Pulmo Flashcards
1
Q
total lung capacity
A
vital capacity + residual volume
inspiratory capacity + functional residual capacity
inspiratory capacity + expiratory residual volume + residual volume
2
Q
what parameters decreased in lung pathology
A
Vital capacity, inspiratory capacity, and expiratory reserve volume are decreased in lung pathology but are also effort dependent
3
Q
what parameters affected in Intrathoracic airway obstruction (asthma, cystic fibrosis)
A
Intrathoracic airway obstruction is associated with air trapping and abnormally high functional residual capacity and residual volume
4
Q
major pathophysiologic conse- quence of decreased FRC
A
hypoxemia
encountered in alveolar interstitial diseases and thoracic deformities
5
Q
what is disadvantage of infant lung
A
ribs more horizontal
diaphragm flatter
decreased capacity
lungs more compliant
6
Q
elastance
A
change in pressure / change in volume
7
Q
compliance
A
change in volume / change in pressure
8
Q
resistance
A
poiseuille’s law
proportional to length, viscosity
indirectly proportional to radius
9
Q
if airway lumen is decreased by half what is resistance
A
16 fold
10
Q
tunica media of pulmonary arteries become more muscular at __ trimester
A
3rd
11
Q
3 days after birth PVR is _% SVR
A
50%
12
Q
2 - 3 mo after birth PVR is _% SVR
A
15%
13
Q
pulmonary vasculature constricts
A
hypoxemia
acidosis
hypercarbua
14
Q
pulmonary vasculature dilates
A
increased o2
hypocarbia
15
Q
third leading cause of infant mortality in USA
A
SIDS
16
Q
implicated in SIDS
A
VEGF 5HT autonomic nervous sys polymorphism Ca ion channel complement/cytokine prematurity prone smoking soft bedding
17
Q
greatest risk for SIDS __ months
A
2-3mo
most deaths by 6 mo
18
Q
risk for regurgitation/aspiration highest in
A
prone
19
Q
t or f
risk for SIDS in sibling same as general population
A
false
higher
20
Q
internal nasal airway doubles in size by
A
6 months
21
Q
nasal passages contribute to __% total resistance of normal breathing
A
50
22
Q
most common nose congenital anomaly
A
choanal atresia
23
Q
most common syndrome associated with choanal atresia
A
CHARGE coloboma heart disease atresia chonae retarded growth/devt or CNS genital abnormalities/hypogonadism ear anomalies/deafness
CHD7 chromatin organization
24
Q
imaging of choice for choanal atresia
A
CT
25
repair of choice for choanal atresia
transnasal repair
26
perforation of nasal septum most common after birth due to
syphilis
tb
trauma
27
most common cause of septal deviation at birth
trauma
28
common site of bleeding in epistaxis
kiesselbach plexus
| in anterior septum where vessels from internal and external carotid meet
29
common cause of epistaxis
trauma
foreign bodies
dry air
inflammation
30
drug to stop epistaxis
oxymetazoline
| may do cautery with silver nitrate
31
adolescent with recurrent profuse bleeding
juvenile nasopharyngeal angiofibroma
32
nasal polyps commonly arise
ethmoidal sinus, middle meatus
33
most common childhood cause of nasal polyposis
cystic fibrosis
34
nasal polyp
aspirin sensitivity
asthma
samter triad
35
it is normal to have _ colds per year in kids
6-8
36
prolonged use of topical adrenergic agents (oxymetazoline, phenyleprine, xylometazoline) lead to rebound nasal obstruction
rhinitis medicamentosa
37
most common complication of cold
otitis media
38
use of oseltamivir in influenza can help reduce incidence of
otitis media
39
bacterial sinusitis is likely if
