Peds Rot Pulmonary
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| In infants and children, bronchiolitis is common and usually caused by | RSV or adenovirus infection.
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| Typical presentation of bronchiolitis | acute onset of tachypnea, cough, rhinorrhea, and expiratory wheezing. Course: 1-2 days of fever, rhinorrhea,& cough, followed by wheezing, tachypnea, and respiratory distress. Shallow rapid breathing. Some rales, rhonchi
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| Lab Dx of bronchiolitis | viral nasal wash may be performed to identify the causative pathogen. THe peripheral WBC count may be nl or may show a mild lymphocytosis
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| Imaging results in bronchiolitis | CX-ray findings are generally non-specific and typically include hyperinflation, peribronchial cuffing, increased interstitial markings, and subsegmental atelectasis.
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| Tx for bronchiolitits | in infants: frequent suctioning, adequate fluids, if hypoxic, supplemental oxygen. Use of bronchodilators and corticosteroids remains controversial. Prophylaxis with palivizumab reduces rates of morbidity in high risk groups
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| Major causative agent of croup | Parainfluenza virus serotypes.
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| Presentation of croup | Usually a prodrome of URI sx followed by a barking cough and stridor. Fever is usually absent or low but may on occasion be high. Pt w/ mild dz may have stridor when agitated. With worse obstruction, stridor can occur at rest
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| On exam, the presence of cough and the absence of drooling favor the dx of ____ over ____ | croup over epiglottitis
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| Tx of croup | mild (no stridor at rest): supportive tx with oral hydration and minimal handling. O2 to pts with O2 desat. More severe:Nebulized racemic epi 2.25% is often used and epi hydrochloride. Glucocorticoids (dexamethasone IM or orally; inhaled budesonide)
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| Detecting RSV | A rapid dx of RSV is made by viral antigen identification of nasal washings using an ELISA or immunofluorescent assay. Culture of nasopharyngeal or LRI secretions reamin the standard of diagnosis, although PCR (polymerase chain rxn) is increasing used
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| RSV is a ______ that causes annual outbreaks, in winter and early spring, or ____, _____, and _____, with the majority of cases occurring in the very young | paramyxovirus; pneumonia, bronchiolitis, and tracheobronchitis. Risk factors: prematurity, less than 6 months, bronchopulmonary dysplasia, dayscare, congenital heart dz. Virus enters through mucosa contact, as in eyes and nose.
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| ___ is a common cause of acute and recurrent OM in children | RSV
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| ___ is the vaccine for RSV in kids under 1 year | Synagis.
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| Essentials of Dx and typical features of Cystic Fibrosis | Greasy, bulky, malodorous stools; failure to thrive despite voracious appetite. Recurrent respiratory infxns, digital clubbing, Bronchiectasis on CX-ray, Sweat chloride>60mmol/L, meconium ileus
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| Name the genetic transmission of CF | autosomal recessive. Defect in a single gene on Chromosome 7. Incidence of 1:3000 among whites in the US
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| The major cause of mortality and morbidity in CF | lung disease
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| What is meconium ileus | failure to pass meconium within 24 hours after birth. Dx: x-ray. A “soap bubble” or “ground glass” appearance due to small air bubbles mixed with the meconium is diagnostic of meconium ileus.
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| In CF, name the cause of greasy, malodorous stools and sometimes edema | Sx are the result of severe exocrine pancreatic insufficiency; pancreas fails to produce the enzymes necessary to break down fat and protein
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| Tx of Cystic Fibrosis at a CF care center | Cornerstone of GI tx: pancreatic enzyme supplementation prior to each meal and w/ snacks. Daily multivitamin. Caloric supplements. Lung Dz Tx: airway clearance tx and aggressive abx use inhaled mucolytic agent,Pulmozyme,inhaled tobramycin,PO azithromycin
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| Median life expectancy in CF patients | 34 years
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| Abrupt onset of cough, choking or wheezing, along with inability to vocalize or cough and cyanosis with marked distress or asymmetrical breath sounds is the presentation for | foreign body aspiration. Children 6mo-4 yo are at highest risk.
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| Tx of FB aspiration | under age 1: 5 blows to the back with heel of hand, followed by 5 chest compressions. >1 heimlich majeuver with abdominal thrusts. Blind finger sweeps should not be performed as they may push object further. Intubation & bronchoscopy may be required
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| Imaging in FB aspiration | inspiratory and forced expiratory chest x-rays. May be nl 25% of the time. Localized hyperinflation may be present. Mediastinal shift away from the affected side. If airway obstruction is complete, atelectasis and vol loss are main findings
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| Dysphagia, refusal to eat or swallow, or drooling plus sudden onset of fever are findings that strongly suggest | acute epiglottitis. Stridor is a late sign. A true medical emergency
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| Epiglottitis is almost always caused by | Haemophilus influenzae type B
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| "sniffing dog position" is associated with | epiglottitis. The child sits with their neck hyperextended and their chin protruded.
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| Thumbprint on lateral X-ray is suggestive of | acute epiglottitis. Once diagnosed, endotracheal intubation must be performed immediately and removed only after significant reduction in the size of the epiglottis,with by abx (ceftriaxone.IV abx cont for 2-3 days, then po abx to complete a 10-day course
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| PE findings of pneumonia | rales, decreased breath sounds, dullness to percussion, and abnormal tactile or vocal fremitus
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| CBC findings in pneumonia | Elevated WBC >15,000 frequently accompany bacterial pneumonia. However, a low WBC <5,000 can be an ominous finding in this dz.
