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126 Cards in this Set
- Front
- Back
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What are the 4 principle causes of respiratory failure in kids? (4)
mneumonic-PARN |
Pulmonary diseases
Airways diseases Restrictive diseases Neuromuscular diseases |
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_ failure is the most frequent cause of life-threatening cardiorespiratory illness inkids. It indicates that there is a failure of gas exchange.
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Respiratory
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Maintenance of normal carbon dioxide homeostasis requires all of the following except 1.
-normal lung mechanics -circulation -available hemoglobin -ventilatory drive - |
available hemoglobin
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Examples of _ disease include, mucus plugs, foreign bodies, anatomic abnormalities, and compressions.
-pulmonary disease -airways disease -restrictive disease -neuromuscular disease |
airways disease
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Examples of _ disease include, myastenia gravis, botulism, tetanus, intoxication and head injury.
-pulmonary disease -airways disease -restrictive disease -neuromuscular disease |
neuromuscular disease
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Examples of _ disease include pneumonia, ARDS, and pulmonary edema.
-pulmonary disease -airways disease -restrictive disease -neuromuscular disease |
pulmonary disease
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Examples of _ disease include pectus excavatum, flail chest and abdominal ascites.
-pulmonary disease -airways disease -restrictive disease -neuromuscular disease |
restrictive disease
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What are the 2 common conditions causing airway occlusion?
-Asthma -mucus plug -pneumonia -cystic fibrosis |
Asthma and cystic fibrosis
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What is the basic function of the respiratory system?
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to supply oxygen to the body and to remove excess carbon dioxide from the body.
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What are the 5 steps to in pulmonary physiology?
mneumonic-VDTDI |
Ventilation-which is the exchange of gas between the atosphere and the alveoli
Diffusion-of gases across the alveolar-capillary membranes Transport of gases in the blood Diffusion of oxygen fromthe capillaries of the systemic circulation to the cells of the body Internal respiration-is the use of oxygen and production of carbon dioxide within the cells |
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The process of respiration cannot occur if there is a mismatch of airflow (__) and blood flow (__) to the alveoli.
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ventilation
perfusion |
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A mismatch of airflow and blood flow is called?
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V/Q mismatch
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What conditions affect the perfusion half of the ventilation/perfusion circulation?
__ or __ vasoconstriction of the pulmonary circulation. And _ to _ shunts. |
Hypoxic or hypercarbic vasoconstriction of the pulmonary circulation and Right to Left shunts (cyanotic heart disease)
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Which conditions might interfere with diffusion of gases across the alveolar-capillary membrane? (2)
-Inflammation -Infection -Infarction -Fibrosis |
Inflammation and fibrosis
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Decreased ventilation may be due to an _ or occlusion of a _ airway.
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absence or occlusion of a conductive
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What is the primary means of oxygen transport in the blood?
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binding to hemoglobin
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Hypoxic or hypercarbic vasoconstriction of the arterioles and capillaries of the alveoli; presence of an abnormal vascular pathway thru the lungs (AV malformation) are examples of problems with ??
-ventilation -perfusion -transport -respiration |
perfusion
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Various disorders of the pulmonary systems affect the first _ steps of the pulmonary physiology.
-2 -3 -4 -5 |
3
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Decreased _ may be due to an absence or occlusion of a conductive airway.
-ventilation -diffusion -transport |
ventilation
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A congenital defect such as stenosis or severe malacia (softness of the cartilage) can affect the _ of the alveolar units.
-ventilation -perfusion -respiration -transport |
ventilation
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What diseases result in the obstruction of the bronchi and bronchioles and are characterized by increased mucus production?
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asthma and cystic fibrosis
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Abnormalities in _ can occur in instances of hypoxic or hypercarbic vasoconstriction of the arterioles and capillaries of the alveoli.
-ventilation -perfusion -respiration -diffusion |
perfusion
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Conditions that can inflame the alveolar epithelium or cause fibrosis and thickening eventually create a decreased _ of gases across the alveolar wall.