mored than 10-14 days
fever
facial pain
swelling
40
what sinuses are present at birth
ethmoidal (pneumatized)
| maxillary (pnuematized at 4 yrs old)
41
sphenoidal sinus present at
5 yrs old
42
frontal sinus
develops at 7-8 years old
43
etiology of chronic sinusitis
h. influenzae
a and b strep
m. catarrhalis
strep pneumo
44
initial therapy for sinusitis
amoxicillin 45mkday
45
tx if fail to respond to amoxicillin
coamoxiclav 80-90mkday
| azithromycin
46
osteomyelitis of frontal bone
| edema and swelling of forehead
Pott puffy tumor
47
tx for intracranial extension of sinusitis
cefotaxime/ceftriaxone + vancomycin
48
treatment for GABHS strep
pen V 250mg <27kg/60lb or 500mg >60lb BID x 10 days
amoxicillin 50mkd OD x 10 days
must be given within 9 days of illness
49
tx for eradicating strep carriages
clindamycin 20mkday TID x 10 days
50
indication for tonsillectomy
>7 episodes in 1 yr
> 5 episodes in 2yr
> 3 episodes in 3yr
51
retropharyngeal abscess occurs most commonly in
children 3-4 yr old
| boys more than girls
52
usual pathogens in retropharyngeal abscess
GABHS
anaerobic bacteria
staph
53
tx for retropharyngeal abscess
3rd gen cephalosporin + ampisul/clinda
54
septic thrombophlebitis if internal jugular vein
| cause?
lemierre disease
| fusobacterium necrophorum
55
tx for lemierre disease
penicillin or cefoxitin
| surgical drainage
56
lymphoid tissue that surrounds opening of oral and nasal cavities
waldeyer ring
57
lymphoid tissue of waldeyer ring most active
4-10 yr old
58
larynx composed of 4 cartilages (in order)
epiglottic, erytenoid, thyroid, cricoid
59
steeple sign
croup
60
tripod position
dyspnea
drooling
thumb sign
acute epiglottitis
61
```
occuring most commonly at night
resembles croup
recurrent
1-3 yrs old
no history of viral prodrome
```
spasmodic croup
62
sudden onset respiratory obstruction
6mo-3yr old
no prodromal signs of infection
foreign body
63
MOA of racemic epinephrine
contriction of precapillary arterioles through B adrenergic receptors
causes: fluid resorption and decrease in edema
64
etiology of bacterial tracheitis
staph (most common)
m. catarrhalis
hib
anaerobes
65
major pathologic feature of bacterial tracheitis
swelling at level of cricoid
| with copius secretions or pseudomembranes
66
treatment of bacterial tracheitis
vancomycin (life threatening)
| or nafcillin/oxacillin
67
T or f
| Obstruction of pharyngeal airway worse in sleep
True
68
T or f
| Obstruction of laryngeal, tracheal and bronchial airway worse when awake
True
69
Most common congenital laryngeal anomaly
Laryngommalacia
70
Most common cause of stridor in infants
Laryngomalacia
71
Symptoms of laryngomalacia appear
1-2 weeks old and increased severity 6mo
72
Diagnosis for laryngomalacia
Flexible laryngoscopy
73
Surgical procedure for laryngomalacia
Supraglattoplasty
74
Second most common cause of stridor
Congenital subglottic stenosis
75
Narrowest part of upper airway in kids
Subglottis
76
Typical presenting symptom for subglottic stenosis
Biphasic or primarily inspiratory stridor
77
Diagnosis of subglottic stenosis
X-ray and confirmed with laryngoscopy
78
Third most common congenital laryngeal anomaly that cause stridor
Vocal cord paralysis
79
Iatrogenic causes for vocal cord paralysis
TEF and PDA repair
80
Diagnosis of vocal paralysis
Laryngoscopy
81
Treatment for vocal cord paralysis
Resolve spontaneously 6-12 mo
If does not resolve in 2-3yrs then permanent
