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peds resp Flashcards

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1
Q

why would infant be cyanotic

A

amniotic fluid in lung

cong. heart disease

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2
Q

why would infant be cyanotic

A

amniotic fluid in lung

cong. heart disease

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3
Q

cong. heart vs respiratory cyanosis: how to tell the difference

A

listen for murmurs

-single S2: worrisome

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4
Q

baby PMI

A

right side hypertrophy, so right shifted–>just left of sternal border (vs. mid clavicular line in adults)

  • ensure not situs inversus
  • ensure no tension pneumothorax (R: right hyper expands, shift left of PMI, vis versa)
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5
Q

baby PMI

A

right side hypertrophy, so right shifted–>just left of sternal border (vs. mid clavicular line in adults)

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6
Q

cong. heart vs respiratory cyanosis: how to tell the difference

A

listen for murmurs

-single S2: worrisome

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7
Q

palpate this before listening to lungs/heart

A

PMI

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8
Q

baby PMI

A

right side hypertrophy, so right shifted–>just left of sternal border (vs. mid clavicular line in adults)

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9
Q

check pre-ductal (PDA) pulse ox

A

right arm: if lower no mixing??

postductal : leg or left arm

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10
Q

cardiac pre vs. post O2

A

pH: 7.44
CO2: 20
O2: 50

pH: 7.44
CO2: 20
O2: 54
not much change! problem with ductus, still not getting O2

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11
Q

lung problem: CO2 levels and hyperoxia test

A

retained CO2 (elevated)
dec. O2
hyperoxia test PaO2>150 mmHg
retracting, gasping, grunting, crackles, rhonchi, rales

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12
Q

heart problem: CO2 levels and hyperoxia test

A

normal or dec. CO2
dec. O2
PaO2 50-150 mmHg
quiet tachypnea
norm.

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13
Q

resp pre vs post O2

A

pH: 7.2
CO2: 70
O2: 50

pH: 7.2
CO2: 66
O2: 160

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14
Q

cardiac pre vs. post O2

A

pH: 7.44
CO2: 20
O2: 50

pH: 7.44
CO2: 20
O2: 54

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15
Q

oxyhood

A

can be given instead of mask/intubation

*if CO2 is not a problem

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16
Q

transient tachypnea of the newborn

A

typ. term baby
mult. deliveries, C sec
respiratory problem
some retained fluid
check CBC

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17
Q

ddx for trans. tachypnea of newborn (“blue baby”)

A

meconium in utero: thick pea soup–>meconium aspirates: would intubate (ET tube, meconium aspirator) may need to bag them
-fluid in lungs–>chemical pneumonitis (bile acid)–>tachypnea
“meconium staining”
rare for premies, mostly term: think inf. w/ listeria if premie

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18
Q

chorioamnioitis orgs

A

group B. Strep, E. coli, listeria

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19
Q

meconium does not have

A

bacteria?

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20
Q

pneumothorax

A

seen on CXR: free air, pushes heart to opposite side

may occur from meconium aspiration

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21
Q

mom had fever while baby in utero, baby has foul smell

A

chorioamnionitis
can dev. into pneumonia
baby comes out w. flu, tachypnic

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22
Q

chorioamnioitis orgs

A

group B. Strep, E. coli, listeria

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23
Q

premature risk w/ O2 deficiency

A 
surfactant deficiency
37 wks
inc. work of breathing
grunting
inc. resp. rate
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24
Q

phys. signs of resp. distress

A

Nasal flaring: causes marked reduction in nasal resistance…can reduce lung resistance, and decrease work of breathing
Retractions: disturbance in lung and chest wall mechanics: intercostal, subcostal and suprasternal muscles
Cyanosis: clinically apparent when at least 5gm/100ml of hgb becomes unsaturated
cardiac baby would NOT grunt

