Resp Flashcards
Foreign body aspiration
- Red flags
- Age?
- Invest
Witnessed choking episode
Sudden onset cough
Usually < 3yo
CXR
Rigid bronchoscopy
Complications of foreign body aspiration?
- Recurrent pneumonia
- Bronchiectasis
- Cardiac arrest and death
Brassy/Barking cough
Airway malacia, tracheal compression
“Honking Cough”
Psychogenic Cough
Or tracheomalacia
Wet Productive Cough ddx
Cystic Fibrosis,
Primary Cilliary dyskinesia
Immunodeficiency
Bronchiectasis
- PersistentBacterialBronchitis
- Missed Foreign body
- Chronic Infections
- Asthma +/- AllergicRhinitis
- Recurrent Viral Infections
What on PFT is most specific to small airway dz?
FEF25-75
Clinical sign of CF in infancy?
• Failure to thrive • *Meconium ileus • Recurrent respiratory symptoms – Wheeze,cough,bronchiolitis • *Hyponatremic, hypochloremic metabolic alkalsosis • Prolonged Jaundice • Severe pneumonia
Clinical signs of CF in childhood/adolescence?
• Recurrent respiratory symptoms – Cough,pneuomonia,wheeze poorly controlled asthma etc.. • Failure to thrive • *Recurrent rectal prolapse • Clubbing • *Bronchiectasis • *Nasal polyps/sinus disease • Chronic Pseudomonas aeroginosa colonization
Bugs in CF?
Pseudomonas S.aureus H.flu Burkholderia Cepacia Aspergillus fumigatus
Inheritance of CF?
AR
CFTR gene - chloride channels
Dx of CF?
Gold Standard: Sweat Chloride > 60 mmol/L
[Clin features OR sibling w CF OR +NNS]
+
[Lab evidence of CFTR dysfunction (abnormal sweat test x2days OR 2 CF mutations OR abnormal nasal potential difference)]
Sweat test: false positive
Malnutrition Adrenal insufficiency Hypothyroidism Panhypopituitarism Glycogen storage disease 1 Mucopolysaccharidosis Ectodermal dysplasia Eczema
(malnutrition, Endo or skin)
Sweat test: false negative
Dilutional Edema Hyponatremia Hypoproteinemia Recent mineralocorticoid Insufficient sample
CF management?
- Multidisciplinary Clinic (Nurse,Physiotherapy, Dietician, Social Worker, Psychologist)
Maintain lung function:
- regular chest physio
- treat acute infections w PO/IV
- treat chronic infections w PO/inhaled abx
- mucolytics
Maintain normal nutrition/growth
- high fat/energy diet
- pancreatic enzymes
- vitamin supplemental
- supplements/Gtube
Family Education
CF poor prognostic factors?
Female Malnutrition Decreased FEV1 Burkohlderia Cepacia Pneumothorax Liver diseases Pancreatitis
ABPA
- clin signs
- investigations
- Dx
- Tx
Allergic bronchopulmonary aspergillosis
Rust coloured sputum
not responsive to abx
CXR: new focal infiltrates
DX:
Skin test for aspergillus
IgE elevated
Tx:
Steroids
Itraconazole and Voriconazole
PCD
- Characteristics
- Dx
Year round wet cough
Year round nasal congestion, sinusitis
Recurrent AOM
Bronchiectasis
50% - situs inverses totalis
DX: electron microscopy (nasal curettage or bronchial bx)
or iNO nasal
or genetics
Asthma diagnosis?
