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3. PEDIATRICS > PEDIATRICS Section 5: CHEST > Flashcards

PEDIATRICS Section 5: CHEST Flashcards

1
Q

When assessing the chest, what are the things you need to look for?

A
  1. Hyper-inflated or not?
    Flattening of the diaphragms
    Horizontal-appearing ribs (6 anterior, 8 posterior)
    Increased lucency under the heart
  2. Know what “Granular, Streaky or Roby” looks like
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2
Q

Describe
A. Granular
B. Streaky
C. Ropy

A

A. Granular

evenly distributed, fine granular opacification and pulmonary hypoventilation.

Classic appearance of “Hyaline Membrane Disease” or Surfactant-defincient Disease

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3
Q

Describe
A. Granular
B. Streaky
C. Ropy

A

B. Streaky

Interstitial opacitification in all areas of both lungs with thickening of interstitium

Seen in Transient Tachypnea of the newbord

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4
Q

Describe
A. Granular
B. Streaky
C. Ropy

A

C. Ropy

Bilateral alveolar opacities. Hyperinflated lungs with flattened hemidiaphragm.

Seen in Meconium aspiration

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5
Q

When you see HIGH volumes + Perihilar streaky, think of these.

A
  1. Meconium
  2. Aspiration
  3. Non GB (Group B) neonatal
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6
Q

When you see Not High volumes (Low or normal) + Granular

A
  1. SDD or Hyaline membrane Disease
  2. Group B
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7
Q

Describe Meconium Aspiration

A

This typically occurs secondary to stress (hypoxia),
POST-TERM babies
The pathophysiology is all secondary to chemical aspiration.

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8
Q

Ropy appearance + Hyperinflation + pneumothorax in 20-40% of cases

A

Meconium aspiration

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9
Q

Why are the lungs in Meconium aspiration hyperinflated?

A

The poop in the lungs act like miniature ball-valves (“floaters” I call them), causing air trapping - hence the increased lung volumes

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10
Q

Describe Transient Tachypnea of the Newborn (TTN)

A

Classic histories: C-Section, Maternal Sedation, Maternal Diabetes
Onset: Peaks at day 1, Resolved by Day 3
Lung Volumes - Normal to Increased

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11
Q

Other names for Surfactant-Deficient Disease

A

Hyaline Membrane Disease or RDS

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12
Q

Describe SDD

A

Classic Histories: PRE-MATURE (born without surfactant)
LOW lung VOlumes + Bilatera GRANULAR opacities (just like B-hemolytic Pneumonia

NORMAL plaine film at 6 hours excludes SDD

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13
Q

Most common cause of death in premature newborns

A

Surfactant-deficient disease

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14
Q

Surfactant Replacement Therapy has increased risk of these conditions

A

Pulmonary Hemorrhage and PDA

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15
Q

Thisisthemostcommontypeofpneumoniainnewborns.

A

Neonatal Pneumonia (Beta-Hemolytic Strep - or “GBS”)

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16
Q

How is Neonatal Pneumonia (GBS) acquired?

A

duringexitofthedirtybirth canal.

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17
Q

Describe Neonatal Pneumonia (GBS)

A

Low lung volume (NON-GB - high)
Granular opacities (for this and SDD)
Pleural effusion
Less likely to have pleural effusion than (25% vs 75% in nonGB)

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18
Q

Describe Neonatal Pneumonia (Non GBS)

A

Patchy asymmetric perihilar densiries
+ effusions
+ Hyperinflation

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19
Q

When high pressures persist in the lungs

A

Persistent Pulmonary HTN

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20
Q

Diagnosis?

A

Pulmonary Interstitial EMphysema

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21
Q
A
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22
Q
  • Consequenceofventilation
  • Usually occurs in the first week of life
  • Warning Sign for Impending Pneumothorax
  • Treatment is to put the bad side down
  • Buzzword = Linear Lucencies
A

