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RC: Specialties Woo Hoo > Respirology > Flashcards

Respirology Flashcards

1
Q

Most sensitive PFT for small airway dx?

A

FEF 25-75

= reflect flow through small airway (<2mm diameter)
= may defect before FEV1 change
= give more flattening on top part of flow loop

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2
Q

List two small airway obstruction dx?

A

Asthma

CF

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3
Q

How do you interpret PFT:

A
  1. FEV1/FVC
    Normal/High
    > if FVC < 80%= restrictive

IF <85% predicted
> But FVC high= obstructive
> If FVC < 80%= mixed pattern

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4
Q

Give two examples of restrictive resp dx?

A
  • neuromuscular (Duchenne Muscular Dystrophy)
  • Interstitial lung dx or interstitial pneumonia
  • Scliosis / chest wall
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5
Q

What is key PFT measurement to monitor progression of CF lung dx?

A

FEV1

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6
Q

What is a bronchial challenge PFT test?

A

Goal: R/A non specific airway hyperactivity via
inhalation challenge
via methacholine or exercise
* very sensitive for asthma.

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7
Q

15 y.o. M with recurrent pneumonia x3. Next test:

  • Immunoglobulin
  • PFT
  • lung scan
A

Immunoglobulin. (Not less likely congenital given age but location key too!)

Suspect IF: 2 pneumonia in 1 yr.

Screen: CBC + diff, serum immunoglobulin

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8
Q

Define recurrent pneumonia and include ddx.

A

Recurrent= 2 in single yr or min. 3 ever in life)

 DDX: 
> Same location
- Anatomic: pulmonary sequestration, lobar emphysema
- Compression (outside or in)
- FB
- RML syndrome
- Bronchiectasis

> Diff Location

  • CF
  • Primary Ciliary Dyskinesia
  • Recurrent Aspiration (neuro, swallow issue, anatomic)
  • Sickle cell
  • Immunity: HIV, immunoglobulin deficiency, SCID, CVID etc.
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9
Q

When is a lung scan helpful?

A 
Congenital malformation (CVS + pul)
OR PE
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10
Q

Duchenne pt. FVC reduced. Which symptom likely?

A

Headache early in morning.

DUE to nocturnal hypoventilation.

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11
Q

List FEV1/FVC, RV, TLC, FEF 25-75 results in patient w/ asthma versus Deconditioning.

A

Asthma= Obstructive

  • FEV1 = down
  • FVC = Norm/down
  • FEV1/FVC= down
  • FEF 25-75= down
  • RV= up
  • TLC = up
  • RV/TLC= up

Deconditioning

  • FEV1= normal
  • FVC= normal
  • FEVI/FVC= N
  • FEF 25-75 = N
  • RV= N
  • TLC= N

Restrictive=instit’l

  • FEV1= down
  • FVC= down
  • FEV1/FVC= N/ up
  • FEF 25-75= N
  • RV = N or down
  • TLC= down
  • functional residual capacity down
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12
Q

T or F: Duchenne Muscular Dystrophy always affect M.

A

True.

X linked= BOY

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13
Q

List Duchenne Muscular Dystrophy Classic Features.

A
  1. Progressive weakness (proximal first)
  2. IQ impairment
  3. Hypertrophy of Calves

Note: common toddler ppt= delayed walking or toe walking
Note: most have cardiomyopathy.

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14
Q

What BW test is really high in Duchenne Muscular Dystrophy?

A

serum CK

If norm= NOT this dx
Dx: genetic study for dystrophin gene (DMD) or muscle biopsy

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15
Q

List Causes/RF for PPHN:

A
  1. Birth Asphyxia
  2. Parenchymal lung dx
    > MAS
    > RDS
    > Pneumonia
    > Early onset sepsis
  3. Pul hypoplasia
    > CDH, Cystic malformation
  4. Idiopathic
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16
Q

List one med tx for PPHN:

A

iNO

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17
Q

what is the most common cause of chronic cough?

