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Pediatrics- Noelle > Respirology > Flashcards

Respirology Flashcards

1
Q

What are 3 main side effects of salbutamol

A

Tachycardia
Tremors
HYPOKALEMIA

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2
Q

Why is iprtropium bromide used in the ER

A

Study indicated increased FEV1 by 10% if added to B2 agonist

Works best in 1st 4 hours

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3
Q

What is the mechanism for steroids in asthma

A

Decreases cytokine production and inhibits various factors in inflammatory cascade
Decreased mediator release for macrophages and eosinophils
Inhibits eosinophils and lymphocyte production

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4
Q

What are some side effects of inhaled steroids (3)

A

Oral thrush
Hoarseness
Decreased linear growth with high dose

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5
Q

What are 4 examples of inhaled steroids

A

Pulmicort
Flovent
Alvesco
QVar

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6
Q

What are 3 combination inhalers?

A

ICS + LABA
Advair
Symbicort
Zenhale

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7
Q

What is omalizumab (anti IgE) used for in asthma

A

For moderate to severe persistent allergic asthma that isn’t controlled with inhaled steroids
Risk of anaphylactic reaction- must get subcutaneous injection q2-4w in MD office
key thing to know is that there is a risk of anaphylaxis

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8
Q 
What are symptoms of good asthma control:
Daytime symptoms:
Nighttime symptoms:
Physical Activity:
Exacerbations:
Absence from school due to asthma:
Need for fast acting beta 2 agonist:
FEV1 or PEF
PEF diurnal variation
Sputum eosinophils (adults)
A 
Daytime symptoms: <4 d/week
Nighttime symptoms: <1 night/week
Physical Activity: Normal
Exacerbations: mild, infrequent
Absence from school due to asthma: None
Need for fast acting beta 2 agonist: <4doses/week
FEV1 or PEF: >/=90% personal best
PEF diurnal variation: <10-15%
Sputum eosinophils (adults): <2-3%
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9
Q

What is the next step in treatment after low dose ICS for age 6-11? Age >/=12?

A

6-11: increase ICS to medium dose

>/=12: add LABA to low dose ICS (ideally combination inhaler)

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10
Q

What is considered a positive sweat chloride test? grey zone? negative?

A

Sweat chloride >60 mmol/l is positive
30-60 mmol/l is grey zone and they require further testing
<30 mmol/l is negative

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11
Q

What is the genetic pattern for CF

A

Autosomal recessive

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12
Q

What is seen on PFTs early in the disease for CF? Late in the disease?

A

Early disease- peripheral airway disease results in airway OBSTRUCTION, gas trapping, decrease in FEF 25-75
Late disease- chronic inflammation, increased lung destruction and fibrosis- see restrictive pattern with persistent gas trapping

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13
Q

If both parents are carriers what is the risk the child will get CF? Be a carrier?

A

1/4 or 25% risk of being affected

2/4 or 50% risk of being a carrier

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14
Q

What can cause an elevated sweat chloride besides CF?

A

Endocrine things: panhypopituitarism
Hypothyroidism
Nephrogenic diabetes insipidus
Untreated adrenal insufficiency

Metabolic: mucopolysaccharoidosis
Fucosidosis
Glycogen storage disease
Malnutrition

Skin things: ectodermal dysplasia

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15
Q

What bug is considered a CF bug

A

Pseudomonas aeruginosa

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16
Q

What is ABPA

A

Allergic bronchopulmonary aspergillosis

Severe allergic reaction after being exposed to aspergillus

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17
Q

What is the clinical presentation of ABPA? Diagnosis? Treatment?

A

Wheeze, worsening cough, mucous plugs that are brown in color
Diagnosis- skin test for aspergillosis and IgE level
Treatment- steroids
Trend IgE to see if it gets better or worse

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18
Q

What is the standard test for CF

A

Sweat chloride

See Hyponatremic, hypochloremic dehydration

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19
Q

If you see nasal polyps in an asthmatic what should you do?

A

Sweat chloride!

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20
Q

What vitamins must be supplemented for cystic fibrosis

A

ADEK (fat soluble vitamins)

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21
Q

How do you maintain normal lung function for CF patients

A

Regular chest physio (BID)
Treat chronic infections with oral or inhaled abx
Treat Acute infections with oral or IV antibiotics
Use mucolytics (pulmozyme or hypertonic saline)

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22
Q

what is PCD? signs on physical exam/history?

