Respiratory Flashcards
(219 cards)
1
Q
What is stridor?
A
Stridor is a high-pitched sound due to turbulance air flow in partially obstructed upper airway.
2
Q
True or False: Stridor can occur during both inhalation and exhalation.
A
Mostly it is inspiratory ( above the glottis) but it can cause expiratory if it is at or immediately below the glottis ( Biphasic stridor).
3
Q
Fill in the blank: Common causes of stridor in pediatric patients include __________.
A
Epiglottitis
croup, bacterial tracheitis
foreign body aspiration,
Asthma
4
Q
What is the difference between stridor and wheezing?
A
Stridor is a high-pitched sound associated with upper airway obstruction, while wheezing is a musical sound typically related to lower airway obstruction.
5
Q
True or False: Stridor is a medical emergency that requires immediate intervention.
A
True, especially if it is acute and associated with respiratory distress.
6
Q
What diagnostic tool is commonly used to assess the severity of stridor in pediatric patients?
A
Clinical assessment, including observation of respiratory effort and stridor characteristics.
7
Q
Parts of respiratory systems:
A
8
Q
Most common symptoms of retropharyngeal abscess
A
Stridor
Fever
Difficult swallwing
Hyperextension of the neck
Respiratory distress
9
Q
Retropharyngeal abscess commonly happened to ____ age group, while peritonsillar abscess is seen in ____.
A
<6 Y
Adolescent.
10
Q
How to differentiate between retropharyngeal abscess and peritonsillar abscess clinically.
A
Retropharyngeal abscess cause fever, throat pain, neck stiffness with purulence of retropharyngeal lymphnode, while Pritonsillar abscess cause trismus with fever and the purulence is in tonsillar fossa with diviation to tonsil and uvula.
11
Q
The investigation used for retrosternal abscess diagnosis is:
A
X-ray on the neck
It’s result: Widening of soft tissue, with anterior displacement of air way.
12
Q
What is croup?
Croup = Laryngotracheobronchitis
A
Croup is a respiratory condition characterized by a barking cough, stridor, and difficulty breathing, primarily affecting children.
13
Q
True or False: Croup is usually caused by a bacterial infection.
A
False: Croup is typically caused by a viral infection.
parainfluenza virus
14
Q
What age group is most commonly affected by croup?
A
Croup most commonly affects children aged 6 months to 3 years.
15
Q
What are the classic symptoms of croup?
A
The classic symptoms of croup include a barking cough, stridor, hoarseness, and respiratory distress.
Stridor maybe inspiratory or Biphasic
Barking cough = brassy cough
16
Q
Typical croup is maily ____ diagnosis
A
clinical
radiography is not necessary
17
Q
How clinically could differentiate between mild, moderate and sever croup.
A
Mild»_space; cough mainly
Moderate»_space; cough, stridor and moderate RD.
Sever»_space; Stridor at rest with sever signs of RD.
18
Q
What is the mainstay treatment for mild croup?
A
The mainstay treatment for mild croup is
symptomatic management, including warm moist humidified air.
with oral dexamethasone if needed.
Parents should be advice to observe the child closely at home for signs of increasing severity.
19
Q
What medication is commonly used for moderate to severe croup?
A
Dexamethasone.
+ adrenaline nebulizer
20
Q
The complete treatment of sever croup is:
A
- Adrenaline nebulizer ( racemic epinephrine).
- Humidified O2.
- Steroids (Dexamethasone, budesonide).
- Intubation & MV in very sever cases.
- Observation for 3-4 h.
Adrenaline is rapid and transient improvement ( short duration of action).
Observation to avoid rebound phenomenon.
21
Q
Multiple Choice: Which of the following is NOT a treatment option for croup?
A) Dexamethasone
B) Antibiotics
C) Cool mist
D) Nebulized epinephrine
A
B) Antibiotics
22
Q
What should be monitored in a child with severe croup?
A
Respiratory effort and oxygen saturation.
23
Q
Fill in the blank: Parents should seek immediate medical attention if a child with croup shows __________.
A
Severe croup :signs of respiratory distress or stridor at rest.
sever croup
Dexamethasone+Adrenaline nebulizer with humidified O2
24
Q
Respiratory distress symptoms are:
A
- Mild» Increase RR ( Tachypnea).
- Moderate»_space; Tachypnea+ Accessory respiratory ms contractions.
- Sever»_space; Tachypnea + accessory respiratory ms contractions + Grunting.
25
Types of steroids used in croup?
