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ctjghjkbgf > Respirology > Flashcards

Respirology Flashcards

1
Q

Definition of apnea

A

Respiratory pause > 20 sec, or associated with pallor, cyanosis, bradycardia

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2
Q

Differential diagnosis of apnea (ie. causes)

A 
CNS infection - meningitis, encephalitis
Seizure
Head trauma
Intracranial bleed
ICP
Breath-holding spell
Pertussis
Botulism
Sepsis
Toxins
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3
Q

Low risk features of a BRUE

A
  • age > 60 days
  • born > 32 weeks gestation, and cGA > 45 weeks
  • no CPR required
  • event lasted < 1 min
  • first event
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4
Q

Definition of a BRUE

A

Sudden, brief, now resolved episode in child < 1 year old, with:

  • cyanosis or pallor
  • absent or irregular breathing
  • change in tone
  • altered responsiveness
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5
Q

Suggested management of a low-risk BRUE

A
  • education
  • CPR training
  • may obtain pertussis swab, 12 lead ECG
  • may briefly monitor with Sat monitor and serial observations
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6
Q

Anatomic/ physiologic differences of infant airway vs. older individuals

A
  • Obligate nasal breathers < 4 months old
  • Larynx is higher, softer, more elastic
  • Trachea has smaller diameter
  • Chest wall more compliant
  • Respiratory control system is more immature
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7
Q

Laboratory criteria for respiratory failure (list 3)

A

PaCO2 > 50 with acidosis (pH < 7.25)
PaCO2 > 40 with severe distress
PaO2 < 60 (or O2 sat < 90%) on 40% FiO2

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8
Q

List 6 life-threatening causes of stridor

A

epiglottitis, RPA, diphtheria, tracheitis, foreign body, anaphylaxis, neck trauma, neoplasm, caustic or thermal injury, hereditary angioedema

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9
Q

List 6 congenital causes of stridor

A

laryngomalacia, laryngeal webs, laryngeal diverticula, vocal cord paralysis, subglottic stenosis, tracheomalacia, vascular anomalies (double aortic arch, vascular sling)

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10
Q

List 4 typical viral causes of bronchiolitis

A

RSV, rhinovirus, parainfluenza, adenovirus, influenza, coronavirus, humanmetapneumovirus

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11
Q

List causes of pneumonia

A

viral causes most common

bacterial (S. pneumo, S. aureus, mycoplasma, chlamydia, group A strep)

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12
Q

Chronic wheezing not responsive to asthma management, consider these 4 diagnoses

A
  • CF (recurrent wheeze, FTT, chronic diarrhea –> sweat chloride test)
  • GERD
  • Recurrent aspiration
  • Retained airway foreign body
  • Mediastinal tumor
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13
Q

Management of brionchiolitis

A

Recommended: oxygen, hydration
Equivocal: epi nebs, nasal suction, epi+dex
Not recommended: ventolin, steroids, antibiotics, antivirals, hypertonic saline, chest physio, CXR, NP swab

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14
Q

Features associated with mycoplasma pneumonia

A

age > 5 years, insidious onset, headache, sore throat, prominent cough, diffuse rales, bilateral interstitial infiltrates

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15
Q

ED management of asthma

A

o Inhaled beta-2 agonists (ie. Salbutamol) via MDI (preferred over neb)
o Inhaled anticholinergics (ie. Atrovent = ipratropium bromide) –> reduced hospitalizations
o PO corticosteroids (IV if vomiting, NPO)
o IV MgSO4
o Continuous Ventolin nebs
o IV Ventolin
o Heliox (contraindicated in pneumothorax – obtain CXR prior)
o Terbutaline bolus and infusions
o CPAP or BiPAP to prevent intubation
- Discharge on inhaled corticosteroids

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16
Q

DDx of resp distress in cystic fibrosis

A

viral illness
bacteria infection
bacterial colonization and subacute exacerbation
GERD
pneumothorax
hemoptysis
allergic bronchopulmonary aspergillosis (ABPA)

17
Q

Most common newborn presentation of CF

A

Meconium ileus

18
Q

Common CF infectious organisms

A

staph aureus, MRSA, pseudomonas aerugiona, stenotrophomonas maltophilia, B. cepacia, A. xylosoxidas, non typable H influenza

19
Q

Management of severe hemoptysis in CF

A

get IV access, CBC/INR/PTT/liver and renal function/gas/type and cross/sputum culture; emergency bronchoscopy to locate site of bleed; consider activation MTP if severe; IV antibiotics (most pulmonary exacerbation); placing bleeding lung dependent position

