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2023 RC Blue's Clues > Resp > Flashcards

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
Q

median survival for CF in Canada

A

60

22
Q

Treatment for CF and known pseudomonas carrier with pulm exacerbation

A

IV ceftaz + tobra (dual IV for pulm exacerbation)

23
Q

non pharmacotherapy interventions for asthma

A

environmental control
education
written action plan
medciation compliance

24
Q

flovent (fluticasone) low / moderate/ high dosing

A

Preschool
- <200
- 200-250
- >250

Children 6-11
- </= 200
- 201-400
- > 400

teens
- </= 250
- 251-500
- >500

25
Q

diagnosis of PCD

A

cilia biopsy (nares or bronch) with electron. microscopy

low nasal nitric oxide

genetic

26
Q

Asthma PFT

A

Obstructive:
FEV1/FVC = <80% predicted

Postbronchodilator increase in FEV1 >12% or 200 ml = reversible = asthma
27
Q

Restrictive PFT

A

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
Q

vocal cord dysfxn PFT

A

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
Q

positive exercise challenge PFT for asthma

A

10-15% drop in FEV1 with exercise

30
Q

Psuedomonas Coverage

A

“The Tazmanian Devil dips his Toes in the Hot Tub while Sipping Tea looking in a Mirror”
- PipTAZO
- CefTAZidime
- TOEbramycin
- CIPromycin
- MEROpenem

2023 RC Blue's Clues (20 decks)

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