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Flashcards in Peds Lung Disease Deck (41)
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1
Q

Croup

  • aka
  • what is this?
  • what causes this?
  • common in what age group?
  • sx
A

aka: laryngotracheobronchitis

what is this:
-infection causing inflamm of the layrnx, trachea, and bronchi

Caused by parainfluenza virus, could also be caused by RSV, influenza virus, and adenovirus

Common in 6mo to 3 years

sx: URI sx, barking cough and stridor, paroxysmal cough(where they cant stop)

2
Q

Whats the difference between stridor and wheezing?

A

Wheeze: inspiratory and expiratory, continuous high pitch sound.

Stridor: high pitched, piercing sound, usually on inspiration, obstruction in upper airway.

3
Q

How do you differntiate croup from epiglotitis?

A

Croup: during day child appears well, they dont look that sick. Nighttime worsening of croupy cough and stridor, excess respiratory muscle use while breathing. Parainfluenza virus of the larynx, trachea, and bronchi.

Epiglotitis: inflamm of the epiglottis, life threatening, toxic ill appearing child, drooling all over, stoic, cant swallow, dog sniffing position, hot potato talk. Caused from H. Flu.

4
Q

When do you worry about hospitalizing children with croup?

A

-when they are not responding to tx.

5
Q

When are croup sx the worst?

A

-during the night, night 3 to be exact.

6
Q

Croup Tx

A

At home:
-breathe cool moist air(opens up bronchi), bring child outside to the porch/patio/deck/front stoop/back stoop.

In the ER:

  • Steroids for inflamm. (Dexamethasone)
  • if barking cough, no stridor at rest: supportive therapy, hydration, minimal handling, cold air
  • stridor: O2, nebulized racemic epinephrine
  • if sx resolve within 3hrs of steroid and epinephrine use they can be d/c’d
  • Hospitalize if recurrent epinephrine tx are required or if resp distress persists.
7
Q

If child with croup comes to clinic post day 1 or cough youre going to give them what medication?

A

-steroids; dexamethasone to help with nights 2 and 3, which are the worst.

8
Q

Why do we not see epiglottitis anymore?

Nowadays we are seeing it in adults, whats the bug?

A
  • vaccinations, HIB vaccince.

- Strep.

9
Q

Epiglottitis

  • cause
  • what is this?
  • sx
  • PE findings
A

Cause: H. flu type B

What this is: sudden* inflammation of the epiglottis

sx:
-fever, dysphagia, drooling, hot potato voice, inspiratory
retractions, soft stridor

-PE: cherry red spot at the back of the throat

10
Q

Tx of Epiglottitis

A

-do not examine this patient!

  • get a stat portable x-ray of neck(maybe)
  • PREPARE TO INTUBATE!!
  • call your peds anesthesia

-start emperic abx once they are intubated, get swab and cultures to tailor your abx.

11
Q

What does a neck radiograph show in epiglottitis?

A

thumb print sign on x-ray

12
Q

Bronchiolitis

  • what is this?
  • caused by?
  • who does this most commonly affect?
  • sx
  • aka(less sever bronchiolitis)
A

What is this: inflammatory response of the smaller lower airway, highly contagious!

Caused by RSV, also by adenovirus and parainfluenza virus (though its less common)

-affects the young! your children! watch out, before it gets you too!

Sx: fever, URI sx, tachypnea, and wheezing (expiratory and inspiratory)

-aka: happy wheezer

13
Q

Bronchiolitis

-Tx

A

Tx:

  • supportive care
  • generally the prognosis is excellent.
  • Ribavirin against RSV is usually reserved for severly ill or imunocompromised patients (inhaled)
  • Palivizumab- non vaccine, injection of abys given monthly to help high risk infants from severe RSV disease.
14
Q

Bronchiolitis:

-what populations of ppl are at greater risk of poorer outcomes of this disease? (such as respiratory failure)

A

infants with congenital heart disease, chronic lung dz, and immunodeficiencies

15
Q

Bronchitis

  • what is this?
  • sx
  • lung sounds
  • cause
  • tx
A

what is this: infection that attacks the bronchiol tubes which lead to the lungs. swelling and mucous.

sx: URI sx with cough and malaise, dry cough to productive over time.

lung sounds: coarse bronchial sounds

cause: most of the time its viral

16
Q

Does the presence of mucopurulent sputum imply a bacterial infection?

A

no

17
Q

If you suspect bronchitis and have to urge to order a CXR and WBC count, you should just prescribe abx, true or false

A

True, most of the time WBC count is normal and CXR is clear, if you have physicacl exam findings that lead you to be suspicious of a bacterial infection dont fight the urge to prescribe abx.

18
Q

Pneumonia

  • cause
  • which cause is most abrupt in onset?
  • Sx of each cause
A

cause: most are viral, but may be bacterial.

Onset: bacterial pneumonia is more abrupt.

Sx:

  • Viral: prodrome of rhinorrhea, cough, low grade fever, pharyngitis
  • Bacterial: high fever, cough, chest pain, sudden, shaking chills, productive cough, SOB w/o URIsx,
19
Q

What are the most common pneumonia bugs for:

  • newborns
  • infants
  • adolescents
A

newborns: group B strep, listeria, gram -‘s like e.coli and klebsiella

Infants: strep pneumo

Adolescents: micoplasma pneumo

20
Q

Sx of newborn with pneumonia

A

-quit nursing, limp, tachypnea, retractions of the chest.

