Respirology Flashcards
Central vs obstructive sleep apnea
OSA has cessation of airflow but not chest wall movement
Central has both airflow and chest wall movement
Classic CF manifestations
1. Sinus
2. Respiratory
3. GI tract
4. Sweat
5. Reproductive tract
- Pansinusitis, nasal polyps
- Clubbing, mucus plugging, chronic cough and recurrent wheeze
- Steatorrhea, meconium ileus, chronic diarrhea, rectal prolpase
- Salty skin
- Atresia of vas deferens, thick cervical mucus
Metabolic abnormality in CF
Hyponatremic hypochloremic metabolic alkalosis
Diagnosis of CF
One of: typical CF features, CF in sibling, positive newborn screen
AND
One of: positive sweat test, 2 CF mutations causing CF, abnormal nasal transepithelial potential difference measurement
Which bugs are typical in
1. Early
2. Late
CF disease exacerbations
- Staph aureus
- Pseudomonas
Treatment of CF exacerbations
Double cover for Pseudomonas
2 weeks duration
Transudative vs exudative effusion causes
Transudative: CHF, hypoalbuminemia, cirrhosis
Exudative: infection, inflammation, malignancy
Lab findings to determine cause of effusion
Exudative: fluid:serum ratio > 0.5, LDH fluid > 2/3 of N, low glucose, high protein
3 ways to diagnose asthma in older children
FEV1/FVC < 80-90% with 12+% change with bronchodilator
20+% increase in PEF after bronchodilator
>10-15% drop in FEV1 post challenge
Paradoxical vocal cord dysfunction
Cords close involuntarily inappropriately during inspiration
Intermittent daytime wheezing, no response to asthma management
Diagnose with laryngoscopy
Management: SLP, avoid triggers, relaxation therapies
Causes of false negative CF tests
Dilution
Malnutrition
Edema
Insufficient sweat quantity
Hyponatremia
Pathway for uncontrolled asthma in preschool (1-5 yr) children
Start low dose ICS
Increase to medium dose
Refer to asthma specialist
Kartagener syndrome
50% of patients with PCD have this
Recurrent infections, bronchiectasis, situs inversus totalis, reduced male fertility
CPAM
Dysplastic lung tissue, generally in 1 lobe
Dx with prenatal US or CT
Mediastinal shift away from lesion
Tx: surgery
Bronchogenic cyst
Abnormal budding of the tracheal diverticulum
More commonly on right and midline, but can be in other places
Cysts can get infected
Tx: surgery
Diagnosis of PE
Spiral CT with contrast
Night terrors
Non-REM parasomnia
First third of the night
Child appears awake but not awake, does not remember episode
Reassure, do not try to wake
Can try pre-emptive awakening 15-30 mins before the usual time
Best test to assess for aspiration
MBS
Congenital lobar emphysema
Results from localized obstruction (multiple causes)
Commonly LUL
Wide spectrum of symptoms
Affected lobe is essentially nonfunction because of overdistension, can cause atelectasis of ipsilateral normal lung - can get mediastinal shift
Tx: surgery
Indications for admission for RSV
Signs of severe respiratory distress
Supplemental oxygen required for sats > 90%
Dehydration or history of poor fluid intake
Cyanosis or history of apnea
Infant at high risk for severe disease (<35 week prem, < 3 mo, HD sig cardio disease, immunodef)
Family unable to cope
Criteria for well controlled asthma
Daytime sx 2x or less a week
Reliever sx 2 or less doses a week
Night sx <1 per week
Normal physical activity
Infrequent and mild exacerbations
No absence from school or week
FEV1 or PEF >90% personal best
Patients at high risk for exacerbation
Any hx of previous exacerbation (systemic steroids, ED visit, hospitalization)
Poorly controlled asthma
>2 SABA inhalers/year
Currently smoking
Low dose ICS for
1. 1-5 years
2. 6-11 years
3. 12+ years
- 100-125
- <200
- <250
Medium dose ICS for
1. 1-5 years
2. 6-11 years
3. 12+ years
- 200-250
- 201-400
- 251-500
High dose ICS for
1. 6-11 years
2. 12+ years
- > 400
- > 500
