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Pulmonary Flashcards

1
Q

What is hypercapnia?

A

Inadequate alveolar ventilation, increased CO2 production

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2
Q

Pattern:

Tachypnea/tachycardia, cyanosis, AMS

A

hypoxemia

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3
Q

Pattern:

Agitation, confusion, flushing, tachycardia, headache

A

hypercapnia

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4
Q

Pattern:

Very low pH, very high CO2, mildly high bicarbonate

A

acute respiratory acidosis

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5
Q

Pattern: Low pH, very high CO2, very high bicarbonate

A

chronic respiratory acidosis

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6
Q

Pattern: Very high pH, very low CO2, mildly low bicarbonate

A

acute respiratory alkalosis

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7
Q

Pattern: High pH, very low CO2, very low bicarbonate

A

chronic respiratory alkalosis

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8
Q

Pattern: very low pH, very low CO2, very low bicarbonate

A

metabolic acidosis

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9
Q

Pattern: very high pH, mildly high CO2, very high bicarbonate

A

metabolic alkalosis

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10
Q

Pattern: recurrent infections, left sided mass in lower lobe, mucoid impaction surrounded by hyperinflated lung

A

Pulmonary sequestration

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11
Q

What is congenital adenomatoid malformation? How does it appear on CT?

A

overgrowth of pulmonary tissue in region of end bronchioles. presents as respiratory symptoms due to compression or infection. Translucent round lesions on chest xray

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12
Q

What is a bronchogenic cyst?

A

foregut cysts with closed epithelium lined saces containing hyaline cartilage plates, most common cysts of infancy, filled with fluid or mucus that may become infected

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13
Q

Pattern:

bronchial destruction, bronchial dilation, accumulation of infected secretions

A

Bronchiectasis from problems such as primary ciliary dyskinesia

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14
Q

Pattern: bronchiectasis, sinusitis, situs inversus

A

Kartagener’s syndrome

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15
Q

3 genes associated with primary ciliary dyskinesia

A

DNA11, DNA H5, DNA H 11

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16
Q

Pattern: chronic production cough, chronic nasal congstion with mucopurulent drainage without seasonal variation, chronic otitis media, sinusitis, nasal polyposis, wheeze, recurrent penumonia, bronchiectasis, respiratory distress in term neonates, male inferitility, hdyrocephalus, situs inversis

A

Primary ciliar dyskinesia

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17
Q

What is acute respiratory distress syndrome?

A

Acute inflammatory lung injury resulting in widespread pulmonary edema as a result of increased alveolar capillary permeability and epithelial destruction

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18
Q

Pattern: catastrophic pulmonary or nonpulmonary event, increased shunt fraction (hypoxemia), decreased lung compliance, diffuse pulmonary infiltrates, exclusion of left heart disease

A

ARDS

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19
Q

Pattern: refractory hypoxemia, tachypnea, increased work of breathing, respiratory muscle fatigue, protein rich pulmonary edema fluid

A

ARDS

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20
Q

Pattern: drooling, dysphagia, dysphonia, distress, deafening

A

epiglottitis

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21
Q

Steeple sign on CXR

A

croup

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22
Q

Thumb print on CXR

A

epiglottitis

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23
Q

Pathogen for viral croup

A

parainfluenza 1, 3

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24
Q

Pathogen for bacterial tracheitis

A

staph aureus
strept
moraxella catarrhalis

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25
Q

Pattern:

high fever, Child sitting toxic, drooling, dysphagia, muffled voice

A

epiglottis

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26
Q

Pattern: low-grade fever, child lying down, nontoxic, barking cough, hoarseness

A

Viral croup

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27
Q

Pattern: high fever, toxic, barking cough

A

bacterial tracheitis

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28
Q

What are 7 things to do as emergency treatment for upper airway obstruction

A
  1. continuous observation
  2. oxygen
  3. cool mist treatment
  4. racemic epinephrine
  5. decadron
  6. helium-oxygen mixtures
  7. intubation or tracheostomy
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29
Q

Pattern: unusual sleep postures, enuresis, systemic HTN, pulm HTN, snoring, distured sleep/agitate arousals, dytime neurobehavioral problems

