פולמונולוגיה

Question 1

בכמה ירדה השכיחות של מוות בעריסה בהשכבת תינוק על הגב?

Answer 1

ירדה בלמעלה מ-50%

אבחון של מוות בעריסה- נתיחה שלאחר המוות

Question 2

Definition of BRUE (Brief resolved unexplained event)

Answer 2

כחלון/ חיוורון / הפסקת נשימה / נשימה לא סדורה / שינוי בטונוס או ברמת התגובתיות בתינוק מתחת לגיל שנה ונמשך פחות מחצי דקה

Question 3

what are the low risk conditions in BRUE?

Answer 3

• age > 60 days
• delivery > 32 weeks +correct now > 45 wks
• first episode
• less then 1 min
• did not rq resusitstion
• no clinical or Hx findings

Question 4

How to manage low risk BRUE?

Answer 4

1. patrossis PCR?
2. ECG- rule out long QT
3. PCR viral
4. O2% sat

Question 5

How to asses high risk BRUE

Answer 5

1. hospitalization with cardial and respiratory monitoring
2. swallowing test
3. Brain imaging- rule out abuse
4. neurologic asses- epilepsy?
5. rule out anatomical lesions in respiratory tracts
6. rule out respiratory abnormalites- OSA, central apnea

Question 6

Dgx of PE?

Answer 6

CT- contrast
gold standart- lung angiography

די דימר לא מקדם בילדים

Question 7

which coagulation factor is most a/w PE in childrens?

Answer 7

5- leiden

Question 8

the following spirometry can be a/w which common disease?

low FEV1
FEV1/FEV < 0.8
12% improve of FEV1 after inhale beta agonists

Answer 8

Asthma

Question 9

Definition of Transient Non ectopic Wheezing

Answer 9

שיעול וצפצופים בעיקר לאחר מחלה רספירטורית ויראלית

נעלמת במהלך הילדות עד הגעה לגיל ביה”ס, ללא סיכוי מוגבר לאסתמה בהמשך החיים

Question 10

1st line for community aq pneumonia?

also 2nd line and for penecillin sensetive and a-typical penumonia

Answer 10

amoxicillin

2nd line- augmentin

if atypical suspect or senetivity to penecillin > macrolides

if resistance to multiple lines > susp. MRSA

Question 11

hospitelized pneumonia

under 1 month
2m-2yr
> 2 yres

Answer 11

• < 1 month- Ampicillin + gentamycin
• 2m-2yr- augmentin / Chephalosporins 2rd generations
• > 2 yrs- ampicillin

Question 12

Complication of pneumonia and Tx?

Answer 12

Para-pneumonia and amphyema

Tx- Abx IV + drainge

Question 13

pathogens a/w pleuropneumonia?

tx?

Answer 13

Pathogens
pneumoccoc
SA
GAS

Tx
Abx IV
second- drainage

Question 14

emphyema definition

Answer 14

הצטברות מוגלה בחלל הפליאורלי

Question 15

emphyema in XCR

Answer 15

הנוזל לא זז כיוון שהוא תחום בספטות

Question 16

מהם האינדיקציות להנחת נקז באמפיאמה?

Answer 16

Positive gram culture
PH < 7.2
PMN > 100K

Question 17

Tx for emphyema?

Answer 17

Ceftriaxone (rochipin) + clindamycin 4 wks + drainage + fibrinolytic (aurokinase)

Question 18

Dgx for eosinophilic lung disease?

Answer 18

Bronchoalvelolar lavage with > 25% eosinophilis in acute phase

Question 19

What is the most common esoinophilic lung disease in kids?

what is the etiology?

Answer 19

Loffler eosinophlic pneumonia = pulmonary infilitrates with esosinophilia syndrome

mostly cause by Ascaris lumbricoides

Question 20

a teenager present with hypoxemia, dyspnea, fever and cough. the kid is telling you he is smoking ciggarte. on blood reasults there are no signs of infection and eosinophils counts are normal. on BAL there is eleveted eosinophils.

what is the most likley disease?
what is the Tx?

