections

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2
Q

what time of day is more suggestive of asthma

A

coughing that’s worse in middle of the night

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3
Q

risks for developing asthma

A
  • RSV infection prior to 6 months of age

- FH of any atopy- allergic rhinitis, eczema

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4
Q

common triggers for asthma

A
  • virus
  • allergies
  • exercise
  • cold air
  • cigarette smoke
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5
Q

CXR in a child with asthma or reactive airway dz (RAD)

A
  • atelectasis (auscultated as dec breath sounds)
  • hyperinflation of both lungs
  • perihilar thickening
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6
Q

capillary refill- in healthy child and child with asthma or RAD

A
  • > 2 sec = very concerning

- healthy- nearly instantaneously!!

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7
Q

best way to obtain blood gases in pediatric pt

A

capillary blood gases

  • quicker and less distressing than arterial gas (which is more accurate for O2)
  • cant use PaO2 from them
  • useful only for pH and CO2
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8
Q

pediatric pt with asthma exacerbation- admitted to?

A

-PICU- due to significant risk for decompensation

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9
Q

options for maintenance IVF in children

A
  • 1/2 NS in >1 yo or 1/4 NS in <1 yo
  • NS is reserved for bolusing
  • in peds usually K is added to IVF
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10
Q

when is it appropriate to intubate an asthmatic (pediatric) pt- treatments to add to intubation?

A
  • time to intubate- when b/w irritable and obtunded
  • ADD terbutaline drip, Mg, Theophylline, subcutaneous epinephrine, heliox (breathing as that is a mixture of helium and oxygen, less resistance and easier to breath), or BiPAP– in order to NOT INTUBATE an asthmatic
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11
Q

Why don’t you want to intubate asthmatics?

A

-they can’t exhale- so you force breaths in with the vent, they get fuller and fuller until they either get b/l pneumothorax or acute right heart collapse and die

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12
Q

which population of asthmatics has the highest mortality

A

-adolescents- b/c they dont carry their rescue inhaler with them

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13
Q

signs of resp distress in a pediatric pt

A
  • inspiratory and expiratory wheezing
  • nasal flaring and tachypnea
  • subcostal, intercostal, and suprasternal retractions
  • stridor
  • sniffing or tripod positioning
  • dec air movement (after albuterol hear wheezing, means improving)
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14
Q

treatment considerations

A
  • albuterol nebulizer or inhaler (rescue inhaler- bronchodilator- short acting Beta-2 agonist)
  • inhaled corticosteroids
  • oral corticosteroids
  • oxygen (put on first if hypoxic)
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15
Q

what would indicate concern for CF?

A
  • poor height and weight
  • clubbing
  • foul-smelling stools
  • recurrent pneumonia
  • edema
  • failure to thrive
  • test with Sweat chloride test!!`
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16
Q

sudden stridor in a child makes you think of what?

A

-foreign body aspiration

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17
Q

O2 options to consider

A
  • NC up to 5 Liter
  • simple face mask at 5-6L
  • NRB at 10-15 L/min
  • bag valve mask
  • bipap
  • intubation
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18
Q

asthma under control- green- YES

A
  • daytime sx- 3 times or less/week
  • nighttime sx- none
  • reliever- 3 times or less/week
  • physical activity- normal
  • able to go to school- yes
  • peak expiratory flow- 85-100%
  • Stay controlled and avoid triggers
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19
Q

asthma under control- yellow- NO

A
  • daytime sx- >3 times/week
  • nighttime sx- some nights
  • reliever- >3 times/week
  • physical activity- limited
  • able to go to school- maybe
  • peak expiratory flow- 60-85%
  • Adjust meds
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20
Q

asthma under control- red- NOT AT ALL

A
  • daytime sx- continuous and worsening
  • nighttime sx- continuous and worsening
  • reliever- relief less than 3-4 hrs
  • physical activity- very limited
  • able to go to school- no
  • peak expiratory flow- <60%
  • call for help
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21
Q

obstetrical history taking- GTPAL

A
  • Gravidity- number of total pregnancies
  • Term births- term deliveries (38 wks)
  • Preterm births- viability up to 37 wks
  • Abortions/miscarriages
  • Living children
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22
Q

total hysterectomy

A

-take uterus and ovaries, usually but not always take the cervix too

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23
Q

CAD risk factors

A

-emotional stress and no exercise

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24
Q

S2 splitting during cardiac exam- cause

A
  • physiologic splitting of S2 on inspiration can be normal
  • persistent splitting of S2 during inspiration and expiration- HD in adults (RBBB), RV pressure overload situations (acute massive PE)
25
Q
  • physiologic splitting of S2 on inspiration can be normal
  • persistent splitting of S2 during inspiration and expiration- HD in adults (RBBB), RV pressure overload situations (acute massive P
A

rales

26
Q

what is an invasive and highly accurate way of measuring BP constantly?

A

arterial line

27
Q

checking for inherited thrombophilia- labs

A

checking for inherited thrombophilia- labs

28
Q

most common findings on an EKG in a pt with a PE?

A
  • nonspecific ST-T wave abnormalities

- sinus tachycardia

29
Q

gold standard imaging choice for PE?

A

CTA (CT angiogram) of chest (PE protocol)

-need to consider the stability of pt before taking them to radiology!

30
Q

EKG- indicative of PE

A

-S1 Q3 T3

31
Q

what is tPA?

