respiratory-final Flashcards
(40 cards)
s/s pnuemonia
Cough Fever Wheezing Dyspnea Poor Feeding Lethargy Vomiting Abdominal pain
clinical findings of Pneumonia
ENT: May be normal or nasal congestion, OM, pharyngitis may be present Lungs: Rales, diminished breath sounds, rhonchi. Respiratory distress Heart: Tachycardia Abdomen: Right sided pain/tenderness General: Poor perfusion, lethargy; ill appearing
who should get a chest xray if pnuemonia is suspected?
Healthy, immunized children who will be treated as an outpatient do not require CXR Particularly helpful when the dx is uncertain Hospitalized children and children with respiratory distress should have a CXR
are blood cultures necessary with pneumonia?
not necessary for patients treated on an outpatient basis Indicated for hospitalized patients as well as for patients who deteriorate or do not improved
additional testing for pneumonia is
CBC CMP Influenza RSV Strep
Indications for hospitalization with pneumonia
Infants Apnea/Grunting/respiratory distress Respiratory rate >70 Poor feeding Comorbidities SaO2 <92% Older Children Grunting/respiratory distress Respiratory rate >50 SaO2 <92% Unable to tolerate po fluids Comorbidities
Outpatient Antimicrobial Therapy for pneumonia
Outpatient Antimicrobial Therapy 60 days to 5 years: Amoxillin 90mg/kg/day; divided bid If penicillin allergic: Zithromax (10mg/kg x1 day then 5mg/kg/day x5d Biaxin (15mg/kg/day; divided bid) Cefzil (30mg/kg/day; divided bid) School aged children & adolescents Amoxillin Consider macrolide if mycoplasma is suspected Zithromax Biaxin
Asthma: clinical manifestations
Chronic Inflammation Bronchial hyper-responsiveness after exposure to allergens, viruses, cold air, exercise, irritants leads to Wheezing Bronchospasm Dyspnea Cough
Asthma Risk Factors
Asthma Risk Factors Frequent Colds Frequent OM Food Allergies Atopic Dermatitis (Eczema) Allergic Rhinitis Persistent Wheezing after age 3
The Road to Asthma
The Road to Asthma Food Allergies Allergy to milk proteins IgE antibody response Markers for atopy Dermatitis 3mo – 3 years Follows exposure to food or external allergen
Diagnostic Criteria
Diagnostic Criteria Periodic symptoms of airway obstruction Airflow obstruction symptoms that can be at least somewhat reversed Exclusion of alternate diagnosis
symptoms of asthma
Asthma Symptoms Cough Wheeze Cough with exercise and/or nocturnal Dyspnea Sensation of chest tightness Sputum Asthma Pattern of Symptoms Continuous or Intermittent Day or Night Time Seasonal, Perennial or Both Onset and Duration
Asthma Precipitating Factors
Asthma Precipitating Factors Allergens (outdoors & indoors) Irritants Viruses Drugs Stress Foods Seasonal changes Other GERD, Sinusitis, rhinitis, menses
Asthma Diagnosis
Asthma Diagnosis Difficult to diagnose if child <3 History Family History Social History Physical PFT
asthma Prevention
Prevention Primary Prevention Breast feeding Hold solid foods until 4 months Healthy diet Exposure to smoke Minimize home allergens Abx sparingly Prevention Secondary Prevention Flu Vaccine Immunotherapy Avoid Triggers Pharmacology ICS, LTRA, Oral Steroids Prevention Tertiary Prevention Daily meds Pre-exercise prophylaxis Management of acute exacerbations
asthma Classification & Treatment
Classification & Treatment Mild Intermittent Day: 2 times or less per week Night: 2 nights or less per month PEF/FEV 80% of expected No daily meds needed SABA PRN Mild Persistent Day: >2/week, less than 1/day Night: 2 or more/month PEF/FEV 80% of expected Low dose ICS SABA PRN Moderate Persistent Day: Daily Night: More than 1/week PEV/FEV 60-80% of expected Low dose ICS (,<5), Med >5) LABA Severe Persistent Day: Continual Night: Frequent PEF/FEV: 60% or less than expected High dose ICS LABA
cf
