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Pediatrics-MJ > T3-Blueprint: Respiratory > Flashcards

T3-Blueprint: Respiratory Flashcards

1
Q

Respiratory: What is the focus for pediatrics-airway or cardio?

A

Airway

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2
Q

When do children have alveoli?

A

Not till age 8 or 9

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3
Q

What type of airways do children have?

A

Short, more narrow airways from trachea to bronchioles

4 mm (child) vs 20 mm (adult)

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4
Q

Describe the trachea of children.

A

Trachea is shorter, angle of the right bronchus at bifurcation is more acute

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5
Q

Child or adult:

Small nasopharynx

A

Child

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6
Q

Child or adult:

Lymph tissue grows rapidly

A

Child

Lymph tissue grows rapidly till age 12, then atrophies

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7
Q

Child or adult:

Smaller nares

A

Child

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8
Q

Child or adult:

Smaller oral cavity

A

Child

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9
Q

Child or adult:

Large tongue

A

Child

*risk for obstruction since they have a large tongue but small oral cavity

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10
Q

What kind of epiglottis does the child have?

A

Long, floppy epiglottis which is vulnerable to swelling

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11
Q

What is higher in the neck for a child..what does this mean?

A

Larynx and glottis is higher in the neck–risk of aspiration

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12
Q

What cartilage is immature in the child and can collapse?

A

Thyroid, cricoid, tracheal cartilage

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13
Q

Do children have few or lots of functional muscles in airway

A

Few

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14
Q

Children have ____ amounts of soft tissues and loosely anchored mucus–risk of edema and obstruction

A

Large

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15
Q

Respiratory: What is the focus for adults-airway or cardio?

A

Cardio

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16
Q

T/F: Chest wall is inflexible in infants and children

A

FALSE–it is flexible–their chest muscles are immature and ribs are cartilaginous—this is why you see their retractions so well

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17
Q

Location of retractions for mild distress?

A

Intercostal (between ribs)

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18
Q

Location of retractions for worsening distress?

A

Substernal & subcostal

*below the sternum and ribs

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19
Q

Locations of retractions for severe distress?

A

Supraclavicular
Suprasternal

*Use of accessory muscles: sternocleidomastoid and trapezius

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20
Q

What is laryngotracheobronchitis (LTB)? And what age?

A

Aka croup; Moderate to severe airway obstruction caused by inflammation of larynx, trachea, and large bronchi

Ages 1-3

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21
Q

What is the classic sign of laryngotracheobronchitis (LTB)/Croup?

A

Inspiratory stridor

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22
Q

How does LTB begin?

A

With simple URI for 1-2 days and infection descends

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23
Q

Since LBT causes problems to larynx, trachea, and large bronchi…what symptoms will occur first: laryngeal, tracheal, bronchial? Describe.

A

Laryngeal

-Stridor, brassy, barking, or seal like cough

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24
Q

LBT: Laryngeal symptoms occur first..Then what?

A

Inflammation of the trachea and bronchi

-Resp obstruction (secretions, swelling of mucosa, muscle spasms)

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25
Q

What are some other s/s of LBT?

A 
Hoarseness
Mild fever
Restlessness
Nasal flaring
Retractions
Hypoxia
Respiratory fatigue
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26
Q

What is treatment for mild croup?

A

Can manage at home if no strider at rest

Oral fluids encouraged if RR is under 60

Cool mist humidifier, steam from shower, go outside in cool night air

Fever control: Acetaminophen

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27
Q

What is treatment for severe croup?

A

If stridor is constant–GO TO HOSPITAL

Oxygen is needed

Nebulized racemic epi or nebulized corticosteroids

Pulse ox needed

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28
Q

Severe croup: What is nebulized racemic epinephrine?

A

Alpha adrenergic causing vasodilation of mucosa

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29
Q

General term applied to a complex of symptoms characterized by a barking cough (swelling of larynx)

A

Croup

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30
Q

Mild or severe croup: croup cough, hoarseness, no stridor at rest

A

Mild

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31
Q

Mild or severe croup: continuous stridor, retractions, use of accessory muscles

A

Severe

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32
Q

A potentially life threatening condition that occurs when the epiglottis swells, blocking the flow of air into your lungs

A

Epiglottitis

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33
Q

What is the epiglottis?