* Dexamethasone (Oral or injection).
* Budesonide nebulizer
26
What is the typical onset pattern of croup symptoms?
Croup symptoms often begin at night with a sudden onset.
27
What is the primary cause of stridor in croup?
Swelling of the upper airway due to inflammation.
28
Multiple Choice: Which of the following is a common complication of croup?
A) Pneumonia
B) Asthma
C) Otitis media
D) All of the above
A) Pneumonia
29
What non-pharmacological method can help relieve croup symptoms?
Using a cool mist humidifier.
30
Fill in the blank: Croup is often preceded by __________ symptoms.
upper respiratory
31
What is the significance of the 'steeple sign' on an X-ray?
The 'steeple sign' indicates subglottic narrowing typical of croup.
32
Indication of admission in croup patient.
* Age <6 m.
* Significant respiratory distress.
* Stridor at rest.
* Hypoxia.
* Inability to feed/ drink.
* Requiring 2 or more nebulized racemic epinephrine.
33
The most common diagnostic criteria for Epiglotitis are:
1-7 Years of age, Hot potato voice with drooling saliva and usually no cough
## Footnote
It is Bacterial infections with staph or strept.
34
The commonest diagnostic differences in diagnosis croup from bacterial tracheitis.
* Croup is a viral infection (by Parainfluenza or RSV), while tracheitis is a bacterial infection ( staph or polymicrobial).
* Croup patients from 3m-3y of age, but tracheitis is 5-8yrs of life.
* Cough associated with croup is seal-like barking, while it is productive with thick sputum in Tracheitis.
* Croup patient has hoarse voice without drpooling saliva, while tracheitis has normal and can complicated with drooling saliva.
35
Which is the most common cause of chronic inspiratory stridor in neonatal period?
Laryngomalacia.
## Footnote
75%
36
Laryngomalacia means:
Laryngomalacia is a congenital abnormality of the larynx cartilage that leads to intermittent airway obstruction and stridor, particularly in newborns.
37
What is clinical features of laryngomalacia that differentiate it from other causes of chronic stridor?
* Exacerbated by crying or feeding
* Placing the patient in a prone position with the head elevated improves the stridor
* Supine position worsens the stridor
38
How to diagnose tracheomalacia?
1. Clinicaly: Typical inspiratory noises (worsen in supine position)with normal growth and development.
2. Laryngoscopy (Flexible) or bronchoscopy.
39
What type of laryngoscopy is used in laryngomalacia diagnosis and when to ues?
Flexible laryngoscope.
If moderate to severe obstruction, difficulty feeding and breathing, unable to gain weight
40
As treatment, laryngomalacia is usually ________, improves with ____, just need
_______________
Benign and self limiting
the age of 1-2Y
careful observation and growth monitoring
41
When surgical treatment take place in laryngeomalacia treatment?
Sever cases not improved with time
Operation: Supraglottoplasty.
42
What is the vascular ring?
A vascular ring is a congenital defect that occurs when the aorta or its branches form an abnormal ring around the trachea (the airway) and esophagus (the food pipe).
## Footnote
chromosome 22p11 deletion
43
Common presented symptoms with vascular ring:
Stridor with noisy breathing that not change with posistion or bronchodilators.
44
What is the diagnostic tool for vascular ring and which is the best one?
CXR
Echocardiogerphy
Barium study
MRI and CT scan ( The best ).
45
Diagnosis?
Vascular ring.
46
The only treatment for vascular ring is:
Surgical intervention
47
When patient developed whoop after repeated attack of cough this is:
Pertussis
48
Patient with cough all day but never during sleep, we consider ____, althought the night cough is caused by:
Psychological or habit.
Sinusitis or asthma.
49
Cough which is accompanies eating or drinking, we search for:
Aspiration
GERD
Tracheoesophageal fistula
50
When the cough is seasonal you think about ____ or ____, while if it is productive it is:
Asthma, Allergic rhinitis
Infection- Bronchiectasis
51
When cough is associated with FTT and last >6 weeks, you should search for ____.
Cystic fibrosis.
52
Chronic cough > ____ w should do imaging studies.
3
## Footnote
Sweat test for CF
Spirometry for asthma
CBC
53
Rhinorrhea is common in __________, whereas a rash, abdominal pain and headache may suggest a ____________.
Acute viral pharyngitis
bacterial infection.
54
Which drug is useful in reduce rhinorrhea with common cold?
First generation antihistamine.
