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Pediatrics > Pulmonary > Flashcards

Pulmonary Flashcards

0
Q

Examples of obstructive versus restrictive defects?

A

Asthma, bronchiolitis, foreign body aspiration

Pulmonary edema, scoliosis, pulmonary fibrosis, respiratory muscle weakness

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1
Q

Bronchial tree develops when? Sufficient air sacs/vasculature for viability when? Alveoli increase in number until?

A

16 weeks; 27 weeks; eight years

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2
Q

Differential for inspiratory strider?

Expiratory wheezing?

Crackles/rales?

A

Extrathoracic obstruction – croup, laryngomalacia

Intrathoracic obstruction – asthma, bronchiolitis

Parenchymal disease – pneumonia, pulmonary edema

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3
Q

Epiglottitis – Ddx? causes? Features? Laboratory studies? Radiographic findings?

A

Croup, bacterial tracheitis, retropharyngeal abscess

H. influenzae type B, GABHS

  1. Rapidly progressive airway obstruction without prodrome
  2. Muffled speech, drooling

Leukocytosis with a left shift and positive blood culture

Thumb sign

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4
Q

Supraglottic versus subglottic disorders – examples?

  1. Strider?
  2. Cough?
  3. Voice?
  4. Drooling?
  5. Fever?
  6. Toxicity?
  7. Posture?
A

Epiglottitis, retropharyngeal abscess versus tracheitis, croup

  1. Quiet versus loud
  2. None versus Barky
  3. Muffled versus hoarse
  4. Yes versus no
  5. High versus low/high
  6. Yes versus no (unless tracheitis)
  7. Tripod versus normal
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5
Q

Epiglottitis secondary to H. influenzae – prophylaxis for who? Drugs?

A

Rifampin for unimmunized children under four

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6
Q

Viral croup – causes? Non-viral cause? Clinical features? Radiologic findings? Management?

A

Parainfluenza, RSV, adenovirus, influenza; Mycoplasma

  1. Prodrome
  2. Inspiratory Strider, barky cough, horse voice

Steeple sign (subglottic narrowing) on x-ray

  1. Cool mist/food
  2. Corticosteroids if stridor at rest
  3. Racemic epinephrine if respiratory distress
  4. Beta agonist if wheezing
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7
Q

Spasmodic croup – cause? Symptoms? Management?

A

Hypersensitivity reaction

  1. Stridor at night
  2. Recurrs and resolves without treatment
  3. Cool mist/food
  4. Corticosteroids if stridor at rest
  5. Racemic epinephrine if respiratory distress
  6. Beta agonist if wheezing
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8
Q

Bacterial tracheitis – causes? Clinical features? Management?

A

Staph aureus, streptococcus, nontypeable H. influenzae

Abrupt onset with high fever, toxicity, and pus in the trachea

Anti-staphylococcal antibiotics

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9
Q

Bronchiolitis – age of typical patient? Causes? Clinical features? CXR? Management?

A

Children under two

RSV >parainfluenza, adenovirus, rhinovirus, influenza, Mycoplasma

  1. Gradual onset with URI symptoms
  2. Progression to tachypnea, Respiratory distress, apnea, hepatosplenomegaly

CXR shows hyperinflation with air trapping, patchy infiltrates, atelectasis

  1. Primarily supportive
  2. Nebulized bronchodilators, steroids, racemic epinephrine
  3. Aerosolized ribavirin
  4. Palivizumab - RSV monoclonal antibody
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10
Q 
Causes of pneumonia: 
Most common in all age groups?
1. 0 to 3 months
2. Three months to five years
3. 6+ years
A

Viruses

  1. Congenital infections, postpartum infections (respiratory viruses), afebrile pneumonitis
  2. Viruses, strep pneumonia/staph aureus/HIB
  3. Mycoplasma, chlamydia, viruses and bacteria
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11
Q

Diagnosis of viral pneumonia?

A

Interstitial infiltrates on chest x-ray and WBC >20 with lymphocytic predominance

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12
Q

Common cause of afebrile pneumonia at 1 to 3 months? Clinical features? Management?

