Resp Flashcards
Bacterial infxn in CF
staph aureus in younger kids
pseudomonas once start to get bronchiectasis (>age 3-5)
*pseudomonas needs double abx coverage
Atypical pneumonia signs
bilateral focal or interstitial infiltrates on CXR
4-year-old with 4 weeks of wet cough. No symptoms with exercise and no nocturnal symptoms. On auscultation, decreased air entry and wheeze to RLL. Dx and next step?
airway foreign body
CXR with inspiration/expiration
CAP (CPS) admit criteria
inadequate oral intake
is intolerant of oral therapy
severe illness or respiratory compromise (eg, grunting, nasal flaring, apnea, hypoxemia)
pneumonia is complicated
< 6mo (may need more supportive care and monitoring)
CAP (CPS) empiric treatment
outpt: po amox
Admit: IV amp
if unwell: Ctx or cefotax
rapidly progressing or pneumatocele: add vanco
atypical: azithro x 5 d
empyeme most likely strep pneumo
5-7 days for outpt
7-10 days for inpt
complicated 2-4 weeks
gold standard test for aspiration
Videofluoroscopic Swallowing Study (VFSS)
CPS ICS dosing for children 1-5yo
QVAR (Beclometasone) low 100, medium 200
Alvesco (Ciclesonide) low 100, med 200
Flovent (Fluticasone) low 100-125, medium 200-250
A 17yo M presents with acute onset chest pain, dyspnea and dysphagia after a bout of vomiting that occurred after an evening of excessive alcohol consumption. His HR is 120, BP is 120/65, RR is 24 and SpO2 is 96% on room air. There is reduced air entry over his right chest and palpable subcutaneous emphysema. His CXR shows a small right pneumothorax and a small pneumomediastinum. Dx and management
esophageal rupture
upper GI endoscopy
SpO2 cut off for bronchiolitis per CPS
<90%
Symptoms of OSA
frequent snoring >/= 3 nights per week
sleep enuresis
headaches on wakening
daytime sleepiness
learning problems
False positives and negatives for sweat chloride test
False positive:
- eczema
- ectodermal dysplasia
- malnutrition
- CAH
- DI
- adrenal insuff
- hypothyroid
- panhypopit
- autonomic dysfunction
- metabolic
False negative
- diluted sample
- malnutrition
- peripheral edema
- low sweat rate
- hypoproteinemia, hypoalbuminemia
- dehydration
AHI in OSA
normal < 5
Mild 5-9
Moderate 15-30
Severe >30
first line tx of osa
adenotonsillectomy if evidence of tonsillar hypertrophy on exam
nasal steroids not first line - consider in those who can’t have surgery
asthma management over 12 yo
ICS + LABA
Symbicort (Budesonide / Formoterol)
lights criteria for pleural effusion
Exudative if 1 of:
PF:Serum Protein >0.5
PF:Serum LDH >0.6
PF LDH > ⅔ Serum LDH ULN
newborn screen for CF
IRT (immunoreactive trypsinogen)
*screening test, not diagnosis, still needs sweat chloride
positive sweat chloride test
> 60 positive
30-60 is grey zone
diagnostic test for CF
PFT in CF
FEF 25-75 decreases first, obstructive pattern with gas trapping (FEV1 is low and FEV1/FVC is low)
late disease get restrictive pattern
CF genetics
autosommal recessive
delta f508 most common
each pregnancy has 25% chance of having diseease
CF complications
- HENT: sino pulm infxn, polyps not increased AOM - frequent AOM is PCD
- lungs: bronchiectasis, infxn, hemoptysis, ptx, allergic bronchopulmonary aspergillosus, not increased risk asthma
- liver: high bilirubin (sludge), gall stones, cirrhosis -> portal htn
- pancreas: insuff, diabetes, pancreatitis (only if pancreatic sufficient)
- intestines: maldigestion, DIOS, meconium ileus infant, rectal prolapse (infant), intuss
- clubbing
- GU: male infertility (absent vas deferens, can do artificial insemmination), decreased fertrility in women due to thick mucous
- infant: dehydration due to high sweat chloride, esp if warm. weather (ex. baby with hyponatremic hypochloremic dehydration with no reason usch as vomiting or diarrhea)
polyps management
screen for CF
CF lung infection bugs
staph aureus (younger)
psudeomonas (older)
burkolderia cepacia (scary bug - increased risk of death d/t cepacia syndrome overwhelming immune rxn, high transmission between CF pt)
aspirgillus (ABPA)
ABPA
hypersensitivity response to aspergillus
present with worsening lung function, cough, increased SOB, wheeze
rust colored/brown mucous plugs!!!
finger in glove mucous plugging on XR
Dx: aspergillus on sputum, eosinophils high, high IgE, aspergillus skin test
Tx: steroids
- can use antifungals to decrease fungal load but not treatment for the reaction
CFTR modulators
oral meds
increased lung function
decreased pulm exacerbations
good outcomes
tricafta available 6yr up
correct at cellular level
needs to be most common genetic mutation df508
median survival for CF in Canada
60
Treatment for CF and known pseudomonas carrier with pulm exacerbation
IV ceftaz + tobra (dual IV for pulm exacerbation)
non pharmacotherapy interventions for asthma
environmental control
education
written action plan
medciation compliance
flovent (fluticasone) low / moderate/ high dosing
Preschool
- <200
- 200-250
- >250
Children 6-11
- </= 200
- 201-400
- > 400
teens
- </= 250
- 251-500
- >500
diagnosis of PCD
cilia biopsy (nares or bronch) with electron. microscopy
low nasal nitric oxide
genetic
Asthma PFT
Obstructive:
FEV1/FVC = <80% predicted
Postbronchodilator increase in FEV1 >12% or 200 ml = reversible = asthma
Restrictive PFT
o Restrictive dx affect both FEV1 and FVC
o TLC < 80%
Ratio FEV1/FVC typically stays the same or increases (as the FVC drops)
Smaller flow volume loop, same shape
vocal cord dysfxn PFT
Truncated and inconsistent inspiratory and exp flow-volume loops
Pattern differs from the reproducible pattern of airflow limitation in asthma that improves with bronchodilators
positive exercise challenge PFT for asthma
10-15% drop in FEV1 with exercise
Psuedomonas Coverage
“The Tazmanian Devil dips his Toes in the Hot Tub while Sipping Tea looking in a Mirror”
- PipTAZO
- CefTAZidime
- TOEbramycin
- CIPromycin
- MEROpenem
