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Peds Primary care 2 > Test number two > Flashcards

Test number two Flashcards

1
Q

Breath sounds in the physical exam of an asthmatic

A

sounds of wheezing heard during normal breathing
forced exhalation
porlonged phase of forced exhalation

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2
Q

Definintion of Atopy

A
  • genetic predisposition to develop immunoglobulin E (IgE) mediated response to aeroallergens
    The strongest identifiable predisposing factor for developing asthma
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3
Q

Definintion of Atopy

A
  • genetic predisposition to develop immunoglobulin E (IgE) mediated response to aeroallergens
    The strongest identifiable predisposing factor for developing asthma
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4
Q

what is eczema aka as? what is is?

A

Atopic dermatitis a chrinic or chronically relapsing pruritic condition with cutaneous hypersensitivity Characterized by very dry skin, eczematou patches (tiny bubbles), and lichenification

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5
Q

Risk factors for eczema

A
  • Family history
  • certain foods
  • climate
  • stress
  • sweating
  • aeroallergens
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6
Q

Exam findings in eczema: by age group: Infants: age 2-12 adolescents:

A

itching, esp at night in infants:erythema and scaling of the cheeks, chin, scalp, extensor surfaces, generalized re papules, exudative lesions Children 2-12: red papules coalesce into plaques, scratching with lichenification, flexural surfaces are commonly affected Adolescents; flexural surfaces with lichenifcation: neck, foot, and hand dermatitis more common, puberty may trigger exacerbation

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7
Q

Airflow limitation in asthma iscaused by a variety of changes in the airway which include:

A
  • Bronchoconstriction
  • airway edema
  • airway hyperresponsiveness
  • airway remodeling
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8
Q

Airflow limitation in asthma iscaused by a variety of changes in the airway which include:

A
  • Bronchoconstriction
  • airway edema
  • airway hyperresponsiveness
  • airway remodeling
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9
Q

Airway edema in asthma is caused by

A
  • inflammation
  • mucus hypersecretion
  • mucus plugs
  • structural changes: hypertrophy and hyperplasia of the airway smooth muscle
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10
Q

What causes airway hyperresponsiveness in asthma?

A

inflammation is the major factor

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11
Q

What causes airway remodeling in asthma?

A
  • permanent alterations in the airway structure thought to be caused by chronic inflammation
  • airflow limitation may only be partially reversible in some people
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12
Q

What causes airway remodeling in asthma?

A
  • permanent alterations in the airway structure thought to be caused by chronic inflammation
  • airflow limitation may only be partially reversible in some people
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13
Q

deficit in lung function growth happens in what age group when diagnosed with asthma?

A

children whos symptoms begin in the first 3 years of life

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14
Q

Preventable: Asthma risk factors Non: preventable:

A
  • allergen exposure
  • tobacco smoke exposure
  • outdoor and indoor air pollution
  • occupational exposures
  • genetics
  • Hx atopic dermatitis
  • viral infections
  • airway size (prematurity)
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15
Q

Immediate or early Asthma response

A

occurs within minutes of exposure immediate bronchoconstriction (hyperresponsiveness) resolves with B2 agonist use

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16
Q

Immediate or early Asthma response

A

occurs within minutes of exposure immediate bronchoconstriction (hyperresponsiveness) resolves with B2 agonist use

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17
Q

Three criteria for diagnosing asthma

A
  • Episodic sx of airflow obstruction or airway hyperresponsiveness are present (recurrence)
  • Airflow obstruction is at lease partially reversible (responds to tx measured by spirometry w/ significant post bronchodilator relief of symptoms
  • Alternative diagnoses are excluded
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18
Q

measurement of Reversibility by spirometry

A
  • Increase in FEV1 of > 12 % from baseline or

* increase in FEV1 > or = 10% of predicted after inhalation of SABA

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19
Q

key history indicators of asthma

A
  • Wheezing
  • hx of cough worse at night
  • recurrent wheeze
  • recurrent difficulty breathing
  • recurrent chest tighness
  • sx worsen with exercise, viral infection, allergens, changes in weather, strong emotional expression, airborne chemicals or dust, menstrual cycles
  • sx occur, worsen at night/ wake pt up
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20
Q

