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Pediatrics 2 > Respiratory Illness > Flashcards

Respiratory Illness Flashcards

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
Q

definition of cystic fibrosis

A
  • generalized exocrinopathy leading to overproduction of thick, tenacious secretions
  • primarily involves the lungs and pancreas
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26
Q

genetics of cystic fibrosis

A
  • autosomal recessive

- mutation on chromosome 7

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27
Q

GI presentation of cystic fibrosis

A
  • meconium ileus after birth
  • FTT
  • rectal prolapse*
  • abundant loose stools
  • panreatitis
  • sampters
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28
Q

respiratory presentation of cystic fibrosis

A
  • chronic productive cough
  • chronic sinusitis
  • pneumonia (often recurrent)
  • nasal polyps
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29
Q

common respiratory pathogens in cystic fibrosis

A
  • staph aureus
  • h. flu
  • pseudomonas aeruginosa
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30
Q

metabolic presentation of cystic fibrosis

A
  • hyponatremia
  • malnutrition
  • dehydration
  • insulin dependent DM
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31
Q

sweat chloride test results in a pt w/ CF

A
  • Na or Cl > 60 mcg/L (<40 is nl)
  • if b/w 40-60 repeat the test
  • > 75 is definitive
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32
Q

CXR in CF

A
  • hyperinflation
  • atelectasis
  • cuffing
  • cystic lesions
  • consolidation
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33
Q

management of CF

A
  • rigorous abx for acute illness
  • chest PT
  • bronchodilators
  • avoid triggers
  • immunizations (flu and pneumococcal)
  • inhaled corticosteroids
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34
Q

abx for CF

A
  • inhaled colistin and Cipro w/ 1st sign of p. aeruginosa**
  • pipercilin acutely
  • tobramycin every other month in severe cases
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35
Q

bronchiolitis

A
  • 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
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36
Q

common bronchiolitis pathogens

A
  • RSV**
  • parainfluenza
  • adenoviruses
  • mycoplasma pneumoniae
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37
Q

presentation of bronchiolitis

A
  • 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
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38
Q

dx of bronchiolitis

A
  • clinical dx
  • listening to lungs sounds like washing machine
  • rapid RSV test
  • XR if very ill or high fever
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39
Q

outpatient tx of bronchiolitis

A
  • supportive: hydration, nl saline in nose and nose frida, education
  • recheck in 24/48 hrs
  • nebulizer
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40
Q

inpatient tx of bronchiolitis

A
  • supportive tx is still mainstay

- supplemental O2, mechanical ventiliation, fluid replacement

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41
Q

bronchitis

A
  • inflammation of the tracheal mucosa and medium and large bronchi**
  • acute, self limited condition
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42
Q

etiology of bronchitis

A
  • MC is viral: rhinovirus, RSV, flu, paraflu, adeno, coxsackie, rubeola, paramyxovirus
  • bacterial: pertussis, TB, diptheria, mycoplasma, strep pneumo, h. flu, staph
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43
Q

what is the pathophysiology of bronchitis

A
  • desquamation of ciliated epithelial lining –> exposed cough receptors –> increased cough
  • mucosa becomes congested
  • PMN cells are responsible for thick purulent mucus
44
Q

presentation of bronchitis d/t RSV

A
  • infants
  • tachypnea
  • hyperinflation
45
Q

presentation of bronchitis d/t influenza

A
  • high fever
  • myalgia
  • HA
46
Q

presentation of bronchitis d/t measles

A

-coryza
-fever
-rash
(3 Cs)

47
Q

presentation of bronchitis d/t pertussis

A

“barking,” spasmodic, inspiratory whoop

48
Q

presentation of bronchitis d/t TB

A

appear chronically ill

49
Q

course of bronchitis

A
  • 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
Q

when is bacterial superinfection suspected in bronchitis?

A
  • if fever recurs or cough does not resolve

h. flu, strep pneumo, staph aureus

51
Q

exam in bronchitis reveals:

A
  • fever, congestion, rhinitis

- rhonchi and wheezing

52
Q

dx of bronchitis

A
  • clinical dx - must know if fever is high and sputum is greener
  • can do CBC w/ diff and RSV
53
Q

supportive tx of bronchitis

A
  • rest
  • fluids
  • humidifier
  • avoid tobacco smoke
54
Q

medication tx of bronchitis

A
  • OTC
  • bronchodilators
  • abx: macrolide, ampicillin, amox, bactrim, cephalosporins
55
Q

common bugs causing pneumonia in neonates

A
  • GBS
  • e. coli
  • klebsiella
  • listeria
  • chlamydia
56
Q

common bugs causing pneumonia in toddlers/kids

A
  • strep pneumo
  • h. flu
  • mycoplasma pneumoniae (college kids)
  • moraxella
57
Q

presentation of pneumonia

A
  • fever
  • irritability
  • poor feeding
  • productive cough
  • tachypnea***
58
Q

