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92 Cards in this Set

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What is the most frequent cause of life threatening cardiorespiratory illness in kids?
respiratory failure
What are some general causes of resp failure in kids?
-pulmonary dz
-airway dz
-restrictive dz
-neuromuscular dz
What is ventilation?
exchange of gas b/w atmosphere and alveoli
What is diffusion?
diffusion of gases across alveolar capillary system
In pulmonology, ther eis transport of gases where?
in blood
What is internal respiration?
use of oxygen and production of carbon dioxide with in cells
Decreased ventilation can be due to stenosis what two things?
stenosis or severe malacia
Decreased diffusion in the lungs can be due to what things?
inflammaiton of alveoli or fibrosis
98% of O2 transport occurs by what?
oxygen-Hgb interaction
What is Pa02?
amount of oxygen disolved in plasma
What Pa02 value is abnormal and what Sa02 value is?
-Pa02 <80
-SaO2<94
What is hypoxemia?
decreased delivery of oxygen from atmoshere to blood
What is hypoxia?
decreased delivery of oxygen to tissues
What is hypercapnia?
alveolar carbon dioxide content is high, which later causes hypoxemia
What is an absolute shunt?
blood passing from right to left side of heart w/o being oxygenated
In what conditions is an anatomical shunt?
-persistent fetal circulation
-idiopathic or 2nd pulmonary HTN
-AVM
-congenital heart defects
What happens in a diffusion defect?
alveolar and bronchiolar epithelium are thickened due to inflammation and fibrosis
Diffusion defects are seen in what diseases?
-CF
-SLE
-Juvenile RA
-Wegener's granulomatosis
Why is carbon dioxide transported easier then oxygen in blood?
b/c it is highly lipid soluble
Respiratory acidosis occurs MC with what?
too much CO2 (hypoventilation)
Oligohydramnios may be a sign of renal anomaly and indicate what?
pulmonary hypoplasia
How is the breath like in restrictive lung dz?
rapid and shallow breaths
Crackles and wheezes orginiate from where?
lower airway dz
Noise that occurs on inspiration and expiration is probably what?
fixed stenosis
Expiratory wheeze in absence of inspriatory stridor (or vice versa) indicated what?
variable stenosis
intrathoracic obstruction is seen on what?
expiration
Extrathoracic obstruction is seen on what?
inspiration
A loud snapping P2 indicates what?
pulmonary HTN
What does plethysmography do?
measures actual volumes of air contained in the thorax
Obstructive lung dz
1-FEV1
2-FEV1/FVC ratio
1-low
2-low
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%
What are some indications to get a CXR?
-chronic cough
-sudden chest pain
-suspected pulm infections
What test would you do for a cough assoc w/feeding or frequent lare emesis after feeding?
barium esophagram
What is a noncontrast fluoroscopy good for?
to assess diaphragmatic excursion and upper airway and pharyngeal anatomy

dx of laryngomalacia or tracheobronchomalacia
What tx of prevered for lower airway and alveolar sampling in kids?
flexible bronschoscopy
What is an advantage to a rigid bronchoscope?
inner diamter can pass intruments and double as endotrachial tube
Stridor is an inspiratory or exspiratory sound?
inspiratory
What is the pathophys of stridor?
sound comes from increased turbulent airflow from obstruction at level of larynx, subglottic region and extrathroacic trachea
What is the only stridor causing disease that doesn't need tx?
congenital laryngomalacia
What are the tx options for stridor causing disease?
uvulopalatoplasty with tracheostomy
Asthma effects which sex more?
males
What are the most important environmental factors in development of asthma? (3)
-intensity
-timing
-mode of exposure
What are the 2 phases of asthma?
-early asthmatic reaction or (rapid bronchoconstriction)