-transport -perfusion -diffusion |
diffusion
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T/F
Acute inflammation affects gas diffusion more than blood perfusion, but progressive fibrosis affects perfusion eventually. |
true
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What are the 2 ways in which gas transport takes place in the blood?
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dissolving in plasma
combining with hemoglobin |
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the arterial oxygen content (PaO2) measures the?
-02 bound to hemoglobin -02 dissolved in the plasma -02 content of the tissues -02 bound to RBC's |
02 dissolved in the plasma
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Approximately 98% of oxygen transport in the blood occurs by an __-__ interaction.
-oxygen-hemoglobin -oxygen-alveolar -hemoglobin-capillary |
oxygen-hemoglobin
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The relationship of the oxygen hemoglobin interaction is based on a relationship of the sigmoidal shape of the __ dissociation curve.
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oxyhemoglobin
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Oxygen saturation (SaO2) is a measure of how many __ of the hgb molecule are saturated by oxygen.
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available O2 binding sites of the hgb molecule are saturated by oxygen.
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Increased CO2 in the blood is called _?
-hypoxemia -hypoxia -hypocarbia -hypercapnia |
hypercapnia
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_ is the decreased delivery of O2 from the atmosphere to the blood.
-hypoxia -hypoxemia -hypocapnia -hypocarbia |
hypoxemia
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What is the cause of the common c/o cough in kids?
-foreign body -allergies -asthma -colds |
asthma
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What is the most important environmental factor in the development of asthma?
The __, __, and __ or exposure to aeroallergens that stimulate the production of IgE. |
The intensity, timing, and mode of exposure to aeroallergens that stimulate the production of IgE.
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Which of the following is the major response to the early phase of inflammation in asthma?
-mucus secretion -inflammation -rapid bronchoconstriction -intractable cough |
rapid bronchoconstriction
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What mediators contribute to the late phase reaction in asthma? (2)
-mast cells -prostaglandins -leukotrienes -basophils |
prostaglandins
leukotrienes |
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_ changes in the hgb molecule are essential within muscles and organs to allow for the release of oxygen and the uptake of carbon dioxide.
-stuctural -physiological -confirmational -diffusion |
confirmational
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Normal physiologic changes in the blood pH such as _ allow for the release of oxygen from the hgb molecule to the tissues, which is essential for proper hemostasis during times of stress, including exercise and disease states such as sepsis.
-alkalosis -acidosis -hypercarbic |
acidosis
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With diseases such as sickle cell, the _ binding affinits.
-low -high |
low
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As sickle cell hgb starts to _ oxygen molecules from its binding sites, it collapses and becomes "sickled".
-uptake -release -absorb -diffuse |
release
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The _ measurement is a measure of how many available oxygen binding sites or the hgb molecule are saturated by oxygen.
-PaO2 -SaO2 |
SaO2
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A PaO2 below _ mmHg, indicates hypoxia and is abnormal.
-60 -70 -80 -90 |
below 80
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A PaO2 reading of 80 mmHg correlates with a SaO2 reading of _%.
-40 -50 -60 -70 |
50%
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A SaO2 level of _% or less indicates hypoxia and is abnormal.
-96 -95 -94 -91 |
below 94% is considered abnormal
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T/F
Even poorly perfused limbs are capable of producing accurate measurements of oxygen saturation. |
false; will produce low or inaccurate transcutaneous measurements of oxygen saturation
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Pulse oximeters are not calibrated to read accurately below a saturation of _%.
-90 -85 -75 -70 |
70%
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_ refers to a decreased delivery of oxygen from the atmosphere to the blood.
-hypoxia -hypoxemia -hypoventilation -hypercapnia |
hypoxemia
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_ is a physiologic state in which the pt is neither breathing a sufficient tidal volume or an adequate number of breaths/minute.
-hypoxia -hypoxemia -hypoventilation -hypercapnia |
hypoventilation
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_ is defined as blood passing from the right to the left side without being oxygenated.
-anatomic shunt -V/Q mismatch -absolute shunt -mixed partial shunt |
absolute shunt; shunt diverts the blood away from oxygenated alveoli and the blood cannot receive oxygen.
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_ refers to decreased delivery of oxygen to the tissues.
