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Pediatrics 2 > Respiratory Illness > Flashcards

Respiratory Illness Flashcards

(105 cards)

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1
Q

signs of respiratory distress

A
  • tachypnea
  • tachycardia
  • accessory mm use
  • cyanosis
  • nose flaring
  • retracting
  • grunting
  • wheezing
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2
Q

average nl respiratory rates

A
  • 6-12 mos: 64
  • 1-2 yr: 35
  • 2-4 yr: 31
  • 4-6 yr: 26
  • 6-8 yr: 23
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3
Q

possible causes of crackles (rales)

A
  • early inspiration: bronchitis, emphysema, asthma

- late inspiration: ILD, PE, HF

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4
Q

causes of wheeze

A
  • asthma
  • COPD
  • HF
  • PE
  • mostly heard on expiration
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5
Q

causes of rhonci

A

suggests secretions in larger airways

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6
Q

causes of stridor

A

severe upper airway obstruction

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7
Q

definition of asthma

A

-chronic inflammatory dz of airways resulting in airway hyperresponsiveness, airflow limitation, and chronic remodeling of the airway wall

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8
Q

what is the MC chronic dz of childhood?

A

asthma

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9
Q

goals of tx of asthma

A
  • no missed school/work
  • no sleep disruption
  • maintenance of nl activity levels
  • no (or minimal) need for ER visits/hospitalizations
  • nl or near nl lung function
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10
Q

3 guidelines to establish dx of asthma

A
  1. intermittent sx of airway obstruction are present
  2. obstructive sx are reversible
  3. alternative dx are excluded
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11
Q

what are the key elements of the hx in a pt w/ asthma?

A
  • recurrent wheezing
  • chronic cough, worse at night
  • recurrent chest tightness and difficulty breathing
  • sx worsen in the presence of stress, illness, or environmental irritants
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12
Q

definition of mild intermittent asthma

A
  • sx 2 or < x / week
  • asx and nl PEF b/w exacerbations
  • exacerbations brief and intensity may vary
  • 2 or less nighttime sx per month
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13
Q

mild persistent asthma

A
  • sx > 2 x / week but < 1 x / day
  • exacerbations may effect activity
  • > 2 nighttime sx per month
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14
Q

moderate persistent asthma

A
  • daily sx
  • daily use of inhaled short-acting beta2 agonist
  • exacerbations affect activity
  • 2 or more exacerbations per week that may last days
  • > 1 nighttime sx per week
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15
Q

severe persistent asthma

A
  • continual sx
  • limited physical activity
  • frequent exacerbations
  • frequent nighttime sx
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16
Q

approach to medications for asthma

A
  • use a stepwise approach based on severity
  • initiate at a high level and step down cautiously as sx are controlled
  • persistent asthma is controlled best w/ daily anti-inflammatory therapy
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17
Q

quick-relief meds for asthma (3)

A
  • short acting beta 2 agonists (SABA)
  • anticholinergics (atrovent)
  • systemic corticosteroids (methylprednisone)
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18
Q

long term control meds for asthma (5)

A
  • inhaled corticosteroids
  • cromolyn sodium and nedocromil
  • long acting beta 2 agonists (LABA)
  • methylxanthines
  • leukotriene modifiers
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19
Q

ADRs of inhaled steroids

A
  • cough
  • dysphonia
  • thrush
  • growth delay
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20
Q

indication for montelukast (singulair)

