Pulmonology-Notes Flashcards by michelle granstrom

In neonates, what EKG finding may accompany hypoxia?

bradycardia

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What is the best non-invasive way to determine pulmonary function? Best invasive way?

Non-invasive way: FVC

Invasive way: Arterial PO2

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What is the ddx of wheezing?

asthma
bronchiolitis
cystic fibrosis
tracheomalacia
foreign body aspiration
CHF

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T/F Hilar lymphadenopathy can be normal in kiddos

False. Never normal, no matter the age.

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What is the ddx for hilar lymphadenopathy?

Malignant: lymphoma, mets
Infectious: TB, histoplasmosis
Inflammation: sarcoidosis (would be bilateral)

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What are the causative agents for bronchiolitis?

RSV
parainfluenza
human metapneumovirus
adenovirus

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What is the presentation of bronchiolitis?

wheezing & crackles
coughing
rhinorrhea
tachypnea

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What is the detailed mechanism behind bronchiolitis?

upper and lower resp infection

upper: nasal congestion, rhinorrhea
lower: edema, epithelial cell necrosis, bronchospasm, increased mucous (atelectasis, hyperinflation)

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What is the workup for bronchiolitis?

Rapid RSV and influenza tests

CXR: see lung hyperinflation, peribronchial thickening, increased interstitial markings

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What is the treatment for bronchiolitis?

supplemental O2
racemic epi PRN
hypertonic saline (decreases mucous)
high risk: palivizumab (prophylaxis)

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What is the pathophysiology of bronchopulmonary dysplasia?

decreased number of alveoli (larger)
decreased vascular growth
decreased surfactant and antioxidant capacity

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What is a part of the presentation of bronchopulmonary dysplasia?

a kiddo who needed oxygen for the first 28 days
chronic resp symptoms
preterm birth (

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What are the possible complications of bronchopulmonary dysplasia?

URI can lead to episodic respiratory distress
pulmonary HTN
R heart failure
Asthma
Exercise intolerance

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What is the treatment for bronchopulmonary dysplasia?

supplemental oxygen
diuretics for pulmonary edema
albuterol if wheezing.

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What is ALTE?

apparent life threatening event
episode of apnea
decreased muscle tone
choking/gagging.

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What are the possible causes of ALTE?

GERD
idiopathic
infections
cardiac
laryngospasm
seizures
hypoxemia
prematurity

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What is the ddx for inspiratory stridor?

laryngomalacia
tracheomalacia
croup
laryngospasm
epiglottis
subglottic stenosis
vascular rings

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What is the ddx for expiratory stridor?

tracheomalacia
bronchomalacia
subglottic stenosis?

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What is the fancy name for broup

laryngotracheobronchitis

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What is laryngomalacia?

floppy larynx
age 4-8mo
infantile inspiratory stridor

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What is something that helps laryngomalacia?

worsens in supine position

BETTER on BELLY (not working against gravity)

What is the workup for laryngomalacia?

flexible laryngoscopy
resolves by 1 year
no real treatment, but supraglottoplasty if there is FTT with it.

What is tracheomalacia?

floppy cartilage, trachea can collapse
positive intrathoracic pressure obstructs expiration
expiratory stridor with wheeze

What is the workup and treatment for tracheomalacia?

workup: CXR to r/o mass
nasal CPAP
tracheostomy

What are the causes of croup? workup? treatment?

``` parainfluenza influenza adenovirus metapneumovirus diphtheria/measles in unvaccinated kids CXR-steeple sign (subglottic narrowing) dexamethasone racemic epi O2 ```

What is epiglottitis?

inflammation of epiglottis 1. Hib 2. staph and strep

What is the presentation and workup of epiglottitis?

