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A. PEDIA BOARD REVIEW > RESPIRATORY Chap 373-419 > Flashcards

RESPIRATORY Chap 373-419 Flashcards

1
Q

T/F
FEV1:VC is NORMAL in Restrictive disease

A

TRUE

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2
Q

T/F
FEV1:VC is NORMAL in Obstructive disease

A

False, decreased

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3
Q

At rest, Tidal Volume is _____ml/kg body weight

A

6-7ml/kg

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4
Q

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

A

Obstructive pulmonary disease (eg. Asthma, cystic fibrosis)

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5
Q

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

A

Restrictive pulmonary disease (eg. pneumonia, kyphoscoliosis)

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6
Q

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

A

Sudden Infant Death Syndrome (SIDS)

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7
Q

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

A

Choanal atresia

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8
Q

Syndrome that is more sommonly associated with choanal atresia

A

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

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9
Q

Treatment of choice for choanal atresia

A

Transnasal repair

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10
Q

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

A

Mitomycin C (chemo drug used for gi cancers)

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11
Q

MC type of congenital midline nasal mass

A

Nasal dermoid

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12
Q

MC site of nasal bleeding

A

Kiesselbach plexus

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13
Q

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

A

Juvenile nasopharyngeal angiofibroma

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14
Q

MC site of nasal polyp

A

Ethmoidal sinus, middle meatus

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15
Q

Unilateral, foul smelling nasal secretion

A

Foreign body

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16
Q

MC complication of common cold (rhinosinusitis)

A

Acute Otitis Media

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17
Q

Sinuses present at birth

A

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

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18
Q

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

A

Sinusitis

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19
Q

Initial treatment for acute bacterial sinusitis

A

Amoxicillin (45mkday BID)

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20
Q

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

A

High dose Co-amoxiclav (80-90mkday)

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21
Q

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

A

IV Ceftriaxone

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22
Q

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

A

Pharyngitis

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23
Q

Pharyngitis associated with conjunctivitis associated with exposure in swimming pools

Pharyngitis resolves in 7 days
Conjunctivitis resolves in 14 days

A

Pharyngoconjunctival fever

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24
Q

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

A

Lemierre Syndrome (internal jugular vein septic thrombophlebitis)

Cause by Fusobacterium necrophorum

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25
Q

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

A

Diphtheria

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26
Q

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

A

GAS Pharyngitis

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27
Q

Drug of choice for GAS pharyngitis in children

A

Amoxicillin

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28
Q

Treatment for eradication of GAS in chronic carriers

A

Clindamycin (20mkday in 3 doses x 10 days)

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29
Q

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

A

Retropharyngeal Abscess

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30
Q

Definitive diagnosis for pharyngeal abscess

A

Incision & drainage and culture

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31
Q

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

A

Lateral pharyngeal abscess

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32
Q

Treatment of choice for pharyngeal abscess

A

3rd generation cephalosphorin + AmpiSulbactam or Clindamycin

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33
Q

Adolescent with recent history of acute pharyngotonsillitis
Presents with sore throat, fever, TRISMUS, dysphagia

Pe: ASYMMETRIC TONSILLAR BULGE, displacement of uvula

A

Peritonsillar abscess

Tx: surgical drainage and antibiotics for GAS

34
Q

MC cause of bacterial infection in the pharynx

A

Group A Beta Hemolytic Streptococcus (GABHS)

35
Q

Rapid unilateral enlargement of tonsil
Appears grossly normal

A

Tonsillar neoplasm
MC Lymphoma

36
Q

Most common form of acute upper respiratory obstruction

Bark-like, brassy cough associated hoarseness, INSPIRATORY STRIDOR, & respiratory distress

A

Croup

37
Q

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)

A

Croup (Laryngotracheobronchitis)

38
Q

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

A

Acute Epiglottitis

39
Q

Mainstay treatment for croup

A

Airway management
Treatment of hypoxia

40
Q

Acute bacterial infection of the upper airway that is potentially life threatening

Often follows a viral infection

A

Bacterial tracheitis

41
Q

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

A

Bacterial tracheitis

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

42
Q

MC congenital laryngeal anomaly

A

Laryngomalacia

43
Q

MC cause of stridor in infants & children

A

Laryngomalacia

44
Q

Infant presents with inspiratory stridor that worsens with crying and feeding

DX & Tx?

