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Pediatric Boards MEC > Pulmonology - Med Study > Flashcards

Pulmonology - Med Study Flashcards

1
Q

What % of predicted lung volumes on spirometry are abnormal?

A

< 80% predicted

>120% predicted may also be significant

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2
Q

What Lung Capacities are affected in restrictive lung disease?

A

Decreased TLC (both VC and RV are decreased)

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3
Q

What spirometry values suggest obstructive lung disease

A

FEV1/FVC is < 0.7

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4
Q

What is Residual volume (RV)?

A

unused space

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5
Q

What is expiratory Reserve volume (ERV)?

A

from full non-forced end expiration to full forced end expiration

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6
Q

what is tidal volume (TV)?

A

normal unforced ventilation

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7
Q

What is Inspiratory reserve volume (IRV)?

A

from normal unforced end-inspiration to full forced end-inspiration

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8
Q

Equation for Vital Capacity (VC)

A

VC = IRV + TV + ERV

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9
Q

Equation for Total Lung Capacity (TLC)

A

TLC = VC + RV

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10
Q

Equation for Inspiratory Capacity (IC)

A

IC = IRV + TV

total capacity available for inspiration after passive exhalation

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11
Q

Equation for functional residual capacity (FRC)

A

FRC = ERV + RV

capacity left in lungs after passive inspiration

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12
Q

Causes of intrathoracic & extrathroacic restrictive lung disease

A

intra: parenchymal disease, interstitial disease
extra: obesity, scoliosis, neuromuscular weakness

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13
Q

How does VQ mismatch lead to hypoxemia & what is treatment

A

some alveoli have more V and some more Q.
major cause in chronic lung disease
responds to 100% O2 supplementation

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14
Q

How does R to L shunting cause hypoxemia

A

perfusion of non-ventilated alveoli

causes: alveolar collapse, intraalveolar filling (pna, pulm edema), intracardiac shunt, AVM

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15
Q

how does decreased alveolar ventilation lead to hypoxemia? is PCO2 deranged? How?

A

low TV or RR

always has high PCO2

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16
Q

how does decreased diffusion cause hypoxemia?

A

doesn’t really unless exercise induced bc it takes tremendous thickening.
occurs with interstitial lung disease
PCO2 may be wnl

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17
Q

how does high altitude cause hypoxemia

A

reduced partial pressure of O2

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18
Q

what shifts oxyhemoglobin dissociation curve to the right (or down)

A

mnemonic TAP
increased Temperature
increased H+ (acidosis or inc PCO2)
increased 2,3-DPG

19
Q

What happens when Hgb dissociation curve shifts right (down)?

A

decreased affinity for O2 –> promotes offloading

20
Q

what happens when HGb dissociation curve shifts left (up)?

A

increased affinity for O2

21
Q

how does Carbon Monoxide poisioning affect hgb dissociation curve

A

binds tightly to Hgb –> O2 cant bind –> already bound O2 binds tightly –> left/up shift in dissociation curve
regular pulse ox can’t differentiate

22
Q

how does methemoglobin affect hgb dissociation curve

A

Hgb molecule oxidized from Fe2+ to Fe3+ –> cant hold onto O2 or CO2 –> regular Hgb holds O2 more tightly –> left/up shift

23
Q

Clinical Presentation of methemoglobinemia & treatment

A

> 25%: perioral/peripheral cyanosis
35-40%: fatigue, dyspnea
60%: coma, death

remove offending agent
100% Oxygen
methylene blue
if hereditary - 1-2g/day ascorbic acid

24
Q

Laryngomalacia

A

most common c/o stridor in newborn
laryngeal cartilage not stiff enough –> luminal narrowing –> inspiratory stridor
heard by 2 weeks of life
stridor worse with agitation, feeding, supine position
most outgrow by 12-24mo, if severe & affecting feeding or nighttime hypoxia, trim supraglottis
Dx with awake flexible laryngoscopy

25
Q

vocal cord paralysis

A

damage to recurrent laryngeal
can be with other neuro abnormalities, after birth trauma (neck stretching), or after CT/thyroid/TEF surgery
absent or weak cry, hoarse raspy voice
aspiration risk
Dx with awake fiberoptic nasopharyngoscopy

26
Q

subglottic stenosis

A

cause stridor & resp distress in newborn or first few months of life
common in Down’s Syndrome
can present with recurrent croup
can be acquired after intubation at any age
Dx with direct laryngoscopy or bronch

27
Q

laryngeal cyst

A

develop from mucous secretion epithelium of supraglottic region
stridor & hoarseness
usu not congenital and 2’2 prolonged or traumatic intubation
tx; remove cyst

