Respiratory System

Question 1

1)Common causes of significant expectoration
2)how to know about etiology of expectoration

Answer 1

1)Bronchiectasis,lung abcess,bronchitis,asthma and tuberculosis
2)amount and nature give clue.

Question 2

Dictum for respiratory sounds
1)snoring
2)rattling
3)stridor
4)wheeze

Answer 2

Pitch increases and intensity decreases as going down in respiratory tract.
1)low pitch high intensity sound due to oropharyngeal obstruction(inspiratory
2)excessive secretion in pharynx or tracheobronchial tree as in asthma and bronchitis.(inspiratory)
3)stridor obstruction of larynx or trachea (inspiratory)
4)wheeze continous high pitched musical sound (expiratory)

Question 3

Pathophysio and etio of wheezing

Answer 3

partial obstruction of the bronchi and bronchioles leading to narrowing produces wheezing.
1)associated with lower respiratory tract infection :hightened senstivity of the respiratory tract after infection.(most frequesnt b/w 3 to 8 yr age)
2)bronchiolitis
3)bronchial asthma
4)inhaled foriegn body
5)tropical eosinophillia
6)hypersentivity pneumonitis

Question 4

What is infectious croup?
Etiology
Presentation

Answer 4

1)laryngotrachealbronchitis as a result of acute viral infection.
2)chiefly parainfluenza type 1
3)onset is gradual cold for few days befor child develop brassy cough

Question 5

Pathological finding in pneumonia

Answer 5

Consolidation of aleveoli or
infiltration of interstitial tissue with inflammatory cells. Or
Both

Question 6

Etiology of pneumonia

Answer 6

Viral(1/3) : RSV,prana influenza, influenza or adenovirus
Bacterial(2/3): according to frequency
<3weeks: group B streptococcus,gram negative(E.COLI ,KLEB),s.pneumoniae,Hib
3 weeks to 4 years : PNEUMOCOCCUS,HIb,mycoplasma pneumoniae
>4 years: Mycoplasma and clamydia (community acquired) PNEUMOCOCCUS

Question 7

Clinical findings on examination of pneumonia patient?

Answer 7

Percussion note is impaired.
On ascultation air entry is diminished for affected lobe
Cepritations and bronchial breathing heard over areas of consolidation.

Question 8

When to suspect for staph pneumonia?

Answer 8

1)as a complication of measels,infuelnza and cystic fibrosis.
2)debiltating conbditions: DM , malnutrition and macrophage dysfunction.
3)pulmoary infection associated with abces in joint ,bones ,muscles etc

Question 9

What is consolidation?
And why does it happens

Answer 9

Consolidation is nothing but deposition of exudate in aleveoli.
It occurs as a result of inflammation leading to increased capillary permeanility.

Question 10

Pathgnomic findings on XRAY for staphylococcal pneumonia?

Answer 10

Consolidation in both lung fields.
Penumatocoele is pathognomic(air entry in the abscess cavity)

Question 11

Complication sof staphylococcal pneumonia?

Answer 11

Empyema,pneumothorax and pericarditis.

Question 12

Pneumonia due to gram negative organisms(e.coli ,klbe,pseudomonas) is seen in

Answer 12

Infant <3mo age,
Peudomonas can be cause of recurrent pulmonary axacerbations of cystic fibrosis

Question 13

Treatemnt for gram -ve penumonia.

DOC FOR PSEDUMONAS

Answer 13

I.V. Ceftriaxone OR CEFOTAXIME (100MG/KG/DAY).

CEFTAZADIME

Question 14

What is loffler syndrome?
Radiographic finding?

Answer 14

Larvae of nematodes passing to lungs and liver via portal circulation.
Presents as pneumonia like symptoms;

Pulmonary infiltrate of varying sizes resembling military tuberculosis

Question 15

Criteria by WHO for diagnosis of pneumonia (for early diagnosis and preventing U5M)

Answer 15

Rapid respiration with or without dificulty.
Difficulty suggest lower chest indrawing.
Rapid respiration:
>60/min below 2 months
>50/min 2-12 months
>40 1-5 yrs age

Question 16

Most common acute LRTI in infants

Answer 16

Bronchiolitis(occuring in winter or spring.)
Affected infants are between 1 to 6 months. But it can affect upto 2 years of life.

