Respiratory Flashcards
1
Q
- What is the stepwise approach to asthma management in children?
A
Stepwise: SABA as needed → add low-dose ICS → increase ICS or add LABA/LTRA
- Tailor to severity and control
2
Q
- What is the role of inhaled corticosteroids in asthma?
A
ICS: First-line controller therapy to reduce inflammation and prevent exacerbations
3
Q
- What is the management of acute severe asthma in children?
A
Management: Oxygen, nebulized SABA ± ipratropium, systemic steroids, IV MgSO4 if severe
- Consider ICU if no improvement
4
Q
- What are the signs of life-threatening asthma?
A
Signs: Silent chest, cyanosis, altered consciousness, bradycardia, exhaustion, poor respiratory effort
5
Q
- What are the indications for hospital admission in pediatric asthma?
A
Admission: Hypoxia, inability to speak/feed, exhaustion, poor response to bronchodilators, previous ICU admission
6
Q
- What are common triggers of asthma exacerbation in children?
A
Triggers: Viral infections, allergens, exercise, cold air, smoke, GERD, stress
7
Q
- What is the stepwise management of allergic rhinitis?
A
Stepwise: Allergen avoidance → antihistamines → intranasal steroids → leukotriene receptor antagonists
- Immunotherapy if severe
8
Q
- What is the classic triad of asthma?
A
Classic triad: Wheeze, cough, and breathlessness (dyspnea)
9
Q
- What is vocal cord dysfunction and how is it differentiated from asthma?
A
VCD: Inspiratory stridor, throat tightness, no response to asthma meds
- Diagnosed by laryngoscopy during symptoms
10
Q
- What are the causes of wheezing in children besides asthma?
A
Non-asthma wheezing: Viral bronchiolitis, tracheomalacia, foreign body, GERD, CF, vocal cord dysfunction
11
Q
- What are common causes of exertional dyspnea in adolescents?
A
Causes: Asthma, vocal cord dysfunction, anemia, poor fitness, congenital heart disease, ILD
12
Q
- What is tracheoesophageal fistula (TEF) and how does it present?
A
TEF: Abnormal connection between esophagus and trachea
- Presents with drooling, choking, cyanosis with feeds
13
Q
- How is TEF diagnosed in newborns?
A
Diagnosis: Inability to pass nasogastric tube, CXR shows coiled tube, confirm with contrast study
14
Q
- What is pulmonary hypoplasia and what conditions is it associated with?
A
Pulmonary hypoplasia: Underdeveloped lungs
- Associated with oligohydramnios, CDH, renal agenesis
15
Q
- What is the management of CDH in neonates?
A
Stabilize with intubation (no bag mask), gentle ventilation, PGE1 if needed, surgery after stabilization
16
Q
- How is CDH diagnosed prenatally and postnatally?
A
Prenatal: Ultrasound showing bowel in chest
- Postnatal: CXR shows bowel loops in thorax, mediastinal shift
17
Q
- What is congenital diaphragmatic hernia (CDH) and how does it present?
A
CDH: Herniation of abdominal contents into thoracic cavity through diaphragm defect
- Causes respiratory distress at birth
18
Q
- What are the types and locations of CDH?
A
Types: Bochdalek (posterolateral, most common, usually left-sided), Morgagni (anterior)
19
Q
- What are the complications of CDH?
A
Complications: Pulmonary hypoplasia, pulmonary hypertension, GI obstruction, poor lung compliance
20
Q
- How does congenital lobar overinflation present and how is it treated?
A
CLO: Overdistension of one lobe (usually LUL) → respiratory distress in infancy
- CXR: Hyperlucency, mediastinal shift
- Tx: Lobectomy
21
Q
- What are the common respiratory pathogens in cystic fibrosis?
A
Pathogens: Pseudomonas aeruginosa, Staph aureus, H. influenzae, Burkholderia cepacia (poor prognosis)
22
Q
- What is the presentation and diagnosis of cystic fibrosis in children?
