Pediatric pulmonolgy Flashcards
(114 cards)
1
Q
Epiglottitis
A
acute inflammation in the supraglottic region
2
Q
Who gets epiglottitis
A
typically kids <6 months
rare in the US
3
Q
Why type of kids are at risk for epiglottitis
A
they are not fully immunized
4
Q
What causes epiglottitis?
A
- strep pyogenes
- strep pneuo
- staph
- H flu (less likely in pedi)
5
Q
Clinical presentation of epiglottitis
A
Rapid onset
- muffled voice
- drooling!
- pain
- labored breathing
- tripodding
6
Q
What is the tripod position
A
- neck hyperextended
- mouth opened
- chin up sniffing
- leaning forward
- outstretched arms
7
Q
Late findings of epiglottitis
A
- air hunger
- stridor
- restlessness
Pre apnea–> coma–> death
8
Q
Diagnosis of epiglottitis is what
A
Clinical suspicion!!!!
can do xray–> look for thumbprint sign
9
Q
If you have clinical suspicion of epiglottitis–>
A
ANESTHESIA
if in office, call ED and EMS
10
Q
What do you do before anesthesia arrives in a child with epiglottitis
A
- keep patient calm and quiet
- O2 if tolerated
- establish 2 lines if tolerated
11
Q
Treatment of epiglottitis
A
- intubation
- IV abx (ceftriaxone, cefotaxime)
- supportive care
12
Q
Is epiglottitis contagious
A
NO!
but if unimmunized or immunosuppressed family contacts consider ppx (rifampin)
13
Q
What is croup
A
subglottic inflammation of the larynx and trachea
14
Q
Etiology of croup
A
typically viral
15
Q
Who gets croup
A
- children 3 months to 5 years (2 is peak)
- males slightly more often than females
16
Q
When is croup typically seen
A
- in fall and spring
- between 10pm and 4am
17
Q
Virus that causes croup
A
- parainfluenza 1,2,3
- influenza A or B
- adenovirus, RSV
18
Q
Symptoms of croup. When do they occur?
A
day 0-2
- rhinorrhea
- low grade temp
- +/- cough
- +/- pharyngitis
Day 0-5
- barking cough
- +/- stridor
19
Q
How long does it take croup to resolve
A
5-7 days
20
Q
When does the course of croup worsen
A
day 2 and 3 of the barking cough
21
Q
Diagnosis of croup?
A
clinical diagnosis!!
22
Q
When do you do outpatient treatment for child with croup? What is it?
A
mild or moderate croup- no stridor
Decadron (IV solution given orally)
23
Q
Treatment for moderate to severe croup
A
- decadron
- racemic EPI by neb
- watch for 2 to 3 hours and watch for recurrence
- if you need to give another dose consider admission
24
Q
At home mild croup treatment
A
- cold night air
- humidified air
- breathe air from air conditioning or freezer
25
Resolution of croup
within 5 to 7 days
26
What is bacterial tracheitis
bacterial infection of the trachea that can cause complete respiratory failure by blockage of the trachea with swelling and purulent drainage
27
Bronchiolitis
inflammation of the lower respiratory tract
28
Who gets bronchiolitis
kids less than 2 years old
29
Which kids with bronchiolitis are at the greatest risk for morbidity/mortality
- kids with underlying cardiopulmonary disease
| - kids <2 months are at risk for respiratory compromise
30
What causes bronchiolitis
- >50% caused by RSV
- viral--> parainfluenza and adenovirus
- Bacterial--> mycoplasma
31
What causes the symptoms seen in bronchiolitis
inflammation fo the bronchioles, secretions into the inflamed bronchial tree
32
What is the typical presentation of bronchiolitis
- begins with URI (copious clear rhinorrhea, congestion, low grade fever)
- wheezing +/- crackles
33
When is bronchiolitis most commonly seen
late fall throughout winter
34
How is bronchiolitis spread
respiratory droplets
35
Vitals in child with bronchiolitis
- fever (up to 102)
- tachycardia
- tachypnea
- respiratory distress
36
Lung sounds in bronchiolitis
- wheezing
| - rhonci or fine rales
37
If decreased breath sounds in bronchiolitis patients-->
BAD
38
When do you preform a nasal washing to do a PCR for RSV
- pt <2 to 3 months or has underlying risk factors
- if you will hospitalize pt
- if youre in the ED and the pcp or hospitalist asks you!