A

Asthma

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18
Q

List 10 causes of persistent cough

A

Nonspecific
> **post-viral

Upper airway
**> chronic sinusitis
> tracheo or bronchomalacia
> external compression of tracheobronchial tract (like vascular ring, node, cyst)

**FB Aspiration

Lower airway

  • *> Asthma
  • *> CF
  • *> ciliary dyskinesia
  • *> immunodeficiency
  • *> chronic TB infection
  • *> pertussis
  • *> recurrent aspiration

**GERD

** Cardiac

** ACEI

**Habit cough/ psychogenic

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19
Q

T or F: kids with cough> 6 wk should be tested for CF regardless of race.

A

True.

= Sweat Cl

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20
Q

Girl w/ cough at night and exertion x 3 mo. PFT normal. Next test?

A

Methacholine challenge

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21
Q

Child w/ morning sore throat. Bad breath. Chronic cough w/ abdo pain. Cough worse w/ activity. Test for dx?

A

GERD
test answer = pH probe

**association w/ hypersensitive airway

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22
Q

Child w/ chronic cough. Not related to illness. Harsh. Gone at night. Barky but croup tx doesn’t work. Dx?

A

Habit cough

**disappear w/ sleep or distraction.
** abrupt, harsh, loud
= Reassure and tell to do full activity

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23
Q

T or F: it’s safe and effective to use OTC cough med in 1 y.o. child.

A

False

  • CPS: OTC cough +cold NOT effective + can harm
  • AAP: OTC cough + cold med should not be used in < 6 y.o.
  • honey may have benefit but don’t know good dosing
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24
Q

How do you tell the diff btwn Chlamydia pneumonia in baby versus RSV infiltrates?

A

No fever + wheezing = NOT RSV.

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25
Q

“Staccato” cough, tachypnea in afebrile 1 month old. Dx?

A

Chlamydia pneumoniae.

CXR: hyper inflated + infiltrates

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26
Q

2 y.o. Bad croup after 1-2 days of viral URTI. No response to epi or dex x 2. Anxious, ++ WOB. What do you do?

A

Intubate

Likely bad croup or bacterial tracheitis.

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27
Q

List three common bugs of Bacterial Tracheitis:

A
  1. S. aureus
  2. Moraxella
  3. Streptococcus pyogenes (GAS)
  4. Streptococcus pneumoniae
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28
Q

Diff in age for croup vs. bacterial tracheitis:

A

Croup: mean 18 mo. (6 mo-3 y.o.)

Bacterial: mean 4 y.o.
1 mo- 16 y.o. range

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29
Q

Common cause of croup?

A

Virus

- most common: parainfluenza 1

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30
Q

T or F: croup or bacterial tracheitis cause drooling?

A

False.

Epiglottitis does!

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31
Q

3 mo. recurrent URTI. on/off stridor since birth. Well but intermittent insp stridor. Dx?

A

Laryngomalacia.

Most common congenital laryngeal anomaly and cause of stridor.

Increase up to 6 mo. Then better.

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32
Q

list ddx for anterior medial mass

A

5 T’s:

Thymus
> thymoma (rare)
> thymic hyperplasia

Teratoma

Terrible lymphoma
> hodgkin or not

T cell leukaemia

Thyroid Mass

Other: lymphangioma, hemangioma, histiocytosis, lipoma

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33
Q

list ddx for middle mediastinal mass

A

A + B

Adenopathy
> Infection
> Histoplasmosis
> TB
> Neoplasm
> Mets
>Sarcoidosis

Bronchogenic Cyst

Other: vascular mass

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34
Q

list ddx for posterior mediastinal mass

A

NEURO

Neurogenic tumour
- neurofibroma
- neurosarcoma
- ganglioneuroma
- neuroblastoma
- pheochromocytoma
etc.
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35
Q

T or F: > 50% of mediastinal mass malignant.

A

TRUE.

