Respiratory Flashcards by Daniele Cataldi

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

VC - decreased
TLC - decreased
FEV1 - decreased
FEV1/FVC - increased >80%
RV - decreased

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

VC - decreased
TLC - decreased
FEV1 - decreased
FEV1/FVC - increased >80%
RV - normal

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What are the patterns of results of VC, TLC, FEV1, FEV1/FVC, and RV in patients with lower airway obstruction?

VC - decreased
TLC - increased
FEV1 - decreased
FEV1/FVC - decreased <70%
RV - increased

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What is vital capacity? Which smaller lung volumes make it up?

VC = the volume you have available for breathing

VC =IRV +TV +ERV

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When is the methacholine bronchoprovocation test performed?

Done in people with normal spirometry and intermittent asthma-like symptoms, or other symptoms suggestive of airflow obstruction, to determine if they have bronchial hyperreactivity

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What is the 1st test performed in the evaluation of a patient with suspected asthma?

Pre and post bronchodilator spirometry

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What is the most common cause of stridor in the newborn?

Laryngomalacia

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

22q11 deletion (DiGeorge)

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How does tracheal stenosis present?

Expiratory stridor

SOB and Retractions

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What is pulmonary venolobar syndrome?

Scimitar syndrome (congenital pulmonary venolobar syndrome)

Rare disorder
Pulmonary venous blood from all or part of the right lung returns to the IVC just above or below the diaphragm
Left to Right shunt

Clinical

Infantile form, abnormalities of venous drainage (e.g., hemianomalous pulmonary venous drainage to the IVC) can present as:
HF and/or pulmonary HTN in the newborn period

Ix
- CXR - may show the shadow of these veins as they course, giving a scimitar-like (Turkish sword) appearance

Prognosis

Worse if present with heart failure
Usually due to associated anomalies, including left-sided heart malformations
Mortality high

Transcatheter occlusion of aortopulmonary collateral
Other = reimplantation of the vein or pneumonectomy

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Why is bronchoscopy not useful in diagnosing pulmonary sequestrations?

Sequestration is NOT connected to the airways

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

Upper airway compromise, inspiratory muscle (i.e., diaphragm, intercostals, accessory) compromise, and/or expiratory muscle compromise

-> swallowing and secretion clearance problems, aspiration, mechanical obstruction of the upper airway, inadequate lung expansion resulting in hypoxemia from V/Q mismatch, and inadequatecough

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What are some of the neuromuscular diseases that can cause respiratory failure?

GBS
Myasthenia Gravis
SMA
Muscular Dystrophy
CP

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Which virus causes most cases of croup?

Parainfluenza Type 1 and 2

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What is the treatment for croup?

Cool-mist humidifiers, using a shower to steam up the bathroom, and/or taking a child outside in the cool night air

Single 0.15 to 0.6 mg/kg (max 10 mg) dose of oral dexamethasone

If Moderate stridor at rest, moderate retractions, or more severe symptoms = Adrenalin neb

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What are the typical causes of epiglottitis?

HiB

H. influenzae (nontypeable) most common cause
Streptococcus pneumoniae
Streptococcus pyogenes (a.k.a. group A β-hemolytic Streptococcus [GAS])
Staphylococcusaureus

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If you visualize a cherry-red epiglottis, what is your diagnosis?

Epiglottitis

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What is the treatment of epiglottitis?

Oxygen
Keep calm
Anasthetic r/v - likely intubate
Prompt antibiotic therapy:
- Antistaphylococcal agent (oxacillin, cefazolin, or clindamycin) and either ceftriaxone or cefotaxime
- Most are bacteremic
- Vanc if MRSA prevalent

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Which organism most often causes bacterial tracheitis?

S. aureus - most common

Others = parainfluenza virus Type I, Moraxella catarrhalis, nontypeable H. influenzae, and anaerobes

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Which pathogen most commonly causes acute bronchiolitis?

RSV – most common

Other = rhinovirus, paraflu, human metapneumovirus, influenza

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In children, the absence of which vital sign abnormality makes the diagnosis of pneumonia unlikely?

FEVER

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

Children

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Are blood cultures routinely recommended in the management of outpatient pneumonia in children?

chance of +ve is <5%

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Gram-positive diplococci seen in a sputum sample with a large number of PMNs and few epithelial cells most likely indicate which organism?

Strep pneumonia

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

Pleural effusions often persist for weeks and resolve without specific therapy

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

Common and disappear spontaneously but often take weeks to resolve

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

Suspect S. aureus pneumonia in a patient with recent URI, chicken pox, or influenza who presents with abrupt onset of fever, tachypnea, tachycardia, and cyanosis. CXR showing distinct pneumatoceles is classic!

Which antibiotic is commonly used for presumed anaerobic pneumonia?

Clindamycin

What are the extrapulmonary manifestations of Mycoplasma infection?

``` Hemolytic anemia Splenomegaly Erythema multiforme (and Stevens-Johnson syndrome) Arthritis Myringitis bullosa Pharyngitis Tonsillitis Neurologic changes—especially confusion ```

Name the geographical areas for histoplasmosis, coccidioidomycosis, and blastomycosis?

Histoplasmosis = Missisipi, Ohio River - soil, bird and bat droppings Coccidioidomycosis = San Joaquin Valley - fungal spores, dry desert areas Blastomycosis = Central, southeastern, and mid-Atlantic seaboard states

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

ABPA

How do you treat ABPA?

Oral corticosteroids | Itraconazole

Describe the location of the obstruction based on inspiratory versus expiratory stridor?