A
CF: Failure to thrive, chronic cough, steatorrhea, recurrent infections
- Diagnosed by sweat chloride test >60 mmol/L
23
Q
- How is bronchiectasis managed in pediatric patients?
A
Management: Airway clearance, chest physiotherapy, antibiotics, bronchodilators
- Surgery for localized disease
24
Q
- What is bronchiectasis and how does it present in children?
A
Bronchiectasis: Irreversible airway dilation due to chronic infection/inflammation
- Persistent cough, purulent sputum, clubbing
25
46. What is primary ciliary dyskinesia and its clinical features?
PCD: Genetic defect in ciliary motility
- Presents with chronic cough, sinusitis, otitis media, situs inversus (Kartagener syndrome)
26
92. What is pulmonary arteriovenous malformation (AVM) and how does it present?
Pulmonary AVM: Abnormal vascular connection between pulmonary artery and vein
- Presents with hypoxemia, cyanosis, clubbing, hemoptysis
27
93. What is the management of pulmonary AVMs in pediatric patients?
Management: Contrast-enhanced CT or angiography
- Treatment: Embolization or surgical resection
28
13. What is laryngomalacia and how does it present?
Laryngomalacia: Most common cause of congenital stridor
- Presents with intermittent inspiratory stridor, worse when feeding/lying down
29
79. What is pulmonary sequestration and how is it managed?
Pulmonary sequestration: Non-functioning lung tissue with systemic blood supply
- Managed with surgical resection
30
14. How is laryngomalacia managed?
Management: Usually self-resolving by 18–24 months
- Severe cases may need supraglottoplasty
31
83. What are interstitial lung diseases (ILDs) in children and common causes?
ILDs: Heterogeneous group of disorders affecting alveoli/interstitium
- Causes: Infection, autoimmune, surfactant protein mutations
32
65. What are the differences between obstructive and restrictive lung diseases in children?
Obstructive: Airflow limitation (asthma, CF)
- Restrictive: Reduced lung volume (fibrosis, scoliosis, neuromuscular disease)
33
82. What is the gold standard for diagnosing pulmonary alveolar proteinosis?
Gold standard: Bronchoalveolar lavage showing milky fluid with PAS-positive material
34
81. What is pulmonary alveolar proteinosis and how does it present in children?
Alveolar proteinosis: Accumulation of surfactant in alveoli
- Presents with cough, dyspnea, hypoxia, failure to thrive
35
78. What are the components of VACTERL association?
VACTERL: Vertebral, Anorectal, Cardiac, TEF, Renal, Limb anomalies
- Associated with TEF
36
66. What pulmonary function test (PFT) findings indicate obstructive lung disease?
Obstructive PFT: ↓FEV1, ↓FEV1/FVC ratio, ↑TLC/RV in severe cases
37
84. What are the clinical features of ILD in pediatrics?
Features: Progressive dyspnea, dry cough, clubbing, hypoxia, failure to thrive
38
67. What PFT changes suggest restrictive lung disease?
Restrictive PFT: ↓FVC, normal or ↑FEV1/FVC ratio, ↓TLC
39
68. What are the common causes of restrictive lung disease in children?
Causes: Interstitial lung disease, scoliosis, muscular dystrophy, obesity, neuromuscular disorders
40
109. What is the management of OSA in children?
Management: Adenotonsillectomy (first-line), CPAP/BiPAP, weight loss, nasal steroids
41
85. What imaging findings suggest ILD in children?
Imaging: Reticulonodular opacities, ground-glass appearance, hyperinflation, honeycombing in advanced cases
42
91. What are the common causes of hemoptysis in children?
Causes: Infection (TB, pneumonia), foreign body, bronchiectasis, AV malformation, trauma, hemosiderosis
43
89. What are the features of hypersensitivity pneumonitis in children?
Hypersensitivity pneumonitis: Immune response to inhaled antigens (e.g., mold, birds)