Question 17

M/c etiology of bronchiolitis

Answer 17

respiratorysyncytial virus (RSV) accounts for 50% of cases. Other viruses (parainfluenza, adenovi- ruses) and mycoplasma species make up the remaining cases.

Question 18

Pathogenesis of bronchiolitis

Answer 18

Resistance to air during inspiration and expiration is increased. (Bronchial mucosal inflammation)
Trapping of air inside the alveoli causing EMPYEMA.
When obstruction is complete trapped air is absorbed resulting in ATELECTASIS.

Question 19

Clinical features and X-RAY findings of bronchiolitis.

Answer 19

URI symptoms (runny nose, sneezing) appear first, quickly re- placed by the hallmarks of the disease, respiratory distress, nasal flaring, re- tractions, tachypnea, cyanosis, and wheezing.

Chest X-RAY shows hyperinflation and infiltrates.
Lung fields appear abnormally translucent.

Question 20

Treatement of bronchiolitis

Answer 20

Child is nursed in reclining position(30 to 40 degree) with head and neck elevated.
Moist oxygen inhalation is mainstay of treatemnent.
Antibiotics have no role.

Question 21

Asthma managements on the basis of sveterity of symptoms:

Answer 21

1)Intermittent asthma : infrequent symptoms and asymptomatic between attacks:
SABA as and when needed.
2)persistent asthma:
A)mild persistent:day episode>twice a month, nigh time episode >1 month
Daily with low dose ICS , SABA (whenever sypmtoms)
B)moderate persistent:daily attacks or need to use SABA daily.
Medium dose ICS
C)severe persistent:continous attacks with limitation of physical activity
High dose ICS and long acting beta 2 agonist.(salmetrol ,formoterol)

Question 22

Presentation of foriegn body aspiration in
A)lower airway:
B)upper airway with treatement

Answer 22

A: 1) sudden (always) any respiratory symptem :cough ,choke,gag
2)unilateral wheeze
3)in chronic cases child can present with recurrent pneumonia(always present same side and same lobe).

B) stridor.
Age>1 yr = hemlich’s maneuver.
Infant.
Prone position- back blows(5 times)
Supine-chest thurst (middle and index fingers on chest 5 times)

Question 23

Treatment of removal of foreign body from lower airway:

Answer 23

Rigid bronchoscopy + removal.
Immediately after diagnosis

Question 24

Typical clinical picture of laryngomalacia?
What will u find on laryngoscopy?

Answer 24

New bornInspiratory stridor that worsens on crying and relieved in prone position.
Laryngomalacia is m/c/c of stridor in infants and m/c congenital anomaly of larynx.
On laryngoscopy, omega shaped epiglottis is visualized/

Question 25

Child vs adult airway.

Answer 25

Children -
1)larger tongue relative to size of oral cavity
2)large and floppy epiglottis
3)superior location of larynx
4)funnel shaped(cricoid ring narrowest)

Question 26

Prevention of the symptoms in excersie induced asthma.

Answer 26

Treat it as persistent asthma.
Regular ICS

Question 27

Cystic fibrosis
(Inheritance pattern?)
(Underlying defect)

Answer 27

Autosomal recessive.
Abnormality in cystic fibrosis transmembrane conductance regulator leading to defective chloride channel.

Question 28

A)Clinical features of cystic fibrosis
B)Drug used for its treatement:

Answer 28

A) :1)recurrent lung infections pneumonia (S.aureus commnly and psudomonas m/cimplicated).
Burkholderia cepacia pneumonia have higher mortality.
2)azoospermia
3)fatty stools(Steatorrhea)

B); ivaCaFTor is used as treatement of CF.

Question 29

Macleod syndrome:

Answer 29

also called Swyer-James syndrome.
refers to the inability of the lungs to grow after a severe obstructive bronchiolitis.
mostly linked to adenovirus.
not a true emphysema.

chronic cough,
recurrent pneumonia, and wheezing.

affected lung shows small size and decreased vascularity, hyperexpansion, and hyperlucency (false
emphysema).

Question 30

Yellow nail syndrome:

Answer 30

Respiratory manifestation (pleural effusion,bronchiectasis)
Lymphedema
Discoloured nails