``` Inspiration = Subglottic area Expiration = Intrathoracic portion of trachea ```

What are the 2 main diagnoses if a patient with acute onset stridor also presents with high fever and rapid deterioration?

Epiglottitis | Bacterial tracheitis

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

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

Montelukast (requires days or even weeks to start working) | Or pretreatment with an inhaled short-acting β-adrenergic agent and/or ipratropium (10–20 minutes before exercise)

What do asthma action plans provide for the families of children with asthma?

Clear mgx | Avoidance of triggers

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

No or minimal daily (including nighttime) symptoms No or minimal exacerbations No limitations on daily activities No missed school or work Minimal use of SABAs, such as albuterol And minimal-to-no adverse effects from therapy

What are some complications of prolonged use of systemic corticosteroids?

``` Suppression of the hypothalamic-pituitary-adrenal axis Immunosuppression Osteoporosis Cataracts Hyperglycemia Weight gain Thinning of the skin, easy bruisability Abdominal striae Growth retardation ```

What are some complications of prolonged use of inhaled corticosteroids?

Growth velocity changes Dermal thinning and increased ease of skin bruising Rarely, cataracts form and hypothalamic-pituitary-adrenal axis function is affected Oral candidiasis (thrush) is common and can be prevented by using a spacer (valved holding chamber) with metered-dose inhalers and rinsing the mouth after inhalation.

Are long-acting beta-agonists useful for rescue therapy in acute asthma attacks?

What does adding erythromycin to a patient’s regimen that already includes theophylline potentially do to the theophylline level?

Increase serum levels

Is omalizumab an appropriate therapy for a 6-year-old asthmatic child with mild disease?

NO Omalizumab is an anti-IgE monoclonal antibody given intramuscularly to patients ≥ 6 years of age who have severe, difficult-to-control, allergic asthma

Is the CXR abnormal in all cases of foreign body aspiration?

NO | 10-15% have a normal X-ray

Which viruses most commonly cause bronchiolitis obliterans?

Adenovirus 3, 7 or 21

How do you diagnose bronchiolitis obliterans?

Lung Biopsy

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 now. What diagnosis do you entertain?

Cryptogenic Organising Pneumonia

Is apnea of prematurity a risk factor for SIDS?

NO But prematurity is a RF

Is prematurity itself a risk factor for SIDS?

YES

Which strategy has had the greatest impact on reducing incidences of SIDS?

Safe to Sleep Campaign

Does maternal smoking during pregnancy increase the risk of SIDS?

YES maternal factors = young age, and smoking during pregnancy

What is the mode of inheritance for CF?

Which gene is responsible for CF?

CFTR gene on Long arm of Chromosome 7 | Most common mutation is DeltaF508

Which factor correlates best with survival in CF patients?

Patients level of fitness

What sinus and nasal findings commonly occur in CF patients?

Nasal polyps | Pansinusitis

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

S. aureus, H. influenzae, and common gram-negative organisms such as Klebsiella

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

Pseudomonas

When does pancreatic insufficiency occur in CF?

Present at birth in 50% of children with CF Although 90% have signs/symptoms of pancreatic insufficiency by 9 years of age

Which GI findings are more common in CF?

``` Bowel obstruction Meconium Ileus Intussusception DIOS Rectal prolapse Liver cirrhosis ```

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

Produce HIGH salt content

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

Atresia of the vas deferens -> obstructive azoospermia and sterility

What is the laboratory test for diagnosing CF?

Sweat test

Who should have a sweat test?

FTT, steatorrhea, and chronic pulmonary disease ``` Meconium ileus Rectal prolapse Prolonged neonatal jaundice Chronic diarrhea Steatorrhea ``` ``` Nasal polyps Pansinusitis Chronic cough Recurrent wheezing S. aureus pneumonia Finding Pseudomonas in throat, sputum, or bronchial cultures ``` Digital clubbing Family history of CFFTT “My baby tastes salty” Male infertility

How does newborn screening detect CF?

Screens for elevated blood immunoreactive trypsinogen (IRT)

Is ceftriaxone acceptable therapy for Pseudomonas?

No - does not cover

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

YES

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

Vitamin K def

What is Kartagener syndrome?

Occurs when one or both dynein arms of the cilia are absent Presents with recurrent infections (i.e., sinusitis, otitis, pneumonia), bronchiectasis, situs inversus totalis, and reduced male fertility Sporadic or familial AR

Which pulmonary abnormalities are seen with α1-antitrypsin deficiency?

Homozygotes = early onset emphysema Heterozygotes = Often have no resp disease

Which liver abnormalities are seen in children with α1-antitrypsin deficiency?

Homozygotes = early liver fibrosis and cirrhosis, hepatoma Heterozygotes = ?

What are the common causes of hemoptysis in children?

Infection Foreign Body Bronchietcasis (especially CF related)

What is diagnostic for a pulmonary source of hemoptysis?

Hemosiderin-laden macrophages on BAL

What does the CXR characteristically show in sarcoidosis?

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

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

Noncaseating granuloma

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

FALSE is good prognosis

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.

Which collagen vascular disease causes pulmonary hypertension out of proportion to the pulmonary disease noted?

Scleroderma

Which laboratory test is positive in many patients with GPA?

c-ANCA

Respiratory Flashcards

(78 cards)