Pulmonology-Notes Flashcards
In neonates, what EKG finding may accompany hypoxia?
bradycardia
What is the best non-invasive way to determine pulmonary function? Best invasive way?
Non-invasive way: FVC
Invasive way: Arterial PO2
What is the ddx of wheezing?
asthma bronchiolitis cystic fibrosis tracheomalacia foreign body aspiration CHF
T/F Hilar lymphadenopathy can be normal in kiddos
False. Never normal, no matter the age.
What is the ddx for hilar lymphadenopathy?
Malignant: lymphoma, mets
Infectious: TB, histoplasmosis
Inflammation: sarcoidosis (would be bilateral)
What are the causative agents for bronchiolitis?
RSV
parainfluenza
human metapneumovirus
adenovirus
What is the presentation of bronchiolitis?
wheezing & crackles
coughing
rhinorrhea
tachypnea
What is the detailed mechanism behind bronchiolitis?
upper and lower resp infection
upper: nasal congestion, rhinorrhea
lower: edema, epithelial cell necrosis, bronchospasm, increased mucous (atelectasis, hyperinflation)
What is the workup for bronchiolitis?
Rapid RSV and influenza tests
CXR: see lung hyperinflation, peribronchial thickening, increased interstitial markings
What is the treatment for bronchiolitis?
supplemental O2
racemic epi PRN
hypertonic saline (decreases mucous)
high risk: palivizumab (prophylaxis)
What is the pathophysiology of bronchopulmonary dysplasia?
decreased number of alveoli (larger)
decreased vascular growth
decreased surfactant and antioxidant capacity
What is a part of the presentation of bronchopulmonary dysplasia?
a kiddo who needed oxygen for the first 28 days chronic resp symptoms preterm birth (
What are the possible complications of bronchopulmonary dysplasia?
URI can lead to episodic respiratory distress pulmonary HTN R heart failure Asthma Exercise intolerance
What is the treatment for bronchopulmonary dysplasia?
supplemental oxygen
diuretics for pulmonary edema
albuterol if wheezing.
What is ALTE?
apparent life threatening event
episode of apnea
decreased muscle tone
choking/gagging.
What are the possible causes of ALTE?
GERD idiopathic infections cardiac laryngospasm seizures hypoxemia prematurity
What is the ddx for inspiratory stridor?
laryngomalacia tracheomalacia croup laryngospasm epiglottis subglottic stenosis vascular rings
What is the ddx for expiratory stridor?
tracheomalacia
bronchomalacia
subglottic stenosis?
What is the fancy name for broup
laryngotracheobronchitis
What is laryngomalacia?
floppy larynx
age 4-8mo
infantile inspiratory stridor
What is something that helps laryngomalacia?
worsens in supine position
BETTER on BELLY (not working against gravity)
What is the workup for laryngomalacia?
flexible laryngoscopy
resolves by 1 year
no real treatment, but supraglottoplasty if there is FTT with it.
What is tracheomalacia?
floppy cartilage, trachea can collapse
positive intrathoracic pressure obstructs expiration
expiratory stridor with wheeze
What is the workup and treatment for tracheomalacia?
workup: CXR to r/o mass
nasal CPAP
tracheostomy
What are the causes of croup? workup? treatment?
parainfluenza influenza adenovirus metapneumovirus diphtheria/measles in unvaccinated kids CXR-steeple sign (subglottic narrowing) dexamethasone racemic epi O2
What is epiglottitis?
inflammation of epiglottis
- Hib
- staph and strep
What is the presentation and workup of epiglottitis?
high fever sore throat inspiratory stridor drooling with dysphagia muffled voice (hot potato) hyperextended noice CXR: thumbprint sometimes see AMS
Which antibiotics are indicated in epiglottitis?
ceftriaxone for hib coverage
vancomycin for staph and strep coverage
Aside from epiglottitis what else can produce a hyperextended neck? excessive drooling?
excessive drooling: tracheoesophageal fistula
hyperextended neck vascular rings
When do vascular rings present? What is the presentation?
before age 1
stridor, wheezing, cough, dysphagia, difficulty breathing
improves with neck extension
What is the workup for vascular rings?
barium contrast esophogram
bronchoscopy
CT
T/F Stridor improves in the prone position for laryngomalacia.
