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Pulmonology > Pulmo > Flashcards

Pulmo Flashcards

1
Q

Transudate findings

A

low specific gravity (<1.015)
ratio pleural fluid to serum total protein <0.5
ratio of pleural fluid to serum lactic acid dehydrogenase <0.6

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2
Q

large pneumothorax

A

American College of Chest Physicians:
>/=3cm lung apex–> cupola

British Thoracic Society:
>/= 2cm lung margin to chest wall at hilum

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3
Q

treatment for Pneumothorax

A

small or moderate sized: may resolve spontaneously
small pneumothorax: 100% oxygen

*needle aspiration 2nd ICS, midclavicular

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4
Q

treatment for recurrent tension pneumothorax

A 
chest tube drainage
sclerosis procedure (talc, doxycycline, iodopovidone
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5
Q

Asthma findings in spirometry

A

decreased FEV1, FEV1/FVC ratio: <0.80

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6
Q

Asthma response to bronchodilator

A

FEV1 >12% or predicted value FEV1>10% after SABA

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7
Q

Asthma findings in exercise challenge

A

worsening FEV1> 15%

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8
Q

Daily PEF or FEV1 monitoring

A

day to day and/or AM-PM >/= 20%

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9
Q

response to exhaled nitric oxide

A

<20ppb: unlikely to respond to ICS
20-35: intermediate; may response
>35: respond to ICS

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10
Q

most common pathogens associated with common colds

A

rhinoviruses

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11
Q

1st symptom of common cold

A

scratchy throat followed by nasal obstruction and rhinorrhea

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12
Q

management of common cold

A

symptomatic

  • Oseltamivir and Zanamivir have modest effect on duration of symptoms associated with influenza viral infection
  • Oseltamivir- reduces frequency of influenza-associated otitis media

*1st gen antihistamines

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13
Q

prolonged use of topical adrenergic agents may cause

A

rhinitis medicamentosa

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14
Q

most common complication of colds

A

otitis media

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15
Q

sinus present at birth

A

ME!!
Maxillary
Ethmoidal - only pneumatized

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16
Q

sinus not pneumatized until 4yrs old

A

Maxillary sinus

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17
Q

sinus present by 5 yrs of age

A

sphenoidal sinus

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18
Q

sinuses which begin development at 7-8yrs

A

frontal sinuses

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19
Q

etiologic agents of sinusitis

A

S. pneumoniae
nontypable Hib
Moraxella catarrhalis

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20
Q

chronic sinusitis is defined as

A

history of persistent respiratory symptoms including cough, nasal discharge, or nasal congestion lasting >90 days

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21
Q

only accurate method of diagnosis of sinusitis but not practical for routine use for immunocompromised patients

A

sinus aspirate culture

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22
Q

treatment for uncomplicated bacterial sinusitis

A

Amoxicillin

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23
Q

treatment for frontal sinusitis

A

parenteral Ceftriaxone

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24
Q

gold standard for diagnosing streptococcal pharyngitis

A

throat culture

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25
Q

prominent sore throat and fever in absence of cough

A

streptococcal pharyngitis

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26
Q

treatment regimen most effective for eradicating streptococcal carriage

A

Clindamycin

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27
Q

bulging of the posterior pharyngeal wall

A

retropharyngeal abscess

  • I&D of an abscessed node provides definitive diagnosis
  • CT useful in identifying presence of retropharyngeal, lateral pharyngeal or parapharyngeal abscess
  • IV antibiotics with or without drainage
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28
Q

treatment for retropharyngeal abscess

A

3rd en cephalosporins combined with Ampicillin-Sulbactam or Clindamycin

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29
Q

asymmetric tonsilar bulge with displacement of uvula

A

Peritonsillar abscess

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30
Q

narrowest portion of the upper airway in children less than 10yo

A

cricoid cartilage

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31
Q

hoarseness, inspiratory stridor and respiratory distress

A

Croup

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32
Q

most commonly identified etiology of acute epiglotittis

A

HiB

S. pneumoniae, S. pyogenes, S. aureus - vaccinated children

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33
Q

most common form of acute upper respiratory obstruction

A

Croup

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34
Q

xray findings in croup

A

subglottic narrowing or steeple sign

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35
Q

treatment for croup

A

nebulized racemic epinephrine for moderate or severe

corticosteroids in viral croup

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36
Q

child assumes tripod position, sitting upright and leaning forward with chin up and mouth open

