PULMO Flashcards
Pathophysiology of Bronchial Asthma (4)
- Airway hyperresponsiveness or hyperreactivity
- Bronchoconstriction
- Airway wall inflammation
- Mucus hypersecretion
Definitive test for cough variant asthma
Peak Flow test w bronchial provocation
>20% increase or more - positive
> Bronchodilator challenge: can be diagnostic and therpaeutic
if FEV1 increase =>12% or more - positive
Major immunoglobulin in the respi tract?
IgA
Light’s criteria (3)
PLL
1. Protein >3.0g; PF/Serum CHON ratio: >0.5
2. PF LDH >200IU/L
3. PF/Serum LDH >0.6
pH of <7.2 = exudative
Indications for chest tube thoracostomy (4)
- pH <7.2
- PF glucose <50
- clearly purulent fluid
- (+) organism on gram stain
Lab determination of chylothorax (3)
- Pleural fluid trigly >110mg/dL
- PF:S trigly ratio >1.0
- PF:S chole ration <1.0
Carboxyhgb level presenting w memory loss, hallucination and imminent cardiovascular collapse?
40-60%
Carboxyhgb level presenting w coma and seizures?
61-70%
Immediately fatal level of carboxyhgb?
> 80%
Indications for tonsillectomy. (3)
With documented histories of GAS infection.
1. at least >7 in the previous year or
2. at least > 5 in each of the previous 2 yrs or
3. at least >3 in each of the previous 3 yrs
TRUE or FALSE. Removal of tonsils results in major immunologic deficiency.
FALSE
Peak incidence of Retropharyngeal abscess?
3-4yrs
> because lymph nodes begin to involute by 5 yo
Sinuses in order of ascending appearances
Birth: Maxillary and ethmoid
Maxillary pneumatized at 4yo
Sphenoid: 5th yr of life
Facial: 7-8yo
Difference between Viral and Bacterial pharyngitis?
Bacterial pharyngitis – ABSENCE of prodrome
Prodrome sx:
> Cough
> Coryza
> Hoarseness
> Conjunctivitis
McIsaac scoring for GAS (5)
FAACCS
1. Fever >38degC
2. Age 3-14y
3. Absence of cough
4. anterior CLAD
5. tonsillar Swelling/exudates
If =>4– do testing for GAS
MC cause of epiglottitis in children?
Prophylaxis and indication?
H. influenza B
Rifampicin 20mg/kg OD x4days
> Age <12mos without primary vaccination
> Age <4yo with incomplete immunization
> Immunocompromised child
MC cause of UAO in children
MC etiology
Laryngotracheobronchitis
Parainfluenza
Clinical finding on Xray, and what Xray view?
1. Croup
2. Epiglottitis
- Croup
> AP CXR: steeple sign - Epiglottitis
> Lateral NECK Xray: thumb sign
Croup vs Spasmodic croup?
Spasmodic croup- NO Fever
MC cause of bacterial tracheitis?
S. aureus
Common location for foreign body aspiration?
Right main bronchus:
> wider and straighter
MC cause of bronchiolitis.
Peak age?
RSV
> infancy, 1-2yo, peak 6-12mos
> TWR
1. Tachypnea
2. Wheezes
3. Retractions
MC etiology of neonatal pneumonia
GBS
MC cause of pleural effusion in neonates
Chylothorax
Characteristic feature in pleural fluid of TB effusion?
Pleural fluid CHON >5g/dL
Mediastinal shift ipsilateral to the lesion: Pneumothorax or atelectasis?
Atelectasis
MC etiology of bronchitis
Adenovirus
MC cause of chronic or persistent cough in children.
Nelsons Chp 401, pg 2161
airway hyperreactivity (asthma)
At what age are infants are at greatest risk for developing SIDS?
1-4mos
> most deaths occur at 6mos
Which sleeping position has been shown to increase risk of SIDS?
Prone or supine?
Prone and side-lying
TRUE OR FALSE. Swaddling infants or wrapping them in a blanket reduces risk of SIDS.
FALSE
> Wearable blankets are an acceptable alternative
MC cause of childhood nasal poypois
Cystic fibrosis
Diagnosis of sinusitis requires how many criteria?
2 major OR 1 Major and =>2 Minor
Treatment of acute uncomplicated bacterial sinusitis
Amoxicillin 45mkday BID, 7-10days
Alternative: Cefdinir, cefuroxime, cefpodoxime or cefixime.
> Azithromycin and TMP-SMX - NO LONGER RECOMMENDED BECAUSE OF HIGH PREVALENCE OF ABX RESISTANCE