A

dysfunction of cilia
ineffective mucociliary clearance
- year round daily wet cough
- persistent rhinitis (year round nasal congestion)
- sinusitis
- recurrent otitis media
- neonatal respiratory distress (most have prolonged O2 need at birth)
- bronchiectasis, chronic cough
- male infertility
- 50% have situs inversus totalis
* if given an X-ray with situs inversus totalis- think PCD!
diagnosis- biopsy fo cilia (nose or bronchial biopsy)
screening test- nasal nitric oxide (not invasive)
neonate can present with head cold from day 1 (nasal stuffiness), atelectasis

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23
Q

what are some treatment options for PCD

A 
no cure available
chest physiologic 
aggressive antibiotic treatment
routine vaccination
surgical interventions: tympanostomy tubes, sinus drainage
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24
Q

Causes of pneumothorax:

A 
idiopathic/spontaneous
thoracic trauma
RDS/meconium aspiration
CF with pleural blebs
asthma
marfans
\+/- mechanical ventilation
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25
Q

what is the treatment for recurrent pneumothorax?

A

pleurodesis

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26
Q

what are the signs of tension pneumothorax

A

intrapleural pressure>atmospheric pressure
ipsilateral lung collapse
mediastinal shift
decreased venous return
tx: OXYGEN and needle decompression (2nd intercostal space mid clavicular line above the 3rd rib) on the side of the pneumothorax, chest tube

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27
Q

what is bronchiectasis?

A

irreversible dilatation of the airways

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28
Q

what are causes of focal/local bronchiectasis (3)

A

foreign body
TB
aspiration

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29
Q

what are causes of generalized bronchiectasis (6)

A

CF
PCD
Immunodeficiency syndrome (HIV, hypo/dysgammaglobulinemia)
ABPA
post infectious (measles, pertussis, adenovirus)

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30
Q

what is alpha 1 antitrypsin deficiency?

A

decreased serum levels of AAT

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31
Q

what is the most common phenotype of alpha-1 antitrypsin?

A

PiZZ is the phenotype most common
emphysema secondary to AAT def
most patients present with liver disease
lung disease presents typically in 30s-40s

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32
Q

what is vital capacity

A

is the maximum amount of air a person can expel from the lungs after a maximum inhalation.

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33
Q

what is residual volume

A

what’s left in your lungs after complete exhalation

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34
Q

what is TLC

A

VC + residual volume

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35
Q

what is tidal volume

A

the normal volume of air displaced between normal inhalation and exhalation when extra effort is not applied

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36
Q

what cannot be measure on spirometry?

A

residual volume

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37
Q

what does a scooped out pattern on PFT suggest? Ddx?

A 
obstructive pattern
Asthma (would see bronchodilator response)
CF
PCD
BO
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38
Q

what does a steep slope and decreased volume on PFT suggest?

A

restrictive pattern

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39
Q

what are two treatment options for OSA

A

T & A

NIPPV- CPAP

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40
Q

what investigations can be done for OSA (4)

A

lateral neck xray (for adenoid hypertrophy)
overnight oximetry
morning capillary blood gas
polysomnography

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41
Q

what are signs of OSA on history

A 
snoring** hallmark symptom
restless sleep/frequent awakenings
excessive sweating
enuresis (especially secondary)
apneas
mouth breathing** common
chronic rhinorrhea
difficulty waking up in the morning
morning headaches
difficulty at school/attention deficit
excessive daytime sleepiness
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42
Q

what are causes of central apnea (absence of effort in breathing)

A 
CCHS (congenital central hypoventilation syndrome)
arnold-chiari malformation
secondary:
asphyxia
brain tumour
central system infarct
medications
decreased muscle strength (Duchenne's, SMA)
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43
Q

what is OSA

A

repeated events of partial or complete upper airway obstruction during sleep, disrupting normal gas exchange and or sleep patterns (arousals)

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44
Q

what is considered a positive methylcholine challenge? negative?

A

<4mg/mL
4-16 is borderline
>16mg/mL is considered negative

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45
Q

what is considered a positive PEF (peak expiratory flow) variability?