-hypoxia -hypoxemia -hypercapnia -hypoventilation |
hypoxia
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An absolute shunt can occur due to an _ shunt with persistent fetal circulation, idiopathic or secondary pulmonary hypertension, AV malformation and congenital heart defects.
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anatomic shunt
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A _ shunt may develop at the level of the alveolus if the alveolus is blocked.
-anatomic -relative -absolute -diffusion |
relative shunt
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Pneumonia, atelectasis, or pulmonary edema may result in the formation of a _ shunt.
-anatomic -relative -absolute -diffusion |
relative shunt
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Cystic fibrosis, SLE, juvenile RA and Wegener granulomatosis may cause decreased diffusion of O2 and CO2 across the alveoli and bronchiolar epithelium d/t inflammation or fibrosis this is termed a _ defects.
-ventilation -perfusion -transport -diffusion |
diffusion
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what organ systems may be affected by cystic fibrosis?
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respiratory
GI reproductive |
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What is the primary morbidity associated with cystic fibrosis?
-progressive obstructive lung dx -progressive restrictive lung dx -progressive chronic pancreatitis |
progressive obstructive lung dx
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What is the underlying defect in cystic fibrosis?
-decreased oxygen transport -decreased chloride secretion -increased mucus formation |
decreased chloride secretion
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What is the MC manifestation of CF in the NB?
-ARDS -inadequate surfactant -meconium ileus -meconium aspiration |
meconium ileus
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What is the MC manifestation of CF in the older child?
-GI dysmotility -empty scrotum -respiratory symptoms -toxic megacolon -diabetes |
respiratory symptoms
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What is the classic findings on the head and neck exam of a child with CF?
-nasal polyps -thick upper respiratory secretions -occluding nasal conchae |
nasal polyps
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What is the gold standard test for the diagnosis of CF?
-bronchial biopsy -sweat test -serum chloride level -bronchoscopy |
chloride sweat test
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Which of the following drug classes has been shown to slow the progression of CF?
-steroids -immunosuppressants -mucomyst -NSAiD's |
nsaids
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What agent is useful in reducing the viscosity of bronchial secretions?
-mucomyst -albuterol -recombinant human DNAse |
recombinant human DNAse
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Oligohydramnios may indicate the presence of pulmonary _, because much of the amniotic fluid produced by the fetus is generated from lung epithelium.
-dysgenesis -hypoplasia -hyperplasia -restriction |
hypoplasia
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If a child presents with a cough that begins when the child is supine is indicative of?
(2) -pertussis -GERD -PND -asthma |
GERD, PND
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A cough early in the morning may indicate?
-asthma -croup -bronchiolitis -tracheitis |
asthma
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A paroxysmal cough may indicate all of the following except?
-pertussis -chlamydia -foreign body -cystic fibrosis |
cystic fibrosis
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t/f
the majority of children diagnosed with CF have a strong family history of the disease. |
false; the majority of children diagnosed with cystic fibrosis have no family history of the disease.
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What is the cause of bronchopulmonary dyplasia?
_ injury and _ in susceptible premature infants. |
oxidant injury and barotrauma
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What are the clinical standards used to define bronchopulmonary dysplasia? (3)
-need for _ for at least 3 days. -signs of respiratory _. Such as tachypnea, wheezing and retractions. -Need for supplemental O2 after _ days of life. |
-Need for PPV for at least 3 days
-signs of respiratory distress (tachypnea, wheezing, and retractions) -Need for supplemental O2 after 28 days of life. |
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_ lung disease is characterized by a reduction in airflow and trapping of air inside the thorax behind tight, plugged airways.
-restrictive disease -obstructive disease -airways disease |
obstructive lung disease
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_ lung disease is characterized by a low FEV1 and a proportionate reduction in the FVC.
-restrictive disease -obstructive disease -airways disease |
restrictive lung disease
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Asthma and cystic fibrosis are examples of a _ lung disease.
-restrictive lung disease -obstructive lung disease |
obstructive lung disease
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What is the cornerstone of management of chronic lung disease?
