respirology Flashcards
DDx for wheeze 4 common and a few uncommon
common 1. asthma 2. bronciolitis 3. PNA - fever cough malaise 4. GERD uncommon 1. CF - prolonged and unresponsive 2. foreign body - sudden onset 3. mass 4. CHF - FTT 5. tracheobronchial abnormalities
def. of asthma
airway hyperactivity, bronchospasm, inflammation, and reversible airway obst
crit. for determining if well controlled
90 of personal best
PEF variations of
important asthma Hx
- severity of episode
- might Sx
- eposures
- hospital and ICU admissions
- fam Hx
invest. for asthmas
- pulse oximetry
- consider ABG if increasing O2 required
- CXR if first time or atypical
- 6 can do spirometry
spirometry def of asthma
FEV/FVC
mgmt of asthma
- humid O2 if
when to hosp. for asthma
absolute
- requires O2
DC instructions for asthma
- B2 agon q4h, 1-2 days
- dex to complete course
- inhaled cort. for at least 3 weeks or seaon
- educations
- reassess in 24-48 hrs
def. of bronchiolitis
self limiting seasonal viral infection of lower tract in child
Hx of bronchilitis
- prodrome of coryza, worsening cough
- low oral intake
- irritable
- resp distress
invest for bronchioitis
- Hx and Phx
- pulse ox
- NP for viral swabs if in hosp
- blood work and CXR NOT necc.
mgmt of bronciolitis
- O2 if sats
when to hosp. for bronchiolitis
absoute - O2 requirements - dehydration evident - Hx of apnea relative - young
def, of CF
- auto reccessive
- mutation of gene causes abnormal Cl - thick secretions
- changes to epithelium of airway, panc ducts, biliary tree, vas def. and sweat glands
present of CF
resp - cough - lower airway colonization - endobronch. infection - hypoxemia upper airway - pansinusitis - nasal polyps GI - protein and fat malabsorption - meconium ileus - distal intestinal obst. - abst. jaundice - rectal prolapse
Dx of CF
- part of newborn screen
- if test is positive, then do sweat chloride test
- CFTR gene mutation analysis
CF complications
lung disease - progressive obst. and inflammaiton lung infection - Staph, H flu, pseudo panc. disease intestinal disease hepatobiliary disease infertility in males
mgmt of CF
methods to promote clearance of airways
def. epiglotitits
acute cellulitis of epiglottis
- most common H flu
death with no Tx
4Ds or epiglottiis
Drooling
Dysphagia
Dyphonia
Distress
Phx of epiglot
- look very unwell
- classic tripods
- stridor
- drolling
- tender to palpate hyoid
- tachy
mgmt of epi
- ENT stat
- xray - thumbprint sign
- secure airway at nearest hosp
- blood and epiglot Cx
- IV Abx - cefuroxime
DDx for stridor
- laryngiomalacia - most common
- tracheomalacia
- croup
- epiglot
- bact. traceitis
- retropharygeal abscess
- foreign body
- angioedema
def. croup
- viral infection of upper airway
- most common parainfluenza
- children under 6 and last 3-7 days
Sx of croup
- cold prodrome
- sudden onset at night
- barking cough
- hoarseness
- inspir. stridor
invest. for croup
not usually necc.
- pulse ox
- lateral and AP neck xray of concerned
mgmt of croup
- keep upright
- O2 if needed
- NOT humidity
- Dexa for all severity (.6mg/kg)
- epi in mod. to severe cases
follow up with fam. doc
see table p 232
night and day Sx of OSA
night - the usual day - mouth breathing - nasal cong - hyperactive - irritable
main Phx finding in OSA
- mouth breath
- large tonsils
- nasal cong
- obese
Dx of OSA
polysomnogram
mgmt of OSA
- if tonisslar/adenoid - take out
- only cures non-obese kids
