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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
Q

“Band like opacities”

A

Bronchopulmonary dysplasia

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26
Q

“Linear lucences”

A

Pulmonary Interstitial Emphysema

27
Q

Both PIE and Chronic Lung Disease (CLD, Bronchopulmonary Dysplaisa) have this similar feature. What is the difference?

A

Both have cystic lucencies. The difference (classic peds) is TIME.

28
Q

“Post Term Baby”

A

Meconium Aspiration

29
Q

“C-Section”

A

Transient Tachypnea of the newborn

30
Q

“Maternal Sedation”

A

Transient Tachypnea of the newborn

31
Q

“Premature”

A

RDS, Hyaline membrane disease or Surfactant defficiency disease.

32
Q

Identify

A

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
Q
A

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
Q

Extracorporeal Memdrane Oxygenation is used for what conditions?

A

as a last resort in neonatal sepsis, severe SSD, and meconium aspiration.

35
Q

When I say “Peribronchial Edema”

A

Think of viral Infection

36
Q

Diagnosis?

<8 years old + cough

What is the culprit?

A

Younger than 8 you are thinking round pneumonia, round pneumonia, round pneumonia - with S. Pneumonia being the culprit.

37
Q

Round pneumonia occurs because of this reeason

A

You don’t have good collateral ventilation pathways

38
Q

Next step if you find round pneumonia

A

NO CT, just follow up x ray

39
Q

Descirbe Neonatal atypical peripheral atelectasis (NAPA)

A

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
Q

Classic look of Neonatal atypical peripheral atelectassi

A

Pleural based mass int he apex

41
Q

history is a parent giving their newborn a teaspoonful of olive oil daily to cultivate “a spirit o f bravado and manliness.

A

Lipoid Pneumonia

42
Q

Result of chronic fat aspiration

A

Lipoid pneumonia

43
Q

classic finding of Lipoid pneumonia

A

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
Q

Key concept of bronchial foreign body

A

The key concept is that it causes air trapping.

45
Q

How to assess Bronchial foreign body

A

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
Q

What do you do to elicit air trapping?

A

Expiratory films

47
Q

This is the classic unilateral lucent lung.

A

Swyer James Syndrome

48
Q

Diagnosis? What’s the cause?

A

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
Q

soft tissue masses within the airway and lungs.

A

Papillomatosis

50
Q

Culprit of papillomatosis?

A

Neonatal HPV
Adult who smoke

51
Q

Diagnosis? Describe

give differential

A

Papillomatosis

Multiple lung nodules which demonstrate cavitation

Diff: LCH

52
Q

Papillomatosis has a risk of this disease

A

Squamous cell CA (2%)

53
Q

Kids with sickle cell can get what disease?

A

“Acute chest”

54
Q

Leading cause of death in sickle cell patients

A

Acute test

55
Q

Pathology of Acute chest in Sickle cell disease?

A

you infarct a rib -> that hurts a lot, so you don’t breathe deep -> atelectasis and infection.

56
Q

Diagnosis?

A

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
Q

Pathophysiology of Cystic Fibrosis

A

sodium pump doesn’t work and they end up with thick secretions and poor pulmonary clearance leading to recurrent infections

58
Q

Diagnosis? Describe

A

Cystic Fibrosis

59
Q

Things to know in cystic fibrosis?

A

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
Q

Give the Cystic fibrosis related diseases

A

Fatty Replaced Pancreas on CT
Abdominal Films with Constipation
Biliary Cirrhosis (from blockage of intrahepatic bile ducts), and resulting portal HTN

61
Q

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.

A

Primary Ciliary Dyskinesia

62
Q

MAin difference of Cystic fibrosis and Primary Ciliary Dyskenesia?

A
63
Q

Things to know in Primary Ciliary Dyskenesia?

A

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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