20
Q

Causes of pulmonary hemorrhage

A

acute infection, exacerbation of pulmonary disease (CF), thoracic trauma, vasculitis (GPA, Goodpasture’s), non-lung sources (hematemesis/GI bleeding, tonsillar or nose bleed)

21
Q

Diagnostic test for PE in children

A

CT-angiography

22
Q

Which body systems are affected by sarcoidosis

A

lungs, lymph nodes, joints, eyes, skin, liver, spleen

23
Q

What is Hamman’s sign

A

crunching sound obscuring heart sounds (occurs in pneumomediastinum)

24
Q

Typical location of diaphragmatic hernia

A

Usually posterior left side (Bochdalek = back to the left)

Less common Morgagni on the right

25
Q

How to perform a needle thoracostomy

A

2nd intercostal space, midclavicular line.
Use a 14 or 16G needle with 10 mL syringe attached with some water (bubbling), insert perpendicular to chest, over the rib. Remove the needle (keep catheter in place). Prepare for a chest tube. Don’t close the catheter (keep it open to air), or pneumothorax will re-accumulate

26
Q

List 4 complications of chest tube insertion

A

bleeding, damage to lung (pneumothorax), bronchopleural fistula, damage to visceral organs, re-expansion pulmonary edema

27
Q

Management of trach obstruction

A

suction, assess if cannula is in place (may be false tract in recent change), apply O2. Change the trach if no response to suctioning

28
Q

Describe the difference between BiPAP and CPAP and when would you use each modality?

A

CPAP: fixed positive pressure throughout the cycle (use in Acute pulmonary edema, Obstructive sleep apnea, Acute respiratory failure with normal lung function)

BiPAP: Different levels of pressure during inspiration and expiration (use in Complex msk disease with weak respiratory muscle function, Asthma in resp failure)

29
Q

List four factors that determine oxygen delivery by the orofacial delivery route

A

Oxygen concentration given
Mixing (non-rebreather vs simple mask)
Patency of nares and mouth
Ability to self-ventilate

30
Q

List 6 clinical findings of respiratory failure

A

Vital signs: tachycardia, tachypnea or bradypnea, hypoxemia
General appearance: cyanosis, diaphoresis, confusion, restlessness, fatigue, shortness of breath, apnea, grunting, stridor, retractions, decreased air entry, wheezing
Pulsus paradoxus > 30 mmHg

31
Q

DDx (causes) of pulmonary edema - list 6

A

Cardiogenic and non-cardiogenic (ARDS) are 2 broad categories

By etiology:

  • CHD associated left sided HF: hypoplastic left heart syndrome, severe AS, coarctation of the aorta, MS, HOCM
  • Over circulation within pulmonary vasculature: VSD, PDA
  • Iatrogenic: overaggressive administration of IV fluids
  • Neurogenic pulmonary edema: increase ICP or seizure
  • Decrease plasma oncotic pressure: nephrotic syndrome, protein losing enteropathy, massive burns, severe malnutrition
  • Breakdown alveolar-capillary barrier: ARDS, toxins
  • Negative pressure pulmonary edema/post obstructive pulmonary edema
32
Q

List 4 central (CNS) causes of respiratory depression

A
  1. Intoxication (ex alcohol, benzos, opioids)
  2. CNS malformation (ex hydrocephalus)
  3. Immaturity
  4. Trauma: Intracranial/brain stem bleed
  5. Mass (ex brainstem tumor, intracranial with raised ICP)
  6. Infection (ex meningitis)
33
Q

List 3 signs and 3 symptoms of HAPE

A

HAPE = high altitude pulmonary edema

3 symptoms: SOB, cough, decreased LOC
3 signs: tachypnea, tachycardia, hypoxia, chest crackles

34
Q

Emergency management of total upper airway obstruction (ie. unable to phonate)

A
  • Heimlich maneuver or back blows for infant
  • start CPR when unconscious
  • Emergency laryngoscopy, intubation, cricothyrotomy or tracheostomy
35
Q

Resistance to airflow in the airway is inversely proportional to what? What is the corresponding law called?

A

Radius of airway lumen

Poseuille’s law

36
Q

What condition should be ruled out when nasal polyps are found?

A

Cystic fibrosis

37
Q

A chest Xray shows honeycombing, atelectasis, and increased bronchial markings. What is the diagnosis?

A

Interstitial lung disease/ bronchiectasis

38
Q

Name 2 mechanisms for acidosis in severe Asthma

A
  • increased CO2 = respiratory acidosis

- ventolin –> lactic acidosis

39
Q

Name main mechanism for decreasing O2 sats after beta agonist treatment in asthma

A

V:Q mismatch

ctjghjkbgf (21 decks)

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