Bilateral vocal cord paralysis require tracheostomy
82
Anomaly associated with laryngeal web
Chromosome 22q11 deletion
83
Diagnosis of laryngeal web
Laryngoscopy
84
Laryngeal clefts associated with
```
Tracheal agenesis
Tef
G syndrome
opitz Frias syndrome
Pallister hall syndrome
```
85
Most common cause of secondary tracheomalacia
Aberrant inominate artery
86
Vascular anomalies from abnormal aortic arch complex
Vascular ring
87
Most common open/incomplete vascular ring
Aberrant right subclavian artery
88
Leading cause of mortality and morbidity in kids
Choking
89
Most foreign body obstruction at
Right bronchus
90
Immediate complication of foreign body airway obstruction
Air trapping/obstructive emphysema
91
90% acquired subglottic stenosis due to
Endotracheal intubation
92
Subglottic stenosis treated with
Endoscopy using gentle dilations and co2 laser
93
Primary tracheomalacia commonly seen in
Premature infants
| Male to female 2:1
94
Diagnosis of tracheomalacia
Bronchoscopy
95
Diagnosis of subglottic stenosis
X-ray then confirmed with scope
| CT not useful
96
B adrenergic should be avoided in bronchomalacia and tracheomalacia in the absence of asthma because
because they can exacerbate loss of airway patency due to decreased airway tone
97
Bronchomalacia and tracheomalacia resolve
3 years
98
most common respiratory tract neoplasms in children
Papillomas
99
Papillomas cause by
Hpv
100
Treatment for recurrent respiratory papillomatosis (RRP)
Surgery
101
Treatment of congenital hemangioma
Prednisone 2-4 mg/kg/day for 4-6 wk then taper
| Propranolol 2-3 mg/kg/day
102
most common benign tumors of trachea
inflammatory pseudotumor and hamartoma
103
Most common malignant tumor of trachea
Bronchial adenoma
104
Second most common bronchial malignant tumor
Bronchogenic carcinoma
105
Characteristic of asthma
airway inflammation, bronchial hyperreactivity, and reversibility of obstruction
106
Three identified patterns of infant wheezing are
transient early wheezer, the persistent wheezer, and the late-onset wheezer
107
Transient wheezer characteristic
(resolved by 6 yr of age)
| • Initial risk factor is primarily diminished lung size
108
Persistent wheezers
(persists beyond 6 yr of age)
• Initial risk factors include parental asthma history, atopic dermatitis, allergen sensitization, peripheral eosinophilia (>4%) and wheezing unrelated to colds in the 1st yr of life
• At increased risk of developing clinical asthma
109
Late-onset wheezer
(symptoms begin after age 3 yr and persist)
110
Cardiac wheeze
Pulmonary edema caused by heart failure can also cause wheezing by lymphatic and bronchial vessel engorgement that leads to obstruction and edema of the bronchioles and further obstruction
111
results from partial obstruction of a bronchus or bronchiole
| causing air trapping
obstructive overinflation
112
hyperresonance
small lung
mediastinal shift towards the abnormal lung
brought about by insult to lower respiratory tract
swyer james or macleod syndrome
113
site most commonly affected by congenital lobar emphysema
left upper lobe
114
important cause of early-onset severe panacinar pulmonary emphysema in adults in the 3rd and 4th decades of life and an important cause of liver disease in children
homozygous deficiency of α1-antitrypsin (α1-AT)
115
what does α1-antitrypsin (α1-AT) and other proteases do
inactivate proteolytic enzymes released from dead bacteria or leukocytes in the lung.