  • hence always need investigating
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36
Q

New onset asthma in teen. R/O

A

Mediastinal mass

- specifically lymphoma

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37
Q

4 y.o. Child CXR shows incidental finding of asymptomatic circular anterior mediastinal mass. Likely:

  • ganglioneuroma
  • neuroblastoma
  • lymphoma
  • teratoma
  • met from Wil’ms
A

Teratoma

Posterior= neuro CA
Middle= A+B

Note: can be lymphoma but typically teen and can be in other areas versus teratoma only anterior but rare.

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38
Q

Neo w/ resp distress & cystic LUL w/ trach deviation. Likely:

a. CPAM
b. pul sequestration
c. pneumonia

A

CPAM

= congenital cystic adenomatoid malformation
= most common congenital malformation of lower resp tract

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39
Q

T or F: bronchial hyper responsiveness can be present even with normal PFT in asthma.

A

True.

  • why we have methacholine challenge.
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40
Q

list side effects of ventolin.

A
  1. tachycardia
  2. shaky or tremor
  3. irritable
  4. low K (nausea, weakness, low DTR, arrhythmia)
  5. h/a
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41
Q

Q30 ventolin. Aminophylline added this morning. Nausea and weak complaints. What BW to check:
Na/BG/K/Mg?

A

K

Low K = nausea (Less peristalsis), neuromuscular excited causing hyporeflexia and paralysis

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42
Q

Pneumo pre-medical air transport. What do you do?

A

Chest tube!

  • air expand when pressure decrease in cabin

Otherwise if < 5% and N child = watch +/- 100% O2 to hasten resolution

If recurrent, secondary, tension, >5%= CT

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43
Q

What is true regarding asthma meds:

a. ventolin act on small airway
b. IV ventolin work better than inhaled
c. steroid increase responsiveness of ventolin
d. cromolyn useful in acute tx

A

Steroids increase responsiveness to beta 2 agonist.

Ventolin: target large + small airways

  • no proven EBM of systemic over inhaled
  • note inhaled not appropriate if only small gas volume shifted

Steroid: anti-inflammatory, beter responsiveness to ventolin, improve lung function and lower relapse

Cromolyn NOT acute phase.

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44
Q

What dose of flovent do you worry about adrenal suppression?

A

Fluticasone 250 mcg BID.

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45
Q

AE of long-standing inhaled corticosteroid.

A

Height velocity.

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46
Q

If on low dose flovent but need more control. What do you do?

A

< 5
= increase to medium dose
+/- LTRA (min. 2 y.o.)

6-11
= increase to medium dose (200-400 daily)
Next: +/- LABA +/- LTRA

> 12 yo.:
- KEEP low dose + LABA (Advair, Zenhale, Symbicort)
NEXT change: medium dose + LABA OR LTRA

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47
Q

Review of when to use MDI and spacer versus dry powder (diskus).

A 
MDI + spacer + mask= 5
MDI + spacer= 5
Dry powder (turbuhaler, discus)= 6
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48
Q

Technique for MDI w/ spacer:

A

Shake.
MDI into spacer
Seal lips around mouthpiece
Inhale and exhale x 6 normal breaths

Wait 30 sec btwn each and shake canister w/ each puff

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49
Q

Describe the one big breath technique for puffers.

A 
1 deep breath 
Should not hear whistle
Typically 4-6 second until lung filled
Hold x 10 seconds
Exhale
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50
Q

Teen w/ MDI without aerochamber. Technique:

  • put in mouth
  • hold breath 3 sec w/ inhalation
  • hold breath for duration of inhalation
  • hold nose during inhalation
A

*assuming without spacer in Q; which we never do.

Hold breath for duration of inhalation

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51
Q

MDI w/ Teen. Proper technique:

  • close mouth
  • hold breath x 3 sec
  • hold MDI 2 finger width from mouth
  • give puffer in middle of inspiration
A

*assuming without spacer in Q; which we never do.

Close mouth technique

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52
Q

Indication of poor controlled asthma:

  • 2 vent/wk pre-exercise
  • 2 vent/wk for symptomatic wheeze
  • 2 vent/wk @ night
  • 2 vent/mon. w/ cold
A

2 ventolin per week at night time.