A

OSAS

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30
Q

Who is at high risk for OSAS

A
  1. Craniofacial disorders/small upper airway
  2. Down syndrome
  3. Cerebral palsy
  4. neuromuscular disorders
  5. chronic lung disease
  6. central hypoventilation syndromes
  7. genetic/metabolic storage disorders
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31
Q

Breathing pattern during REM and non-REM

A

REM - erratic

Non-rem - regular

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32
Q

Pattern:
Increased work of breaking, abnormal use of respiratory muscle, prolonged expiratory phase of respiration, pulsus paradoxus, altered mental status

A

Lower airway disease

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33
Q

ABG analysis for hypoxemia

A

SaO2

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34
Q

ABG analysis for hypocapnia

A

PaCO2

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35
Q

ABG analysis for hypercapnia

A

PaCO2 >50mmHg

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36
Q

Describe patient and symptom with RSV associated apnea

A
  1. H/o or premature brith and neonatal apnea

2. Post-conceptional age at hospitalization

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37
Q

Overwhelmingly most common reason for cardiopulmonary arrest in children

A

primary respiratory

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38
Q

Cardiopulmonary arrest occurs most often in children of what age range

A
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39
Q

Pattern: cyanotic at rest in newborn, upon stimulation, baby begins to cry and cyanosis resolves

A

choanal atresia

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40
Q

Most common type of tracheo-esophageal fistula

A

Esophageal atresia with distal TEF - 85%

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41
Q

Pattern: maternal hydramnios, excessive mucus, respiratory distress, failure to pass NG tube

A

Atresia with fistula

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42
Q

Can tracheoesophageal fistula result in tracheomalacia?

A

yes

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43
Q

What are the three most common vascular rings?

A
  1. Double aortic arch
  2. Right aortic arch with ligamentum arteriosum
  3. Aberrant right subclavian artery
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44
Q

What are diagnostic tests for vascular rings?

A

Barium swallow
Bronchoscopy
Angiography
MRI scanning

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45
Q

Definition of BPD

A

Oxygen dependence, typical ground glass radiographic abnormalities, respiratory symptoms beyond 28 days of life

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46
Q

What is the CXR pattern for BPD?

A

Ground glass transform cystic lucencies

47
Q

Pathophysiological characteristics of BPD?

A
  1. Increased lung field
  2. Diffuse airway inflammation
  3. Decreased alveolarization
  4. Altered pulmonary vascular development
  5. Minimal fibrosis
  6. Airway hyperreactivity
48
Q

Clinical manifestations of BPD

A
  1. Tachypnea
  2. Shortness of breath
  3. Crackles and wheezes
  4. Tracheomalacia or subglottic stenosis
  5. Irritability
  6. Cyanotic spells
  7. Failure to thrive
  8. GERD
  9. Pulm HTN
  10. Aversive oral motor behavior
49
Q

Rx of BPD

A

supplemental oxygen >95%, diuretics, aerosolized bronchodilators, aerosolized corticosteroids (budesonide), GERD, nutritional support

50
Q

Pattern:

Cough, fever, tachypnea, chest pain, sputum production, hemoptysis, weight loss

A

pulmonary abscess

51
Q

Pattern: fever, tachypnea, marked hypoxemia, difuse alveolar disease, bronchoalveolar lavage

A

pneumocystis jiroveci

52
Q

Most significant morbidity and mortality in drowning

53
Q

Principal respiratory complication in drowning and near drowning

A

pulmonary edema secondary to upper airway obstruction

54
Q

What do you do for a child you suspect has hydrocarbon aspiration?

A

CXR, observe, DO NO induce emesis, hospitalization for signs of respiratory distress, oxygen, supportive care, mechanical ventilation

55
Q

Pattern:

Child around adult wit URI, sporadic, paroxysmal cough, no whoop, thick, tenacious mucus, perihilar infiltrates

56
Q

What is Rx for pertussis?

A

Erythromycin

57
Q

What conditions are associated with congenital central hypoventilation syndrome?

A

Hirschsprung’s disease, ganglioneuroma, neuroblastoma, hypothalamic dysfunction, seizures, Phox 2 B gene

58
Q

What are Rx for congenital central hypoventilation?

