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92 Cards in this Set
- Front
- Back
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What is the most frequent cause of life threatening cardiorespiratory illness in kids?
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respiratory failure
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What are some general causes of resp failure in kids?
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-pulmonary dz
-airway dz -restrictive dz -neuromuscular dz |
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What is ventilation?
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exchange of gas b/w atmosphere and alveoli
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What is diffusion?
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diffusion of gases across alveolar capillary system
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In pulmonology, ther eis transport of gases where?
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in blood
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What is internal respiration?
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use of oxygen and production of carbon dioxide with in cells
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Decreased ventilation can be due to stenosis what two things?
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stenosis or severe malacia
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Decreased diffusion in the lungs can be due to what things?
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inflammaiton of alveoli or fibrosis
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98% of O2 transport occurs by what?
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oxygen-Hgb interaction
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What is Pa02?
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amount of oxygen disolved in plasma
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What Pa02 value is abnormal and what Sa02 value is?
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-Pa02 <80
-SaO2<94 |
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What is hypoxemia?
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decreased delivery of oxygen from atmoshere to blood
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What is hypoxia?
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decreased delivery of oxygen to tissues
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What is hypercapnia?
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alveolar carbon dioxide content is high, which later causes hypoxemia
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What is an absolute shunt?
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blood passing from right to left side of heart w/o being oxygenated
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In what conditions is an anatomical shunt?
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-persistent fetal circulation
-idiopathic or 2nd pulmonary HTN -AVM -congenital heart defects |
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What happens in a diffusion defect?
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alveolar and bronchiolar epithelium are thickened due to inflammation and fibrosis
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Diffusion defects are seen in what diseases?
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-CF
-SLE -Juvenile RA -Wegener's granulomatosis |
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Why is carbon dioxide transported easier then oxygen in blood?
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b/c it is highly lipid soluble
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Respiratory acidosis occurs MC with what?
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too much CO2 (hypoventilation)
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Oligohydramnios may be a sign of renal anomaly and indicate what?
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pulmonary hypoplasia
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How is the breath like in restrictive lung dz?
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rapid and shallow breaths
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Crackles and wheezes orginiate from where?
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lower airway dz
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Noise that occurs on inspiration and expiration is probably what?
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fixed stenosis
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Expiratory wheeze in absence of inspriatory stridor (or vice versa) indicated what?
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variable stenosis
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intrathoracic obstruction is seen on what?
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expiration
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Extrathoracic obstruction is seen on what?
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inspiration
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A loud snapping P2 indicates what?
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pulmonary HTN
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What does plethysmography do?
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measures actual volumes of air contained in the thorax
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Obstructive lung dz
1-FEV1 2-FEV1/FVC ratio |
1-low
2-low |
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Restrictive lung dz:
1-what are the FEV1 and FVC 2-ratio? |
-1 low FEV1 and reduction in FVC
2-ratio is normal or >80% |
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What are some indications to get a CXR?
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-chronic cough
-sudden chest pain -suspected pulm infections |
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What test would you do for a cough assoc w/feeding or frequent lare emesis after feeding?
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barium esophagram
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What is a noncontrast fluoroscopy good for?
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to assess diaphragmatic excursion and upper airway and pharyngeal anatomy
dx of laryngomalacia or tracheobronchomalacia |
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What tx of prevered for lower airway and alveolar sampling in kids?
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flexible bronschoscopy
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What is an advantage to a rigid bronchoscope?
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inner diamter can pass intruments and double as endotrachial tube
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Stridor is an inspiratory or exspiratory sound?
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inspiratory
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What is the pathophys of stridor?
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sound comes from increased turbulent airflow from obstruction at level of larynx, subglottic region and extrathroacic trachea
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What is the only stridor causing disease that doesn't need tx?
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congenital laryngomalacia
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What are the tx options for stridor causing disease?
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uvulopalatoplasty with tracheostomy
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Asthma effects which sex more?
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males
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What are the most important environmental factors in development of asthma? (3)
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-intensity
-timing -mode of exposure |
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What are the 2 phases of asthma?
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-early asthmatic reaction or (rapid bronchoconstriction)
-late asthmatic reaction |
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What is the cause of inflammation in the early asthma phase?
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release of mast cells and eosinophils
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In the early phase of asthma, mast cell degranulation leads to what?
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release of mediators including prostaglandins, leukotrienes, which lead to late asthmatic reaction and result in increased vascular permeability, mucus hypersecretion, and smooth muscle contraction
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When does the late stage of asthma begin?
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2-3 hrs after exposure with max response in 4-8 hrs
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When does the late stage of asthma typically resolve?
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12-24 hrs
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In the late stage of asthma, there is highly cellular infiltration into bronchial epithelium of what cells?
