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
2
Q
List two small airway obstruction dx?
A
Asthma
CF
3
Q
How do you interpret PFT:
A
- FEV1/FVC
Normal/High
> if FVC < 80%= restrictive
IF <85% predicted
> But FVC high= obstructive
> If FVC < 80%= mixed pattern
4
Q
Give two examples of restrictive resp dx?
A
- neuromuscular (Duchenne Muscular Dystrophy)
- Interstitial lung dx or interstitial pneumonia
- Scliosis / chest wall
5
Q
What is key PFT measurement to monitor progression of CF lung dx?
A
FEV1
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.
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
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.
9
Q
When is a lung scan helpful?
A
Congenital malformation (CVS + pul) OR PE
10
Q
Duchenne pt. FVC reduced. Which symptom likely?
A
Headache early in morning.
DUE to nocturnal hypoventilation.
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
12
Q
T or F: Duchenne Muscular Dystrophy always affect M.
A
True.
X linked= BOY
13
Q
List Duchenne Muscular Dystrophy Classic Features.
A
- Progressive weakness (proximal first)
- IQ impairment
- Hypertrophy of Calves
Note: common toddler ppt= delayed walking or toe walking
Note: most have cardiomyopathy.
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
15
Q
List Causes/RF for PPHN:
A
- Birth Asphyxia
- Parenchymal lung dx
> MAS
> RDS
> Pneumonia
> Early onset sepsis - Pul hypoplasia
> CDH, Cystic malformation - Idiopathic
16
Q
List one med tx for PPHN:
A
iNO
17
Q
what is the most common cause of chronic cough?
A
Asthma
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
19
Q
T or F: kids with cough> 6 wk should be tested for CF regardless of race.
A
True.
= Sweat Cl
20
Q
Girl w/ cough at night and exertion x 3 mo. PFT normal. Next test?
A
Methacholine challenge
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
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
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
24
Q
How do you tell the diff btwn Chlamydia pneumonia in baby versus RSV infiltrates?
A
No fever + wheezing = NOT RSV.
25
"Staccato" cough, tachypnea in afebrile 1 month old. Dx?
Chlamydia pneumoniae.
CXR: hyper inflated + infiltrates
26
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?
Intubate
Likely bad croup or bacterial tracheitis.
27
List three common bugs of Bacterial Tracheitis:
1. S. aureus
2. Moraxella
3. Streptococcus pyogenes (GAS)
4. Streptococcus pneumoniae
28
Diff in age for croup vs. bacterial tracheitis:
Croup: mean 18 mo. (6 mo-3 y.o.)
| Bacterial: mean 4 y.o.
1 mo- 16 y.o. range
29
Common cause of croup?
Virus
| - most common: parainfluenza 1
30
T or F: croup or bacterial tracheitis cause drooling?
False.
Epiglottitis does!
31
3 mo. recurrent URTI. on/off stridor since birth. Well but intermittent insp stridor. Dx?
Laryngomalacia.
Most common congenital laryngeal anomaly and cause of stridor.
Increase up to 6 mo. Then better.
32
list ddx for anterior medial mass
5 T's:
Thymus
> thymoma (rare)
> thymic hyperplasia
Teratoma
Terrible lymphoma
> hodgkin or not
T cell leukaemia
Thyroid Mass
Other: lymphangioma, hemangioma, histiocytosis, lipoma
33
list ddx for middle mediastinal mass
A + B
```
Adenopathy
> Infection
> Histoplasmosis
> TB
> Neoplasm
> Mets
>Sarcoidosis
```
Bronchogenic Cyst
Other: vascular mass
34
list ddx for posterior mediastinal mass
NEURO
```
Neurogenic tumour
- neurofibroma
- neurosarcoma
- ganglioneuroma
- neuroblastoma
- pheochromocytoma
etc.
```
35
T or F: > 50% of mediastinal mass malignant.
TRUE.
- hence always need investigating
36
New onset asthma in teen. R/O
Mediastinal mass
| - specifically lymphoma
37
4 y.o. Child CXR shows incidental finding of asymptomatic circular anterior mediastinal mass. Likely:
- ganglioneuroma
- neuroblastoma
- lymphoma
- teratoma
- met from Wil'ms
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.
38
Neo w/ resp distress & cystic LUL w/ trach deviation. Likely:
a. CPAM
b. pul sequestration
c. pneumonia
CPAM
= congenital cystic adenomatoid malformation
= most common congenital malformation of lower resp tract
39
T or F: bronchial hyper responsiveness can be present even with normal PFT in asthma.
