Pulmonology & Atopy Flashcards
(119 cards)
1
Q
what is the MC reason for pediatric hospitalization?
A
respiratory dz
2
Q
hallmark airway noise for upper airway obstruction
A
stridor
3
Q
hallmark distinction of lower airway obstruction
A
wheezing
4
Q
air trapping & prolonged expiratory phase can occur in?
A
either upper or lower obstruction
5
Q
ventilation & oxygenation occur_________from one another
A
independent
processes compromise each function differently
6
Q
ventilation & oxygenation both may be affected by what?
A
severe obstruction
7
Q
respiratory rate in infant
A
24-38
8
Q
respiratory rate 1-3 yo
A
22-30
9
Q
respiratory rate 4-6 yo
A
20-24
10
Q
respiratory rate 7-14 yo
A
16-24
11
Q
respiratory rate 14-18 yo
A
14-20
12
Q
you want to always count respiratory rate for how long?
A
60 seconds
13
Q
what is the most sensitive sign of pneumonia in CH?
A
tachypnea
14
Q
continuous sound caused by turbulent flow in narrow airways
A
wheezing
15
Q
fine, interrupted sounds that suggest pulmonary parenchymal dz
A
rales (crackles)
16
Q
course, interrupted sounds that suggest large airway dz
A
rhonchi
17
Q
predominately inspiratory, monophasic noise
A
stridor
18
Q
expiratory stridor
A
pretty rare
means there’s most likely an obstruction in larger thoracic part
19
Q
children mount a progressive effort w/ worsening compromise in respiratory distress how?
A
tachypnea
labored breathing
positioning
20
Q
what will you see in labored breathing?
A
retractions
nasal flaring
grunting
21
Q
retractions include?
A
abdominal (“subcostal”)
intercostal
supraclavicular
22
Q
grunting is an attempt to?
A
maintain area for gas exchange by providing extra end expiratory pressure
23
Q
positioning
A
upright
tripodding
sniffing positon
24
Q
upright positioning
A
gravity aids diaphragmatic contraction
25
tripodding
allows more efficient scalene & intercostal work
26
sniffing position
opens upper airway
27
what is a good screening test for parenchymal or pleural dz?
plain chest film
28
a plain chest film is a poor test of?
pulmonary function
29
what is the best plain chest film in respiratory distress?
upright film at limit of inspiration
- often difficult in small children, may require repeat of film
- radiography tech often forgets to compensate for child size when determining exposure
30
if you have a prolonged expiration you have?
an obstruction
31
ventilation is used to do what?
get CO2 out
32
mild obstruction effects what?
ventilation
33
what test is good to measure pulmonary function?
arterial blood gas- esp. useful if serial measurements allow description of trends
- cap blood gas easier to obtain, but pO2 less helpful
- no utility of pO2 in venous blood gases
34
ABG worrying findings include?
respiratory acidosis
hypoxemia
uncompensated acidosis
35
rising pCO2 over 45 mmHg
respiratory acidosis
36
rales (crackles) sound like what?
crumpled seran wrap un-crumpling
37
decreasing pO2 less than 85 mmHg
hypoxemia
38
acidemia
uncompensated acidosis
39
stridor DDx
```
laryngeal papillomatosis
laryngeal trauma
larygomalacia
viral croup
epglottitis
bacterial tracheitis
anaphylaxia
vocal cord paralysis/ dysfunction
FB
subglottic stenosis
retropharyngeal abscess
congenital anomalies
```
40
congenital anomalies include
Pierre-Robin sequence
neuromuscular dz
hemangioma
41
a respiratory illness (inflammation of larynx & surrounding airways) that manifests in young children
croup
42
signs of croup
hoarse voice
dry, barking cough
inspiratory stridor
43
croup is most commonly what type of infxn
viral- fever & cough
44
viral croup typically occurs before the age of?
6 yo
45
viral croup can occur any time of year, but most commonly occurs when?
late fall & winter
46
viral croup symptoms are typically worse?
at night
| 2nd & 3rd night usually the worst
47
what type of virus is most commonly the cause of viral croup?
parainfluenza viruses
| but also: influenza A & B, adenovirus, RSV (respiratory syncytial virus)
48
DDx for croup
airway FB
angioneurotic edema (anaphylaxis)
retropharyngeal abscess
bacterial tracheitis (common airway pathogens, also M. pneumoniae & Candida spp.)
in unimmunized pt: acute epiglottitis (Hib), laryngeal dipheria
49
screen all pts w/ stridor for what?
immunizations
recent choking/ FB spiration
food allergies
50
Dx of viral croup
based on clinical findings
plain films only useful if atypical presentation
pulse ox usually nml unless severe case
visualization of epiglottis not usually indicated unless concern for epiglottis (drooling, toxic-appearing)
51
what type of sign will you see on CXR in viral croup?