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neutrophils, eosinophils, and lymphocytes
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In older children, the MC triggers for asthma are what/
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dust or other allergens
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What is the MC trigger for asthma in younger kids?
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viral respiratory infections
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How does foreign body present, especially in toddlers?
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-sudden cough
-wheezing -stridor |
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What is the tx for persistent asthma?
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daily tx with anti-inflam therapy
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What is the tx for exercise induced asthma?
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cromolyn sodium or salmeterol 15-30 mins before exercise
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What medications are most commonly prescribed to achieve anti inflammatory goals in asthma?
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-inhaled corticosteroids like beclemethasone, fluticasone or budesonide
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What is the tx for mild intermittent asthma?>
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-short acting Beta PRN
-cromolyn sodium seasonal use |
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What is the tx for mild persistant asthma?
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-short acting beta PRN
-long acting beta daily -inhaled corticosteroids -leukotriene -anticholingergic |
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What is tx for severe asthma?
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-short acting Beta PRN
-long acting beta daily -inhaled stroids -leukotriene -anticholingeric -Theophylline |
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In CF, primary morbidity is from what?
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progressive obstructive lung
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What is the mean survivale age for CF?
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31
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What is the MC lethal genetic dz?
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CF
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What is the MC CF manifestation in infants?
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meconium ileus
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What PE finding should be a red flag in CF pts?
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rectal prolapse
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If a pt present with growth failure and failure to thrive, what should you test for?
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CF
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What is a classic facial finding in CF pts?
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nasal polyps
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Tell me about the Maxillary and frontal sinuses in CF.
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Maxillary are small and frontal are underdeveloped or absent
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What are some other PE findings in CF?
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-firm stool masses felt on palpation
-splenomegaly may be present -spermatic cords may be absent -clubbing of fingers and toes |
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What is the gold standard test for CF?
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sweat test or pilocarpine iontophoresis test
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Why must sweat test be done after 9 weeks of age?
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because sweat glands not fully formed yet?
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What are some "modes of clearance" of excess mucus in CR?
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-flutter device
-positive expiratory pressure device -manual chest physiotherapy -intrapulmonary percussive ventilation -percussion vest -active cycle of breathing -autogenic drainage |
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What is the tx for CF pts colonized w/P. aeruginosa?
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BID inhaled tobramycin 28 day cycles every other month
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What 2 drugs do you want to use in a CF pt with PNA?
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an aminoglycoside (Tobramycin) and a 3rd generation cephalosporine
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Why are oral pancreatic enzymes used in CF?
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to replace missing enzymes in needed to maintain nutritional status and minimize malabsorption, steatorrhea, constipation, and diarrhea
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What are some things that can happen because of CF?
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-hemoptysis
-pheumothorax -resp failure and cor pulmonale |
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What are the cause of pneumothorax in most CF pts?
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rupture of blebs
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Hypertrophy of what ventricle is more common in adults with severe cystic fibrosis?
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right ventricle
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What is bronchopulmonary dysplasia (BPD?)
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chronic phase of neonatal lung damage caused by oxidant injury and braotraumas in susceptible premature infants
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What are some things needed for the dx of BPD?
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-positive pressure ventilation for at least 3 days
-respiratory distress such as tachypnea, wheezing, and retractions |
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What is chronic lung dz?
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complex interaction of antenatal and postnatal factors that lead to ongoing symptoms and need for tx for respiratory problems in infants
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Chronic lung dz is also accompanied by what other diseases?
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-GERD
-congenital anomalies -growth impairment -nutritional difficulty -sensory and neurodevelopmental handicaps |
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What is the hallmark of chronic lung dz treatment?
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adequate oxygenation
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SIDS is more likely to occur when in a child's life?
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in cooler months in the 2nd to 4th months of life
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Risk for SIDS in siblings of SIDS pts is what?
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4x greater
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There is a higher risk of SIDS in what race?
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African American infants
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What are some risk factors for SIDS?
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-prone sleep
-exposure to cigg smoke during gestation or birth -over heating -not breastfeeding |
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Apparent life threatening events is a risk factor for what?
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SIDS
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What is a frequent cause of apnea in infants?
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RSV
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How long should ALTE pts be hospitalized after an ALTE?
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48 hrs
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What pts require monitoring after an ALTE?
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-infants who have had 1 or more severe ALTE requiring mouth to mouth or vigorous stimulation
-siblings of 2 or more SIDS victims -infants with central hypoventilation |
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What are 4 criteria for discontinuing monitoring of ALTE pts?
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-no even requiring vigorous stimulation or resusitations in 2-3 months
-no observed prolonged apnea or bradycardia for 2 months -no alarms with stress -normal even recording |
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What drug reduces the progression of resp symptoms in CF pts?
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ibuprofen
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At wich p02 or oxygen sat does cyanosis become visible?
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60
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What is apnea?
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pause in breathing for >20 seconds
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