Pediatric Pulmonology Flashcards Preview

Clin Med IV - Pediatrics > Pediatric Pulmonology > Flashcards

Flashcards in Pediatric Pulmonology Deck (84):
1

What happens in acute epiglottitis?

Inflammation of supraglottic region (epiglottis, vallecula, arythenoids, aryepiglottic folds)

2

Acute epiglottitis typically occurs in kids age ____. Why?

<6mo. Not fully immunized

3

Acute epiglottitis is typically caused by what organisms (3)

- S. pyogenes (strep throat)
- Stre. pneumonia
- Staph

4

Presentation of epiglottitis

- Mild sore throat and fever → rapidly turns into respiratory distress
- Drooling, tripoding (impending doom)
- Stridoer (late finding)

5

Dx epiglottitis

Clinical suspicion - pts tend to deteriorate before imaging can be done

6

If you were doubtful of epiglottitis and just needed to rule it out, what diagnostics/imaging could you get? What would you see if it was positive?

- Lateral neck film → thumb print sign
- Direct visualization via intubation/endoscopy

7

Management of epiglottitis

- Anesthesia STAT for intubation → if office setting, call EMS then ED to have anesthesia on standby
- Keep child calm/quiet
- O2, IV access if tolerated
- IV ceftriaxone or cefotaxime
- INTUBATION for 2-3 days while abx take effect

8

Is epiglottitis contagious?

No BUT the causative organism is

9

Your pedi pt has epiglottitis, should mom be worried about it spreading to the rest of the fam?

Epiglottitis isn't contagious but causative organism is → consider rifampin ppx if non-immunized/immunocompromised or <6mo without complete HIB vaccine

10

What happens in croup?

Inflammation of subglottis region (trachea, larynx)

11

Etiology of croup

Parainfluenza 1-3 virus

12

Common age of croup pts

3mo-5yo

13

When do you usually see croup?

Spring/fall
10pm-4am

14

What is pathognomonic for croup?

Barking cough

15

Presentation of croup

- Days 0-2 → URI sx's (rhinorrhea, low-grade fever, +/- cough/pharyngitis)
- Days 0-5 → barking cough +/- stridor

16

How long does croup usually last?

5-7 days

17

Croup tends to worsen on days ________

2-3

18

Diagnosis of croup

Clinical dx

19

Tx mild-moderate croup (i.e. no stridor)

- IV dexamethasone (Decadron) given PO
- Cold night air
- Humidified air
- NO abx

20

Dosing for dexamethasone (Decadron) for croup pt

IV solution given PO
0.6mg/kg x1 → max 10-12mg

21

Tx mod-severe croup (i.e. stridor)

- Emergency Department
- IV dexamethasone (Decadron) given PO
- Racemic Epi via neubilizer prn

22

If racemic epi doesn't work for croup, what should you consider?

- Continuous racemic epi after 2nd dose
- IM epi
- Consider transfer to ICU

23

What happens in bronchiolitis?

Inflammation of lower respiratory tract with secretions into inflamed bronchial tree

24

Pts at greatest risk for morbidity/mortality with bronchiolitis

- <2mo
- Cardiopulmonary disease → preemies, asthmatic, immunocompromised

25

Etiology of bronchiolitis

RSV (>50%)

26

Presentation of bronchiolitis

- Begins with URI (rhinorrhea, congestion, low-grade fever)
- Wheezing

27

When is bronchiolitis commonly seen?

Late fall and throughout winter

28

Bronchiolitis worsens on day______

2-5

29

Bronchiolitis usually lasts _____

10-12 days

30

Prognosis of bronchiolitis

40% will have wheezing again

31

Diagnostics involved with bronchiolitis

- NO CBC
- CXR if 1st episode of wheezing ever or considering PNA
- Nasal washings for RSV PCR if <2mo, risk factors, hospitalization, or requested

32

Tx bronchiolitis

- +/- bronchodilators, cool mist
- PO steroids (dexamethasone, prednisolone)
- NO abx

33

Should you hospitalize pts with bronchiolitis?

Yes if:
- O2 required
- Apneic episodes
- Preemie <12wo
- <12wo and signs of resp. distress or days 1-3 of illness
- Underlying cardiopulmonary dz/risk factors
- Parent unable to care for child at home

34

Tx for inpatient bronchiolitis

- O2 → SpO2 >94%, high flow O2 if <92% on O2
- Consider CPAP, no chest PT
- PICU if intubation needed or expected

35

Tx for outpatient bronchiolitis

- Fluids
- Tylenol/motrin
- ED if worsens, tachypnea w/o fever, or resp. distress

36

What is Synergis?

IM vaccine ppx for certain pts during RSV season

37

Who might need Synergis?

- 0-12mo → preemi <12wo, chronic lung dz, neuro dz, CHD, CF, heart transplant, immunocompromised
- 12-24mo → chronic lung dz needing O2, heart transplant during RSV season, immunocompromised, some CF pts

38

All pedi asthma pts should use ______

spacer

39

When can you officially diagnose asthma in kids?

Age 4-6 when methacholine challenge can be administered

40

Presentation of asthma in kids

- Cough (could be only sx)
- Wheezing
- Breathlessness, chest tightness, chest pain

41

Kids with asthma usually have ______

Other atopic illnesses (e.g. atopic dermatitis, food allergies, allergic rhinitis)

42

Dx asthma

Improvement of >8% of FEV1 with bronchodilator

43

Tx asthma in kids

- Mild (intermittent) → SABA
- Persistent → ICS (low-high dose) +/- adjuncts, consult pedi pulmonologist

44

Etiology of pertussis

Bortadella pertussis (95% US cases) → G- coccobacillus that colonizes ciliated epithelium

45

Transmission of pertussis

Spread via respiratory droplets → nearly 100% contagious to non-immunized close contacts

46

Is there a vaccine for pertussis?

