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Pediatrics Clerkship > Respiratory Diseases of Neonates and Children > Flashcards

Respiratory Diseases of Neonates and Children Flashcards

1
Q

Bronchiolitis is caused by ___ and primarily affects ___.

A

Bronchiolitis is caused by respiratory syncytial virus and primarily affects children age 2 and younger.

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2
Q

Initial presentation of respiratory infection in an infant

A
  • Decreased oral intake
  • Poor sleep
  • Fussiness
  • Malaise
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3
Q

Signs and symptoms suggestive of pneumonia over bronchiolitis

A

High or persistent fever

Area of persistently decreased aeration on auscultation of lungs

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4
Q

Generally speaking, glucocorticoids and bronchodilators are not often used for ___, but are standard therapy for ___.

A

Generally speaking, glucocorticoids and bronchodilators are not often used for bronchiolitis, but are standard therapy for croup.

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5
Q

Indications for hospitalization of an infant with respiratory illness

A
  • Poor oral intake
  • Hypoxia
  • Apnea
  • Moderate to severe respiratory distress
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6
Q

Palivizumab

A

Antibody against RSV

Given monthly as prophylaxis to infants at high risk for severe RSV infection (premature infants, infants with pre-existing lung or heart disease) during RSV season (winter)

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7
Q

Magnesium for pediatric asthma

A

Given IV as a step-up from inhaled albuterol and steroids

Useful for inpatient management of pediatric asthma

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8
Q

Standard ED course of croup

A

Give dexamethasone. If not improving, give one or two doses of racemic epinephrine. If still not improving, admit.

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9
Q

Meconium aspiration syndrome

A
  • Delivery through meconium-stained fluid + syndrome of respiratory distress + CXR showing air trapping, patchy atelectasis, and irregular densities
  • May be complicated by pulmonary hypertension secondary to atelectasis
  • Meconium inactivates surfactant
  • Treatment: Just supplemental oxygen for mild cases. More severe may require intubation and positive pressure ventilation. Surfactant administration may be necessary in severe cases. Treat associated pulmonary hypertension with inhaled nitrous oxide.
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10
Q

Respiratory distress syndrome of the newborn is also called. . .

A

. . . hyaline membrane disease

For obvious reasons

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11
Q

Paradoxically, ongoing fetal stress, such as from preeclampsia, is associated with ___ lung maturation

A

Paradoxically, ongoing fetal stress, such as from preeclampsia, is associated with accelerated lung maturation

This makes sense if you think about endogenous cortisol production, and has clear evolutionary benefit.

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12
Q

___ may delay fetal lung maturation

A

Oligohydramnios or maternal hyperglycemia may delay fetal lung maturation

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13
Q

It takes ___ following delivery for type II pneumocytes to take up the task of differentiating and producing surfactant in RDS.

A

It takes ~72 hours following delivery for type II pneumocytes to take up the task of differentiating and producing surfactant in RDS.

Infants with RDS will need respiratory support until this time. They generally get worse until 48 hours, then progressively better as they approach 72 hours.

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14
Q

Most common etiologies of pneumonia in the neonate

A
  1. Group B Strep
  2. E. coli
  3. Klebsiella pneumoniae
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15
Q

Differentiating neonatal pneumonia from other neonatal respiratory distress syndromes

A
  • Chest radiograph will be more diffuse than non-infectious processes
  • Sepsis-associated signs: Temperature instability, poor feeding, lethargy
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16
Q

Treatment of neonatal pneumonia

A
  • Ampicillin + gentamycin
  • Same as chorioamnionitis
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17
Q

Bronchopulmonary dysplasia

A
  • Chronic condition caused by RDS
  • Effectively, scarring of the alveoli due to chronic atelectasis
  • Need chronically elevated FiO2 AND a lung protective strategy
    • ​Since chronically elevated FiO2 is lung damaging, a minimum necessary FiO2 should be used
  • Diagnosis: CXR showing ground glass opacities and history of requiring supplemental oxygen > 28 days
  • Treatment: Surfactant\
  • This diagnosis effectively becomes diffuse parenchymal lung disease in the adult
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18
Q

Nasal bridge crease

A

Finding on exam during testing the facial nerve. Develops due to characteristic upward nose rubbing in individuals with chronic rhinitis

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19
Q

Distinguishing allergic rhinitis from vasomotor rhinitis

A

Allergic: Associated with certain seasons or allergen-assodicated activities. Atopic history often present, nasal smear shows eosinophils in Hansel stain.

Vasomotor: Associated with certain weather changes, physical stimuli, or emotion. Usually in patients lacking atopic history or nasal smear eosinophilia on Hansel stain.

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20
Q

Any young child with nasal polyps should be screened for. . .

