Pulmonology Atopy Flashcards Preview

Pediatrics > Pulmonology Atopy > Flashcards

Flashcards in Pulmonology Atopy Deck (34):
1

What is the most common reason for pediatric hospitalization?

respiratory disease is the most common reason for pediatric hospitalization

2

hallmark distinction of airway noise
upper airway obstruction
lower airway obstruction

upper airway obstruction - stridor

lower airway obstruction - wheezing

3

air trapping and prolonged expiratory phase can occur in

either upper or lower obstruction

4

ventilation and oxygenation occur

independent from one another

5

Respiratory rate varies with age

infant
1-3 years
4-6 years
7-14
14-18

respiratory rate

24-38
22-30
20-24
16-24
14-20

always count respiratory rate over 60 seconds

6

tachypnea is the most sensitive sign of ?

wheezing is continuous sound caused by?

rales (crackles) are fine, interrupted sounds that suggest ?

rhonchi are ?

stridor is a predominantly ?

pneumonia in children

turbulent flow in narrow airways

pulmonary parenchymal disease

coarse, interrupted sounds that suggest large airway disease(sounds like snoring)

inspiratory, monophasic, noise.

7

Whats the order for the progressive effort with worsening comprimised?

first, tachypnea
then, further labored breathing
-retractions
--abdominal (“subcostal”)
--intercostal
--supraclavicular
nasal flaring
grunting
-attempt to maintain area for gas exchange by providing extra end expiratory pressure

8

Whats a Plain chest film good for?

good screening test for parenchymal or pleural disease
poor test of pulmonary function
upright film at limit of inspiration is best

9

Is Arterial blood gas good?

useful measure of pulmonary function
even more useful if serial measurements allow description of trends
worrying findings include
rising pCO2 over 45 mmHg (respiratory acidosis)
decreasing pO2 less than 85mmHg (hypoxemia)
acidemia (uncompensated acidosis)
capillary blood gases are easier to obtain, but pO2 is less helpful
no utility of pO2 in venous blood gases

10

What are the sounds for Croup?
(inflammation of larynx and surrounding airways

hoarse voice
dry, barking cough
inspiratory stridor

most commonly viral
fever and cough

11

Whats the age range for viral Croup?
When does it occur most often?
When are symptoms worse?
What causes it the most?

typically 6 years of age and younger
occurs any time of year
most commonly late fall and winter
symptoms typically worse at night
2nd and 3rd nights usually the worst
most commonly parainfluenza viruses
also
influenza A and B
adenovirus
respiratory syncytial virus (RSV)

12

Viral croup imaging?
Pulse ox?
do you want to look in their mouth?

plain films only useful if atypical presentation
pulse oximetry usually normal in viral croup unless a severe case
if main airway is compromised to the point of hypoxemia, inpatient monitoring is warranted
visualization of epiglottis not usually indicated unless concern for epiglottitis (drooling, toxic-appearing)

13

Viral croup tx?

cool mist
home shower “steam”
car ride with windows down
cool water humidifiers
systemic corticosteroids
onset of action is several hours after dose
no demonstrable benefit for more than two daily doses of dexamethasone
nebulized racemic epinephrine
benefit is transient
for severe cases
edotracheal intubation (avoided if possible)
helium-oxygen mixture

14

whats the def Cystic fibrosis

defect in the cystic fibrosis transmembrane conductance regulator resulting in a deficiency in chloride ion transport, causing abnormal fluid secretion
secretions, including mucus, are thick and tenacious
most fiding involve sectretions in lungs and gastro track.
"did your kid have a meconioum plug"?