True.
- why we have methacholine challenge.
40
list side effects of ventolin.
1. tachycardia
2. shaky or tremor
3. irritable
4. low K (nausea, weakness, low DTR, arrhythmia)
5. h/a
41
Q30 ventolin. Aminophylline added this morning. Nausea and weak complaints. What BW to check:
Na/BG/K/Mg?
K
Low K = nausea (Less peristalsis), neuromuscular excited causing hyporeflexia and paralysis
42
Pneumo pre-medical air transport. What do you do?
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
43
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
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.
44
What dose of flovent do you worry about adrenal suppression?
Fluticasone 250 mcg BID.
45
AE of long-standing inhaled corticosteroid.
Height velocity.
46
If on low dose flovent but need more control. What do you do?
< 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
47
Review of when to use MDI and spacer versus dry powder (diskus).
```
MDI + spacer + mask= 5
MDI + spacer= 5
Dry powder (turbuhaler, discus)= 6
```
48
Technique for MDI w/ spacer:
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
49
Describe the one big breath technique for puffers.
```
1 deep breath
Should not hear whistle
Typically 4-6 second until lung filled
Hold x 10 seconds
Exhale
```
50
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
*assuming without spacer in Q; which we never do.
Hold breath for duration of inhalation
51
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
*assuming without spacer in Q; which we never do.
Close mouth technique
52
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
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
53
Best indicator for mortality in asthma:
Previous Intubation
54
T or F: You have to coordinate breath if you use MDI w/ spacer.F
False.
Just reg breath x 6.
55
What test is key in asthma pt w/ WOB and can speak sentences.
- PFT
- O2 sat
- CXR
- cap gas
O2 sat
56
List 3 things on ddx for asthma:
FB
CF
GERD
Other:
Aspiration
Chronic sinusitis
Vocal cord dsyfunction
57
Described controlled asthma:
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
58
List two common side effects of ICS:
1. Thrush
2. Dysphonia
3. Growth suppression (~1cm)
59
How do you treat STATUS asthmatics:
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
List two complications w/ bad asthma:
1. Hypoxemia
2. Atelectasis
3. Pneumothorax
61
Normal PFT FEV1 and FEV1/FVC values:
FEV1 > 80%
FEV1/FVC > 80%
Successful bronchodilator: FEV1 >12%
62
Most common cause of exercise intolerance:
Sedentary Lifestyle (decondition, weak, obese)
Other: Asthma, CF
63
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
deconditioning
= physical training
64
List 3 way to help prevent developing asthma:
1. Avoid cig smoke (starting prenatal)
2. BF > 4 mo.
3. active lifestyle + healthy diet
65
Teen w/ ventolin 2-3X/wk. Flovent 125 BID. Suggestion?
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
Name two mechanism to delivery asthma med in 4 y.o.
1. Multiple dose inhaler.
2. Dry powder inhaler device (diskus)
3. Nebulized Solution
67
Most common cause of spontaneous pneumothorax in teen:
Idiopathic
= Primary idiopathic
= result from sub pleural bleb
68
List 4 causes of pneumothorax
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
Where do you do a needle decompression?
1. Second ICS (over 3rd rib) in midclavicular line
| 2. 4th ICS in anterior axillary line
70
T or F: ARDS results in poor compliance.
True.
71
Describe ARDS:
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
Describe ARDS Criteria
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
Post abortion. Sudden resp distress, crackle and hemoptysis. Dx?
Pulmonary Embolism
R/O via Pulmonary angiography or Spiral CT
74
What is the Virchow Triad in PE:
1. Flow stasis
2. Endothelial damage
3. Hypercoagulability
75
What is the most common object in foreign body aspiration?
Food
= 1/3 = Nuts (esp peanuts**ask on hx)
- round food like hot dog, grape, nut, candies
76
Acute choking episode --> followed by coughing, wheeze +/- stridor in toddler. Dx?
Foreign body aspiration
77
T or F: you must ALWAYS image a patient with local wheeze or findings if ppt for chronic cough or wheeze?
True!
78
T or F: GAEB rules out Foreign body aspiration.
False
only 30-60% have lower AE.
79
What imaging should you order if you suspect foreign body aspiration?
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
T or F: You can go straight to a bronch if you have (+) hx and convinced of foreign body aspiration.
True.
Or if (-) results should do bronch.
Nelson: any hx of eating nuts + symptoms = bronch!
81
Infant with problem vomiting and wheezing. Upper GI show indent of upper esophagus. Two dx?
