RESPIRATORY Chap 373-419 Flashcards by Karen Morales

T/F
FEV1:VC is NORMAL in Restrictive disease

TRUE

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T/F
FEV1:VC is NORMAL in Obstructive disease

False, decreased

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At rest, Tidal Volume is _____ml/kg body weight

6-7ml/kg

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Decreased FEFmax (Maximal Forced Expiratory Flow)
Decreased FVC
Decreased FEV1/FVC

Obstructive pulmonary disease (eg. Asthma, cystic fibrosis)

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Normal FEFmax (Maximal Forced Expiratory Flow)
Decreased FVC
Normal FEV1/FVC

Restrictive pulmonary disease (eg. pneumonia, kyphoscoliosis)

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Sudden, unexpected death of an infant taht is unexplained even by autopsy

Sudden Infant Death Syndrome (SIDS)

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MC congenital anomaly of the nose

Usually associated with syndromes if bilateral
May remain asymptomatic if unilateral until a respiratory tract infection that may cause obstruction

Dx by inability to pass a catheter through each nostril

Choanal atresia

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Syndrome that is more sommonly associated with choanal atresia

CHARGE (Coloboma, Heart disease, Atresia choanae, Retarded growth & development, Genital anomaly, Ear anomalies)

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Treatment of choice for choanal atresia

Transnasal repair

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Drug used to help prevent development of granulation tissue and stenosis post choanal atresia repair

Mitomycin C (chemo drug used for gi cancers)

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MC type of congenital midline nasal mass

Nasal dermoid

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MC site of nasal bleeding

Kiesselbach plexus

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Profuse unilateral epistaxis associated with a masal mass in an adolescent boy

Juvenile nasopharyngeal angiofibroma

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MC site of nasal polyp

Ethmoidal sinus, middle meatus

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Unilateral, foul smelling nasal secretion

Foreign body

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MC complication of common cold (rhinosinusitis)

Acute Otitis Media

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Sinuses present at birth

Maxillary (pneumatized at 4yrs)
Ethmoid (pneumatized at birth)

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Patient has persistent, non improving nasal congestion for more than 10 days, with high grade fever (39C), associated with headache and facial pain

Pe: sinus tenderness, with erythema and swelling of the nasal mucosa, purulent discharge, negative transillumination

Sinusitis

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Initial treatment for acute bacterial sinusitis

Amoxicillin (45mkday BID)

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Treatment for sinusitis who fail to respond to amoxicillin within 72 hours or severe sinusitis

High dose Co-amoxiclav (80-90mkday)

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Drug of choice for Frontal sinusitis or severe sinusitis with noted vomiting or poor compliance

IV Ceftriaxone

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Inflammation of the pharynx that may present as erythema, edema, exudates or enanthem

Pharyngitis

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Pharyngitis associated with conjunctivitis associated with exposure in swimming pools

Pharyngitis resolves in 7 days
Conjunctivitis resolves in 14 days

Pharyngoconjunctival fever

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Patient presents with fever, sore throat, EXUDATIVE PHARYNGITIS, &/or PERITONSILLAR ABSCESS
Symptoms persists, neck pain and swelling develops
Patient appears TOXIC

Lemierre Syndrome (internal jugular vein septic thrombophlebitis)

Cause by Fusobacterium necrophorum

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Unimmunized patient was noted to have bull neck appearance with gray pharyngeal pseudomembrane

Diphtheria

Patient,5yr, was noted to have fever and sore throat Pe: erythematous pharynx, enlarged tonsils with white exudates, petechial lesion on the soft palate (DOUGHNUT SIGN), swollen uvula, anterior CLADS

GAS Pharyngitis

Drug of choice for GAS pharyngitis in children

Amoxicillin

Treatment for eradication of GAS in chronic carriers

Clindamycin (20mkday in 3 doses x 10 days)

3-4yrs, boy with recent history of ear infection Present with fever, irritability, decreased oral intake, drooling, neck pain, stridor Noted bulging of posterior pharyngeal wall With CLADS