Thoracic findings in physcial exam of asthmatic

A

Hyperexpansion of the thorax
use of accessory muscles
appearance of hunched shoulders
Chest deformity

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21
Q

Thoracic findings in physcial exam of asthmatic

A

Hyperexpansion of the thorax
use of accessory muscles
appearance of hunched shoulders
Chest deformity

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22
Q

Exam findings of the nose in an asthmatic

A

increased nasal secretion, mucosal swelling, nasal polyps

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23
Q

exam findings of the skin in asthmatics

A

atopic dermatitis

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24
Q

at what age can you use spirometry?

A

at least not until 5: some say not reliable till age 7

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25
Q

what does spirometry test?

A

one true objective assessment:

indicates degree of airflow obstruction

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26
Q

what is FVC?

A

forced vital capacity: maximum olume of air forcibly exhaled from the point of maximal inhalation

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27
Q

what is FEV1?

A

forced expiratory volume of air exhaled in 1 sec

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28
Q

what should be included on the pedi spirometry measures due to it being a more sensitive marker of impairment than FEV1 in kids?

A

FEV1/FVC

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29
Q

What does a positive methacholine test mean?

A

asthma med trial: positive is not definitive, can be from other diseases
Neg rules out asthma

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30
Q

What does a positive methacholine test mean?

A

asthma med trial:

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31
Q

How is the degree of narrowing determined with a methacholine or histamine test?

A

Spirometry

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32
Q

What is the reversibility test after a methacholine or histamine test?

A

Going a bronchodilator to counteract the bronchconstrictor then preparing spirometry

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33
Q

D/D’s of Asthma

A 
AR
Sinusitis
Foreign body in trachea or bronchi
Vocal chord dysfunction
Vascular rings or laryngeal webs 
Largyngomalacia
Tracheal stenosis 
Bronchostenosis
Viral bronchitis or bronchiolitis
BPD
Heart disease
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34
Q

What are the aspect of asthma impairment?

A 
S/S
Night awakenings
Use of SABAs 
Work or school missed
Interference w normal activity
Quality of life assessment 
PFTs
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35
Q

What are the aspects of asthma risk?

A

ED or hospitalizations

Exacerbations requiring steroid bursts

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36
Q

Classifications of control

A

Well controlled
Not well controlled
Very poorly controlled

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37
Q

Step 1 of managing asthma

A

Needs SABA only occasionally

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38
Q

What is important about steps 2-6 in asthma management?

A

Need a controller med

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39
Q

At what step therapy should u consult a specialist?

A

Step 3 or higher

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40
Q

How is severity classified?

A

Spirometry

Recall of s/s in previous 2-4 wks

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41
Q

What is included in consideration risk of death of asthma

A

Reduced lung growth measure by failure to obtain PFTs values for age
Progressive loss of pulmonary function
Risk of adverse effects from meds

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42
Q

what body position will an asthmatic assume during an emergency?

A

tripod to try to get more diaphragmatic movement

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43
Q

exam findings during asthmatic emergency

A 
breath sounds from wheezing to silent chest
suprasternal or intercostal retractions
accessory muscle use
"worried look"
increased RR
SOB
decreased activity tolerance
nasal flaring
may not be able to complete a sentence
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44
Q

predictors of risk of exacerbations of asthma?

A

sever airflw obstruction as measured by spirometry
persistent airflow obstruction
2 ED visits or hospitalizations in past year
intubation or ICU admission ever, especially if in last 5 years
pt reports they feel in danger or frightened
femlae
nonwhite
nonuse of ICS
smoker
depression
stress
attitudes/beliefs about taking medicine

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45
Q

when to refer to asthma specialist

A 
life thratening evernt
2 steroid bursts in one yr or a hosptializations
poor control at 3-6 months of therapy
problems diagnosing
complicating comorbid conditions
need further education
need immunotherapy
if step 3 is required in 0-4 age group
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46
Q

what is a PFM used for? (Peak Flow Meter?)