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25
common pulm. causes
``` Retained Fetal Lung Liquid Syndrome (RFLLS or also known as Transient Tachypnea of newborn or TTN)* Respiratory Distress Syndrome Meconium Aspiration Syndrome Pneumonia Air leak* most likely for premie ```
26
non-pulm causes RD
Cardiac: ie: cyanotic congenital heart disease Infection : sepsis Metabolic Disorders: ie Hypoglycemia, inborn errors of metabolism CNS disorders: ie: meningitis, seizure, obstructed hydrocephalus Other: ie Anemia, polycythemia, asphyxia "panting like a dog" not retractions
27
CXR for surf. deficiency
``` air bronchograms wet lungs "ground glass" higher surface tension (with 100% O2, O2 would inc., CO2 would still be elevated) ```
28
can give babies CPaP?
yes, can also intubate but use oxyhood if not as bad
29
what lung cells respond to surfactant
type 2 alveolar cells
30
can give exogenous surfactant?
Yes, down trachea via intubation, tip them around, let ventilator blow into lungs, get better quickly
31
complication of surfactant
pulmonary hemorrhage, calculate amount need to be given
32
Sweat chloride test
The most discriminatory test for CF and is the gold standard -IRT/DNA method can detect single CFTR (cystic fibrosis transmembrane conductance regulator) gene (But child with single gene may not have CF)
33
what lung cells respond to surfactant
type 2 alveolar cells
34
meconium ileus
poor weight gain **(buzzword for CF) elevated IRT
35
IRT: immunoreactive trypsinogen
meas. fraction of pancreatic enzymes normally rel. in low conc. if elevated, suspect pancr. dysfunc, CF
36
Sweat chloride test
The most discriminatory test for CF and is the gold standard -IRT/DNA method can detect single CFTR (cystic fibrosis transmembrane conductance regulator) gene, i.e. + for carrier (But child with single gene may not have CF) >60 is dx 40-60 intdeterminant (>30) -newborns don't sweat much
37
CF can result in...
``` chronic sinopulmonary disease and pancreatic insufficiency Chronic cough Decreased appetite/failure to thrive Weight loss Dyspnea Increased sputum production Rectal prolapse pseudomonas infection ```
38
CF inheritance
autosomal recessive | chromosome 7
39
CF affects
- Peribronchial cuffing - Tram lines (bronchial line shadows) - Recurrent infiltrates - Fibrosis - Pulmonary blebs and bullae
40
CF also affects
vas deferens | nasal polyps
41
In managing a child with CF, which of the following is the most appropriate choice? a. Pulmonary therapies including bronchodilators and mucolytics b. Macrolides for suspected bacterial infections c. Pancreatic enzymes only for those with pancreatitis d. Avoidance of live vaccines
all except d. | will put on macrolides later, pseudomonas is a big dog
42
CF complications
``` Recurrent pneumonia Recurrent sinusitis Hemoptysis Pneumothorax Respiratory failure Nasal polyps ```
43
Which of the following is the LEAST likely to be a complication of CF? a. Hemoptysis b. Pneumothorax c. Pancreatic cancer d. Male infertility e. Cirrhosis
pancreatic ca
44
Which of the following is usually clinically diagnostic of CF in neonate?
meconium ileus (1/5)
45
macrolide tx
give during cataharral stage, ameliorate, but after cough, have no effect on course but limit spread
46
CF tx
``` Oxygen Empiric antibiotic therapy Bronchodilators Support of ventilation Support nutrition with pancreatic enzymes/GI Treat complications: Pneumothorax Hemoptysis Diabetes (usually as teens) ```
47
what dx studies for CF?
lymphocytes on CBC (70%), elevated WBC
48
CF colonization
S aureus, nontypeable H influenzae, gram-negative bacilli P aeruginosa becomes predominant organism by 10 years of age. Antibiotic therapy continued for 2 to 3 weeks and may be given on an inpatient service combined with home IV therapy
49
macrolide tx
give during cataharral stage, ameliorate, but after cough, have no effect on course but limit spread
50
how to prevent pertussis
infant DTaP adult TdaP pregnant: TdaP + flu shot-->passive imm. to baby
51
more wheezing bac or viral?
viral
52
most common cause of bronchiolitis
RSV | collect via saline tube on ice
53
other causes of bronchiolitis
hMPV, adenovirus, influenza, hit kids
54
peribronchial cuffing
"donut" rings around bronchi
55
other CXR findings bronchiolitis
air expansion, air in subQ tissuses (crackly), hyperinflation
56
bronchiolitis
don't need steroids, albuterol; but can try | sev. may need to be intubated(premies, CV probe)
57
RSV ppx
Palivizumab (MoAb IM) criteria: typ. premies on O2 $$
58
bronchiolitis: complications
``` Apnea (most common in premature infants and young term infants) Pneumonia Atelectasis Dehydration Respiratory failure Bacterial superinfection Air leaks ```
59
Ribavirin
don't use much give in a hood ppx and supp. care is better
60
placenta previa or abruption can result in
fetal anema or hypovolemia-->resp. distress
61
poorly controlled DM can result in fetal
hypoglycemia, polycythemia, rel. surfactant deficiency
62
polyhydramimnios can cause
tracheoesophageal fistula
63
oligohydramnios can be a sign of
hypoplastic lungs
64
triple screen
a-fetoprotein, hCG, estradiol
65
during prey, lung epi is mostly
secretory membrane; chloride pump cause influx of Cl and H2O from interstitial into alv space
66
just before delivery, fluid begins to clear
alv. space about 2-3 days before labor onset, pulm. epi becomes an absorbing membrane
67
fetal RR
60 implies resp. distress)
68
prior to delivery, if notice lecithin:sphingomeylin ratio is
implies fetal lung is immature | -give mom steroids (betamethason >2 days before)
69
acute onset fever CP grunting
BACTERIAL most common: S. pneumo -localized lobar pneumonia
70
pneumonia diagnostics
CXR | CBC: high WBCs, left shift
71
pneumonia: bac or viral?
viral more common, bac higher mortality/morbidity
72
leading cause of bac CAP
1. S. pneumo 2. S. aureus 3. GAS
73
pneumonia vs. effusion
pneumo: rhonchi, wheezes, rales eff: not as much, dec. breath sounds, egonphony
74
Mycoplasma pneumonia
(teens) "walking pneumonia" tx: macrolide neg. Gs

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