-adequate oxygenation -adequate perfusion -adequate ventilation |
adequate oxygenation
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What pathophysiologic mechanisms may contribute to SIDS?
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abnormality of brainstem neuroregulation of cardiorespiratory function
pre-existing, chronic, low-grade hypoxemia attributed to sleep-related hypoventilation found on autopsy. |
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SIDS is most likely to occur during what months of life?
-1 to 3 -2 to 4 -4 to 6 |
2 to 4 months of life
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SIDS is most commonly found during what time of the year?
-spring -summer -fall -winter |
winter or colder months
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If a sibling has previously died of SIDS what is the risk of another baby dying of SIDS?
-none -2x's increased -4x's increased -10x's increased |
4x's increased risk
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Which position while sleeping puts a baby at increased risk of dying from SIDS?
-supine -prone -side lying |
supine
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Name the 4 environmental factors that are associated with an increased risk for SIDS.
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prone position for sleep
cigarette exposure overheating NOT breastfeeding |
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_ measures "active" lung volumes.
-spirometry -plethysmography -functional residual capacity |
spirometry
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_ measures the actual volumes of air contained within the thorax.
-spirometry -plethysmography -functional residual capacity |
plethysmography
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_ is the amount of air inhaled during breath.
-FEV1 -Tidal volume -total lung capacity |
tidal volume
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The relationship between __ and FVC is the key to differentiating obstructive lung disease from __ lung disease.
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FEV1 and FVC
obstructive lung disease and restrictive lung disease |
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All of the following labs except what would you order in the evaluation of a child with recurrent otitis, bronchiectasis, or productive cough unresponsive to antibiotics?
-IgE -IgG -radioallergosorbent -skin testing |
all but IgG
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_ is a form of a wheeze, if frequently loud and harsh in quality. Usually an inspiratory sound.
-wheeze -stridor -atelectasis -croup |
stridor
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_ is a disease of the bronchial airways characterized by hyperresponsiveness to inhaled allergen.
-asthma -bronchitis -stridor -croup |
asthma
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In _, sound is generated by increased turbulent airflow from obstruction at the level of the larynx, subglottic region of the larynx, and the extrathoracic trachea.
-bronchitis -pneumonia -stridor -asthma |
stridor
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The pitch of stridor is r/t the degree of _ as well as to the velocity of airflow thru the obstructed area.
-restriction -plugging -obstruction -vibration |
obstruction
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What diagnostic test is the test of choice when evaluating causes of stridor?
-bronchoscopy -chest ct -flexible fiberoptic bronchoscopy -flouroscopy |
flexible fiberoptic bronchoscopy
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The only type of stridor that might not require treatment is _ _.
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congenital laryngomalacia
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t/f
the differential diagnosis of stridor varies with the age at presentation, the type of noise, and the acuity of the presentation |
true
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t/f
asthma is more common in the rural farm land areas than urban areas. |
false; more common by far in the urban areas
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Incidence of asthma is highest during what period of life?
0-2 years 3-4 years 5-7 years 6-8 years |
3-4 year olds; 80% are diagnosed before age 4.
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t/f
asthma is a developmental disease with a strong genetic component. |
true
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t/f
females are more likely than males to have asthma |
false; males > females
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All of the following are true about the epidemiology of asthma except?
-has a genetic component -males > females -more common in caucasions -more common in urban areas |
more common in african americans
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In asthma, the exposure to antigens, especially _, at an early age is an important determinant in the development of asthma.
-smoke -dust mites -eggs |
dust mites
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The most important environmental factors in the development of asthma are the intensity, timing, and mode of exposure to aeroallergens that stimulate the production of _.
-IgE -IgG -IgA |
IgE
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Rapid bronchoconstriction usually occurs, after bronchial provocation with an allergen to which the subject is sensitized; this lasts for about 1 hour. This is _.
-early asthmatic reaction -late asthmatic reaction |
early asthmatic reaction
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The cause of the acute inflammation of the airways is the release of mediators from a variety of effector cells such as _ and _.
-mast cells -leukotrienes -basophils -eosinophils |
mast cells and eosinophils
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The _ _ _, a more prolonged phase of airway narrowing that follows the early asthmatic reaction, starts 2-3 hours after exposure, max airway response in 4-8 hours and resolves in 12-24 hours.