A

measures large airway function, good monitoring device, can be used for self monitoring during exacerbations.
especially good for pts who have difficulty perceiving signs of worsening asthma

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47
Q

big prinicples of step therapy in asthma

A

if not well controlled, step up
go by the most sever syptom or criterion
if they had exacerbations whould probably step up

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48
Q

What step does mild persistant ashtma in the 0-4 age group require? What does therapy involve?

A

Step two:
low dose ICS
alternate: singulair or cromolyn

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49
Q

what step does intermittent asthma need in the 0-4 age group?

A

Step one:

SABA PRN

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50
Q

What step does persistent: moderate or severe asthma need in the 0-4 age group? what does it involve?

A 
may need steroid burst
start with step 3:
     *Medium dose ICS
Step 4: 
     * medium dose ICS + either singulair or LABA
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51
Q

When to start daily control meds in the 0-4 age range

A

if 4 episodes of wheezing in last year that lasted longer than 1 day AND that affected sleep AND who have risk factors for developing persistent asthma
consistently require symptomatic relief more than two days per week for 4 weeks
have 2nd exacerbation requiring steroid burst within 6 months

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52
Q

what are risk factors for developing persistent asthma per the guideline requiring daily controller meds?

A

a parent w/ asthma or
a physcician dx of atopic dermatitis or
evidence of sensitivity to aeroallergens or
2 of the following:
*evidence of sensitization to foods
* > or = 4% Peripheral blood eosinophilia
* wheezing apart from colds

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53
Q

tx of exacerbations due to URI in ages 0-4

A

mild s/s: SABA q4-6 hoursx 24 hours
moderate-severe: steroid burst
for those with history of sever s/s, consider initiating steroid burst at 1st sign of URI

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54
Q

what is the step needed for intermittent asthma in ages 5-11?

A

Step 1: SABA PRN

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55
Q

What is the step needed for persistent mild asthma in ages 5-11?

A

Step 2:
Perferred: Low dose ICS
alternate; singular, cromolyn, nedocromil, theophylline

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56
Q

what is the step needed for moderate or sever persistent in ages 5-11?

A

start with step three: Low dose ICS + either LABA, singulair or theophylline OR Medium dose ICS
Step 4:
Perferred: medium dose ICS + LABA
alternative: medium dose ICS + either sigular or theophyillin

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57
Q

adjusting therapy based on control: Well controlled

A

Well controlled: maintain tx, follow up in 1- 6 months, step down if well controlled for at least 3 months

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58
Q

adjusting therapy based on control: not well controlled

A

Step up 1 step
follow up in 2-6 weeks
if side effects consider alternative tx options
0-4: if not better adjust therapy again or consider another diagnosis

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59
Q

adjusting therapy based on control: very poorly controlled

A

Consider steroid burst
go up 1-2 steps
follow up in 2 weeks
if side effects: consider alter. tx options
if 0-4: if no benefit in 4-6 weeks consider alter. dx or adjusting therapy again

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60
Q

Rules of 2 with using controller meds in asthma

A 
uses SABA > or = to 2 times a week
awakens at night > or = 2 times a month
refills SABA > 2 times/ year
has > or = 2 unscheduled visits/ year due to asthma 
requires > or = 2 steroid bursts/ year
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61
Q

Dosages of ICS vary according to what?

A

whether persistent asthma is mild, moderate, or severe

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62
Q

ICS and the effect on linear growth

A

not significant: approximately 1 cm in first year of threatment, generally does not progress over time after this

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63
Q

What is the risk of high dose ICS for prolonged periods, particualarly in association with frequent oral steroid bursts?
what can help?

A

associated with adverse growth effects
risk of cataracts
reduced bone density
*be sure they get enough calcium and vitamin D

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64
Q

what is the primary cell that drives asthma?

A

eosinophils

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65
Q

what happens in early stage of asthma?

A

FEV drops by 40% in 15 min: mast cells in lungs have antibodies called IgE that are specific to particular antigens: mast cell releases HISTAMINE and causes:
Contraction of smooth muscles of the bronchioles
Mast cell secretes histamine until it is gone, about 3 hours later, after it is gone, pt feels better, FEV1 up to about 80%

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66
Q

what happens in late stage of asthma?

