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*Review TD 2020 > Resp > Flashcards

Resp Flashcards

1
Q

Foreign body aspiration

  • Red flags
  • Age?
  • Invest
A

Witnessed choking episode
Sudden onset cough

Usually < 3yo

CXR
Rigid bronchoscopy

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2
Q

Complications of foreign body aspiration?

A
  • Recurrent pneumonia
  • Bronchiectasis
  • Cardiac arrest and death
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3
Q

Brassy/Barking cough

A

Airway malacia, tracheal compression

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4
Q

“Honking Cough”

A

Psychogenic Cough

Or tracheomalacia

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5
Q

Wet Productive Cough ddx

A

Cystic Fibrosis,
Primary Cilliary dyskinesia
Immunodeficiency
Bronchiectasis

  • PersistentBacterialBronchitis
  • Missed Foreign body
  • Chronic Infections
  • Asthma +/- AllergicRhinitis
  • Recurrent Viral Infections
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6
Q

What on PFT is most specific to small airway dz?

A

FEF25-75

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7
Q

Clinical sign of CF in infancy?

A 
• Failure to thrive
• *Meconium ileus
• Recurrent respiratory symptoms
– Wheeze,cough,bronchiolitis
• *Hyponatremic, hypochloremic metabolic alkalsosis
• Prolonged Jaundice
• Severe pneumonia
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8
Q

Clinical signs of CF in childhood/adolescence?

A 
• 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
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9
Q

Bugs in CF?

A 
Pseudomonas
S.aureus
H.flu
Burkholderia Cepacia
Aspergillus fumigatus
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10
Q

Inheritance of CF?

A

AR

CFTR gene - chloride channels

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11
Q

Dx of CF?

A

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)]

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12
Q

Sweat test: false positive

A 
Malnutrition
Adrenal insufficiency
Hypothyroidism
Panhypopituitarism
Glycogen storage disease 1
Mucopolysaccharidosis
Ectodermal dysplasia
Eczema

(malnutrition, Endo or skin)

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13
Q

Sweat test: false negative

A 
Dilutional
Edema
Hyponatremia
Hypoproteinemia
Recent mineralocorticoid 
Insufficient sample
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14
Q

CF management?

A
  • 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

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15
Q

CF poor prognostic factors?

A 
Female
Malnutrition
Decreased FEV1 
Burkohlderia Cepacia
Pneumothorax
Liver diseases
Pancreatitis
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16
Q

ABPA

  • clin signs
  • investigations
  • Dx
  • Tx
A

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

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17
Q

PCD

  • Characteristics
  • Dx
A

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

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18
Q

Asthma diagnosis?

A

FEV1/FVC < 80%

FEV1 Change of 12% w bronchodilator

19
Q

Asthma control

A 
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
20
Q

Methacholine challenge

A
  • +ve: <4 mg/mL
  • Borderline: 4-16 mg/mL
  • Negative: >16mg/mL
21
Q

Asthma mgmt (triangle)

A

1) confirm dx
2) Education, Environmental control
3) Bronchodilator PRN
4) ICS
5) Escalation

22
Q

ICS dosing

A

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

23
Q

Side effects of ICS?

A

oral thrush
hoarseness
decreased linear growth on high dose

24
Q

Escalation of therapy for asthma?

A

12yo:
Add LABA -> Increase to medium ICS OR add LTRA

6-11yo:
Increase to medium ICS -> Add LABA or LTRA

25
Q

Congenital Pulmonary Airway Malformation

A

C AND C

cystic and adenomatoid malformations
cause pulmonary hypoplasia

CXR - cystic

26
Q

Pulmonary sequestrations

A

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

27
Q

OSA - gold standard

A

Polysomnography

Only need if evidence of enlarged adenoids

28
Q

Pertussis

  • bug
  • presentation
A

Bordetella pertussis
Whooping cough

Tx: azithromycin
(risk of infantile hypertrophic pyloric stenosis)

29
Q

RSV prophylaxis

A

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

30
Q

MAS mechanism?

A

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.

31
Q

Treatment of Croup?

mild v mod v severe?

A

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

32
Q

Causes of CF exacerbation?

A
  • Pulmonary exacerbation (pseudomonas)
  • CFRD - we know CF diabetes is related to lung function
  • ABPA
  • Viral illness
  • Noncompliance
33
Q

Bronchiolitis - O2 to keep sats >?

A

90%

34
Q

How to distinguish exercise induced asthma from deconditioning?

A

Cough

35
Q

Aspiration pneumonia - abx?

A

Clindamycin

Gentamicin

36
Q

CF pt w pleuritic chest pain?

A

pneumothorax

37
Q

Next step in OSA?

A

PSG
or
ENT referral

38
Q

ARDS - key characteristic?

A

decreased compliance

39
Q

Child with Duchenne MD, now confined to wheelchair and FEV1 has gone from 30% to 21% predicted. What will he complain of?

A

AM headaches

nocturnal hypoventilation

40
Q

infant Tachypnea + cough but appears well

CXR patchy atelectasis and interstitial infiltrates

A

Chlamydia pneumoniae

41
Q

CP with recurrent aspiration - what investigation?

A

Pleural fluid culture

42
Q

Examples of LABA?

A

Formoterol (sold as Oxeze® or Foradil®)

Salmeterol (sold as Serevent®)

43
Q

Examples of LRTA?

A

Montelukast (Singulair)

44
Q

Right sided aortic arch - what to worry about?

A

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

*Review TD 2020 (16 decks)

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