PE in pneumonia

A
  • respiratory distress / hypoxia
  • crackles
  • decreased breath sounds
  • pleuritis / abd pain
59
Q

diagnostic tools for pneumonia

A
  • CXR
  • pulse ox
  • NP wash for viral source
  • sputum culture
60
Q

abx tx for pneumonia for neonates

A

-ampicillin and gentamycin

61
Q

abx tx for pneumonia for toddlers/kids

A

-high dose ampicillin, cefuroxime, cefotaxime

62
Q

when to hospitalize for pneumonia

A
  • < 3 mos old
  • respiratory distress
  • hypoxia
  • poor feeding, family support, or f/u potential
63
Q

definition of croup

A
  • laryngotracheobronchitis
  • viral illness resulting in upper airway obstruction
  • always involves the larynx*
  • may or may not involve trachea and bronchi
64
Q

causes of croup

A
  • ***parainfluenza type 1
  • parainfluenza type 2, 3
  • influenze a, b
  • RSV
  • rhionovirus
65
Q

common patient presenting w/ croup

A
  • almost always < 5 yo
  • MC b/w 6 mos and 2 yo
  • M>F
66
Q

pathophys of croup

A
  • 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
Q

sx of croup

A
  • stridor
  • hoarseness**
  • retractions
  • “barky” cough
  • coryza
  • worsens at night
68
Q

dx of croup

A
  • clinical

- can do CBC, viral culture, CXR

69
Q

if CXR is done for croup, what is the hallmark sign?

A

steeple sign

70
Q

tx of croup

A
  • steroids if severe: dexamethasone 0.6 mg/kg in office

- humidifier and cold air (but limited data)

71
Q

when to hospitalize for croup

A

-if sx are worsening: retractions, stridor, cyanosis, lethargy

72
Q

definition of epiglottitis

A
  • acute swelling of glottic structures
  • bacterial infection
  • medical emergency
73
Q

major causative organism of epiglottitis

A

-haemophilus influenza b

74
Q

other causative organisms of epiglottitis

A
  • strep pneumo becoming more prominent since HIB vaccine
  • staph aureus
  • beta hemolytic strep
  • h. flu a
75
Q

pathophys of epiglottitis

A
  • systemic infection that causes edema and swelling of epiglottis, narrowed airway and purulent exudate
  • most pts have postiive blood cultures
76
Q

PE of epiglottitis

A
  • high fever, toxic appearing
  • tachycardia
  • sore throat
  • stridor, SOB
  • drooling
  • no hoarseness
77
Q

lateral XR in epiglottitis shows

A

“thumblike appearance”

78
Q

tx of epiglottitis

A
  • keep child upright
  • intubate under anesthesia
  • IVs, blood draw, etc
  • abx
79
Q

abx for epiglottitis

A

-cefuroxime
-cefotaxime
(3rd gen)

80
Q

prevention of epiglottitis

A
  • HIB vaccine - 2, 4, 6, 15 mo

- rifampin prophylaxis to household members and contacts under 4 yo

81
Q

definition of pertussis

A
  • 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
Q

prevention of pertussis

A
  • transmitted by droplets

- immunizations don’t provide lifelong protection so need to be getting tdap

83
Q

pathophys of pertussis

A
  • bacteria sticks to respiratory ciliated epithelial cells and multiplies w/o invading tissues
  • tissue changes remain even after the cure
84
Q

3 stages in the course of pertussis

A
  1. catarrhal
  2. paroxsymal
  3. convalescent
85
Q

pertussis stage 1 (catarrhal)

A
  • mild URI, sneezing, nocturnal cough, mild fever

- highest infectivity**

86
Q

pertussis stage 2 (paroxysmal)

A
  • several short then 1 long cough**
  • mucus plug, vomiting, forehead, petichiae, periorbital edema, engorged conjuntivae
  • lasts 2-4 weeks
87
Q

pertussis stage 3 (convalescent)

A
  • slow recovery

- lasts 4-12 weeks

88
Q

dx of pertussis

A
  • clinical: paroxysmal coughing w/ terminal inspiratory whoop
  • CBC shows leukocytosis
  • nasal swab
89
Q

when to hospitalize for pertussis

A

if < 6 mo

90
Q

supportive tx of pertussis

A
  • hydration
  • nutrition
  • O2
91
Q

medication tx of pertussis

A
  • erythromycin x 14 days
  • steroids
  • albuterol
92
Q

definition of diptheria

A
  • 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
Q

pathophys of diptheria

A
  • 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
Q

course of diptheria

A
  • 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
Q

dx of diptheria

A
  • clinical

- culture from beneath the membrane, nasopharynx and any suspicious skin lesion

96
Q

tx of diptheria

A
  • neutralize toxin
  • eliminate organism w/ IV penicillin and erythromycin
  • supportive care: airway, EKG,
  • isolate to prevent transmission
  • notify health department
97
Q

prevention of diptheria

A
  • 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
Q

SIDS

A
  • 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
Q

RFs for SIDS

A
  • prematurity
  • low apgars
  • anemia
  • twins
  • siblings w/ SIDS
  • mom: ETOH, drugs, tobacco, < 20
  • race
  • sleeping prone
100
Q

pathogenesis of SIDS

A
  • chronic hypoxemia increases levels of fetal hgb

- prone sleeping –> rebreathing, asphyxia, nasal obstruction, apposition of palate and back of tongue

101
Q

prevention of SIDS

A
  • supine sleeping until at least 6 mos
  • warm room
  • avoid heavy blankets
  • safe cribs
  • maintain breast feeding as long as possible
  • no smoking
102
Q

foreign body aspiration can lead to what?

A

atelectasis, inflammation, bronchiectasis

103
Q

variable clinical presentation of foreign body aspiration

A
  • dyspnea
  • stridor
  • retractions
  • drooling
  • cough
  • asymmetrical chest movement and breath sounds
104
Q

Dx of foreign body aspiration

A
  • SaO2

- CXR: AP.lat

105
Q

tx of foreign body aspiration

A

-rigid endoscopy w/ ventilating bronchoscope

Pediatrics 2 (7 decks)

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