Respiratory Flashcards
Compare signs in upper airway infections
Croup- 3mo-5y, barking cough/stridor + coryza
EBV- teenager, malaise/fatigue, lymphadenopathy/HSM
Quinsy/paratonsillar abscess- teenager, trismus, hot potato voice, drooling
Epiglottitis- toxic, fever, drooling, stridor, unvaccinated
Bacterial tracheitis- toxic, fever, stridor
Retropharyngeal abscess- odynophagia/dysphagia, drooling, dysphonia, neck stiffness/torticollis
Indications for neuraminidase inhibitors in pneumonia
Inpatients with complicated disease thought to be related to influenza
Patients requiring ICU during influenza season
Child with suspected influenza at high risk of complications (congenital heart disease, respiratory disease, or immunosuppression)
Most common cause pneumonia <5yrs & >5yrs
<5yrs = viral most common (adeno, entero, RSV, parainfluenza etc), bacterial - ENT bugs- strep pneumo, moraxella, h.influenza, MSSA, s.pyogenes
>5yrs = strep. pneumo, mycoplasma/chlamydia (atypical)
Pathogenesis of round pneumonia
Inter-alveolar communication and collateral airways (pores of Kohn and canals of Lambert) develop as children age and allow air-drift between the parenchymal subsegments- infection walled between these spaces
Signs of empyema on pleural fluid tap
Empyema consistent with:
pH <7.0
Glucose <40 mg/DL
LDH >1000 IU
Protein level > 3.0 g/dL
Pleural fluid: serum protein ratio >0.5
Syndromes associated with laryngeal cleft
G syndrome: hypertelorism, hypospadias, stridor, and swallowing difficulties
Opitz-Frias syndrome: midline defects (as above)
Pallister-Hall syndrome
VACTER/VACTERL
CHARGE
Distinguish saccular laryngeal cyst from larygocoele
Saccular cyst distinguished from a laryngocele in that its lumen is isolated from the interior of the larynx and it contains mucous, not air
Stages of lung development
Embryonic (Wk 4 -5) lung buds from ventral foregut, lobar division
Pseudoglandular (5-17) Airway branching- vascular & conducting airways complete
Canalicular(16-25) - bronchioles/ ^ capillaries, alveolar Type 1&2 alveolar cells, air blood barrier
Saccular (24-40) Alveolar ducts, air sacs
True alveoli seen by 32 weeks gestation – recognizable by 36 weeks
Alveolar (32-36 week to 8 years)
Secondary septation occurs, marked increase of the number and size of capillaries and alveoli
Most development is postnatal - 85% of alveolarization occurs postnatally
15 million alveoli at birth (term) 🡪 300-600 million as an adult [exponentially increase until 2 years old
When do babies have true alveoli
True alveoli seen by 32 weeks gestation – recognizable by 36 weeks
Alveolar (32-36 week to 8 years)
Differences between CPAM/Sequestration
CPAM - dysplastic lung mixed w normal lung, blood supply from lungs, connected to bronchial tree
Sequestration- blood supply systemic, no connection to bronchial tree
Difference intrapulmonary vs extrapulmonary sequestration
Intrapulmonary 75-85%, lower lobe, no pleura
Extrapulmonary 15-25% boys, L) lung, 60% assoc w congenital defects- Diaphragmatic hernia
Colonic duplication
Vertebral anomalies
Pulmonary hypoplasia + CPAM
Scimitar syndrom
Compare Granulomatosis w Polyangiitis & Churg-Strauss Syndrome
Systemic disease leading to interstitial lung disease
GPA: 90% cANCA raised, pulm hemorrhage, rhinosinusitis- nasal discharge/septum degradation- skin, joint, conjunctivitis, peri/myocarditis can be rapidly progressive
Rx: long term immunosuppression, plasma exchange, rituximab
Churg-Strauss: pANCA raised, rhinitis/asthma, eosinophilia, multisystem vasculitis (kidneys, skin, heart)
Rx: steroids
Symptoms of sarcoidosis
> 8yrs
Idiopathic, multisystem inflammatory disorder
Skin rash, iridocyclitis, and arthritis- often without lung Dx
CXR shows changes despite no Sx 90%
Bloods: hypergamm, ACE elevated, high Ca, elevated CD4
Bx: non-caseating granulomas- predominant in upper lobes, ACE
Rx: 75% self resolve, if Stage 3 and above steroids +/- other immunosuppression
Symptoms of sarcoidosis
> 8yrs
Idiopathic, multisystem inflammatory disorder
Skin rash, iridocyclitis, and arthritis- often without lung Dx
CXR shows changes despite no Sx 90%
Bloods: hypergamm, ACE elevated, high Ca, elevated CD4
Bx: non-caseating granulomas- predominant in upper lobes, ACE
Rx: 75% self resolve, if Stage 3 and above steroids +/- other immunosuppression
Mx of chylothorax
50% resolve spontaneously
Enteral feeds
Medium chain triglycerides (MCTs) can be provided – absorbed directly into intestinal cells and transported directly to the liver via the portal vein – BYPASSING the thoracic duct
TPN if not improving 1-2wks
Consider pleuroperitoneal shunt
Composition chyle
TG in the form of chylomicrons
T lymphocytes
Electrolyte concentration similar to plasma
Immunoglobulins and fat soluble vitamins
Dx of this CXR?
CCAM
- Hamartomatous or dysplastic lung tissue mixed with normal lung
- Often unilateral
- Connected to pulmonary blood supply
Type 1 – macrocystic, single or several large cysts
Type 2 – microcystic, multiple small cysts
Type 3 – lesion is solid with bronchiole-like structures, poorest prognosis
Present with resp distress as neonate if large, recurrent infection in childhood if small
Dx of this CXR?
Eventration of diaphragm
- elevation, with paradoxical downwards motion in other diaphragm
-Assoc: congenital cardiac lesions, pulmonary sequestrations and chromosome trisomies
Dx of this CXR?
Congenital lobar emphysema
- Most commonly L) upper lung/upper lung fields
- Usually presents neonatal period with resp distress
- Airspace widening w mediastinal shift/contralateral atelectasis
Dx of this CXR?
CDH
- Bochaldek - most common, more L) sided, resp distress at birth/diagnosed antenatally
- Foramen of Morgani (2-6%)- anterolateral, R) sided, asymptomatic
Dx of this CXR?
Pneumomediastinum
- Spinnaker sail sign
- Elevated thymus
- Conservative Mx
Dx of this CXR?
Eosinophillic pneumonitis
- Bilateral infiltrates
- Acute: often in teenagers, idiopathic, BAL shows >25% Eosinophils, Rx: steroids
- Chronic: more common in adults
Dx of this CXR?
Churg-Strauss
- Rhinitis -> eosinophilia -> vasculitis
- Skin, heart & GI manifestations, elevated pANCA, eosinophils on BAL
- More insidious onset
Dx of this CXR?
Miliary TB
> 2 organs affected
Early complication of primary infection
Due to massive release of organisms
CXR- diffuse, bilateral, micronodular pattern