Control: daytime max 2d/week

Mild:

  • day: 3-6d/wk
  • 1-2 night/mon
  • minor limit on f’n

Moderate:

  • daily symp
  • 3-4 night/mo
  • FEV1 60-80

Severe:

  • daily daytime
  • > 1 night vent/wk
  • FEVI < 60
  • limited f’n
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53
Q

Best indicator for mortality in asthma:

A

Previous Intubation

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54
Q

T or F: You have to coordinate breath if you use MDI w/ spacer.F

A

False.

Just reg breath x 6.

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55
Q

What test is key in asthma pt w/ WOB and can speak sentences.

  • PFT
  • O2 sat
  • CXR
  • cap gas
A

O2 sat

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56
Q

List 3 things on ddx for asthma:

A

FB
CF
GERD

Other:
Aspiration
Chronic sinusitis
Vocal cord dsyfunction

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57
Q

Described controlled asthma:

A

Day symptoms:
< 4 d per week

Night time:
< 1-2 / month

No activity limitation

FEV1/FVC > 90% of personal best (old: > 80%)

Oral steroid 0-1/year

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58
Q

List two common side effects of ICS:

A
  1. Thrush
  2. Dysphonia
  3. Growth suppression (~1cm)
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59
Q

How do you treat STATUS asthmatics:

A
  1. SABA + anticholinergic
  2. Steroids (prednisone or methylpred)
  3. MgSO4
  4. Continuous ventolin (0.5mg/kg/hour)
  5. IV salbutamol
  6. PPV/high Flow
  7. Heliox
  8. Theophylline (aminophylline)
60
Q

List two complications w/ bad asthma:

A
  1. Hypoxemia
  2. Atelectasis
  3. Pneumothorax
61
Q

Normal PFT FEV1 and FEV1/FVC values:

A

FEV1 > 80%
FEV1/FVC > 80%

Successful bronchodilator: FEV1 >12%

62
Q

Most common cause of exercise intolerance:

A

Sedentary Lifestyle (decondition, weak, obese)

Other: Asthma, CF

63
Q

8 y.o. BMI 25. SOBOE. Atopy hx. PFT show FVC and FEV1 > 80% with 7% change w/ bronchodilator. Tx?

a. flovent
b. ventolin pre exercise
c. montelukast
d. physical training

A

deconditioning

= physical training

64
Q

List 3 way to help prevent developing asthma:

A
  1. Avoid cig smoke (starting prenatal)
  2. BF > 4 mo.
  3. active lifestyle + healthy diet
65
Q

Teen w/ ventolin 2-3X/wk. Flovent 125 BID. Suggestion?

A
  1. review technique and adherence
  2. environment (smoke, allergen, pet, dust, wood burning stove)
  3. med: increase to medium dose ICS, LABA-ICS combined med, LTRA (montelukast), if significant allergy omalizumab option
  4. F/U PFT
66
Q

Name two mechanism to delivery asthma med in 4 y.o.

A
  1. Multiple dose inhaler.
  2. Dry powder inhaler device (diskus)
  3. Nebulized Solution
67
Q

Most common cause of spontaneous pneumothorax in teen:

A

Idiopathic

= Primary idiopathic
= result from sub pleural bleb

68
Q

List 4 causes of pneumothorax

A
  1. **Idiopathic/Primary (usually bleb, M, tall, thin)
  2. **Pneumonia (w/ empyema)
  3. **Asthma (rupture bleb or cyst)
  4. CF (rupture bleb or cyst)
  5. Drug (cocaine, ecstasy, crack, MJ)
  6. **Traumatic
  7. Catamenial (menses)
69
Q

Where do you do a needle decompression?

A
  1. Second ICS (over 3rd rib) in midclavicular line

2. 4th ICS in anterior axillary line

70
Q

T or F: ARDS results in poor compliance.