-early asthmatic reaction -late asthmatic reaction |
late asthmatic reaction
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t/f
any child with persistent asthma should not just receive daily treatment with anti-inflammatories, unless there is an excerbation. |
false; they should receive daily anti-inflammatories.
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When is it appropriate to begin NSAID therapy in a child who suffers from seasonal allergies?
-when symptoms begin -1 week prior to symptoms -several weeks prior to symptoms -year round/chronic use |
several weeks prior to season of allergies
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what is the most efficacious treatment currently available for the long-term use in the management of asthma.
-NSAID's -mast cell stabilizers -corticosteroids -leukotrienes |
corticosteroids
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If you prescribe a MDI to a child what other prescription must you write?
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for a spacer
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_ is a chronic, multisystem, lethal recessive disorder that results from defective epithelial chloride transport with major systems of respiratory, GI, and reproductive being affected.
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Cystic fibrosis
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All of the following are true about the epidemiology of CF except?
-autosomal recessive gene -most parents are asympomatic -MC lethal dx of caucasions -1 of 32 births are carriers -mutation is located on chromosome 7 -all of the above are true |
all are true; nasty shit that no one wants!!!
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What is the characteristic defect in CF?
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reduced ability of epithelial cells in the airways and pancreas to secrete chloride in response to cAMP mediated agonists
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Colonization with all of the following bugs except 1 eventually occurs in CF pt's.
-s. pneumoniae -s. aureus -h. flu -psuedomonas |
not strep pneumo
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After colonization with which of the following bugs (by age 10 usually) does lung function typically decline rapidly?
-s. aureus -h. flu -psuedomonas |
pseudomonas
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__ of the newborn is the MC manifestation in infants.
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meconium ileus
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All of the following are true about the epidemiology of CF except?
-autosomal recessive gene -most parents are asympomatic -MC lethal dx of caucasions -1 of 32 births are carriers -mutation is located on chromosome 7 -all of the above are true |
all are true; nasty shit that no one wants!!!
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What is the characteristic defect in CF?
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reduced ability of epithelial cells in the airways and pancreas to secrete chloride in response to cAMP mediated agonists
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Colonization with all of the following bugs except 1 eventually occurs in CF pt's.
-s. pneumoniae -s. aureus -h. flu -psuedomonas |
not strep pneumo
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After colonization with which of the following bugs (by age 10 usually) does lung function typically decline rapidly?
-s. aureus -h. flu -psuedomonas |
pseudomonas
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__ of the newborn is the MC manifestation in infants.
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meconium ileus
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t/f
as many as 25% of kids with CF are in the 25th percentile on the growth chart. |
true; but 20% of kids with CF do not have any pancreatic disease until age 5 and therefore will not show any signs of failure to thrive.
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t/f
virtually all kids with CF will show edematous nasal mucosa |
true
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what is the gold standard testing for CF?
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sweat chloride test or the pilocarpine iontophoesis test
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_ appears to slow the progression of CF significantly.
-steroids -NSAIDs -recombinant human DNAse |
NSAID's
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_ is effective in decreasing sputum viscosity, increasing expectorate quantity, and minimizing the number of pulmonary excerbations.
-steroids -NSAID's -recombinant human DNAse |
recombinant human DNAse
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_ is the chronic phase of neonatal lung damage caused by oxidant injury and barotruama in susceptible premature infants.
-pneumothorax -bronchopulmoary dysplasia/chronic lung d -cor pulmonale |
bpd/chronic lung disease
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What are the criteria for BPD? (4)
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-need PPV for at least 3 days
-respiratory distress signs -need O2 to maintain PaO2 at >50mmHg at 28 days of life -typical radiological changes |
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_ is the cornerstone of CLD management.
-ppventilation -adequate oxygenation -corticosteroids |
adequate oxygenation
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t/f
an apparent life-threatening event is not a risk factor for SIDS |
false; it is a risk factor
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_ is the sudden death of an infant younger than 1 year of age.
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SIDS
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