A

Mast cell releases other mediators: PAC, ECF, LRD4, NCF:
4-6 hours later: airway diamerter further decreases from INFLAMMATION, thickening of the bronchiole wall, and mucus production

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67
Q

Why does airway remodeling occur?

A

EOS are designed to fight off parasites, instead they are turned loose in our lungs, causes gradual scarring. used to think this was reverisble…now we think it isnt

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68
Q

Fever is normally maintained by what?

A

the hypothalamus

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69
Q

what happens in fever as the setpoint is raised?

A 
they hypothalmus signals increase in heat peroduction and conservation
peripheral vasoconstriction
epi relase
muscle tone increses: shivering
person feels cold: bundles
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70
Q

what happens when fever breaks?

A 
hypotalamus signals a decrease in heat porduction and increase in heat reduction
decreased muscle tone
peripheral dilation
flushing of the skin
sweating
person feels warm, stretches out
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71
Q

benefits of fever:

A

kills many microorganisms
has adverse effects on the growth and replication of others
decreases serum levels of iron, zinc, and copper, which are needed for bacterial replication in infected cells
increases lymphocytic transformation and motility of PMS: facilitates the immune response
enhances phagocytosis

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72
Q

when to treat fever:

A

to imporve childs overall comfort rather than focus on the normalization of body temp

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73
Q

Why do neonates sometimes not have a fever response or become hypothermic during significant infection?

A

immature liver

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74
Q

why is hyperthermia different than fever?

A

hyperthermia is marked warming of core temperature that is NOT mediated by pyrogens and there is no resetting of the hypothalaic set point

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75
Q

Fever of short duration

A

accompanined by localizing s/s, in which a diagnosis can be established by clnical history or physcial exam

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76
Q

Fever without localizing signs (FWS)

A

AKA fever without source

H & P fails to establish a cause of fever, frequently occurs in kids < 3 years

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77
Q

Fever of Unknown origin (FUO)

A

fever present for > 14 days that does not have an etiology despite H & P, labs
older kids and adolescents: fever over 38 C for more than 2 weeks that remains udiagnosed despite detailed comprehensive eval for 7 days

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78
Q

Bacteremia

A

positive blood culture

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79
Q

sepsis

A

infection of the blood stream by microorganisms or their toxins: a systemic response to the infection

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80
Q

sepsis manefestations

A

hyperthermia or hypothermia, tachycardia, tachypnea, Shock

May be irritable or lethargic, poor perfusion, may have DIC (petechiae or ecchymosis)

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81
Q

causes of febrile illness in < 3 month olds

A

most common: common viruses

  • Bacteremia: S pneumo, Hib, slamonella, GBS, N. meningitidis
  • UTI:E coli
  • Pneumonia: S. pneumo, S. aureus, GBS
  • Meningits: S. Pneumo, Hib, GBS, meningococcus, HSV, enteroviruses
  • Bacterial Diarrhea: slamonella, shigella, E coli
  • Osteomyelitis or septic arthritis: S. aureus, GBS
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82
Q

Causes of febrile Illness in 3 months to 2 years: at risk for organisms with polysaccharide capsules: which ones?

A

Strep pneumo
H flu type B
meningococci
Salmonella

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83
Q

management in fever infants < 1 month

A

hospitalize
maintain ABX pending cultures
CBC with diff, cultures, maybe LP. CXR

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84
Q

management of fever in infants 1-3 months

A

if appear well and labs fine: probably ok

if looks sick: need to admit

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85
Q

risk factors for occult bacteremia in children < 3 years of age

A

Temp > or = 102.2
WBC > or = 15,000
elevateed absolute neutrophil, bands, ESR or CRP

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86
Q

How can you change the set point?

A

antipyretics

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87
Q

shift to the left

A

incrase in numbers of circulating imature cells of the neutrophil series: including band forms, metamyelocytes, and myelocytes

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88
Q

what might you see on a WBC in the first 24-48 hours of a viral infection?