- Presents with cough, fever, crackles
44
26. What are the common side effects of inhaled corticosteroids in pediatrics?
Side effects: Oral candidiasis, hoarseness, slowed growth velocity (minimal), adrenal suppression (rare)
45
94. What is the evaluation for chronic cough in children?
Chronic cough: >4 weeks
- Evaluate for asthma, postnasal drip, GERD, protracted bacterial bronchitis, FB, CF
46
99. What are the clinical features of allergic rhinitis in children?
Features: Sneezing, rhinorrhea, nasal congestion, itchy eyes/nose, allergic shiners, mouth breathing
47
101. What are the pulmonary manifestations of sickle cell disease in children?
Sickle cell: Recurrent pneumonia, acute chest syndrome, pulmonary hypertension, chronic hypoxia
48
95. What are the red flag signs in a child with chronic cough?
Red flags: Hemoptysis, weight loss, night sweats, clubbing, abnormal CXR, hypoxia, failure to thrive
49
107. What are the features of obstructive sleep apnea (OSA) in children?
OSA: Snoring, restless sleep, daytime fatigue, behavioral problems
- Often due to adenotonsillar hypertrophy
50
108. What are the risk factors for OSA in pediatrics?
Risk factors: Obesity, Down syndrome, craniofacial anomalies, neuromuscular disease, allergic rhinitis
51
90. What is the role of high-resolution CT in pediatric diffuse lung disease?
HRCT: Best modality to evaluate diffuse lung disease pattern (ground-glass, fibrosis, nodules, septal thickening)
52
105. What are the respiratory complications of neuromuscular disorders in children?
NMD complications: Weak cough, aspiration, hypoventilation, nocturnal hypoxia, pneumonia
53
86. How is ILD managed in pediatric patients?
Management: Supportive care, oxygen, corticosteroids, immunosuppressants based on underlying cause
54
96. What are the causes of recurrent pneumonia in the same lung lobe?
Same lobe: Anatomical anomaly, foreign body, compression by mass, bronchiectasis, TB
55
31. What are the radiological findings of pneumonia in children?
Findings: Lobar consolidation, patchy infiltrates, interstitial patterns, pleural effusion, air bronchograms
56
27. What are the causes and classification of pneumonia in children?
Pneumonia: Classified as bacterial, viral, atypical
- Causes vary by age: S. pneumoniae, RSV, Mycoplasma, Chlamydia
57
28. What are the clinical features of typical bacterial pneumonia?
Typical features: High fever, productive cough, chest pain, tachypnea, crackles, consolidation on exam
58
29. What are common causes of viral pneumonia in children?
Viral causes: RSV, influenza, adenovirus, parainfluenza
- Often cause diffuse wheeze, less toxic appearance
59
30. What is the treatment approach for community-acquired pneumonia (CAP) in children?
Outpatient: Amoxicillin (bacterial), supportive for viral
- Inpatient: Ampicillin, ceftriaxone, add macrolide if atypical suspected
60
60. What are the complications of MAS?
Complications: Air leak (pneumothorax), PPHN, chronic lung disease
61
58. What are the clinical features of meconium aspiration syndrome (MAS)?
MAS: Term/post-term baby with respiratory distress, coarse breath sounds, meconium-stained fluid
62
38. What is the role of ultrasound in pleural effusion evaluation?
Ultrasound: Detects loculations, guides thoracentesis, differentiates fluid from consolidation
63
37. What are the signs of pleural effusion in children?
Signs: Dullness to percussion, decreased breath sounds, mediastinal shift if large, reduced vocal resonance
64
36. How is empyema thoracis diagnosed and managed?
Diagnosis: CXR, ultrasound, thoracentesis
- Management: Antibiotics, chest tube ± fibrinolytics, VATS if loculated
65
35. What is parapneumonic effusion and how is it classified?
Parapneumonic effusion: Effusion from pneumonia
- Types: Simple, complicated, empyema (pus)
