Pulm

Question 1

development

Answer 1

90% alv dev after birth. incr until 8yo

Question 2

obstructive defect

Answer 2

2/2 to decr airflow through narrowed airway: asthma, bronchiolitis, foreign body aspiration

Question 3

restrictive defects

Answer 3

2/2 decr lung V (air filling alveoli) ex: pul edema, scoliosis, pul fibrosis, respiratory M weakness

Question 4

PE

Answer 4

inspiratory stridor- extrathoracic obstruction~ croup and larygnomalacia (layrngeal cartiage soften and collapse into airway especially in supine)
expiratory wheezing: intrathoracic obstruction, asthma, bronchiolitis
crackles or rales- parenchymal disease- pneumonia and pul edema
incr second heart sound- elevated pul P,
eczema, digital clubbing

Question 5

epiglottitis: define, epi, etio, P, labs, CXR, Dx, Tx

Answer 5

acute inflm and edema of epiglottis, arytenoids and aryepiglottic folds
2-7yo M=F
etio: haemophilus influenzae type B (HIB) but rare bc vaccine. grou A beta hemolytic strep
P: abrupt onset of rapidly progressive upper airway obstruction w/o prodrome. May have high fever, toxic, muffled speech, quiet stridor, dysphagia with drooling, sitting forward in tripod position with neck hyperextension. complete airway obstruction with respiratory arrest may occur suddenly
Labs: leukocytosis with left shift. 90% pos blood culture
CXR: thumbprint on lateral
Dx: cherry red swollen epiglottis
tx: emergency, nasotracheal intubation, antibiotics-2/3 cephalosporen. rifampin if HIB. prophylax unionized contacts

Question 6

laryngotracheobronchitis (croup)

Answer 6

inflm and edema of subglottic larynx, trachea, bronchi.
epi: 2 types: viral croup (most common cause of stridor, 3mo-3yo F>M, fall/winter), spasmodic croup (year round preschool)
etio: viral- parainfluenza. spasmodic- HS rxn
P:
1) viral: URI prodrome then inspiratory stridor worse at night and with agitation, barky cough, hoarse voice, possible wheezing, steeple sign
2) spasmodic: a night, recur and resolve w/o tx
D: clinical
tx: cool mist, systemic corticosteroid if stridor at rest (dexamethasone), racemic epi and hospitalization if respiratory distress, beta2 agonist with wheezing,

Question 7

supraepiglotic D features

Answer 7

quiet stridor, no cough, muffled voice, dysphagia or drooling, high fever, to, neck extended tripod

Question 8

subepiglotic D features

Answer 8

loud stridor, barky cough, hoarse, no dysphagia, variable fever, no tox unles tracheitis, normal posture

Question 9

bronchiolitis

Answer 9

inflm of bronchioles due to virus

epi: most common lei in F, nov-aril, worse if have chronic lung disease or

Question 10

pneumonia, etio

Answer 10

infection and inflm of parenchyma
etio: dep on age. viruses most common cause in all age. 0-3mo- congenital - syphilis, too, CMV, intrapartum like GBS, post part like RSV, afebrile- chlaydia trachoma’s, ureaplasma urelyticum, CMV, PCP
3-5mo: virus like adenovirus, influenza a/b
bacteria- strep pneumonia
>6yo: mycoplasma pneumoniae, chlamydia pneumonia
virus: adenovirus, influenza, parainfluenca. bacteria- s pneumoniae

Question 11

pneumonia dx and tx

Answer 11

viral: URI sx then fever cough dyspnea, PE- tachypnia, wheezin, rales or distress, dx- intersitial infiltrates on CXR and WBC 20K, lobar consolidation on CXR. tx: antibiotics
chlamydia trachomatis: most common cause of afebrile pneumonia at 1-3mo, staccato type cough, hx of conjunctivitis, dx- eosinophilia and CXR- interstitial infiltrates. culture or direct fluorescent ab. tx- erythromycin or azithromycin
mycoplasma pneumoniae- sx: fever, chill, nonproductive cough 3-4wk, HA, widespread rales, dx- pos cold agglutinins nonspecific, CXR vary, igM for mycoplasma incr. tx: azy/erythromycin