71
Q

Describe ARDS:

A

Insult (dx in lungs or systemic)

  • -> inflammation +++
  • -> endothelial injury and increased permeability
  • -> Edema
  • -> inactivate surfactant + pul HTN
  • > sudden RR and low O2
  • > refractory to ++ FiO2
  • -> diffuse patchy infiltrate
  • > less lung compliance (need high PEEP)
72
Q

Describe ARDS Criteria

A

1-Bilateral-Fail

  1. acute (< 1 wk onset)
  2. B/L opacities (pul edema)
  3. PaO2/FiO2 < 300 with min. PEEP 5
  4. not HF or fluid overload only
73
Q

Post abortion. Sudden resp distress, crackle and hemoptysis. Dx?

A

Pulmonary Embolism

R/O via Pulmonary angiography or Spiral CT

74
Q

What is the Virchow Triad in PE:

A
  1. Flow stasis
  2. Endothelial damage
  3. Hypercoagulability
75
Q

What is the most common object in foreign body aspiration?

A

Food

= 1/3 = Nuts (esp peanuts**ask on hx)
- round food like hot dog, grape, nut, candies

76
Q

Acute choking episode –> followed by coughing, wheeze +/- stridor in toddler. Dx?

A

Foreign body aspiration

77
Q

T or F: you must ALWAYS image a patient with local wheeze or findings if ppt for chronic cough or wheeze?

78
Q

T or F: GAEB rules out Foreign body aspiration.

A

False

only 30-60% have lower AE.

79
Q

What imaging should you order if you suspect foreign body aspiration?

A
  1. Inspiratory and Expiratory films (air trapping on expiration on area affected)
  2. L and R lateral decubitus if can’t do above (side with FB will not deflate when placed in dependent position)
80
Q

T or F: You can go straight to a bronch if you have (+) hx and convinced of foreign body aspiration.

A

True.

Or if (-) results should do bronch.

Nelson: any hx of eating nuts + symptoms = bronch!

81
Q

Infant with problem vomiting and wheezing. Upper GI show indent of upper esophagus. Two dx?

A
  1. Vascular ring

2. Pulmonary Artery Ring

82
Q

SOBOE w/ wheeze. normal sat. Negative bronchodilator challenge. Normal XR. Dx and Tx? PFT shows?

A

Paradoxical vocal cord dysfunction.

PFT: waving at bottom loop

Tx: relaxation breathing technique, speech therapy, + tx any thing causing irritability to vocal cord (i.e. high GERD, allergic rhinitis)

83
Q

Child with nasal polyps. Next step:

a. Sx excision
b. intranasal steroid
c. PO antihistamine
d. PO decongestant
e. sweat chloride

A

Sweat Chloride

CF considered in any kid < 12 w/ nasal polyp.

84
Q

T or F: CF is most common cause of childhood nasal polyposis.

85
Q

What is the best tx for nasal polyp?

A

Try intranasal steroid
OR remove Sx

  • local or systemic decongestant NOT usually effective
  • intranasal steroid spray CAN sometimes shrink
86
Q

Patient w/ CF w/ sudden onset left pleuritic CP involving left shoulder. Likely dx?

A

Pneumothorax

rare complication (<1%).
CT + IV Abx
+/- Sx as high risk for recurrence.

87
Q

Most common cause of death in CF:

A
  1. resp failure
  2. transplant complication
  3. liver dx
88
Q

T or F: malnutrition is major prognostic factor kids w/ CF.

89
Q

List CF prognostic factors.

A
  • type of genetic mutation
  • F > M
  • type of infection (**Burkholderia cepacia)
  • **FEV1
  • **nutrition + wt
  • ** CF related DM
  • **transplant
90
Q

List 3 reasons for false (-) sweat chloride.

A
  1. *Insufficient sweat
  2. *Low albumin
  3. *Low Na
  4. Dilution
  5. Malnutrition
91
Q

List 3 reasons for false (+) Sweat chloride.

A
  1. *Eczema
  2. *Malnutrition/ FTT
  3. AN
  4. *CAH
  5. *Adrenal insuff
  6. *G6PD (glucose-6-phosphatase def)
  7. *Hypothyroidism
92
Q

Girl w/ rectal prolapse x 2- what test must you do?

