Download Pediatric Acute Care Pulmonology Study Notes and more Exams Nursing in PDF only on Docsity!
Pediatric Acute Care – Pulmonology Study Notes
acute laryngotracheobronchitis (CROUP) - correct answer Peak 6 months
to 3 years. Viral. PARA FLU, ADENOVIRUS, RSV Xray are not to document the diagnosis but rather to exclude other, more serious, causes of upper airway obstruction that require intervention. Best seen on frontal xray. inverted V or a church
steeple laryngotracheobronchitis (croup) LTB - correct answer effects of
Dexamethasone 0.6mg/kg steroids can be seen within 6 hours Diff from epiglottis = history of URI symptoms, barking cough* Peds: narrowest airway is at cricotracheal junction.
laryngotracheobronchitis (CROUP) - correct answer Subglottic airway-
larynx, trachea, and bronchi High in 3 months to 3 yrs. Parainfluenza** Symptoms can last for up to 1 week. Tx: Humidified air, fever control, one time dose of Dexamethasone 0.6mg/kg. Nebulized epineb. (0.5ml of2.25% in 3 ml of NS)- at risk for rebound for 4 hours post neb. Heliox 70-30 (improves laminar air flow through narrow airway)
Epiglotitis - correct answer Hemophilus
influenzae a paraflu, H flu ( nontypable) GAS, strep Pneumo toxic appearing. abrupt stridor, dysphagia, fever, restlessness The patients are typically older than those with croup; the classically described peak incidence occurs at age 3.5. Obtain a Lateral radiography of neck will reveal a large epiglottis with extension of the hypopharynx " thumb sign"
Epiglotitis - correct answer pending cultures: 7-10 day course of 3rd gen
cephalosporin + or - Vancomycin if MRSA is suspected.
Epiglottis - correct answer H influenza * cases reduced since invention of
vaccine. Less likely causes : S.pneumo, s. aureus, B-hemo-strep. AP lateral neck "thumb sign" at epiglottis.
Exudative tracheitis - correct answer purulent infection
of the trachea in which exudative plaques form along the tracheal walls (much like those seen in diphtheria).6 to 10 years.
Staph areus Hemangioma - correct answer Facial
hemangiomas in the "beard" distribution have been associated symptomatic airway hemangiomas, which should raise the providers concern for airway compromise
Subglottic stenosis - correct answer 3rd most common anomaly
of larynx. Males* small cricoid cartilage with associated thickening of sub mucous layer. PE: May be NO sx until URI or cold. Stridor and barking cough. Often diagnosed with chronic laryngotracheobronchitis (CROUP). ** recurrent croup** red flag Dx made if lumen is < 4mm in term infant. Tx: Balloon dilation, tracheostomy, rib plasty.
laryngomalacia - correct answer most common cause of stridor and
congenital abnormality of larynx* males* Not necessarily in prematurity symptoms are absent at birth, arise @ 2-4w. inspiratory stridor worse when supine* poor feeding, GERD, Pt has normal cry and rarely respiratory distress. Dx: Awake laryngoscopy= elongated and laterally extended omega epiglottis, that falls posteriorly on itself on inspiration. collapse of aryepiglottic folds on inspiration 15 % will require trach. co-existing GERD worsens patho. Tx: Acid reflux precautions, OR for epiglottoplasty ( dividing aryepiglottic folds and trimming epiglottis)
Vocal cord paralysis - correct answer 2nd most common cause of larynx
anomaly. unilateral (trauma) or bilateral (CNS dx). May spontaneously resolve by 2 yrs. Asymptomatic unless agitated. Associated with Arnold Chiari, meningomyelocele, hydrocephalus, birth trauma. PE: weak cry, biphasic stridor, aspiration, feeding difficulty. Tx: Tracheostomy
Retropharyngeal cellulitis - correct answer
pyogenic infection of the retropharyngeal space that usually follows a recent pharyngitis or upper respiratory tract infection. Children present with sudden onset fever, stiff neck, dysphagia, and occasionally stridor. PEAK : 6-12 months of age. On lateral radiography, there is thickening of the retropharyngeal soft tissues. The only radiographic feature that can differentiate abscess from cellulitis is the identification of gas within the retropharyngeal soft tissues
Retropharyngeal and peritonsillar abscess - correct answer
Polymicrobial (Strep pyrogens, S. aureus, and Haemophilus) P: unilateral pain, trismus, neck swelling, muffled speech. Vanc and linezolid pending cultures x 14 days. Large may require I and D.