Cystic Fibrosis Exocrine gland dysfunction Chronic respiratory infections Pancreatic enzyme deficiency 90% of patients have lung involvement Principle cause of death is respiratory failure
cf
Resultant reduced height of epithelial lining fluid and decreased hydration of mucus results in mucus that is stickier to bacteria, which results in infection and inflammation. These abnormalities result in viscid secretions in the respiratory tract, pancreas, GI tract, sweat glands, and other exocrine tissues. Increased viscosity of these secretions makes them difficult to clear. defects result in decreased chloride excretion, increased sodium and water reabsorption across endothelial cells
Cystic Fibrosis History intestinal symptoms? respiratory? pancreatic? gu symptoms
Intestinal Symptoms Infants Intestinal obstruction at birth Meconium Ileus, Volvulus, Intestinal Atresia Delayed Meconium passage; prolonged jaundice Infants and Children Frequent Stooling; oil/fat in stools FTT Intussusception Rectal prolapse Pancreatic Symptoms Pancreatic Insufficiency Fat soluable vitamin deficiency Malabsorption of protein, carbs and fats Steatorrhea (frequent, poorly formed, large, bulky, foul-smelling, greasy stools that float in water) FTT, flatulence, abd pain, abd distention, anorexia, GER Respiratory Symptoms Chronic or recurrent cough; dry and hacking at the beginning and can produce mucoid (early) and purulent (later) sputum. Prolonged symptoms of bronchiolitis occur in infants. Coughing fits that can lead to vomiting Recurrent wheezing, recurrent pneumonia, atypical asthma, pneumothorax, hemoptysis, and digital clubbing (may be the initial manifestation) Dyspnea on exertion, history of chest pain, recurrent sinusitis, nasal polyps, and hemoptysis may occur GU Symptoms Males Vas deferens absence causes males sterility. Hyrdoceles Undescended Females Fertility is maintained, but may be decreased. Secondary sexual development is often delayed. Amenorrhea may occur in patients if the patient has severe nutritional or pulmonary involvement.
Cystic Fibrosis Physical
Cystic Fibrosis Physical Pulmonary Tachypnea Respiratory distress Wheeze and/or rales Cough (dry or productive of mucoid or purulent sputum) Increased anteroposterior diameter of chest Clubbing Cyanosis Hyperresonant chest upon percussion Cystic Fibrosis GI Abdominal distention Hepatosplenomegaly (fatty liver and portal hypertension) Rectal prolapse Dry skin (vitamin A deficiency) Other Findings Scoliosis Kyphosis Swelling of submandibular gland or parotid gland Rhinitis Nasal Polyps
Work Up for cf
Work Up Sweat Test quantitative pilocarpine iontophoresis test (QPIT) to collect sweat and perform a chemical analysis of its chloride content is currently considered to be the only adequately sensitive and specific type of sweat test Neonatal Screening: Multiple states in the US have implemented neonatal screening for cystic fibrosis. All screening algorithms in current use in the United States rely on testing for immunoreactive trypsinogen (IRT) as the primary screen for cystic fibrosis.7 The presence of high levels of IRT, a pancreatic protein typically elevated in infants with cystic fibrosis, warrants second level testing in the form of repeat IRT testing, DNA testing, or both. Within these 2 categories, various modifications are used.
findings on cxr for cf
CXR Hyperinflation peribronchial thickening
Cystic Fibrosis Treatment
Cystic Fibrosis Treatment Multidisciplinary Approach Medical Home PCP, Pulmonology; Gastroenterology, Nutritionist, ENT, Cardiology, Surgery Diet: High energy, high fat Exercise Bronchodilators, pulmonary hygiene Pancreatic Enzyme Replacement
ages for Croup
Croup Common viral respiratory illness Kids 6-36 months, but can occur in older children as well, especially up to age 5 More common in the fall and winter Pathogens Viruses Parainfluenza virus accounts for approximately 80% of cases Adenovirus RSV Enterovirus
