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61 Cards in this Set

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What are the principle causes of respiratory failure in children? Give an example of each type.
*Pulmonary dz - PNA, ARDS

*Airway dx - FB, asthma

*Retrictive dx - flail chest

*Neuromuscular dz - myasthenia, tetanus, etc.
What disorders of the pulmonary system reduce ventilation?
Absence or occlusion of a conductive airway
What are the two common conditions causing airway occlusion?
*Asthma

*CF

(mainly due to mucous)
What conditions affect the perfusion half of the ventilation/perfusion ratio?
*Hypoxic or hypercarbic vasoconstriction of the pulmonary circulation
*right-to-left shunts (anything that bi-passes the lungs)
Which conditions might interfere with diffusion of gases across the alveolar capillary membrane?
*inflammation (i.e. PNA, asthma)

*fibrosis (thickening of the membranes)
What is the primary means of oxygen transport in the blood?
Binding to Hgb
What is the correlation between the oxygen saturation and the arterial oxygen content?
*arterial oxygen content measures the amt of O2 dissolved in the plasma
*oxygen saturation is a measure of how many available O2 binding sites of the Hgb molecules are saturated by oxygen
What is the result of hypoventilation?
*Hypercapnia --> CO2 retention

*Hypoxemia --> can't get air back & forth rapidly enough
What is the most important environmental factor in the development of asthma?
*intensity
*timing
*mode of exposure to aeroallergens that stimulate the production of IgE
What is the major response to the early phase of inflammation in asthma?
bronchoconstriction
What mediators contribute to the late phase reaction in asthma?
*Prostaglandins

*Leukotrienes
What organ systems may be affected by cystic fibrosis?
*Respiratory

*Gastrointestinal

*Reproductive
What is the primary morbidity associated with cystic fibrosis?
Progressive obstructive lung disease
What is the underlying defect in cystic fibrosis?
Decreased chloride secretion --> can't get Na or H2O, leads to secretions, & eventually lung disease
What is the most common manifestation of CF in the newborn? The older child?
* Meconium ileus

* Respiratory symptoms
What is the classic finding on physical exam of the head & neck of the pt w/CF?
Nasal polyps
Exam of the male genitals of the pt with CF might reveal ______.
absence of the vas deferens
What is the gold standard test for the dx of CF?
Sweat Test - >60 mg = strongly suggested
What agents have been shown to slow the progression of CF?
NSAIDs
What agent is useful in reducing the viscosity of bronchial secretions?
Recombinant human DNAse
What is the cause of bronchopulmonary dysplasia (BPD)?
Oxidant injury & barotrauma in susceptible premature infants
What are the clinical standards used to define BPD?
*Need for PPV for at least 3 days
*Signs of resp distress
*Need for supplemental O2 after 28 days of life
*Need for O2 at 36 weeks gestation regardless of age at birth
What is the cornerstone of management of chronic lung disease?
Adequate oxygenation
What pathophysiologic mechanisms may contribute to sudden infant death syndrome (SIDS)?
*Abnormality of brainstem neuroregulation of cardiorespiratory fxn
*Pre-existing, chronic, low-grade hypoxemia attributed to sleep-related hypoventilation found on autopsy
What epidemiologic pattern is associated with SIDS?
*> in colder months

*More likely to occur in 2-4 month

*4x > risk in siblings of SIDS victims
What environmental factors are associated with an increased risk for SIDS?
*Prone sleeping
*Exposure to cigarette smoke
*Overheating ("bundling")
*NOT breast-feeding
An ABG measures all of the following except:
a. pH
b. acid excess
c. PO2
d. base excess
e. PCO2
b. acid excess
_________ is the physiologic state in which the pt is neither breathing a sufficient tidal volume or an adequate # of breaths/min.
Hypoventilation
Alveolar hypoventilation results in CO2 retention and _________.
hypercapnia
Resp acidosis develops from an imbalance btw metabolic CO2 production and pulmonary CO2 excretion. This is most often due to ________.
most often arises from decreased efficiency of CO2 elimination in the lung -- alveolar hypoventilation
_______ is the most common reason for referral to a pediatric pulmonologist. What is the 2nd?
1 - recurrent or chronic cough