A

transient low lymphocyte count

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89
Q

which WBCs are the granulocytes?

A

neutrophils, basophils, eosinophils

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90
Q

which WBCs are the agranulocytes?

A

lymphocytes and monocytes

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91
Q

what is the function of neutrophils

A

combats pyogenic infections

most important leukocyte in reaction to inflammation

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92
Q

what is the function of eosinophils?

A

combat allergic disorders and parasitic infections

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93
Q

what is the function of basophils

A

combat parasitic infections, some allergic disorders

94
Q

what is the function of lymphocytes

A

combat viral infections

95
Q

what is the function Monocytes

A

combat severe infections

bodies 2nd line of defense against infections

96
Q

what is a normal WBC for 0-2 weeks of age?

A

9000 - 30,000

97
Q

what is a normal WBC for 2-8 weeks of age?

A

5000 - 21,000

98
Q

what is normal WBC in 2 mos to 6 years?

A

5000-19,000

99
Q

what is normal WBC in 6-18 years

A

4800 - 10,800

100
Q

what could elevated CRP and TNF be associated with?

A

bacterial disease

101
Q

two patterns of fever in FUO

A

Prolonged daily fevers

repeated discrete febrile episodes over a prolonged period of time

102
Q

most cause of FUO fall into to what 3 categories

A

Infectious, infalmmatory or rheumatoid, neoplastic

103
Q

definition of a febrile seizure

A

seizure accompanied by fever w/out cental nervous system infection occuring in infants an children between 6 months and 5 years

104
Q

meds that can cause fever

A 
penicillins
cephalosporins
acetaminophen
anticonvulsans
methylphenidate
105
Q

noninfectious diseases that present with fever

A 
rheumatoid diseases
kawasakis disease
inflammatory bowel disease
poisoning
malignancy
106
Q

what is a chronic cough defined as?

A

lasting longer than 3 weeks

107
Q

type of cough usually seen in a URI

A

dry hacking cough

108
Q

type of cough usually seen in sinusitis

A

cough more than 10 days w/ purulent nasal discharge

109
Q

type of cough in asthma

A

grunting cough

110
Q

type of cough in laryngitis

A

dry hacking cough with hoarsness

111
Q

type of cough in croup

A

barking cough and stridor, w/ or w/out fever

112
Q

type of cough in tracheitis

A

cough and striodr precded onset of respiratory distress

113
Q

type of cough in bronchitis:

A

hacking cough appears several days after onset of a typical URI

114
Q

type of cough in pertussis

A

paroxysmal cough: violent, may be staccato like followed by a whoop

115
Q

type of cough in bronchiolitis

A

rhinorrhea precedes the cough which is persistent and harsh with expiratory wheezing

116
Q

type of cough in pneumonia

A

associated with rales and wheezes

117
Q

type of cough in Chlamydia pneumonia

A

in 1-3 months of age: staccato cough w/ conjunctivitis, tachypnea, rales

118
Q

type of cough in mycoplasma

A

paroxysmal, uncommon before age 5

119
Q

cough associated with bronchiectasis:

A

chronic productive cough w/ crackles and rhonchi

120
Q

s/s of foreign body aspiration

A

choking, gagging, followed by persistent coughing and wheezing

121
Q

cough + sore throat + fever =

A

influenza

122
Q

illnesses that cause paroxysmal cough

A

pertussis
mycoplasma
chlamydia

123
Q

illnesses that cause bry barking brassy cough

A

Viral croup

epiglottitis

124
Q

what causes moist cough

A

hallmark of supperative lung disease

125
Q

illnesses that cause staccato cough

A

Pertussis

chlamydia pneumonia

126
Q

illness that causes loug honking cough

A

habitual or psychogenic

127
Q

illnesses characterised by nonproductive cough

A

Viral rhinitis
AR
Asthma
Foreign body

128
Q

illness that cause clear or mucoid productive cough

A

Asthma
AR
Smoking

129
Q

Illnesses that cause purulent, prodcutive cough

A

CF
Bronchiectasis
Pneumonia
lung abscess

130
Q

Illnesses that cause blood streaked, productive cough

A

TB
Diphtheria
Nasopharyngeal irritation
Pneumonia

131
Q

illness that causes malodorous, productive cough

A

sinusitis

132
Q

What is procutive cough upon awakening attributed to?

