Respiratory Flashcards
What is the first investigation in mgmt of likely laryngomalacia?
Flexible laryngoscopy
What are the indications for investigation of likely laryngomalacia?
Stridor at rest Late onset (> 4 months old) Poor weight gain Persistent or severe stridor
Note: usually self resolves by 1 yr old
In an acute severe asthma attack the peak flow is 33-50% of best/predicted T/F
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
OSA is commonly associated with nocturnal enuresis T/F
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
What is the 1st line treatment in new diagnosis Crohns disease?
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
Where is an azygous lobe seen on CXR?
Right upper lobe
Normal variant - seen in 0.5% chest xray
According to the NICE guidelines for what persistent O2 saturation is oxygen supplementation rec for bronchiolitis?
Persistently less than 92%
Defn of a + sweat test?
Chloride greater than or equal to 60mmol
What % of infants born with mec ileus have CF?
> 95%
Note: 15% of new borns with CF will present with mec ileus
A large bore chest tube is indicated in the drainage of an empyema T/F
F - want a thin bore, shown these patient are d/c from hospital earlier
When a person is standing is the blood flow and ventilation higher or low at the apex compared to the bases?
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
Does congenital lobar emphysema commonly upper or lower lobes?
Commonly the upper lobes
Of note it can be found incidentally on chest xray and be asymptomatic
Pulmonary stenosis is a common cause of pulmonary hypertension T/F
F - pulmonary stenosis protects against pulmonary hypertension
Common causes of pulmonary hypertension
- Chronic lung disease
- Post tricuspid shunts - large VSD, atrioventricular septal defect, PDA
- Cardiomyopathy
- TGA
- Familial/idiopathic (most common)
What is the most common cause of pulmonary hypertension in paediatrics?
Idiopathic or familial disease (55%)
Followed by pulmonary htn secondary to congenital heart disease (35%) and resp disorders (15%).
What is the most common secondary cause of pulmonary htn in children?
Congenital heart disease
Note: familial or idiopathic is the most common cause overall though
Compare the clinical presentation of croup to epiglottitis
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
What is the most common cause of epiglottitis?
H influenzae B
Note: bacterial tracheitis is also commonly caused by H flu or staph aureus
Most common cause of croup?
Parainfluenza
In Guilain-Barre syndrome what is the most sensitive measure of respiratory muscle weakness?
Vital capacity - used to monitor progression
Note: GBS leads to restrictive lung disease
Pulmonary haemorrhage results in what type of resp failure?
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
Where is surfactant made?
Type 2 pneumocytes
What is the function of type 1 pneumocytes?
Gas exchange
Nebulised steroids have no role in the treatment of croup T/F
F - can be helpful in reducing upper airway swelling
In croup inhaled humid air only helps with symptom relief T/F
T - no therapeutic effects, can relieve symptoms in some cases
What children with asthma should be considered for monoclonal antibody treatment?
Children over the age of 6 with severe and persistent asthma
What is the drug used for RSV prophylaxis called?
Palivizumab
Tidal vol is the vol inspired with each breath at rest T/F
F - it is inspired AND expired
Note: functional residual capacity is what is left in the lungs after normal tidal expiration
Total lung capacity is the total vol of air in the lungs following max inspiration T/F
T
Total lung capacity is the max volume of air that can be expired after a max inspiration T/F
F - this is vital capacity
Residual volume is a commonly measured PFT T/F
F - it cannot be measured via spirometry, it is the volume of air remaining in the lungs after max expiration
Loss of normal shoulders of the subglottic airway on X-ray, what pathology?
Croup
This is the steeple sign
Thickening of the aryepiglottic fold and epiglottis on X-ray what pathology?
Epiglottitis
This is the thumbprint sign
Presentation and tx of bronchogenic cysts?
Recurrent pulmonary infections; pneumothorax
Tx: excision
Note: caused by abnormal budding of the tracheal diverticulum of the foregut before 16 weeks gestation.
What is the procedure of choice for foreign body aspiration?
Rigid bronch
The most common clinical manifestation of alpha 1 antitrypsin def in children is recurrent wheeze. T/F
F - rare to see any pulmonary manifestations until 40 or 50s.
May see hepatic manifestations in children
Lymphocytic interstitial pneumonitis while rare in children is associated with what other chronic disease?
HIV
Note: usual interstitial pneumonitis is not seen in children
When is heliox contraindicated in the mgmt of status asthmaticus?
If the patient requires FiO2 > 40% due to the diminished benefit of a low density gas as the oxygen conc increases
Classic presentation of bacterial tracheitis?
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
What is the most common cause of bacterial tracheitis?
S aureus
What is the best initial lab evaluation for mycoplasma pneumonia?
Serum mycoplasma pneumonia IgM
or PCR
What is the best clinical index to predict outcomes in status asthmaticus?
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
Presentation of a pulmonary sling?
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
Findings on barium swallow in a pulmonary sling?
Anterior indentation/filling defect of the oesophagus best seen on lateral projection
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
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