39
When should you do a CXR in pt with suspected bronchiolitis
if it is first episode of wheezing ever--> look for foreign body
40
Treatment for bronchiolitis
- albuterol
- cool mist
- PO steriods (decadron, prednisolone)
- supportive treatment (fluids, tylenol)
41
When should a patient with bronchiolitis be hospitilized
-if hypoxic
awake <91-93%
asleep <91%
- apneic episodes
- premie <12 weeks
- NB to 12 weeks and any suggestion of resp distress
- underlying cariopulm disease
- parents unable to care for child
ANY CHILD THAT IS WORRISOME
42
Inpatient bronchiolitis treatment
- oxygen support
- consider CPAP or high flow O2
- intubation if impending respiratory failure
43
What is the course of bronchiolitis
- gets worse days 2 to 5
| - last for 10 to 12
44
RVS vaccine prophylaxis
Synergis
45
Pediatric asthma-->
spacers! spacers! spacers!
46
Does wheezing always equal asthma
NOPE
47
Making the diagnosis of asthma
1. demonstration of variable episodic expiratroy airflow limitation that is reversible
2. exclusion of other reasons for the finding
48
If a child presents with first time wheezing can you say they have asthma
NO, reactive airway disease
49
Symptoms of asthma
- dry cough
- wheezing
- possible breathlessness, chest tightness, chest pain
50
Symptoms pattern with asthma
- intermittant w/ asxs at baseline
- chronic with periods of worsening
- worse in the morning ("morning dipping")
51
Asthma triggers
- seasonal allergies
- houshold allergies
- URIs
- exercise
- weather
- stress
- perfumes, hair spray, cleaning products, paint
52
Atopic illness?
- asthma
- atopic dermatitis
- food allergies
- allergic rhinitis
53
What causes pertussis
- bortadella pertussis--> epidemic pertussis
| - para pertussis--> sporadic pertussis
54
What is bortadella pertussis
gram negative coccobaccilus that colonizes the ciliated epithelium
55
How is pertussis spread
through the air by infection droplets from respiratory mucous membrane
*highly contagious
56
How long is the incubation period for pertussis
3-12 days
57
Stages of pertussis
- catarrhal stage
- paroxysmal stage
- conval
58
What stage of pertussis is most contagious
catarrhal stage
59
What classifies each stage of pertussis? How long does it last?
Catarrhal stage: 1 to 2 weeks: runny nose, sneezing, low grade fever and mild cough
Paroxysmal stage: 1 to 6 weeks: burst of numerous, rapid coughs followed by a long inhaling effort characterized by a high pitched whoop
Convalescent stage: can last for months: paroxysms may recur whenever the patient suffers any subsequent respiratory infection
60
Children or infants with paroxysms may have what types of thing
- respiratory distress
- tongue protruding
- face turning purple
- eye bugling
- watery eyes
- post tussive emesis and exhaustion
61
Pertussis in adolescents and adults
- typically milder
- persistent cough similar to that found in other URIs
- have the cough in paroxysms without or without he "whoop"
62
Diagnosis of pertussis
Clinical!--> if suspiscious, treat and watch for results
can do nasopharygneal swab
63
Treatment of pertussis
Zithromax 10mg/kg on day 1 then 5mg/kg days 2-5
supportive care
64
Mild complications of pertussis
- ear infection
- loss of appetitis
- dehydration
- pneumonia
- rib fracture
65
More severe complications of pertussis
if hypoxic from paroxysm--> encephalopathy and seizures
66
Are there usually complications of pertussis
nope!
67
Partial airway obstruction=
stridor
68
Airway obstruction=
silence
69
No airway=___=___=___
no airway =no oxygenation= no ventilation= tissue death
70
Most FBA in infants and toddlers
food--> peanuts
71
What causes fatal aspiration
- balloons
- balls
- marbles
- toys
anything strong, round and unbreakable
72
Where does the FB lodge in kids
proximal mainstem bronchus
73
When should you suspect a FB aspiration in a kid
- witnessed choking event
- wheezing
- formerly speaking and wont speak
- coughing without URI symptoms
74
Acute and life threatening foreign body aspiration has what symptoms
- respiratory distress
- cyanosis
- altered mental status
75
Symptoms of less acute and not emergent life threatening FBA
Classic triad!
- wheezing
- decreased air entry especially regionally
- cough
76
Diagnosis of FBA
History!
