Pulmonology Flashcards

1
Q

what are common etiologies of bronchiolitis?

A

viral - RSV, influenza, parainfluenza, metapneumovirus

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2
Q

what is the presentation of bronchiolitis?

A

apnea (esp. in 4 months of age -RSV)

copious rhinorrhea

cough/wheeze

fever

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3
Q

how do you diagnose bronchiolitis?

A

PE findings and history

x-ray unecessary

specific cause can be confirmed by antigen testing or PCR?

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4
Q

what’s the most common cause of bronchiolitis?

A

RSV

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5
Q

how do you manage bronchiolitis?

A

supportive care - nasal suction, hydration, supplemental O2 if sats<90% on room air

meds - trial of beta 2 agonist or racemic epinephrine (works, keep it up), nebulized 3% hypertonic saline

no benefit to chest PT

screen for RSV to avoid abx and isolate infants in hospitals

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6
Q

what are the sequelae of bronchiolitis?

A

obstruction of the u and l respiratory tract that can lead to respiratory failure

  • highest risk in premies and those with lung disease
  • give these babies Synagis
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7
Q

What is Synagis?

A

Palivizumab

IgG monoclonal Ab

<29 weeks gestation, younger than a year at onset of RSV season

chronic lung dz less than 24 years

*consider in immunocompromised, CV disease, neuromuscular disease

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8
Q

what are the causes of respiratory failure in infants?

A

upper airway ob

lower airway ob

sepsis

hypotonia

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9
Q

what presentations in infants is concerning for impending respiratory failure?

A

inreased accessory muscle use

inability to coordinate feeding (poop out)

decreased arousability

hypoxemia/hypercarbia

*normal PCO2 with marked tachypnea very poor sign

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10
Q

what are the three phases of pertussis and the clinical features of each?

A
  1. catarrhal: cough and rhinorrhea (1-2 weeks)
  2. paroxysmal: fits of coughing, inspiratory whoop, post-tussive emesis (2-8 weeks)
  3. convalescent - gradual waning of symptoms (weeks to months)

Generally, NO FEVER

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11
Q

what is the incubation period for pertussis?

A

7-10 days

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12
Q

how is diagnosis of pertussis made?

A

clinical - paroxysmal cough, whoop, post-tussive emesis

lymphocytosis is a clue

PCR and culture

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13
Q

what is the treatment for pertussis?

A

macrolides

azithromycin (5 days)

preferred in young, pregnant women

alternatives: erythromycin (14 days), clarithromycin (7 days), TMP-SMX (14 days)

*prevents spread and limits cough in catrarrhal

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14
Q

what are the complications of pertussis?

A

abx don’t do much

hospitalization

apnea

2ndary pneumonia

seizure

death

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15
Q

what is the most common source in infant pertussis?

A

family members

one of the reasons we have been moving to immunizing mother during pregnancy

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16
Q

what are the clinical manifestations of pneumonia by age?

A

neonates - fever or hypoxia only

young infants - apnea may be first sign

children - fever, chills, tachypnea, cough, malaise, retractions, apprehension

17
Q

which type of pneumonia usually presents with high fever, chills, and focal findings?

A

bacterial

18
Q

what type of pneumonia presents with diffuse crackles?

A

atypical

19
Q

what are the most common causative organisms for pneumonia by age?

A
20
Q

in longstanding asthma, what may occur?

A

remodeling of the airway that can lead to incomplete reversability

21
Q

what’s a common clinical sign of childhood asthma?

A

post-tussive emesis (night or early morning)

22
Q

when do peds usually diagnose with asthma?

A

after recurrent episodes

usually 4

partially reversible measured by spirometry increase of FEV 1 > 200 mL AND 12% from baseline after SABA admin.

23
Q

using metered dose inhaler without a spacer can cause loss of up to how much of the medicine?

A

60%

24
Q

how often should children have spirometry once the asthma is under control?

A

every 1-2 years

25
Q

what’s an unusual asthma trigger?

A

essential oil infusers

26
Q

what percentage of children with asthma have an allergic phenotype?

A

60-80%

27
Q

what happens during exercise induced bronchospasm?

A

airway dries out, and bronchospasm ensues from inflammation

28
Q

what do you need to know to determine asthma severity?

A

symptoms

nighttime awakenings

SABA use for rescue

interference with normal activities

PFTs

29
Q

what is the preferred approach to initiate controller therapy in pediatric asthma?

A

inhaled cortiocosteroids if already on SABA

add LABA to ICS if not well controlled

leukotriene alternative (good for allergic)

30
Q

what are the components of an asthma action plan?

A

green - daily regimen

yellow - acute loss of asthma control (nip exacerbation in the bud)

red - ER

31
Q

what are the highest risks for severe asthma exacerbations?

A

poor asthma control

higher disease severity

prior hospitalizations/intubations

non-adherence to therapy

32
Q

what is status asthmaticus?

A

no response to reptitive or continuous administration of SABA

33
Q

what are third tier therapies for asthma?

A

IV ketamine

inhaled anesthetics

ECMO

34
Q

what are 2nd tier asthma exacterbation treatments?

A

IV magnesium

aminophylline

salbutamol

non-invasive ventilation

heliox

35
Q

what are 1st tier asthma exacerbation treatments?

A

inhaled Beta agonists

inhaled anti-cholinergics

systemic corticosteroids

36
Q
A