66
34. What are the risk factors for aspiration pneumonia in children?
Risk factors: GERD, neurologic disorders, cleft palate, sedation, poor swallowing mechanism
67
59. How is MAS managed in the delivery room and NICU?
Management: Supportive ventilation, suctioning if non-vigorous, surfactant, antibiotics if infection suspected
68
33. What is aspiration pneumonia and where is it usually located?
Aspiration pneumonia: Inflammation from inhaled material
- Usually affects right upper or lower lobe (posterior segments)
69
52. What are the risk factors for RDS in neonates?
Risk factors: Prematurity, maternal diabetes, C-section without labor, male sex, second twin
70
53. What are the clinical signs of RDS in newborns?
Signs: Grunting, nasal flaring, retractions, cyanosis, tachypnea within hours of birth
71
54. What are the radiographic features of neonatal RDS?
CXR: Ground-glass appearance, air bronchograms, low lung volumes
72
32. What is the difference between lobar and bronchopneumonia on chest X-ray?
Lobar: Homogeneous opacity with air bronchograms
- Bronchopneumonia: Patchy, bilateral, peribronchial infiltrates
73
56. What is transient tachypnea of the newborn (TTN)?
TTN: Delayed lung fluid clearance → tachypnea in term infants
- Self-limiting, resolves in 24–72 hours
74
57. How is TTN differentiated from RDS?
TTN: Term infant, hyperinflated lungs on CXR
- RDS: Premature, ground-glass lungs, surfactant responsive
75
51. What is neonatal respiratory distress syndrome (RDS) and what causes it?
RDS: Surfactant deficiency in premature lungs → alveolar collapse and impaired gas exchange
76
55. How is RDS managed in neonates?
Management: Oxygen, CPAP, surfactant replacement, supportive care, antenatal steroids if preterm labor
77
97. What is the approach to a child with chronic hypoxia and digital clubbing?
Approach: CXR, pulse oximetry, echocardiogram, CT chest, rule out CHD and lung disease
78
110. What is primary pulmonary hypertension in children and how is it diagnosed?
Primary PH: Idiopathic elevation in pulmonary artery pressure
- Diagnosis: Echo, catheterization, BNP
- Tx: Sildenafil, bosentan
79
63. What are the causes and risk factors for PPHN?
Causes: Meconium aspiration, RDS, birth asphyxia, sepsis, diaphragmatic hernia
- Risk: Male, C-section, maternal diabetes
80
64. How is PPHN managed in neonates?
Management: Oxygen, ventilation, inhaled nitric oxide, sildenafil, ECMO in refractory cases
81
62. What are the clinical signs and diagnostic methods for PPHN?
Signs: Hypoxemia unresponsive to oxygen, pre-/post-ductal SpO2 difference
- Diagnosis: Echo with high RV pressure, tricuspid regurgitation
82
61. What is persistent pulmonary hypertension of the newborn (PPHN)?
PPHN: Failure of pulmonary vascular resistance to decrease after birth → right-to-left shunting and hypoxia
83
106. What is the role of polysomnography in pediatric respiratory medicine?
Polysomnography: Sleep study to diagnose OSA, central apnea, hypoventilation
- Evaluates oxygen, CO2, airflow, effort
84
102. What is acute chest syndrome and how is it managed?
Acute chest syndrome: New infiltrate + respiratory symptoms, fever, hypoxia
- Treat with O2, antibiotics, pain control, transfusion
85
87. What is idiopathic pulmonary hemosiderosis?
IPH: Rare condition with recurrent pulmonary hemorrhage
- Autoimmune-related or idiopathic
86
88. What is the classic triad of idiopathic pulmonary hemosiderosis?
Triad: Hemoptysis, iron deficiency anemia, diffuse pulmonary infiltrates
87
39. What is tuberculosis (TB) and how does it present in children?
TB: Presents with chronic cough, weight loss, fever, night sweats, hilar lymphadenopathy