116
therapy for α1-AT deficiency is
intravenous replacement with enzyme derived from pooled human plasma
117
t or f
| right lung agenesis has higher morbidity and mortality than left
true
118
consequence when right lung is absent
aorta can compress the trachea
119
pulmonary agensis seen in
VACTERL
120
four types of CCAM
Type 0 (acinar dysplasia)
Type 1 (60%)
Type 2 (20%)
Type 3 (<10%)
Type 4 (10%)
121
Type 0 CCAM
```
Type 0 (acinar dysplasia)
is least common (<3%) and consists of microcystic disease throughout the lungs
prognosis is poorest for this type, and infants die at birth
```
122
Type 1 ccam
Type 1 (60%)
is macrocystic and consists of a single or several large (>2 cm in diameter) cysts lined with ciliated pseudostratifed epithelium;
Presentation is in utero or in the newborn period
Cartilage is rarely seen in the wall of the cyst.
good prognosis for survival
123
type 2 ccam
Type 2 (20%)
is microcystic and consists of multiple small cysts
associated with other serious congenital anomalies (renal, cardiac, diaphragmatic hernia) and carries a poor prognosis
124
type 3 ccam
```
Type 3 (<10%)
is seen mostly in males; the lesion is a mixture of microcysts and solid tissue with bronchiole-like structures lined with cuboidal ciliated epithelium and separated by areas of nonciliated cuboidal epithelium
poor prognosis
```
125
type 4 ccam
```
Type 4 (10%)
is commonly macrocystic and lacks mucus cells. It is associated with malignancy
```
126
what lesion can appear similar to CCAM
pleuropulmonary blastoma
127
common location of intrapulmonary sequestration
lower lobe
128
common location extrapulmonary sequestration
left lung
129
common sex extrapulmonary sequestration
more common in boys
130
common location of bronchogenic cyst
right near midline structure
131
congenital weakness of spurapleural membrane in neck
sibson's fascia
132
most common type of lung hernia
cervical
133
what can we use to differentiate cardiogenic from non cardio pulmo edema
brain natriuretic peptide BNP
>500 if cardiogenic
<100 if non cardio
134
what does PEEP do to help pulmo edema
prevents complete closure of alveoli
recruits collapsed alveoli
leads to increased functional residual capacity FRC, improved compliance, dec pulo vascular resistance
135
treatment for high altitude pulmonary edema
hyperbaric chamber
supplement o2
nifedipine
beta adrenergic
136
pulmonary edema caused by
| INCREASED PULMONARY CAPILLARY PRESSURE
Cardiogenic, such as left ventricular failure
Noncardiogenic, as in pulmonary venoocclusive disease, pulmonary
venous brosis, mediastinal tumors
137
pulmonary edema caused by
| INCREASED CAPILLARY PERMEABILITY
```
Bacterial and viral pneumonia
Acute respiratory distress syndrome
Inhaled toxic agents
Circulating toxins
Vasoactive substances such as histamine, leukotrienes,
thromboxanes
Diffuse capillary leak syndrome, as in sepsis Immunologic reactions, such as transfusion reactions Smoke inhalation
Aspiration pneumonia/pneumonitis
Drowning and near drowning
Radiation pneumonia
Uremia
```
138
pulmonary edema caused by
| LYMPHATIC INSUFFICIENCY
Congenital and acquired
139
pulmonary edema caused by
| DECREASED ONCOTIC PRESSURE
Hypoalbuminemia, as in renal and hepatic diseases, protein-losing states, and malnutrition
140
pulmonary edema caused by
| INCREASED NEGATIVE INTERSTITIAL PRESSURE
Upper airway obstructive lesions, such as croup and epiglottitis Reexpansion pulmonary edema
141
pulmonary edema caused by
| MIXED OR UNKNOWN CAUSES
Neurogenic pulmonary edema High-altitude pulmonary edema Eclampsia
Pancreatitis
Pulmonary embolism
Heroin (narcotic) pulmonary edema
142
gastric aspirate with increased severity
0.8ml/kg
| ph<2.5
143
what kind of hydrocarbons have more potention for aspiration
lower surface tensions (gasoline, turpentine, naphthalene) rather than mineral/fuel oil