28
Q

laryngocele

A

epithelium lined diverticula from laryngeal saccule (above each vocal cord that lubes the cords)
laryngeal obstruction of neck mass
excise

29
Q

laryngeal atresia

A

failure of larynx to recanalize in 10th week gestation

usually incompatible with life

30
Q

laryngeal web

A

abnormal development of structures in & around laryngeal inlet
present with abnormal voice, stridor, resp distress
assoc with velocardiofacial syndrome –> test for 22q11 gene deletion
Dx: direct laryngoscopy
Tx: incision or dilation

31
Q

Tracheal agenesis - 3 types

A

type 1: proximal trachea closed, distal communicates with esophagus
type 2: bronchi meet in midline & communicate with esophagus thru fistula
type 3: absent trachea, both main bronchi communicate with esophagus separately

RDS + absent cry. suspect if unable to intubate despite visualizing larynx

32
Q

tracheal stenosis

A

segmental, usu involves complete cartilage rings occuring anywhere along length
severe retractions + expiratory stridor
bronch, CT, or MRI to confirm
mild can observe, if symptomatic dilate or resect

33
Q

Tracheomalacia/bronchomalacia

A

inadequate cartilagenous tone or external compression –> collapses with breathing –> expiratory stridor
usually mild but can be assoc with other things like TEF, cardiac abnormality, cervical/mediastinal masses

34
Q

lobar emphysema

A

RDS in neonate up to 5-6 months - tachypnea, grunting, expiratory wheezing
usually LUL
diaphragm down & mediastinum to opposite side
if severe, lobectomy

35
Q

Pulmonary hypoplasia

A

RDS, hypoxic, hypercarbic

assoc/w oligohydramnios, PROM

36
Q

Congenital Pulmonary Venolobar syndrome (Scimitar syndrome)

A

pulm venous blood flow from all/part of R lung –> IVC just above or below diaphragm which is L to R shunt
heart failure or pulm htn
transcatheter occlusion of aortopulmonary collaterals

37
Q

AVM - Hereditary Hemorrhagic telangiectasia (aka Osler Weber Rendu)

A

skin, mucous membrane, organ issues
epistaxis by age 20 but can come earlier
PAVM uncommon in childhood but incidence increases with age and often asymptomatic
R–>L shunting –> dyspnea, bleeding hemoptysis, exervise intolerance
risk for CVA/TIA, brain abscess
known HHT should get screening echos - positive is air bubble in systemic
Tx for symptomatic - surgery or pulm angiography

38
Q

pulmonary sequestration

A

mass of abnormal, nonfunctioning lung tissue isolated from normal lung, fed by systemic arteries

intralobar: lower lobe (m/c posterior basal section of LLL), usually isolated & discovered in childhood/adolescence

extralobar: males, just above/below diaphragm, left side
communicates with foregut
other anomalies common (colon duplication, vertebral anomaly, diaphragm defects)

pleuritic CP out of proportion to other findings

Dx on CXR/CT. not bronchoscopy bc not connected to airway.

39
Q

Bronchogenic cyst

A

abnormal budding of tracheal diverticulum of foregut before 16wga
m/c cyst in infancy
single, unilocular, right sided
most filled with mucous
incidental on CXR vs RDS d/t compression of airway
can get infected - fever, CP, productive cough
rupture –> pneumothorax or hemoptysis
Tx - excision

40
Q

Eventration of diaphragm

A

marked elevation, usually congenital but can be 2’2 phrenic nerve injury
males, left sided

41
Q

accessory diaphragm

A

rare. most often right side. can cause lung hypoplasia

surgery if symptomatic

42
Q

Croup

A

3mo-3yo, peak 2yo
boys > girls
fall, early winter
paraflu > RSV, flu, measles, other
low pitched barking cough, inspiratory stridor, steeple sign
humidifier, steamy shower, cool air
dexamethasone or if moderate stridor at rest/moderate rtx/severe sxs use rac epi (need to observe bc can rebound)

43
Q

Epiglottits

A

2y-5y
abrupt onset fever, sore throat, drooling, stridor, look toxic, tripod positioning
abx with anti-staph (clinda, oxacillin, cefazlin) & ceftriaxone or cefotax
airway w anesthesia or ENT
ppx with rifampin

44
Q

Bacterial Tracheitis

A

S. aureus > paraflu, moraxella, NtHflu, anaerobes
previously healthy child <3yo with recent URI
toxic, high fever, brassy productive cough, rapid deterioration
fall, winter
Tx: nafcillin, usually need hospitalization. vanco if MRSA common in community

Pediatric Boards MEC (1 decks)

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