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pediatric Boards > cardio/pulm > Flashcards

cardio/pulm Flashcards

0
Q

What are 4 main triggers for asthma?

A

Weather change
Aspirin
Beta blockers
Viral URI

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1
Q

How many children will outgrow mild asthma ?

A

60%

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2
Q

What is the trend in asthma mortality?

A

Mortality of asthma is increasing!

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3
Q

Is asthma more common in boys or girls?

A

More common in boys until puberty - but later it is equal in boys and girls

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4
Q

What are the 3 clinical descriptions associated with mild intermittent asthma?

A

Symptoms less then 2x weekly
Night symptoms less then 2x monthly
No pulmonary function abnormalities

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5
Q

What are the 3 clinical descriptions associated with mild persistent asthma ?

A

Normal PFTs
Symptoms more than 2x per week
Night symptoms more than 2x per month

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6
Q

What is the treatment for mild persistent asthma?

A

Low dose inhaled steroids

2nd line - leukotriene inhibitor

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7
Q

What is the treatment for moderate persistent asthma?

A

Low to medium dose steroid + laba

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8
Q

When do you classify a child as having moderate persistent asthma?

A

When a child requires bronchodilators more than twice per week

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9
Q

What is the definition of mild exacerbation of asthma ?

A

Decreased pulmonary function but still >50% of predicted

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10
Q

When is levalbuterol indicated instead of albuterol?

A

Only in patients with tachycardia, tremors or irritability

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11
Q

When is chest PT and mucolytics indicated for asthma?

A

Never

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12
Q

What are 5 side effects of beta adrenergic agonists?

A 
Tremors
Tachycardia
Hypokalemia
Hyperglycemia
Hypomagnesemia
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13
Q

What does high or low CO2 indicate in the setting of acute asthma?

A

High pCO2 indicates CO2 retention and fatigue with respiratory failure
Low pCO2 reflects tachypnea

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14
Q

What are 5 signs of hypercapnia?

A 
Agitation
Flushing
Altered mental status
Headache
Tachycardia
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15
Q

What is the most common cause of chronic nighttime cough?

A

Reactive airway disease

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16
Q

What are 4 main causes of infant wheezing, other than asthma?

A

Aspiration
Bronchopulmonary dysplasia
Foreign body
Vascular rings

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17
Q

What is the definition of exercise induced asthma?

A

Coughing and wheezing 5 minutes after exercising with improvement within 15 minutes of rest

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18
Q

What diagnosis should you consider in a patient with a “respiratory infection that is not clearing”?

A

Foreign body

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19
Q

What are the 4 main causes of poor exercise tolerance ?

A

Cardiac disease
Anemia
Muscle weakness
Psychological factors

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20
Q

What medication may be indicated for exercise induced asthma?

A

Leukotriene inhibitor (montelukast)

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21
Q

What are the 4 risk factors for persistent asthma ?

A

Onset before age 3
IgE elevated
Maternal hx asthma
Eosinophilia

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22
Q

What diagnosis must be considered in a patient with unlabored breathing but sudden onset of intermittent productive cough and wheezing?

A

Foreign body aspiration

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23
Q

What diagnosis corresponds with blunted inspiratory loop on spirometry?

A

Vocal cord paralysis

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24
Q

What is the safest and most effective way to confirm foreign body aspiration?

A

Airway fluoroscopy

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25
Q

What is the treatment for a swallowing dysfunction ?

A

Thickened formula and upright feeding position

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26
Q

What are 3 signs of respiratory failure ?

A

Tachypnea
Retractions
Pulsus paradoxus

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27
Q

What is pulsus paradoxus?

A

When the difference in blood pressure during inspiration and expiration is >10mmHg

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28
Q

What is the first thing to do when deciding whether to intubate a patient ?

A

Assess respiratory effort

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29
Q

What is the best way to assess for the severity of respiratory distress ?

A

Sweating / fast heart rate

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30
Q

What is the proper way to administer oxygen in a patient with chronic lung disease and why?

A

At the lowest concentration needed to maintain sats above 90 …rapid correction of hypoxia can lead to respiratory arrest because respiratory drive is driven by hypoxia

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31
Q

What are 3 initial screening tests for a chronic cough?

A

Sweat choride test
Tb skin test
Cxr

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32
Q

What value indicates an abnormal sweat chloride test?

