Pulm Flashcards by Lindsey Dutton

What is the most common casue of acute bronchiolitis and when does it typically present

Most often caused by RSV - commonly in fall and winter months

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How is Acute Bronchiolitis diagnosed

Nasal washing for RSV culture and antigen assay
CXR = normal

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what is the treatment for Acute Bronchiolitis

Oxygen
+ supportive

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when should a patient be hospitalized with Acute Bronchiolitis

if O2 saturation < 95-96%
Less than 3 months old
>70 years old
nasal flaring
retractions
atelectasis on CXR

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what is a reversible inflammatory airway disease with recurrent attacks of breathlessness and wheezing

Asthma

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what tool is used to diagnose and monitor asthma

Peak flow spirometry

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What is Intermitten asthma
and what is the treatment

less than 2x/week or < 2 night symtpoms/month
- SABA PRN

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What is Mild persistent asthma
and how is it treated

more than 2x/week or 3-4 night symptoms/month
- Low dose ICS daily

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What is moderate persistent asthma
and how is it treated

daily symptoms or more than 1 nightly episode/week
- Low dose ICS + LABA daily
- Medium dose ICS + LABA daily

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What is severe persistent asthma
and how is it treated

Symptoms several tiems per day and nightly
- High dose ICS + LABA daily
- High dose ICS + LABA + oral steroids daily

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What is the acute treatment for asthma

oxygen, nebulized SABA, ipratropium bromide and oral corticosteroids

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what is an infection of the upper airway that obstructs breathing and causes a barking cough

croup

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what pathogen causes Croup

Parainfluenza virus

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what is seen on AP CXR in Croup

Steeple sign
(narrowing of the trachea in subglottic region)

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What is the treatment for Croup

Supportive (air humidifier) and antipyretics

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What is cystic fibrosis

autosomal recessive mutation in the CFTR gene causing abnormally thick mucus, causing difficulty to clear the mucus

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what is the presentation of CF

recurrent respiratory infections (esp. Pseudomonas), Steatorrhea

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What is steatorrhea

excretion of abnormal quantities of fat with feces due to reduced absoprtion of fat by intestines

How is CF diagnosed?

Quantitiative sweat chloride test
- CXR may reveal hyperinflation, mucus plugging and focal atelectasis

what is the treatment of CF

maintenance and acute exacerbatiosn

Maintenance: chest physiotherapy, hight-fat diet, supplement fat-soluble vitamins (A, D, E, K).
Acute exacerbations: antibiotics

what are risk factors for foreign body aspiration

institutionalization
advanced ageg
poor dentitition
alcohol
sedative use

what test is required to appropriatly assess ventilation

ABG

what is the presentation of nasal foreign body

persistent foul-smelling purulent unilateral nasal discharge in a young child without respiratory symtpoms

What can be used with nasal foreign bodies to shrink the mucous membrane prior to removal of the FB

Oxymetazoline drops

how are ocular foreign bodies diagnosed

full inspection of lids, conjunctiva and cornea Slit lamp exam will assist in ID and removal

What is hyaline membrane disease

when infants are born before the lungs are producing adequate amounts of surfactant

What causes hyaline membrane disease

prematuraty deficiency in sufactant resulting in poor lung compliance an dn atelectasis

what is the presentation of hyaline membrane disease on CXR

diffuse bilateral atelectasis causing a "ground glass appearance"

What is the treatment of hyaline membrane disease

antenatal steroid within 24-48 hours of birth (Betamethasone IM x 2) - artificial surfactant can be given via endotracheal tube - mechanical ventilation with postivie pressure

What is the common viral cause for pneumonia in kids

RSV: comes on fast

What is the common viral cause of pneumonia in adults

influenza

how are viral pneumonias diagnosed

CXR: bilateral insterstitisl infiltrates -rapid antigen testing for flu, RSV nasal swab

what is the treatment for viral pneuomnia

flu - tamiflu if sxs began <48hours symptomatic tx: BEta2 agonists, fluid and rest

what is the presntation of bacterial pneumonia

fever, dyspnea, tachycardia, tachypnea, cough, +/- sputum

how is bacterial pneumonia diagnosed

CXR: patchy, segmental, lobar, mulitlobar consolidation Blood culutres x2, sputum gram stain

what is the outpatient treatment for bacterial pneumonia

Doxycycline Macrolides

what is the inpatient treatment for bacterial pneumonia

Ceftriazone + azithromycin/respiratory FQs

what is the most common cause of lower respiratory tract infection in children worldwide

RSV (respiratory synctial virus)

what is the presentation of RSV

rhinorrhea, wheezing/coughing that persists for months, lowgrade fever, nasal flaring/retractions, nail bed cyanosis

what are indications for hospitalization with RSV

tachypnea with feeding difficulties visible retractions oxygen desaturation < 95-96%

who are RSV vaccinations approved for

individuals 60+ years and older

what is the preventative management for infants and younger children with RSV

- 1 dose Nirsevimab for all infants younger than 8 months born during/entering their first RSV seaso - 1 dose Nirsevimab for infants/children 8-19months who are at increased risk for severe RRSV disease and entering their second RSV season

what is the prophylaxis for RSV

Palivizumab (Synagis) - FDA approved for children at high risk for severe RSV