Pulmonary

Question 1

Asthma Predictive Index Criteria

Answer 1

Major: parent with asthma; Dx with eczema; Evidence of allergies
Minor: Evidence of food allergies; 4% or greater blood eosinophilia; wheezing apart from colds
Needs one major or two minor

Question 2

Dx of CF?

Answer 2

Greater than 60 mEq/L on chloride sweat test

Question 3

Spasmodic croup

Answer 3

At night and short lived, higher incidence of asthma, atopic hx common

Question 4

Bronchiectasis

Answer 4

Irreversible bronchial dilation
Chronic cough with thick purulent sputum
Linear atelectasis on CXR
End result of other disease processes including CF, pertussis, ABPS, strep pneumo, TB

Question 5

Vascular ring is often associated with

Answer 5

Double aortic arch

THEN right sided aortic arch

Question 6

What should you test for in a child with right sided aortic arch?

Answer 6

DiGeorge syndrome (22.q11)

Question 7

Schwachman-Diamond syndrome

Answer 7

Exocrine pancreatic insufficiency PLUS cytopenias
Aka looks like CF but with weird CBC and no lung findings
Usually can outgrow needing enzymes
Fatty replacement of pancreas on imaging

Question 8

Restrictive lung disease changes in PFTs?

Answer 8

Decreased total lung capacity

Decreased vital capacity and residual volume

Question 9

Obstructive lung disease changes on PFTs?

Answer 9

Decreased FEV1

Question 10

Apnea of prematurity

Answer 10

<34 was
Treat with caffeine (decreases CO2 threshold in respiratory center)
if continues, use CPAP

Question 11

Most common symptoms of increased PaCO2

Answer 11

Headache

CO2 is an intracranial vasodilator

Question 12

Definition of BPD

Answer 12

For infants <32 wks: Require supplemental oxygen at 36 wks corrected
For infants >32 weeks, test at 29-55days,
if no O2 - mild BPD
If <30% O2 - moderate BPD
If >30% O2 - severe BPD

Question 13

Definition of ARDS

Answer 13

syndrome of lung inflammation with increased vascular permeability and is characterized by acute onset, bilateral infiltrates on chest radiography, absence of left atrial hypertension, and a Pao2/Fio2 of less than 200 mm Hg
Mortality rates vary depending on the underlying disease process
Most commonly occurs after sepsis, trauma, aspiration, pneumonia, near drowning, or multi organ failure
Pneumothoraces are common

Question 14

Kartagener syndrome

Primary ciliary dyskinesia

Answer 14

Recurrent otitis media
+ sinusitis/ “bronchitis”
+ dextrocardia

CT can show moderate degrees of hyperinflation, peribronchial thickening, atelectasis and bronchiectasis
“Tram track lines”

Question 15

Bronchopulmonary sequestration

Answer 15

Lung tissue that has a systemic arterial supply, not pulmonary and lacks bronchial communications
More common in the lower lobe (left)

Question 16

Pulmonary hypoplasia

Answer 16

reduction in the number of bronchioles and alveoli

Question 17

Congenital pulmonary airway malformation

Answer 17

dysplastic lung tissue

Question 18

Congenital lobar emphysema

Answer 18

idiopathic hyperinflation of 1 or more lobes

Question 19

If worsening while incubated, what should you think of?

Answer 19

DOPE
displacement of the tube
obstruction of the tube
pneumothorax
equipment failure

Question 20

Most common side effect of foreign body aspiration

Answer 20

Infection! Pneumonia and atelectasis

Bronchoscopy is gold standard for both diagnosis and management

Question 21

Chylothorax risk and fluid characteristics

Answer 21

Often results from injury to thoracic duct during cardiac surgery
Chyle has a characteristic milky white appearance, high concentrations of triglycerides, and electrolyte composition similar to plasma, and a predominance of lymphocytes
Difficult to treat - use diet, medial, and surgical management

Question 22

Most common complication of pneumonia

Answer 22

Effusion can occur in up to 40%

Then empyema can happen in up to 50% of these

Question 23

Classic phenotype of primary ciliary dyskinesia

Answer 23

Hx of neonatal respiratory distress (more than 80%)
Daily nasal congestion and wet cough, starting in neonatal period
Chronic otitis media and sinus disease starting in early childhood

Question 24

Triad of Kartagener syndrome

Answer 24

Chronic sinusitis
Bronchiectasis
Situs inversus totalis