A

≥ 20%

diurnal variation not recommended

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46
Q

what is considered a positive PFT for asthma

A

reduced FEV1/FVC (less that lower limit of normal for age 0.8-0.9)
and
Increase in FEV1 after a bronchodilator (>12%)

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47
Q

what is considered a positive exercise challenge

A

≥ 10-15% decrease in FEV1 post exercise

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48
Q

What are 3 PFT criteria supportive of an asthma diagnosis

A

spirometry showing reversible airway obstruction
PEF variability
positive test such as methylcholine or exercise challenge

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49
Q

what type of aerochamber should be used in a child >5? <5?

A

> 5 one with a mouthpiece

<5: mask

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50
Q

at what age can you consider dry powder inhalers?

A

> 6

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51
Q

ICS low dose age 6-11? >12?

A

Low dose:
6-11: ≤ 200
<12: ≤ 250

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52
Q

ICS medium dose age 6-11? >12?

high dose?

A

Medium dose:
6-11: 201-400
>12: 251-500

High dose:
6-11: >400
>12: >500

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53
Q

what are the major criteria for asthma predictive index?

minor criteria?

A

1 Major Criteria
– Parental Asthma
– Doctor Diagnosed Eczema
– Sensitization to aeroallergen

2 Minor Criteria
– Wheezing in between episodes
– Peripheral eosinophilia
– Sensitization to food allergens

AND >3 wheezing episodes
helps predict who will continue to wheeze

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54
Q

how can cystic fibrosis present in infancy?

A

failure to thrive
Meconium ileus*
recurrent respiraron symptoms (wheeze, cough, bronchiolitis)
hyponatremic, hypochloremic metabolic alkalosis *
prolonged jaundice
severe pneumonia

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55
Q

how does cystic fibrosis present in childhood/adolescents?

A

recurrent respiratory symptoms (cough, wheeze, poorly controlled asthma)
failure to thrive
recurrent rectal prolapse *
bronchiectasis *
nasal polyps/ sinus disease
chronic pseudomonas aeroginosa colonization
clubbing

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56
Q

Newborn screen programs for CF may miss what percentage?

A

5% of classic CF

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57
Q

Laryngeal cleft is associated with what syndromes

A 
VACTRL
CHARGE
Opitz Fritz
Midline defects
- rigid bronchoscopy to rule out
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58
Q

what is the gold standard for diagnosing H type fistula?

A

rigid bronchoscopy

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59
Q

DDX for recurrent aspirations (2)

A

laryngeal cleft

H type fistula

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60
Q

what investigations should you consider for a child with chronic wet cough?

A

CXR
pulmonary function testing with bronchodilator testing
sweat chloride testing

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61
Q

DDX wheeze

A 
asthma/transient wheezing
cystic fibrosis
large airway obstruction (extrinsic, intrinsic, wall abnormality)
foreign body aspiration
chronic aspiration
PCD
TB
Fungal infection
Chronic lung disease of prematurity
rare interstitial lung disease
congestive heart failure
GERD
62
Q

sudden wheezing without URTI symptoms might suggest?

A

foreign body

63
Q

recurrent wheeze and cough at a young age should always elicit the possibility of?

A

cystic fibrosis

64
Q 
Beclamethasone=
Budesonide=
Fluticasone=
Ciclesonide=
Mometasone=
A 
Beclomethasone: QVAR
Budesonide: Pulmicort
Fluticasone: Flovent
Ciclesonide: Alvesco
Mometasone: Asmanex
65
Q

ICS low dose in children less than 5? medium dose?

A

Low dose (mcg):
beclomethasone: 100
ciclesonide 100
fluticasone 100- 125

medium dose (mcg:

beclomethasone: 200
ciclesonide: 200
fluticasone: 200-250

66
Q

what is the definition of recurrent pneumonia?

A

≥ 2 pneumonias in 1 year or ≥ 3 in a lifetime

- radiologic clearing in between episodes

67
Q

what is the most common cause of recurrent pneumonia?

