פולמונולוגיה Flashcards
בכמה ירדה השכיחות של מוות בעריסה בהשכבת תינוק על הגב?
ירדה בלמעלה מ-50%
אבחון של מוות בעריסה- נתיחה שלאחר המוות
Definition of BRUE (Brief resolved unexplained event)
כחלון/ חיוורון / הפסקת נשימה / נשימה לא סדורה / שינוי בטונוס או ברמת התגובתיות בתינוק מתחת לגיל שנה ונמשך פחות מחצי דקה
what are the low risk conditions in BRUE?
- age > 60 days
- delivery > 32 weeks +correct now > 45 wks
- first episode
- less then 1 min
- did not rq resusitstion
- no clinical or Hx findings
How to manage low risk BRUE?
- patrossis PCR?
- ECG- rule out long QT
- PCR viral
- O2% sat
How to asses high risk BRUE
- hospitalization with cardial and respiratory monitoring
- swallowing test
- Brain imaging- rule out abuse
- neurologic asses- epilepsy?
- rule out anatomical lesions in respiratory tracts
- rule out respiratory abnormalites- OSA, central apnea
Dgx of PE?
CT- contrast
gold standart- lung angiography
די דימר לא מקדם בילדים
which coagulation factor is most a/w PE in childrens?
5- leiden
the following spirometry can be a/w which common disease?
low FEV1
FEV1/FEV < 0.8
12% improve of FEV1 after inhale beta agonists
Asthma
Definition of Transient Non ectopic Wheezing
שיעול וצפצופים בעיקר לאחר מחלה רספירטורית ויראלית
נעלמת במהלך הילדות עד הגעה לגיל ביה”ס, ללא סיכוי מוגבר לאסתמה בהמשך החיים
1st line for community aq pneumonia?
also 2nd line and for penecillin sensetive and a-typical penumonia
amoxicillin
2nd line- augmentin
if atypical suspect or senetivity to penecillin > macrolides
if resistance to multiple lines > susp. MRSA
hospitelized pneumonia
under 1 month
2m-2yr
> 2 yres
- < 1 month- Ampicillin + gentamycin
- 2m-2yr- augmentin / Chephalosporins 2rd generations
- > 2 yrs- ampicillin
Complication of pneumonia and Tx?
Para-pneumonia and amphyema
Tx- Abx IV + drainge
pathogens a/w pleuropneumonia?
tx?
Pathogens
pneumoccoc
SA
GAS
Tx
Abx IV
second- drainage
emphyema definition
הצטברות מוגלה בחלל הפליאורלי
emphyema in XCR
הנוזל לא זז כיוון שהוא תחום בספטות
מהם האינדיקציות להנחת נקז באמפיאמה?
Positive gram culture
PH < 7.2
PMN > 100K
Tx for emphyema?
Ceftriaxone (rochipin) + clindamycin 4 wks + drainage + fibrinolytic (aurokinase)
Dgx for eosinophilic lung disease?
Bronchoalvelolar lavage with > 25% eosinophilis in acute phase
What is the most common esoinophilic lung disease in kids?
what is the etiology?
Loffler eosinophlic pneumonia = pulmonary infilitrates with esosinophilia syndrome
mostly cause by Ascaris lumbricoides
a teenager present with hypoxemia, dyspnea, fever and cough. the kid is telling you he is smoking ciggarte. on blood reasults there are no signs of infection and eosinophils counts are normal. on BAL there is eleveted eosinophils.
what is the most likley disease?
what is the Tx?
acute eosinophilic syndrome
Tx- Few weeks steroids
a teenager present with hypoxemia, dyspnea, fever and cough lasting for . the kid is telling you he is smoking ciggarte. on blood reasults there are is no signs of infection and eosinophils counts are eleveted. on BAL there is eleveted eosinophils.
what is the most likley disease?
what is the Tx?
Chroni eosinophilic pneumonia
Tx- steroids
Tx for sinusitis?
1st line- amoxicillin
2nd line- augmentin
a 4 yr old boy is present with high fever, torticolis, stirodr with normal orophyngeal testing.
his mother mentioned that a 2 wks ago he had an ear infection
what is the most likely dgx?
what is the Tx?
Retrophyrngeal abcess- CT
Tx- IV augmentin, consider drainge
Tx for croup / lryngotracheobronchilitis?
Steroids PO
X-ray- steeple sign
what is the clinical presentation and treatment of Spasmodic croup?
sudden stridor in night hours, usally w/o fever
Tx- as croup (steroids PO)
Tx for Epiglottitis?
intubation and Ceftriaxone IV 10d
Bacterial trachitis clinical presentation
Dgx? Tx?
barking cough, stridor, dyspnea and high fever.
dgx- abcsence of epiglottitis + clinical
Tx- Ceftriaxone + Vanco / clindamycin, oxygen. think about intubation
Main etiology for subglottic stenosis??
Prolong intubation
dgx- bronchoscopy
bi-phasic stridor
most common cause of stridor in babeis?
layngomalacia- low tonus of muscles in pharynx area»_space; lead to collapse of glottic structures during inspirium
develop in first few weeks and worsen until 6 months of age
Clinical presentation of laryngomalacia?
when stridor is ease or worsening and how we dgx?
inspiratory stridor
worsen in effort- crying agitation ,eating
relief in resting / laying on abdomen
dgx- confirmation by flexibale laryngoscope
Which type of respiratory infection is a/w adenovirus?
Bronchiolitis obliterans
clinical presenation of CPAMמום מולד בדרכי הנשימה
Dg and Tx
mainly a-symp in childhood. but later can presented with reccurent lung infections and chest pain
Dgx- CT = consolidation and marks with contrast
Tx-surgery (fear for malignant transformation)
What is pulmonary sequestration?
lung anomelis in creating lung tissue outside of the lung tree.
could present with reccurent lung infections and hemoptysis
or left lung and boys»_space; diaphragmatic hernia and other anomalies
Tx- surgrty
most common nose anomaly?
Choanal atresia
תינוק לא יכול לנשום דרך האף
יכול להיות חד צדדי או דו צדדי
A recent deliver new born present with porminant cyanosis while eating which pass when the baby stop and start crying
what is most likley the dgx? how can we confirm it?
choanal atresia
dgx- try to pass nasal tube
CF tx for pt with acute infection?
מינון מקסימאלי למשך שבועיים
לעיתים פי 2-3 מהמומלץ
בחשד לפסאודומונס- קוינולונים (2 תרופות)
Which CF complication is a/w high levels of IgE and rusty colour sputum
ABPA
Allergic- broncho pulmonary aspergillosis
tx- Steroids PO
מתי תבחין זיעה עם כלור נחשב לחיובי?
CF
> 60 microL/L
False positive sweat test for CF etiologies?
5
hypothyroidism
hypoparathyroidism
anorexia
atopic dermatitis
addison
Which disease is a/w the following triad?
* bronchoectasis
* chronic sinusitis
* recurent ear infections
Primary cilliary dyskinesia
50% - present with situs inversus
Dgx for primary cilliary dyskinesia?
epithel nose biopsy or airways and check on electron microscope
Tension pneumothroax
location of the trachea?
deviation of the trachea to the healty side (also the mediastenum)