- May be primary or reactivation
88
40. What is the Mantoux test and how is it interpreted in pediatrics?
Mantoux: Intradermal PPD test
- ≥10 mm is positive in high-risk children, ≥5 mm in immunocompromised
89
41. What is the difference between latent and active tuberculosis in children?
Latent TB: Positive PPD, asymptomatic, normal CXR
- Active TB: Symptoms present, abnormal imaging, infectious
90
43. What are the side effects of anti-TB drugs in children?
Side effects: INH—hepatotoxicity, neuropathy; RIF—orange urine, hepatitis; PZA—hepatotoxicity; EMB—optic neuritis
91
44. What is primary complex in pediatric TB?
Primary complex: Initial TB infection with Ghon focus + regional lymphadenopathy
- Common in primary TB
92
45. What is the role of BCG vaccine in tuberculosis prevention?
BCG: Live vaccine given at birth in endemic areas
- Protects against severe TB forms (meningitis, miliary TB)
93
42. What are the first-line drugs used in pediatric tuberculosis?
Drugs: Isoniazid, rifampicin, pyrazinamide, ethambutol (first 2 months), then continuation with INH and RIF
94
3. How is bronchiolitis diagnosed and when is hospitalization indicated?
Diagnosis: Clinical
- Hospitalize if hypoxia, apnea, poor feeding, <3 months old, or comorbidities
95
2. What are the clinical features of acute bronchiolitis?
Features: Rhinorrhea, wheezing, cough, tachypnea, chest retractions, poor feeding
- Peak at 2–6 months
96
4. What is the treatment for acute bronchiolitis?
Supportive care: Oxygen if needed, hydration, nasal suctioning
- No routine bronchodilators or steroids
97
5. What are the complications of bronchiolitis in infants?
Complications: Apnea, respiratory failure, secondary bacterial infections, wheezing later in childhood
98
6. What are the clinical features of croup (laryngotracheobronchitis)?
Features: Barking cough, inspiratory stridor, hoarseness, fever
- Caused by parainfluenza virus
99
7. What are the indications for hospitalization in croup?
Indications: Stridor at rest, poor feeding, hypoxia, dehydration, altered mental status
100
16. What are the clinical features of foreign body aspiration?
Features: Sudden onset cough, choking, unilateral wheeze, decreased breath sounds
- May be afebrile
101
9. How is epiglottitis differentiated from croup?
Epiglottitis: Sudden onset, drooling, dysphagia, tripod position, toxic appearance
- Croup: Gradual onset, barking cough
102
10. What is the first step in management of suspected epiglottitis?
Do not examine throat
- Secure airway in OR with ENT/anesthesia
- Start IV antibiotics after securing airway
103
11. What are the causes of stridor in children?
Causes: Croup, laryngomalacia, epiglottitis, vocal cord paralysis, subglottic stenosis, foreign body
104
12. How do you differentiate inspiratory vs expiratory stridor?
Inspiratory stridor: Supraglottic/upper airway obstruction
- Expiratory: Intrathoracic obstruction
- Biphasic: Subglottic/tracheal
105
15. What are the signs and causes of upper airway obstruction in children?
Signs: Stridor, retractions, hypoxia, drooling, tripod position
- Causes: Croup, FB, anaphylaxis, infections, trauma
106
17. How is foreign body aspiration diagnosed?
Diagnosis: History, CXR (may show air trapping or localized hyperinflation), bronchoscopy (diagnostic and therapeutic)
107
18. What is the management of suspected airway foreign body?
Rigid bronchoscopy is gold standard for diagnosis and removal
- Do not delay for imaging if high suspicion
108
80. What is congenital pulmonary airway malformation (CPAM)?
CPAM: Hamartomatous lung lesion with cysts
- May be detected prenatally or present with respiratory distress
109
8. What is the treatment for moderate to severe croup?
Treatment: Dexamethasone (oral/IM), nebulized epinephrine for moderate/severe cases
110
1. What is the most common cause of acute bronchiolitis in infants?
Most common cause: Respiratory syncytial virus (RSV)