Retropharyngeal Abscess

Definitive diagnosis for pharyngeal abscess

Incision & drainage and culture

3 yr old, previous history of throat infection Present with fever, dysphagia, prominent bulge lateral pharyngeal wall with medial displacement of tonsil

Lateral pharyngeal abscess

Treatment of choice for pharyngeal abscess

3rd generation cephalosphorin + AmpiSulbactam or Clindamycin

Adolescent with recent history of acute pharyngotonsillitis Presents with sore throat, fever, TRISMUS, dysphagia Pe: ASYMMETRIC TONSILLAR BULGE, displacement of uvula

Peritonsillar abscess Tx: surgical drainage and antibiotics for GAS

MC cause of bacterial infection in the pharynx

Group A Beta Hemolytic Streptococcus (GABHS)

Rapid unilateral enlargement of tonsil Appears grossly normal

Tonsillar neoplasm MC Lymphoma

Most common form of acute upper respiratory obstruction Bark-like, brassy cough associated hoarseness, INSPIRATORY STRIDOR, & respiratory distress

Croup

Patient present with URTI, rhinorrhea, pharyngitis, mild cough, low grade fever for 1 to 3 days Then develops barking cough, hoarseness, and INSPIRATORY STRIDOR Symptoms are worse at night, and patient prefers to sit up in bed There was noted other family members with mild respiratory illness NECK XRAY: STEEPLE SIGN (subglottic narrowing)

Croup (Laryngotracheobronchitis)

Acute course of high fever, sore throat, dyspnea & rapidly progressing respiratory obstruction. There was noted drooling, with neck hyperextended. Patient assumes TRIPOD position (sitting upright, leaning forward with chin & mouth open) No other family members were ill Pe: large, cherry red, swollen epiglottis Neck Xray: THUMB SIGN Patient was noted to be restless

Acute Epiglottitis

Mainstay treatment for croup

Airway management Treatment of hypoxia

Acute bacterial infection of the upper airway that is potentially life threatening Often follows a viral infection

Bacterial tracheitis

Presents with high fever, brassy cough, toxic looking. Patient can lie flat, no drooling, no dysphagia mucosal swelling of cricoid cartilage (major pathologic feature) with copious, thick purulent secretions

Bacterial tracheitis Treatment: Vancomycin or Clindamycin & 3rd generation cephalosphorin (Cefotaxime or Ceftriaxone)

MC congenital laryngeal anomaly

Laryngomalacia

MC cause of stridor in infants & children

Laryngomalacia

Infant presents with inspiratory stridor that worsens with crying and feeding DX & Tx?

Laryngomalacia Tx: expectant observation

Presents with BIPHASIC stridor Occurs with a respiratory tract infection Second most common cause of stridor On direct laryngoscopy, reveals a small sized tracheal opening

Subglottic stenosis

High pitched inspiratory stridor associated usually with CNS lesions

Bilateral Vocal cord paralysis

Presents with aspiration, coughing and choking after a GI surgery. Noted to have weak & breathy cry

Unilateral vocal cord paralysis

Abnormal AIR-filled dilation of laryngeal saccule that arises from the false vocal cords to the inner surface of thyroid cartilage. Communicates WITH laryngeal lumen Presents with dyspnea & hoarseness

Laryngocele

MUCUS-filled dilatation of the laryngeal saccule DOES NOT communicate with laryngeal lumen Presents with respiratory distress and stridor

Saccular cyst (congeniyal cyst of the larynx)

MC location where foreign bodies in the airway are seen

Right bronchus

Immediate complication of bronchial foreign body

Air trapping Other features: obstructive emphysema, shift of mediastinum OPPOSITE the side of obstruction

2nd MC cause of stridor in neonates MC cause of airway obstruction requiring tracheostomy Usually associated with oversuzed ET tube

Laryngotracheal stenosis

MC cause of chronic hoarseness in children

Vocal nodules Causes: 1. Vocal abuse - voice worse at night 2. Laryngopharyngeal reflux - voice worse in the morning

MC respiratory tract neoplasm in children

Papillomas

MC respiratory tract neoplasm in children

Papillomas

MC cause of papillomas in children

HPV 6 & 11

3 yr old patient present with chonic hoarseness since 2 years of age but was noted to be increasing in quality. There was noted of mild respiratory distress while playing Prenatal hx: born term via NSD, mother was previously treated for warts DX & TX?