Answer 20

acute eosinophilic syndrome

Tx- Few weeks steroids

Question 21

a teenager present with hypoxemia, dyspnea, fever and cough lasting for . the kid is telling you he is smoking ciggarte. on blood reasults there are is no signs of infection and eosinophils counts are eleveted. on BAL there is eleveted eosinophils.

what is the most likley disease?
what is the Tx?

Answer 21

Chroni eosinophilic pneumonia

Tx- steroids

Question 22

Tx for sinusitis?

Answer 22

1st line- amoxicillin
2nd line- augmentin

Question 23

a 4 yr old boy is present with high fever, torticolis, stirodr with normal orophyngeal testing.
his mother mentioned that a 2 wks ago he had an ear infection

what is the most likely dgx?
what is the Tx?

Answer 23

Retrophyrngeal abcess- CT
Tx- IV augmentin, consider drainge

Question 24

Tx for croup / lryngotracheobronchilitis?

Answer 24

Steroids PO

X-ray- steeple sign

Question 25

what is the clinical presentation and treatment of Spasmodic croup?

Answer 25

sudden stridor in night hours, usally w/o fever Tx- as croup (steroids PO)

Question 26

Tx for Epiglottitis?

Answer 26

intubation and Ceftriaxone IV 10d

Question 27

Bacterial trachitis clinical presentation Dgx? Tx?

Answer 27

barking cough, stridor, dyspnea and high fever. **dgx- abcsence of epiglottitis + clinical** **Tx-** Ceftriaxone + Vanco / clindamycin, oxygen. think about intubation

Question 28

Main etiology for subglottic stenosis??

Answer 28

Prolong intubation dgx- bronchoscopy | bi-phasic stridor

Question 29

most common cause of stridor in babeis?

Answer 29

**layngomalacia**- low tonus of muscles in pharynx area >> lead to collapse of glottic structures during inspirium | develop in first few weeks and worsen until 6 months of age

Question 30

Clinical presentation of laryngomalacia? when stridor is ease or worsening and how we dgx?

Answer 30

inspiratory stridor worsen in effort- crying agitation ,eating relief in resting / laying on abdomen **dgx-** confirmation by flexibale laryngoscope

Question 31

Which type of respiratory infection is a/w adenovirus?

Answer 31

Bronchiolitis obliterans

Question 32

clinical presenation of CPAMמום מולד בדרכי הנשימה | Dg and Tx

Answer 32

mainly a-symp in childhood. but later can presented with reccurent lung infections and chest pain **Dgx-** CT = consolidation and marks with contrast **Tx-**surgery (fear for malignant transformation)

Question 33

What is pulmonary sequestration?

Answer 33

lung anomelis in creating lung tissue outside of the lung tree. could present with reccurent lung infections and hemoptysis or left lung and boys >> diaphragmatic hernia and other anomalies Tx- surgrty

Question 34

most common nose anomaly?

Answer 34

**Choanal atresia** תינוק לא יכול לנשום דרך האף יכול להיות חד צדדי או דו צדדי

Question 35

A recent deliver new born present with porminant cyanosis while eating which pass when the baby stop and start crying what is most likley the dgx? how can we confirm it?

Answer 35

choanal atresia dgx- try to pass nasal tube

Question 36

CF tx for pt with acute infection?

Answer 36

מינון מקסימאלי למשך שבועיים לעיתים פי 2-3 מהמומלץ בחשד לפסאודומונס- קוינולונים (2 תרופות)

Question 37

Which CF complication is a/w high levels of IgE and rusty colour sputum

Answer 37

ABPA Allergic- broncho pulmonary aspergillosis ## Footnote tx- Steroids PO

Question 38

מתי תבחין זיעה עם כלור נחשב לחיובי? | CF

Answer 38

> 60 microL/L

Question 39

False positive sweat test for CF etiologies? | 5

Answer 39

hypothyroidism hypoparathyroidism anorexia atopic dermatitis addison

Question 40

Which disease is a/w the following triad? * bronchoectasis * chronic sinusitis * recurent ear infections

Answer 40

Primary cilliary dyskinesia 50% - present with situs inversus

Question 41

Dgx for primary cilliary dyskinesia?

Answer 41

epithel nose biopsy or airways and check on electron microscope

Question 42

Tension pneumothroax location of the trachea?

Answer 42

deviation of the trachea to the healty side (also the mediastenum)