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good paeds > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Name two things that lower lung compliance

A

Oedema and fibrosis

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2
Q

What are the name of three conditions causing diaphragmatic muscle weakness ?

A

Muscular dystrophy, spinal muscle atrophy and myasthenia gravis

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3
Q

What is the volume of dead space

A

2cc/kg

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4
Q

Poiseuilles law

A

Flow = pressure x r4 x pi / 8 x viscosity x length

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5
Q

Significant response in spiro to bronchodilator

A

12% increase fev1

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6
Q

Ficks law

A

Flux is directly proportional to the steepness if the gradient (pressure difference both sides and area by which diffusion occurs) over thickness

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7
Q

Two main causes of VQ mismatch and examples

A
  1. Shunt (cardio or pulm I.e AV malformation)

2. Dead space increased I.e in PE, mucous plug

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8
Q

A-a gradient

A

Alveolar gas equation

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9
Q

Body plethysmography utilises Boyles law

A

In a closed system pressure and volume change inversely when temperature is constant

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10
Q

What is Niemann-Pick disease?

A

Types A,B,C1andC2 lysosomal storage disorder

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11
Q

Most common virus causing croup

A

Parainfluenza Type 1

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12
Q

How many mm at 2nd cervical vertebrae would be concerning for retropharyngeal abscess

A

7mm

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13
Q

What does a displaced uvula in a teenager possibly represent?

A

Peritonsillar abscess

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14
Q

What percentage of kids with tracheolaryngomalacia have cardiovasc abnormalities

A

60%

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15
Q

Name four other odd causes of bronchi tasks

A

UC, Alpha antitripsan def, young syndrome, sawyer-James-Macleod syndrome

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16
Q

Inheritance of primary ciliary dyskinesia

A

AD

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17
Q

Vocal cord dysfunction spirometry change

A

Flattening of the inspiratory flow loop

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18
Q

How does montelukast work

A

Block effects of cysLT1 receptor (leukotriene receptor antagonists)

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19
Q

Cf newborn screen

A

Blood immunoreactive trypsinogen

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20
Q

Falsely elevated saturation from

A

Methaemoglobimaemia

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21
Q

Sickle cell and sats

A

Can be high or low

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22
Q

Macrolide use in CF for

A

Anti inflammatory effect

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23
Q

Narcolepsy test

A

Multiple sleep latency test

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24
Q

Kartageners syndrome is

A

Primary ciliary dyskinesia
AR
Dextrocardia

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25
Q

Bradycardia with cabal stimulation treat

A

Atropine

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26
Q

Three most common mutations CF

A

F508
G451X
G551D
5, 12, 31

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27
Q

Pulmozyme

A

RhDNase
Synthetic enzyme reduces sputum viscosity
For FeV1 persistently below 70%

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28
Q

K complexes and spindles in which stage of sleep

A

N2 (3)

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29
Q

% with OSA and sleep disordered breathing

A

OSA 1-4%

SDB 12-13%

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30
Q

Nasal steroids OSA

A

Halve score can cure mild

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31
Q

High CO2 indicates

A

Inadequate ventilation

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32
Q

Does dry air worsen asthma

A

Yes

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33
Q

Provocation asthma timing after intense exercise

A

6-8min (HR 85% of max)

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34
Q

Montelukast timing of action

A

2 hours and accelerates recovery

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35
Q

LABa not recommended isolated use in children because

A

Reduction in B2 density

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36
Q

Cytokines produced by Th2 in asthma

A

IL-4/5/13

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37
Q

Older child montelukast (blocks leukotreine receptors)

A

EIA if on ICS and no improvement with LABA

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38
Q

Over 12 with severe asthma can use

A

Omalizumab (humanised monoclonal anti-IgE antibody) sc

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39
Q

Wheeze persisting from viruses (name 2)