Bronchoscopy is diagnostic tool and treatment
+/- xray
77
When do you do a flexible bronchoscopy for diagnosis of FBA
- chronic or recurrent pneumonia
- chronic cough
- can remove object
78
When do you use a rigid bronchoscopy for diagnosis of FBA
-if you suspect a non emergent FBA
* anesthesia required
* less risk of dislodgement
79
Complications of FBA removal
- dislodgement or breakage w/ advancement into bronchioles or lings
- infection if fb is in too long
- inflammation
80
What is cystic fibrosis in its simplest form
genetically driven disruption of the chloride channel
81
Which protein affected in CF? What does that protein typically do
CFTR protein--> complex chloride channel and regulatory protein found in exocrine tissue
82
CF causes viscous secretions where
- lungs
- intestine
- pancreas
- liver
- reproductive tract
83
What happens to sw3eat gland secretions in CF
increased salt content
84
Respiratory features of CF
- persistant productive cough
- hyperinflation of lungs on cxr
- PFTs consistent with obstructive airway disease
85
Progressive respiratory symptoms of CS
- chronic bronchitis
- bronchiectasis
- increase cough/sputum-tachypnea
- malaise
- anorexia and weight loss
- clubbing
86
What colonizes in the lungs of CF patients
- staph aureus
- h flu
- pseudomonas
87
Extrapulmonary clinical features of CF
- panopacification of sinuses
| - nasal polyposis
88
Pancreatic features of CF
- exocrine function typically insufficient
- insufficient digestive enzymes-->malabsorption--> FTT, electrolye abnl, anemia
+/-glucose intolerance or CF related DM
89
What is an important early clinical feature of CF
meconium ileus and distal ileal obstruction in newborns
Distal intestinal obstructive syndrome--> seen in sicker CF patients
90
Billiary issues for CF
- focal billiary cirrhosis caused by impissated bile
- hepatomegaly
- aymptomatic liver disease
- cholelithiasis
91
Muscluoskeletal manifestations of CF
- reduced bone mineral content
- hypertrophic osteoarthropaathy
- clubbing of fingers and toes
92
What is needed to make diagnosis of CF
- clinical sxs in at least one organ system
- evidence of CFTR dysfunction on any one of the following tests (sweat chloride, presense of 2 disease causing mutation, abnormal nasal potential difference)
93
Classic CF
- disease in or or more organ systems
| - pt has elevated sweat chloride
94
Non-classic CF
- meet disease criteria in one or more organ systems with normal or borderline sweat test
- requires DNA analysis for dx
- more common in adults and older adolescents--> milder
95
Clinical features that make you suspicious of CF
- chronic reproductive cough
- recurrent upper and lower resp infections
- hyperinflation on CXR
- PFTs that show obstructive disease
96
Newborn screening for CF
measure levels of immunoreactive trypsin on dried blood sample
confimred by DNA or sweat tsting
97
Primary test for dx of CF?
sweat test
98
How is a sweat test done
by applying pilocarpine iontophoresis and determining the chloride concentration in the resulting sweat chemically
99
When is a sweat test done
if positive new born screen
meconium ileus after DOL 2
100
When is molecular dx done for CF
on all pts w/ intermediate sweat test results
prognostic and epidemiologic interest
101
How many mutations are screened when testing for CF
23
pt has to have at least 2 to be considered positive for CF
102
Infants at risk for RDS
born before 30 weeks
103
When does formation of alveoli begin
24 weeks
104
The majority of RDS infants are born before when
28 weeks
105
Etiology of RDS
surfactant deficiency--> atelectasis--> V/Q mismatch--> pulmonary inflammatory response--> potential lung injury and pulmonary edema
106
Clinical manifestation of RDS
- tachypnea
- nasal flaring
- expiatory grunting
- retractions
- cyanosis/pallor
- decreased breath sounds
- diminished peripheral pulses
- peripheral edema
- poor urine output
107
ARD on chest xray
- airbronchograms
- low lung volume
- ground glass appearance
- pneumothorax
108
Ways to prevent RDS
- antenatal corticosteriods
- exogenous surfactant
- assisted ventilation
109
Who gets antenatal corticosteriods
pregnant women at risk of delivery before 34 weeks
110
When is eogenous surfactant given to infants
preterm infants with resp distress/apnea/ fail cpap
given through ET tube
111
Positives of mechanical ventilation in ADS babies
- PEEP corrects atelectasis and give route for exogenous surfactant
- improves arterial oxygenation
112
Negative to mechanical ventilation in ADS babies
- traums by volume adn pressure
- oxygen toxicity
- intervention can lead to BPD
- intubation injury
113
New ventilation for RDS?
- nasal CPAP
| - NIPPV
114
Other things to think about for RDS babies
- thermoregulation
- fluid management
- cardiovascular management
- nutritional support
