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1. pediatrics > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

[Pulm/Asthma]

Asthma predictive index?

Children ≤ __ year of age

  • Major criteria (1 of the following)
    One of the parents has __
    The child has __
  • Minor criteria (2 of the following)
    The child has __
    The child has __
    The child has __
A

Children ≤ 3 year of age

  • Major criteria (1 of the following)
    One of the parents has asthma
    The child has eczema
  • Minor criteria (2 of the following)
    The child has allergic rhinitis
    The child has wheezing unrelated to cold/URI
    The child has eosinophilia
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2
Q

[Pulm/Asthma]

Predictors of persistent asthma into adolescence and adulthood (2)

A
  1. Obesity
  2. Vitamin D deficiency
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3
Q

[Pulm/Basic]

What makes oxyhemoglobin dissociation curve shifts to right (less affinity) (3)?

A

Temperature
Acidosis
Phosphorus (2,3-DPG)

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4
Q

[Pulm/Basic]

What makes pulse oxymeter falsely elevated and its mechanism (2)?

A
  1. CO poisoning: COHb has high affinity to O2
  2. Methemoglobinemia: MetHb(Fe3+) can’t bind to O2 or CO2, high affinity to O2
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5
Q

[Pulm/Cong/URT]

Causes of neonatal stridor (4)?

A
  1. Laryngomalacia
    2 .Subglottic stenosis
  2. Vocal cord paralysis
  3. Laryngeal atresia/webs
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6
Q

[Pulm/Cong/URT]

Cause of neonatal stridor and diagnostic test?

Age: by 2 weeks of age
Inspiratory stridor aggravating with feeding, agitation, supine position
Resolves by 12-24 months of age

A

Laryngomalacia

  • Test:
    Awake flexible laryngoscopy
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7
Q

[Pulm/Cong/URT]

Diagnosis?
Test?

Stridor, respiratory distress in the first few months of life
Recurrent croup before 12 months of age
Associated with trisomy 21

A

Subglottic stenosis

  • Test:
    Direct laryngoscopy or bronchoscopy
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8
Q

[Pulm/Cong/URT]

Cause of neonatal stridor?
Diagnostic test?

Infant with absent or weak cry, aspiration during feeding
Infants with other neurologic abnormalities (hydrocephalus, Arnold-Chiari malformation) or birth trauma or intubation

A

Vocal cord paralysis
(recurrent laryngeal nerve damage)

  • Test:
    Awake fiberoptic nasopharyngoscopy
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9
Q

[Pulm/Cong/URT]

Cause of neonatal stridor?
Diagnostic test?

Neonatal stridor and respiratory distress at birth
Associated with velocardiofacial syndrome (DiGeorge)

A

Laryngeal atresia

  • Test:
    Direct laryngoscopy
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10
Q

[Pulm/Cong/LRT]

Diagnosis?

Expiratory stridor
History of vascular ring or sling

A

Tracheomalacia

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11
Q

[Pulm/Cong/LRT]

Diagnosis?

Infant with heart failure, pulmonary hypertension
Often with left sided heart anomalies
Characteristic CXR: scimitar-like (Turkish sword) apparence

A

Congenital pulmonary venolobar syndrome (Scimitar syndrome)
(Pulmonary venous blood from right lung returns to the inferior vena cava)

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12
Q

[Pulm/Cong/LRT]

Diagnosis?
Test?

Patients with hereditary hemorrhagic telangiectasia (episodes of epistaxis)
Increased risk of cerebral stroke, brain abscess

A

Pulmonary Arteriovenous malformation

  • Test:
    Contrast (bubble) echocardiogram
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13
Q

[Pulm/Cong/LRT]

Diagnosis?

Respiratory distress in infancy
Recurrent pneumonia, hemoptysis, infection
CXR/CT: dense mass, cystic changes, air-fluid levels

A

Pulmonary sequestrations
(non-functioning lung tissue, isolated from the normal functioning lung tissue fed by systemic arteries)

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14
Q

[Pulm/Cong/LRT]

Diagnosis?
Test?

Pregnancy complicated with hydramnios, pre-eclampsia, premature birth, and hydrops fetalis
Progressive respiratory distress in the neonatal period
Or recurrent pulmonary infections
Presentation similar to congenital diaphragmatic hernia

A

Congenital Pulmonary Airway Malformation (CPAM, adenomatoid proliferation of bronchioles that result in cysts rather than alveoli)

  • Test:
    Thin-section chest CT
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15
Q

[Pulm/Cong/Diaphragm]

Diagnosis?
Cause?

Male>Female
Unilateral decrease in breath sounds
CXR: elevation of diaphragm

A

Eventration

  • Cause:
    Phrenic nerve injury
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16
Q

[Pulm/Stridor]

Differentials for stridor beyond infancy
Acute with fever (2)
Acute without fever (2)
Subacute (3)

A
  • Acute with fever (2):
    Epiglotitis
    Bacterial tracheitis
  • Acute without fever (2):
    Anaphylaxis
    Foreign body
  • Subacute (3):
    Croup
    Peritonsillar abscess
    Retropharyngeal abscess
17
Q

[Pulm/Stridor]

Vocal cord dysfunciton vs Asthma

Not responding to albuterol
Difficulty breathing in inspiration
Wheezing at maximal exercise (asthma up to 20 min after exercise)
Associated with anxiety

A

Vocal cord dysfunction

18
Q

[Pulm/Infection of URT]

Diagnosis?
Most common cause?
Treatment?