A

RSV

Rhinovirus

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40
Q

CF screened for using

A

Immunor active trypsinogen level and genetics

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41
Q

Azithromycin in CF

A

Anti inflammatory

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42
Q

Ivacaftor used for

A

CF G551D mutation to improve transport of Cl through ion channel

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43
Q

Cataplexy is

A

Intense emotions cause sudd n loss of muscle tone

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44
Q

Periodic sleepiness syndrome

A

Klein-levin syndrome

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45
Q

Multiple sleep latency test in narcolepsy

A

Short latency (quick to sleep) and two periods of REM

46
Q

Narcolepsy two special tests and results

A

HLA 95% positive for DQB1*0602
(Also positive in 20% normal)
Hypocretin-1 levels low or absent in CSF

47
Q

What Does sleep deprivation lead to

A

Obesity (more time to eat and more hungry)

Leads to inflam and insulin resistance

48
Q

Slow sleep waves in

A

N3

49
Q

R.E.M. With age

A

Decreases

50
Q

Adolescent sleep duration in time

A

Has decreased

51
Q

Percent of autism with sleep problem

A

44-83%

52
Q

Parasomnia vs frontal lobe sz

A

In frontal lobe sz not related to stage of sleep, pointing and pelvic thrust stereotypical and looks same each time

53
Q

Treat Periodic limb disorder with

A

Iron

54
Q

Commonest cause of hypersomnia (excessive sleepiness)

A

Lack of sleep

55
Q

Variation limit in spirometry performance

A

5%

56
Q

Flow loop in obstruction

A

Concave

57
Q

Spirometry flattened inspired curve causes

A

Vocal cord paralysis or dysfunction

58
Q

Flat expiration curve spirometry cause

A

Tracheomalacia (variable intrathoracic obstruction)

59
Q

Flat inspiration and expiration curve cause

A

Tracheal stenosis (fixed upper airway obstruction)

60
Q

Loss of loop contour on spirometry due to

A

Poor effort

61
Q

Jaggered expiration on spirometry

A

Coughing

62
Q

Airway resistance highest..

A 
Nasal airway (50% total)
Intermediate bronchi (4-8th generation)
63
Q

Inspiration and expiration muscles (NMD)

A

Insp (diaphragm)
Exp (intercostal and abdominal
)

64
Q

Aspirin overdose ABG

A

Respiratory alkalosis

65
Q

Age can use dry powder inhaler

A

6

66
Q

Montelukast

A

CysLT1 receptor on bronchial sm antagonist (leukotriene 4 blocked)

67
Q

DMD thresholds in FVC

A

<60% is SDB

<20% daytime respiratory failure

68
Q

CF FEV1 0% survival perfect in 2 years

A

50%

Lung transplant

69
Q

Most useful spirometry measurement in obstructive lung disease progression

A

FEV1

70
Q

NMD respiratory test to detect early failure

A

Polysomnography

71
Q

FEV1 severity

A

> 70% mild
50% moderate
35% severe

72
Q

I NO short duration of action due to

A

Binding to hb

73
Q

iNO near tracheal tube due to

A

Minimise risk of NO2 which is toxic

74
Q

Virus associated with brochiolitis obliterans

A

Adenovirus

75
Q

L atrial enlargement compresses what

A

L main bronchus

76
Q

Most common pathogen in CF

A

SA

77
Q

Max fluticasone under 12y

A

Usually 200mcg but can go up to 400mcg if >4y

90% of effectiveness achieve at dose of 125mcg/day or 250mcg/day budesonide

78
Q

PaO2 at 70%, 80%, 90%

A

40’ 50, 60

79
Q

More sensitive in small airway disease

A

Recent research suggests that FEF25-75% or FEF25-50% may be a more sensitive
parameter than FEV1 in the detection of obstructive small airway disease

current practice guidelines
recommend using FEV1, FVC, and FEV1/FVC as indicators of obstructive disease.
Low FEV1 indicates current obstruction (impairment) and risk for future exacerbations
(risk). For children, the ratio of the FEVI/forced vital capacity (FVC) appears to be a
more sensitive measure of severity and control in the impairment domain. FEV1 is a
useful measure of risk for exacerbations,