15

Cystic fibrosis dx

diagnosis
newborn genetic screening
family history
sweat chloride
functional test
most sensitive
DNA testing
LESS SENSITIVE
can only screen for known mutations
"when you kiss your baby, does it taste salty"

16

Cystic fibrosis red flags

meconium ileus & chronic constipation
prolonged jaundice (biliary obstruction)
failure to thrive
signs of malabsorption
bulky, foul smelling stools
greasy or oily stools
recurrent lung disease

17

Obstructive sleep apnea may progress on to

cor pulmonale (pulmonary vascular-source right heart disease)
pulmonary hypertension
sleeping difficulties
frequent sleep arousals
increased sleeptime respiratory effort
daytime hypersonmonlence impairing school performance
less common in children than in adults
snoring

18

clinical manefestation?

peak incidence age 4-8 years
exam
“allergic shiners”
maxillary expansion
related to chronic nasal obstruction
allergic rhinitis
tonsillar and adenoidal hypertrophy

19

Diagnosis of obstructive sleep apnea

polysomnography
monitors oxygenation and ventilation during sleep

also
lateral neck film to evaluate airway
EKG to screen for right ventricular hypertrophy

20

Obstructive sleep apnea management

medical management for temporary relief
treat allergic rhinitis
treat tonsillitis
surgical management
tonsillectomy and adenoidectomy
palatouvuloplasty (less common)

21

Bronchiolitis most common cause?

most common cause of acute hospital admissions for infants less than 2 years of age during the winter months
most common cause
RSV (respiratory syncytial virus)
infects about ~1/3 of all children every year
immunity is not long-lasting
other causes
influenza, parainfluenza, adenovirus
pathogenesis
infection and inflammation of the lower airways
obstruction results from edema, mucus plugging

22

Bronchiolitis dx?

RSV and influenza enzyme immunoassay
may be useful for cohorting if performed rapidly
CXR - hyperinflation, atelectasis, multifocal (and often shifting) infiltrates
CBC - commonly normal, may show mild lymphocytosis consistent with viral illness

23

Bronchiolitis prevention

Prevention (RSV infects at high rate)
hand-washing
RSV intravenous immune globulin
palivizumab
given to high-risk groups during RSV season each year

24

Bronchiolitis tx?

treatment
no curative therapy
supportive care
oxygen
hydration IV fluids/frequent feedings
pulmonary toilet (nasal suction, airway clearance, positioning)

25

Asthma is?

the most common chronic disease of childhood
despite technologic advances, morbidity has increased

26

Asthma and tidal volume?

tidal volume reduced as patient must inspire again before exhaling sufficient volume

air trapping evident on exam and chest plain films

FEV1 reduced, FEV25-75 reduced
improvement with administration of β-agonist

27

mild asthma exacerbation sx's

cough
wheeze
exercise intolerance
chest congestion

28

moderate asthma exacerbation

dyspnea
chest tightness
labored breathing

29

severe asthma exacerbation

mental status changes
may become paradoxically unlabored when entering respiratory failure
cyanosis
pulsus paradoxus

30

Asthma treatment of acute exacerbation

systemic corticosteroids
mainstay of therapy
impairs new inflammation
inflammation present in airways needs time to “burn out”
β2-agonist (albuterol) – briefly impairs small airway smooth muscle bronchoconstriction
ipratropium – inhaled atropine analog (anticholinergic) for large airway dilation
supportive care (oxygen, hydration)

31

severe cases may require

parenteral β2-agonist (terbutaline)
parenteral epinephrine
parenteral magnesium
parenteral theophylline
mechanical ventilation generally avoided, but if necessary:

32

Chronic asthma treatment?

medications
inhaled corticosteroids
long-acting β2-agonist – associated with increased risk of death
leukotriene modifiers
mast cell stabilizers (cromolyn)
environment modification
Hepa filters
smoking
dust mite control
pets
reduction of exacerbating factors

33

Atopic dermatitis def

Hints to diagnosis
generalized dry skin
accentuation of skin markings on palms and soles
Dennie-Morgan lines
symmetric depression folds just beneath the eyelids
fissures at base of earlobe
history of atopy
asthma, allergic rhinitis (hay fever)

34

Atopic dermatitis tx

treatment
emollients to moisturize
apply within 10 minutes of bathing (after drying)
Vaseline is oil-based
Aquaphor is water-based
topical corticosteroids
to be applied under emollients
anti-histamines for itching
alternatives