peds resp Flashcards Preview

CSI > peds resp > Flashcards

Flashcards in peds resp Deck (74):
1

why would infant be cyanotic

amniotic fluid in lung
cong. heart disease

2

why would infant be cyanotic

amniotic fluid in lung
cong. heart disease

3

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

listen for murmurs
-single S2: worrisome

4

baby PMI

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)

5

baby PMI

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

6

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

listen for murmurs
-single S2: worrisome

7

palpate this before listening to lungs/heart

PMI

8

baby PMI

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

9

check pre-ductal (PDA) pulse ox

right arm: if lower no mixing??
postductal : leg or left arm

10

cardiac pre vs. post O2

pH: 7.44
CO2: 20
O2: 50

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

11

lung problem: CO2 levels and hyperoxia test

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

12

heart problem: CO2 levels and hyperoxia test

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

13

resp pre vs post O2

pH: 7.2
CO2: 70
O2: 50

pH: 7.2
CO2: 66
O2: 160

14

cardiac pre vs. post O2

pH: 7.44
CO2: 20
O2: 50

pH: 7.44
CO2: 20
O2: 54

15

oxyhood

can be given instead of mask/intubation
*if CO2 is not a problem

16

transient tachypnea of the newborn

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

17

ddx for trans. tachypnea of newborn ("blue baby")

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

18

chorioamnioitis orgs

group B. Strep, E. coli, listeria

19

meconium does not have

bacteria?

20

pneumothorax

seen on CXR: free air, pushes heart to opposite side
may occur from meconium aspiration

21

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

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

22

chorioamnioitis orgs

group B. Strep, E. coli, listeria

23

premature risk w/ O2 deficiency

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

24

phys. signs of resp. distress

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

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