Resp Flashcards
Foreign body aspiration
- Red flags
- Age?
- Invest
Witnessed choking episode
Sudden onset cough
Usually < 3yo
CXR
Rigid bronchoscopy
Complications of foreign body aspiration?
- Recurrent pneumonia
- Bronchiectasis
- Cardiac arrest and death
Brassy/Barking cough
Airway malacia, tracheal compression
“Honking Cough”
Psychogenic Cough
Or tracheomalacia
Wet Productive Cough ddx
Cystic Fibrosis,
Primary Cilliary dyskinesia
Immunodeficiency
Bronchiectasis
- PersistentBacterialBronchitis
- Missed Foreign body
- Chronic Infections
- Asthma +/- AllergicRhinitis
- Recurrent Viral Infections
What on PFT is most specific to small airway dz?
FEF25-75
Clinical sign of CF in infancy?
• Failure to thrive • *Meconium ileus • Recurrent respiratory symptoms – Wheeze,cough,bronchiolitis • *Hyponatremic, hypochloremic metabolic alkalsosis • Prolonged Jaundice • Severe pneumonia
Clinical signs of CF in childhood/adolescence?
• Recurrent respiratory symptoms – Cough,pneuomonia,wheeze poorly controlled asthma etc.. • Failure to thrive • *Recurrent rectal prolapse • Clubbing • *Bronchiectasis • *Nasal polyps/sinus disease • Chronic Pseudomonas aeroginosa colonization
Bugs in CF?
Pseudomonas S.aureus H.flu Burkholderia Cepacia Aspergillus fumigatus
Inheritance of CF?
AR
CFTR gene - chloride channels
Dx of CF?
Gold Standard: Sweat Chloride > 60 mmol/L
[Clin features OR sibling w CF OR +NNS]
+
[Lab evidence of CFTR dysfunction (abnormal sweat test x2days OR 2 CF mutations OR abnormal nasal potential difference)]
Sweat test: false positive
Malnutrition Adrenal insufficiency Hypothyroidism Panhypopituitarism Glycogen storage disease 1 Mucopolysaccharidosis Ectodermal dysplasia Eczema
(malnutrition, Endo or skin)
Sweat test: false negative
Dilutional Edema Hyponatremia Hypoproteinemia Recent mineralocorticoid Insufficient sample
CF management?
- Multidisciplinary Clinic (Nurse,Physiotherapy, Dietician, Social Worker, Psychologist)
Maintain lung function:
- regular chest physio
- treat acute infections w PO/IV
- treat chronic infections w PO/inhaled abx
- mucolytics
Maintain normal nutrition/growth
- high fat/energy diet
- pancreatic enzymes
- vitamin supplemental
- supplements/Gtube
Family Education
CF poor prognostic factors?
Female Malnutrition Decreased FEV1 Burkohlderia Cepacia Pneumothorax Liver diseases Pancreatitis
ABPA
- clin signs
- investigations
- Dx
- Tx
Allergic bronchopulmonary aspergillosis
Rust coloured sputum
not responsive to abx
CXR: new focal infiltrates
DX:
Skin test for aspergillus
IgE elevated
Tx:
Steroids
Itraconazole and Voriconazole
PCD
- Characteristics
- Dx
Year round wet cough
Year round nasal congestion, sinusitis
Recurrent AOM
Bronchiectasis
50% - situs inverses totalis
DX: electron microscopy (nasal curettage or bronchial bx)
or iNO nasal
or genetics
Asthma diagnosis?
FEV1/FVC < 80%
FEV1 Change of 12% w bronchodilator
Asthma control
Day time sx < 4days/week Nighttime sx never Vent use < 4x/week (not incl pre-exercise) Normal physical activity No absence from school Mild, infrequency exacerbations FEV1 or PET > 90% personal best
Methacholine challenge
- +ve: <4 mg/mL
- Borderline: 4-16 mg/mL
- Negative: >16mg/mL
Asthma mgmt (triangle)
1) confirm dx
2) Education, Environmental control
3) Bronchodilator PRN
4) ICS
5) Escalation
ICS dosing
Low dose
12yo: ≤250 mcg/day
6-11 : ≤200 mcg /day
Medium dose
12yo: 251-500 mcg/day
6-11yo: 201-400 mcg /day
High dose:
12yo: >500 mcg/day
6-11 yo: >400 mcg /day
Side effects of ICS?
oral thrush
hoarseness
decreased linear growth on high dose
Escalation of therapy for asthma?
12yo:
Add LABA -> Increase to medium ICS OR add LTRA
6-11yo:
Increase to medium ICS -> Add LABA or LTRA
