Resp Flashcards

Question

. Kid with coughing fits during the day but none at night, what is it? a. Habit cough

Answer 1

habit cough

Answer 2

MRI head Brain imaging – Neuroimaging, ideally with magnetic resonance imaging (MRI), is performed to exclude brainstem malformations that might impair ventilatory control, including Chiari malformations.

Answer 3

hypoalbuminemia hypothyroid - causes false POSITIVE -Sweat chloride test - pilocarpine iontophoresis to collect sweat, measure Cl, >60 mEq/L diagnostic, Usu wait 48 hours of life but can be low sweat 1-2w of life

Answer 4

methacholin echallenge

Answer 5

Methacholine test

Answer 6

verfiy technique

Answer 7

salbutomol

Answer 8

a. Echocardiography In very severe cases, there may be evidence of pulmonary hypertension, right-sided heart failure, and cor pulmonale; systemic hypertension may occur, especially in obese children.

Answer 9

sweat chloride

Answer 10

sweat chloride It is also responsible for many cases of hyponatremic salt depletion, nasal polyposis, pansinusitis, rectal prolapse, pancreatitis, cholelithiasis, and nonautoimmune insulin-dependent hyperglycemia.

Answer 11

b. Budesonide and formoterol (ICS + LABA) 12 years of age and over with moderate asthma and poor asthma control on ICS/LABA combination maintenance therapy.

Answer 12

a. ventolin PRN In children with frequent symptoms (≥2 days/week [3] or ≥8 days/month) or ≥1 moderate or severe asthma-like exacerbation (ie, treated with oral corticosteroids or a hospital admission), a therapeutic trial with a medium (200 µg to 250 µg) daily dose of ICS and as-needed SABA, administered by metered-dose inhaler, is suggested

Answer 13

u/s A chest radiograph (CXR) should always be the initial imaging modality. Ultrasound provides a noninvasive, radiation-free modality to confirm the presence of a pleural effusion suspected on CXR. As well, ultrasound can estimate the size of the effusion, and differentiate free-flowing effusions from those that are loculated

Answer 14

avoid second hand smoke avoidance of environmental tobacco smoke (beginning prenatally), prolonged breastfeeding (>4 mo), an active lifestyle, and a healthy diet—might reduce the likelihood of asthma development

Answer 15

a. check technique and compliance

Answer 16

?weight managgement T&A T+A - first line if significant adenotonsillar hypertrophy, including if multifactorial (including obesity), generally results in complete resolution in uncomplicated cases CPAP/BiPAP - indicated if T+A not indicated, if residual disease after T+A, or major risk factors not amenable to surgical therapy, patient’s preference for no surgery In obese patients - recommend weight loss Also treat additional risk factors (asthma, seasonal allergies, GERD)

Answer 17

habitual cough - treat with assurance cough is abrupt and loud and has a harsh, honking, or “barking” quality. A disassociation between the intensity of the cough and the child’s affect is typically striking. This cough may be absent if the physician listens outside the examination room, but it will reliably appear immediately on direct attention to the child and the symptom. It typically begins with an upper respiratory infection but then lingers.

Answer 18

pulm abscess b. Pulmonary sequestration - mass on CXR, no air bubbles, often in lower lobes c. CCAM - now known as CPAM, CXR should demonstrate a mass Classically, the chest radiograph shows a parenchymal inflammation with a cavity containing an air–fluid level (Fig. 402-1). A chest CT scan can provide better anatomic definition of an abscess, including location and size

