pulmonary Flashcards
what is the safest and most effective way to confirm the dx of foreign body aspiration in a 1 y/o child
airway fluoroscopy
dx of swallowing dysfunction
1- barium swallow study
2- video fluoroscopy
pulsus paradoxus
the difference in blood pressure during inspiration and expiration >20
should not be >10
suggestive of cardiac or pulmonary problems
why is not a good idea to give supplemental O2 to a pt with chronic hypoxemia?
can send into respiratory arrest
goal to maintain sat 90%
CBC changes with chronic hypoxemia
H/H increase (d/t increased EPO)
worry about Hct >65 –> HA, joint pain, clots, PE, hemoptysis
low plts –> d/t decreased lifespan, risk of bleeding
methemoglobinemia
iron in hemoglobin is defective and unable to carry O2
results in cyanosis
treatment for methemoglobinemia
methylene blue
work up for chronic cough (3)
1- sweat test
2- TB testing
3- CXR
what is an abnormal sweat test finding indicative of CF
60 mEq or greater is diagnostic
*sweat test is the gold standard for diagnosing CF!
what is the inheritance of CF
AR
what is the incidence of CF in the general Caucasian population
1/3000
what vitamin deficiency do you often see in CF
think fat soluble- DEAK
E deficiency is a major problem and need supplementation before age 5
K deficiency can lead to prolonged PT and PTT
how sensitive is the newborn screen for CF
95% (this is not very good)
remember sensitive means it rules out- a negative is truly negative
acid/base abnormality with CF
hypochloremic alkalosis
presentation of meconium ileus
can present as polyhydraminos in utero
can also see ground glass appearance on abdominal film 2/2 decreased bowel gas
** think CF
presentation of meconium peritonitis
can present as pseudocyst (calcified meconium)
** think CF
bacterial infections in CF (name 4 bugs)
1- staph aureus
2- H flu
3- pseudomonas
4- burkholderia (severe dz)
treatment of acute CF exacerbation
aminoglycoside (gent, neo, amikacin, tobra) & piperacillin
infant who is hypoxic — post ductal sat low, pre ductal sat appropriate with cyanosis to the LE and notable precordial lift
there is some type of R to L shunt (likely across the PDA – with persistent fetal circulation
precordial lift indicates the RV is working hard!
inheritance of primary ciliary dyskinesia
AR
how to dx primary ciliary dyskinesia
biopsy
chylothorax make up
electrolyte concentrations close to the serum
TG > 110
elevated lymphocytes
protein >3
** post op pt - think after heart surgery
LDH and protein values in transudate vs exudate
EXUDATE
- LDH > 2/3 LDH serum
- protein > 3
- see in pna, ca, trauma, inflammatory dz
TRANSUDATE
- LDH < 2/3 LDH serum
- protein <3
- typically see in CHF
what is the most accurate testing in determining whether a parapneumonic effusion is an exudate or transudate
- test the pH
exudates have a pH < 7.3
transudates have a pH > 7.45 or greater than the blood pH
how to diagnose bronchiectasis
chest CT
what race is more at risk for SIDS
AA
what gender is more at risk for SIDS
males
affect of pacifiers on SIDS
may help prevent-
use after 1 mo in BF babies so they do not interfere
are ALTE and SIDS related?
NOOOOO
they are separate entities
ALTE does not put you at risk for SIDS
what is the best diagnostic text to confirm a pna dx by CXR
blood cx
what is a likely cause of stridor in infants with trisomy 21
congenital subglottic stenosis
what is a likely cause of stridor in infants with hydrocephalus
BL vocal cord paralysis
common with CNS defects (myelomeningocele, arnold chiari, hydrocephalus)
what is the carrier rate of CF in the general caucasian population
1/25
what is winter’s formula
used to calculate respiratory compensation
pCO2 = 1.5[HCO3]+8+/-2
what is the safest and most effective way to confirm FB aspiration in a young child?
airway fluoroscopy
not CXR (will not detect radiolucent food objects)