Bacterial Tracheitis - correct answer bacterial invasion of larynx,
trachea, or bronchi. mucopurulent pseudo membranes = narrowing airway. Fall and winter*. S Aureus, MRSA, Moraxella, H. influenza b. seen with current or recent viral infection.
- acute high fever, toxic, high WBC, stridor, croup sx, lower airway symptoms are usually associated with concurrent viral infection.
Plan: obtain lateral (narrowing or hazy trachea) to rule out PTA, croup and epiglottis. Tx: Broad spectrum coverage for Staph, Strep, Moraxella, and Haemophilus :
to the trachea just inferior to the level of the thoracic inlet. On lateral radiography, there is indentation of the anterior aspect of the trachea at or just below the thoracic inlet.
Tracheomalacia - correct answer tracheal wall
softening related to abnormality of the cartilaginous rings of the trachea. It can be a primary or secondary condition and results in intermittent collapse of the trachea.e diagnosis cannot be made on a single static radiograph. However, lateral fluoroscopy or endoscopy can demonstrate dynamic changes in the caliber of the trachea, and they are diagnostic. The most common soft tissue masses in the trachea are hemangiomas, which most commonly occur in the subglottic region
xray findings on foreign body aspiration - correct answer symmetric lung
aeration, hyperinflation, oligemia, atelectasis, lung consolidation, pneumothorax, and pneumomediastinum. Most FB are non-radioopaque. ** The key radiographic feature is the lack of change in lung volume demonstrated at different phases of the respiratory cycle**
Foreign body - correct answer Laryngeal or tracheal
foreign bodies are far less common than bronchial foreign bodies** and usually present with abrupt stridor or respiratory distress. Radiographic findings
include a radiopaque foreign body, soft tissue density within the airway, and loss of visualization
intermittently obstructing the airway. " kissing
tonsils" kissing tonsils - correct answer
CHAOS (Congenital high airway obstruction syndrome) - correct answer utero
laryngeal atresia, subglottic stenosis, and head and neck masses obstructing the upper airway, most commonly lymphatic malformations or teratomas. EXIT strategy = head delivery during c-section with immediate intubation or tracheostomy.
Situs solitus - correct answer normal
configuration; it is associated with a 0.6% incidence of congenital heart disease.
Situs inversus - correct answer the
mirror image of normal and is associated with a 3% to 5% incidence of congenital heart disease.
situs ambiguous - correct answer The
major types of situs ambiguous include asplenia (bilateral right-sidedness) and polysplenia (bilateral right-sidedness). 100% incidence of CHD
Position of aortic arch - correct answer Right-sided
aortic arch is also a red flag for the presence of congenital heart disease
TTN - correct answer C-section baby.
Respiratory distress develops by 6 hours of age, peaks at 1 day of age, and is resolved by 2 to 3 days. combination of airspace opacification, coarse interstitial markings, prominent and indistinct pulmonary vasculature, fluid in the fissures, pleural effusion,
and cardiomegaly (Fig. 3-2). Lung volumes are normal to increased.
chest radiographs in children in the presence of
hyperlucency, the depression of the hemidiaphragm to more than 10 posterior ribs, and the increased anterior-to-posterior chest diameter. Hyperinflation is often much better appreciated on lateral than on frontal radiographs in infants and small children. Subsegmental atelectasis appears as wedge-shaped areas of density.
bacterial pneumonia - correct answer appears ''round'' in younger
children (<8 y S. pneumoniae) -localized air space consolidation
- air bronchograms -highly associated with effusions
Pneumatocele - correct answer
hinwalled cysts seen at imaging and may represent a later or less severe stage of resolving or healing necrosis
Bronchiectasis - correct answer enlargement of
the diameter of the bronchi that is related to damage to the bronchial walls. It is best demonstrated by highresolution CT, where the diagnostic finding is that the bronchus in question is larger in diameter than the adjacent pulmonary artery
Tuberculosis - correct answer May present with pulm consolidation.