A

Bronchitis or sinusitis

133
Q

illnesses associated with cough and fever

A

viral or bacterial infection: croup, pneumonia, TB, pertussis

134
Q

illnesses associated with hemoptysis

A 
Bronchitis
Foreign body
Lung abscess
Bronchiectasis
CF
135
Q

illness associated with cough and stridor

A

Croup
Foreign body
Epiglottitis

136
Q

illnesses associated with cough and wheezing

A

Asthma
bronchiolitis
foreign body aspiration
pneumonia

137
Q

illnesses associated witch cough and conjunctivitis

A

measles

chlamydia in newborns

138
Q

illnesses associated with cough and feeding problems

A

congenital malformation
pneumonia
CHD
Aspiration

139
Q

cough associated with cold air

A

vasomotor rhinitis

140
Q

illness associated with cough and cyanosis

A

foreign body
bronchiolitis
asthma

141
Q

Dysphagia with coughing suggests

A

esophageal foreign body

142
Q

dysphonia with coughing suggests

A

laryngeal or glottis pathology

143
Q

what are the three stages of pertusiss?

A

catarrhal stage:, paroxysmal stage, and convalescent stage

144
Q

what is the cararrhal stage of pertussis?

A 
last 1-2 weeks
mild URI sx
dry cough
low grade fever or afebrile
sneezing
lacrimation
red conjunctiva (suffusion)
145
Q

What is the paroxysmal stage of pertussis?

A

2-4 weeks
paroxysmal coughing, increases in severity and intensity
noram b/t coughing episodes
worseing cough followed by whoop and often vomiting
apnea in young infant

146
Q

What is the convalescent stage of pertussis?

A

1-2 weeks but my be longer

number, severity, and duration of coughing diminishes

147
Q

when does a pertussis culture usually not turn positive until?

A

after 4 weeks of sx

148
Q

CBC results in pertussis

A

leukocytosis with lymphocytosis and thrombocytosis: most pronounced with unimmunized people
may not be in infants

149
Q

CXR in pertussis

A

perihilar infiltrates ( butterfly appearance) and atelectasis are common

150
Q

what does pertussis look like in the catarhal stage?

A

a viral URI

151
Q

DOC in pertussis and dose

A

emycin: 40mg/kg/day bid for 14 days

152
Q

how long must pt be in isolation with pertussis

A

until treated with 5 days of ABX for 5 days

153
Q

Stridor is seen in airway obstruction where?

A

above or below the glottis

154
Q

what illnesses is stridor usually seen in?

A 
croup
epiglotitis
laryngitis
bacterial tracheitis
laryngomalacia
155
Q

inspiratory stridor with laryngomalacia will get worse when?

A 
LYING SUPINE
NECK FLEXION
W/ CRYING
W/FEEDING
AGITIATION
INCREASED ACTIVITY
URI
156
Q

when does laryngomalacia usually resolve by?

A

18 months

157
Q

presentation of tracheomalacia can be delayed until when?

A

2-3 months

158
Q

what does stridor from tracheomalacia get worse from?

A

crying
agitiation
feeding
URIs

159
Q

what noise can be heard with tracheomalacia?

A

inspiratory stidor when extrathoracic

expiratory wheeze when intrathoracic

160
Q

what is the triad of sx in viral croup?

A

barking cough, inspiratory stridor and hoarseness

161
Q

what age is viral croup most prevalent?

A

6 months to 3 years

162
Q

what age is spasmodic croup more prevelant?

A

3 months - 3 years

163
Q

what X ray finding will you see with croup? how do you find it?

A

steeples sign : start at 3rd or 4th rib and look up

164
Q

what X ray finding will you see in epiglottits

A

Thumb sign

165
Q

how does croup present in the beginning?

A

starts with a cold: 1-4 day cryzal prodrome

166
Q

what pulsus paradoxus?