Between 2 and 5 years old
Fever, sore throat, drooling, stridor
Ill-appearing, tripod position, chin extended

A

Epiglottitis

  • Cause:
    nontypeable H. influenza (m/c),
    S. pneumoniae, S. pyogenes, S. aureus
  • Treatment:
    Ceftriaxone or cefotzxime
    Plus
    Clindamycin, oxacillin, cefazolin
19
Q

[Pulm/Infection of URT]

Diagnosis?
Most common cause?
Treatment?

< 3 years old
Brassy productive cough,
Ill-apperaing, high fever
Stridor, croup, not responding croup treatment

A

Bacterial tracheitis

  • Cause:
    S. aureus (m/c)
    S. pneumoniae, Moraxella, nontypeable H. influenza
  • Treatment:
    Nafcillin
20
Q

[Pulm/Infection of LRT/RSV]

Palivizumab (Synagis) indication

  1. Infants and children < 24 months of age with ___ who require medical therapy (e.g., diuretics, oxygen, systemic corticosteroids) within 6 months of the start of RSV season
  2. Infants born at __ weeks of gestation in their 1st winter
  3. Children < 24 months of age with __
A
  1. Infants and children < 24 months of age with chronic lung disease of prematurity who require medical therapy (e.g., diuretics, oxygen, systemic cortico­ steroids) within 6 months of tlie start of RSV season (Chronic lung disease of prematurity is defined as the requirement of oxygen for > 28 days in infants bom at < 32 weeks of gestation.)
  2. Infants bom at < 29 weeks of gestation in their 1st winter
  3. Children < 24 months of age with hemodynamically
    significant cyanotic and acyanotic congenital heart disease
21
Q

[Pulm/Infection of LRT]

Diagnosis?
Test?
Treatment?

Asthma with difficult to control, worsening symptoms
Coughing up brownish mucous plugs, hemoptysis
CBC: eosinophilia
CXR: recurrent infiltrates, central bronchiectasis (fingers in glove)
Increased risk for cystic fibrosis

A

Allergic bronchoplumonary aspergillosis (ABPA)

  • Test:
    Immediate skin reactivity to Aspergillus
    ABPA panel: Aspergillus-specific IgE and IgG titers
  • Treatment:
    Oral corticosteriods and itraconazole
22
Q

[Pulm/chronic cough]

Diagnosis?
Treatment?

Children 1-6 years old
Prolonged wet cough > 4 weeks, not responding to albuterol
Repeated respiratory infection
Well-appearing, continuous rhonchi
CXR: normal

A

Protracted bacterial bronchitis (PBB)

  • Treatment:
    Amoxicillin/clavulanate for 2-4 weeks
23
Q

[Pulm/chronic cough]

Diagnosis?
Treatment?

Prolonged cough after viral illness
Cough that worsens when lying down
Rhinorrhea, congestion, ear pain, sore throat

A

Upper airway cough syndrome (Postnasal drip syndrome)

  • Treatment:
    antihistamines, decongestants, nasal irrigation
24
Q

[Pulm/chronic cough]

Diagnosis?
Treatment?

Non-specific chronic cough, fever
Recurrent bronchitis, responding to antibiotics
Patients with AIDS, chemotherapy, BM-transplant
CXR: patchy infiltrates

A

Cryptogenic organizing pneumonia (COP)
(Bronchiolitis obliterans with organizing pneumonia BOOP)

  • Treatment:
    Corticosteroids
25
Q

[Pulm/chronic cough]

Diagnosis?

Children with lower respiratory tract infection (adenovirus)
Persistent respiraotry symptoms > 60 days
Chronic cough, tachypnea, wheezing, failure to thrive

A

Bronchiolitis obliterans

26
Q

[Pulm/chronic cough]

Diagnosis?
Test?

Chronic wet cough persists after 4 weeks of antibiotics
Patients with cystic fibrosis, chronic aspiration, a1-antitrypsin deficiency, dysmotile cilia syndromes
PE: clubbing

A

Bronchiectasis

  • Test:
    High resolution chest CT
27
Q

[Pulm/hemoptysis]

Diagnosis?

Children < 10 yers
Recurrent hemoptysis, progressive anemia,
Dyspnea, recurrent cough, fatigue
PFT: restrictive
BAL: hemosiderin-laden macrophages

A

Idiopathic pulmonary hemosiderosis

28
Q

[Pulm/ILD]

Diagnosis?

Children 2-3 years old
Cough, dyspnea
Patients with perinatally acquired HIV
CXR: bibasilar infiltrates

A

Lymphocytic Interstitial Pneumonia (LIP)

29
Q

[Pulm/ILD]

Diagnosis?
Test?

<4 years old, 13-15 years old
Non-specific, Fatigue, fever, cough, skin nodules
CXR: bilateral hilar +/- mediastinal adenopathy
Hypercalcemia, hypercalciuria, hypergammaglobulinemia

A

Sarcoidosis

  • Test:
    biopsies with noncaseating granuloma

1. pediatrics (22 decks)

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