144
ingestion of __ml is assoc with severe pneumonitis
>30ml
145
CHAMP have inherent systemic toxicity
camphor, halogenated carbons, aromatic hydrocarbons, and those associated with metals and pesticides
Patients who ingest these compounds in volumes >30 mL
may benefit from gastric emptying
146
most common underlying problem in recurrent aspiration
oropharyngeal coordination
147
anticholinergics for recurrent saliva aspiration
glycopyrrolate and scopolamine
148
nitrogen dioxide toxicity (corn silo)
silo filler disease or silage gas poisoning
149
primary eosinophilic lung disease
loffler syndrome
150
most common pathogen in pcap kids 3wk-4yr old
strep
151
most common pathogen in pcap kids >5yr old
mycoplasma pneumoniae
| chlamydophila pneumoniae
152
major cause of hospitalization and death from pcap
strep
hib
staph
153
pathogen pcap neonate
Group B streptococcus, Escherichia coli, other Gram-negative bacilli, Streptococcus pneumoniae, Haemophilus in uenzae (type b,* nontypeable)
154
pathogen pcap
| 3 wk-3 mo
Respiratory syncytial virus, other respiratory viruses (rhinoviruses, parain uenza viruses, in uenza viruses, adenovirus), S. pneumoniae, H. in uenzae (type b,* nontypeable); if patient is afebrile, consider Chlamydia trachomatis
155
pathogen pcap
| 4 mo-4 yr
Respiratory syncytial virus, other respiratory viruses (rhinoviruses, parain uenza viruses, in uenza viruses, adenovirus), S. pneumoniae, H. in uenzae (type b,* nontypeable), Mycoplasma pneumoniae, group A streptococcus
156
pathogen pcap
| ≥5 yr
M. pneumoniae, S. pneumoniae, Chlamydophila pneumoniae, H. in uenzae (type b,* nontypeable), in uenza viruses, adenovirus, other respiratory viruses, Legionella pneumophila
157
most common cause of parapneumonic pleural effusion
staph
strep pneumoniae
strep pyogenes
158
if aspiration happened while lying down
right and left upper lobes and apical segment of right lower lobe
159
if aspiration happened while upright
posterior segment of upper lobes
160
primary abscesses are found left or right?
right
161
secondary abscesses are found left or right?
left
162
duration of tx for lung abscess
2-3 weeks IV if uncomplicated followed by oral antibiotics to complete 4-6 weeks
if no improvement after 7 days, surgery
163
most common life limiting autosomal recessive trait among whites
cystic fibrosis
164
problem with cystic fibrosis
failure of epithelial cells to secrete chloride in response to CAMP
165
xray finding of meconium ileus
(cystic fibrosis)
dilated loops with air fluid levels
ground glass in lower central abdomen
166
diagnosis of cystic fibrosis
positive quantitative sweat test (Cl− ≥60 mEq/L)
PLUS
1 or more:
typical chronic obstructive pulmonary disease
documented exocrine pancreatic insuffciency
positive family history
167
test used in cystic fibrosis to check for exocrine pancreatic dysfunction
stool elastase
168
acid base balance seen in cystic fibrosis
hypochloremic alkalosis
169
to confirm diagnosis of meconium ileus
enema with diatrizoate
| diagnotic and for passage of meconium plug
170
surfactant secreted by
type II pneumocytes
171
what are the four surfactant proteins
surfactant proteins A and D (SP-A, SP-D)
participate in host defense in the lung
surfactant proteins B and C (SP-B, SP-C)
contribute to the surface tension–lowering activity of the pulmonary surfactant
172
iron-deficiency anemia, hemoptysis, and multiple alveolar infiltrates on chest radiographs
pulmonary hemosiderosis
173
most common cause of primary pulmonary hemosiderosis causing hemoptysis
goodpasture
| anti basement membrane hyperreactivity
174
cow milk hypersensitivity presenting as hemoptysis and pulmonary hemosiderosis
heiner syndrome
175
seen on histopath with recurrent or chronic pulmonary hemorrhages
hemosiderin laden macrophages