A

large inspriatory drop in SBP because of airway obstruction

167
Q

tx of croup

A

raccemic epi for emergent care
humitiy at home
tent or face mask in hosptial
steroids: in ed (im decadron) or at home: prednisone or pulmocort

168
Q

what organism generally causes epiglottitis?

A

HIB

169
Q

sx of epiglottitis?

A 
sudden onset of high fever
resp distress
sever dysphagia
muffled voice
dooling, can't swallow
170
Q

tx of epiglottits?

A

ceftrioxone and immediate intubation

171
Q

most common cause of tracheitis

A

Staph aureus

172
Q

sx of tracheitis

A 
sx progress over 8-10 hours
fever
appears toxic
lethargy 
axiousness
cough
dyspnea
stridor 
noisy respirations
cyanosis
retractions
barking cough
air hunger
173
Q

comon sequela of tracheitis

A

tracheal stenosis: even w/out intubation

maybe pneumonia

174
Q

what is bronchiolitis?

A 
acute lower resp. infection:
acute inflammation
edema
necrosis or epithelial cells lining small airways
increased mucus production
bronchospasm
175
Q

what is the most commone lower respiratory tract infection in infants?

A

bronchiolitis

176
Q

manifestations of bronchiolitis

A 
rhinorrhea (thick)
watery eyes in RSV
may have otitis
sneezing
hacking cough
may have low grade fever
later:
rapid breathing and wheezing
feed poorly leads to poor hydration
177
Q

X ray fidings of bronchiolitis

A 
air trapping
flattened diaphragm
peribronchial thickening
atelectasis
diffuse infiltrates
178
Q

causes of bronchitis

A

viral in younbg: RSV, parainfluenza, flu, rhinovirus, adenovirus
Mycoplasma in school age and adolescent

179
Q

what is bronchitis?

A

inflammation of the trachea and bronchi

180
Q

cough associated with bronchitis?

A

dry, hacking, nonproductive cough after a URI

181
Q

sx in mycoplasma or influenza bronchitis:

A

HA, myalgia, anorexia, and letharty

182
Q

lung sounds in bronchitis

A

rhonchi and no rales

if wheezing, indicates lower disease or RAD

183
Q

onset of bacterial pneumonia

A

rapid: fever and resp distress

184
Q

WBC in viral vs bacterial pneumonia

A

viral: not elevated: lymphocytes predominate
bacterial: 15,-20 thousand, neutrophils predominate

185
Q

most common causes on pneumonia in newborns

A

Group B strep
E coli
Staph aurus
chlamydia: maybe 1/3 of all pneumonia up to 6 months

186
Q

x ray findings in chlamydia pneumonia

A

hyperinflation and bilateral insterstitial infiltrates

187
Q

most commone causes of pneumonia in kids < 5

A

S pneumo and H flu

188
Q

most common causes of pneumonia in kids > 5 years

A

S. pneumo and mycoplasma

189
Q

manefestations of mycoplasma pneumonia

A 
hallmark:
fever
cough (paroxysmal)
fatigue
other:
HA
myalgia
sore throat
m/p rash
190
Q

x ray in mycoplasma pneumonia

A

patchy unilateral segmental consolidation OR diffuse bilateral intersitial infiltrates

191
Q

lobar consolidation on X ray: which organisms?

A

strep and H flu

192
Q

hilar adenopathy seen in?

A

TB

193
Q

pneumatoceles seen in which organisms?

A

Staph Aureus and gram neg

194
Q

manifestions of flu

A 
fever
cough
sore throat
runny nose
muscle or body aches
headache
fatigue and malaise
vomiting and diarrhea
195
Q

type of flu that has been associated with more illness and more deaths

A

H3N2

196
Q

when are false positive and tru negative flu test results most likely to occur?

A

when the disease prevelance is low (usually beginning and end of season)

197
Q

when are false negative and true positive flu test results most likely to occur?

A

when the disease prevelance is high, typically at the height of the season

198
Q

CXR in flu

A

usually normal

199
Q

how long does it take for viral flu culture to come back?