A
  • relief of allergy sx and also to prevent asthma attacks
  • reduced congestion in nose and cuts down on sneezing, itching and eye allergies
  • helps reduce inflammation of the airways
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21
Q

management of mild intermittent asthma

  • long term
  • quick relief
A
  • long term: no daily meds

- quick: short-acting PRN; using > 2x/wk may indicate need for long term therapy

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22
Q

management of mild persistent asthma

  • long term
  • quick relief
A
  • long term: daily anti-inflammatory; inhaled corticosteroid OR leukotriene modifier
  • quick: SABA (daily use indicated need for more aggressive long term tx)
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23
Q

management of moderate persistent asthma

  • long term
  • quick relief
A
  • long term: daily inhaled steroid (med. dose) OR daily steroid (los dose) + LABA
  • quick: SABA (daily use or increasing requirement indicates need for more long term tx)
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24
Q

management of severe persistent asthma

  • long term
  • quick relief
A
  • long term: high dose inhaled steroid + LABA + systemic steroids
  • quick: SABA (increased requirement indicates need to increase steroids or add agent)
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25
definition of cystic fibrosis
- generalized exocrinopathy leading to overproduction of thick, tenacious secretions - primarily involves the lungs and pancreas
26
genetics of cystic fibrosis
- autosomal recessive | - mutation on chromosome 7
27
GI presentation of cystic fibrosis
- meconium ileus after birth - FTT - rectal prolapse* - abundant loose stools - panreatitis - sampters
28
respiratory presentation of cystic fibrosis
- chronic productive cough - chronic sinusitis - pneumonia (often recurrent) - nasal polyps
29
common respiratory pathogens in cystic fibrosis
- staph aureus - h. flu - pseudomonas aeruginosa
30
metabolic presentation of cystic fibrosis
- hyponatremia - malnutrition - dehydration - insulin dependent DM
31
sweat chloride test results in a pt w/ CF
- Na or Cl > 60 mcg/L (<40 is nl) - if b/w 40-60 repeat the test - > 75 is definitive
32
CXR in CF
- hyperinflation - atelectasis - cuffing - cystic lesions - consolidation
33
management of CF
- rigorous abx for acute illness - chest PT - bronchodilators - avoid triggers - immunizations (flu and pneumococcal) - inhaled corticosteroids
34
abx for CF
- inhaled colistin and Cipro w/ 1st sign of p. aeruginosa** - pipercilin acutely - tobramycin every other month in severe cases
35
bronchiolitis
- common acute illness w/ inflammation and necrosis of the respiratory epithelium in the small airways** - process results in decreased airway diameter and resistance to flow
36
common bronchiolitis pathogens
- RSV** - parainfluenza - adenoviruses - mycoplasma pneumoniae
37
presentation of bronchiolitis
- 1-7 days prior: cold sx, cough, fever, rhinorrhea - < 50% febrile by onset - tachypnea (40-80) - wheezing - known exposure (almost always daycares) - cyanosis, retracting, flaring - hyperresonance - palpable liver and spleen - room air hypoxia
38
dx of bronchiolitis
- clinical dx - listening to lungs sounds like washing machine - rapid RSV test - XR if very ill or high fever
39
outpatient tx of bronchiolitis
- supportive: hydration, nl saline in nose and nose frida, education - recheck in 24/48 hrs - nebulizer
40
inpatient tx of bronchiolitis
- supportive tx is still mainstay | - supplemental O2, mechanical ventiliation, fluid replacement
41
bronchitis
- inflammation of the tracheal mucosa and medium and large bronchi** - acute, self limited condition
42
etiology of bronchitis
- MC is viral: rhinovirus, RSV, flu, paraflu, adeno, coxsackie, rubeola, paramyxovirus - bacterial: pertussis, TB, diptheria, mycoplasma, strep pneumo, h. flu, staph
43