Answer 19

``` low albumin OTHER FALSE NEG: Dilution Malnutrition Edema Insufficient sweat quantity Hyponatremia Cystic fibrosis transmembrane conductance regulator mutations with preserved sweat duct function ```

Answer 20

bacterial pneumonia

Answer 21

oxygen bronchiolitis

Answer 22

allergic rhinitis

Answer 23

eliminate from envt breastfeeding can also improve

Answer 24

conditioning

Answer 25

bronchoscopy

Answer 26

bronchoscopy and culture

Answer 27

bronch and culture

Answer 28

clinda and gent Aspiration pneumonia: oral anaerobe/gram negative coverage

Answer 29

2x/ night for cough if its more then once a week for NIGHT symptoms then poor control for daytime >4

Answer 30

rsv | RSV has been postulated to alter the sensitivity of laryngeal chemoreceptors and reinforce reflex apnea.

Answer 31

malnutrition

Answer 32

malnutrtion

Answer 33

MRI its central

Answer 34

alpha 1 antitrypsin RARE rarely causes lung disease in children, homozygous deficiency of α1-antitrypsin (α-AT) is an important cause of early-onset severe panacinar pulmonary emphysema in adults in the 3rd and 4th decades of life and an important cause of liver disease in children (Chapter 349.5). It has been associated with panniculitis and vasculitis in adults.

Answer 35

alpha 1 Within the first 4 decades of life, liver dysfunction is most prominent and lung issues are less of a concern. Lung involvement is characterized by emphysema. Bronchiectasis can occur in severe deficiency, but onset is later as well.

Answer 36

Spontaneous - likely referring to primary spontaneous other 3 are considered secondary causes of spontaneous pneumothorax, according to Nelson’s. The other major category of pneumothorax is Traumatic. incidence of primary highest in adolescent vs secondayr older in adults. Pre adol rates of both are equal

Answer 37

RSV 0.5 to 1 percent of children and adolescents will experience at least one afebrile seizure by age adolescence (UTD) Incidence increases with decreasing gestational age. Infants born <28 weeks of age virtually all are affected, and it can persistent beyond 37 weeks to 44 weeks GA.

Answer 38

prev intubation others MALE, alcohol/substance/SES Previous severe exacerbation (ICU, intubation) Sudden asphyxia episode (resp failure, arrest) 2+ hospitalizations for asthma in the past year 3+ ED visits for asthma in the past year Use of >2 beta agonist inhalers per month Poor response to systemic corticosteroid therapy

Answer 39

bact pneumonia

Answer 40

MRI - known central central control of breathing, including brain tumors or malformations that impinge on the brainstem (eg, Chiari malformations, achondroplasia, some craniosynostosis syndromes, or osteopetrosis), as well as CNS depressant medications, epilepsy, or infections. Children with Down syndrome and Prader-Willi syndrome are at risk for both CSA and obstructive sleep apnea (OSA).

Answer 41

malnutrition

Answer 42

lung abscess aspiration event, sometimes related to a seizure or underlying neuromuscular disease. Frequently involved microbes are mouth organisms, including Streptococcus and anaerobes; S aureus and gram-negative rods also may be involved. . r/o TB with skin test and acid fast

Answer 43

. Infective exacerbation b. Pulmonary embolism - not at increased risk of PE with CF c. Pneumothorax - <1% of children with CF (Nelson’s) d. Pleurodynia - acute enteroviral illness characterized by fever and paroxysmal spasms of the chest and abdominal muscles

Answer 44

separation GAD- other facets of life affected

Answer 45

02 saturation A normal capillary carbon dioxide level despite persistent respiratory distress is a sign of impending respiratory failure.

Answer 46

ENT consult - best option if PSG option use this

Answer 47

MRI | central

Answer 48

needs ventlin 2x/w Nighttime awakenings Well controlled = ≤1x/month if <12 yo, ≤2x/month if >12yo Pre-exercise use of Ventolin DOES count when assessing control Symptomatic wheeze Well controlled = ≤ 2 days/week (but not more than once in one day) Colds also don’t count in assessment of control

Answer 49

T/A Results in resolution of symptoms in 70-90% of cases. Indications include is T&A is contraindicated, residual disease following removal or major risk factors not amenable to treatment (obesity, hypotonia).

Answer 50

bacterial pneumohnia

Answer 51

decreased compliance Lung injury has numerous consequences including impairment of gas exchange, decreased lung compliance, and increased pulmonary arterial pressure.

