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CVPR > CVPR Week 9: Pediatric pulmonology > Flashcards

CVPR Week 9: Pediatric pulmonology Flashcards

1
Q

Objectives

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2
Q

General approach to a clinical problem

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3
Q

The approaches to respiratory distress in the neonate

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4
Q

Neonate is having respiratory distress now what?

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5
Q

Neonate is having respiratory distress historical components

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6
Q

Neonate is having respiratory distress: Physical exam

A
  • Color
  • Work of breathing (rate, retractions)
  • Pulse oximeter
  • Shape of chest and belly
  • Obvious malformations
  • Pulses/perfusion/BP
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7
Q

Neonate is having respiratory distress: Tests

A
  • CXR & other imagery
  • blood work
  • consultant evaluations
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8
Q

Case 1

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9
Q

Describe

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10
Q

What causes these?

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11
Q

What is this?

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12
Q

Key history for tracheoesophageal polyhydramnios

A

Maternal polyhydramnios

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13
Q

Clinical presentation of tracheoesophageal fistula

A
  • choking
  • gurgling
  • noisy respiratory distress
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14
Q

Prevalence of tracheoesophageal fistula

A

relatively common 1:3,000 births

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15
Q

Common comorbidities of tracheoesophageal fistula

A
  • Multiple anomalies 80%
  • Congenital heart disease - 20%
  • Imperforate anus -10%
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16
Q

VACTERL association

A

Vertebral-rib, anus, cardiac, TEF, renal, limb anomaly

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17
Q

TEF AKA

A

tracheoesophageal fistula

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18
Q

Types of TEF

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19
Q

Reevaluate clinical vignette

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20
Q

Prenatal evaluation of the respiratory system

A
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21
Q

What is Polyhydramnios?

A

Too much amniotic fluid

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22
Q

Polyhydramnios features

A
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23
Q

What is oligohydramnios?

A

Too little amniotic fluid

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24
Q

Oligohydramnios features

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25
Q

PE of neonate with respiratory problems

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26
Q

What is this?

A
27
Q

Surfactant is produced by?

A

Type II pneumocytes

28
Q

What is surfactant and what does it do?

A
  • It is a complex molecule that is part protein part phospholipid and it
  • lowers surface tension when surface area is small
  • increases Surface Tension when a surface area is large
29
Q

What does surfactant directly oppose?

A

Laplace’s law

30
Q

What would happen without surfactant?

A
  • small alveoli would deflate
  • large alveoli would inflate
31
Q

The physiological consequence of not having surfactant

A

a pattern of atelectasis and hyperinflatiion would emerge

and upon ventilation air would preferentially go to already large alveoli and avoid deflated alveoli

32
Q

Premature birth and respiratory distress syndrome

A
33
Q

Surfactant deficiency does what to lung compliance?

A
34
Q

Risk factors for surfactant deficiency

A
  • Prematurity 28 GA
  • Gestational diabetes
  • Male/White/Twins
  • Previously affected sibling
35
Q

Clinical features of surfactant deficiency

A
36
Q

RDS AKA

A

Respiratory distress syndrome

37
Q

Antenatal Tx of RDS

A

Delay birth - Tocolysis, bedrest

Administer antenatal corticosteroids (betamethasone, dexamethasone)

38
Q

Post-natal Tx of RDS

A
39
Q

What is surfactant replacement therapy?

A

synthetic product from bovine and ovine

40
Q

Conditions that may mimic RDS in life

A
41
Q

TTN AKA

A

Transient tachypnea of the newborn

42
Q

Transient tachypnea of the newborn features

A
  • term or near term
  • C-section
  • CXR shows increased fluid but NOT ground glass opacities
  • gets better after 2-3 days
43
Q

Transient tachypnea of the newborn excess interstitial lung fluid causes?

A

reduced lung compliance

44
Q

Transient tachypnea of the newborn presentation

A
  • Cesarean section delivery / short labor
  • Late preterm delivery
  • Tachypnea/grunting/retractions/nasal flaring
45
Q

CXR of Transient tachypnea of the newborn

A

normal lung volume, increased interstitial lung markings

46
Q

Transient tachypnea of the newborn duration

A

usually self-limited to 24-48 hours

47
Q

What is a diaphragmatic hernia

A
48
Q

Diaphragmatic hernia pre-natal pulmonary complications

A
  • inadequate fetal respiratory movements
  • poor lung inflation in utero (with amniotic fluid)
  • lung underdevelopment
    • pulmonary hyperplasia
    • pulmonary vascular underdevelopment
      • set up for pulmonary HTN post-natally
49
Q

Diaphragmatic hernia post-natal pulmonary complications

A
  • insufficient respiratory movements
    • inadequate ventilation
    • can be fixed with positive pressure ventilator support
  • Pulmonary HTN
    • since pulmonary vascular bed is underdeveloped
    • the pulmonary vascular system remains a high resistance system
    • even if available vessels dilate (normal)
      • pHTN may be refractory due to poor vasculature development
    • May need ECMO Extra Corporeal Membrane Oxygenation
50
Q
A
51
Q

Diaphragmatic hernia presentation

A
52
Q

Diaphragmatic hernia Incidence and mortality

A

1:3000 births

high mortality depending upon severity

53
Q

What is this?

A
54
Q

Identify

A
55
Q

Types of pulmonary HTN in an infant

A
56
Q

Pulmonary HTN in an infant presentation

A
57
Q

Pulmonary HTN in an infant lung compliance and volume

A

normal lung compliance / increased lung volume

58
Q

Pulmonary HTN in an infant oxygenation

A
  • worsening oxygenation with poor response to oxygen
  • mechanical ventilation
  • cascades to respiratory failure
59
Q

Pulmonary HTN in an infant CXR

A

anywhere from abnormal to clear

60
Q

Pulmonary HTN in an infant ECHO

A

indirect signs of Pulmonary HTN

61
Q

Pulmonary HTN in an infant - pulmonary hypoplasia

A
62
Q

Pulmonary HTN in an infant - PPHN

A
63
Q

PPHN AKA

A

Persistent pulmonary hypertension of the newborn

64
Q

Pulmonary HTN in an infant PPHN treatment

A

CVPR (93 decks)

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