A

Epiglotittis

  • stridor is a late finding
  • diagnosis: large, cherry red swollen epiglottis by laryngoscopy
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37
Q

radiograph findings in epiglotittis

A

thumb sign

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38
Q

indications for Rifampicin prophylaxis

A

all household members are any contact <48 months of age who is incompletely immunized
any contact <12months who has not received the primary vaccination series
immunocompromised child in the household

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39
Q

etiology of bacterial tracheitis

A

staphylococcal aureus

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40
Q

brassy cough, high fever and toxicity with respiratory distress

A

Bacterial tracheitis

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41
Q

most common congenital laryngeal anomaly

A

laryngomalacia

diagnosis: outpatient flexible laryngoscopy

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42
Q

most common cause of stridor in infants and children

A

laryngomalacia

diagnosis: outpatient flexible laryngoscopy

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43
Q

3 stages of symptoms from aspiration

A
  • initial event: violent paroxysms of coughing, choking, gagging, possibly airway obstruction immediately
  • asymptomatic interval: foreign body becomes lodged, reflexes fatigue and immediate irritating symptoms subside; most treacherous and accounts for large percentage of delayed diagnosis
  • complications: obstruction, erosion or infection
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44
Q

Prev healthy adolescent with history of recent pharyngitis who becomes acutely ill with fever, hypoxia, tachypnea and respiratory distress

A

Lemierre disease

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45
Q

Most episodes of acute pharyngotonsilitis are caused by

A

Virus

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46
Q

Most common cause of recurrent cough in children

A

Reactive airway disease

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47
Q

Bronchiolitis obliterans is usually caused by

A

Adenovirus

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48
Q

Hyperinflation with bilateral interstitial infiltrates and peribronchial cuffing

A

Viral pneumonia

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49
Q

Most common complaints in patients with bronchiectasis

A

Cough and production of copious purulent sputum

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50
Q

Treatment for mild pneumonia not needing hospitalization

A

Amoxicillin

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51
Q

Drug of choice for children with M. Pneumoniae or C. pneumoniae in school aged children

A

Macrolide such as Azithromycin

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52
Q

Mainstay of therapy for bacterial pneumonia in a hospitalized child

A

Parenteral Cefotaxime or Ceftriaxone

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53
Q

most common bacterial pathogen for pneumonia in children 3 weeks to 4 yrs old

A

Streptococcus pneumoniae

54
Q

most frequent pathogen for pneumonia in children 5 yrs and older

A

Mycoplasma pneumoniae

Chlamydophila pneumoniae

55
Q

major causes of hospitalization and death from bacterial pneumonia among children in developing countries

A

S. pneumoniae
H. influenzae
S. aureus

56
Q

prominent cause of lower respiratory tract infection in infants and children <5 yrs old

A

Viral pathogens

57
Q

attaches to respiratory epithelium, inhibits ciliary action and leads to cellular destruction and inflammatory response in the submucosa

A

M. pneumoniae

58
Q

produces local edema that aids in the proliferation of organisms and their spread into adjacent portions of lung, often resulting in characteristic focal lobar involvement

A

S. pneumoniae

59
Q

causes more diffuse infection with interstitial pneumonia

A

Group A streptococcus

60
Q

manifests in confluent bronchopneumonia

A

S. aureus

61
Q

what is recurrent pneumonia?

A

2 or more episodes in a single year or 3 or more episodes ever with radiographic clearing between occurrences

62
Q

usually characterized by hyperinflation with bacterial interstitial infiltrates and peribronchial cuffing

A

Viral pneumonia

63
Q

confluent lobar consolidation is seen in

A

Pneumococcal pneumonia

64
Q

for mildly ill patients with pneumonia who do not require hospitalization

A

Amoxicillin

65
Q

what to give in patients with pneumonia caused by M. pneumoniae or C. pneumoniae

A

Macrolide such as Azithromycin

66
Q

mainstay of therapy when bacterial pneumonia is suggested in a hospitalized child

A

Parenteral Cefotaxime or Ceftriaxone

67
Q

pneumatoceles

A

staphylococcal pneumonia

68
Q

initial antibiotic of choice for staphylococcal pneumonia

A

Vancomycin or Clindamycin

69
Q

what is the 1st step in determining the reason for delay in response to treatment in pneumonia?