A

viral respiratory infections with atelectasis

68
Q

DDX for recurrent pneumonia in the same location

A

anatomic abnormality (external airway compression- lymphadenopathy, vascular abnormality, intrinsic airway abnormality)
congenital malformation ( CPAM, pulmonary sequestration bronchogenic cyst)
foreign body
right middle lobe syndrome
bronchiectasis
persisten infection (ie TB)

69
Q

DDX for recurrent pneumonia in multiple locations (4)

A

immune deficiency
Cystic fibrosis
PCD
Recurrent aspirations (anatomical, swallowing disorder, neurologic impairment)

70
Q

what are common congenital pulmonary malformations

A

CPAM/CCAM (Congenital pulmonary airway malformation)
pulmonary sequestration
bronchogenic cyst

71
Q

Children with congenital pulmonary malformations are at increased risk of what?

A

pneumonia*

malignancy eventually

72
Q

what investigation is required to investigate for pulmonary sequestration?

A

CT with contrast

- need to know where the vessels are pre-op

73
Q

what are the sequelae of OSA

A

Neurocognitive

  • behavioural
  • attention
  • school performance
  • development

Cardiovascular

  • HTN
  • Cor pulmonale

Failure to thrive
inflammatory
quality of life

74
Q

what syndromes increase your risk of OSA

A

craniofacial abnormalities

  • micrognathia
  • retrognathia
  • glosoptosis
  • midface hypoplasia
  • macrogloassia
  • nasal deformities

hypotonia
trisomy 21

75
Q

what are some symptoms suggestive of OSA

A 
behavioural problems
"ADHD" symptoms
poor school performance
developmental delay
shyness
difficulty waking in AM
failure to thrive
enuresis
daytime fatigue
76
Q

what is the gold standard for diagnosis of OSA

A

polysomnography

- best differentiation of severity

77
Q

what are the benefits and limitations fo overnight oximetry

A

benefits:
- positive test in context of symptoms can be diagnostic
limitations:
- poor sensitivity
does not differentiate causes of desaturations

78
Q

what are some treatment options for adenoidal hypertrophy

A

Non- pharmacologic:

  • nasal hygiene
  • sleep hygiene

Pharmacologic:

  • intranasal corticosteroids
  • montelukast

surgical:
adenoidectomy

79
Q

what are 2 treatment options for OSA associated with obesity

A 
weight loss (primary treatment)
CPAP (continuous positive airway pressure)
80
Q

what is the definition of a chronic cough

A

cough >4-8 weeks

81
Q

what is the definition of an acute cough

A

<3 weeks

82
Q

how many viral infections do children have per year?

A

3-8

10-12% have ≥12

83
Q

what are 2 red flags for foreign body aspiration?

A

witnessed choking episode

sudden onset of cough

84
Q

what is the most common foreign body aspiration

A

food items!

majority of cases < 3 years of age

85
Q

what are some radiologic findings associated with foreign body aspiration?

A

pneumonia
atelectasis
localized emphysema
normal

86
Q

what are 3 consequences of a missed foreign body

A

recurrent pneumonia
bronchiectasis
cardiac arrest and death

87
Q

DDX chronic cough

A

healthy children:
frequent viral respiaroty tract infections
postviral cough
pertussis/pertussis like cough

chronic cough:
cough variant asthma
chronic rhinitis
persistent bronchitis
GERD
Psychogenic cough
non-specific isolated chronic cough
Potentially serious lung disorder:
CF
PCD
immunodeficiency
foreign body aspiration
recurrent pulmonary aspirations
tuberculosis
anatomic disorder
interstitial lung disease
88
Q

what should you think of with a “honking cough”? brassy/barking cough?

A

honking cough: psychogenic cough

brassy/barking cough: airway malacia, tracheal compression

89
Q

dry cough, dyspnea, restrictive spirometry

A

interstitial lung disease

90
Q

Causes of anterior mediastinal masses

A 
5 T's
Teratoma
Terrible lymphoma
Thymus
Thyroid
T cell leukemia
91
Q

Most common airway tumor in children

A

bronchial carcinoid

92
Q

3 criteria used to make the diagnosis of asthma in a preschooler (age 1-5)

A

1) airflow obstruction
wheezing is the most specific sign
≥ 2 asthma like exacerbations**
2) reversibility
documented improvement in airflow obstruction to SABA +/- corticosteroids
symptomatic response to 3 month trial of ICS
convincing parental report of response to SABA
3) no alternative diagnosis

93
Q

Name 3 reasons for RSV prophylaxis

A

Children with hemodynamically significant CHD or CLD (defined as a need for oxygen at 36 weeks’ GA) who require ongoing diuretics, bronchodilators, steroids or supplemental oxygen, should receive palivizumab if they are <12 months of age at the start of RSV season

In preterm infants without CLD born before 30 + 0 weeks GA who are <6 months of age at the start of RSV season, it is reasonable (but not essential) to offer palivizumab.