FEV1/FVC < 80%
FEV1 Change of 12% w bronchodilator
Asthma control
Day time sx < 4days/week Nighttime sx never Vent use < 4x/week (not incl pre-exercise) Normal physical activity No absence from school Mild, infrequency exacerbations FEV1 or PET > 90% personal best
Methacholine challenge
- +ve: <4 mg/mL
- Borderline: 4-16 mg/mL
- Negative: >16mg/mL
Asthma mgmt (triangle)
1) confirm dx
2) Education, Environmental control
3) Bronchodilator PRN
4) ICS
5) Escalation
ICS dosing
Low dose
12yo: ≤250 mcg/day
6-11 : ≤200 mcg /day
Medium dose
12yo: 251-500 mcg/day
6-11yo: 201-400 mcg /day
High dose:
12yo: >500 mcg/day
6-11 yo: >400 mcg /day
Side effects of ICS?
oral thrush
hoarseness
decreased linear growth on high dose
Escalation of therapy for asthma?
12yo:
Add LABA -> Increase to medium ICS OR add LTRA
6-11yo:
Increase to medium ICS -> Add LABA or LTRA
Congenital Pulmonary Airway Malformation
C AND C
cystic and adenomatoid malformations
cause pulmonary hypoplasia
CXR - cystic
Pulmonary sequestrations
congenital anomaly in lung development
SPACE occupying lesion
feeding vessel from aorta
lung tissue does not connect to bronchus
= no gas exchange
dx: CT w contrast
OSA - gold standard
Polysomnography
Only need if evidence of enlarged adenoids
Pertussis
- bug
- presentation
Bordetella pertussis
Whooping cough
Tx: azithromycin
(risk of infantile hypertrophic pyloric stenosis)
RSV prophylaxis
1) <12mo hemodynamically significant CHD or CLD (need for O2 at 36wga) req’ing diuretics, bronchodilators, steroids or supplements O2
2) <6mo preterm infants w/o CLD born < 30wga
3) consider <6mo born <36wga in remote communities who would req transportation
MAS mechanism?
1) airway obstruction
- meconium may partially or completely block the airway, leading to either hyperdistention or atelectasis of the alveoli.
2) pulmonary vasoconstriction and hypertension
- with right-to-left shunting caused by increased pulmonary vascular resistance.
3) surfactant dysfunction
- components of meconium may inactivate surfactant.
4) infection
- good medium for enhancing bacterial growth in vitro
5) possible chemical pneumonitis
- meconium is acidotic, may cause airway irritation. The enzymes and bile salts of meconium may cause a release of cytokines.
Treatment of Croup?
mild v mod v severe?
Mild - occasional barky without stridor at rest - tx with Dex and educate parents
Mod - frequent barking, stridor and WOB at rest - Dex and obs prior to discharge, nebulized racemic epinephrine for moderate or severe croup
Severe - marked stridor and WOB - Dex and Epi. Obs 3-4 hrs post epi for rebound
Causes of CF exacerbation?
- Pulmonary exacerbation (pseudomonas)
- CFRD - we know CF diabetes is related to lung function
- ABPA
- Viral illness
- Noncompliance
Bronchiolitis - O2 to keep sats >?
90%
How to distinguish exercise induced asthma from deconditioning?
Cough
Aspiration pneumonia - abx?
Clindamycin
Gentamicin
CF pt w pleuritic chest pain?
pneumothorax
Next step in OSA?
PSG
or
ENT referral
ARDS - key characteristic?
decreased compliance
Child with Duchenne MD, now confined to wheelchair and FEV1 has gone from 30% to 21% predicted. What will he complain of?
AM headaches
nocturnal hypoventilation
infant Tachypnea + cough but appears well
CXR patchy atelectasis and interstitial infiltrates
Chlamydia pneumoniae
CP with recurrent aspiration - what investigation?
Pleural fluid culture
Examples of LABA?
Formoterol (sold as Oxeze® or Foradil®)
Salmeterol (sold as Serevent®)
Examples of LRTA?
Montelukast (Singulair)
Right sided aortic arch - what to worry about?
vascular ring– can cause tracheal/esophageal compression (or be asymptomatic)
Diverticulum of Kommerell – vascular structure from which abberant subclavian and ductus arteriosus can arise from; this structure may contribute to the posterior compression of the trachea/esophagus and may produce symptoms even after surgical division of the vascular ring, if the structure is not also resected