A

Repeat chest radiograph

70
Q

most common causes of parapneumonic effusions and empyema

A

S. aureus
S. pneumoniae
S. pyogenes

71
Q

what is affected when a child aspirates while recumbent?

A

right and left upper lobes and apical segment of the right lower lobe which are the dependent areas

72
Q

primary abscess in the lung is most often seen on the

A

right side

73
Q

secondary abscess in the lung is most often seen on the

A

left side

74
Q

CT scan findings in patients with lung abscess

A

thick walled lesion with a low density center progressing to an air fluid level

75
Q

management for lung abscess

A

2-3 weeks of parenteral antibiotics for uncomplicated cases followed by oral antibiotics to complete 4-6 weeks

76
Q

pain is the principal symptom exaggerated by deep breathing, coughing and straining

A

Dry or Plastic Pleurisy (pleural effusion)

77
Q

normal fluid in the pleural space

A

4-12ml of fluid

78
Q

3 stages of empyema

A

exudative stage: fibrinous exudate in pleura
fibrinopurulent stage: fibrinous septa causing loculation of fluid and thickening of the parietal pleura
organizational: fibroblast proliferation

79
Q

treatment for pleural effusion

A

systematic antibiotics, thoracentesis possible chest tube drainage with or without fibrinolytic agent, VATS or open decortication

80
Q

occurs without trauma or underlying lung disease

A

primary spontaneous pneumothorax

81
Q

complication of an underlying lung disorder but without trauma

A

secondary spontaneous pneumothorax

82
Q

small (<5% ) pneumothorax management

A

may resolve without specific treatment usually within 1 week

83
Q

recurrent, secondary or under tension pneumothorax is managed by

A

chest tube drainage

84
Q

used in chemical pleurodesis

A

talc
doxycycline
Iopovidone

85
Q

Best single predictor of death in patients with pneumonia

A

Presence of retraction on admission

86
Q

Diagnostic aids requested for PCAP A and B

A

None

87
Q

Diagnostic aids for PCAP C and D

A 
Chest xray PA and Lateral
WBC count
Culture and sensitivity of
Blood for PCAP D
Pleural fluid
Tracheal aspirate upon initial intubation
Blood gas and/or pulse oximetry
88
Q

When is antibiotics needed in pneumonia

A

PCAP A or B and beyond 2yrs old and having high grade fever without wheeze

PCAP C beyond 2 years old, having high grade fever without wheeze or having alveolar consolidation in the chest xray

PCAP D

89
Q

Best predictor of underlying etiology of pediatric pneumonia

A

Age

90
Q

Treatment for PCAP A or B without previous antibiotic

A

Oral amoxicillin 40-50mkday in 3 divided doses

91
Q

Treatment for PCAP C without previous antibiotic and has completed primary immunization against HiB

A

Pen G 100,000units/kg/day in 4 divided doses

92
Q

For patients without primary immunization to Hib

A

IV Ampicillin 100mg/kg/day in 4 divided doses

93
Q

if viral etiology in pneumonia is strongly suggested, what treatment should be given?

A

Oseltamivir 2mg/kg/dose for 5 days or Amantadine may be given for Influenza

94
Q

when is a patient considered as responding to treatment for pneumonia?

A

decrease in respiratory signs and defervescence within 72 hours after initiation of antibiotic therapy

persistence of symptoms beyond 72 hours of antibiotics requires re-evaluation

end of treatment xray should NOT be done

95
Q

In patients with Pneumonia not responding to current antibiotic use?

A

if PCAP A or B:
change initial antibiotics or start oral macrolide
or reevaluate diagnosis

If PCAP C:
consult a specialist
may be S. pneumoniae penicillin resistant; presence of complications, other diagnosis

PCAPD: re-consultation with specialist

96
Q

how can pneumonia be prevented?