Infants in remote communities who would require air transportation for hospitalization born before 36 + 0 weeks’ GA and <6 months of age

94
Q

List 3 organisms that colonize airway of patients with CF

A

Staphylococcus aureus
Pseudomonas aeruginosa
and Burkholderia cepacia complex

95
Q

What is the most common reason for obstructive sleep apnea in children

A

Tonsillar and Adenoid Hypertrophy

96
Q

Name 2 severe complications of OSA (4)

A

pulmonary HTN
systemic HTN
cor pulmonale
ventricular hypertrophy

97
Q

comorbid conditions you should treat with asthma

A

rhinitis- detected in 90% of children with asthma
sinusitis
GERD

98
Q

The most commonly encountered ICS adverse effects are?

A

oral candidiasis

dysphonia

99
Q

CXR shows right aortic arch. You suspect vascular ring. 3 investigations.

A

Echo – not helpful for seeing ring itself but to rule out any associated congenital heart defects.
50% of vascular rings will have assoc cardiac anomaly
CT
MRA
Bronchoscopy

100
Q

how does a vascular ring present

A

presents before 1 year of age
stridor improves with neck extension
50% associated with cardiac abnormalities

101
Q

What are the causes of a false negative sweat test?

A 
Dilution
Malnutrition
Edema
Insufficient sweat quantity
Hyponatremia
102
Q

Mild
moderate
severe OSA

A

mild: AHI 2-5
moderate: AHI 5-10
severe: AHI >10

103
Q

salbutamol

ipratropium bromide

A

salbutmol- B2 agonist

ipratropium bromide- anticholinergic

104
Q

what is the benefit of Symbicort over Advair

A

Symbicort has formeterol which has a faster onset of action then Advair (salmeterol)
better for exercise

105
Q

what are 2 LABAs

A

fometerol (faster onset of action)

salmeterol

106
Q

what’s an example of an antileukotriene used to treat asthma? main side effect we worry about?

A

montelukast (Singulair)
Modest bronchodilator effects
Attenuates bronchoconstriction in EIA
risk of suicidality

107
Q

what is the most common bug to cause epiglottis?

A

H influenza B

108
Q

How can CF be diagnosed prenatally?

A

CVS with DNA analysis or amniocentesis

109
Q

Physical exam findings of CF
head and neck
lungs
abdo

A

head and neck: nasal polyps
opacification of the sinuses (chronic sinusitis)
they taste salty (baby presents to ER with low sodium, low chloride, appears dehydrated but no history of vomiting or diarrhea)- have to do a sweat test

Lungs- 
chronic infections
asthma (but not increased risk)
pneumothorax
hemoptysis (airway blood not a pulmonary hemorrhage but bronchial arteries supplied by systemic therefore they can exsanguinate)
bronchiectasis
ABPA (brown plugs or rust color sputum)

Pancreas: pancreatic insufficiency (90%)
CF related diabetes
pancreatic sufficient (10%)- can get pancreatitis

Liver- CF related cirrhosis
prolonged jaundice

Gallbladder- increased risk of gallstones

Intestines- distal intestinal obstructive syndrome (DIOS)
meconium ileus (CF until proven otherwise)
volvulus
intussusception
rectal prolapse

clubbing

Males are infertile (absence of the vas deferens)
Women: decreased fertility in CF because cervical mucous is thicker (main reason)

delayed puberty
osteoporosis (don’t have great vitamin D levels)

110
Q

what is the median survival in Canada for CF?

A

52 years but increasing yearly

111
Q

which has a higher protein content exudate or transudate?