** when lung consolidation is seen with associated lymphadenopathy or
Acute Chest Syndrome - correct answer y fever, chest pain,
hypoxia, and pulmonary opacities on chest radiographs. Radiography often shows segmental to lobar pulmonary opacities but can also be normal. There can be an associated increase in cardiomegaly. Bone scans may show rib infarcts.
Cystic Fibrosis - correct answer
demonstrates hyperinflation, increased peribronchial markings, mucus plugging, and bronchiectasis. The hilar areas can become prominent because of a combination of lymphadenopathy secondary to the chronic inflammation and enlarged central pulmonary arteries related to the development of pulmonary arterial hypertension
'Spinnaker sail sign' - correct answer pneumomediatstinum
Metabolic alkalosis - correct answer is rare. Usual causes are
pyloric stenosis, chronic diuretic use, and bicarbonate infusions.
Heliox - correct answer a helium-oxygen mixture, has
the theoretical benefit of improving laminar airflow through the restricted, inflamed airway found in patients with lower airway obstruction
Reye's syndrome - correct answer Asprin at time of influenze illness.
Presents with fever, convulsions. leathery and coma. Hallmark: fatty degeneration of liver with cerebral edema. Elevated serum AST with high serum ammonia levels. Negative CSF findings.
Influenza - correct answer viral culture* may take up to 6 days for viral ID.
Viral nucleic have > sensitivity than rapid PCR Tx: 1. Amantadanes ( Rimantadine and Amantidine) first 48. Ineffective for H1N1. Effective for FLU A only. OR 2. Neuraminidase inhiitors (Oseltamivir (PO), and peramivir (IV) ) effective against A and B. First Line tx for H1N1.
2.Paroxysmal : whoop (hurried and deep). post tussive emesis. 3.progressive resolution of cough. pertussis aka
"cough of 100 days " - correct answer Diagnostics: WBC shows high >
10,000 absolute neutrophils. PCR and bacterial culture. * Dacron swap is held against the nasopharynx for at least 10 seconds. Plan: Erythromycin 50 mg/kg/day x 14 days. may cause pyloric stenosis in neonate. No school or daycare until 5 days of treatment.
adult vs peds airway anatomy - correct answer Peds more superior and
anterior. larger tongue and epiglottis. Glottic opening is at C2-C3 in infant and older child C3-C
- cricoid ring is narrowest in child, vocal cords are narrowest in adult.
- peds have symettrical bronchial angles until 15 yrs, then aortic knob is fully developed causing displacement of LMSB
Mallampati - correct answer
P50 - correct answer quantifies the affinity of HGB for 02. Most
important physiological variables : pH, Pc02, and temperature
Fetal Heme - correct answer P50 of 20 torr compared to adult with 26torr
Red flag - correct answer Normal Pco2 in a tachypnea hyperventilating child is
a sign of early respiratory muscle fatigue.
measles - correct answer aerosol and respiratory spread. Brain and lungs.
High fever 8-12 days after exposure. Last 1-7 d. Coryza cough watery eyes, enanthem- small white Koplik spots near molars. Rash begins on face then progresses cephalocaudally. Maculoparular erythemous. Pulmonary hyperinflation with fluffly periohilar infiltrates. Tx Vitamin A
200,oooiu q 24 hours. saccular period - correct answer characterized by
intense vascularization of the lung and loss of its glandular appearance, occurs during the weeks 28 to 36 of gestation. Elastic fibers, important in true alveolar development, begin to develop. For the first time, close contact between the air spaces and the pulmonary capillaries is established. There is concurrent active development of the lymphatic capillaries. The first true alveoli are
