peds resp.

Question 1

def. asthma

Answer 1

inflammatory disorder of the airway char by paroxysmal or persistnet Sx associated with variable degree of airflow limitations and responsiveness of the airway to stim.

Question 2

Sx suggestive of athsma

Answer 2

• freq. breathlessness, wheeze or cough
• Sx worse at night or in early AM
• dev with infection, excercise, exposure to allergens
• after playing or laughing
• better with roids or dilators

Question 3

2 requirements for asthma diagnosis

Answer 3

1. FEV1/FVC 12% with dilators (in adults must be over 200ml)

Question 4

how to diagnose in preschoolers

Answer 4

• not able to do PFTs

- need careful Hx and PHx

Question 5

what is in asthma predictive index

Answer 5

>4 wheezing episodes in past year
PLUS
ONE major crit.:
- parent with astma
- atopic dermatitis
- allergen sens
OR
2 minor crti.:
-food sens
- peripheral eosinophilia
- wheezing not related to infection

Question 6

what is goal of asthma Sx management

Answer 6

want them to be asymtomatic

Question 7

what are two main therapeutic targets

Answer 7

1. smooth muscle dysfunction

2. airway inflammation

Question 8

2 main types of meds and their types

Answer 8

1. controllers
   - roids
   - LTRA
   - amalizumab
2. relievers
   - SABA
   - LABA

Question 9

what are guidelines for controller therapy

Answer 9

1. regular controller therapy indicated for those with poor asthma control
2. ICS are first line for all ages
   - second line is LTRA

Question 10

if taking low dose ICA, what are three options to increase

Answer 10

1. increase to mod or high dose
2. add LABA
3. add LTRA
   - not enough evidecne for

Question 11

what is reccomendation for adults with low dose ICS for escalation

Answer 11

add a LABA

Question 12

what is reccomendations for children on low dose ICS

Answer 12

mod or high dose

Question 13

what is recc for children on mod-high dose ICS

Answer 13

add a LABA

Question 14

what is CF

Answer 14

• auto recc. disorder
• affects lung, panc, intestines, liver
• affects CF transmembrae regulator

Question 15

what is CFTR needed for

Answer 15

allows Cl out to keep a good layer of airway surface fluid

Question 16

what are 6 classes of CF

Answer 16

1. no protein
2. poor folding- not on surface
3. gets to surface, doesn’t work
4. doesn’t work well
5. not very many
6. less stable

Question 17

what are 2 types of CF and what classes in each

Answer 17

1. panc. insuff
   - !,2,3
2. panc suff
   4,5,6

Question 18

3 things that influence CF outcomes

Answer 18

1. genes
2. env.
3. time

Question 19

what is needed for CF diagnosis

Answer 19

clinical features compatible OR CF in sib OR +ve newborn screeen
PLUS
lab evidence
- sweat test
- nasal PD
- 2 disease causing mutations

Question 20

what is levels for sweat test

Answer 20

sweat Cl > 60 is pos
30-60 intermediate
panc. insuff. have lower mean sweats

Question 21

what are newborn screening steps

Answer 21

1. check for trypsinogen on blood spot
2. if elevated, check for 35 DNA mutations
3. is mutations found - sweat test

Question 22

Tx of pulm. manifestations for CF

Answer 22

• chest physio
• mucolytics
• ABs
• SABA
• ICS
• O2
• lung transplant

Question 23

Tx of extra-pulm manifestations

Answer 23

• enzyme replacement
• ADEK vits
• high cal, high fat diet
• ursodiol

Question 24

def. Obst. Sleep Apnea

Answer 24

recurrent events of full or partial complete upper airway obst. during sleep

Question 25

what defines severe OSA

Answer 25

apnea-hyponea index >100/hour

Question 26

2 general issues that make the balance

Answer 26

1. neuromuscular activation

2. structural narrowing

Question 27

2 ways to diagnose

Answer 27

1. Hx and Phx - poor accuracy

2. polysomnogram

Question 28

Tx for OSA

Answer 28

adenotonsillectomy

- cures 80%