A

A small cartilage lid that covers your windpipe

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34
Q

What are 3 ways to get epiglottis?

A

Bacterial (comes from H flu if not immunized)

Staph

Strep

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35
Q

Is inflammation of the epiglottis a medical emergency?

A

YES

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36
Q

What is the hallmark sign for Epiglottitis?

A

Drooling

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37
Q

Epiglottitis: Describe the S/S?

A

*Hallmark: Drooling

Others:

  • Very sore throat
  • Refuse to swallorw
  • *Prefers UPRIGHT TRIPOD POSITION with chin out and mouth open
  • Muffled voice
  • Reluctant to cry/speak
  • Retractions
  • Anxiety, fever
  • *Epiglottis is SWOLLEN AND CHERRY RED
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38
Q

How is epiglottitis diagnosed?

A

“Thumb sign” in lateral X-ray verse the normal little finger shape of the trachea

*must take lateral X-ray of neck

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39
Q

Epiglottitis: Is intubation necessary?

A

May be depending on how closed the airway is due to inflammation

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40
Q

Epiglottitis: What antibiotic?

A

Methyprednisolone

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41
Q

Epiglottitis: Why would we give IV steroids?

A

To help with inflammation

42
Q

Is epiglottis seen much still today?

A

No seen as much because of the Hib vaccine

43
Q

Sudden onset of symptoms of obstruction of airway of varying degrees due to inhalation of object

A

Foreign body aspiration

44
Q

If a FB is taken in through nose, where can it move to?

A

Into lower structures

45
Q

FB aspiration is common in what ages?

A

Toddlers, 1-3

46
Q

What do the symptoms of FB inhalation depend on?

A
  • Size of object
  • Where object lands in resp. tree
  • If it was witnessed or unwitnessed
47
Q

FB: If it was unwitnessed, what may be the first indication that event has occurred?

A

Infection

48
Q

FB: If there is partial obstruction and the patient is moving air what do we do?

A

Go to ED

49
Q

FB: Partial obstruction signs?

A

Coughing and wheezing but continues to move air with decreased breath sounds or absence of breath sounds in lung segment

50
Q

FB: What are signs of total obstruction?

A

Cyanosis
Cant speak
Collapse
*can cause death!!

51
Q

FB: What do we do for total obstruction for a child under 1 year?

A

Back blows, chest thrusts

52
Q

FB: What do we do for total obstruction for an older child?

A

Abdominal child

53
Q

What are choking hazard foods?

A
  • Hot dog
  • Nuts
  • Grapes
  • Veggie pieces (carrots, peas, beans, corn)
  • Popcorn
  • PB
  • Gum
  • Hard candy
  • Small parts of balloons
  • Coins
  • Beads
  • Buttons
  • Pins
54
Q

What are management for FB?

A

Xray: object is visible on chest xray

Surgery: Laryngoscopy and bronchoscopy

55
Q

Signs of a foreign body in the nose:

  • What kind of discharge?
  • What kind of obstruction?
A

Unilateral nasal discharge that is foul smelling

Local obstruction with sneezing and mild discomfort

56
Q

Foreign body in the nose: Discomfort may ____ in time, especially as objects may grow bigger as it absorbs moisture. Local _____

A

Increase in time

Local mucosal swelling

57
Q

Foreign body in the nose: Can infection occur?

A

Yes, followed by foul breath and purulent or bloody discharge from one nostril

58
Q

What is a lower respiratory tract (RSV) problem?

A

Bronchiolitis

59
Q

What are the initial signs and symptoms of bronchiolitis?

A

URI with fever, sneezing, rhinorrhea, coughing, and anorexia

60
Q

What are the signs after a few days of having bronchiolitis?

A
  • Rapid respirations and retractions
  • CHOKING COUGH
  • FROTHY MUCOUS
  • Nasal flaring
  • Rales, rhonchi
  • Prolonged expiratory wheeze
  • Decreased intake in infants
61
Q

What are some treatments for bronchiolitis?

A
  • Home rest
  • Chest x ray
  • RSV culture
  • Possible hospitalization
62
Q

What are meds for bronchiolitis?

A

Bronchodilators
Corticosteroids
Humidified O2

63
Q

Bronchiolitis (LRT-RSV) is very common. When is the higher incidence?