A

> 60

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33
Q

How is cystic fibrosis inherited?

A

Autosomal recessive (carriers show no signs of disease)

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34
Q

What is the most effective test for confirming cystic fibrosis?

A

Sweat chloride

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35
Q

What disease should you suspect in an infant with hypochloremic alkalosis ?

A

Cystic fibrosis

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36
Q

If a sibling of someone with CF marries someone in the general population, what are the odds of them having a child with CF?

A

1 in 150

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37
Q

If two carriers of CF are married, what is the risk they will have a child with Cf?

A

1 in 4

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38
Q

What is the carrier rate of CF in the general population ?

A

1 in 25

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39
Q

What are the odds of a healthy sibling of someone with CF being a carrier?

A

2/3

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40
Q

What vitamin may be deficient in patients with CF? What should be done about this deficiency ?

A

Vitamin E (supplements should be started prior to age 5)

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41
Q

What lab study if abnormal in patients with vitamin K malabsorption?

A

Prolonged PT

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42
Q

What are 3 common GI manifestations of CF in the neonatal period?

A

Meconium ileus
Meconium peritonitis
Unconjugated hyperbilirubinemia

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43
Q

What are the X-ray findings of meconium peritonitis?

A

Pseudocyst (calcified meconium)

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44
Q

What is the abdominal film appearance with meconium ileus?

A

Ground glass appearance due to decreased bowel gas

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45
Q

What is the antibiotic treatment of an acute exacerbation of CF?

A

Aminoglycoside and piperacillin (for pseudomonas coverage )

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46
Q

What diagnosis should you consider in a patient with lower body edema, hepatomegaly, gallop heart rhythm and clubbing of fingers?

A

Cor pulmonale

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47
Q

What causing flushing and agitation as well as headaches due to cerebral vasodilation?

A

Hypercarbia

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48
Q

How is apnea of prematurity treated?

A

Caffeine

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49
Q

What are 4 main causes of central apnea which must be ruled out before the diagnosis “apnea of prematurity” is given?

A

Sepsis
Medication
Anemia
Electrolyte abnormalities

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50
Q

What is the likely cause of a patient in acute respiratory distress who is post-op tonsillectomy due to history of obstructive apnea?

A

Pulmonary edema

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51
Q

What is the definition of apnea?

A

Cessation on breathing >20 seconds or <20 seconds if associated w bradycardia or cyanosis

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52
Q

What is the diagnosis in a patient with pleural fluid that has >110 triglycerides, high lymphocytes and protein >3?

A

Chylothorax

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53
Q

When is pleural effusion likely to be an “exudate”?

A

With pneumonia, Cancer, inflammation or trauma

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54
Q

What will the fluid LDH and protein levels be in an exudative pleural effusion?

A

LDH 3x the serum LDH

Protein >3 grams

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55
Q

What are 3 causes of transudative pleural effusion?

A

Cirrhosis
Nephrotic syndrome
CHF

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56
Q

What is the triglyceride level in transudative pleural fluid?

A

<50

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57
Q

What is the diagnosis and treatment for a patient with tachypnea, tachycardia, low BP and tracheal deviation ?

A

Tension PTX - needle or chest tube ASAP

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58
Q

What are 3 causes of respiratory deterioration in an intubated patient?

A

Tension PTX
Incorrect tube positioning
Equipment failure

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59
Q

What are 6 main risk factors for SIDS ?

A 
Sleeping on tummy
Co sleeping 
Low income
Smoking
Cold weather
Young parents
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60
Q

What are 6 possible causes of ALTE in an infant?

A 
Neurological abnormality
Abuse/trauma
Lung infection / apnea
Sepsis
Hypoglycemia
Gerd / aspiration
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61
Q

When can an infant with ALTE be discharged home from the ER?

A

First episode that is brief and presents with an explanation (uri or reflux)

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62
Q

What is the initial step when presented with an infant with noisy breathing?

A

Birth history and observe breathing in different positions

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63
Q

What is the only way to correlate pulse oximetry and pulmonary lung function?

A

ABG (CBG is unreliable)

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64
Q

What diagnosis should you consider in a patient with chocolate colored blood and cyanosis despite normal pulse ox?

A

Methemoglobin

65
Q

What are 3 conditions in which pulse oximetry is unreliable?

