Respirology

Question 1

ARDS

Answer 1

Interstitial and alveolar edema.

Decreased compliance, increased pulmonary arterial pressure. Impaired gas exchange with ventilation perfusion mismatch and increased physiologic dead space that impairs CO2 elimination.

Question 2

Alpha-1-anti trypsin

Answer 2

AR deficiency of a-AT
Mostly liver disease in Peds, non specific lung findings/emphysema in Peds.
Measure aAT level (low) conform phenotype by electrophoresis and genotype by pcr.

Question 3

CF progression of bugs and drugs

Answer 3

Eradicate to prevent progression
H flu (amox)
Staph (clox long term for all <2, increase dose if grows, add clinda if persists)
Pseudomonas: tobramycin + cipro x3 weeks, inhaled tobi, iv ceftaz, pip/tazo, ticaricillin/clav
Burhoderia cepacia: ceftaz, mero, pip/tazo
Stenotrophomonas matophilia (person to person spread) difficult to treat Septra

Question 4

Causes for false positive sweat chloride test

Answer 4

Insufficient sample
Hypothyroid
Addisons
GSD
Malnutrition
Skin affected by eczema 
Sample contamination with lotions etc

Question 5

Causes for false negative sweat chloride test

Answer 5

Hypoproteinemia with edema

Question 6

Esophageal FB location

Answer 6

Cricopharygeus (ues)
Aortic arch
Superior to diaphragm at LES

Question 7

Food bolus management ( in esophagus)

Answer 7

Observe up to 12 hours

Can try glucagon to decrease LES pressure if no prior esophageal surgery

Question 8

<12 with nasal polyps - what test/diagnosis

Answer 8

Sweat chloride for CF