A

95% of kids have by age 3; winter and early spring usually

64
Q

What is an upper respiratory infection?

A

Strep pharyngitis

65
Q

Strep pharyngitis: majority or bacterial or viral?

A

Viral

66
Q

Strep pharyngitis: What do we do if it is bacterial or suspect it to be bacterial?

A

Throat culture

67
Q

S/S of strep pharyngitis?

A
  • Sudden onset of sore throat/fever
  • Headache
  • Abdominal pain
  • Vomiting
  • Poss rash
  • Lyphadenopathy (neck)
  • Neck pain
68
Q

Poss rash is a s/s of strep pharyngitis. What is this?

A

Fine, sandpaper like rash

69
Q

What is the treatment for pharyngitis?

A

Oral penicillin G for 10 days

70
Q

Oral penicillin G is given for treatment of strep pharyngitis. What is given to penicillin sensitive patients?

A

Erythromycin

71
Q

Strep pharyngitis: What can we put on the neck? What can help soothe the throat?

A

Neck: warm or cool compress

Mouth: Gargle with warm saline

72
Q

Tonsillitis have a ___ throat and difficulty ____

A

Sore throat and difficulty swallowing

*have a fever

73
Q

Tonsillitis patients have a history of what?

A

Otitis media and hearing difficulities

74
Q

Tonsillitis: Nose or mouth breathers?

A

Mouth breathing and snoring; have mouth odor

75
Q

Tonsillitis: What kind of qualities are heard in the voice

A

Nasal

76
Q

Tonsillitis: What kind of inflammation?

A

Tonsil inflammation with redness and edema

*small patches of yellowish pus also may become visible

77
Q

What is a tonsillectomy?

A

Removal of the palatine tonsiles

78
Q

Tonsillectomy is removal of the palatine tonsils. Where are these palatine tonsils located?

A

Both sides of oropharynx

79
Q

What is an adenoidectomy?

A

Removal of the pharyngeal tonsils

80
Q

What is another name for pharyngeal tonsils?

A

Adenoids

81
Q

What is the normal color for TM?

A

Translucent

Slightly pink of grey

82
Q

When we shine the light in an ear of a patient with a normal TM, what should we see?

A

Well defined light reflex, and the cone shaped reflection (points away from face)

83
Q

Inflammation of middle ear without reference to etiology or pathogenesis

A

Otitis media

84
Q

Infection of the structures of the middle ear with rapid clinical symptoms of infection

A

Acute otitis media

85
Q

S/S of acute otitis media?

A
  • Pain and irritable
  • Fever and rhinorrhea
  • Decreased appetite
  • Ruptured TM (will be non transparent grayish color)
86
Q

Treatment for acute otitis media?

A

Antibiotics for at least 10 days

87
Q

How do we look in ear of a child less than 3?

A

Pull pinna down and back

88
Q

T/F: Many acute otitis media infections can clear up spontaneously in a few days

A

True

89
Q

What if a child has recurrent otitis media?

A
  1. Tympanostomy tube placement

2. Adenidetomy

90
Q

What does a tympanovstomy tube placement do for a child with recurrent otitis media?

A

They are pressure equalizer tubes and spontaneously fall out in ~6 months

91
Q

Otits media problems are mostly related to eustachian tube malfunction. How are these tubes in children?

A

Short and more horizontal

92
Q

Otitis media: What age is this common in?

A

First 24 months of life and again during school (5-6)

*infrequently after age 7

93
Q

What months and homes are otitis media cases common in?

A
  • Winter months

- Homes with second hand smoke

94
Q

What other illnesses/disorders increase risk of otitis media?

A

Down Syndrome

Cleft lip/palate

95
Q

Lower or higher risk of otitis media in those who are breastfed?

A

Lower

96
Q

Collection of fluid in the middle ear but not infection

A

Otitis media effusion

97
Q

“Swimmers ear”–infection of outer ear canal.

A

Otitis externa

*inflammation of skin of ear canal

98
Q

FB: How do we remove soft objects (paper, insects)?

A

With foreceps

99
Q

FB: How do we remove small, hard objects (like pebbles)?

A

Suction tip
Hook
Irrigation

100
Q

FB: When is irrigation contraindicated?

A

If subject is a vegetative matter (beans, pasta) because it will swell with fluid

Pediatrics-MJ (61 decks)

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