A

exudate-infectious
high protein
high LDH

112
Q

Ddx restrictive pattern on PFT (4)

A

lung fibrosis
neuromuscular
chest wall deformity
obesity

113
Q

what is the most common mutation for CF

A

delta 508

CFTR protein

114
Q

what tests are done to diagnose CF (2)

A

sweat chloride

CFTR genetic analysis

115
Q

how would you determine pancreatic insufficiency

A 
72 hour fecal fat
fecal elastase (spot test)
116
Q

how do you diagnose PCD

A

nasal brush biopsy

EM of cilia- gold standard

117
Q

what are 3 causes of a positive TB skin test

A
  1. active or latent TB
  2. BCG vaccine
  3. non tuberculosis mycobacterium
118
Q

What two other investigations will you do to determine latent TB

A

CXR

acid fast bacilli smear and culture

119
Q

What are the 3 most important interventions in CF that affects prognosis?

A
  1. Nutrition
  2. Antibiotics
  3. Chest physiotherapy
120
Q

What are 3 complications of bronchiectasis?

A
  1. Increased risk of infection secondary to trapping of secretions
  2. Increased risk of pneumothorax
  3. Increased risk of pulmonary hemorrhage (and thus hemoptysis)
121
Q

What is the treatment for acute vocal cord dysfunction exacerbations? (2)

A
  1. Relaxation breathing techniques

2. Inhalation of heliox to relieve vocal cord spasm

122
Q

What is the gene involved in congenital central hypoventilation syndrome?

A

PHOX2B gene: essential to embryologic development of the autonomic nervous system from the neural crest

  • 90-95% are de novo mutations and the rest inherit the mutation from asymptomatic mosaic parent (autosomal dominant)
  • an individual with CCHS has 50% chance of passing on the mutation to their children
123
Q

In a child with congenital central hypoventilation syndrome presenting with constipation, what condition should be ruled out?

A

Hirschsprung disease: 20% of CCHS children

-should undergo rectal biopsy to screen for absence of ganglion cells

124
Q

What is the polysomnographic parameter most commonly used in evaluating sleep disordered breathing?

A

Apnea/Hypopnea index (AHI): tells us number of apneic and hypopneic events per hr of sleep
AHI> 5 should be treated

125
Q

What is the treatment of a pneumothorax that is small

A

No treatment needed: will self-resolve usually in 1 wk

126
Q

What is the difference between a primary and secondary lung abscess?

A

Primary: occurs in previously healthy patient with no underlying medical conditions
-more commonly found on right side

Secondary: occurs in patient with underlying medical conditions
-more commonly on the left side

127
Q

Which conditions predispose children to the development of pulmonary abscesses? (6)

A
  1. Aspiration pneumonia
  2. Cystic fibrosis
  3. GERD
  4. TEF
  5. Immunodeficiencies
  6. Neurological conditions
    * *anything that can lead to aspiration of infected materials with oral organisms
    * *can also occur secondary to a pneumonia
128
Q

What is the classic finding on CXR for a lung abscess?

A

Parenchymal inflammation with a cavity containing an air fluid level

129
Q

What are the causes of ARDS?

-two broad categories

A

Direct lung injury

  1. Pneumonia (most common)
  2. Aspiration
  3. Pulmonary contusion
  4. Submersion injury
  5. Inhalational injury

Indirect lung injury:

  1. Sepsis
  2. Shock
  3. Burns
  4. Transfusion related
  5. Trauma
130
Q

What are the 3 phases of ARDS?

A
  1. Exudative phase: decreased pulmonary compliance, increased hypoxia, increased tachypnea
    - see inflammation, diffuse alveolar infiltrates, pulmonary edema
  2. Fibroproliferative phase: increased alveolar dead space, pulmonary hypertension
    - scarring of lung, epithelial damage, surfactant deactivation
  3. Recovery phase: restoration of pulmonary epithelial barrier
131
Q

What is the treatment for alpha-1-antitrypsin deficiency?

A

IV enzyme replacement from pooled human plasma

132
Q

What is the gold standard for diagnosis of PE?

  • what is the diagnostic test of choice?
  • what is the utility of a V/Q scan?
A

Gold standard: pulmonary angiography

  • not necessary except in unusual cases since spiral CT is almost always available
  • diagnostic test of choice: spiral CT with IV contrast (specificity 90%)
  • V/Q scans are noninvasive and sensitive: use if pre-test probability is low
133
Q

What recreational drug is associated with pneumothorax?