Yes, it's extremely effective but immunity wanes after 5 yrs and disappears by 12 yrs (booster)

47

Incubation period of pertussis

3-12 days

48

3 stages of pertussis. During which one is pt most contagious?

- Catarrhal stage → most contagious
- Paroxysmal stage
- Convalescent stage

49

How long does catarrhal stage of pertussis last?

1-2 weeks

50

What happens in catarrhal stage of pertussis?

URI sx's - rhinorrhea, sneezing, low-grade fever, mild cough

51

How long does paroxysmal stage of pertussis last

1-6 weeks, up to 10 weeks

52

What happens in paroxysmal stage of pertussis?

Paroxysm of numerous rapid coughs, followed by whooping cough → pt may be in resp. distress, protruding tongue, purple face, bulging/watery eyes, post-tussive emesis/exhausion

53

What is pathognomonic for pertussis?

Whooping cough

54

What happens in convalescent stage of pertussis?

Paroxysms may recur when pt suffers subsequent respiratory infections → may last for months

55

Dx pertussis

Nasopharyngeal swab BUT if highly suspicious, treat b/c takes days to weeks

56

Tx pertussis

Azithromycin

57

Partial vs. complete airway obstruction

Partial = stridor
Complete = silence

58

80% FB aspirations involve pts age _____

<3 yo

59

Most common FBs aspirated by infants/toddlers

*Peanuts (50%)
*Nuts
*Popcorn
*Hot dogs
Coins, toys, batteries, seeds

60

Most common FBs aspirated by older kids

Nonfood items - coins, paper clips, pen caps, coins

61

FBs that lead to fatal aspiration

- Balloons
- Balls
- Marbles
- Toys
- Strong/round/unbreakable

62

Location of FB aspiration in kids

Proximal mainstem bronchus - no preference over R vs. L b/c similar size/angle

63

Highest morbidity/mortality d/t FB aspiration occurs with ______ . Why?

Laryngeal FB - blocks R and L airways

64

Classic triad of FB aspiration

- Wheezing
- Cough
- Decreased air entry regionally

65

What's one of the most important ways of diagnosing FB aspiration?

History

66

Sure, history is important in diagnosing FB aspiration. But what's the official way of diagnosing it?

Bronchoscopy → diagnosis + treatment

67

What may you see on radiograph of FB aspiration?

- FB if radiopaque
- Subglottic density/swelling
- Air trapping distal to partial obstruction
- Atelectasis if complete obstruction
- Late = consolidation d/t infection, abscess, bronchiectasis

68

What happens in cystic fibrosis?

Mutation in CFTR protein → dysfunctional Cl- channel in exocrine tissues

69

Epidemiology of cystic fibrosis

Caucasians

70

What is pathognomonic for cystic fibrosis?

Meconium ileus

71

Respiratory signs of cystic fibrosis

- Persistent productive cough
- Recurrent URI/LRI
- Obstructive airway dz findings → hyperinflation on CXR, PFTs
- Colonization with S. aureus and H. flu in childhood; Pseudomonas in adulthood

72

Reproductive effect of cystic fibrosis

95% males are infertile (and up to 20% females)

73

What organ systems are involved in cystic fibrosis?

- Pulmonary
- Sinuses
- Pancreas
- Liver
- Intestines
- Reproductive tract
- Kidneys
- Bone

74

Dx cystic fibrosis

- Newborn screening via heel stick → high rate of false positives (see below)
- Chloride sweat test
- Molecular DNA testing if sweat test inconclusive → 2 mutations = dx
- Nasal potential difference if above inconclusive

75

When is newborn screening for CF via heel stick performed?

Well before 8wo b/c trypsin levels fall

76

When is chloride sweat test performed?

- Asymptomatic positive heel stick
- After 2wo and >2kg
- Meconium ileus after day 2

77

When is molecular DNA testing done for CF?

- Inconclusive sweat test
- All CF pts for prognosis and epidemiologic interest

78

Infants and children with CF usually present with ________

Respiratory sx's - chronic URI, wheezing of unclear etiology

79

Tx for CF

- Expansive list b/c multisystem
- Ivacaftor → CFTR modulator
- Specific sequence of inhaled Rx: albuterol → hypertonic saline → chest PT → Dnase → azithromycin
- Steroids (PO or inhaled)
- Supportive → O2, BiPAP, immunizations
- Lung transplant (but remember, multisystem dz)

80

Respiratory distress syndrome usually occur in what pts?

<28wo GA

81

Pathophysiology of respiratory distress syndrome

Prematurity = surfactant deficiency, incr. risk of PDA and foramen ovale

82

Dx respiratory distress syndrome

Clinical diagnosis

83

What might you see on CXR of respiratory distress syndrome

- Airbronchograms
- Low lung volume
- Ground glass appearance
- Pneumothorax

84

Prevention of Respiratory Distress Syndrome

- Antenatal corticosteroids for pregnant pts at risk for delivery at <34wks GA
- Exogenous surfactant within first 30-60 min. of life for <30wks GA with resp. distress
- Assisted ventilation w/ PEEP
- Thermoregulation, fluids, CV management, nutrition support