A
  • recombinant tissue type plasminogen activator (alteplase)- “clot buster”
  • enzyme produced by a number of tissues, including endo cells- binds to fibrin, which inc its affinity for plasminogen and enhances plasminogen activation
  • systemic thrombolysis is preferred- can give rapidly (as compared to taking to cath lab for angiogram and direct injection into the clot itself)
32
Q

Indications for thrombolytic therapy in venous threomboembolism

A
  • hypotension related to PE
  • severe hypoxemia
  • substantial perfusion defect
  • right ventricular dysfxn assoc with PE
  • extensive DVT
33
Q

hormones are what?

A

pro-thrombotic

-hormone replacement therapy- premarin (Estrogen)

34
Q

what is Factor V Leiden?

A

mutant form of coagulation factor V

  • FVL mutation renders factor V insensitive to the actions of activated protein C (aPC), a natural anticoagulant
  • FVL mutations- inc risk of venous thromboembolism
  • extremely common!!- many pts will never have a VTE
35
Q

Virchow’s Triad

A

VTE occurs as a result of:

  • alterations in blood flow (stasis)
  • vascular endothelial injury
  • hypercoagulable state (inherited or acquired)
36
Q

Wells Criteria

A 
(assessment for PE)
-clinical sx of DVT- 3
-other dx less likely than PE- 3
-HR > 100- 1.5
-immobilization or surgery in prev 4 wks- 1.5
-previous DVT/PE- 1.5
-Hemoptysis- 1
-malignancy- 1
SCORE
-high >6
-moderate 2-6
37
Q

contraindications to fibrinolytic therapy?

A
  • prior intracranial hemorrhage
  • structural cerebral vascular lesion
  • malignant intracranial neoplasm
  • ischemic stroke within 3 months
  • suspected aortic dissection
  • active bleeding or bleeding diathesis
  • close-head trauma in last 3 months
38
Q

types of shock

A
  • hypovolemic
  • cardiogenic
  • distributive
  • obstructive
39
Q

what is MAP

A

mean arterial P

  • diastolic BP + [(systolic BP - diastolic BP) / 3]
  • > 65 = good perfusion to all organs
  • <65 = hypotension/hypoperfusion
40
Q

dd for Tb

A
  • NTM (nontuberculosis mycobacterial infection- M kansaii)
  • fungal infection
  • lung cancer
  • lymphoma
41
Q

NTM (nontuberculosis myobacterial infection- M kansaii)- sx, dx

A
  • fatigue, dyspnea, occasional hemoptysis

- sputum Cx and molecular diagnostics

42
Q

fungal infection- sx, dx

A
  • PNA, nodules, cavitation

- dx- Cx results, regional exposure

43
Q

lung cancer- sx, dx

A
  • fevers, cough, chest pain, hemoptysis, dyspnea

- dx- histopathology

44
Q

lymphoma- sx, dx

A
  • fevers, night sweats, weight loss

- dx- histopathology

45
Q

pts at risk for tb

A
  • close contact with someone who has active tb
  • immigrants from endemic areas
  • jail, nursing homes, homeless shelters, healthcare facilities
  • medically underserved, poor populations
  • IV drug abuse
  • HIV/AIDS
46
Q

PPD >5 mm induration

A
  • HIV
  • close contact with actively infected person
  • CXR with fibrotic changes consistent with TB
  • immunosuppression
47
Q

PPD > 10 mm induration

A
  • clinical conditions that INC risk of react- silicosis, DM, chronic renal failure, malignancies
  • children < 4
  • from country with high prevalance
  • jail, healthcare facilities, homeless shelters
48
Q

PPD > 15 mm induration

A

-healthy individual > 4 with low likelihood of true TB infection

49
Q

signs/sx of active tb

A

-fever, night sweats, cough (>2 wks), weight loss, lymphadenopathy

50
Q

workup for tb

A
  • Sputum culture
  • sputum staining
  • PPD skin test
  • IGRA
  • CXR
  • NAAT
51
Q

TB- sputum culture

A
  • tb is a microbiological diagnosis!!
  • 3 separate morning sputum samples
  • takes 6-8 wks
  • culture is the gold-standard for dx!!!!!
52
Q

TB- sputum staining

A

Acid-fast bacillus!!

  • Rhodamine-auramine stain- initial screening
  • Ziehl-Neelsen and/or Kinyun stain- confirmatory
53
Q

tb- IGRA- indication

A
  • diagnostics of LATENT tb

- pts who have received a BCG vaccination and those with a positive PPD in whom latent tb is suspected

54
Q

TB- CXR

A

-cavitary lesions- apex of lung

55
Q

TB- NAAT

A

-detects INH and rifampin resistance

56
Q

TB- drug therapy and SE’s

A
  • Isoniazid- peripheral neuropathy (give pt Vit B6)!!
  • Rifampin- red/orange body fluids
  • Pyrazinamide- gout, joint aches
  • Ethambutol- optic neuritis, color-blindness
  • monitor CMPs- kidney and liver fxn!!!
57
Q

clinical dx of active TB

A
  • clinical sx
  • risk factors
  • order radiography
  • sputum culture
  • dont delay treatment when awaiting sputum culture!!
58
Q

PPD + with no BCG vaccine

A
  • check CXR- make sure there’s no active TB

- treat as latent tb- 9 months of INH

59
Q

PPD + with BCG vaccine

A
  • check CXR and IGRA
  • if IGRA positive- treat as latent tb
  • if IGRA negative- NO active or latent tb

P3.2 (11 decks)

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