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Respiratory > Respiratory Diseases In Pediatric Patients > Flashcards

Respiratory Diseases In Pediatric Patients Flashcards

1
Q

WBCs that take part in asthma

A

Mast cells

Neutrophils

Eosinophils

T-lymphocytes

Macrophages

Epithelial cells

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2
Q

Status asthmaticus

A

Acute severe asthma that occurs in the refractory state of a failed SABA/LABA treatment
- can also be treatment from subcutaneous epinephrine

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3
Q

What is the most common lower airway disease in children under 18?

A

Asthma

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4
Q

Asthma physiology

A

Chronic inflammatory condition that result in the lung airways being episodically obstructed

The chronic inflammation heightens the sensitivity of airways leadings to hyper responsiveness of airways (bronchospasms)

In children, up to 50% of the total airway resistance can increase

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5
Q

Etiology of wheezing in children’s

A

1) infections

2) transient wheezers w/ asthma
- wheezing with asthma up to 6yrs (then goes away spontaneously)

3) persistent wheezers w/ asthma
- same as #2 but goes further past age 6

4) late onset wheezer w/ asthma
- same as #3 except starts at 3 yrs rather than when born

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6
Q

Anatomic causes of wheezing

A

1) central airway wheezing
- laryngomalacia and tracheomalacia

2) extrinsic airway anomalies
- infections
- tumors
- foreign bodies in esophagus

3) intrinsic airway anomalies
- hemangiomas
- tumors
- cystic malformations

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7
Q

Common triggers related to asthma

A

Allergies

Tobacco smoke

Air pollution and strong orders

exercise induced broncoconstriction

Medications (NSAIDs and BBs)

Emotional anxiety/stress

Weather

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8
Q

Asthma management in children

A

Always aimed at reducing airway inflammation

1) minimize proinfllatory environment exposures

2) use anti inflammatory medications (pending on what the degree of asthma is)
- corticosteroids
- LABAs
- leukotriene modifers

3) use quick relief medications (SABAs)

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9
Q

When nebulizer vs normal inhaler?

A

Young child or person cant take in deep breaths for whatever reasons

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10
Q

What does respiratory distress in asthma for children look like?

A

Retractions

Supraclavicular Indrawing when breathing

Prolonged Expiratory phase of breathing

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11
Q

Standard treatment for asthma exacerbation

A

Albuterol nebulizer treatments for 15 min

If not better, after albuterol monotherapy, give 3 back-to-back treatments of prednisilone or dexamethasone (corticosteroids) and try again
- If not better at this point send to ER

Send home with albuterol and inhaled steroid for recurrent wheezing
- start inhaled steroid immediately once coughing begins

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12
Q

Laryngomalacia

A

Exaggerated collapse of the glottis structures during inspiration
- diagnosis is confirmed based on symptoms and flexible laryngoscopy

Requires xrays if in respiratory distress to rule out worse diagnosis

Symptoms:

  • noisy breathing and stridor on inhalation (worsens with agitation/crying/feeding/sleeping on back)
  • poor weight gain
  • apnea
  • cyanosis
  • GERD
  • aspiration
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13
Q

Treatment of laryngomalacia

A

Usually outgrows it and just requires monitoring during severe episodes

If reflux is present, must be managed differently

If respiratory distress/cyanosis or serious weight loss occurs: requires supraglattoplasty surgery

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14
Q

Tracheomalacia

A

Chondromalacia of a central airway that leads to insufficient cartilage to maintain airway conductance and latency

Causes persistent wheezing in infancy

Males get this more than females and can be primary or secondary

Symptoms:
- low pitched monophonic wheezing on expiration 
- is persistently congested 
- wheezing is loudest over trachea 
-
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15
Q

Primary vs secondary tracheomalacia

A

Primary:
- congenital absence of tracheal supporting cartilage (may also be oddly shaped as well)

Secondary:
- caused by blockage or obstruction of the airway secondary to an underlying disease

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16
Q

Treatment of tracheomalacia

A

Usually outgrows it and just requires pall Atari very care during episodes
- Postural drainage helps a lot also

Can use nebulized ipratropium bromide (rare to need)

Surgical approach is required in life-threatening apnea and cyanosis

DONT use SABA/LABA unless patient also has asthma

17
Q

Sudden Infant Death Syndrome (SIDS)

A

Unexpected death of an infant younger than 1 year of age in which the cause remains unexplained after autopsy

Risk factors:

  • premature births
  • African/Native Americans
  • low income mother who smokes
  • drug abuse mothers
  • higher in winter born babies
  • genetic based (if sibling dies of SIDS, 3-5x more likely for next births)
18
Q

SIDS theories

A

1) cellular brainstem abnormalities and maturational delay related to neural/ cardiorespiratory control
2) may be due to prolonged QT intervals
3) abnormal CNS control of respiration
4) CO2 breathing from sleeping face down

19
Q

Croup (layngotracheobronchitis)

A

Most common infection of the middle respiratory tract

  • most common in winter
  • most common in children 3 months - 5 years
  • more common in males

Viral infection of the glottis and subglottic regions that induces Laryngotracheal inflammation w/ mucosal edema

  • increases airway resistance and the work of breathing.
  • Spreads by secretions

Is caused by any of the following

  • parainfluenza viruses 1-4
  • influenza
  • enteroviruses
  • RSV
  • adenovirus
20
Q