Answer 52

no coordination inexpensive. They: decrease the coordination required to use MDIs, especially in young children improve the delivery of inhaled drug to the lower airways minimize the risk of propellant-mediated adverse effects (thrush) MDI: 5s inhalation then 5-10s breathhold. No waiting time between puffs is needed. Young children cannot do this. MDI with spacer and mask: each puff administered with regular breathing for 30s or 5-10 breaths (must maintain tight seal, talking/coughing/crying will blow med out of spacer).

Answer 53

CCAM adenomatoid proliferation of bronchioles resulting in cysts rather than alveoli. Radiographically, a large gas-filled cyst, a conglomerate of gas-filled cysts, or a solid mass (ie, liquid-filled cyst) can be seen. These lesions can cause mass effect with contralateral mediastinal shift. 25% symptomatic with resp distress in newborn period. pulm sequestration - usu LL - A bronchopulmonary sequestration represents a nonfunctioning mass of lung tissue that lacks normal communication with the tracheobronchial tree and receives its arterial blood supply from the systemic circulation. Sequestrations initially appear as solid masses since they do not communicate with the bronchial tree

Answer 54

alpha 1 anti EXCEPT question

Answer 55

low albumin think false neg - dilution or edema things false positive- eczema, ED, FTT, anorexia , (problems wiht SKIN, hpothyroidisim)

Answer 56

risk of emphyesema if he smokes in 20s Early adult-onset emphysema associated with alpha-1-antitrypsin deficiency occurs most commonly with PiZZ gene mutation. Most patient with PiZZ genotype have little or no detectable lung disease in childhood. Smoking greatly increases the risk of emphysema in patients with mutant Pi types.

Answer 57

normal or high C02

Answer 58

height velocity ``` with med/high dose - bone - height velocity - adrenal suppresion refer to endo if >1 month of high dose ```

Answer 59

hold MDI 2 finger appart Shake the MDI; 2. Breath out to the end of a normal breath; 3. Actuate through an open mouth, just after inhalation begins; 4. Breath in slowly over 4 s to 6 s, to full lung volume; 5. Hold breath 5 s to 10 s; and 6. Wait 30 s to 60 s, shake and repeat above steps

Answer 60

b. Cxray r/o pneumonia

Answer 61

pneumothorax <1% The episode may be asymptomatic but is often attended by chest and shoulder pain, shortness of breath, or hemoptysis. A

Answer 62

K hypokalemia from salbutomol, Aminophylline [UTD] Adverse Reactions Central nervous system: Headache, insomnia, irritability, restlessness, seizure Dermatologic: Allergic skin reaction, exfoliative dermatitis Gastrointestinal: Diarrhea, nausea, vomiting Genitourinary: Diuresis (transient) Neuromuscular & skeletal: Tremor **No specific electrolyte abnormalities **Not used routinely because of narrow therapeutic index and wide interpatient variability in clearance of drug

Answer 63

meth challenge

Answer 64

c. overnight oxygen saturation recording best answer ENT ref and Polysomn

Answer 65

idiopthic Drugs: Ecstasy, crack cocaine and marijuana are associated w/ pneumo

Answer 66

add a long-acting beta-2 adrenergic medication Next step: add long-acting beta-agonist (LABA) OR leukotriene receptor antagonist (LTRA) LABA: e.g. fluticasone plus salmeterol (Advair) or budesonide plus formoterol (Symbicort) LTRA: montelukast (singulair)

Answer 67

swet chloride Cystic fibrosis is the most common childhood cause of nasal polyposis and up to 50% of CF patients experience obstructing nasal polyposis,

Answer 68

o2 clinical documentation of vital signs. Pulse oximetry should be used in all patients. Pulsed oxygen saturation (SpO2) of 92% or less on presentation (before oxygen or bronchodilator treatment) is associated with higher morbidity and greater risk for hospitalization

Answer 69

increase responisveness to beta 2 agonist systemic beta2 works less well then inhaled Cromolyn and nedocromil are nonsteroidal anti-inflammatory agents that can inhibit allergen-induced asthmatic responses and reduce exercise induced bronchospasm. According to the NIH guidelines, both

Answer 70

insert chest tube on effected side a pneumothorax is a contraindication to air travel patients who have a chest tube in place with a unidirectional valve (Heimlich valve) for decompression may be able to tolerate air travel when medically necessary prevent deterioration from expansion of the PTX or development of tension PTX.

