Respirology Flashcards
CHARGE syndrome
Coloboma
Heart disease
Atresia choanae
Retarded growth+ development or CNS anomalies or both
Genital anomalies or hypogonadism or both
Ear anomalies or deafness or both
2012 Asthma guidelines for good asthma control
Daytime sx: < 4 days /week Activity: normal Nighttime sx: < 1 night /week Exacerbations: mild, infrequent Absence from work or school: none FEV1 or PEF >= 90% of personal best other: PEF diurnal variation < 10-15% sputum eosinophils < 2-3%
False negative sweat chloride test
- Peripheral edema
- Insufficient quantity
- Hyponatremia
- Dilution
- CF transmembrane conductance regulator mutations with preserved sweat duct function
False positive sweat chloride test
- Atopic dermatitis
- Ectodermal dysplasia
- Malnutrition
- Congenital adrenal hyperplasia
- Adrenal insufficiency
- Hypothyroidism
- Glucose-6-phosphatase deficiency
- Nephrogenic diabetes insipidus
- Munchausen syndrome by proxy
and more
Common organisms pulmonary exacerbation CF
Younger children = MSSA
Young adulthood = Pseudomonas
Colonizing pathogens: MSSA, MRSA, Pseudomonas, haemophilus, burkhorderia, stenotrophomonas
Burkholderia cepacia complex = deteriorate very quickly
Asthma escalation 12 yrs old (CTS guidelines)
- once 12 yrs old can add LABA to low dose ICS
- if 11 yrs increase ICS to medium dose from low dose
Bronchiolitis O2 saturation threshold
90%
RSV prophylaxis qualification
must get, reasonable to offer, consider for
SHOULD get:
1. significant CHD or CLD who require ongoing treatment if <12mo
2. preterm infants <36wks in remote communities who would require air transport for hospitalization and <6mo
MAY get:
1. still on O2 with CLD and 2nd RSV season
2. prems <30 weeks without CLD and <6mo
CONSIDER for:
1. term Inuit infants <6mo if community with high rates of hospitalization (e.g. Baffin)
2. <24mo if on home O2, had prolonged hospitalization for severe pulm disease, or severe immunocompromise
Truncated inspiratory loop on spirometry
vocal cord dysfunction
Diagnosis of asthma
- obstruction (decreased FEV1/FVC) + increase in FEV1 by >= 12% with bronchodilator
- peak flow: increase by 20+ % with bronchodilator
- methacholine +Ve = <4mg/mL
Exercise: worsening in FEV1 by >= 15%
Congenital central hypoventilation syndrome - At risk for….
Holter monitor annually - at risk of asystole (may need pacemaker)
Also at risk for neuroblastoma, neural crest tumors, Hirschsprung disease
Dont let them swim!
Camphor ingestion (hydrocarbon) pulmonary findings
Pneumatoceles and pleural effusions may occur within 48-72 hrs
ICS and height
- slight decrease in height
-1.1cm for budesonide 400mcg daily dose
chronic cough duration
4+ weeks
order CXR and spirometry!
Consequences of missed foreign body
- recurrent pneumonia
- bronchiectasis
- cardiac arrest and death
CF presentations - infancy
- FTT
- meconium ileus
- recurrent resp sx
- hyponatremic, hypochloremic, metabolic alkalosis
- prolonged jaundice
- severe pneumonia
CF presentations - childhood
- recurrent resp sx
- FTT
- recurrent rectal prolapse
- clubbing
- bronchiectasis
- nasal polyps
- chronic pseudomonas colonization
CF diagnosis
- sweat chloride >= 60
- CFTR analysis
- NBS misses 1-5% (immunoreactive trypsinogen)
Poor prognostic factors in CF
- female
- lung disease (FEV1, burkhorderia, PTX, massive hemoptysis)
- nutritional status +DM
PCD diagnostic options
- nasal nitric oxide measurements (95%)
- genetics
- electron microscopy of cilia
consequences of OSA
- FTT
- inflammatory
- QoL
- cardiovascular: HTN, cor pulmonale
- neurocognitive: behavioral, attention, school performance, development
OSA diagnosis
PSG = gold standard
Treatment adenoidal hypertrophy
Non-pharm: nasal hygiene
- sleep hygiene
Pharm: intranasal corticosteroids, montelukast
Surgical: adenoidectomy +/- tonsillectomy
CPAM presentation neonatal (if symptomatic)
- resp distress
CXR: cystic mass, +/-mediastinal shift away from lesion
Trach emergency response - initial steps
call for help
- manually ventilate with 100% oxygen and attempt suctioning
- remove trach
- insert new trach
Sensitivity
true positive/ (true positive + false negative)
number positive by test/total number positive
Specificity
true negative /(true negative + false positive)
number negative by test/ total number without disease
Cough DDX in first few months of life
CRADLE
- CF
- RTIs
- Aspiration e.g. FBA, GERD
- Dyskinetic cilia
- Lung and airway malformations e.g. laryngeal web
- Edema e.g. CHF
Positive predictive value
TP/(TP+FP)
= true positive / total positive
Negative predictive value
TN/ (FN+TN)
= true negative/total negative