A

Laryngomalacia

Tx: expectant observation

45
Q

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

A

Subglottic stenosis

46
Q

High pitched inspiratory stridor associated usually with CNS lesions

A

Bilateral Vocal cord paralysis

47
Q

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

A

Unilateral vocal cord paralysis

48
Q

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

A

Laryngocele

49
Q

MUCUS-filled dilatation of the laryngeal saccule
DOES NOT communicate with laryngeal lumen

Presents with respiratory distress and stridor

A

Saccular cyst (congeniyal cyst of the larynx)

50
Q

MC location where foreign bodies in the airway are seen

A

Right bronchus

51
Q

Immediate complication of bronchial foreign body

A

Air trapping

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

52
Q

2nd MC cause of stridor in neonates
MC cause of airway obstruction requiring tracheostomy

Usually associated with oversuzed ET tube

A

Laryngotracheal stenosis

53
Q

MC cause of chronic hoarseness in children

A

Vocal nodules

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

54
Q

MC respiratory tract neoplasm in children

A

Papillomas

54
Q

MC respiratory tract neoplasm in children

A

Papillomas

55
Q

MC cause of papillomas in children

A

HPV 6 & 11

56
Q

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?

A

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)

57
Q

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

A

Acute bronchiolitis

58
Q

Distention of air spaces with IRREVERSIBLE disruption of the alveolar septa

A

Pulmonary emphysema

59
Q

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

A

Congenital lobar emphysema

60
Q

MC site affected by lobar emphysema

A

Left upper lobe

61
Q

Treatment for Congenital lobar emphysema

A

Surgery & excision of the lobe

62
Q

Chronic obstructive lung disease of the bronchioles & smaller airways

FIBROSIS of the small airways

Chest CT: Mosaic pattern of hyperlucency, air trapping & bronchiectasis

A

Bronchiolitis obliterans

63
Q

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

A

Pulmonary alveolar microlithiasis (PAM)

64
Q

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

Chest CT is diagnostic

A

Pulmonary agenesis

65
Q

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

A

Pulmonary hypoplasia

66
Q

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

A

Congenital pulmonary airway malformation (CPAM)

67
Q

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

A

Type I

68
Q

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

A

Type 0

69
Q

Earliest clinical signs of pulmonary edema

A

Increased work of breathing, tachypnea, dyspnea

70
Q

Inflammation of the lung parenchyma

A

Pneumonia

71
Q

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

A

Streptococcus pneumoniae

72
Q

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

A

Recurrent pneumonia

73
Q

Most consistent manifestation of pneumonia

A

Tachypnea

74
Q

Hyperinflation with bilateral interstitial infiltrates & peribronchial cuffing

Viral or Bacterial pneumonia?

A

Viral pneumonia

75
Q

Confluent lobar consolidation

Viral or Bacterial pneumonia?

A

Bacterial pneumonia

76
Q

Patient presents with fever, tachypnea, increased work of breathing

PE: Crackles bilateral lobe

Cxr: bilateral interstitial infiltrates

Wbc slightly elevated with LYMPHOCYTIC predominance

A

Viral pneumonia

77
Q

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

A

Bacterial pneumonia

Tx: AMOXICILLIN (80-90mkday)

78
Q

Incomplete expansion or complete collapse of air bearing tissue

A

Atelectasis

79
Q

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

A

Atelectasis

80
Q

MC cause of pleural effusion in children

A

Bacterial pneumonia

A. PEDIA BOARD REVIEW (13 decks)

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