what is the pathophysiology of bronchitis
- desquamation of ciliated epithelial lining --> exposed cough receptors --> increased cough - mucosa becomes congested - PMN cells are responsible for thick purulent mucus
44
presentation of bronchitis d/t RSV
- infants - tachypnea - hyperinflation
45
presentation of bronchitis d/t influenza
- high fever - myalgia - HA
46
presentation of bronchitis d/t measles
-coryza -fever -rash (3 Cs)
47
presentation of bronchitis d/t pertussis
"barking," spasmodic, inspiratory whoop
48
presentation of bronchitis d/t TB
appear chronically ill
49
course of bronchitis
- starts as URI (thinitis, nasopharyngitis) x 3-5 days w/ harsh/brassy hacking dry cough - day 6-12: lower respiratory tract involvement w/ productive cough of thick yellow sputum - days 13-21: usu shows recovery but cough may continue 1-2 more weeks
50
when is bacterial superinfection suspected in bronchitis?
- if fever recurs or cough does not resolve | h. flu, strep pneumo, staph aureus
51
exam in bronchitis reveals:
- fever, congestion, rhinitis | - rhonchi and wheezing
52
dx of bronchitis
- clinical dx - must know if fever is high and sputum is greener - can do CBC w/ diff and RSV
53
supportive tx of bronchitis
- rest - fluids - humidifier - avoid tobacco smoke
54
medication tx of bronchitis
- OTC - bronchodilators - abx: macrolide, ampicillin, amox, bactrim, cephalosporins
55
common bugs causing pneumonia in neonates
- GBS - e. coli - klebsiella - listeria - chlamydia
56
common bugs causing pneumonia in toddlers/kids
- strep pneumo - h. flu - mycoplasma pneumoniae (college kids) - moraxella
57
presentation of pneumonia
- fever - irritability - poor feeding - productive cough - tachypnea***
58
PE in pneumonia
- respiratory distress / hypoxia - crackles - decreased breath sounds - pleuritis / abd pain
59
diagnostic tools for pneumonia
- CXR - pulse ox - NP wash for viral source - sputum culture
60
abx tx for pneumonia for neonates
-ampicillin and gentamycin
61
abx tx for pneumonia for toddlers/kids
-high dose ampicillin, cefuroxime, cefotaxime
62
when to hospitalize for pneumonia
- < 3 mos old - respiratory distress - hypoxia - poor feeding, family support, or f/u potential
63
definition of croup
- laryngotracheobronchitis - viral illness resulting in upper airway obstruction - always involves the larynx* - may or may not involve trachea and bronchi
64
causes of croup
- ***parainfluenza type 1 - parainfluenza type 2, 3 - influenze a, b - RSV - rhionovirus
65
common patient presenting w/ croup
- almost always < 5 yo - MC b/w 6 mos and 2 yo - M>F
66
pathophys of croup
- upper airway infection manifesting as rhinorrhea and congestion, followed by lower airway infection manifested as airway obstruction and hypoxemia - larynx is edematous, erythematous w/ exudate resulting in airway obstruction - hypoxemia d/t secretions, bronchospasm, PE and interstitial fluid
67
sx of croup
- stridor - hoarseness** - retractions - "barky" cough - coryza - worsens at night
68
dx of croup
- clinical | - can do CBC, viral culture, CXR
69
if CXR is done for croup, what is the hallmark sign?
steeple sign
70
tx of croup
- steroids if severe: dexamethasone 0.6 mg/kg in office | - humidifier and cold air (but limited data)
71
when to hospitalize for croup
-if sx are worsening: retractions, stridor, cyanosis, lethargy
72
definition of epiglottitis
- acute swelling of glottic structures - bacterial infection - medical emergency
73
major causative organism of epiglottitis
-haemophilus influenza b
74
other causative organisms of epiglottitis
- strep pneumo becoming more prominent since HIB vaccine - staph aureus - beta hemolytic strep - h. flu a
75
pathophys of epiglottitis
- systemic infection that causes edema and swelling of epiglottis, narrowed airway and purulent exudate - most pts have postiive blood cultures
76
PE of epiglottitis
- high fever, toxic appearing - tachycardia - sore throat - stridor, SOB - drooling - no hoarseness