A

Carboxyhemoglobin
Methemoglobin
Impaired perfusion (septic shock)

66
Q

What are the 4 common causes of stridor in a neonate?

A

Choanal atresia
Vascular ring
Laryngeal web/stenosis
Vocal cord paralysis

67
Q

What is the most common cause of stridor in a 1 month old infant?

A

Laryngomalacia/tracheomalacia

68
Q

What are 3 causes of stridor in a child age 1-4 years old?

A

Croup
Epiglotitis
Foreign body aspiration

69
Q

What is the likely cause of stridor in a child older than 5 years old?

A

vocal cord dysfunction
Peritonsillar abscess
Anaphylaxis

70
Q

What are classic X-ray findings with bronchiolitis?

A

Hyperinflation and patchy infiltrates

71
Q

How can bronchiolitis be distinguished from chlamydia pneumonia ?

A

Chlamydia typically presents at 1-3 weeks of age with staccato cough and no fever or wheezing

72
Q

What is the most common cause of bronchiectasis?

A

Cystic fibrosis

73
Q

What is a permanent dilation of small airway segments?

A

Bronchiectasis

74
Q

How is bronchiectasis diagnosed?

A

CT of the chest

75
Q

What diagnosis should you consider in a patient with repeat lower respiratory tract infections with consistent right middle love atelectasis and cough that is worse after lying down?

A

Bronchiectasis

76
Q

Other than CF, what are 6 causes of bronchiectasis ?

A 
Dyskinesia (primary ciliary dyskinesia)
Immunodeficiency 
Lobar pneumonia 
Aspergillosis
TB
Extrinsic compression (Lymph nodes)
77
Q

What syndrome presents with chronic sinusitis, situs inversus and male infertility?

A

Kartagener

78
Q

What diagnosis should be considered in an infant with recurrent wheezing that is worse with feeding ? How would you diagnose this?

A

Tracheal or esophageal compression (vascular ring, double aortic arch)
Diagnose with barium swallow

79
Q

What is the hyperinflation of one or more lobes of the lung which presents as respiratory distress or airway obstruction in newborns?

A

Congenital lobar emphysema

80
Q

What is the malformation of dysplastic lung tissue that presents as recurrent pneumonia ?

A

Congenital cystic adenomatoid malformation

81
Q

What incidental finding presents with consistent airway compression ?

A

Bronchogenic cysts

82
Q

What is the name of lung tissue that is supplies by systemic instead of pulmonary arterial supply?

A

Pulmonary sequestration

83
Q

What is the appropriate treatment for a patient with positive PPD but negative chest X-ray for TB?

A

Isoniazid x 9 months

84
Q

What diagnosis should you consider in a patient with low grade fever an cough for one month and a cxr that shows hilar adenopathy?
How would you treat?

A

TB -
2months rifampin, INH and pyrazinamide followed by 4 months of INH and rifampin OR
9 months INH and rifampin

85
Q

What are 4 presentations of extrapulmonary TB?

A

Meningitis
Adenitis
Pleuritis
Disseminated (miliary)

86
Q

How is TB meningitis treated differently than regular pulmonary TB?

A

Add streptomycin and steroids

87
Q

What is the appropriate initial step in a patient with flail chest after chest wall trauma?

A

Intubation and pain management

88
Q

What is the most important procedure to perform following blunt trauma to the chest?

A

Physical exam

89
Q

What is the cause of death in a patient with ARDS?

A

Multiorgan failure

90
Q

What is the best method of temperature control following a near drowning?

A

External rewarding of the head and neck

91
Q

What are 4 likely causes of hemoptysis in children?

A

Infection
Cystic fibrosis
Foreign body aspiration
Hemosiderosis

92
Q

What is the best course of action when presented with a patient with acute hemoptysis?

A

PH of aspirate to determine if acidic (from stomach) or alkaline (from lungs)
CBC and coags

93
Q

What are the 4 most common causes of pneumonia in the patient age 3 weeks to 3 months?

A

Chlamydia
RSV
Parainfluenza
Pertussis

94
Q

What are the 3 most common causes of pneumonia in a patient from 3 months to 4 years of age?

A

Viral
Strep pneumo
Mycoplasma

95
Q

What abx are used to treat necrotizing pneumonia?

