Pulmonology Flashcards by Pearl Olvera

What is Mild Persistent asthma?

Sxs >2 times a week, but not every day
Waking up 3-4 times a night/ month
FEV >80%
Variability of 20-30%

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What is the recommended tx for Mild Persistent asthma?

Daily low dose inhaled corticosteroid

- SA B2 agonist PRN

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Which of the following can NOT be used to tx Mild Persistent asthma?

A. Flovent
B. Pulmicort
C. Qvar
D. Prednisone

D. Prednisone–systemic po steroid

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A 12 y/o male patient is having daily sxs of his asthma, which are not continual. He states he is waking up 5-6 times a month at night. What would you expect his FEV to be?

FEV 60-80%
Variability >30%
Moderate Persistent

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A 14 y/o female patient is having asthma attacks every day at school, but they do not last throughout the day. She states she is waking up 7-8 times a month at night. What is the best management for this patient?

Moderate dose of inhaled corticosteroid
MAY add on a LA B2 agonist OR leukotriene modulator
SA B2 agonist PRN
Moderate persistant

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A 15 y/o female patient is having daily asthma attacks that seem to last all day. She reports waking up frequently in the night. What would you expect her FEV to be?

FEV <60%
Variability >30%
Severe Persistent

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A 15 y/o female patient is having daily asthma attacks that seem to last all day. She reports waking up frequently in the night. What would be the best management for this patient?

High dose of inhaled steroids
WITH a LA B2 agonist OR a leukotriene modulator
SA B2 agonist PRN
Severe Persistent

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How do you treat Severe Acute asthma?

A short burst of oral steroids then taper

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How can you tell if a patient’s asthma is managed/controlled?

Rule of 2’s
Has has an urgent care visit
Awakens at night with sxs
Increased need for SA B2 agonist
Uses more than 1 canister of B2 agonist/month

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What is the Rule of 2’s?

Using 2 canisters of B2 agonists/year
Using 2 doses of B2 agonists/week
Having 2 nocturnal awakenings/month
Having 2 unscheduled visits/year
Needing 2 prednisone bursts/year

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How is Peak Flow useful?

-Useful when the spirometry is negative OR at home usage for the family

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What Peak Flow result would indicate poorly controlled asthma?

If there is greater than 20% difference between the AM and PM peak flow

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What is the Green Zone for Peak flow?

> 80% of the patients best

-signifies the asthma is well controlled

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What is the Yellow Zone for Peak flow?

<80% but >50% of the patients best

if this happens, have the patient take a dose of their rescue inhaler and repeat
On repeat, there should be a 20% + improvement
Medications may beed to be evaluated

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What is the Red Zone for Peak flow?

<50% of the patients personal best

-if this happens, have the patient use their rescue inhaler, and call drs office, or go to the ER

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When do you schedule f/u for patients just starting tx or who require a step up in tx to achieve/regain control?

2-6 weeks

2 weeks to a month and a half

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When do you schedule f/u for patients after control is achieved?

1-6 month intervals-consider a 3 month f/u if considering a step down

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If control is not achieved in 3-6 months, what is the appropriate next step?

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Referral

When a child has a foreign body, how can you tell if it is upper or lower based on clinical sxs?

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Upper: Coughing and strider
Lower: Coughing and wheezing with unilateral decreased breath sounds, with retractions/accessory muscle use

With a high suspicion of a foreign body, what is the study of choice?

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Rigid bronchoscopy: allows for removal at the time of visualization

Which of the following is NOT true regarding Cystic Fibrosis?

CF is autosomal dominant
It is an abnormality of the CF conducting regulator that affects chloride channels effecting movement of salt across the cell
Children often present with FTT
Confirmation of CF dx is done with a Pilocarpine sweat test

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is NOT true: CF is autosomal recessive

Note: >60 mmol for the Pilocarpine sweat test

What is the CF “quad” seen in children? (You made up “quad”)

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Meconium ileus*
Later have FTT WITH foul smelling stools
GERD
Clubbing

What bacteria becomes predominant in CF patients?