| detected by prussian blue
176
type of vasculitis that is ANCA antineutrophil cytoplasmic antibody positive
wegener granulomatosis
177
treatment for idiopathich pulmonary hemosiderosis
corticosteroids
| for immunosuppresion
178
most common embolus
thromboemboli
179
common risk factor of pulmo embo in kids
central venous catheter
180
prothrombotic diseases linked to pulmo embo
```
factor V leiden mutation
hyperhomocysteinemia
anticardiolipin antibody
elevated lipoprotein a
nephrotic
antiphospholipid antibody
sle
```
181
occlusion of artery bu pulmo embo leads to
increase in dead space
increase alveolar arterial oxygen difference
increase pulmonary vascular resistance
182
ecg finding of pulmo embo
```
st segment changes
RV failure (cor pulmonale)
```
183
diagnostic of choice to detect for pulmo embo
helical or spiral ct
184
gold standard for diagnosis of pulmo embo
pulmo angiography
185
target APTT value for anticoagulation in pulmo embo
1.5 - 2 times control
186
anemia of idiopathic pulmonary hemosiderosis similar to
hemolytic anemia
187
malignancies that metastasize to lungs
wilms, osteosarcoma, hepatoblastoma
188
most common cause of pleural effusion in children
bacterial pneumonia
other causes: heart failure, rheuma, malignancy
189
rate of fluid formation in pleural effusion dictated by
starling law
190
normal fluid in pleural space
4-12ml
191
exudative pleural effusion
AT LEAST 1:
protein level >3.0 g/dL
pleural fluid : serum protein ratio >0.5
pleural fluid lactic dehydrogenase values >200IU/L
fluid:serum lactic dehydrogenase ratio >0.6
pH <7.20 suggests an exudate
192
rapid removal of pleural effusion >1L associated with
reexpansion edema
193
empyema most assoc with
strep pneumoniae
194
stages of empyema
Empyema has 3 stages: exudative, fibrinopurulent, and organizational
195
exudative stage of empyema
fibrinous exudate forms on the pleural surfaces
196
fibrinopurulent stage of emypema
fibrinous septa form, causing loculation of the fluid and thickening of the parietal pleura
197
organizational stage of empyema
fibroblast proliferation
198
collagen defects prone to spontaneous pneumothorax
ehlers danlos
| marfan
199
related to menses
| associated with diaphragmatic defect and pleural blebs
catamenial pneumothorax
200
chemical pleurodesis for pneumothorax
talc
doxycycline
iodopovidine
201
fibronlytic treatment in empyema
urokinase
streptokinase
tissue plasminogen activator
202
mediastinal crunch
hamman sign
| pneumomediastinum
203
chylothorax most common after
thoracic duct injury after TCVS surgery
204
in no resolution of chylothorax in 1-2weeks, may do
total parenteral nutrition
| IF IT DOESN'T WORK, then a pleuroperitoneal shunt, thoracic duct ligation, or application of brin glue is considered
205
neonates with chylothorax and indication for surgery
chyle output of >50 mL/kg/day despite maximum medical therapy for 3 days
206
pectus excavatum occurs most commonly in what sex
males
207
most common chest wall deformity
90%
| pectus excavatum
208
ecg in pectus excavatum
RAD
| wolff parkinson white syndrome
209
2 main surgical intervention in pectus excavatum
Ravitch
| Nuss
210
pectus carinatum occurs most commonly in what sex
males
211
bell shaped chest on xray with short horizontal flaring ribs and high clavicles
Thoracic-Pelvic-Phalangeal Dystrophy
| or Asphyxiating Thoracic Dystrophy
212
as the severity of scoliosis increases, the following respi parameters will have
Vital capacity, forced expiratory volume in 1 sec (FEV1), work capacity, oxygen consumption, diffusion capacity, chest wall compliance, and partial pressure of arterial oxygen decrease
213
spinal curve more than __ degrees define scoliosis
10
214
chronic respiratory failure defined as
pulmonary insufficiency for a protracted period, usually 28 days or longer