A

Chlamydia

Staccato type cough, eosinophilia

Erythromycin, azithromycin

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13
Q

Causes of recurrent pulmonary infiltrates in single lobe of lung?

A
  1. Intraluminal obstruction – foreign body, tumor, mucous plug
  2. Extraluminal obstruction – lymph node, malignancy
  3. Structural abnormalities – bronchial stenosis, bronchiectasis, congenital abnormalities,
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14
Q

Causes of recurrent pulmonary infiltrates in multiple lobes?

A
  1. Aspiration
  2. Mucociliary clearance dysfunction – CF, Kartagener’s
  3. Bronchopulmonary dysplasia – chronic lung disease
  4. Asthma
  5. Immunodeficiency
  6. Misc - Congenital heart disease, alpha-1-antitrypsin deficiency, sickle cell, hypersensitivity pneumonitis
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15
Q

Stages of pertussis?

A
  1. Catarrhal – URI symptoms
  2. Paroxysmal – forceful cough with inspiratory whoop (And possible post-tested vomiting)
  3. Convalescent – Recovery stage, where paroxysmal cough slowly improves
16
Q

Characteristics findings in pertussis? Diagnosis?

A
  1. Whooping cough
  2. Lymphocytosis

Culture/direct fluorescent antibody test

17
Q

Chest x-ray findings of asthma?

A
  1. Hyperinflation
  2. Peribronchial thickening
  3. Patchy atelectasis
18
Q

Wheezing – differential?

A
  1. Asthma
  2. Hypersensitivity reaction
  3. Bronchiolitis
  4. Pneumonia
  5. Aspiration
  6. Environmental irritants
19
Q

Theophylline – drug class? Why not used anymore?

A

Methylxanthine; narrow toxic-therapeutic ratio

20
Q

Classic hallmarks of cystic fibrosis? Structural abnormality? Sinopulmonary infections – bugs?
Finding at birth?
Nutritional deficiency?
Acid/base status?

A
  1. Lungs - Chronic progressive pulmonary insufficiency
  2. Pancreas - Pancreatic insufficiency
  3. Skin - High sweat electrolytes

Also see:

  1. Chronic sinopulmonary disease – nasal polyps, staph aureus/pseudomonas infection
  2. G.I. – meconium ileus, pancreatic insufficiency, chronic hepatic disease
  3. Nutritional – fat-soluble vitamin deficiencies (decreased pancreatic enzymes)
  4. Metabolic – hypoNa/Cl/K metabolic alkalosis
21
Q

Diagnosis of cystic fibrosis?

A
  1. Laboratory evidence – sweat chlorine over 60 OR two CF mutations OR ion transport abnormality across nasal epithelium
  2. One or more phenotypic features OR +family hx OR Immunoreactive trypsinogen on newborn screen
22
Q

Chronic lung disease – definition? Commonly occurs in? Causes? Clinical features? ABG findings?Chest x-ray? Management?

A

Oxygen dependency beyond 28 days of life

Children with hyaline membrane disease or surfactant deficiency syndrome

  1. Acute injury – meconium aspiration, infection, mechanical ventilation
  2. Oxidants or proteases
  3. Abnormally healed lung – fibrosis

Low PaO2, high PaCO2

CXR – hyperinflation, atelectasis, cystic radiodensity

Supplemental oxygen, bronchodilators/diuretics, immunization,

23
Q

Apnea of infancy/prematurity? Periodic breathing?

ALTE?

A

Cessation of breathing for more than 20 seconds

Breathing pattern with 3+ respiratory pauses lasting over 3 seconds each with less than 20 seconds of normal respiration in between

Apnea, color change, choking, gagging – recovery only with resuscitation

24
Q

Risk factors – SIDS?

A
  1. Belly sleeping
  2. Soft bedding, over bundling
  3. Prematurity
  4. Lack of breast-feeding
  5. Maternal smoking, drug

Pediatrics (38 decks)

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