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pediatrics > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Croup - definition, causes

A

infection of the upper airway
- MC: Parainfluenza type 1+ 2
RSV is 2nd MC

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2
Q

Croup - presentation

A

barking cough, coryza, inspiratory stridor
- difficulty breathing when lying down and may show signs of hypoxia such as peripheral cyanosis and accessory muscle use

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3
Q

Croup - x-ray

A

STEEPLE SIGN: narrowing of the air column in the trachea

RARELY DONW AND IS ALWAYS WRONG ANSWER

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4
Q

Croup - diagnostic

A

clinically, can be aided by radiology if the symptoms are mild

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5
Q

it helps to differentiate croup from epiglotitis

A

hypoxia

croup: hypoxia on presentation
epiglottitis: hypoxia imminent

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6
Q

Croup - treatment

A

mild: steroids

moderate - severe: racemic epinephrine

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7
Q

epiglottitis - definition / causes

A

severe, life threatening swelling of the epiglottitis and arytenoids
- H. influenza type B

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8
Q

epiglottitis - presentation

A

HISTORY OF VACCINATION DELINQUENCY with:

  • potato voice
  • fever
  • drooling in the tripod position
  • refusal to lie flat
  • CHERRY RED EPIGLOTITIS
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9
Q

epiglottitis - x-ray

A

thumbprint signs

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10
Q

epiglottitis vs croup on x-ray

A

epiglottitis - thumbprint signs

croup - steeple sign

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11
Q

epiglottitis - diagnosis

A

clinically

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12
Q

epiglottitis - treatment

A
  1. incubate (in OR in case unsuccesful intubation makes tracheostomy necessary
  2. ceftriaxone for 7-10d
  3. Rifampin for all close contacts
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13
Q

epiglottitis vs croup on season

A

croup: winter
epiglottitis: year round

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14
Q

epiglottitis vs croup - most accurate test

A

croup: PCR
epiglottitis: C+S from tracheal aspirate

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15
Q

Whooping cough - definition / causes

A

form of bronhitis caused by Bortetella pertusis

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16
Q

Whooping cough - presentation

A

catarrhal stage: congestion and rhinorrhea: 14d
paroxysmal stage: severe coughing with extreme gasp of air (inspiratory whoop) followed by vomiting (14-30 days duration)
Convalescent: decrease of frequency of cough: 14d in duration
burst blood vessels in the eyes

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17
Q

Whooping cough - diagnostic tests

A
  • clinically diagnosis
  • Butterfly pattern on chest x-ray
  • PCR of nasal secretions or Bartonella pertusis toxin
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18
Q

Whooping cough - treatment

A
  • Erytrhomycin or azithrom aids only in the catarrhal stage, not in the paroxysmal
  • isolate the child
  • macrolides in close contacts
  • DTaP vaccine
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19
Q

Bronchitis - etiology / presentation / diagnosis / treatment

A
  • bacteria and viruses
  • produtive cough lasting 7-10 d
  • clinical diagnosis
  • supportive treatment
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20
Q

Diphtheria - treatment

A

antitoxin (antibiotics do not work)

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21
Q

Bronchiolitis - definition and etiology

A

viral infection of bronchioles caused by RSV (MC) or parainfluenza virus TYPE 3 (less common)

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22
Q

Bronchiolitis - season and age

A

winter and spring in children younger than 2

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23
Q

Bronchiolitis - presentation

A

nasal, cough, RESPIRATORY distress, WHEEZING, fever, crackles, prolonged expiration, hyperresonance to percussion

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24
Q

bronchiolitis - complications

A

increased risk of developing asthma

25
Q

how to assess the maturity of fetal lungs

A
  1. lecythin:sphingomyelin ratio more than 2

2. phosphatidyl glycerol in amniotic fluid

26
Q

meconium aspiration syndrome - definition

A

aspiration of meconium causes obstruction + pneumonia

27
Q

meconium aspiration syndrome - diagnosis

A

meconium stained amniotic fluid seen during delivery,

cyanosis, intercostal retractions, distended chest etc

28
Q

meconium aspiration syndrome - radiology

A

CXR: atelectasis, hyperinflation, pneumothorax

29
Q

meconium aspiration syndrome - treatment

A

suction nose, mouth, upper airway at birth, O2 intubation, surfactant treatment, maybe empiric antibiotics

30
Q

characteristics of epiglottitis but not croup

A

drooling, tripod position

31
Q

Primary ciliary dyskenesia vs CF regarding respiratory features

A

the same: 1. Chronic sinopulm infections 2. NASAL POLYPS 3. bronchiectasis 4. digital growth

