Respiratory Flashcards
Side effects of ventolin and MgSO4?
Ventolin: Tachycardia, hypokalemia, hyperglycemia, lactic acidosis
- IV: Arrhythmia
MgSO4: Hypotension, bradycardia
Signs/symptoms of CF (acronym)
CF PANCREAS Chronic cough, FTT, Pancreatic insufficiency (malabsorption), Alkalosis + hypoNa dehydration, Nasal polyps + neonatal mec ileus, CXR changes + clubbing, rectal prolapse, electrolyte elevation in sweat, absent or congenital atresia of vas deferens, sputum (S. aureus or pseudomonas) -DIOS, intussception/volvulus -PTX -Vitamin deficiency
CF - basic defect + pathophysiology
Defect in CF transmembrane conductance regulator protein = ion channel dysfunction = Cl poorly secreted into lumen + there is increased Na absorption from luminal surface = dehydrated + viscid secretions
Diagnosis of asthma in preschoolers
- Documentation of airflow obstruction
- Documentation of reversibility of airflow obstruction
- Preferred: by professional
- Alternative: response to 3 month trial of ICS or parental report of response to SABA - No clinical evidence of an alternative diagnosis
Alternative diagnoses to asthma
- GERD
- EoE
- Post nasal drip
- Swallowing dysfunction, aspiration
- Immune dysfunction
- BPD
- Bronchiolitis
- Rhinosinusitis
- CPAM
- Primary ciliary dyskinesis
- CF
- Pulmonary edema
x3 organisms that we worry about in CF for airway colonization?
- Pseudomonas aeruginosa
- Staph aureus
- Burkholderia cepacia
Intestinal complications of CF (x7)
- DIOS
- Mec ileus
- Rectal prolapse
- Reflux
- Malabsorption
- Biliary cirrhosis
- Pancreatitis
Definition of acute vs chronic cough
-Chronic >3-4 weeks
DDx for chronic cough
-Frequent viral illness
-Post-viral cough
-Pertussis or pertussis like cough
-Asthma
-Chronic rhinitis
-Persistent bronchitis
-GERD
-Psychogenic cough
-CF
-Immunodeficiency
-Primary ciliary dyskinesia
-Foreign body aspiration
-Recurrent pulmonary aspirations
-TB
-Anatomic disorder
Interstitial lung disease
Diagnosis of Cystic Fibrosis
Clinical signs OR NMS+ OR sibling with CF
PLUS
x2 sweat chloride OR x2 CFTR mutations OR abnormal nasal potential difference
Poor prognostic features for Cystic Fibrosis
- Male
- Lung disease: FEV1, Burkholderia cepacia, PTX
- Nutritional: DM, growth parameters
What to think of in case of neonatal respiratory distress for unclear reason or requiring supplemental oxygen for longer than expected?
Primary Ciliary Dyskinesia
Key features of primary ciliary dyskinesia (x4)?
- Unexplained resp distress in term neonate
- Year round daily cough/congestion
- Laterality defects
- Recurrent AOM
Asthma control criteria (x7)
- Daytime symptoms <2 days/week
- Nighttime symptoms <1 day/week
- Physical activity = normal
- Exacerbations = mild/infrequent
- Absence from school/activities = none
- Fast acting B-agonist <2 doses/week
- FEV1 or PEF = >90% of personal best
Diagnosis of asthma in children >5 years old
- Clinical symptoms PLUS
- Objective evidence: spirometry (dec FEV1/FVC + bronchodilator response >12%), peak flow (inc by 20% following bronchodilator), or metacholine challenge (<4mg/mL)
Diagnosis of asthma in children 1-5 years old
- Documentation of airflow obstruction
- Documentation of reversibility of airflow obstruction
- No clinical evidence of alternative diagnosis
Predictive index for asthma in 1-5 years olds
1 Major = parental asthma, personal eczema, personal aeroallergen
OR
2 minor = wheezing between episodes, peripheral eosinophila, sensitization to food allergens
AND
>3 wheezing episodes
At what age should you move from full mask to mouthpiece for asthma puffers?
5 years old
Management algorithm for children with asthma <5 years old?
- Low ICS
- Medium ICS
- Add in leukotriene receptor antagonist
Management algorithm for children with asthma 5-11 years old?
- Low ICS
- Medium ICS
- Add LABA or LTRA
- Add the other from above
Management algorithm for children with asthma >12 years old?
- Low ICS
- Low ICS + LABA
- Med ICS or SMART or LTRA
- Low-med ICS + LABA + LTRA +/- SMART
Roughly what is low-medium-high dose of Fluticasone for (a) children 6-11 years old and (b) children >12 years old
(a) <200, 200-400, >400
(b) <250, 250-500, >500
Should you do a CT with or without contrast for investigation of recurrent pneumonia?
With
x4 stages of snoring pathology
- Primary snoring
- Upper airway resistance syndrome
- Obstructive hypoventilation syndrome
- OSA
Causes of OSA (x4)
- Obesity
- Enlarged tonsils/adenoids
- Craniofacial syndromes
- Hypotonia
OSA clinical features
- Daytime fatigue, difficulty waking in the AM
- Headaches
- Enuresis
- FTT
- Behaviour, ADHD, poor school performance
- Developmental delay
x2 cardiovascular complications from OSA
- HTN
- Cor pulmonale
x3 potential investigations for OSA
- PSG = gold standard
- Pulse oximetry = does not differentiate causes
- XR = poor correlation, but could be enough in combination with symptoms
Management for OSA
- Non-pharma: nasal hygiene, sleep hygiene, weight loss
- Pharma: intranasal steroids, montelukast
- Surgical: adenoidectomy/tonsillectomy
- Other: CPAP
What to think of in a child with CF who has eosinophilia and high Ige?
Aspergillosus