21
Q

what does viral peneumonia look like on CXR?

A

-increased bronchovascular markings, no consolidation.

22
Q

Tx pneumonia

A
  • abx
  • bronchodilators if wheezing
  • fluids, o2 therpy
  • most cases in children are viral but we are unable to predict so we treat with abx.
23
Q

Pertussis

  • aka
  • caused by
  • -gram -/+ and shape
  • prevention
  • severity
  • duration
  • cue from hx
A

-whooping cough

caused by: bordetella pertussis
–gram negative encapsulated coccobacillus

Prevention: TDAP vaccine

Severity:

adults: mild illness
infants: dangerous, respiratory distress from coughing is lethal.

Duration:

  • insidious
  • 4-12 weeks

Cue: cough so hard i could vomit.

24
Q

Pertussis

-sx

A

Sx:

  • insidious
  • URI sx (stuffy nose, sore thraot, stuffy nose, cough)
  • slight fever
  • cough is irritating early on
  • after 2 weeks, cough becomes sudden with classic whoop & lasts 2-4weeks
25
Q

Pertussis

-guidlines for dx

A
  • ask about immunization status (DTAP)
  • cough greater 2weeks
  • nasal swab for culture
  • nasal swab PCR (results in 3-7 days)
26
Q

Pertussis

-tx

A

erythromycin for 14 days

azithromycin for 5-7 days

  • will not shorten course of cough unless given in early phase but will prevent transmission
  • some patients with cough for 3 mos, you must educate the pt/family.
27
Q

pneumonia is usually bacterial or viral?

A

viral.

28
Q

Cystic Fibrosis

  • cause
  • what is this?
  • how do you get this?
  • what test is done on newborns?
A
  • cause: mutation in cl- channel, decrease in cl- secretion leads to dehydration and thick viscous secretions in the parotid glands, lungs, pancreas, liver, intestines, and reproductive tract that have abnormal mucociliary clearance.
  • what is this: disease of the exocrine gland system
  • autosomal recessive inheritance (both parents must be carrier)
  • chloride sweat test on every newborn, its 88% sensitive so it could be missed even with testing.
29
Q

CF

-abnormal sweat cl- test values

A

Abnormal: greater than 60mEq/L

30
Q

What causes failure to thrive in CF pts?

A

-the great effort in breathing, hes not absorbing/digesting his nutrients (lipids in stool)

31
Q

What would you expect to find with a stool examination of CF patient?

A

-steatorrhea (frothy, greasy, light colored floaters)

32
Q

What is the difference between endocrine and exocrine glands?

A

endocrine: secretes directly into the blood stream
exocrine: glands reach an epithelial surface through ductal secretion.

33
Q

CF

-complications

A

Complications:

  • Respiratory:
  • -pulmonary fibrosis
  • -obstruction
  • -frequent infections
  • -chronic sinusitis
  • pancreatic:
  • -malabsorption of fats and proteins (steatorrhea & meconium ileus**)
  • -failure to thrive
  • -rectal prolapse
  • -intussesception (currant jelly stool*)
34
Q

Dx of CF

A
  • IRT Assay*
  • DNA Assay*
  • Sweat Chloride Test*
  • family hx
  • typical GI features
  • typical pulm features
35
Q

CF Tx

A

Pulmonary Tx:

  • oxygen
  • bronchodilators
  • mucolytics (acetylcysteine)
  • steroids
  • abx (tobramycin, Piperacillin/Ticaricillin for pseudomonas)

Pancreatic Tx:

  • pancreatic enzyme supplememnts
  • vitamins
  • hgih caloric high protein diet
36
Q

what is the median lifespan of CF pt?

A

37years

37
Q

CF is often dx in hospotal at birth, why? (3)

A
  • chloride sweat test
  • have higher suspicion if they havent passed meconium in the first 24hrs.
  • abdominal distention and thick, sticky meconium with enema examination.

-failure to thrive in infancy or respiratory compromise

38
Q

SE of Tobramycin

A

ototoxic and nephrotoxic

39
Q

Respiratory Distress Syndrome
AKA
what is it
who gets this

A

AKA
-Hyaline Membrane Disease

What is it
-under-developed lungs that dont function properly, primarily due to surfactant deficiency.

Who gets this
-premature babies (less than 36 weeks gestation)

40
Q

RDS:

  • pathophysiology
  • clinical manifestations
  • clinical course
  • dx
A

Pathophysiology

  • surfactant deficiency
  • inflammation
  • pulmonary edema
  • pulmonary function
  • hypoxemia

Clinical Manifestations:

  • Tachypnea
  • Nasal flaring
  • Expiratory gruting
  • accessory muscle breathing
  • cyanosis

Clinical course:

  • progress over 48-72
  • marked diuresis

Dx:

  • clinical dx
  • CXR (ground glass appearance, air bronchograms, alveolar collapse and atelectasis)
  • ABG
  • Hyponatremia (from water retention)
41
Q

Tx RDS

A
  • O2
  • CPAP
  • Surfactant (exogenous)
  • Steroids