2 - noisy breathing
Oligohydramnios may indicate the presence of _________.
pulmonary hypoplasia
What are the basic steps in the process of supplying O2 to and removing CO2 from the body?
*ventilation
*diffusion - of gases across the alveolar-capillary membranes
*transport
*diffusion- of O2 from the capillaries to the cells
*internal respiration
What condition must be present for the previous processes to occur?
They can't occur efficiently if there is a mismatch of airflow (ventilation) & blood flow (perfusion) to the alveoli. This is a ventilation-perfusion (V/Q) mismatch
Describe the interaction between O2 & HgB -- uptake & release
The avidity of Hgb for O2 changes as the heme molecule becomes more "loaded" w/O2. This relationship is the basis of the sigmoidal shape of the oxyhemoglobin dissociation curve.
What conditions may produce inaccurate transcutaneous measurements of oxygen saturation?
*shock
*vasopressor administration
*severe edema
*peripheral edema
What is the difference btw hypoxemia & hypoxia?
Hypoxemia -- decreased delivery of O2 from the atmosphere to the blood
Hypoxia -- decreased delivery of O2 to the tissues
What is an absolute shunt & what causes it?
*blood passing from the right side to the left side of the heart w/out being oxygenated
*Can occur due to an anatomic shunt w/persistent fetal circulation, idiopathic or secondary pulmonary HTN, AV malformation, & congenital heart defects
What is a relative shunt & what causes it?
May develop @ the level of the alveolus if the alveolus is blocked (PNA), collapsed (atelectasis), or filled w/fluid (pulmonary edema)
What is a diffusion defect?
*decreased diffusion of O2 & CO2 across the alveolar epithelium to the pulmonary capillary bed.
What conditions are associated with a diffusion defect?
*CF
*SLE
*JRA
*Wegener granulomatosis
What calculation can help differentiate shunting from hypoventilation?
Alveolar-arterial oxygen gradient while pt is breathing room air.
What factors can alter arterial oxygen values?
*FIO2
*condition of the alveolar air-blood barrier
*amt of pulmonary blood flow
Why does oligohydramnios indicate a possible lung problem?
b/c much of the amniotic fluid produced by the fetus is generated from lung epithelium
In addition to lung disease, what else might oligohydramnios indicate?
*renal anomaly

*presence of other congenital anomalies
What breathing pattern is associated with obstructive lung disease?
Obstructive - breathe w/a prolonged expiratory phase; I:E ratio increases to 1:3 or 1:4; may also have a hyperinflated thorax
What is the breathing pattern of restrictive lung disease?
breathe rapidly & shallowly
How does the pitch, distribution, & quality of lung sounds help differentiate location of abnormalities?
Helps differentiate btw upper (extrathoracic) & lower (intrathoracic) airway pathology
What does a loud pulmonary component of the second heart sound indicate?
Pulmonary HTN
What is the current minimum age for performing pulmonary function test?
>5 years of age
What are the uses for PFTs?
*differentiating btw restrictive & obstructive lung pathology

*answering questions about respiratory fxn
What basic methods are available to determine lung volume & fxn, & what do they measure?
*Spirometry - measures "active" lung volumes
*Plethysmography - measures the actual volumes of air contained w/in the thorax
How is obstructive lung dz characterized on PFTs?
*reduction in airflow & trapping of air inside the thorax behind tight, plugged airways
*FEV1 is lowered & therefore results in a low FEV1/FVC ratio
How is restrictive lung dz characterized on PFTs?
*low FEV1 & a proportionate reduction in FVC
*FEV1/FVC ratio is unchanged from normal (>80%)
How is stridor generated?
By an increased turbulent airflow from obstruction at the level of the larynx, the subglottic region, & extrathoracic trachea
How is stridor managed?
With some form of medical or sx intervention
What is asthma?
Dz of the bronchial airways characterized by hyper-responsiveness to inhaled allergen
What gastrointestinal condition of CF pts should raise a "red flag" for the practitioner?
episodes of rectal prolapse
SIDS is the sudden death of an infant younger than ____ that remains unexplained after completion of a postmortem investigation.
1 year
What are the criteria used to determine which pts with ALTE should undergo resp monitoring?
*infants who have had 1 or > severe ALTE's requiring mouth-to-mouth
*siblings of 2 or more SIDS victims
*infants w/central hypoventilation
What are the criteria for discontinuing monitoring?
*No event requiring vigorous stimulation or resuscitation in 2-3 months
*No observed prolonged apnea or bradycardia for 2 months
*No alarms w/stress (URI, immunization)
*Normal event recording