A

. . . cystic fibrosis

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21
Q

Rhabdomyosarcoma in children

A

Frequent cancer of the head and neck in children

Often presents due to its obstruction of sinuses or airways

MRI of the affected area is the first step if suspected.

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22
Q

Presentation of a retropharyngeal abscess

A
  • May mimic pharyngitis or meningitis
  • Will have severe pain with swallowing, fever, neck stiffness, and fullness of the posterior orophaynx
  • Diagnosis is with lateral neck X-ray
23
Q

___ is a common complication of meconium aspiration syndrome

A

Spontaneous pneumothorax is a common complication of meconium aspiration syndrome

Due to air-trapping. CXR will usually show hyperinflation and flat diaphragm prior to spontaneous pneumothorax. Needle thoracostomy (if emergent) or chest tube placement (if non-emergent) is indicated.

24
Q

In an infant with RDS of the newborn, the degree of tachypnea often precludes ___

A

In an infant with RDS of the newborn, the degree of tachypnea often precludes oral feeding

NG tube is usually required

25
Q

Bacterial tracheitis

A
  • Usually caused by Staph aureus, sometimes by Moraxella or H. influenzae
  • May occur as a sequella to viral croup
  • May require emergent intubation and tracheostomy, similar to severe croup
26
Q

Spasmodic croup

A
  • Describes sudden onset nighttime hoarseness, “barky” cough, and inspiratory stridor in a previously healthy, afebrile child
  • Viral infection, respiratory allergy, GERD, and psychosocial factors are implicated as possible etiologies
27
Q

Diagnosis of suspected foreign body aspiration

A

CXR is usually performed, but after than the next step is bronchoscopy rather than a neck film

Most aspirated foreign bodies will not be visible on radiograph

An aspirated coin will appear as a flat line since it will rest upon the cartilaginous rings of the trachea

28
Q

Anyone who presents with signs and symptoms of croup is going to get. . .

A

. . . racemic epinephrine and corticosteroids

29
Q

Tracheomalacia

A
  • Collapse of the airway with breathing
  • May present with intermittent stridor (such as with crying) or with persistent stridor
  • Usually noticed first early in infancy
  • Narrowing most prominent with valsalva
  • PFTs show a reduction in peak expiratory flow
  • Fiberoptic bronchoscopy with direct observation during inspiratory and expiratory cycles is the gold standard for diagnosis
  • Treatment usually involves tracheostomy
30
Q

Croup

A
  • Caused by parainfluenza virus
  • Classically affects those 3 months - 3 years of age
  • Stridor and “barky” cough
  • Diagnosis: Clinical, do NOT do a CXR (steeple sign is neither sensitive nor specific). Response to racemic epi is diagnostic.
  • Treatment:
    • Mild: Cold misting
    • Moderate: Racemic epinephrine and corticosteroids, maybe oxygen
    • Severe: Admit
31
Q

Bacterial tracheitis

A
  • Caused by S. aureus
  • Presents JUST like croup, but does not improve with standard croup therapies. May appear slightly more toxic (more fever, leukocytosis)
  • Diagnosis: Croup Hx in the context of no response or poor response to racemic epinephrine. Then tracheal culture, sometimes from scope.
  • Treatment: IV abx
32
Q

Pre-teen presents with high spiking fever, sore throat, odynophagia, dysphagia. On exam they are drooling and their uvula is deviated to one side. What is the diagnosis?

A

Peritonsilar abscess

The clues here are 1) the age of the patient, and 2) the deviation of the uvula

Those would both be unusual features for epiglottitis or retropharyngeal abscess

33
Q

Approach to management of epiglottitis vs oropharyngeal abscesses

A
  • Epiglottitis: First thing to do is secure the airway. Then, begin abx. No imaging necessary, the diagnosis is confirmed when observing a cherry red epiglottis while intubating.
  • Oropharyngeal abscess: First, CT scan to confirm abscess location. Then, aspiration/drainage of abscess and antibiotics.
34
Q

Before considering step-up in asthma therapy, you should ensure that the patient. . .