steeple sign
52
tx of viral croup
cool mist
systemic corticosteroids
nebulized racemic epinephrine
severe cases: endotracheal intubation, helium-oxygen mixture
53
cool mist for croup
home shower "steam"
car ride w/ windows down
cool water humidifiers
54
systemic corticosteroids for croup
onset of action is several hrs after dose
| no demonstrable benefit for more than 2 daily doses of dexamethasone
55
cystic fibrosis occurs d/t a defect in what?
cystic fibrosis transmembrane conductance regulator resulting in a deficiency in chloride ion transport, causing abnormal fluid secretion
autosomal recessive
56
secretions & mucus in cystic fibrosis has what type of quality to it?
thick & tenacious
57
cystic fibrosis is most prevalent in who?
northern Europeans
58
cystic fibrosis involves multiple organ systems, including?
chronic pulmonary dz & exocrine pancreatic insufficiency
59
Dx cystic fibrosis
newborn genetic screening
FH
sweat chloride- functional test, most sensitive
DNA testing- less sensitive, can only screen for known mutations
60
red flags in cystic fibrosis
```
meconium ileus & chronic constipation
prolonged jaundice (biliary obstruction)
FTT
signs of malabsorption (bulky, foul smelling stools, greasy/oily stools)
recurrent lung dz
```
61
complications of cystic fibrosis
```
chronic recurrent & indolent pneumonias
recurrent infxns contribute to airway & lung parenchymal changes (bronchiectasis, asthma)
systemic & inhaled Abx therapy
airway clearance measures
pancreatic enzyme replacement
```
62
define obstructive sleep apnea
spectrum of d/o's where obstruction of airflow results in increased respiratory effort & frequent sleep arousal, incrased respiratory effort, hypoventilation, & (sometimes) hypoxemia
63
obstructive sleep apnea may progress to
```
cor pulmonale (pulmonary vascular-source right heart dz)
pulmonary HTN
```
64
sleeping difficulties in obstructive sleep apnea
frequent sleep arousals
increased sleeptime respiratory effort
daytime hypersomnolence impairing school performance (CH
65
what type of S&S might be present in children w/ obstructive sleep apnea
"allergic shiners"
maxillary expansion- related to chronic nasal obstruction
allergic rhinitis
tonsillar & adenoidal hypertrophy
66
a polysomnography can be used to Dx what?
obstructive sleep apnea
it monitors oxygenation & ventilation during sleep
gas challenges to determine source of apnea (central vs. obstructive)
67
besides a polysomnography, what else can be used to Dx obstructive sleep apnea?
lateral neck film to evaluate airway
| EKG to screen for right ventricular hypertrophy
68
how can you medically manage obstructive sleep apnea temporarily
tx allerigic rhinitis
| tx tonsillitis
69
surgical mgnt of obstructive sleep apnea
tonsillectomy & adenoidectomy
| palatouvuloplasty (less common)
70
DDx for wheezing
```
pneumonia
aspiration
laryngotracheomalacia
vascular rings
airway stenoisis/Web
paratracheal adenopathy
mediastinal mass
airway FB
BPD/BOOP
CF
vocal cord paralysis
vocal cord dysfunction
cardiovascular dz (CHF)
asthma
```
71
what is the MCC of acute hospital admissions for infants < 2yo during the winter months
bronchiolitis
72
MCC of bronchiolitis?
RSV (respiratory syncytial virus)
infects ~ 1/3 of all CH q yr
immunity is NOT long lasting
73
other causes of bronchiolitis?
influenza
parainfluenza
adenovirus
74
if you have infection & inflammation of the lower airways you have?
bronchiolitis
75
obstruction in bronchiolitis results from what?
edema, mucus plugging
76
early findings of bronchiolitis
similar to typical URI- fever, rhinorrhea, cough
77
later findings in bronchiolitis
signify lower airway dz- lower airway secretions, tachypnea
78
lab tests that may be useful in Dx bronchiolitis
RSV & influenza enzyme immunoassay- may be useful for cohorting if performed rapidly
CXR- hyperinflation, atelectasis, multifocal ( & often shifting) infiltrates
CBC- commonly nml, may show mild lymphocytosis consistent w/ viral illness
79
prevention of bronchiolitis
hand washing
RSV IVIG- palivizumab, given to high-risk groups during RSV season each year
*RSV infects at a high rate
80
Tx of bronchiolitis
no curative therapy
| supportive care- O2, IV fluids/freq. feedings, pulmonary toilet
81
what is a pulmonary toilet?
nasal suction, airway clearance, positioning
82
what is the MC chronic dz of CH?
asthma
| *despite technologic advances, morbidity has increased
83
what population of people have a disproportionate amt of dz burden for asthma?