A

Respiratory stimulants, tracheostomy and PPV, non-invasive ventilation, diaphragm pacing

59
Q

What 4 conditions is associated with diffuse alveolar hemorrhage?

A

Idiopathic pulmonary hemosiderosis, lung immaturity, Cow’s milk sensitivity, pulmonary capillary hemangiomatosis

60
Q

What other organ dysfunction is associated with alveolar hemorrhage?

A

nephritis, myocarditis, celiac disease, collagen vascular disease: SLE, purpuric rash: HSP

61
Q

Pattern:

A

Idiopathic pulmonary hemosiderosis

62
Q

Pattern: upper lobe opacities, sputum has eosinophilia, RAST A. fumigatus positive, incrased serum igE, cystic fibrosis pt.

A

allergic bronchopulmonary aspergillosis

63
Q

Pattern:

Very loud bark or honk, single cough, absent during sleep

A

psychogenic cough

64
Q

Pleural protein levels and pleural/serum protein ratio for transudate and exudate

A

Transudate 3gm/dL >0.5

65
Q

Pattern:

Sterile milky appearance, lymphocytic predominance, increased triglycerides and fat

A

chylothorax

66
Q

Indications for bronchoscopy

A

Noisy breathing (stridor, chronic wheezing, voice disturbance-hoarse, decreased amplitude), persistent moist cough, persistent radiographic abnormality, congenital anomaly, recurrent penumonia, atelectasis, retained foreighn body, hemoptysis, intersititial lung disease, PNA in immunocompromised host, tracheostomy evaluation, post-lung transplantation evaluation

67
Q

95% of chronic cough in kids are caused by what?

A

asthma, GER, upper airway cough syndrome (allergic rhinitis, nonallergic rhinitis, and sinusitis

68
Q

What typically precedes a psychogenic cough?

A

An uncomplicated URI viral illness and then cough lingers

69
Q

Most common cause of congenital stridor

A

Laryngomalacia

70
Q

Difference in symptoms of laryngomalacia and tracheomalacia

A

Laryngomalacia - congenital stridor
Tracheomalacia - expiratory wheezing or inspiratory cessation of airflow with airway collapse unless positive distending pressure is applied

71
Q

Symptom to tracheal hemangioma

A

expiratory wheezing from airway obstruction

72
Q

What is the purpose of exhaled nitric oxide measurement useful for?

A

Measure NO lever as a marker of airway inflammation

73
Q

What are the most commonly used measurements of lung function that can be obtained with spirometry?

A 
FVC
FEV1
FEV1/FVC
PEF (Peak expiratory flow)
FEF25-75 airflow during the middle half of the effort
74
Q

What are the risk factors for development of ARDS?

A

Sepsis, trauma, aspiration, penumonia, near-drowning, and multiorgan dysfunction

75
Q

Outline phases of ARDS

A
  1. Exudative phase - pulmonary edema, profound hypoxemia and atelectasis (recovery in 3 to 7 days)
  2. Fibroproliferative state - persistent hypoxemia, decreased lung compliance, and development of penumothoraces
  3. Recovery phase - resolution of hypoxemia and improved lung compliance (complete resolution take 6 to 12 months)
  4. Sequelae - Lifelong restrictive lung disease, lung cysts, or decreased exercise tolerance
76
Q

Define acute respiratory distress syndrome

A

lung inflammation with increased vascular permeability with acute onset, bilateral infiltrates, absence of left atrial hypertension and PaO2/FiO2

77
Q

Mortality rate for ARDS and what is the main cause

A

30 to 40% - death usually not due to lung failure alone but from multiorgan system failure

78
Q

Best test for measuring cyanosis and hypoxemia

A

arterial blood gas

79
Q

When should co-oximetry be done

A

suspicion of presence of abnormal hemoglobins (carboxyhemoblogin or methemoglobin)

80
Q

When is admiinistration of 100% oxygen and assssment of response used

A

in the neonatal period to distinguish pulmonary from cardiac disease

81
Q

What are most common infectious pathogens for epiglottitis?

A

Strep PNA, group A beta hemolytic strept, staph aureus

82
Q

Initial treatment for epiglottitis

A

direct examination under anesthesia in case tracheostomy is needed should be performed

83
Q

Rectal prolapse can be seen in what disorders?