A

Ecstasy! (MDMA)

134
Q

In children with prolonged or high inhaled corticosteroid therapy, what are two things you should monitor for?
-does the use of inhaled corticosteroids affect adult height?

A
  1. Height velocity
  2. Cataracts

***Does not affect adult height

135
Q

What is the differential diagnosis for middle mediastinal mass?

A

A+B

  1. Adenopathy: infectious (histoplasmosis most common), neoplastic, metastatic, sarcoidosis
  2. Bronchogenic cyst
136
Q

What is the differential diagnosis for posterior mediastinal mass?

A

The Ns

  1. Neurogenic tumor: neuroblastoma, benign ganglioneuroma, ganglioneuroblastoma
  2. Neurofibroma
  3. Esophageal duplication cysts
  4. Pulmonary sequestration
137
Q

What is a clue on exam that can help you differentiate between laryngomalacia vs. tracheomalacia?

A
  • Laryngomalacia = inspiratory stridor (above thoracic inlet)
  • tracheomalacia (weak tracheal rings collapse with expiration)= expiratory or biphasic stridor (below thoracic inlet)
138
Q

A patient with a pleural effusion receives a chest tube for drainage. The pleural fluid is chocolate colored. What is your diagnosis?

A

Amebiasis (entamoeba histolytica)

139
Q

Where is the acute airway obstruction seen in croup?

A

Subglottic narrowing at the cricoid cartilage!!

140
Q

What are the 3 most common causes of epiglottis in the post-HIB vaccine era?

A
  1. Strep pneumo
  2. GAS
  3. Staph aureus
141
Q

What is the role of azithromycin therapy in the treatment of CF?

A

Azithromycin = shown to reduce lung inflammation if given 3x weekly, thus decreasing pulmonary exacerbations

142
Q

What medication class should be avoided in individuals with history of obstructive or central sleep apnea?

A

OPIOIDS!!!! They are very sensitive to these medications and have worsening of apnea

143
Q

Why should you never put O2 on a child with history of OSA and walk away?

A

Children with OSA are chronic CO2 retainers and thus their respiratory drive is dependent on hypoxia! If you give them O2, then there will be no more respiratory drive and they will become apneic

144
Q

What are poor prognostic indicators in CF? (4)

A
  1. Poor nutritional status
  2. Pneumothorax
  3. Burkholderia cepacia (very deadly bug in CF)
  4. Poor FEV1
145
Q

What is the best test to rule out laryngeal cleft?

-clinical feature of laryngeal cleft?

A

Clinical feature: coughing/choking occurs DURING swallowing

-best test: rigid bronchoscopy is REQUIRED to rule it out!

146
Q

How do you diagnose TEF? Name 2 tests.

A

UGI series to start, rigid bronchoscopy is gold standard

147
Q

What is the differential diagnosis for vocal cord paralysis?

-unilateral vs. bilateral?

A

Bilateral vocal cord paralysis (hear inspiratory stridor)
-congenital CNS lesion (myelomeningocele, arnold-chiari malformation, hydrocephalus) = think of things that compress the brainstem (CN X)

Unilateral vocal cord paralysis (see choking, aspiration, coughing, weak cry)
-usually damaged by surgery/intubation to the recurrent laryngeal nerve

Dx: flexible awake laryngoscopy, need MRI head if bilateral vocal cord palsy, consider Neuro and Cardio consult

Tx: most spontaneously resolve within 6-12 mo but some bilateral paralysis require trach temporarily

148
Q

You are unable to obtain a sweat sample in a neonate. List 3 other ways to confirm the diagnosis of CF.

A
  • nasal potential difference
  • genetic test for common mutations
  • newborn screen (serum immunoreactive trypsinogen)
149
Q

IV antibiotic treatment for lung abscess

A

clindamycin and gent
Treatment regimens should include a penicillinase-resistant agent active against S. aureus and anaerobic coverage, typically with clindamycin or ticarcillin/clavulanic acid. If gram-negative bacteria are suspected or isolated, an aminoglycoside should be added.

150
Q

A 7 year old with CP, severe GERD and frequent choking spells while eating is admitted to the hospital with fever and increased RR. On CXR there is an air bubble in the LLL with surrounding consolidation and pleural effusion. What is the most likely organism that is causative:

A

anaerobes

Pediatrics- Noelle (28 decks)

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