African-Americans
84
airway hyperresponsiveness to triggers resulting in excess inflammation is what?
asthma
85
the processes that narrow the lumen of the airway in dz of excess inflammation (asthma) are
```
inflammatory cell infiltration
mucus plugging
shedding of airway epithelium
mast cell activation
bronchoconstriction
```
86
widespread small airway constriction & obstruction impairs air movnt in asthma, particulary during?
exhalation
87
in asthma, what is evident on exam & chest plain films?
air trapping
88
in asthma,_____________ is reduced as pt must inspire again before exhaling sufficient volume
tidal volume
89
Asthma S&S
baseline sx's may be very subtle & clinically hard to dx
| there may be mild, moderate, & severe asthma exacterbation
90
mild asthma exacerbation S&S
cough
wheeze
exercise intolerance
chest congestion
91
moderate asthma exacerbation S&S
dyspnea
chest tightness
labored breathing
92
sever asthma exacerbation S&S
mental status changes
may become paradoxically unlabored when entering respiratory failure
cyanosis
pulsus paradoxus
93
you may have hypoxia in asthma with what?
significant airway compromise, or w/ significant atelectasis
94
what might you see on chest plain films in asthma
lung hyperinflation
atelectasis related to airway plugging
peribronchial thickening/cuffing
95
pulmonary function testing in asthma
reveal small airway dz
methacholine challenge
FEV1 reduced, FEV25-75 reduced
improvement w/ administration of B-agonist
96
tx of acute asthma exacerbation
systemic corticosteroids
B2-agonist
ipratropium
supportive care (oxygen, hydration)
97
systemic corticosteroids in athma
mainstay of therapy
impairs new inflammation
inflammation present in airways needs time to "burn out"
98
B2-agonist in asthma
albuterol- briefly impairs small airway smooth muscle bronchoconstriction
99
ipratropium
inhaled atropine analog (anticholinergic) for large airway dilation
100
severe cases of asthma exacerbation may require what tx
parenteral B2-agonist (terbutaline)
parenteral epinephrine, magnesium, theophylline
mechanical ventilation generally avoided, but if necessary: ketamine + halothane anesthesia w/ helium-oxygen mixture
101
ketamine + halothane anesthesia w/ helium-oxygen mixture can be used for?
mechanical ventilation in sever cases of asthma
102
chronic asthma tx
education
medications
environment modification
reduction of exacerbating factors
103
medications used in chronic asthma tx
inhaled corticosteroids
long-acting B2-agonist- assoc. w/ increased risk of death
leukotriene modifiers
mast cell stabilizers (cromolyn)
104
environment modification in chronic asthma tx
Hepa filters
smoking
dust mite ctrl
pets
105
reduction of exacerbating factors in chronic asthma tx
ID triggers & find ways to avoid
tx of reflux, sinusitis, allergic rhinitis
stress redcution
influenza vaccine
106
larger tx goals in asthma
anti-inflammatory agents
individualized mngt plans
reduction of risks must be ongoing
early dx & vigilant monitoring w/ utilization of latest tx modalities
107
atopic dermatitis
acute followed by chronic, superficial inflammation of the skin
108
atopic dermatitis may first present w/ ?
acute edema
erythema
oozing & crusting
109
usual progression of atopic dermatitis
infancy- cheeks, scalp, trunk
childhood- flexural areas
adolescence- occurs frequently in hands
110
hints to diagnosing atopic dermatitis
```
generalized dry skin
accentuation of skin markings on palms & soles
Dennie-Morgan lines
fissures at base of earlobe
hx of atopy
```
111
symmetric depression folds just beneath the eyelids are what?
Dennie-Morgan lines
| seen in atopic dermatitis
112
hx of atopy includes what?
```
asthma
allergic rhinitis (hay fever)
```
113
treating atopic dermatitis
emollients to moisturize
topical corticosteroids- apply under emollients
anti-histamines for itching
alternatives
114
emollients for atopic dermatitis
apply w/in 10 min of bathing (after drying)
Vaseline is oil-based
Aquaphor is water-based
115
alternative tx for atopic dermatitis includes what?
tacrolimus
Abx to decrease bacterial superinfxn
Domeboro (acetic acid w/ aluminum acetate) soaks
sun exposure promotes malanin production
116
allergic rhinitis
```
seasonal or episododic
boggy nasal mucosa w/ clear to thin white nasal secretions
allergic shiners are frequent
nasal congestion/obstruction
may contribute to OSA
```
117
the "allergic salute" creates what?
transverse nasal crease
118
you want to screen for what in allergic rhinitis?
overuse of OTC nasal sprays that cause rhinitis medicamentosa (rebound rhinitis)
119
treating allergic rhinitis
typically nasal steroids
also: leukotriene inhibitiors, antihistamines
incidental tx- change environment