A

Vaccines
Zinc supplementation 10mg for infants and 20mg for children beyond 2 years of age given 4-6 months

Vitamin A immunomodulators and Vitamin C should not be routinely administered

97
Q

“fuzzy vessels”
sunburst pattern
peripheral air trapping

A

TTN

98
Q

persistent fetal circulation

A

PPHN

99
Q

gold standard to confirm PPHN

A

2D echo:

useful in identifying sites of extrapulmonary shunting and assessing right and left ventricular function

100
Q

“bubbly lungs”

A

BPD

101
Q

prevention of BPD

A 
early use of nasal CPAP (nCAP)
early surfactant therapy
caffeine to prevent apnea
Vitamin A supplementation
systemic corticosteroids (not routine)
101
Q

prevention of BPD

A

early use of nasal CPAP (nCAP)

early surfactant therapy

102
Q

CHARGE syndrome

A 
Coloboma
Heart anonalies
Atresia (choanal)
Retarded growth
Genital abnormalities
Ear abnormalities
103
Q

VACTERL syndrome

A 
Vertebral defects
Anus imperforate
Cardiac defect
TEF
Renal defect
Limb anomalies
104
Q

Acute sinusitis

A

<30 days

105
Q

Subacute sinusitis

A

1-3 months

106
Q

Chronic sinusitis

A

> 3 months

107
Q

Paradise criteria

A

> /=7 episodes in the previous year
Or >/=5 episodes in each of preceding 2 years
/=3 episodes in each of preceding 3 years

108
Q

Bronchiolitis is caused by

A

RSV

109
Q

Indications for admission for patients with bronchiolitis

A 
Marked respiratory distress
Age <12weeks
Toxic appearance, poor feeding, lethargy, dehydration
Apnea
O2 sat <92%
History of prematurity
Underlying cardiopulmonary, neurologic or immunologic disease
Unreliable caregivers
110
Q

Inflammation of large and medium sized airways of the lungs

A

Acute bronchitis

111
Q

Clinical triad of pneumonia

A

Fever
Cough
Tachypnea

112
Q

Pneumatocele

A

Staphylococcal pneumonia

113
Q

Following tests may be requested for PCAP A and B

A

Chest radiograph
O2 sat by pulse oximetry
Gram stain, aerobic culture and sensitivity of sputum
Chest ultrasound

114
Q

Tests may be requested for PCAP C and D

A 
O2 sat by pulse oximetry
ABG to assess gas exchange
Chest radiograph
Blood work up: CRP, Procalcitonin
Chest UTZ or radiograph: if with clinical suspicion of multi-lobar consolidation, necrotizing pneumonia. Lung abscess, pleural effusion, air leak

To determine etiology: may do GS/CS sputum, nasopharyngeal aspirate, tracheal aspirate, pleural fluid and/or blood cultures

115
Q

Preferred management for asthma in 0-3years

A

pMDI with spacer and face mask

116
Q

Preferred treatment for asthma in 4-5 years old

A

pMDI with spacer and mouthpiece

117
Q

In asthma, consider stepping down if symptoms are controlled for ___months

A

3 months

118
Q

Findings in exudate have at least 1 of the ff:

A 
Protein >3g/dL
PH <7.20
Pleural fluid:serum protein ratio >0.5
Pleural fluid:serum LDH >0.6
Pleural fluid LDH level >200 IU/L or pleural fluid LDH >2/3 serum LDH upper limit of normal
119
Q

most common cause of postneonatal infant mortality

A

SIDS

120
Q

most common site of epistaxis

A

kiesselbach plexus

121
Q

most common form of acute upper respiratory obstruction

A

Croup

122
Q

most common laryngeal anomaly

A

Laryngomalacia

123
Q

most common cause of stridor in infants and children

A

Laryngomalacia

124
Q

most common cause of secondary tracheomalacia

A

aberrant innominate artery

125
Q

most common cause of chronic hoarseness in chidlren

A

vocal nodules

126
Q

most common presenting symptom of pulmonary embolism in all pediatric patients

A

unexplained and persistent tachypnea

127
Q

most common pulmonary malignancy in children

A

metastatic lesions

128
Q

Intrathoracic vs Extrathoracic obstruction

A

Intrathoracic obstructionis most severe during expiration and is relieved during inspiration.

Extrathoracic obstructionis increased during inspiration because of the effect of atmospheric pressure to compress the trachea below the site of obstruction.

129
Q

Most common cause of pleural effusion in children

A

Bacterial pneumonia

Pulmonology (1 decks)

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