week 5 module 14 peds resp

Question 1

primary muscles of respiration

Answer 1

diaphragm
- primary
- contracts during inspiration
external intercostal muscles
- inc. the anteroposterior chest diameter during inspiration
interior intercostal muscles
- dec. the transverse chest diameter during expiration

Question 2

accessory muscles of respiration

Answer 2

sternocleidomastoid and trapezius

- associated with pulmonary problems and compromise

Question 3

peds and lung compliance

Answer 3

inc. compliance of chest wall
-> inc. risk collapse
less fatigue resistant muscles: tire easy

Question 4

infant lung growth and development

Answer 4

derives from foregut during 4th week gestation
bronchial tree by 16th week
alveoli develop from latter 3rd of gestation through first months of life
- alveoli inc. in number throughout childhood

Question 5

chest in infant

Answer 5

rounded

circumference equal to head until about age 2

Question 6

infants anatomical risk for respiratory compromise

Answer 6

upper airway smaller and less firm than adults
more compliance in chest wall -> collapse when stressed
fewer fatigue resistant diaphragm muscles: tire easy

Question 7

retractions

Answer 7

chest wall seems to cave

- suggests obstruction to inspiration

Question 8

paradoxic breathing

Answer 8

on inspiration, the lower thorax is drawn in, and on expiration, the opposite occurs
- chest wall collapses as the abdomen distends on inspiration

Question 9

periodic breathing

Answer 9

sequence of relatively vigorous respirations followed by apnea of as long as 10-15 seconds
- common in newborn and infant

Question 10

persisting round chest

Answer 10

indication of a pulmonary problem after 2 y/o

Question 11

stidor

Answer 11

high-pitched, piercing sound most often heard during inspiration
result of an obstruction high in the respiratory tree

Question 12

grunting

Answer 12

mechanism by which the infant tries to expel trapped air or lung fluid while trying to retain air and increase oxygen levels

Question 13

nasal flaring

Answer 13

indicator of respiratory distress

Question 14

asthma

Answer 14

chronic inflammatory condition of the lung airways resulting in episodic outflow obstruction

Question 15

asthma and genetics

Answer 15

more than 22 loci on 15 autosomal chromosomes linked

• IL-4 gene cluster on chromosome 5
• • proallergic, proinflammatory

Question 16

clinical manifestations of asthma

Answer 16

intermittent dry cough
expiratory wheezing
prolonged expiratory phase
SOB
chest tightness or pain
resp. symptoms worsen at night 
self-imposed limitation of physical activities 
generalized fatigue

Question 17

PFT

Answer 17

help confirm the dx of asthma and determine severity

- >6y/o

Question 18

bronchiolitis patho

Answer 18

acute viral infection of the smaller airways

• > hyperinflation of lungs
• primarily caused by RSV

Question 19

croup

Answer 19

results from infection with a variety of viral agents
- particularly parainfluenza 
- common from 1.5-3yrs 
Inflammation of upper airway
- larynx, trachea, bronchi

Question 20

croup characterized by

Answer 20

bark like cough
possible hoarseness
high-pitched resp. sound
inspiratory stridor
resp. distres
worse at night

Question 21

resp. distress syndrome

Answer 21

preterm infant has great difficulty breathing

-dec. surfactant

Question 22

Cystic fibrosis patho

Answer 22

autosomal recessive disorder of exocrine glands involving lungs
pancreas
sweat glands
- single gene on the long arm of chromosome 7
Thick mucus plugs clog the bronchi and bronchioles

Question 23

clinical manifestations of CF subjective

Answer 23

viscous meconium in newborn 
wt loss despite large appetite
recurrent resp. infections
liquid, large, bulky foul-smelling stools
recurrent or persistent wheezing
salty skin
frequent flatulence of abd. pain
chronic cough
retractions
dyspnea on exertion

Question 24

newborn RR

Answer 24

30-80

Question 25

1 year RR

Answer 25

20-40

Question 26

3 year RR

Answer 26

20-30

Question 27

6 year RR

Answer 27

16-22

Question 28

10 year RR

Answer 28

16-20

Question 29

17 year RR

Answer 29

12-16

Question 30

diaphragmatic hernia patho

Answer 30

result of an imperfectly structured diaphragm

- 90% of the time the liver is not there to get in the way

Question 31

diaphragmatic hernia subjective

Answer 31

degree of resp. distress can be slight or severe depending on extent of bowel invading the chest through the defect

Question 32

diaphragmatic hernia objective

Answer 32

bowel sounds heard in the chest 
flat of scaphoid abdomen 
heart displaced to the right
tachypnea
retractions 
grunting

Question 33

CF objective

Answer 33

bronchiectasis
barrel chest
nasal polyps
low body mass
clubbing
pulmonary hypertension
cor pulmonale

Question 34

croup subjective

Answer 34

URI s/s
- mild fever
awakens suddenly after going to bed, often frightened, with harsh, barking cough

Question 35

croup objective

Answer 35

labored breathing 
retractions
hoars
barking cough
stridor
restless
irritable

Question 36

tracheomalacia patho

Answer 36

lack of rigidity of the trachea or airway

Question 37

trachomalacia subjective

Answer 37

noisy breathing or wheezing in infancy

inspiratory stridor

Question 38

tracheomalacia objective

Answer 38

stridor

wheezing

Question 39

bronchiolitis subjective

Answer 39

begins with URI
poor feeding
vomiting 
diarrhea
lethargy
expiration becomes difficult
infant appears anxious

Question 40

bronchiolitis objective

Answer 40

breaths rapid and short
generalized retractions
perioral cyanosis 
wheezing, grunting
diminished breath sounds 
altered mental status
hyperinflation -> inc. AP diameter
hyperresonant percussion