A

2 to 6 days

200
Q

most common complications of the flu

A 
OM
sinusitis
pneumonia
 dehydrationb
worsening of chronic med conditions
febrile seizures
reyes syndrome
acue myositis
201
Q

antiviral meds for flu

A

neuraminidase inhibitors: Tamiflu or Relenza
start by 2 days of symptoms
can expect one day of shortening

202
Q

side effects of tamiflu

A

N/V expecially in 2 days of tx; take with food

203
Q

how old must u be to get tamiflu?

A

1 year

204
Q

important about relenza

A

is inhaled: cant be given if breathing problems

205
Q

age u must be for relenza

A

7 years for tx: 5 years for prevention

206
Q

characteristics of type one hypersensitivity reaction

A 
due to a previous exposure to an allergen
happens in:
 hayfever
asthma
anaphylactic shock
It is IgE mediated
207
Q

how soon does a type I HS reaction occur?

A

it is immediate: within one hour

208
Q

how are classic IgE mediated Type I reactions best tested?

A

scratch or prick tests

209
Q

What is a type II HS reaction?

A

antibody is directed against a self antigen or a semi self antigen
they are antibody mediated cytotoxic reactions where cells are attacked (can be RBCs, Platelets, kidney, neuromuscular and thyroid cells
The antigen is usually NONSELF: from a drug, virus or part of a bacterium

210
Q

what is the test for type II HS reaction?

A

coombs test: test if one is making antibodies against own RBCs

211
Q

What is a type III HS reaction?

A

antigen attaches to part of an IgG molecule and another and another; forming immune complexes
they happen when there is lots of antibody around and lots of antigen around and clog things up like:
Capillary beds
filtering organs
lungs

212
Q

What can type III HS reactions cause?

A 
immune mediated vasculitis: inflammation of the blood vessels: ulcers on legs, feet
erythema multiforme
henoch schonlein purpura
steven johnson syndrom
toxic dermal necrolysis
213
Q

what is the time frame of a type III HS reaction?

A

usually within 12-24 hours

214
Q

What drugs most likely cause type III HS reactions?

A

cephalosporins
sulfas
CT scan dye

215
Q

example of type III HS reaction?

A

serum sickness

216
Q

what is a type IV HS reaction?

A

delayed HS reaction

occurs and causes inflammation reaction

217
Q

testing for a type IV HS reaction:

A

patch test: allergen is put on the skin and covered with a patch and checked 48 hours later

218
Q

Examples of type IV HS reactions

A 
ppd skin test
poison ivy
nickel allergen
neomycin allergy
topical meds like benadryl cream
latex (can be type I or IV)
219
Q

what is the mechanism behind allergy to cold or cold induced urticaria or anaphylaxis?

A

some protein changes shape when it gets cold and becomes an antigen

220
Q

what causes hives?

A

vasodilation and increased permeability of capillaries of the skin as the result of mast cell release

221
Q

if no itching during a HS reaction what does that usually mean?

A

usually not IgE mediated reaction

222
Q

what is the dose of epi pen?

A

0.01ml/kg: max: 0.3 to 0.5 ml:

repeat Q15 min until reaction subsides

223
Q

what are most common food allergies attributed to (foods)?

A 
peanut
soy
egg
wheat
milk
nuts
fish
shellfish
224
Q

before puberty, sebaceous glands are

A

atrophic

225
Q

what is another name for a closed comedone

A

whitehead

226
Q

what is another name for an open comedone

A

blackhead

227
Q

what are characteristics of mild acne ?

A

comedones without inflammation, no redness to the lesions, no papules, no pustules, no cysts

228
Q

what are characteristics of moderate acne?

A

comedones + papules + or - local inflammation: no pustules

229
Q

what are characteristics of moderate-severe acne?

A

comedones + papules + pustules

230
Q

what are characteristics of severe acne?

A

nodules, cysts

231
Q

which topical acne med should be avoided in dark skinned individuals?

A

axelacic ace: allergan or azelex

232
Q

side effect in tetracycline, minocycline, and doxycycline?

A

staining of the teeth, dont use in kids < 8years old

Peds Primary care 2 (2 decks)

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