False. it improves with hyperextended neck
prone position helps laryngomalacia
What is the pathophysiology of asthma?
airway hyper-responsiveness th2, igE mediated
get obstruction
bronchospasm
rhonchi are from increased secretions
get inflammation–>fibrosis–>SM hypertrophy
decreased FEV1/FVC
spiral shaped mucous plugs (Curshmann spirals)
eosinophil derived crystals (Charcot-Leyden Crystals)
Which symptoms, nighttime awakenings, # times use rescue inhaler, exacerbations requiring oral steroids…
fit with intermittent asthma?
symptoms:
Which symptoms, nighttime awakenings, # times use rescue inhaler, exacerbations requiring oral steroids…
fit with mild asthma?
symptoms: >2d/wk, not daily rescue inhaler: >2d/wk, not daily nighttime awakenings: 1-2/mo minor limitation on activities ~4/yr steroid exacerbations
Which symptoms, nighttime awakenings, # times use rescue inhaler, exacerbations requiring oral steroids…
fit with moderate asthma?
daily symptoms and need for rescue inhaler
nighttime awakenings: 3-4X/mo
some limitation on activity
~4/yr steroid exacerbations
Which symptoms, nighttime awakenings, # times use rescue inhaler, exacerbations requiring oral steroids…
fit with severe asthma?
all day symptoms and >1X/d need for rescue inhaler
>1X/wk nighttime awakenings
extremely limited activity level
~4/yr steroid exacerbations
If Albuterol PRN isn’t working…what is the next step?
Low dose steroid (fluticasone, budesonide, beclamethasone)
+ Albuterol PRN
If low dose steroid + Albuterol PRN isn’t working…what is the next step?
Low dose steroid + LABA + montelukast + albuterol PRN
If low dose steroid + LABA + montelukast + albuterol prn isn’t working…what is the next step
change the low dose steroid to a medium or high dose steroid
What are the LABAs?
formeterol (faster acting) and salmeterol (20 min until action onset)
What are some possible causes of asthma exacerbations?
rhinovirus RSV HMV influenza mycoplasma chlamydia fungi tree weed grass pollen animal exposures chemical exposures airway pollutants
What is the workup for an asthma exacerbation?
peak flow
What defines status asthmaticus?
an attack SO bad that there is no response to bronchodilators
What is the treatment for an asthma exacerbation?
albuterol q1h nebulizer
ipratropium nebulized
methylprednisolone PO
if no response: magnesium sulfate
if no response: terbutaline
if no response: intubation
What is aspirin exacerbated respiratory disease?
happens in patients with asthma and chronic rhinosinusitis who are on aspirin
difficulty breathing, chest tightness
What is bronchiectasis?
obstructive lung dx-permanent dilation of bronchioles and bronchi, get air trapping
necrotizing chronic inflammation
lots of sputum, recurrent resp infections
What is a possible cause of bronchiectasis?
cystic fibrosis
What are some multisystemic presentations for cystic fibrosis?
bronchiectasis meconium ileus (failure to pass w/i first 24 hours) pancreatic insufficiency, DM chronic rhinosinusitis nasal polyposis fatty liver
How do you diagnose pancreatic insufficiency?
CCK-secretin stimulation
measure bicarb (decreased)
bentiromide test (will decrease PABA in pts with steatorrhea)]
quantitative fecal fat excretion
What is the treatment for the respiratory symptoms of Cystic fibrosis?
antibiotics
albuterol
DNAse mucolytic
chest physiotherapy