Answer 71

admit for bcx iv abx use of antibiotics is not recommended unless there is a suspicion of an underlying bacterial infection in this case there is decreased LLL air entry without any wheezing → could be sign of pneumonia Ribavarin not used often - not efficiacious and very expensive and can be toxic to provider

Answer 72

c. FEF25-75 FEF25-75 = flow between 25% and 75% of the vital capacity aka maximal midexpiratory flow rate measures the flow in smaller conducting airways less effort dependent good measure of milder intrathoracic airway obstruction can be reduced by 25% or more even when the patient has no symptoms, normal physical exam, normal FEV1, and normal peak expiratory flow rate

Answer 73

bronch If it states BEST/or appropriate TEST with FB - do BRONCH, if its NEXT then CXR If there is a clear history and chronic cough, even if CXR is normal - still BRONCH In most cases, such patients proceed directly to bronchoscopy without CT. The tracheobronchial tree should be examined in all cases with a moderate or high suspicion of FBA, typically using rigid bronchoscopy so that the object can be safely removed.

Answer 74

a. reduces pulmonary airway resistance Heliox is a mixture of helium (usually 70 to 80 percent) and oxygen (usually 20 to 30 percent). The potential therapeutic effects of heliox relate to its low density and its ability to decrease the proportion of turbulent air flow relative to laminar airflow. The reduction in turbulent flow acts to decrease airway resistance, pleural pressures swings, and dynamic hyperinflation [Up to date] Helium is less dense than Nitrogen, giving heliox replaces N2 with He = decreased gas density = decreased air flow resistance

Answer 75

sleep in same room children must be placed on back to sleep increased risk of SIDS with prone and lateral sleeping sleep positioners increase risk of suffocation maternal smoking and secondhand exposure to smoke increases the risk of SIDS soft bedding like comforters and duvets and bumper pads increase risk of suffocation overheating is another risk factor → if a blanket is needed it should be a thin lightweight blanket room sharing is protective against SIDS, especially in the first 6 months of life where the risk of SIDS is the highest bed sharing, especially in the first four months, increases the risk of SIDS even greater risk if parent smokes, has used alcohol or other drugs, or is overly tired breastfeeding is protective pacifier use is protective - if baby uses a pacifier, they should be given one for every sleep but it does not need to be reinserted if it falls out during sleep

Answer 76

intubate infants who have ongoing or worsening severe respiratory distress despite a trial of HFNC or CPAP, those who have hypoxemia despite O2 supplementation, and those with apnea may require intubation and ventilation signs of impending resp failure in bronchiolitis marked retractions absent or decreased breath sounds poor responsiveness to stimulation fatigue blood gas will often show incr CO2 → >55 mmHg on ABG and >60 mmHg on VBG do not use CO2 as the sole indication for intubation

Answer 77

pneumothorax

Answer 78

bronchiol bx Pharyngeal cobblestoning may be seen in allergic rhinitis OR chronic sinusitis Given presentation of recurrent sinopulmonary infection with chronic sinusitis, immunoglobulins for CVID THEY ARE GETTING AT PCD

Answer 79

a. Is present even if spirometry is normal

Answer 80

malnutrition Low clinical score, low weight percentile, and Pseudomonas cepacia colonization of the lower respiratory tract at the age of 18 years indicated a poor prognosis.

Answer 81

bronch this could be something anatomic → vascular ring, web, tracheal stenosis, foreign body

Answer 82

List 3 criteria used to make the diagnosis of asthma in a preschooler. Documentation of airflow obstruction (wheeze from doc or parent) Documentation of reversibility of airflow obstruction (saba from doc, parent says saba works, or 3 month med ICS by parents work) No clinical evidence of alternative diagnosis

Answer 83

Poor compliance with maintenance medications Incorrect dosing of maintenance medications (ICS) Improper inhaler medication technique Continued exposure to triggers/allergens in the home or environment Exposure to secondhand smoke Poor control of co-morbid conditions, eg obesity, GERD Failure to take prophylactic SABA prior to exercise/activity Poor recognition of symptoms/when to treat (lack of parental/patient education)

Answer 84