Pulmonary Interstitial Emphysema

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23
Q

Prolonged ventilation in a premature (<32wk) tiny (<1000g) kid

A

Bronchopulmonary dysplasia

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24
Q

DIagnosis?
Describe the classic look

A

Bronchopulmonary dysplasia

Alternating regions of:
Fibrosis (coarse reticular opacities) + Hyperaeration

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25
"Band like opacities"
Bronchopulmonary dysplasia
26
"Linear lucences"
Pulmonary Interstitial Emphysema
27
Both PIE and Chronic Lung Disease (CLD, Bronchopulmonary Dysplaisa) have this similar feature. What is the difference?
Both have cystic lucencies. The difference (classic peds) is TIME.
28
"Post Term Baby"
Meconium Aspiration
29
"C-Section"
Transient Tachypnea of the newborn
30
"Maternal Sedation"
Transient Tachypnea of the newborn
31
"Premature"
RDS, Hyaline membrane disease or Surfactant defficiency disease.
32
Identify
Umbilical Venous Catheter (UVC) Things to know about UVCs: * The ideal spot is at the IVC - Right Atrium junction. * Clot forming in a portal vein branch can cause lobar atrophv * Development of a "Cystic Liver Mass" (Hematoma) can suggest UVC erosion into the liver.
33
Umbillical Artery Catheter Things to know about UACs: * It goes down first * It should be placed either high (T8-T10) or low (L3-L5) * Should stay left of midline on AXR (aorta on the left) * Omphalocele is a contraindication
34
Extracorporeal Memdrane Oxygenation is used for what conditions?
as a last resort in neonatal sepsis, severe SSD, and meconium aspiration.
35
When I say "Peribronchial Edema"
Think of viral Infection
36
Diagnosis? <8 years old + cough What is the culprit?
Younger than 8 you are thinking round pneumonia, round pneumonia, round pneumonia - with S. Pneumonia being the culprit.
37
Round pneumonia occurs because of this reeason
You don't have good collateral ventilation pathways
38
Next step if you find round pneumonia
NO CT, just follow up x ray
39
Descirbe Neonatal atypical peripheral atelectasis (NAPA)
It is best to think about this as a cousin or uncle of Round Pneumonia (they are in the same family). essentially the same thing except it is peripheral.
40
Classic look of Neonatal atypical peripheral atelectassi
Pleural based mass int he apex
41
history is a parent giving their newborn a teaspoonful of olive oil daily to cultivate “a spirit o f bravado and manliness.
Lipoid Pneumonia
42
Result of chronic fat aspiration
Lipoid pneumonia
43
classic finding of Lipoid pneumonia
CXR is nonspecific - it is just airspace opacities. CT is much more likely to be the modality used on the exam. The classic finding is low attenuation (-30 to -100 HU) within the consolidated areas reflecting fat content.
44
Key concept of bronchial foreign body
The key concept is that it causes air trapping.
45
How to assess Bronchial foreign body
You put the affected side down and it will remain lucent (from air trapping). under fluoro the mediastinum will shift AWAY from the affected side on EXPIRATION
46
What do you do to elicit air trapping?
Expiratory films
47
This is the classic unilateral lucent lung.
Swyer James Syndrome
48
Diagnosis? What's the cause?
The size of the affected lobe is smaller than a normal lobe (it’s not hyper-expanded). occurs after a viral lung infection in childhood resulting in POST INFECTIOUS OBLITERATIVE BRONCHILITIS.
49
soft tissue masses within the airway and lungs.
Papillomatosis
50
Culprit of papillomatosis?
Neonatal HPV Adult who smoke
51
Diagnosis? Describe give differential
Papillomatosis Multiple lung nodules which demonstrate cavitation Diff: LCH
52
Papillomatosis has a risk of this disease
Squamous cell CA (2%)
53
Kids with sickle cell can get what disease?
"Acute chest"
54
Leading cause of death in sickle cell patients
Acute test
55
Pathology of Acute chest in Sickle cell disease?
you infarct a rib -> that hurts a lot, so you don’t breathe deep -> atelectasis and infection.
56
Diagnosis?
Sickle cell disease * Kid with Big Heart * Kid with bone infarcts (look at the humeral heads) * Kid with H shaped vertebra (look on lateral) * Cholecysectomy Clips (look at right upper abdomen)
57
Pathophysiology of Cystic Fibrosis
sodium pump doesn’t work and they end up with thick secretions and poor pulmonary clearance leading to recurrent infections
58
Diagnosis? Describe
Cystic Fibrosis
59
Things to know in cystic fibrosis?
Things to know * Bronchiectasis (begins cylindrical and progresses to varicoid) * It has an apical predominance (lower lobes are less involved) * Hyperinflation * They get Pulmonary Arterial Hypertension * Mucus plugging (finger in glove sign) * Men are infertile (vas deferens is missing)
60
Give the Cystic fibrosis related diseases
Fatty Replaced Pancreas on CT Abdominal Films with Constipation Biliary Cirrhosis (from blockage of intrahepatic bile ducts), and resulting portal HTN
61
The motile part of the cilia doesn’t work. They can’t clear their lungs and get recurrent infections. These guys have lots o f bronchiectasis just like CF.
Primary Ciliary Dyskinesia
62
MAin difference of Cystic fibrosis and Primary Ciliary Dyskenesia?
63
Things to know in Primary Ciliary Dyskenesia?
Bronchiectasis (lower lobe) 50% have kartageners (situs inversus), so 50% will not Men are infertile (sperm tails don't work) Women are subfertile (Cilia needed to push eggs around)

3. PEDIATRICS (32 decks)

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