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| Imaging in pneumonia | Cxray (lateral and frontal views) define bacterial pneumonia. Patchy infiltrates, atelectasis, hilar adenopathy, or pleural eff may be observed. Complete lobar consolidation not a common finding in infants/kids. Clinical resolution precedes res on Xray
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| In critically ill patients for whom you are concerned about pneumonia, you should | do invasive diagnostic procedures (bronchial brushing or washing, lung puncture, or open or thorascopic lung biopsy) when other means do not adequately identify the cause
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| The most prevalent bacterial pathogen in pneumonia | Streptococcus pneumoniae. Vaccination with pneumococcal vaccine will aid in the prevention of pneumonia.
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| Tx of bacterial pneumonia | abx tx should be guided by gram stain of sputum, tracheobronchial secretion or pleural fluid if available.
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| Reasonable coverage for tx of bacterial pneumonia in the sick or compromised: | Ceftazidime, flindamycin, vancomycin, a macrolide for Legionella and Mycoplasma, & possibly septra for P. jiroveci.
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| Less severe bacterial pneumonias can often be treated with oral abx based on the patient's age and suspected organism | lobar pneumonias presumed to be due to S. pneumoniae can be tx initially w/ oral b-lactams: cefuroxime axetil, amoxicillin, or augmentin. Persistence of sx 3-5 days later suggests resistant organism: then use newer quinolones, clindamycin or vancomycin
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| Febrile pneumonias in infants and toddlers require | admission. Careful follow up w/in 12 hours to 5 days is often indicated in those not admitted.
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| Essentials of Dx and typial features of bacterial pneumonia | fever, cough, dyspnea. abnl cxray (infilatrates, hilar adenopathy, pleural effusion), abnl chest exam: rales or decreased breath sounds,
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| Essentials of Dx and typical features of viral pneumonia | URI prodrome (fever, coryza, cough, hoarseness), wheezing or rales, myalgia, malaise, Headache (older children)
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| Major causative agents of viral pneumonia | RSV, parainfluenza 1,2,and 3, influenza A and B, and human metapneumoviruses.
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| substantial pleural effusions, pneumatoceles, abscesses, lobar consolidation with lobar volume expansion, and "round" pneumonias are generally consistent with | bacterial pneumonias (not viral, although the two can coexist)
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| CBC in differentiating bacterial from viral pneumonia | The peripheral WBC may be nl or slightly elevated in both and is not useful in distinguishing. A markedly elevated neutrophil count, however, indicates that bacterial is MORE likely. Rapid nasal test sould be performed.
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| Antivirals available to tx viral pneumonia | Amantadine hydrochloride, rimantadine, or oseltamivir phosphate can be used early in tx of high risk infants or children who appear to be affected. Respiratory isolation
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| pneumonia with pink eye suggests | chlamdyia trachomatis.
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| Eosinophilia, conjunctivitis, and elevated immunoglobulins in addition to cough, pharyngitis, tachypnea, rales, few wheezes and fever | Chlamydial pneumonia. C trachomatis and C pneumonia. C trachomatis can be found in nasal washings; C pneumoniae can be found often in serology
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| Tx for Chlamydial pneumonia | Erythromycin or sulfisoxazole tx for 14 days.
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| essentials of diagnosis and typical features of mycoplasmal pneumonia | fever, cough, most common age>5 yo. Total and differential WBC usually nl. Cold hemagglutinin titer of 1:64 supports diagnosis. PCR.
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| Tx for mycoplasmal pneumonia | abx tx with a macrolide for 7-10 days usually shortens the course of illness. Ciprofloxacin is a possible alternative
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| The most common chronic disease of childhood | asthma. Affects over 6 million children in the US. 80% of children develop sx before their 5th b-day. Atopy is the strongest identifiable predisposing factor.
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| Pathologic features of asthma | shedding of airway epithelium, edema, mucus plug formation, mast cell activation, and collagen deposition beneath the basement membrane.Inflammatory cell infilatrate includes eosinophile,lymphocytes,& neutrophils.Inflammation can lead to airway remodeling
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| Is sx of asthma are absent or mild, a PE technique to elicit sx is: | chest auscultation on forced expiration may reveal prolongation of the expiratory phase and wheezing.
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| Dx of asthma | airway hyperresponsiveness to nonspecific stimuli (methacholine, histamine, cold air)is a hallmark of asthma. Drop in FEV1 of 20%
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| All asthma patients should have | bronchodilator as needed for sx < or = 2d/wk. Preferred tx: inhaled SABA by nebulizer of face or space-holding chamber. alternative: Oral B2 agonist.
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| Tx of choice in an acute asthma exacerbation | Inhaled bronchodilators/SABAs - levalbuterol
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| Which asthma medication is appropriate for exercise induced asthma | b2 agonists (levalbuterol)
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| The most common cause of respiratory failure in newborn infants | Respiratory Stress Syndrome/Hyaline membrane disease. Predominantly in premature infants. Surfactant is produced by Type II pneumocytes. Occurs in infants 37 weeks or less
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| which amniotic fluid marker can predict lung maturity? | lecithin-to-sphingomyelin ratio less than 2.0
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| Signs of Hyaline membrane disease in a newborn | tachypnea, grunting, nasal flaring, chest wall retractions, and cyanosis in the first 3 hours of life. Dx confirmed by uniform reticulonodular or ground-glass pattern and air bronchograms consistent with diffuse atelectasis
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| Administration of _____ to the mother 48 hours before delivery of an infant with underdeveloped lungs may induce or accelerate the production of fetal surfactant and minimize the incidence of RDS | corticosteroids
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| Tx of RDS | respiratory support with oxygen, continuous positive airway pressure, and or mechanical ventilation. . Tx with artificial surfactant
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| Severe RDS may cause | pulmonary hyptertension,causing a right to left shunt at the patent foramen ovale and the ductus arteriosus
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