``` high fever sore throat inspiratory stridor drooling with dysphagia muffled voice (hot potato) hyperextended noice CXR: thumbprint sometimes see AMS ```

Which antibiotics are indicated in epiglottitis?

ceftriaxone for hib coverage | vancomycin for staph and strep coverage

Aside from epiglottitis what else can produce a hyperextended neck? excessive drooling?

excessive drooling: tracheoesophageal fistula | hyperextended neck vascular rings

When do vascular rings present? What is the presentation?

before age 1 stridor, wheezing, cough, dysphagia, difficulty breathing improves with neck extension

What is the workup for vascular rings?

barium contrast esophogram bronchoscopy CT

T/F Stridor improves in the prone position for laryngomalacia.

False. it improves with hyperextended neck | prone position helps laryngomalacia

What is the pathophysiology of asthma?

airway hyper-responsiveness th2, igE mediated get obstruction bronchospasm rhonchi are from increased secretions get inflammation-->fibrosis-->SM hypertrophy decreased FEV1/FVC spiral shaped mucous plugs (Curshmann spirals) eosinophil derived crystals (Charcot-Leyden Crystals)

Which symptoms, nighttime awakenings, # times use rescue inhaler, exacerbations requiring oral steroids... fit with intermittent asthma?

symptoms:

Which symptoms, nighttime awakenings, # times use rescue inhaler, exacerbations requiring oral steroids... fit with mild asthma?

``` symptoms: >2d/wk, not daily rescue inhaler: >2d/wk, not daily nighttime awakenings: 1-2/mo minor limitation on activities ~4/yr steroid exacerbations ```

Which symptoms, nighttime awakenings, # times use rescue inhaler, exacerbations requiring oral steroids... fit with moderate asthma?

daily symptoms and need for rescue inhaler nighttime awakenings: 3-4X/mo some limitation on activity ~4/yr steroid exacerbations

Which symptoms, nighttime awakenings, # times use rescue inhaler, exacerbations requiring oral steroids... fit with severe asthma?

all day symptoms and >1X/d need for rescue inhaler >1X/wk nighttime awakenings extremely limited activity level ~4/yr steroid exacerbations

If Albuterol PRN isn't working...what is the next step?

Low dose steroid (fluticasone, budesonide, beclamethasone) | + Albuterol PRN

If low dose steroid + Albuterol PRN isn't working...what is the next step?

Low dose steroid + LABA + montelukast + albuterol PRN

If low dose steroid + LABA + montelukast + albuterol prn isn't working...what is the next step

change the low dose steroid to a medium or high dose steroid

What are the LABAs?

``` formeterol (faster acting) and salmeterol (20 min until action onset) ```

What are some possible causes of asthma exacerbations?

``` rhinovirus RSV HMV influenza mycoplasma chlamydia fungi tree weed grass pollen animal exposures chemical exposures airway pollutants ```

What is the workup for an asthma exacerbation?

peak flow

What defines status asthmaticus?

an attack SO bad that there is no response to bronchodilators

What is the treatment for an asthma exacerbation?

albuterol q1h nebulizer ipratropium nebulized methylprednisolone PO if no response: magnesium sulfate if no response: terbutaline if no response: intubation

What is aspirin exacerbated respiratory disease?

happens in patients with asthma and chronic rhinosinusitis who are on aspirin difficulty breathing, chest tightness

What is bronchiectasis?

obstructive lung dx-permanent dilation of bronchioles and bronchi, get air trapping necrotizing chronic inflammation lots of sputum, recurrent resp infections

What is a possible cause of bronchiectasis?

cystic fibrosis

What are some multisystemic presentations for cystic fibrosis?

``` bronchiectasis meconium ileus (failure to pass w/i first 24 hours) pancreatic insufficiency, DM chronic rhinosinusitis nasal polyposis fatty liver ```

How do you diagnose pancreatic insufficiency?

CCK-secretin stimulation measure bicarb (decreased) bentiromide test (will decrease PABA in pts with steatorrhea)] quantitative fecal fat excretion

What is the treatment for the respiratory symptoms of Cystic fibrosis?

antibiotics albuterol DNAse mucolytic chest physiotherapy