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Pseudomonas aeruginosa

What is the leading cause of death in pre-term infants?

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Infant Respiratory Distress Syndrome/Hyaline Membrane Disease
(IRDS)

What are the 3 main causes for Hyaline membrane disease?

1. Developmental insufficiency of of pulmonary surfactant production and structural maturity in the lungs 2. Neonatal infection 3. Genetic problem with the production of surfactant associated proteins

What are the risks of developing IRDS?

Risks decrease with advancing gestational age: 1. 50% chance with infants born at 26-26 weeks 2. 25% chance with infants born at 30-31 weeks 3. More frequent with children born to diabetic mothers 4. the second born of premature twins

You are performing a newborn exam on a 26-week infant in the hospital. Vital signs reveal tachypnea, tachycardia and high CO2. On PE, you notice nasal flaring, grunting, and some cyanosis. What would you expect to see on a chest x ray?

"Bell shaped chest" | -IRDS

PREVENTION is the best tx: in premature births, giving mother steroids can increase rate of surfactant production - O2 via CPAP and surfactant - Infant may need ET tube and ventilation

What is Acute Bronchiolitis?

Nonspecific inflammation of the bronchioles

A 1 year old infant is seen in the clinic. Vital signs reveal an increased RR. On PE, you hear rhonchi and wheezing; you see retractions while the patient is breathing. Parents say their child has had a cough for about 2-3 days. What is the most common cause of this child's condition?

Usually caused by RSV or Adenovirus

A 1 year old infant is seen in the clinic. Vital signs reveal an increased RR. On PE, you hear rhonchi and wheezing; you see retractions while the patient is breathing. Parents say their child has had a fever, cough, and runny nose for about 2-3 days. What is the most appropriate treatment for this patient?

Supportive: Albuterol and O2; cool mist humidifier - RSV is self limiting - If there is a pneumonia --> treat - Steroids may be used in severe cases

What is the MCC of pneumonia in children <2 y/o?

Viral: - RSV - Parainfluenza - Influenza A/B - Human metapneumovirus

What is the difference between a pneumonia CXR and a bronchiolitis CXR?

Pneumonia: perihilar streaking, increased interstitial markings, peribronchial cuffing Bronchiolitis: "patchy pneumonia"? and HYPERINFLATION

What is the MC bacterial cause of pneumonia in neonates?

1. Group B strep*** | 2. Chlamydia

What is the MC bacterial cause of pneumonia in children older than neonate age?

1. Strep pneumo*** 2. Hib 3. M. cat 4. Staph 5. Klebsiella 6. E. coli

What are the following findings consistent of: - Increased vocal fremitus - Dullness to percussion - Tachypnea - Tachycardia - Fever with productive cough* (part of hx)

Bacterial pneumonia

What is the most appropriate tx for bacterial pneumonia for a <4 wk old infant?

-admission for Gentamicin and Ampicillin

What is the most appropriate tx for bacterial pneumonia for a 3months to 5 yrs old child?

-Amoxicillin 50-90 mg/kg/d x 7-10 days

What is the most appropriate tx for bacterial pneumonia for a child >5y/o?

-Amoxicillin, Macrolide, or Penicillin G can all be effective based on the pathogen

What is "lobar consolidation" consistent with on CXR?

bacterial pneumonia

What CXR finding is the classic hallmark of Croup?

Steeple sign = Supraglottic narrowing

A 4 year old child is seen in the office with a balky, seal cough. You notice stridor while the child is breathing. Vital signs reveal a low grade 99 degrees fever. What is the most likely cause of this condition?

- Croup | - Parainfluenza virus***

A 4 year old child is seen in the office with a balky, seal cough. You notice stridor while the child is breathing at rest. Vital signs reveal a low grade 99 degrees fever. What is the most appropriate tx for this child?

- Supportive therapy - Hydration and O2 - Nebulized racemic epinephrine***--used when pt has resting stridor - Glucocorticoids like Dexamethasone

Pulmonology Flashcards

(43 cards)