A

Acute or chornic diarrheal illness, intestinal infections and malabsorptive disorders, heavy parasitic infstations enterobiasis (pinworm), amebiasis, trichuriasis (whipworm)

84
Q

Signs of cystic fibrosis in infants

A

hypoproteinemia, anemia, hypochloremic metabolic alkalosis, recurrent pulmonary symptoms

85
Q

Describe how sweat test is done

A

application of pilocarpine to stimulate sweat production followed by measurement of the chloride concentration in the sweat

86
Q

What is a positive result of sweat test and what conditions can give you false-positive results

A

> 60mEq/L, Addison disease, hypotheyroidism, glycogen storage

False negative - malnourished infant or if inadequate sweat volume is obtained

87
Q

Pattern: watery diarrhea, abdominal pain, bloating

88
Q

What is elevated in stool in protein-losing enteropathy that can be seen in CF?

A

alpha-1-antitrypsin

89
Q

Pattern: stridor, wheezing, dyspnea exacerbated by feeding

A

vascular ring

90
Q

Complications of untreated vascular ring

A

recurrent pneumonia and progressive difficulty with feeding

91
Q

What is best test for vascular ring

A

barium swallow

92
Q

Can bronchopleural fistulas self heal?

93
Q

Rx for broncopleural fistualas

A

insertion or continuation of chest tubes, decreasing mechnical ventilator support to the lowest pressures needed to allow spontaneous healking, differential lung ventilation, application of sealants through a bronchoscope and surgical closure

94
Q

Congenital lung malformation - reduction in bronchioloe number and alveoli

A

pulmonary hypoplasia

95
Q

Congenital lung malformation: absense of vascular and lung tissue

A

pulmonary agenesis

96
Q

Congenital lung malformation: presence of rudimentary bronchus but absence of vascular and lung tissue

A

pulmonary aplasia

97
Q

congenital lung: malformation: dysplastic lung tissue

A

congenital cystic adenomatoid malformation

98
Q

congenital lung malformation: idiopathic hyperinflation of one or more lobes

A

congenital lobar emphysema

99
Q

Congenital lung malformation: lung tissue that has a system arterial supply instead of pulmonary arterial supply and generally lacks bronchial communication

A

pulmonary sequestration

100
Q

Pattern: chronic cough, recurrent respiratory infections, dullness to percussionw ith decreased aeration over the affected area, crackles frequently audible during infection, radiograph show air-filled cystic lesion during active infections

A

pulmonary sequestration

101
Q

Pattern: exercise-induced dyspnea not responsive to B-agonist treatment

A

Vocal cord dysfunction

102
Q

Test for wheezing from birth or perinatal period that is not asthma

A

CXR, barium swallow for congenital abnormalities

103
Q

Pattern: microcytic anemia, bilateral alveolar opacities, hemosiderin laden macs on sputum analysis

A

diffuse alveolar hemorrhage

104
Q

Pattern: hemoptysis with pulmonary capillaritis

A

inflammation in pulmonary capillary bed, SLE, Goodpasture, granulamosis with polyangiitis and HSP

105
Q

Pattern: d/dx hemoptysis without capillaritis

A

Cardiac - AVM, PH

Noncardiac - celiac, coagulation, acute idiopathic pulmonary hemorrhage of infancy

106
Q

If vascular malformation seen on barium esophagram what workup next?

107
Q

Pattern: mass of tissue in lungs with own blood supply

A

sequestration

108
Q

Pattern: malformation that communicates with racheobronchial tree and blood supply is from the bronchial circulation

109
Q

Threshold for dx of OSA

A

apnea index >1

AHI >1.5

110
Q

Who is at risk for anesthesia complication?

A

Children with AHI =/> 24

111
Q

What factors lower affinity of hemoglobin to oxygen

A

acidosis, higher temperature, and elevated levels of 2,3-bispohsphoglyceric acid

112
Q

Dx of choanal atresia

A

cannot pass firm catheter in nostrils to a depth of 3-4cm

113
Q

What two symptoms are associated with cleft tongue?

A

1) oral-facial-digital syndrome

2) mohr syndrome

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