1. Vascular ring
| 2. Pulmonary Artery Ring
82
SOBOE w/ wheeze. normal sat. Negative bronchodilator challenge. Normal XR. Dx and Tx? PFT shows?
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
Child with nasal polyps. Next step:
a. Sx excision
b. intranasal steroid
c. PO antihistamine
d. PO decongestant
e. sweat chloride
Sweat Chloride
CF considered in any kid < 12 w/ nasal polyp.
84
T or F: CF is most common cause of childhood nasal polyposis.
True.
85
What is the best tx for nasal polyp?
Try intranasal steroid
OR remove Sx
- local or systemic decongestant NOT usually effective
- intranasal steroid spray CAN sometimes shrink
86
Patient w/ CF w/ sudden onset left pleuritic CP involving left shoulder. Likely dx?
Pneumothorax
rare complication (<1%).
CT + IV Abx
+/- Sx as high risk for recurrence.
87
Most common cause of death in CF:
1. resp failure
2. transplant complication
3. liver dx
88
T or F: malnutrition is major prognostic factor kids w/ CF.
True.
89
List CF prognostic factors.
- type of genetic mutation
- F > M
- type of infection (**Burkholderia cepacia)
- **FEV1
- **nutrition + wt
- ** CF related DM
- **transplant
90
List 3 reasons for false (-) sweat chloride.
1. *Insufficient sweat
2. *Low albumin
3. *Low Na
4. Dilution
5. Malnutrition
91
List 3 reasons for false (+) Sweat chloride.
1. *Eczema
2. *Malnutrition/ FTT
3. AN
4. *CAH
5. *Adrenal insuff
6. *G6PD (glucose-6-phosphatase def)
7. *Hypothyroidism
92
Girl w/ rectal prolapse x 2- what test must you do?
Sweat Chloride
Cl > 60= dx
93
CF is AR or AD? Which gene
AR
CFTR gene on chromosome 7
Delta-F508 mutation
94
List CF sinopulmonary, GI, renal/endo ppt per age:
| - Infant, Child, Teen
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
CF Diagnostic Triad:
- chronic pul dx
- pancreatic insuff
- high sweat Cl-
96
CF management:
- 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
List CF lung organisms:
1. S. aureus
2. Haemophilus influenzae
3. **Pseudomonas aeruginosa
4. ** Stenotrophomonas maltophilia
5. **Burkholderia cepacia
6. Aspergillus
98
3 mo. M w rectal prolapse. Most likely cause:
Idiopathic (most)
But 20%= CF so must R/O
99
Teen with CF with chest pain, cough, rust coloured sputum. Likely Dx ? Investigations? Tx?
Allergic Bronchopulmonary Aspergillosis (ABPA)
*rust colour sputum w/ CF pt KEY
- sputum Culture
- sputum for IgE antibodies
- Tx: PO corticosteroids
- Refractory: antifungal
100
CF Criteria.
```
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
Can't get a sweat chloride in a bb. 3 other way to confirm dx?
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
Child w/ CF with poor PFT and maxed on salbutamol. Give 4 more things we can do:
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)
5. Abx therapy
103
Child with chest tube show persistent pleural air hours after insertion. List 3 causes for this:
1. broncho-pleural fistula
2. necrotizing pneumonia
3. equipment failure
104
List two causes of RSV:
1. RSV
2. human metapneumovirus
1/3= multiple virus
5% febrile RSV= bacterial UTI
105
RF for severe bronchiolitis:
1. *prem (<35 wk GA)
2. *age < 3 mon.
3. *cardiopulmonary dx
4. *immunodeficiency
5. congenital anomalies
6. in utero smoke exposure
106
When should you admit a bronchiolitis (CPS):
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
What are the two things that are recommended tx for bronchiolitis? What is equivocal?
Recommended:
- O2
- hydration
Equivocal:
- epi neb
- nasal suction
- 3% NS neb
- combined epi and dex
108
T or F: ventolin is recommended for bronchiolitis.
False.
Not recommended:
- Steroids
- Salbutamol
- Abx
- antivirals
- cool mist/saline neb
109
How does palivizumab minimize risk? How does it work?
Work:
- passive immunity
Proof:
- decrease hospitalization risk
- does NOT decrease severity of infection
110
Who gets RSV prophylaxis?
- 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
T or F: palivizumab should be continued in the 2nd season.
False.
- does not reduce incidence after 1 y.o.