Symptoms of croup

A

Barry/seal coughing

Hoarseness

Low-high grade fever

Occasional respiratory distress

Can present with stridor on inspiration

Rinorrhea

Pharyngitis

  • symptoms are worse at night and recur for several days*
  • 3rd night is worst

Complete resolution within 1 week

21
Q

Croup treatment

A

At home remedies (since more croup is self-limiting)

1) Warm humidity air
- closed bathroom with hot shower running

2) Cold air
- open refrigerator/freezer and breath for a bit

Hospital treatments (if serious)
1) dexamethasone phosphate (1st line since it requires 1 dose)

2) prednisilone (alternate since it requires multiple doses)
* if significant airway compromise is noted, use race ic epinephrine*

22
Q

Bronchiolitis

A

Disease of small bronchioles w/ increased mucus production
- leads sometimes to bronchospasms and serious airway obstruction

Most severe in young infants since it can kill young children

More common in early spring/late winter

Spread by secretions and hand carriage is most frequent method of transmission

Causes:

  • RSV (#1 by far)
  • parainfluenza
  • influenza
  • rhinoviruses
  • coronaviruses
23
Q

Bronchiolitis symptoms/signs

A 
Early on (1-2 days)
- similar symptoms to the common cold

Late phase (3-7 days)

  • same symptoms as early on
  • also noisy/raspy breathing
  • also audible wheezing
  • low grade fever
  • increased work of breathing
  • rare apnea
  • prolonged Expiratory phase
  • intercostal retractions
  • air trapping w/ hyper expansion of lungs
24
Q

Severe RSV infection

A

1-2/100 infants (<6 months) gets this with an RSV infection

Requires oxygen and sometimes intubation/ ventilation

Lasts 2-5 days and low mortality if caught
- cough can linger for up to a month

25
Q

Bronchiolitis prevention with vaccine

A

Indicated only very babies under 2 years with any of the following

  • cyanotic heart disease with visible cyanosis
  • very low birth weight
  • chronic lung disease
  • premature brith

The Vaccine is palivizumab (RSV monoclonal antibodies)

  • give just before RSV season
  • monthly injections of 15mg/kg

also must immunize with flu vaccine once 6 months or older

26
Q

Epiglottis

A

Inflammation and edema of the epiglottis caused by one o the following:

  • haemophilus influenza
  • GAS
  • s. Aureus
  • strep pneumonia

Is an emergency risk since patients can go into sudden complete airway obstruction

27
Q

Symptoms/signs of epiglottis

A
  • All are rapid onset*
  • high grade fever
  • muffled voice
  • dysphagia and drooling
  • Prefers to sit with jaw forward
  • Appears toxic
  • will refuse to intake anything orally since it hurts to swallow
28
Q

Treatment for epiglottis

A

Requires airway management with oxygen therapy until in the ER

Once in ER, get early tracheal intubation
- can use cricothyrotomy if you cant intubate normally

IV fluids and IV steroid

IV antibiotics (start empirically and work to specifics once cultures come back)

29
Q

Streptococcus pneumoniae specific pneumonia signs/symptoms

A

Signs/symptoms

  • crackles and rales usually in the consolidation area
  • consolidation on chest xray
  • pleural effusion on chest xray
  • elevated WBCs and PMNs on labs
  • signs of respiratory distress will be present
  • arterial blood gas shows hypoxemia
30
Q

Hameophlius influenza specific pneumonia signs/symptoms

A

Signs/symptoms

  • crackles usually unilateral
  • arterial blood gas shows hypoxemia
  • lobar pneumonia is on chest xray
  • high WBCs and PMNs on tests
  • pleural effusions present on xrays

very frequent in infants and often shows secondary infections

31
Q

Myocoplasma pneumoniae specific pneumonia sings/symptoms

A
  • is the major cause of respiratory infections in school aged children*
  • gradual onset with headache, sore throat, cough and malaise
  • fine crackles
  • unilateral lower lobe pneumonia on xray

Treatment (any of the following)

  • azithromycin
  • erythromycin
  • clarithromycin
32
Q

Pertussis (whooping cough)

A

Caused by bordatella pertussis Or bordetella parapertussis

Before vaccination, was the leading cause of death in children younger than 14yrs old
- vaccine TDaP (diphtheria toxoid w/ acellular pertussis antigens) makes people almost completely immune for life

Has three stages

33
Q

Catarrhal stage of pertussis

A

Lasts 1-2 weeks

Broad symptoms such as

  • congestion
  • rhinorrhea
  • low grade fever
  • sneezing
  • lacrimation
  • conjunctival suffusing
34
Q

Paroxysmal stage of pertussis

A

Lasts 2-6 weeks

Symptoms are

  • dry intermittent irrational coughing. “Machine gun coughing”
  • whooping on inhalation

infants 3 months or lower will not show the above, instead they choke/gasp/gag and flail extremtities

35
Q

When to suspect pertusssis?

A

If chief compliant is just coughing that is not specific
- if coughing over 14 days is a high probability

Treatment:

1) azithromycin (1st line and must give even if suspected)
* dont give to patients with high risk of cardiovascular events or have QT syndrome*

2) TMP-SMX (2nd line in all cases where azithromycin cant be used)

Respiratory (40 decks)

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