``` Oral corticosteroids Oral antifungals (itraconazole) ```

Answer 85

malnutrtion Acute pulmonary exacerbation ABPA Development of CF-related DM Lack of compliance with treatment (pancreatic enzymes, pulmonary therapies) Body image issues with intentional weight loss

Answer 86

``` Poor controlled asthma. List 5 items to assure good controlled asthma Regular follow up Avoidance of triggers Inhaler technique Diagnose and treat co-morbidities Written action plan Spirometry ```

Answer 87

Respiratory failure Blood pressure instability Tachy/bradyarrythmias

Answer 88

``` Daytime somnolence Behavioural issues Mouth breathing/dry mouth Chronic nasal congestion/rhinorrhea Hyponasal speech Morning headaches Poor appetite ``` ``` Name 2 long term consequences Systemic hypertension Pulmonary hypertension Cor pulmonale LVH ```

Answer 89

1) daytime sx more then 4x/w 2) nighttime sx more then 1/w 3) use of saba more hten 4x/w 4) exercise intol 5) missing school 6) FEV1<90% of best 7) freq exacerbations

Answer 90

1) Decreased FEV1/FVC (<0.80) 2) Decreased FEV1, with >= 12% improvement with bronchodilator 3) Decreased FEF 25-75 4) Increased RV 5) Worsening of FEV1 by >=15% with exercise challenge

Answer 91

Interpret the blood gas? Respiratory acidosis What is the diagnosis? symptomatic nocturnal hypoventilation What treatment is the treatment needed for this condition?

Answer 92

Collect sputum C+S; Treat with antibiotics based on most recent sputum cultures (ideally within last 3 months); Use double coverage for pseudomonas (ie: pip-tazo + cipro, ceftaz + tobra) IV; - Can consider oral antibiotics if mild exacerbation with single organism, and with close f/u for response - Ensure optimum nutrition, rest and chest physiotherapy - Mucolytics – ie DNAase - Other inhaled agents – tobramycin, bronchodilators

Answer 93

1) resp sx occur wthin a week of inciditng event 2) bilat opacities on CXR with pulm edema 3) not explained by CHF 4) difficutly with oxygenation

Answer 94

``` Bronchopleural fistula (communication between lung and pleural space) Necrotizing pneumonia (gas-forming bacteria!) Tube malposition Trapped lung (doesn’t re-expand) → Lung entrapment refers to visceral pleural restriction caused by an active process (malignancy, infection or inflammation). ```

Answer 95

Frequent use of bronchodilators history of requiring hospitalizations for asthma exacerbations Previous intubation for asthma exacerbation Recent exacerbation requiring systemic steroids Asthma exacerbation in the past 6 weeks Recent URTI in the last two weeks (but this would be a risk for any kid, but worse in asthmatic. This risk is risk for bronchospasm or laryngospasm; the other options are risks for intraoperative bronchospasm).

Answer 96

``` pseudomonas aeruginosa aspergillus burkholderia cepacia stenotrophomonas maltophilia achromobacter species ```

Answer 97

Carbonaceous sputum, evidence of carbon deposits in the oropharynx or nose Singed facial hair stridor and hoarseness tachypnea, wheezing, crackles or poor air entry upper airway obstruction from airway edema facial burns

Answer 98

allergic aspergillosis (allergic bronchopulmonary aspergillosis = ABPA) investigations to confirm: positive aspergillus skin test elevated total IgE treatment oral corticosteroids +/- oral antifungals if refractory

Answer 99

for asthma