UNLESS has CLD and still on or weaned off O2 in past 3 month
112
Pt w/ recurrent pneumonia, sinusitis, bronchiectasis. Could they have alpha-1-anti trypsin def?
No; could have CF, ciliary dyskinesia, immuodef.
Alpha-1-Antitrypsin:
- usually liver dx
- low level a-AT in serum
- IV replacement
113
Most common cause of bronchiectasis in developed nations:
CF
114
List 5 causes of bronchiectasis:
- CF
- primary ciliary dyskinesia
- FB aspiration
- immunodef
- infection (pertussis, TB)
115
What test should you order for OSA?
Polysomnography.
Alternative to triage: overnight oximetry.
116
Define Obstructive Sleep Apnea:
1. Sleep disruption
2. Hypoxemia
3. Daytime symptoms
117
RF for OSA:
```
> 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
What pattern do you see on overnight oximetry in kids with OSA?
"sawtooth desaturation"
Helps if abN = (+) predictive value.
But doesn't R/O OSA
119
List 3 co-morbidities seen with OSA:
1. Insulin resistance
2. HTN
3. HC utilization
4. Neurobehav (cognitive f'n, low grade)
120
How do you treat OSA?
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
If you see signs of central apnea- what test must you do?
Brain MRI
122
Most common cause of obstructive sleep apnea:
adenotonsillar hypertrophy
123
Name 3 severe complications of OSA:
- pul HTN
- systemic HTN
- R side heart failure
124
List 5 daytime symptoms of OSA:
- 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
5 thing to improve sleep hygiene:
- consistent bed time, waking time
- dark, quiet place
- avoid caffeine, alcohol
- no screen before bed
- relaxation technique before bed
- bedtime routine
126
Kid with CP and recurrent choking. LLL and air fluid level. Dx? Tx?
Lung Abscess
Cx helpful
Amp + Gent
or Amox/Clav or Piptazo
127
Why is oxygen-helium mixture used in airway dx?
Reduces pul airway resistance.
- Helium + oxygen lower density so overcome obstruction and help bring small particle (ventolin) to distal airway
128
What is intal and why is it used in asthma?
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
Can intal (cromolyn) be used in kids min. > 5?
NO.
must be min. 2 y.o.
130
How should we treat community acquired pneumonia?
PO amox
hospitalization= Amp
If severe toxic (pen resistant pneumococcal and moraxella) = ceftiraxone.
Atypical= azithro x 5d
131
Child URTI w/ resp distress, now high BP + hematuria.
Post Strep Glomerulonephritis
132
What is the gold standard to dx GAS pharyngitis?
Throat culture.
133
Why do we treat GAS pharyngitis?
Early Abx = Amox or Pen x 10 d
- hasten recovery (by 24h)
- prevent acute rheumatic illness (if given within 9d of illness)
134
Child w/ eczema and recurrent pneumonia. Hepatomegaly, petechiae. Low plt. What BW do you expect?
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
What is the most likely ppt in kids with alpha-1-antitrypsin?
Jaundice.
136
What is Primary Ciliary Dyskinesia Kartagener Triad:
1. Situs Inversus Totalis
2. Chronic sinusitis and otitis
3. Bronchiectasis
137
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
Bronch
138
List three consequences of missed foreign body
Recurrent pneumonia
Bronchiectasis
Cardiac Arrest and death
139
year round daily wet cough and year round nasal congestion. Dx?
Primary ciliary dyskinesia
140
What test is required to R/O laryngeal cleft?
Rigid bronchoscopy
May ppt: cough w/ feeds
DDX: neurologic issue, syndromes (VACTERL)
141
T or F: barium study will confidently R/O H type fistula
False.
Can be missed on routine
Rigid bronchoscopy is GOLD standard.
142
In asthma you can use an MDI alone?
No
143
When should you get a baseline CXR 4-6 after last pneumonia?
Only if recurrent pneumonia.
Doc resolution to see if same thing continued or truly recurrent (min. 2/yr or min. 3 in life)
144
Two most important questions about aetiologies for recurrent pneumonia:
1. single vs. multiple location
| 2. systemic symptom
145
What are possible complication of congenital pulmonary malformations?
++ risk of:
1. recurrent aspiration
2. malignant potential
All symp. lesion= Sx
Asymp= controversial
146
Recurrent pneumonias in same location in 3 y.o. Next?
- sweat Cl-
- immunoglobulin
- flexible bronch
- CT
- CT w/ contrast
- Video swallowing study
CT
| MUST do w/ contrast (to R/O pulmonary sequestration)