A

. . . knows how to use their inhaler

35
Q

Bronchopulmonary dysplasia

A
  • Due to barotrauma and oxygen toxicity. Is a complication of prolonged mechanical ventilation in premature infants.
  • Classic presentation of BPD includes persistent tachypnea, labored breathing (intercostal and subcostal retractions), FiO2 > 30% to maintain peripheral saturation > 90%, and diffuse granular densities with basal atelectasis on x-ray.
  • Later in the disease course, interspersed cystic areas and diffuse hyperinflation of the lung can develop
  • Treatment of BPD primarily focuses on limiting oxygen toxicity and preventing complications (pneumothorax, cardiovascular collapse, and neonatal sepsis).
36
Q

ED nebulizer courses

A
  • One of albuterol only
  • One of albuterol + ipratropium
  • Albuterol + ipratropium x 3 (aka Unineb at BCH)
37
Q

Typical treatment of severe asthma in the ED

A
  1. Unineb (3x albuterol + ipratropium)
  2. Dexamethasone IV
  3. IV magnesium as a bolus
38
Q

Presentation of “croup in the summer”

A

Vessels or thyroid constricting the trachea

39
Q

Laryngomalacia

A
  • “Floppy airways” due to maldevelopment of laryngeal cartilage, weak laryngeal muscle tone and short aryepiglottic folds.
  • “Omega shaped epiglottis” on laryngoscopy.
  • Stridor results from vibration of the epiglottis in the larynx.
  • Manifestations include low-pitched inspiratory stridor, swallowing dysfunction, reflux, and, in severe cases, failure to thrive.
  • Presents a few weeks after birth, peaking at ~6 months.​ Typically self-corrects around 12-18 months. If persists, can be resolved surgically.
40
Q

Adenoid hypertrophy

A
  • Hyperplasia of the pharyngeal tonsils
  • Common in setting of recurrent or chronic upper airway inflammation
  • May cause congestion of choanae or eustacian tubes
  • Sx: Mouth breathing, snoring, hyponasal speech (hard to pronounce m, n, ng), adenoid facies, halitosis
  • Dx: Flexible nasopharyngoscopy showing hypertrophy of adenoids
  • Tx: If asymptomatic, no Tx. Adenotonsillectomy is indicated for recurrent otitis/sinusitis or sleep apnea. Intranasal corticosteroids and abx as necessary to reduce inflammation.
41
Q

Choanae

A
  • Equivalent of eustacian tubes for the nose
42
Q

Mastoiditis

A
  • Complication of otitis media
  • Presents as persistent or recurrent symptoms of OM after initial improvement, profuse ear discharge, tender and erythematous mastoid, and anterolateral displacement of ear
  • Confirm the diagnosis with CT scan of temporal bone showing mastoid air cells, erosion of air cell walls, and pus in the mastoid cavity seen as areas of enhancement
  • Treatment is with IV antibiotics (often vancomycin) AND tympanostomy with tube insertion. Mastoidectomy may be necessary in severe cases.
43
Q

Normal temporal and mastoid anatomy on CT

A
44
Q

Treatment for otitits media in someone penicillin allergic

A

Macrolides are fine

45
Q

If patient presents with a neck abscess, the first question you should ask before thinking about antibiotics or imaging is. . .

A

. . . does this patient need to be intubated?

Tachypnea, stridor, evidence of respiratory strain on exam are sufficient to indicate intubation

46
Q

Acute unilateral pyogenic lymphadenitis

A
  • Unilateral, painful infectious swelling of an anterior cervical lymph node
  • Caused by S. aureus, S. pyogenes, or oral anaerobes
  • If symptoms are mild, workup and treatment may be unnecessary
  • Moderate symptoms indicate workup and empirical treatment with clindamycin
47
Q

Kartagner syndrome aka primary ciliary dyskinesia

A
  • Triad of:
    • Recurrent sinusitis
    • Bronchiectasis
    • Dextrocardia (situs inversus)
  • And later on:
    • Men: Immotile sperm
    • Women: Infertility due to fallopian tube failure
48
Q

Vascular ring anomaly

A
  • Can cause an afebrile croup-like presentation with narrowing and bowing of the trachea on CXR
  • Treat w/ surgical division
49
Q

Treating CF and Primary ciliary dyskinesia lung guck

A
  • Chest physical therapy
  • Vigorous exercise
  • Frequent coughing
  • Bronchodilators
  • Recombinant human DNAse via nebulizer
50
Q

Hemoptysis with frank blood loss of >___ in 24 hours is an emergency requiring bronchial artery embolization

A

Hemoptysis with frank blood loss of >500 mL in 24 hours is an emergency requiring bronchial artery embolization

51
Q

A R sided aortic arch is likely to. . .

A

. . . compress the R mainstem bronchus

This can produce wheeze or respiratory distress

52
Q

Pulmonary hemosiderosis

A
  • Restrictive lung disease caused by lung fibrosis secondary to iron accumulation from chronic hemorrhage into luns
  • History will include hemoptysis or pulmonary hemorrhage
  • Dx is with hemosiderin-laden macrophages visualized on bronchial lavage OR gastric aspirate
  • Clinical picture involves dyspnea, hemoptysis, hematemesis, iron deficiency anemia, restrictive lung pattern
53
Q

Pectus excavatum

A

Don’t forget that it is a form of restrictive lung disease!

Pediatrics Clerkship (23 decks)

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