Respiratory Papillomatosis Tx: Endoscopic surgical removal If with recurrence of more than 4 times a year, rapid regrowth with airway compromise or distal multisite spread, need for adjunct therapy (Antiviral eg. Acyclovir, photodynamic therapy, NSAIDS, retinoids, mumps vaccine)

Patient presents with first episode of wheezing with associated decreased feeding and tachypnea There was noted family member who has a mild respiratory disease

Acute bronchiolitis

Distention of air spaces with IRREVERSIBLE disruption of the alveolar septa

Pulmonary emphysema

5mos patient presents with mild tachypnea & wheeze CXR: Distention of left upper lobe, with shift of mediastinum to the right Previous congenital scan revealed problem in the lungs

Congenital lobar emphysema

MC site affected by lobar emphysema

Left upper lobe

Treatment for Congenital lobar emphysema

Surgery & excision of the lobe

Chronic obstructive lung disease of the bronchioles & smaller airways FIBROSIS of the small airways Chest CT: Mosaic pattern of hyperlucency, air trapping & bronchiectasis

Bronchiolitis obliterans

Formation of lamellar concretions of CALCIUM PHOSPHATE or "microliths" in alveoli Rare, autosomal recessive Sandstorm appearance in CXR (bilateral infiltrates with fine micronodular appearance) more on the mid &lower lung fields

Pulmonary alveolar microlithiasis (PAM)

Complete absence of a lung Associated with VACTERL CXR: unilateral lung collapse, shift of mediastinal structures TOWARDS AFFECTED site Chest CT is diagnostic

Pulmonary agenesis

Decrease in the number of alveoli and airway generations Secondary to intrauterine disorders OLIGOHYDRAMNIOS

Pulmonary hypoplasia

Consists of hamartomatous or dysplastic lung tissue mixed with normal lung Generally confined to one lobe Can be diagnosed prenatally

Congenital pulmonary airway malformation (CPAM)

MC type of CPAM Macrocystic (>5mm cyst) Localized in one part of the lobe Good prognosis

Type I

Least common type of CPAM MICROcystic throughout Poorest prognosis Patients usually die at birth

Type 0

Earliest clinical signs of pulmonary edema

Increased work of breathing, tachypnea, dyspnea

Inflammation of the lung parenchyma

Pneumonia

MC bacterial pathogen of pneumonia in children 3wk to 4yr

Streptococcus pneumoniae

Pneumonia that occurs for - 2 or more episodes in a year or - 3 or more episodes ever with radiographic clearing in between

Recurrent pneumonia

Most consistent manifestation of pneumonia

Tachypnea

Hyperinflation with bilateral interstitial infiltrates & peribronchial cuffing Viral or Bacterial pneumonia?

Viral pneumonia

Confluent lobar consolidation Viral or Bacterial pneumonia?

Bacterial pneumonia

Patient presents with fever, tachypnea, increased work of breathing PE: Crackles bilateral lobe Cxr: bilateral interstitial infiltrates Wbc slightly elevated with LYMPHOCYTIC predominance

Viral pneumonia

Patient presents with HIGH fever, tachypnea, increased work of breathing, PE: Crackles right middle lobe, retractions Cxr: right middle lobe consolidation Wbc elevated with NEUTROPHILIC predominance

Bacterial pneumonia Tx: AMOXICILLIN (80-90mkday)

Incomplete expansion or complete collapse of air bearing tissue

Atelectasis

CXR presents with volume loss and displacemet of fissures; mediastinal structures are displaced TOWARDS AFFECTED side (if massive)

Atelectasis

MC cause of pleural effusion in children

Bacterial pneumonia