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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
Gram positive diplococci in sputum, large number of PMNs and few epithelial cells. Organism?
S.pneumoniae
26
What do you do about a pleural effusion in a child with recent pneumococcal pneumonia who is clinically responding to therapy?
Effusions can persist for weeks, resolve without specific therapy
27
What do you do about pneumomatoceles if they occur in S pyogenes pneumonia?
Nothing. Disappear spontaneously, can take weeks to resolve
28
A patient with influenza develops a secondary bacterial pneumonia. Besides pneumococcus, which bacterial pathogen do you especially consider?
S.aureus
29
What antibiotic is commonly used for presumed anaerobic pneumonia?
Clindamycin
30
What are the extrapulmonary manifestations of Mycoplasma infection?
``` HAemolytic anaemia Splenomegaly Erythema multiforme Arthritis Myringitis bullosa Pharyngitis Tonsillitis Confusion ``` Diagnosis with IgM (M for mycoplasma) - positive cold agglutinin suggestive
31
A patient presents with worsening control of their asthma and an extremely high IgE level. What do you suspect as an aetiology?
Allergic bronchopulmonary aspergilliosis
32
How do you treat ABPA?
Oral corticosteroids and itraconazole
33
Does having an abnormal sinus x-ray indicate bacterial infection in a child with asthma?
No | Asthma often have abnormal sinus XR without infection
34
What is the preferred treatment for the prevention of exercise induced bronchospasm?
Monteleukast | Pre-treatment with salbutamol
35
When do you consider stepping down controller therapy in a child with asthma?
When symptoms are being controlled
36
What are some complications of prolonged use of systemic corticosteroids?
``` Supporession of HPa axis Immunosuppression Osteoporosis Cataracts Hyperglycaemia Weight gain Thinning of skin Abdominal striae Growth retardation ```
37
What are some complications of prolonged use of inhaled corticosteroids?
Growth velocity changes Dermal thickening Cataracts Oral thrush
38
What does adding erythromycin to a patients regimen that already includes theophylline potentially do to a theophylline level?
Increase serum levels
39
Is omalizumab an appropriate therapy for a 6yo with mild asthma?
No For difficult to control asthma >6yo anti-IgE monoclonal antibody
40
Which viruses cause bronchiolitis obliterans?
Adenovirus
41
How do you diagnoses bronchiolitis obliterans?
Lung biopsy needed to confirm diagnosis
42
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?
Cryptogenic organizing pneumonia
43
Is apnoea of prematurity a risk factor for SIDS?
No
44
What causes increased incidence of SIDS?
``` Prematurity IUGR Winter months Hours between midnight and 0800 Second hand smoke after birth Young maternal age Smoking during pregnancy ```
45
What protects against SIDS?
Breastfeeding | Immunisations
46
What is mode of inheritance of CF?
Autosomal recessive | Prevalence 1/2500
47
Which gene is responsible for CF?
CFTR gene long arm of Ch7
48
Which factor correlates best with survival in CF?
Patients level of fitness (moreso than pulm function)
49
What sinus and nasal findings commonly occur in CF patients?
Pan-sinusitis Nasal polyps - in 25% of patients, and finding <12yo guides towards CF as diagnosis Clubbing
50
Early in CF, which bacterial organisms are most likely to cause pulmonary infection? What about later in CF?
Early: S.aureus, H.influenzae, Klebsiella Late: Pseudomonas aeruginosa, MRSA
51
When does pancreatic insufficiency occur in CF?
Present at birth in 50% | 90% by 9 years of age
52
Which GI findings are more common in CF?
10-20% Bowel obstruction - Meconium ileus 20% rectal prolapse Intussusception
53
What is the abnormality of the sweat glands in patients with CF?
Very high salt content >60mEq/L
54
What is the abnormality of the reproductive tract in males with CF?
Atresia of vas deferens | Obstructive azoospermia and sterility
55
What is the laboratory test for diagnosing CF?
Sweat test
56
Who should have a sweat test?
FTT, steatorrhoea, chronic pulm disease Digital clubbing "My baby tastes salty" FHx of CF Male infertility
57
How does a newborn screening detect CF?
Elevated blood immunoreactive trypsinogen
58
Is ceftriaxone acceptable therapy for Pseudomonas?
Piptaz or cefepime + ciprofloxacin
59
Does the finding of a pneumothorax suggest more severe lung disease in a CF patient?
Poor prognostic sign | Suggests severe lung disease
60
Which vitamin deficiency do you consider in a CF patient with haemoptysis with heavy bleeding and history of easy bruisability?
Vitamin K deficiency
61
What is ivacaftor?
>2yo Targeted CFTR function potentiator - G551D mutation
62
What is orkambi?
CFTR corrector Treat F508del (2 copies) Correcting the misfolded CFTR protein
63
What is kartagener syndrome?
Both dynein arms of the cilia are absent Presents with recurrent infections, bronchiectasis, situs inversus totalis and reduced male infertility Autosomal recessive
64
How fast do cillia usually beat?
7-22x per second
65
Which pulmonary abnormalities are seen with a-1-antitrypsin deficiency?
Non spokers with early onset emphysema with lower lobe predominance
66
Which liver abnormalities are seen in children with a-1-antitrypsin deficiency?
15% with homozygote PiZZ phenotype get progressive liver fibrosis and cirrhosis
67
What are the common causes of haemoptysis in children?
Infection Foreign bodies Bronchiectasis (esp CF related)
68
What is diagnostic for a pulmonary source of haemoptysis?
Bronchoscopy with bronchoalveolar lavage - haemosiderin laden macrophages (appear 3 days after bleeding)
69
What does CXR characteristically show in sarcoidosis?
Bilateral hilar and/or mediastinal adenopathy +/- reticulonodular or alveolar infiltrates
70
What does the biopsy of an affected bronchial wall in sarcoidosis show?
Non caseating granuloma
71
True or false: erythema nodosum is a poor prognostic indicator in sarcoidosis
False, it is a good prognosis
72
In a patient with pulmonary alveolar proteinosis, hypoxemia is often due to what?
Large R-to-L shunt because gas exchange is impaired secondary to clogged alveoli
73
Which collagen vascular disease causes pulm HTN out of proportion to the pulmonary disease
Intimal proliferation - occurs in scleroderma
74
Which lab test is positive in many patients with GPA?
c-ANCA

RACP Paediatric Exam - Medstudy edition (9 decks)

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