Pulmonology Flashcards
[Pulm/Asthma]
Asthma predictive index?
Children ≤ __ year of age
- Major criteria (1 of the following)
One of the parents has __
The child has __ - Minor criteria (2 of the following)
The child has __
The child has __
The child has __
Children ≤ 3 year of age
- Major criteria (1 of the following)
One of the parents has asthma
The child has eczema - Minor criteria (2 of the following)
The child has allergic rhinitis
The child has wheezing unrelated to cold/URI
The child has eosinophilia
[Pulm/Asthma]
Predictors of persistent asthma into adolescence and adulthood (2)
- Obesity
- Vitamin D deficiency
[Pulm/Basic]
What makes oxyhemoglobin dissociation curve shifts to right (less affinity) (3)?
Temperature
Acidosis
Phosphorus (2,3-DPG)
[Pulm/Basic]
What makes pulse oxymeter falsely elevated and its mechanism (2)?
- CO poisoning: COHb has high affinity to O2
- Methemoglobinemia: MetHb(Fe3+) can’t bind to O2 or CO2, high affinity to O2
[Pulm/Cong/URT]
Causes of neonatal stridor (4)?
- Laryngomalacia
2 .Subglottic stenosis - Vocal cord paralysis
- Laryngeal atresia/webs
[Pulm/Cong/URT]
Cause of neonatal stridor and diagnostic test?
Age: by 2 weeks of age
Inspiratory stridor aggravating with feeding, agitation, supine position
Resolves by 12-24 months of age
Laryngomalacia
- Test:
Awake flexible laryngoscopy
[Pulm/Cong/URT]
Diagnosis?
Test?
Stridor, respiratory distress in the first few months of life
Recurrent croup before 12 months of age
Associated with trisomy 21
Subglottic stenosis
- Test:
Direct laryngoscopy or bronchoscopy
[Pulm/Cong/URT]
Cause of neonatal stridor?
Diagnostic test?
Infant with absent or weak cry, aspiration during feeding
Infants with other neurologic abnormalities (hydrocephalus, Arnold-Chiari malformation) or birth trauma or intubation
Vocal cord paralysis
(recurrent laryngeal nerve damage)
- Test:
Awake fiberoptic nasopharyngoscopy
[Pulm/Cong/URT]
Cause of neonatal stridor?
Diagnostic test?
Neonatal stridor and respiratory distress at birth
Associated with velocardiofacial syndrome (DiGeorge)
Laryngeal atresia
- Test:
Direct laryngoscopy
[Pulm/Cong/LRT]
Diagnosis?
Expiratory stridor
History of vascular ring or sling
Tracheomalacia
[Pulm/Cong/LRT]
Diagnosis?
Infant with heart failure, pulmonary hypertension
Often with left sided heart anomalies
Characteristic CXR: scimitar-like (Turkish sword) apparence
Congenital pulmonary venolobar syndrome (Scimitar syndrome)
(Pulmonary venous blood from right lung returns to the inferior vena cava)
[Pulm/Cong/LRT]
Diagnosis?
Test?
Patients with hereditary hemorrhagic telangiectasia (episodes of epistaxis)
Increased risk of cerebral stroke, brain abscess
Pulmonary Arteriovenous malformation
- Test:
Contrast (bubble) echocardiogram
[Pulm/Cong/LRT]
Diagnosis?
Respiratory distress in infancy
Recurrent pneumonia, hemoptysis, infection
CXR/CT: dense mass, cystic changes, air-fluid levels
Pulmonary sequestrations
(non-functioning lung tissue, isolated from the normal functioning lung tissue fed by systemic arteries)
[Pulm/Cong/LRT]
Diagnosis?
Test?
Pregnancy complicated with hydramnios, pre-eclampsia, premature birth, and hydrops fetalis
Progressive respiratory distress in the neonatal period
Or recurrent pulmonary infections
Presentation similar to congenital diaphragmatic hernia
Congenital Pulmonary Airway Malformation (CPAM, adenomatoid proliferation of bronchioles that result in cysts rather than alveoli)
- Test:
Thin-section chest CT
[Pulm/Cong/Diaphragm]
Diagnosis?
