Respirology Flashcards
What are the side effects of inhaled corticosteroids?
- Oral candidiasis
- Dysphonia
- Growth suppression
- Osteopenia
What is the next step after low-dose ICS in asthma if uncontrolled? (1-5yo, 6-11yo, >11yo)
- 1-5yo: increased to medium dose ICS
- 6-11yo: same
- >11yo: add LABA
What are admission guidelines for bronchiolitis?
- Signs of severe respiratory distress (indrawing, RR >70, grunting)
- Supplemental O2 to keep sats >90%
- Dehydration or hx of poor fluid intake
- Cyanosis or hx of apnea
- Infant at high risk of severe disease (born <35wk, <3mo old, hemodynamically significant cardiac disease, immunodeficiency)
- Family unable to cope
What is the differential diagnosis for wheezing in teenagers?
- Asthma
- Vocal cord dysfunction
- Bronchiolitis obliterans
- Bronchitis
- Pulmonary edema
- Interstitial lung disease
- Tumors & lymphadenopathy
What are clues for vocal cord dysfunction (instead of another diagnosis)?
- Subjectively more difficulty on inspiration
- Minimal response to aggressive asthma treatment
- A flattened inspiratory flow-volume loop
- Normal expiratory spirometry, lung volumes, and gas
What is the gold standard diagnostic test for vocal cord dysfunction?
Laryngoscopy
What is the criteria for diagnosis cystic fibrosis?
One of: 1. Presence of typical features of CF (GI, resp, GU), 2. Hx of CF in a sibling OR 3. +NBS
AND One of: 1. 2 elevated sweat Chl concentrations on different days, 2. two CF mutations, OR 3. an abnormal nasal potential difference
What is the most common mutation in CF?
F508del (CFTR protein created but misfolded)
How do you interpret a Chloride sweat test?
- >60: positive - need 2nd sweat chloride
- 30-59 - intermediate - if 2 CFTR mutations present, suggests diagnosis
- <30 - negative
For a cough, what do these key words indicate? Staccato, never during sleep, barking/brassy, abrupt onset, accompanies eating, throat clearing, night cough, sputum
- Staccato, paroxysmal → pertussis, CF, foreign body, chlamydia or mycoplasma
- All day, never during sleep → habit cough
- Barking, brassy → croup, habit cough, tracheomalacia
- Abrupt onset → FB, PE
- Accompanies eating → aspiration, GERD, TEF
- Throat clearing → post-nasal drip, vocal tic
- Night cough → sinusitis, asthma, GERD
- Sputum → infection, CF, bronchiectasis
What factors can give a false negative on a sweat chloride test?
Dilution, malnutrition, edema, insufficient sweat quantity, hyponatremia, CFTR mutation with preserved sweat function
What factors should you consider if a patient with asthma is using lots of ventolin?
- Do you have the right diagnosis?
- Are there lots of triggers (e.g. environmental)?
- Poor adherence to controller medication
- Poor technique
- Need more medication?
What factors should you consider if a patient with asthma is using lots of ventolin?
- Do you have the right diagnosis?
- Are there lots of triggers (e.g. environmental)?
- Poor adherence to controller medication
- Poor technique
- Need more medication?
What are the risk factors for mortality in asthma?
- Previous life-threatening events, admissions to an intensive care unit (ICU), intubation
- Hospitalizations or ED visits for asthma in the last year
- Deterioration while on, or recently after stopping, systemic steroids
- Using >1 canister of salbutamol per month
- Lack of an asthma action plan or poor adherence to treatment
- Comorbidities (e.g., food allergy, obesity)
- Low socioeconomic status, psychosocial concerns
What are some factors that can cause the sweat chloride test to be falsely positive?
Eczema, untreated Addison’s disease, ectodermal dysplasia, glycogen storage disorders, untreated hypothyroidism, CAH
