Resp Flashcards

1
Q

Bacterial infxn in CF

A

staph aureus in younger kids
pseudomonas once start to get bronchiectasis (>age 3-5)

*pseudomonas needs double abx coverage

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2
Q

Atypical pneumonia signs

A

bilateral focal or interstitial infiltrates on CXR

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3
Q

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?

A

airway foreign body
CXR with inspiration/expiration

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4
Q

CAP (CPS) admit criteria

A

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)

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5
Q

CAP (CPS) empiric treatment

A

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

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6
Q

gold standard test for aspiration

A

Videofluoroscopic Swallowing Study (VFSS)

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7
Q

CPS ICS dosing for children 1-5yo

A

QVAR (Beclometasone) low 100, medium 200
Alvesco (Ciclesonide) low 100, med 200
Flovent (Fluticasone) low 100-125, medium 200-250

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7
Q

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

A

esophageal rupture
upper GI endoscopy

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7
Q

SpO2 cut off for bronchiolitis per CPS

A

<90%

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7
Q

Symptoms of OSA

A

frequent snoring >/= 3 nights per week
sleep enuresis
headaches on wakening
daytime sleepiness
learning problems

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7
Q

False positives and negatives for sweat chloride test

A

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
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8
Q

AHI in OSA

A

normal < 5
Mild 5-9
Moderate 15-30
Severe >30

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9
Q

first line tx of osa

A

adenotonsillectomy if evidence of tonsillar hypertrophy on exam

nasal steroids not first line - consider in those who can’t have surgery

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10
Q

asthma management over 12 yo

A

ICS + LABA
Symbicort (Budesonide / Formoterol)

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11
Q

lights criteria for pleural effusion

A

Exudative if 1 of:
PF:Serum Protein >0.5
PF:Serum LDH >0.6
PF LDH > ⅔ Serum LDH ULN

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12
Q

newborn screen for CF

A

IRT (immunoreactive trypsinogen)
*screening test, not diagnosis, still needs sweat chloride

13
Q

positive sweat chloride test

A

> 60 positive

30-60 is grey zone

diagnostic test for CF

14
Q

PFT in CF

A

FEF 25-75 decreases first, obstructive pattern with gas trapping (FEV1 is low and FEV1/FVC is low)

late disease get restrictive pattern

15
Q

CF genetics

A

autosommal recessive
delta f508 most common

each pregnancy has 25% chance of having diseease

16
Q

CF complications

A
  • 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)
17
Q

polyps management

A

screen for CF

18
Q

CF lung infection bugs

A

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)

19
Q

ABPA

A

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

20
Q

CFTR modulators

A

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

21
median survival for CF in Canada
60
22
Treatment for CF and known pseudomonas carrier with pulm exacerbation
IV ceftaz + tobra (dual IV for pulm exacerbation)
23
non pharmacotherapy interventions for asthma
environmental control education written action plan medciation compliance
24
flovent (fluticasone) low / moderate/ high dosing
Preschool - <200 - 200-250 - >250 Children 6-11 - 400 teens - 500
25
diagnosis of PCD
cilia biopsy (nares or bronch) with electron. microscopy low nasal nitric oxide genetic
26
Asthma PFT
Obstructive: FEV1/FVC = <80% predicted Postbronchodilator increase in FEV1 >12% or 200 ml = reversible = asthma
27
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
28
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
29
positive exercise challenge PFT for asthma
10-15% drop in FEV1 with exercise
30
Psuedomonas Coverage
"The Tazmanian Devil dips his Toes in the Hot Tub while Sipping Tea looking in a Mirror" - PipTAZO - CefTAZidime - TOEbramycin - CIPromycin - MEROpenem