Cause?
Male>Female
Unilateral decrease in breath sounds
CXR: elevation of diaphragm
Eventration
- Cause:
Phrenic nerve injury
[Pulm/Stridor]
Differentials for stridor beyond infancy
Acute with fever (2)
Acute without fever (2)
Subacute (3)
- Acute with fever (2):
Epiglotitis
Bacterial tracheitis - Acute without fever (2):
Anaphylaxis
Foreign body - Subacute (3):
Croup
Peritonsillar abscess
Retropharyngeal abscess
[Pulm/Stridor]
Vocal cord dysfunciton vs Asthma
Not responding to albuterol
Difficulty breathing in inspiration
Wheezing at maximal exercise (asthma up to 20 min after exercise)
Associated with anxiety
Vocal cord dysfunction
[Pulm/Infection of URT]
Diagnosis?
Most common cause?
Treatment?
Between 2 and 5 years old
Fever, sore throat, drooling, stridor
Ill-appearing, tripod position, chin extended
Epiglottitis
- Cause:
nontypeable H. influenza (m/c),
S. pneumoniae, S. pyogenes, S. aureus - Treatment:
Ceftriaxone or cefotzxime
Plus
Clindamycin, oxacillin, cefazolin
[Pulm/Infection of URT]
Diagnosis?
Most common cause?
Treatment?
< 3 years old
Brassy productive cough,
Ill-apperaing, high fever
Stridor, croup, not responding croup treatment
Bacterial tracheitis
- Cause:
S. aureus (m/c)
S. pneumoniae, Moraxella, nontypeable H. influenza - Treatment:
Nafcillin
[Pulm/Infection of LRT/RSV]
Palivizumab (Synagis) indication
- Infants and children < 24 months of age with ___ who require medical therapy (e.g., diuretics, oxygen, systemic corticosteroids) within 6 months of the start of RSV season
- Infants born at __ weeks of gestation in their 1st winter
- Children < 24 months of age with __
- Infants and children < 24 months of age with chronic lung disease of prematurity who require medical therapy (e.g., diuretics, oxygen, systemic cortico steroids) within 6 months of tlie start of RSV season (Chronic lung disease of prematurity is defined as the requirement of oxygen for > 28 days in infants bom at < 32 weeks of gestation.)
- Infants bom at < 29 weeks of gestation in their 1st winter
- Children < 24 months of age with hemodynamically
significant cyanotic and acyanotic congenital heart disease
[Pulm/Infection of LRT]
Diagnosis?
Test?
Treatment?
Asthma with difficult to control, worsening symptoms
Coughing up brownish mucous plugs, hemoptysis
CBC: eosinophilia
CXR: recurrent infiltrates, central bronchiectasis (fingers in glove)
Increased risk for cystic fibrosis
Allergic bronchoplumonary aspergillosis (ABPA)
- Test:
Immediate skin reactivity to Aspergillus
ABPA panel: Aspergillus-specific IgE and IgG titers - Treatment:
Oral corticosteriods and itraconazole
[Pulm/chronic cough]
Diagnosis?
Treatment?
Children 1-6 years old
Prolonged wet cough > 4 weeks, not responding to albuterol
Repeated respiratory infection
Well-appearing, continuous rhonchi
CXR: normal
Protracted bacterial bronchitis (PBB)
- Treatment:
Amoxicillin/clavulanate for 2-4 weeks
[Pulm/chronic cough]
Diagnosis?
Treatment?
Prolonged cough after viral illness
Cough that worsens when lying down
Rhinorrhea, congestion, ear pain, sore throat
Upper airway cough syndrome (Postnasal drip syndrome)
- Treatment:
antihistamines, decongestants, nasal irrigation
[Pulm/chronic cough]
Diagnosis?
Treatment?
Non-specific chronic cough, fever
Recurrent bronchitis, responding to antibiotics
Patients with AIDS, chemotherapy, BM-transplant
CXR: patchy infiltrates
Cryptogenic organizing pneumonia (COP)
(Bronchiolitis obliterans with organizing pneumonia BOOP)
- Treatment:
Corticosteroids