-late asthmatic reaction
What is the cause of inflammation in the early asthma phase?
release of mast cells and eosinophils
In the early phase of asthma, mast cell degranulation leads to what?
release of mediators including prostaglandins, leukotrienes, which lead to late asthmatic reaction and result in increased vascular permeability, mucus hypersecretion, and smooth muscle contraction
When does the late stage of asthma begin?
2-3 hrs after exposure with max response in 4-8 hrs
When does the late stage of asthma typically resolve?
12-24 hrs
In the late stage of asthma, there is highly cellular infiltration into bronchial epithelium of what cells?
neutrophils, eosinophils, and lymphocytes
In older children, the MC triggers for asthma are what/
dust or other allergens
What is the MC trigger for asthma in younger kids?
viral respiratory infections
How does foreign body present, especially in toddlers?
-sudden cough
-wheezing
-stridor
What is the tx for persistent asthma?
daily tx with anti-inflam therapy
What is the tx for exercise induced asthma?
cromolyn sodium or salmeterol 15-30 mins before exercise
What medications are most commonly prescribed to achieve anti inflammatory goals in asthma?
-inhaled corticosteroids like beclemethasone, fluticasone or budesonide
What is the tx for mild intermittent asthma?>
-short acting Beta PRN
-cromolyn sodium seasonal use
What is the tx for mild persistant asthma?
-short acting beta PRN
-long acting beta daily
-inhaled corticosteroids
-leukotriene
-anticholingergic
What is tx for severe asthma?
-short acting Beta PRN
-long acting beta daily
-inhaled stroids
-leukotriene
-anticholingeric
-Theophylline
In CF, primary morbidity is from what?
progressive obstructive lung
What is the mean survivale age for CF?
31
What is the MC lethal genetic dz?
CF
What is the MC CF manifestation in infants?
meconium ileus
What PE finding should be a red flag in CF pts?
rectal prolapse
If a pt present with growth failure and failure to thrive, what should you test for?
CF
What is a classic facial finding in CF pts?
nasal polyps
Tell me about the Maxillary and frontal sinuses in CF.
Maxillary are small and frontal are underdeveloped or absent
What are some other PE findings in CF?
-firm stool masses felt on palpation
-splenomegaly may be present
-spermatic cords may be absent
-clubbing of fingers and toes
What is the gold standard test for CF?
sweat test or pilocarpine iontophoresis test
Why must sweat test be done after 9 weeks of age?
because sweat glands not fully formed yet?
What are some "modes of clearance" of excess mucus in CR?
-flutter device
-positive expiratory pressure device
-manual chest physiotherapy
-intrapulmonary percussive ventilation
-percussion vest
-active cycle of breathing
-autogenic drainage
What is the tx for CF pts colonized w/P. aeruginosa?
BID inhaled tobramycin 28 day cycles every other month
What 2 drugs do you want to use in a CF pt with PNA?
an aminoglycoside (Tobramycin) and a 3rd generation cephalosporine
Why are oral pancreatic enzymes used in CF?
to replace missing enzymes in needed to maintain nutritional status and minimize malabsorption, steatorrhea, constipation, and diarrhea
What are some things that can happen because of CF?
-hemoptysis
-pheumothorax
-resp failure and cor pulmonale
What are the cause of pneumothorax in most CF pts?
rupture of blebs
Hypertrophy of what ventricle is more common in adults with severe cystic fibrosis?
right ventricle
What is bronchopulmonary dysplasia (BPD?)
chronic phase of neonatal lung damage caused by oxidant injury and braotraumas in susceptible premature infants
What are some things needed for the dx of BPD?
-positive pressure ventilation for at least 3 days
-respiratory distress such as tachypnea, wheezing, and retractions
What is chronic lung dz?
complex interaction of antenatal and postnatal factors that lead to ongoing symptoms and need for tx for respiratory problems in infants
Chronic lung dz is also accompanied by what other diseases?
-GERD
-congenital anomalies
-growth impairment
-nutritional difficulty
-sensory and neurodevelopmental handicaps
What is the hallmark of chronic lung dz treatment?
adequate oxygenation
SIDS is more likely to occur when in a child's life?
in cooler months in the 2nd to 4th months of life
Risk for SIDS in siblings of SIDS pts is what?
4x greater
There is a higher risk of SIDS in what race?
African American infants
What are some risk factors for SIDS?
-prone sleep
-exposure to cigg smoke during gestation or birth
-over heating
-not breastfeeding
Apparent life threatening events is a risk factor for what?
SIDS
What is a frequent cause of apnea in infants?
RSV
How long should ALTE pts be hospitalized after an ALTE?
48 hrs
What pts require monitoring after an ALTE?
-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
What are 4 criteria for discontinuing monitoring of ALTE pts?
-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
What drug reduces the progression of resp symptoms in CF pts?
ibuprofen
At wich p02 or oxygen sat does cyanosis become visible?
60
What is apnea?
pause in breathing for >20 seconds