A

Vanco or clinda

96
Q

What is the best diagnostic study to confirm the diagnosis in a patient with pneumonia that has been confirmed on chest X-ray?

A

Blood culture (sputum or nasopharyngeal culture are not the correct answer )

97
Q

What is the goal of treatment in a patient with CHF due to left to right shunting?

A

Reducing volume overload with diuretics

98
Q

When is verapamil contraindicated as treatment for CHF?

A

In a child less than 1 year old

99
Q

What is the goal of treatment in an infant with coarctation of the aorta?

A

Maintain patent PDA with prostaglandin

100
Q

What are 5 causes of cyanotic congenital heart disease ?

A 
Truncus arteriosis
Transposition of great arteries
Tricuspid atresia 
Tetralogy of fallot 
Total anomalous pulmonary venous return
101
Q

What is the only cyanotic heart disease that presents in the first few hours of life?

A

Transposition of the great vessels

102
Q

What is the treatment of methemoglobinemia?

A

Methylene blue

103
Q

What is the possible diagnosis in a patient whose mother mixes the formula with well water and presents with cyanosis but no respiratory distress ?

A

Methemoglobinemia

104
Q

Why does methemoglobin cause cyanosis ?

A

Defective hemoglobin molecule can not carry oxygen to tissues

105
Q

What are 3 causes of CVA in infants ?

A

Cyanotic heart disease
Polycythemia
Iron deficiency anemia

106
Q

What is appropriate workup for a patient with blue hands and feet on a off since births in an otherwise normal baby?

A

Reassurance

107
Q

What must occur in order for total anomalous venous return to be compatible with life?

A

PFO or ASD which connects right and left atrium

108
Q

What is the pathology of total anomalous pulmonary venous return?

A

None of the 4 veins that drain blood from the lungs to the heart is attached to the left atrium therefore oxygenated blood returns to the right atrium

109
Q

What are the 4 components of tetralogy of fallot?

A

Pulmonary stenosis
Overriding aorta
VSD
RVH

110
Q

What abnormal heart sounds will be heart in a patient with total anomalous venous return?

A

Fixed split S2 and short systolic murmur

111
Q

What cxr findings are consistent with total anomalous pulmonary venous return?

A

Pulmonary congestion (due to increased venous return) and normal to small heart size

112
Q

What ABG abnormalities are consistent with total anomalous pulmonary venous return ?

A

Hypoxia

Hypercarbia

113
Q

What is the treatment for a patient who was normal until the 2nd day of life when he became cyanotic with tachypnea and normal cxr ?

A

Prostaglandin to maintain patent PDA

114
Q

What is the first line treatment for pulmonary hypertension?

A

Nitric oxide

115
Q

What are 4 factors that correlate with cognitive prognosis in patients with cyanotic heart disease ?

A

Neurological baseline before surgery
Seizures after surgery
Coexisting problems
Duration of circulatory arrest intraoperatively

116
Q

What diagnosis presents with a boot shaped heart on CXR?

A

Tetralogy of fallot

117
Q

What is the treatment of an acute TET spell ?

A

Place child in squatting position to increase PVR + morphine, phenylephrine, propranolol and IVF

118
Q

What is the pathology behind a TET spell?

A

Dehydration or anemia cause increased right to left shunting and therefore a hypercyanotic hypoxic episode

119
Q

What are the symptoms of an acute TET spell?

A

Agitated infant with absent heart murmur

120
Q

When do patients with tetralogy of fallot typically present?

A

Age 3-5 months

121
Q

What cardiac defect presents with an egg shaped heart and increased pulmonary vascularity?

A

Transposition of the great vessels

122
Q

A 10 day old newborn presents with tachypnea, thready pulses and large liver as well as EKG findings of aortic stenosis. What therapy should be started immediately?

A

Prostaglandin- this baby is in cardiogenic shock and ductus needs to be reopened

123
Q

What atypical heart sound is present in both tetralogy of fallot and transposition?

A

Single 2nd heart sound

124
Q

What are olser nodes?

A

Tender nodules on fingers and toes

125
Q

What are janeway lesions?

A

Non tender red nodules on palms and soles

126
Q

What diagnosis should you consider in a patient with generalized facial swelling, fatigue, weight loss and dusky color?

A

Superior Vena Cava syndrome

127
Q

What is persistent fetal circulation?

