Pulmonology

-congenital condition choanea are occluded

-failed recanalization

-unilateral

-female

-trisomy 21

choanal atresia

-feeding difficulties

-uilateral: mucopurlent discharge

-bilateral: unstable to breate, choking and airway obstruction, releived with crying, paradoxical cyanosis

choanal atresia sx

-dx: nasal endoscopy, CT scan

-tx: surgical correction

choanal atresia dx/tx

-congenital

-cartiaginous support of the supraglottix structure is underdeveloped and collapses with inspiration

-sx: intermitten stridor, within 6 mons of life

-dx: clinical, laryngoscopy

-tx: self limiting by age 2

-severe: surgical

laryngomalacia

-MCC: parainfluenza 1

-patho: infection leads to inflammation and edema in subglottic space

laryngotracheitis (croup)

-seal like cough (worse at night)

-stridor, hoarseness, absent or LG tempus, URI sx

-airway obstruction and edema progress, stridor occurs at rest

laryngomalacia sx

-dx: clinical

-AP/lat neck XR: steeple sign

-tx: single dose of dexamethasone

-severe: nebulized racemic epi (monitor), oral dexamethasone, O2

laryngomalacia dx/tx

-inflammation of bronchioles

-muscous in tinest lung tubes (chest cold)

-etiology: RSV

-2mon to 2 years

acute bronchiolitis

-viral prodrome (fever, URI sx) for 1-2 days following URI

-wheezing, scattered rhonchi, grunting, nasal flaring

-striodor and wheezing prominent

acute bronchiolitis sx

-dx: clinical, viral testing

-CXR: hyperinflammation, peribronchial, cuffing, patchy infiltrates

-tx: support measures

acute bronchiolitis dx/tx

-hypoemia on room air, hx of apnea, tachypnea with feeding difficulties, respiratory distress

-higher risk: <6 mon that are premature, children with cadiopulm disorder

-impatient tx: supportive, O2, intubation

acute bronchiolitis admission

-MCC- RSV

-most will get by age 3

respiratory syncytial virus

-abrysvo: 1 dose 32-36 weeks of pregnancy

-beyfortus: 1 dose 8 months

respiratory syncytial virus vaccine

-synagis: 1x month for high risk 0-24 mon

-high risk: premature, cardiopulm conditions

respiratory syncytial virus prophylaxis

-inflammation of lungs

-virus most common

-s. pnu most common bacteria

pneumonia

-usually follows viral LRTO

-most common strep pnu

-sx: fever over 39C, tachypnae, cough, abdominal pain

community acquired pneumonia

-etiology: RSV

-sx: fever, productive cough, pleuetic chest pain, dyspnea

-tachypnea, tachycardia, bronchia breath sounds, inspiratory rales

-dx: CXR- bilateral interstitial infiltrates

-tx: SABAs. fluids, rest

viral pneumonia

->5 years

-2-3 week inoculation

-M pnu, C pnu

-sx: cough dry onset, sputum production bulbous myringitis

-afebrile, conjuctivitis and staccato cough

atypical pneumonia

-clinically in kids with fever and exam

-CXR: asymmetrial lung exam, respiratory distress, >101F, hospital addmission

-bacterial: gram stain, PCR

-viral: viral respiratory panal

-atypical: PCR

pneumonia dx for all types

-supportice care in all

-mild to mod: bacterial: amoxicillin 90mg/kg/day 5-7 days

-atypicals: macrolides

-viral: antiviral therapy

pneumonia tx outpatient

-supportive care

-O2

-hydration and electrolytes

-nutrition

-IV ampicillin or ceftriaxone

-IV marolide for walking pnuemona

-antivirals

pneumonia tx inpatient

-most common lethal genetic disease

-chronic sinopulmonary infection, malabsorption, nutritional abnormalities

-lung disease is major cause of morbidity

-most develop obstructive lung disease

-autosomal recessive

cystic fibrosis

-mutation of CFTR gene on chromosome 7 > abnormal chloride, water transports aceross exocrine gands > thick viscous secretion of lungs pancreas sinus intestine liver

cystic fibrosis patho

-infancy: meconium ileus, FTT, diarrhea

-pulmonary: bronchiestasis

-GI: malabsorption, steatorrhea, diarrhea, pancreatitis

-cough, wheezing, recurrent pnumonia, exercise intolerance, hempotysis

cystic fibrosis patho sx

-dx: sweat chloride testing = >60 greater

-tx: managed by CF foundation accredaiated CR care center

-supplementation, nutrition, airwasy, abx, lung transplant

cystic fibrosis dx/tx

-autosomal recessive

-impaired mucocilliary clearance leads to chronic sunopulmonary disease

primary ciliary dyskinesia

-respiratory distress and often require supplemental O2

-year round nasal drainage, chronic sinutsitis, nasal polyps, chronic serous otitis media

-year roudn productive cough, reccurent bronchitis, reccurent pnuemonia

-situs inversis totalis

primary ciliary dyskinesia sx

-dx: phenotypic findings year round + confirmation of pathogenic mutation + defects noted in cillia

-tx: no specific therapy

-routine pulm monitor, airway clearance, nebulization, aggresive upper and lower airways tx

primary ciliary dyskinesia dx/tx

-most commonly on right side

-sx: sudden onset of cough, shokinh, dyspnea

-wheezing, asymmetic breath sounds, inspiratory stridor if FB is high in airway

-dx: chest xray, ct chest,

-difinitive: rigid bronchoscopy

foreign body aspiration

-infants younger than 1 year, apnea or irregular breathing, cyanosis, pallow, marked change in muscle tone, decreased responsiveness

-nervous system immaturity

-most hospitalized

-not a precursor of SIDS

-most with BRUE have serious underlying condition

brue