General Flashcards
Most common causes for common cold
Rhinovirus Coronavirus RSV Influenza HMPV …
Increased incidence of colds
Mannose binding lectin deficiency
False negative sweat chloride
Malnutrition Edema Insufficient sweat Hyponatremia CFTR mutation but normal sweat
OSA symptoms
Morning headache FTT Pulmonary HTN Neurocognitive effect Growth Obesity/HTN Fatigue Apnea-hypopnea index=if under 12 > 1.5 per hour, if greater than 12 > 5 per hour
Pneumothorax causes
Primary- idiopathic sub pleural bleb, marfan, erlers danlos Secondary-CF, pneumonia, asthma, malignancy Ecstasy
Anterior mediastinal mass
5 t s Teratoma Thymoma Terrible lymphoma Thymus Thyroid T cell leukaemia Cystic hygroma Intrathoracic goiter
Posterior mediastinum mass
Neurogenic tumours Neurofibroma
Penicillin allergic pneumonia treatment
Azithromycin Clarithromycin
what is pulsus paradoxus? and when does it occur?
> 10 mmgh - large decrease in systolic blood pressure and pulse wave amplitude during inspiration. Cardiac tamponade, severe dyspnea, obesity, and positive pressure ventilator support, constrictive pericarditis, tension pneumo, large PE
what PFT features will be affected in restrictive lung disease
decreased TLC, VC and resting lung volume
what PFT features will be affected in OBSTRUCTIVE lung disease
decreased peak exp flow and FEV1
what are the bad bugs for CF?
staph aureus H.Flu Pseudomonas aeroginosas Burhoderia cepacia Stenotrophomonas Maltophilia Aspergillus
what are the genetics of CF
AR in CFTR gene on long arm of Chrom 7 3 base pair deletion Delta 508 - 70%
which CF bugs are associated with worst outcome
Pseudomonas Burkoderia cepacia
what autoimmune disorders can present with hemoptysis?
HSP idiopathic pulmonary hemosiderosis Goodpasture’s Wegener’s SLE polyarteritis nodosa
causes of cough in first month of life
CRADLE CF Resp infection-viral Aspiration - swallowing issues, GERD, TEF, FB Dyskenisia - ciliary Lung and airway malformation - laryngeal web, malacia, Edema - cardiac
what causes exudative pleural effusion
All high! prot, sp gravity… pneumonia TB Malignancy SLE Chylothorax
what causes transudate pleural effusions
CHF hypoproteinemia state cirrhosis upper airway obstruction
what is Kartagener Syndrome
Version of primary ciliary dyskinesia situs inversus chronic sinusitis bronchiectasis
which is more specific - intradermal skin test for allergies or Prick skin test
prick skin test
which is more sensitive - in vitro testing for allergies or skin testing?
Skin Testing!
Allergic Bronchopulmonary Aspergillosis
What are the clinical features?
hypersensitivity reaction to Aspergillus in CF
leads to inflammation and obstruction
Rx: steroids and antifungal (Voriconazole)
What are causes of restrictive lung disease?
they have decreased lung compliance
- neuromuscular weakness
- alveolar filling process: lobar pneumonia, pulm edema
- pleural disease
- thoracic narrowing - scoliosis
- abdo distention
what are causes of Chronic Cough
- asthma
- post nasal drip
- post infectious tussive syndrome
- GERD
- tracheoesophageal fistula
- tracheomalacia
- chronic infection
- FB
- psychogenic
- environmental
patients with congenital central alveolar hypoventilation syndrome have a increased risk of..
Hirschsrpung and neural crest tumors
defect in PHOX2B
what are secondary causes of central hypoventilation
- narcotics
- Chiari malformation
- inc ICP
- CNS tumour
- mitochondrial/metabolic disorder
- dysautonomia
what syndrome is associated with choanal atresia
10-20% with Choanal atresia have CHARGE syndrome
Coloboma,
Heart disease,
Atresia choanae,
Retarded growth(development, CNS anomalies or
Genital anomalies or hypogonadism or both, and
Ear anomalies or deafness or both
what are causes of vocal cord paralysis?
- left recurrent laryngeal nerve is more susceptible
- trauma - thoracic procedure
- mediastinal lesion
- Central - chiari malformation, hydrocephalus, intracranial hemorrhage
how does vocal cord paralysis present?
biphasic stridor
weak cry
hoarsness
aphonia
inc risk of aspiration
should improve in 3-6 mo, likely permanent after 1 year
what is the most common cause of tracheal compression
anomalous innominate artery-arises more distally than normal from aortic arch
when is a cough deemed chronic?
> 4-8 weeks
What are CXR findings suggestive of foreign body aspiration
- localized emphysema
- pneumonia
- atelectasis
- normal
what electrolyte abnormality would you expect with CF
hyponatremic
hypochloremic
metabolic alkalosis
what % of CF can be missed with the newborn screen?
5%
what are prognostic factors for CF?
MAles do better
FEV1
Burkohderia Cepacia
pneumotorax
nutrition status
DM
if a patient comes to you with year round wet cough and nasal congestion, recurrent AOM. What should you think of?
primary ciliary dyskinesia
Hx of neonatal resp distress and 47% have laterality defects
Dx on electron microscopy
if a patient has recurrent aspiration pneumonias, what is in your DDX
- laryngeal cleft - VACTRL, CHARGE, midline defects
- H type fistula - gold standard is rigid brnch
what are features of psychogenic cough
honking
disapears at night
no other features
worse with stress
can last months to years
all investigations are normal
what are 3 important investigatons to do for chronic wet cough?
CXR
PFT and bronchodilator response
Sweat test
for CF with resp exacerbation. What Abx choice?
cetfatzidine + Tobramycin for pseudomonas
+ Staf aureus coverage
