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RACP Paediatric Exam - Medstudy edition > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the pattern of results of VC, TLC, FEV1, FEV1/FVC and RV in intrathoracic restriction?

A 
VC - low 
TLC - low 
FEV1 - 
FEV1/FVC - normal or high 
RV - low
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2
Q

What are the pattern of results of VC, TLC, FEV1, FEV1/FVC and RV in extrathoracic restriction?

A 
VC - low 
TLC - low 
FEV1 - 
FEV1/FVC - normal or high 
RV - can be normal
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3
Q

What are the pattern of results of VC, TLC, FEV1, FEV1/FVC and RV in airway obstruction?

A 
VC - 
TLC - increased 
FEV1 - 
FEV1/FVC - <0.7 (<80% of predicted) 
RV -
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4
Q

What is vital capacity?

A

Volume available for breathing

IRV + TV + ERV

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5
Q

Difference in flow volume loops for obstructive and restrictive disease

A

Obstructive

  • concave
  • loop moved to the left and smaller

Restrictive

  • parenchymal = decreased RV, moved to right
  • extrathoracic = smaller but no shift - normal RV
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6
Q

When is the metacholine bronchoprovocation test performed?

A

Normal spirometry and intermittent asthma like symptoms
Or other symptoms suggestive of airflow obstruction

To determine if bronchial hyperreactivity
- asthmatics can have significant drop with low dose, non asthmatics do not

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7
Q

What is the first test performed in the evaluation of a patient with suspected asthma?

A

pre- and post- bronchodilator spirometry

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8
Q

What moves the O2 dissociation curve to the right?

A

Right = dec affinity for oxygen

Inc temp
Inc H+ (dec pH)
Inc 2,3,DPG
Inc CO2

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9
Q

Most common cause of stridor in newborn?

A

Laryngomalacia

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10
Q

Which chromosomal abnormality is tested for in patients with glottic webs?

A

22q11 deletion

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11
Q

How does tracheal stenosis present?

A

Severe retractions, dyspnoea, EXPIRATORY stridor

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12
Q

What is pulmonary venolobar syndrome?

A

Scimatar Syndrome
Pulm venous blood from all or part of right lung returns to the IVC just above / below diaphragm.
Left to right shunt.

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13
Q

Why is bronchoscopy not useful in diagnosing pulmonary sequestrations?

A

Sequestration is not connected to normal airways

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14
Q

Muscle weakness from neuromuscular disease results in which specific problems that can lead to resp failure?

A

Upper airway compromise
Inspiratory muscle compromise
Exp muscle compromise

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15
Q

What are some of the neuromuscular disorders that can cause resp failure?

A 
Guillain Barre syndrome
Myasthenia gravis
Spinal muscular atrophy
Muscular dystrophy
Cerebral palsy
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16
Q

Which virus causes most cases of croup?

A

Parainfluenza virus

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17
Q

What is the treatment for croup?

A

Oral dexamethasone

Neb adrenaline

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18
Q

Typical causes of epiglottitis?

A

H.influenzae (non typeable)
S.pneumoniae
Group A strep
S.aureus

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19
Q

What does the epiglottis look like in epiglotittis?

A

Cherry red

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20
Q

Treatment for epiglottitis?

A

Airway management

Antibiotic therapy - anti staph and ceftriaxone/cefotaxime

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21
Q

Which organism most often causes bacterial tracheitis?

A

S. aureus

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22
Q

Pathogen causing most bronchiolitis?

A

RSV

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23
Q

Absence of which vital sign makes pneumonia unlikely?

A

Without fever, pneumonia unlikely

NPV 97%

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24
Q

When do you get a CXR in a child with a fever?

A

<5yo, fever and high WBC unknown source
Clinical evidence of pneumonia, not clear cut
Pleural effusion
Pneumonia unresponsive to ABx

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25
Q

Gram positive diplococci in sputum, large number of PMNs and few epithelial cells. Organism?

A

S.pneumoniae

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26
Q

What do you do about a pleural effusion in a child with recent pneumococcal pneumonia who is clinically responding to therapy?

A

Effusions can persist for weeks, resolve without specific therapy

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27
Q

What do you do about pneumomatoceles if they occur in S pyogenes pneumonia?

A

Nothing. Disappear spontaneously, can take weeks to resolve

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28
Q

A patient with influenza develops a secondary bacterial pneumonia. Besides pneumococcus, which bacterial pathogen do you especially consider?

A

S.aureus

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29
Q

What antibiotic is commonly used for presumed anaerobic pneumonia?

A

Clindamycin

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30
Q

What are the extrapulmonary manifestations of Mycoplasma infection?

A 
HAemolytic anaemia 
Splenomegaly
Erythema multiforme
Arthritis 
Myringitis bullosa
Pharyngitis 
Tonsillitis
Confusion

Diagnosis with IgM (M for mycoplasma) - positive cold agglutinin suggestive

31
Q

A patient presents with worsening control of their asthma and an extremely high IgE level. What do you suspect as an aetiology?

A

Allergic bronchopulmonary aspergilliosis

32
Q

How do you treat ABPA?

A

Oral corticosteroids and itraconazole

33
Q

Does having an abnormal sinus x-ray indicate bacterial infection in a child with asthma?

A

No

Asthma often have abnormal sinus XR without infection

34
Q

What is the preferred treatment for the prevention of exercise induced bronchospasm?

A

Monteleukast

Pre-treatment with salbutamol

35
Q

When do you consider stepping down controller therapy in a child with asthma?

A

When symptoms are being controlled

36
Q

What are some complications of prolonged use of systemic corticosteroids?