A

Sweat Chloride

Cl > 60= dx

93
Q

CF is AR or AD? Which gene

A

AR

CFTR gene on chromosome 7

Delta-F508 mutation

94
Q

List CF sinopulmonary, GI, renal/endo ppt per age:

- Infant, Child, Teen

A

Infant:

  • sinopul infectxn
  • meconium ileus
  • pancreatic insuff
  • prolonged jaundice
  • rectal prolapse
  • dehydration
  • low Na, low Cl metabolic alk

Childhood:

  • ABPA
  • sinusitis
  • polyposis
  • DIOS
  • intussusception
  • hep, biliary fibrosis
  • rectal prolapse
  • renal calculi

Teen:

  • ABPA
  • hemoptysis
  • pneumo
  • resp failure
  • DIOS
  • intussusception
  • biliary fibrosis, cirrhosis
  • delayed puberty
  • DM
95
Q

CF Diagnostic Triad:

A
  • chronic pul dx
  • pancreatic insuff
  • high sweat Cl-
96
Q

CF management:

A
  • envirnmt (avoid smoke, chemical)
  • nutrition (high cal, pancreatic enzyme replace, ADEK fat replace)
  • Avoid scuba dive
  • Chest PT
  • Salbutamol pre PT
  • Dornase alfa (DNAase)
  • inhaled 3% NS
  • inhaled tobra for 1st (+) pseudomonas
  • Abx for exacerbations
  • Tx complications (sinusitis, polyp, ABPA, DIOS, hold anti inflam + PT for hemoptysis)
97
Q

List CF lung organisms:

A
  1. S. aureus
  2. Haemophilus influenzae
  3. **Pseudomonas aeruginosa
  4. ** Stenotrophomonas maltophilia
  5. **Burkholderia cepacia
  6. Aspergillus
98
Q

3 mo. M w rectal prolapse. Most likely cause:

A

Idiopathic (most)

But 20%= CF so must R/O

99
Q

Teen with CF with chest pain, cough, rust coloured sputum. Likely Dx ? Investigations? Tx?

A

Allergic Bronchopulmonary Aspergillosis (ABPA)

*rust colour sputum w/ CF pt KEY

  • sputum Culture
  • sputum for IgE antibodies
  • Tx: PO corticosteroids
  • Refractory: antifungal
100
Q

CF Criteria.

A 
Typical clinical feature (chronic obstructive pul dx, pancreatic insuff, GU)
OR
hx of CF sibling
OR 
sweat chloride (+)

AND
Lab proof (two sweat Cl or two CF mutation or abN nasal potential diff measurement)
101
Q

Can’t get a sweat chloride in a bb. 3 other way to confirm dx?

A
  1. (+) sibling CF
  2. OR typical features documented (i.e. fecal elastase or chronic resp dx)
  3. Either + lab finding
    ( CF mutation, or nasal potential difference)
102
Q

Child w/ CF with poor PFT and maxed on salbutamol. Give 4 more things we can do:

A
  1. Ensure adequate nutrition, cal, aerobic exercise
  2. Bronchodilator and inhaled corticosteroid
  3. DNAase inhaled
  4. Chest PT 1-4X/d
  5. Nebulized 3% NS prior to PT (improve mucociliary clearance)
  6. Abx therapy
103
Q

Child with chest tube show persistent pleural air hours after insertion. List 3 causes for this:

A
  1. broncho-pleural fistula
  2. necrotizing pneumonia
  3. equipment failure
104
Q

List two causes of RSV:

A
  1. RSV
  2. human metapneumovirus

1/3= multiple virus
5% febrile RSV= bacterial UTI

105
Q

RF for severe bronchiolitis:

A
  1. *prem (<35 wk GA)
  2. *age < 3 mon.
  3. *cardiopulmonary dx
  4. *immunodeficiency
  5. congenital anomalies
  6. in utero smoke exposure
106
Q

When should you admit a bronchiolitis (CPS):

A
  1. O2 (to keep sat > 90%)
  2. severe WOB or RR > 70
  3. dehydration
  4. cyanosis or hx of apnea
  5. high risk of severe dx
  6. family unable to cope
107
Q

What are the two things that are recommended tx for bronchiolitis? What is equivocal?