80
Q

serum periostin

A

a protein secreted by airway epithelial cells and lung fibroblasts in response to IL-4 and IL-13

81
Q

What to us in asthma if all avenues exhausted

A

Omalizumab is a humanized, monoclonal anti‐IgE
antibody that binds specifically to circulating IgE
molecules, thus interrupting the allergic cascade.
Consider > 12 years for severe allergic asthma when all
other avenues exhausted.
Given by a subcut injection – may get site reactions
Well tolerated, but occasional anaphylaxis (medical
supervion needed)
Costly. NZ$500

82
Q

Which viruses are associated with
increased risk of wheezing
persisting at age 6 years?
Think of 2 viruses

A

RSV

rhinovirus

83
Q

Most common CF genetic mutations (3)

A

delta F 508, G451X and G551D

84
Q

Sweat test not reliable when

A

<75g sweat (false if <60 Cl)

  1. Malnutrition
  2. Mineralocorticoid use
    3.Adrenal insufficiency
    4.Fucosidosis
  3. G6PD deficiency
85
Q

Azithromycin action in CF

A

Anti inflammatory

86
Q

ivacaftor use for

A

Class III mutations in CF gene

87
Q

Scimitar syndrome, or pulmonary venolobar syndrome , is…

A

a rare congenital heart defect characterized by anomalous venous return from the right lung

88
Q

Surfactant def accounts for 10% ILD what are the four genetic def

A

Protein B (SPB)
Protein C
ABCA3
Thyroid transcription factor related disease

89
Q

Ventilator tidal volume in relatively normal lungs

A

7-10ml\kg

90
Q

Ground glass on CT indicates

A

Neuroendocrine cell hyperplasia of infancy

91
Q

Long history of SOB on exertion and bay wing appearance on CXR with bronchopulmonary lovage milky coloured

A

Pulmonary alveolar proteinosis (increased surfactant)

92
Q

Oxygen index equation

A

Oxygen index = (FiO2 x MAP)/PaO2

93
Q

Is flow curve doesn’t meet the

A

Poor technique

94
Q

Main component of surfactant

A

Phosphatidycholine

95
Q

What virus can cause obliterative bronchiolitis

A

Adenovirus can cause obliterative bronchiolitis.

96
Q

Round pneumonia under 8y most commonly due to

A

Strep pneumoniae

Proposed underdevelopment of pores of kohn and canals of lambert

97
Q

Xray for suspected inhaled FB

A

Insp and exp films (air trapping)

98
Q

Incidence CF

A

1/3,500

99
Q

Types of CF mutations

A

5 main classes:
 I: Lack of/no protein production.
 Eg: Stop codons (eg. Trp1282X, Gly542X) and splicing defects
with no protein production.
 II: CFTR not processed correctly, so no protein gets to the cell
membrane.
 Eg: Phe508del.
 III: Defective regulation; but transfer of CFTR occurs.
 IV: Reduced chloride transport/current through CFTR at the apical
membrane.
 V: Synthesis of CFTR abnormal but is transferred.

100
Q

DMD study to review early respiratory failure

A

Polysomnography (sleep study)

101
Q

Fractional exhaled NO associated with eosinophilic airway inflammation therefore high value predicts ? And low value what two conditions

A

High - atopy (asthma)

Low - CF/ciliary dyskinesia

102
Q

Peak of bronchoconstriction how many minutes after start exercise

A

10

103
Q

Long acting beta agonist not safe alone because

A

Reduction of beta two density

104
Q

Virus associated with increased risk of wheeze persisting at 6y

A

Rhinovirus

RSV but gone by 11y

105
Q

Ivacaftor for class?

A

Three

106
Q

Another test for restrictive and asthma

A

Plethysmography

Exercise test

107
Q

Best lung test in restrictive?

A

FVC

108
Q

Inert gas washout actually can measure

A

Rv and FRC

109
Q

Two test to review FRC

A

Plethysmography

Inert had washout test

110
Q

Gas transfer test?

A

Diffusing capacity of lung to carbon monoxide

good paeds (19 decks)

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