Question 12

pertussis

Answer 12

whooping cough. bordetella pertussis

severe risk when

Question 13

asthma

Answer 13

most common chronic pediatric disease. 50% sx by 1, 90% by 5. 30-50% remission by puberty
CXR: hyperinflmation, peribronchial thickening, pathy atelectasis
PFT: incr lung V and decr expiratory flow rate

Question 14

acute wheezing dd

Answer 14

astham ,HS rxn, broncholitis, pneumonia, FBA, acute aspiration of stomach contents, enviro irritants

Question 15

cromolyn Na and nedocromil NA

Answer 15

anti0inflm prophylaxis by inhibit activation of inflm mediators. no effect on acute sx but prevent exacerbation of asthma

Question 16

anti-cholinergic v asthma

Answer 16

atropine or ipratropium bromid (astrovent).. 2nd line bronchodilators. decr airway vagal tone and block reflex bronchoconstriction

Question 17

leukotriene modifiers

Answer 17

montelukast. oral antiinflm agents for long term ctrl of mild persistent asthma

Question 18

CF sx

Answer 18

altered exocrine gland secretion
etio: auto recessive chromosome 7
abn CFTR protein
P: chornic progressive pul insufficiency, pancreatic insuf, high sweat electrolytes.
1) meconium ileus at birth in 20%
2) recurrent chronic respiraotry sx, steatorrhea, FTT
3> respiratory sign and sx- chronic productive cough, dyspnea, hyperinflation, crackles, wheezing, digital clubbing, PFT-decr respiratory flow rate, decr lung V
4) pneumonia with ss aureus then P aeruginosa
5) pum complications- hemoptysis, penumothorax, astham ,nasal polyps, precurrent pneumonia, pul fibrosis, cor pulmonale, respiratory fialure
6) pancreatic insuf in 90%

Question 19

CF dx

Answer 19

1+ pheno, pos fx, inr immunoreactive trypsinogen on newborn screen
lab: abn CFTR, sweat chloride>60, or t CF mut, or characteristic ion transport abn

Question 20

CF management

Answer 20

antibiotics, pul toilet, bronchodialtors, pancreatic enzyme replacement, oxygen, antiinflm, lung transplant,

Question 21

chronic lung disease

Answer 21

oxygen dependency beyond 28d of life. most common in premie with respiratory distress syndrome
etio: follow acute lung injury then secondary lung injury by oxidants and proteases, then healing of lung tissue is abn - tissue fibrosis, chronic airflow limits, decr compliance, obstructive+ restrictive disease
P: decr ocygenation, hypercarbia, intermittent tachypanea, freq respiratory infection
CXR: hyperinflation, atelectasis, linear or cystic radiodensities
incr caloric needs and delayed growth and dev
tx: sup O2, bronchodilators, diuretics, anti inflm, optimize caloric intake , prevent infection, ID complications like subglottic stenosis, reflux
prog- incr risk of sudden death

Question 22

apnea of infancy

Answer 22

unexplained cessation of breathing for 20s. respiratory pause may be central (no respiratory effort), obstructive (unsuccesful effort), or both
short central apnea

Question 23

ALTE: apparent life threatening event.

Answer 23

combo of apnea, color change, change in M tone, chokign or gaggin. recovery only after stimulation or resuscitation
DD; sz d, breath holding spells,incr in ICP by trauma bleeding tumor etc,Cardiac (bradycardia 2/2 congenital heart block of long QT –> apnea. or CHD, tof), pulm (upper aieway obsturction, most common is RSV, pertussis, LRI), intracranial mass, sepsis, metabolic, arrhythmia, abn central ctrl, munchausen, trauma, GI (GERD, swallow abn, tracheoesophaeal fistula)

Question 24

SIDS

Answer 24

sudden death in