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MJ- Peds Block 1 > Peds Pulm > Flashcards

Peds Pulm Flashcards

1
Q

Are crackles heard on inspiration or expiration?

A

inspiration

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2
Q

What are the 4 possible causes of crackles heard on auscultation?

A
  1. Bronchiolitis
  2. Pulmonary Edema
  3. PNA
  4. Asthma

(B PAP)

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3
Q

Are wheezes heard on inspiration or expiration?

A

Predominantly on expiration

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4
Q

What are the 3 possible causes of wheezes?

A
  1. Asthma
  2. Bronciolitis
  3. FB

(You are still FAB even if you wheeze)

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5
Q

What are the 2 possible causes of Rhonchi?

A
  1. PNA
  2. Cystic Fibrosis
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6
Q

Is stridor heard on inspiration or expiration?

A

Inspiration

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7
Q

What are the 6 possible causes of Stridor?

A

1. Croup

  1. Laryngomalacia
  2. Subglottic stenosis
  3. Allergic rxn
  4. vocal cord dysfunction
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8
Q

What ages usually get croup?

A

6mo-5y/o

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9
Q

The following are s/s of what?

  • URI sxs
  • Inspiratory stridor
  • Hoarsness
  • Barking, “seal-like” cough
A

Viral Croup (laryngotracheobronchitis)

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10
Q

What is the #1 etiology of Viral Croup

A

Parainfluenza virus

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11
Q

What is viral croup?

A

Subglottic narrowing

(most likely caused by parainfluenza virus)

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12
Q

What is the Wesley Croup Score used for?

A

to distinguish b/w mild, mod and severe croup

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13
Q

What is seen on x-ray for viral croup?

(POPCORN)

A

“Steeple sign”

(Bi, symmetrical subglottic narrowing)

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14
Q

How do you manage mild croup?

A

supportive therapy

cool mist

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15
Q

How do you manage moderate viral croup (score >3)?

(KNOW)

A

Dexamethasone

+/- Nebulized racemic epinephrine

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16
Q

How do you manage severe croup?

A

Airway support

Admit

IV corticosteroid, nebulized epi

etc

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17
Q

What is Epiglottitis caused by?

A

H. flu

(incidence reduced by HIB vax)

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18
Q

What are the 3 main s/s of Epiglottitis? (3 D’s)

What type of posturing will the pt have?

A

1. Dysphagia

2. Drooling

3. Distress

Tri-pod posturing

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19
Q

T/F: you should always use a tongue blade when examining a pt with suspected epiglottitis?

A

FALSE

NEVER DO THIS

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20
Q

What is seen on x-ray for epiglottitis?

(KNOW)

A

“Thumb sign”

(Enlarged epiglottitis protruding from the anterior wall of the hypopharynx)

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21
Q

How do you manage Epiglottitis? (3 steps)

A
  • Airway support
  • blood culture
  • IV abx- 3rd gen cephalosporin + Vanco
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22
Q

How old are patients with Bronchiolitis?

A

<2y/o

(peak 2-6mo old)

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23
Q

What is Bronchiolitis?

A

Lower respiratory tract infection that affects the bronchioles

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24
Q

What is the #1 cause of Bronchiolitis?

A

RSV

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25
Q

Is Croup an upper or lower resp tract infection

A

upper

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26
Q

Bronchiolitis:

LRT sxs peak on days ___ to ____

A

3-5

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27
Q

Bronchiolitis sxs usually resolve over ___ to ___ weeks

A

2-3 weeks

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28
Q

What are heard on auscultation in bronchiolitis?

A

Wheezing

Crackles

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29
Q

How do you dx Bronchiolitis?

A

Clinical

30
Q

How do you tx Bronchiolitis?

A
  • Supplemental O2 (maintain above 90-92%)
  • Maintain hydration
  • Nasal suctioning
  • (Albuterol and Epi NOT recommended)
31
Q

What is the most important cause of LRTI in children <1 y/o?

A

RSV

32
Q

What are sxs of RSV

A
  • Diffuse wheezing and tachypnea following URI sxs
  • Low grade fever
  • LOTS OF MUCUS! (if no mucus, not bronchiolitis or RSV)
33
Q

What is seen on CXR in RSV?

(KNOW)

A

Hyperinflation

Peribronchial thickening

34
Q

What is heard on auscultation in RSV?

A

Crackles, prolonged expiration, wheezing, retractions

35
Q

How is RSV diagnosed?

A

Rapid assay

CXR for secondary PNA

36
Q

How do you tx RSV?

A
  • Supportive
  • Ribavirin/Palivizumab- if immunocompromised/indicated
37
Q

What is the most common cause of respiratory distress in preterm infant?

