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Respiratory Flashcards

1
Q

What is the first investigation in mgmt of likely laryngomalacia?

A

Flexible laryngoscopy

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2
Q

What are the indications for investigation of likely laryngomalacia?

A 
Stridor at rest
Late onset (> 4 months old)
Poor weight gain
Persistent or severe stridor

Note: usually self resolves by 1 yr old

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3
Q

In an acute severe asthma attack the peak flow is 33-50% of best/predicted T/F

A

T

Other features:

  • Can’t complete sentences in one breath
  • O2 < 92%
  • HR > 140 or RR > 40 in 2-5 yrs; HR >125 or RR >30 in >5
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4
Q

OSA is commonly associated with nocturnal enuresis T/F

A

T - thought to be due to changes in intra thoracic pressure leading to increased production of atrial natriuretic peptide –> increased frequency of urination

Note: also associated with poor growth and polycythaemia due to prolonged hypoxaemia

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5
Q

What is the 1st line treatment in new diagnosis Crohns disease?

A

Elemental diet or steroid monotherapy

Would choose elemental therapy over steroids if the child is young so there is concern about growth or there have already been issues with growth

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6
Q

Where is an azygous lobe seen on CXR?

A

Right upper lobe

Normal variant - seen in 0.5% chest xray

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7
Q

According to the NICE guidelines for what persistent O2 saturation is oxygen supplementation rec for bronchiolitis?

A

Persistently less than 92%

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8
Q

Defn of a + sweat test?

A

Chloride greater than or equal to 60mmol

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9
Q

What % of infants born with mec ileus have CF?

A

> 95%

Note: 15% of new borns with CF will present with mec ileus

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10
Q

A large bore chest tube is indicated in the drainage of an empyema T/F

A

F - want a thin bore, shown these patient are d/c from hospital earlier

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11
Q

When a person is standing is the blood flow and ventilation higher or low at the apex compared to the bases?

A

Both are lower at the apex

Note: the V/Q ratio is higher at the apex though as the reduction in V is less than the reduction in Q

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12
Q

Does congenital lobar emphysema commonly upper or lower lobes?

A

Commonly the upper lobes

Of note it can be found incidentally on chest xray and be asymptomatic

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13
Q

Pulmonary stenosis is a common cause of pulmonary hypertension T/F

A

F - pulmonary stenosis protects against pulmonary hypertension

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14
Q

Common causes of pulmonary hypertension

A
  1. Chronic lung disease
  2. Post tricuspid shunts - large VSD, atrioventricular septal defect, PDA
  3. Cardiomyopathy
  4. TGA
  5. Familial/idiopathic (most common)
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15
Q

What is the most common cause of pulmonary hypertension in paediatrics?

A

Idiopathic or familial disease (55%)

Followed by pulmonary htn secondary to congenital heart disease (35%) and resp disorders (15%).

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16
Q

What is the most common secondary cause of pulmonary htn in children?

A

Congenital heart disease

Note: familial or idiopathic is the most common cause overall though

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17
Q

Compare the clinical presentation of croup to epiglottitis

A

Croup - barking cough, hoarse voice, harsh stridor, non toxic appearing, no drooling

Epiglottitis - no cough, muffled voice, soft stridor, sudden onset (lacks typical viral prodrome), toxic

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18
Q

What is the most common cause of epiglottitis?

A

H influenzae B

Note: bacterial tracheitis is also commonly caused by H flu or staph aureus

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19
Q

Most common cause of croup?

A

Parainfluenza

20
Q

In Guilain-Barre syndrome what is the most sensitive measure of respiratory muscle weakness?

A

Vital capacity - used to monitor progression

Note: GBS leads to restrictive lung disease

21
Q

Pulmonary haemorrhage results in what type of resp failure?

A

Type 1 - due to V/Q mismatch and results in hypoxia without hypercarbia

Injury to lung parenchyma - other type 1 pulmonary oedema, resp distress syndrome

22
Q

Where is surfactant made?

A

Type 2 pneumocytes

23
Q

What is the function of type 1 pneumocytes?

A

Gas exchange

24
Q

Nebulised steroids have no role in the treatment of croup T/F

A

F - can be helpful in reducing upper airway swelling

25
Q

In croup inhaled humid air only helps with symptom relief T/F

A

T - no therapeutic effects, can relieve symptoms in some cases

26
Q

What children with asthma should be considered for monoclonal antibody treatment?

A

Children over the age of 6 with severe and persistent asthma

27
Q

What is the drug used for RSV prophylaxis called?

A

Palivizumab

28
Q

Tidal vol is the vol inspired with each breath at rest T/F

A

F - it is inspired AND expired

Note: functional residual capacity is what is left in the lungs after normal tidal expiration

29
Q

Total lung capacity is the total vol of air in the lungs following max inspiration T/F

A

T

30
Q

Total lung capacity is the max volume of air that can be expired after a max inspiration T/F

A

F - this is vital capacity

31
Q

Residual volume is a commonly measured PFT T/F

A

F - it cannot be measured via spirometry, it is the volume of air remaining in the lungs after max expiration

32
Q

Loss of normal shoulders of the subglottic airway on X-ray, what pathology?

A

Croup

This is the steeple sign

33
Q

Thickening of the aryepiglottic fold and epiglottis on X-ray what pathology?

A

Epiglottitis

This is the thumbprint sign

34
Q

Presentation and tx of bronchogenic cysts?

A

Recurrent pulmonary infections; pneumothorax

Tx: excision

Note: caused by abnormal budding of the tracheal diverticulum of the foregut before 16 weeks gestation.

35
Q

What is the procedure of choice for foreign body aspiration?

A

Rigid bronch

36
Q

The most common clinical manifestation of alpha 1 antitrypsin def in children is recurrent wheeze. T/F

A

F - rare to see any pulmonary manifestations until 40 or 50s.
May see hepatic manifestations in children

37
Q

Lymphocytic interstitial pneumonitis while rare in children is associated with what other chronic disease?

A

HIV

Note: usual interstitial pneumonitis is not seen in children

38
Q

When is heliox contraindicated in the mgmt of status asthmaticus?

A

If the patient requires FiO2 > 40% due to the diminished benefit of a low density gas as the oxygen conc increases

39
Q

Classic presentation of bacterial tracheitis?

A

Usually have croup first but had seemed like they were getting better/stabilised. Signs of acute respiratory distress and toxic appearing.

Note: Considered a bacterial complication of a viral disease. Do not have the drooling associated with epiglottis though

40
Q

What is the most common cause of bacterial tracheitis?

A

S aureus

41
Q

What is the best initial lab evaluation for mycoplasma pneumonia?

A

Serum mycoplasma pneumonia IgM

or PCR

42
Q

What is the best clinical index to predict outcomes in status asthmaticus?

A

No single clinical or diagnostic index has been shown to predict clinical outcomes in status asthmaticus

Note: hx of near fatal asthma require intubation is the single greatest predictor of death from asthma

43
Q

Presentation of a pulmonary sling?

A 
Stridor 
Chronic wheeze
Resp distress
Apnoea
Swallowing dysfunction with emesis

Note: AKA aberrant left pulmonary artery - the anomalous vessel courses between the trachea and oesophagus. It is a type of vascular ring

44
Q

Findings on barium swallow in a pulmonary sling?

A

Anterior indentation/filling defect of the oesophagus best seen on lateral projection

45
Q

In a child under 4 yrs old with a known TB exposure treatment for latent TB should be initiated even if initial PPD is negative T/F

A

T - should also get a chest xray as part of initial eval. PPD should be repeated 10-12 weeks later. If PPD is negative at that time can stop the treatment

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