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DU PA Peds Resp

Duke PA Pediatrics Respiratory

What is asthma Airway inflammation, airway hyperreactivity, reversible airway obstruction
What are the symptoms of asthma Wheezing, coughing, chest tightness or pain, shortness of breath
What parts of the physical exam do you include for a child with asthma Pulmonary, HEENT, skin, extremities
What should be in your differential for chronic asthma Anatomic abnormality, infection, foreign body, cystic fibrosis, gastroesophageal reflux, bronchopulmonary dysplasia, pulmonary edema, laryngeal dysfunction
What are the indications to get a chest x-ray when evaluating for asthma Atypical presentation, asymmetric breath sounds, suspicion of foreign body, lack of clinical improvement, worsening of clinical course, persistent oxygen requirement
What is the ideal asthma management Daily anti-inflammatory agent plus PRN bronchodilator agent
What are the types of bronchodilators Methylxanthine derivatives, beta-2 agonists, anti-cholinergics
What are the types of anti-inflammatories used for asthma Mast cell stabilizers, steroids, leukotriene inhibitors, anti-IgE antibodies
What are the beta-2 agonists Albuterol, levalbuterol (Xopenex), salmeterol (Serevent)
What are the anti-cholinergics Atropine, ipratropium (Atrovent)
What are the mast cell stabilizers Cromolyn (Intal), nedocromil (tilade)
What are the inhaled steroids Beclomethasone (Qvar), triamcinolone (Azmacort), flunisolide (Aerobid), fluticasone (Flovent), budesonide (Pulmicort)
Name two combo therapies for asthma Advair (fluticasone and salmeterol), Symbicort (budesonide and formoterol)
What are systemic steroids useful for when treating asthma Acute attacks
How long should a patient be on systemic steroids for a mild to moderate flare 3-5 days with no taper
How long should a patient be on systemic steroids for a moderate to sever flare 5 days with taper as per clinical course
What are the short term side effects of systemic steroids Increased appetite, wt gain, fluid retention, irritability
What are the long term side effects of systemic steroids Growth suppression, adrenal suppression, immunosuppression, decreased bone density, hypertension, diabetes, glaucoma, cataracts
What is the best way to asses inhaler canister fullness Count the number of uses
What are inaccurate methods for determining canister fullness Weight, sound, bone dry
Peak flow meters are very useful for __ Following lung function at home
Peak flow reading of __ is in the green zone >80%
Peak flow reading of __ is in the yellow zone 50-80%
Peak flow reading of __ is in the red zone <50%
What may be the possible reason for a patient on what appears to be a good asthma treatment plan that is still doing poorly Not enough medication, confounding feature (allergies, GERD, CF), wrong diagnosis, suboptimal medication delivery (poor technique, poor adherence)
When should you refer your allergy patient Acute life threatening attack, moderate to severe asthma, steroid dependent, atypical/complicated asthma, poor response to optimal therapy, confounding variables, more complicated diagnostic studies required
__% of the pediatric population experiences sleep apnea 7-10
What is the male female ration for sleep apnea in children before the onset of puberty Male=female
What is the treatment plan for primary snoring No intervention
Partial to complete upper airway obstruction during sleep, associated with O2 desaturations and or CO2 elevations Obstructive sleep apnea syndrome
__% of the pediatric population experiences obstructive sleep apnea syndrome 1-3
Pediatric obstructive sleep apnea syndrome peaks at ages __ 2-7 years
What are the possible etiologies of pediatric obstructive sleep apnea Enlarged tonsils and or adenoids, obesity, craniofacial abnormalities, nasal polyps, chronic allergic rhinitis, pharyngeal infections
What are some complications of pediatric obstructive sleep apnea Pulmonary hypertension, developmental delay, growth retardation, death, cor pulmonale, behavioral problems, failure to thrive
Symptoms of obstructive sleep apnea while asleep Snoring, observed apnea, resuscitative gasps, disturbed or restless sleep, paradoxical chest wall movements, observed difficulty breathing, enuresis
Symptoms of obstructive sleep apnea while asleep Mouth breathing, nasal obstruction, excessive daytime tiredness, behavioral problems, hyperactivity trouble concentrating
What are the respiratory parameters for obstructive apnea in children Obstructive apnea for 2 or more breaths
What are the respiratory parameters for obstructive apnea in adults Obstructive apnea for >10 seconds
What is the respiratory parameter for central apnea Central apnea for > or = 20 seconds, any central apnea associated with an O2 desat >4% and or bradycardia
What is the parameter for hypopnea Decreased in measured airflow of > or = 50%
The apnea index for children is >__ apneas/hour 1
The apnea index for adults is > __ apneas/hour 5-10
Treatment options for pediatric obstructive sleep apnea Observation, surgery, wt loss, CPAP, dental appliance, medication
What are indications for surgery for obstructive sleep apnea Failed CPAP therapy, patient not a candidate for CPAP therapy, surgically amenable problem
What is the key to successful surgery with obstructive sleep apnea Correctly identifying the area of obstruction
What are the causes of obstruction in the nasopharynx Turbinate enlargement, deviated septum, nasal polyps
What are the causes of obstruction in the oropharynx Tonsillar hypertrophy, adenohypertrophy, macroglossia, adipose tissue
What are the causes of obstruction in the hypopharynx Adipose tissue, macroglossia, mandibular size or structure abnormalities (micro/retrognathia)
What is the most common obstructive sleep apnea surgery in children Adenotonsillectomy
What are the advantages of adenotonsillectomy High safety record, very common, outpatient procedure, curative in many cases
What are the disadvantages of adenotonsillectomy Pain, dehydration, bleeding, post-op swelling can transiently worsen obstructive sleep apnea, adenoids can grow back
Number of apneas decreases by up to __% for each 10% decrease in wt 50
CPAP complications Nasal/oral dryness, epistaxis, nasal congestion, sneezing, rhinorrhea, sinusitis, claustrophobia, mask irritation, nasal abrasions, aerophagy, facial deformities, decreased cardiac output
Medications used for treatment of obstructive sleep apnea Oxygen, thyroxine, theophylline, acetazolamide, medroxyprogesterone, antidepressants (SSRI, tricyclic)
What is the main difference between the treatment of adult vs pediatric obstructive sleep apnea Surgery is comes before CPAP, and wt loss in for children
What is the difference in causes of pediatric vs adult obstructive sleep apnea Children usually have enlarged tonsils and adenoids whereas adults are usually obese
What are the criteria for not sending a snoring child to get a polysomnogram for evaluation of obstructive sleep apnea Patient > 2 yo, “classic” history, excellent underlying health, normal physical exam, no underlying risk factors, low risk for post-operative complications
What are the indications for sending a child for polysomnography Snoring, witnessed apneas, restless sleep, excessive daytime tiredness, sleep disturbances, neuromuscular dz with FEV1 <40-50%, poorly controlled SS dz, unexplained pulm hypertension/cor pulmonale/polycythemia
Created by: bwyche