(KNOW)

A

Infant Respiratory Distress Syndrome (RDS)

“Hyaline Membrane Disease”

38
Q

What is Infant Respiratory Distress Syndrome (RDS), “Hyaline Membrane Disease”

A
  • Deficiency of surfactant production + surfactant inactivation by protein leak into airspaces
  • hypoxia due to V/Q mismatch
39
Q

What is the main risk factor for Infant Respiratory Disterss Syndrome (“Hyaline Membrane Disease”)?

A

Prematurity (< 37wks, highest if <28 wks)

40
Q

What is seen on CXR in Infant Respiratory Distress Syndrome?

A

“Ground-glass appearance”

41
Q

How do you tx infant RDS? (3)

A
  • Resp support
  • Steroids
  • Surfactant Replacement
42
Q

What are s/s of PNA in an infant?

A
  • F
  • cough
  • +/- preceding URI
  • Poor feeding
  • irritability
43
Q

What is a sign of imminent respiratory failure in a pt w/ PNA?

A

Grunting

44
Q

What is heard on auscultation in a pt w/ PNA

A
  • Crackles
  • Rhonchi
  • Decreased air movement
45
Q

What is the MCC of PNA 1-12mo of age

A

Viral MC

RSV #1

46
Q

What is the MCC of PNA in patients 2-5yrs of age

A

Viral MC

Parainfluenza, influeza, others

47
Q

What is the MCC of PNA in patients 3-12mo of age

A

Viral MC

RSV #1

48
Q

What is the MCC of PNA in patients 5-18yrs of age

A

Bacterial MC

S. Pneumo

Atypical bacteria

49
Q

Is the MCC of PNA under the age of 5 viral or bacterial

A

viral

50
Q

What is the MCC of bacterial pneumonia for all ages?

A

Strep Pneumo

51
Q

What is the MCC of afebrile PNA of infancy?

A

Chlamydia

52
Q

PNA on x-ray: Bacterial or viral?

Lobar= ____

Infiltrates=_____

A

Lobar= bacterial

Infiltrates= Viral

53
Q

How do you tx PNA in a patient < 3-6mo old or if they are hypoxemic?

A
  • ADMIT
  • Amoxicillin
54
Q

How do you tx PNA if atypical bacteria is NOT suspected?

A

Amoxicillin

55
Q

How do you tx PNA if atypical bacteria is suspected?

A

Azithromycin

56
Q

What is the MC age of pts w/ afebrile PNA of infancy?

A

infants 2wks- 4 months

57
Q

What is the incubation period of Pertussis?

A

7-10d

58
Q

What are the 4 complications of Pertussis in infants/young children?

A
  1. Hypoxia
  2. Apnea
  3. PNA
  4. Seizures

(“PASH”)

59
Q

What are the 3 phases of Pertussis?

A

P1- Catarrhal (URI, fever) x1-2wks

P2- Paroxysmal (Cough, inspiratory whoop, post-tussive emesis) x2-6wks

P3- Convalescent (cough) x weeks-months

60
Q

What is the gold standard for Dx of Pertussis?

A

PCR and Culture of nasal secretions

61
Q

How do you tx pertussis?

A
  • Macrolides (Z-pack), TMP-SMX
  • Prophylaxis for household
62
Q

What is the MC life-shortening genetic disease in white individuals?

A

Cystic Fibrosis

63
Q

What is the inheritance pattern of Cystic Fibrosis?

A

Autosomal Recessive Disorder

64
Q

What is the hallmark sx of Cystic Fibrosis?

(KNOW)

A
  • High salt content in sweat glands
65
Q

What are 4 s/s of Cystic Fibrosis

A

1. High salt content in sweat glands

  1. Recurrent sinus infections
  2. Nasal polyps
  3. Chronic ear infections
66
Q

What are the 2 MC infectious organisms early in life in a pt w/ Cystic Fibrosis?

A

H. Flu

Staph aureus

67
Q

How do you dx Cystic Fibrosis

A

Newborn screen

Sweat test

68
Q

What is the MCC of death in Cystic Fibrosis

A

Respiratory failure at ~40y/o

69
Q

How do you tx Cystic Fibrosis?

A
  • Airway clearance therapies
  • Chest percussion
  • Regular exercise
70
Q

Treat CF pts early if cough or respiratory infections >___ week(s) as viral URIs often lead to pulmonary exacerbations

A

>1 week

71
Q

What are CF pts at an increased risk for developing?

A

Hyponatremic dehydration

MJ- Peds Block 1 (7 decks)

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