Flashcards in Pulmonology Atopy Deck (34):
What is the most common reason for pediatric hospitalization?
respiratory disease is the most common reason for pediatric hospitalization
hallmark distinction of airway noise
upper airway obstruction
lower airway obstruction
upper airway obstruction - stridor
lower airway obstruction - wheezing
air trapping and prolonged expiratory phase can occur in
either upper or lower obstruction
ventilation and oxygenation occur
independent from one another
Respiratory rate varies with age
always count respiratory rate over 60 seconds
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.
Whats the order for the progressive effort with worsening comprimised?
then, further labored breathing
-attempt to maintain area for gas exchange by providing extra end expiratory pressure
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
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
What are the sounds for Croup?
(inflammation of larynx and surrounding airways
dry, barking cough
most commonly viral
fever and cough
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
influenza A and B
respiratory syncytial virus (RSV)
Viral croup imaging?
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)
Viral croup tx?
home shower “steam”
car ride with windows down
cool water humidifiers
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)
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"?
Cystic fibrosis dx
newborn genetic screening
can only screen for known mutations
"when you kiss your baby, does it taste salty"
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
Obstructive sleep apnea may progress on to
cor pulmonale (pulmonary vascular-source right heart disease)
frequent sleep arousals
increased sleeptime respiratory effort
daytime hypersonmonlence impairing school performance
less common in children than in adults
peak incidence age 4-8 years
related to chronic nasal obstruction
tonsillar and adenoidal hypertrophy
Diagnosis of obstructive sleep apnea
monitors oxygenation and ventilation during sleep
lateral neck film to evaluate airway
EKG to screen for right ventricular hypertrophy
Obstructive sleep apnea management
medical management for temporary relief
treat allergic rhinitis
tonsillectomy and adenoidectomy
palatouvuloplasty (less common)
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
influenza, parainfluenza, adenovirus
infection and inflammation of the lower airways
obstruction results from edema, mucus plugging
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
Prevention (RSV infects at high rate)
RSV intravenous immune globulin
given to high-risk groups during RSV season each year
no curative therapy
hydration IV fluids/frequent feedings
pulmonary toilet (nasal suction, airway clearance, positioning)
the most common chronic disease of childhood
despite technologic advances, morbidity has increased
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
mild asthma exacerbation sx's
moderate asthma exacerbation
severe asthma exacerbation
mental status changes
may become paradoxically unlabored when entering respiratory failure
Asthma treatment of acute exacerbation
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)
severe cases may require
parenteral β2-agonist (terbutaline)
mechanical ventilation generally avoided, but if necessary:
Chronic asthma treatment?
long-acting β2-agonist – associated with increased risk of death
mast cell stabilizers (cromolyn)
dust mite control
reduction of exacerbating factors
Atopic dermatitis def
Hints to diagnosis
generalized dry skin
accentuation of skin markings on palms and soles
symmetric depression folds just beneath the eyelids
fissures at base of earlobe
history of atopy
asthma, allergic rhinitis (hay fever)