77
lateral XR in epiglottitis shows
"thumblike appearance"
78
tx of epiglottitis
- keep child upright - intubate under anesthesia - IVs, blood draw, etc - abx
79
abx for epiglottitis
-cefuroxime -cefotaxime (3rd gen)
80
prevention of epiglottitis
- HIB vaccine - 2, 4, 6, 15 mo | - rifampin prophylaxis to household members and contacts under 4 yo
81
definition of pertussis
- non invasive and highly communicable bacterial respiratory illness - occurs in all age groups but MC in infants and kids - bordatella pertussis is causative organism
82
prevention of pertussis
- transmitted by droplets | - immunizations don't provide lifelong protection so need to be getting tdap
83
pathophys of pertussis
- bacteria sticks to respiratory ciliated epithelial cells and multiplies w/o invading tissues - tissue changes remain even after the cure
84
3 stages in the course of pertussis
1. catarrhal 2. paroxsymal 3. convalescent
85
pertussis stage 1 (catarrhal)
- mild URI, sneezing, nocturnal cough, mild fever | - highest infectivity**
86
pertussis stage 2 (paroxysmal)
- several short then 1 long cough** - mucus plug, vomiting, forehead, petichiae, periorbital edema, engorged conjuntivae - lasts 2-4 weeks
87
pertussis stage 3 (convalescent)
- slow recovery | - lasts 4-12 weeks
88
dx of pertussis
- clinical: paroxysmal coughing w/ terminal inspiratory whoop - CBC shows leukocytosis - nasal swab
89
when to hospitalize for pertussis
if < 6 mo
90
supportive tx of pertussis
- hydration - nutrition - O2
91
medication tx of pertussis
- erythromycin x 14 days - steroids - albuterol
92
definition of diptheria
- acute infectious dz caused by cornebacterium diphtheriae that affects the upper respiratory tract - pseudomembrane may be present* - gram + - can produce exotoxin causing myocarditis or neuronitis**
93
pathophys of diptheria
- colonization of mucosal surface of nasopharynx - pseudomembrane forms on tonsils from necrosis caused by toxins - can cause respiratory obstruction if membrane involves palate and larynx - can get in blood stream
94
course of diptheria
- 1-7 days incubation - sore throat, malaise, mild fever - white tonsillar exudate forms, turning grey over 1-2 days - cervical adenopathy and soft tissue swelling make "bull neck appearance" and stridor
95
dx of diptheria
- clinical | - culture from beneath the membrane, nasopharynx and any suspicious skin lesion
96
tx of diptheria
- neutralize toxin - eliminate organism w/ IV penicillin and erythromycin - supportive care: airway, EKG, - isolate to prevent transmission - notify health department
97
prevention of diptheria
- immunization w/ diphtheria toxoid - 2, 4, 6, 15 mos and 5 and 12 yo - every 10 years you need a booster - DTaP vaccine - immunization doesn't confer life long immunity
98
SIDS
- sudden death of a child under age of 1 - unexplainable after autopsy, exam of death scene and case investigation - 95% < 6 mos - M>F - MC cause of death for 1-6 mo olds
99
RFs for SIDS
- prematurity - low apgars - anemia - twins - siblings w/ SIDS - mom: ETOH, drugs, tobacco, < 20 - race - sleeping prone
100
pathogenesis of SIDS
- chronic hypoxemia increases levels of fetal hgb | - prone sleeping --> rebreathing, asphyxia, nasal obstruction, apposition of palate and back of tongue
101
prevention of SIDS
- supine sleeping until at least 6 mos - warm room - avoid heavy blankets - safe cribs - maintain breast feeding as long as possible - no smoking
102
foreign body aspiration can lead to what?
atelectasis, inflammation, bronchiectasis
103
variable clinical presentation of foreign body aspiration
- dyspnea - stridor - retractions - drooling - cough - asymmetrical chest movement and breath sounds
104
Dx of foreign body aspiration
- SaO2 | - CXR: AP.lat
105
tx of foreign body aspiration
-rigid endoscopy w/ ventilating bronchoscope

Pediatrics 2 (7 decks)

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