A

Recommended:

  • O2
  • hydration

Equivocal:

  • epi neb
  • nasal suction
  • 3% NS neb
  • combined epi and dex
108
Q

T or F: ventolin is recommended for bronchiolitis.

A

False.

Not recommended:

  • Steroids
  • Salbutamol
  • Abx
  • antivirals
  • cool mist/saline neb
109
Q

How does palivizumab minimize risk? How does it work?

A

Work:
- passive immunity

Proof:

  • decrease hospitalization risk
  • does NOT decrease severity of infection
110
Q

Who gets RSV prophylaxis?

A
  • prem born < 30+0 who < 6 mo. at start of season
    • if < 1 yr at start of season AND hemodynamic signif CHD or CLD (O2 at 36 wk GA) who need diuretic, broncho dilator, steroid, O2
  • infant in remote community who would need air transport born < 36+0 and < 6 mo. at start of RSV season

Can consider if < 2 y.o. who are on home oxygen.

111
Q

T or F: palivizumab should be continued in the 2nd season.

A

False.
- does not reduce incidence after 1 y.o.

UNLESS has CLD and still on or weaned off O2 in past 3 month

112
Q

Pt w/ recurrent pneumonia, sinusitis, bronchiectasis. Could they have alpha-1-anti trypsin def?

A

No; could have CF, ciliary dyskinesia, immuodef.

Alpha-1-Antitrypsin:

  • usually liver dx
  • low level a-AT in serum
  • IV replacement
113
Q

Most common cause of bronchiectasis in developed nations:

114
Q

List 5 causes of bronchiectasis:

A
  • CF
  • primary ciliary dyskinesia
  • FB aspiration
  • immunodef
  • infection (pertussis, TB)
115
Q

What test should you order for OSA?

A

Polysomnography.

Alternative to triage: overnight oximetry.

116
Q

Define Obstructive Sleep Apnea:

A
  1. Sleep disruption
  2. Hypoxemia
  3. Daytime symptoms
117
Q

RF for OSA:

A 
> Nose: nasal stenosis, nasal polyp
> Adenotonsillary hypertrophy
> ** Neuro: CP, neuromuscular dx
> **Syn: T21 (tone, macroglossia), Prader Willi, Pierre Robin Sequence
Resp: (+) link w/ asthma
118
Q

What pattern do you see on overnight oximetry in kids with OSA?

A

“sawtooth desaturation”

Helps if abN = (+) predictive value.
But doesn’t R/O OSA

119
Q

List 3 co-morbidities seen with OSA:

A
  1. Insulin resistance
  2. HTN
  3. HC utilization
  4. Neurobehav (cognitive f’n, low grade)
120
Q

How do you treat OSA?

A
  1. Envirn’t: avoid smoke, pollutant, allergen
  2. Lifestyle: wt loss if obese
  3. Very mild= nasal steroid (fluticasone) or LTRA (singulair)
  4. Sx: Adenotonsillectomy
  5. CPAP/BiPAP
121
Q

If you see signs of central apnea- what test must you do?

122
Q

Most common cause of obstructive sleep apnea:

A

adenotonsillar hypertrophy

123
Q

Name 3 severe complications of OSA:

A
  • pul HTN
  • systemic HTN
  • R side heart failure
124
Q

List 5 daytime symptoms of OSA:

A
  • mouth breath
  • dry mouth
  • chronic nasal congestion
  • **hypo nasal speech
  • **morning h/a
  • difficulty swallowing
  • poor appetite
  • secondary enuresis
  • **low mood
  • **behave (irritable, aggression, impulsive)
  • **daytime sleepy
125
Q

5 thing to improve sleep hygiene:

A
  • consistent bed time, waking time
  • dark, quiet place
  • avoid caffeine, alcohol
  • no screen before bed
  • relaxation technique before bed
  • bedtime routine
126
Q

Kid with CP and recurrent choking. LLL and air fluid level. Dx? Tx?