A 
Supporession of HPa axis 
Immunosuppression
Osteoporosis
Cataracts
Hyperglycaemia
Weight gain
Thinning of skin
Abdominal striae
Growth retardation
37
Q

What are some complications of prolonged use of inhaled corticosteroids?

A

Growth velocity changes
Dermal thickening
Cataracts
Oral thrush

38
Q

What does adding erythromycin to a patients regimen that already includes theophylline potentially do to a theophylline level?

A

Increase serum levels

39
Q

Is omalizumab an appropriate therapy for a 6yo with mild asthma?

A

No
For difficult to control asthma >6yo
anti-IgE monoclonal antibody

40
Q

Which viruses cause bronchiolitis obliterans?

A

Adenovirus

41
Q

How do you diagnoses bronchiolitis obliterans?

A

Lung biopsy needed to confirm diagnosis

42
Q

An adolescent presents with multiple episodes of bronchitis that clear with antibiotics and then recur in a month or two. He has had 6 episodes. What diagnosis do you entertain?

A

Cryptogenic organizing pneumonia

43
Q

Is apnoea of prematurity a risk factor for SIDS?

A

No

44
Q

What causes increased incidence of SIDS?

A 
Prematurity
IUGR
Winter months
Hours between midnight and 0800
Second hand smoke after birth
Young maternal age 
Smoking during pregnancy
45
Q

What protects against SIDS?

A

Breastfeeding

Immunisations

46
Q

What is mode of inheritance of CF?

A

Autosomal recessive

Prevalence 1/2500

47
Q

Which gene is responsible for CF?

A

CFTR gene long arm of Ch7

48
Q

Which factor correlates best with survival in CF?

A

Patients level of fitness (moreso than pulm function)

49
Q

What sinus and nasal findings commonly occur in CF patients?

A

Pan-sinusitis
Nasal polyps - in 25% of patients, and finding <12yo guides towards CF as diagnosis
Clubbing

50
Q

Early in CF, which bacterial organisms are most likely to cause pulmonary infection?

What about later in CF?

A

Early: S.aureus, H.influenzae, Klebsiella

Late: Pseudomonas aeruginosa, MRSA

51
Q

When does pancreatic insufficiency occur in CF?

A

Present at birth in 50%

90% by 9 years of age

52
Q

Which GI findings are more common in CF?

A

10-20% Bowel obstruction
- Meconium ileus
20% rectal prolapse
Intussusception

53
Q

What is the abnormality of the sweat glands in patients with CF?

A

Very high salt content >60mEq/L

54
Q

What is the abnormality of the reproductive tract in males with CF?

A

Atresia of vas deferens

Obstructive azoospermia and sterility

55
Q

What is the laboratory test for diagnosing CF?

A

Sweat test

56
Q

Who should have a sweat test?

A

FTT, steatorrhoea, chronic pulm disease

Digital clubbing
“My baby tastes salty”
FHx of CF
Male infertility

57
Q

How does a newborn screening detect CF?

A

Elevated blood immunoreactive trypsinogen

58
Q

Is ceftriaxone acceptable therapy for Pseudomonas?

A

Piptaz or cefepime + ciprofloxacin

59
Q

Does the finding of a pneumothorax suggest more severe lung disease in a CF patient?

A

Poor prognostic sign

Suggests severe lung disease

60
Q

Which vitamin deficiency do you consider in a CF patient with haemoptysis with heavy bleeding and history of easy bruisability?

A

Vitamin K deficiency

61
Q

What is ivacaftor?

A

> 2yo
Targeted CFTR function potentiator
- G551D mutation

62
Q

What is orkambi?

A

CFTR corrector
Treat F508del (2 copies)
Correcting the misfolded CFTR protein

63
Q

What is kartagener syndrome?

A

Both dynein arms of the cilia are absent
Presents with recurrent infections, bronchiectasis, situs inversus totalis and reduced male infertility
Autosomal recessive

64
Q

How fast do cillia usually beat?

A

7-22x per second

65
Q

Which pulmonary abnormalities are seen with a-1-antitrypsin deficiency?

A

Non spokers with early onset emphysema with lower lobe predominance

66
Q

Which liver abnormalities are seen in children with a-1-antitrypsin deficiency?

A

15% with homozygote PiZZ phenotype get progressive liver fibrosis and cirrhosis

67
Q

What are the common causes of haemoptysis in children?

A

Infection
Foreign bodies
Bronchiectasis (esp CF related)

68
Q

What is diagnostic for a pulmonary source of haemoptysis?

A

Bronchoscopy with bronchoalveolar lavage
- haemosiderin laden macrophages
(appear 3 days after bleeding)

69
Q

What does CXR characteristically show in sarcoidosis?

A

Bilateral hilar and/or mediastinal adenopathy +/- reticulonodular or alveolar infiltrates

70
Q

What does the biopsy of an affected bronchial wall in sarcoidosis show?

A

Non caseating granuloma

71
Q

True or false: erythema nodosum is a poor prognostic indicator in sarcoidosis

A

False, it is a good prognosis

72
Q

In a patient with pulmonary alveolar proteinosis, hypoxemia is often due to what?

A

Large R-to-L shunt because gas exchange is impaired secondary to clogged alveoli

73
Q

Which collagen vascular disease causes pulm HTN out of proportion to the pulmonary disease

A

Intimal proliferation - occurs in scleroderma

74
Q

Which lab test is positive in many patients with GPA?

A

c-ANCA

RACP Paediatric Exam - Medstudy edition (9 decks)

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