32
Q

primary ciliarry dyskenesia vs CF regarding extrapulm features

A

1ry ciliary: sinus inversus, infertility, NORMAL GROWTH

CF: pancreatic insuf, infertility, FAILURE TO THRIVE

33
Q

1ry ciliary dyskenesia vs CF on growth

A

1ry ciliary has NORMAL GROWTH

34
Q

in the delivery rook - respiratory distress and suspicion of diaphragmatic hernia - next step

A

incubation
also gastric tube to decompress stomach and bowel
never CPAP

35
Q

foregin body aspiration - next step

A

bronchoscopy

36
Q

bacterial pneumonia in CF

A

children: s. aureus

adults? Pseudomonas

37
Q

hormones that influence surfactant secretion

A

cortisol –> increases

insulin –> decreases

38
Q

common causes of neonatal respiratory distress - causes

A
  1. transient tachypnea of newborn (term or posterm)
  2. resp distress syndrome (preterm)
  3. persistent pulm hypertension (term or posterm) –> makes R to L shunts (through foramen ovale, PDA)
39
Q

CF in males - inferitily vs pancreatitis

A
  • 100% have infertility

- 10 develops pancreatitis. If pancretic insufficiency in early life, low risk of developing pancreatitis

40
Q

Apgar scores are helpful in assessing the

A

status of a neonate and sesponse to neonatal resuscitation

- DO NOT CORRELATE WITH PROGNOSIS OR RISK FOR CEREBRAL PALSY

41
Q

born of baby with HR less than 60 –>

A

chest compression

42
Q

subcutaneous emphysema 2ry to severe coughing coughing paroxysm –>

A

chest x-ray to rule out pneumothorax

43
Q

infants bronchiolitis - complications

A
  1. apnea (esp if younger than 2 months)

2. respiratory failure (esp if younger 2 months)

44
Q

emergency incubation is indicated for

A

oroph edema, significant stridor or resp failure

45
Q

pneumonia and effusion on chest x-ray - management

A

small effusion and No resp distress or hypoxia –> oral antibiotics and close monitoring
moderate/large effusion OR resp distress OR hypoxia –> U/S, IV antibiotics, drainege

46
Q

exudative effusions - pleural fluid analysis

A
  • pleural protein / serum protein ratio more than 0.5
  • pleural LDH / serum LDH more than 0.6
  • pleural LDH more than 2/3 upper limit of normal serum LDH
47
Q

transient tachypnea of the newborn

A

compression of rib cage through vaginal canal –> helps to remove fluid from lungs (also resorption)
if C-cection –> excess lung fluid –> hypoxic –> transient for LESS THAN 4 HOURS
RF: C-section, prematurity, DM
FLUID IN INTERLOBULAR FISSURES

48
Q

transient tachypnea of the newborn - management / RF

A

supportive care
self resolution in 1-3 days
RF: C-section, DM, prematurity

49
Q

vit D and K def in children –> think

A

pancreatitis

50
Q

primary cilliary dyskenesia - diagnosis

A
  1. low nasal NO levels
  2. Genetic testing
  3. Bronchoscopy and electron microscopic visualisation of ciliary abnormalities
51
Q

thymus is visible in chest x-ray until …. years old / explain

A

3
sailed sign: triangular shape, scallope border, uniform density
variable with phases of respiration
shrink durung times of stress or illness and rebound to a larger size after recovery

52
Q

factors that decrease the risk of RDS

A
  1. IUGR
  2. maternal hypertension
  3. chronic intrauterine stress for prolonged rupture of membranes
53
Q

RDS - initial treatment

A

continuous positive air pressure ventilation

54
Q

indications for palivizumab in infants

A
  1. preterm births less than 29
  2. chronic lung diseaes of prematurity
  3. hemodynamically significant CHF
55
Q

causes of chylotoraces

A
  1. traumatic causes (cardiothoracic surgery)
  2. congneital malformations
  3. specific syndromes (eg. down, Noonan syndrome)
  4. malignancy
56
Q

kartegener - classic triad

A
  1. situs inversus
  2. recurrent sinusitis
  3. bronchiecatsis
57
Q

health young children who attend day care or have older siblings may experience up to …. (number) resp infections per year

A

12

58
Q

croup - prevention

A
  1. handwashing
  2. decontamination of surfaces
  3. Ensure proper ventilation

pediatrics (16 decks)

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