A

Lung Abscess

Cx helpful

Amp + Gent

or Amox/Clav or Piptazo

127
Q

Why is oxygen-helium mixture used in airway dx?

A

Reduces pul airway resistance.

  • Helium + oxygen lower density so overcome obstruction and help bring small particle (ventolin) to distal airway
128
Q

What is intal and why is it used in asthma?

A

Intal= Cromolyn
= Na Cromoglicate

= mast cell stabilizer

  • no bronchodilator effect but prevent histamine, leukotriene release
  • not status med

= good for exercise induced asthma
= prevent late onset allergic effect

129
Q

Can intal (cromolyn) be used in kids min. > 5?

A

NO.

must be min. 2 y.o.

130
Q

How should we treat community acquired pneumonia?

A

PO amox
hospitalization= Amp

If severe toxic (pen resistant pneumococcal and moraxella) = ceftiraxone.

Atypical= azithro x 5d

131
Q

Child URTI w/ resp distress, now high BP + hematuria.

A

Post Strep Glomerulonephritis

132
Q

What is the gold standard to dx GAS pharyngitis?

A

Throat culture.

133
Q

Why do we treat GAS pharyngitis?

A

Early Abx = Amox or Pen x 10 d

  • hasten recovery (by 24h)
  • prevent acute rheumatic illness (if given within 9d of illness)
134
Q

Child w/ eczema and recurrent pneumonia. Hepatomegaly, petechiae. Low plt. What BW do you expect?

A

Wiskott-Aldrich Syn:

  • X link
  • WASP mutation
  • impaired humoral
  • atopic dermatitis (1st yr of life)
  • recurrent pneumonia, AOM
  • thrombocytopenia; SMALL plt
  • Low IgM, up IgE and up IgA (drink whiskey your blood Ethyl Alcohol UP but Mental f’n down)
  • poor response to polysacc vaccine (i.e. pneumovax)
  • Tx: infuse monthly IVIG
135
Q

What is the most likely ppt in kids with alpha-1-antitrypsin?

136
Q

What is Primary Ciliary Dyskinesia Kartagener Triad:

A
  1. Situs Inversus Totalis
  2. Chronic sinusitis and otitis
  3. Bronchiectasis
137
Q

2 y.o. 2 month wet cough. No cough free days. 3 month ago witnessed choking on toy. P/E normal:

  • branch
  • insp/exp film
  • tx abx for persistent bronchitis
  • Inhaled corticosteroids
  • Reassurance + wait
138
Q

List three consequences of missed foreign body

A

Recurrent pneumonia
Bronchiectasis
Cardiac Arrest and death

139
Q

year round daily wet cough and year round nasal congestion. Dx?

A

Primary ciliary dyskinesia

140
Q

What test is required to R/O laryngeal cleft?

A

Rigid bronchoscopy

May ppt: cough w/ feeds
DDX: neurologic issue, syndromes (VACTERL)

141
Q

T or F: barium study will confidently R/O H type fistula

A

False.

Can be missed on routine

Rigid bronchoscopy is GOLD standard.

142
Q

In asthma you can use an MDI alone?

143
Q

When should you get a baseline CXR 4-6 after last pneumonia?

A

Only if recurrent pneumonia.

Doc resolution to see if same thing continued or truly recurrent (min. 2/yr or min. 3 in life)

144
Q

Two most important questions about aetiologies for recurrent pneumonia:

A
  1. single vs. multiple location

2. systemic symptom

145
Q

What are possible complication of congenital pulmonary malformations?

A

++ risk of:

  1. recurrent aspiration
  2. malignant potential

All symp. lesion= Sx
Asymp= controversial

146
Q

Recurrent pneumonias in same location in 3 y.o. Next?

  • sweat Cl-
  • immunoglobulin
  • flexible bronch
  • CT
  • CT w/ contrast
  • Video swallowing study
A

CT

MUST do w/ contrast (to R/O pulmonary sequestration)

RC: Specialties Woo Hoo (31 decks)

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