A

Pulmonary vascular resistance greater than systemic resistance causes right to left shunting

128
Q

What is the best test to confirm endocarditis?

A

Blood culture (not an ECHO)

129
Q

What diagnosis should you consider in a patient with two weeks of fever and lethargy as well as new murmur, petechiae and splenomegaly on physical exam?

A

Endocarditis

130
Q

What is the likely pathogenic organism in a patient with subacute bacterial endocarditis?

A

Strep viridans

131
Q

What are the 3 most common bacterial causes of acute bacterial endocarditis?

A

Strep viridans
Strep bovis
Staph aureus

132
Q

What are the 5 HACEK bacteria?

A 
Haemophilus 
Actinobacillus
Cardiobacterium 
Eikenella 
Kingella
133
Q

What is the appropriate antibiotic prophylaxis against endocarditis ?

A

Amoxicillin 30-60 minutes prior to procedure

134
Q

When is antibiotic prophylaxis recommended prior to dental procedure?

A

Incompletely repaired cyanotic heart dz
Heart disease corrected w hardware within past 6 months
Defect near prosthetic cardiac device

135
Q

What is the most common bacterial cause of pericarditis?

A

Staph aureus

136
Q

What are the 2 most common causes of pericarditis?

A

Viral infection

Collagen vascular disease

137
Q

What classic EKG finding is associated with pericarditis?

A

Diffuse ST elevation

138
Q

What 3 physical exam findings are associated with pericarditis ?

A

Muffled heart sounds
Pericardial friction rub
Jugular venous distention

139
Q

What is the most important study to order when pericarditis is suspected?

A

CXR

140
Q

What is the pathological cause of a pansystolic murmur best heard at the left lower sternal border?

A

VSD

141
Q

What cardiac defect is associated with maternal use of lithium ?

A

Epstein anomaly

142
Q

What cardiac defect is associated with maternal use of alcohol?

A

VSD and ASD

143
Q

What cardiac abnormality should you consider in a patient with split loud S2 and hyperdynamic precordium?

A

VSD

144
Q

What malformation is associated with bounding carotid pulses and decreased peripheral pulses?

A

Cranial bruit associated with AV malformation of the brain

145
Q

What should you do if you hear a 3rd heart sound on physical exam?

A

Sit the child up and the sound should disappear - if the sound is present while sitting up, further workup is needed

146
Q

What diagnosis should you expect in a patient with exercise intolerance and fixed split 2 heart sound on exam?

A

ASD

147
Q

What cardiac abnormality presents with systolic click and normal S2?

A

Pulmonary stenosis

148
Q

What cardiac abnormality presents with systolic click and murmur at right upper sternal border that radiates to the neck?

A

Aortic stenosis

149
Q

What activities should be avoided in a patient with Marfan syndrome and why?

A

Weight lifting and contact sports - risk for aortic enlargement and dissection

150
Q

What EKG finding would be present in coarctation of the aorta?

A

RVH

151
Q

What EKG finding would be present in a patient with aortic stenosis?

A

LVH

152
Q

When are PACs on EKG abnormal?

A

Children on digoxin or children less than 1 year old due to risk of atrial flutter

153
Q

What syndrome should you be concerned about in a patient with short PR interval and delta wave on EKG?

A

Wolff Parkinson white

154
Q

What syndrome must be ruled out in a patient who presents with sudden onset of syncope after vigorous exercise or emotional stress?

A

Prolonged QT

155
Q

What is the likely diagnosis in a patient with recurrent episodes of syncope with prolonged standing but no family hx of sudden cardiac death?

A

Neurocardiogenic syncope

156
Q

What is the first thing to do in a stable patient with HR 225?

A

12 lead EKG

157
Q

What first thing should you do with a child with HR 230 in SVT and hemodynamic instability? What if cardiac failure?

A

Vasovagal maneuvers then adenosine or cardioversion–if cardiac failure, adenosine is first line!!

158
Q

What is the risk in a patient with AV block and prolonged QRS complex?

A

Compromised blood flow to the brain causing seizure and syncope

159
Q

What medication is contraindicated in a child with WPW?

A

Digoxin

160
Q

What type of chest pain would raise suspicion for cardiac origin?

A

Radiation to neck/back/shoulders

Pain is constant, dull and pressure-like

pediatric Boards (23 decks)

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