## Footnote
Second generation antihistamine** not **helpful
55
How to differentiate between LLergic rhinitis and common cold?
Allergic rhinitis is associated with itching and sneezing.
56
Unilateral foul smelling secretions is sign of:
Nasal foreign body
57
Sinusitis as a complication of common cold is contain:
* Fever
* facial pain
* periorbital edema
* persistence of rhinorrhea >14 days.
## Footnote
* Change in color or consistency does not indicate sinusitis.
* Elevated WBC does not indicate bacterial super infection.
58
Which respiratory part affected in acute bronchiolitis?
Lower respiratory tract viral infection. (Bronchioles)
59
The most common organism cause lower respiratory tract infection in 2 yrs of age and younger is:
| Viral bronchiolitis
RSV
## Footnote
Responsible for more than 50% of acute bronchiolitis
60
The 2nd most common organism cause viral bronchiolitis is:
Human meta-pneumovirus.
## Footnote
Other viruses are: Parainfluenza virus- Adenovirus- Influenza- Rhinovirus –Mycoplasma.
61
Interperitate and give possible diagnosis.
An A-P chest X-ray shows the typical bilateral perihilar fullness of bronchiolitis and hyperventilation in the peripheral lung areas resulting from air-trapping. The left lung is more affected than the right one.
Diagnosis: RSV bronchiolitis.
62
Which is the earliest and most sensitive vital sign change in acute bronchiolitis?
Tachypnea.
63
In premature young infant <2yrs, is mostly to developed _____ accompained with acute bronchiolitis .
Apnea
## Footnote
Late respiratory distress symptom that need hospitalization.
Any patient <6m with respiatory destress symptome should be hospitalization.
64
Peak or the worst symptoms of acute bronchiolitis on day ____ of
illness
3-4
65
Typical acute bronchiolitis is diagnosed mostly ____.
Clinically, No need for x-ray of further investigation.
66
How you deal with acute bronchiolitis child ?
1. Assessment the degree of severity according to: RR, work of breathing, and hypoxia.
2. Mainstay ot ttt is supportive ( O2, Hydration, Frequent nasal suctioning).
67
Role of bronchodilators and systemic steriods in acute bronchiolitis.
should be avoided exceot in recurrent wheezing babies.
68
What is the prophylactic treatment of RSV bronchiolitis, and when to give?
Palivizomab, givin monthly to the high risk infants and children during the active season ( winter).
69
Enumerate the acute bronchiolitis high risk patient should receive RSV Immunoprophylaxis.
1. Infants and children < 24 m of age with chronic lung disease of prematurity.
2. Infants born at < 29 weeks in their 1st winter.
3. children < 24 m of age with hemodynamically significient cyanotic and a cyanotic congenital heart disease.
## Footnote
In (3)>> should be still suffer from it.
70
Which patient discribed to be chronic lung disease of prematurity?
Every infant born at < 32 weeks of gestation which required of O2 for > 28 days.
71
Interperitate, and give diagnosis.
P-A CXR image demonistrate consolidation in the right middle lobe, which silhouettes the right heart border (big arrow ).
Diagnosis : Right middle lobe pneumonia.
72
The main common causitive organisms of pneumonia are:
1. Streptococcus pneumoniae (MOST COMMON).
2. Chlamydia trachomatus.
3. RSV.
4. Parainfluenza.
5. Bordertella pertussis.
6. Mycoplasma pneumonia.
73
Normally school age patient comes with this CXR it its mostly ____, caused by ________, and treated by ____.
Pneumonia
Mycoplasma pneumonia
Azethromycin or Microlid
74
Clinical presentation of pneumonia in children.
1. Fever.
2. Tachypnea.
3. Respiratory distress.
4. Retractions.
5. Wheezing.
6. Dullness to percussion
75
Auscultatory findings of pneumonic child are:
* Wheezes.
* Crackles.
* Decreased breath sounds.
* Bronchial breathing.
76
Bacterial pneumonia should excluded when:
Absence of fever, tachypnea, increased work of breathing, and auscultatory abnormalities.
77
The most sensitive and specific sign of pneumonia is:
Tachypnea.
78
Define tachypnea in pediatrics.
* >50 breaths/min at 2 to 12 months of age
* >40 breaths/min at 1 to 5 years
* >20 breaths/min for those older than 5 years
79
Diagnosis of pneumonia is purely ____, except in some cases may need ____.
clinical
CXR
80
Role of X-Ray in pediatric pneumonia?
* It not changes clinical management for most children who are being treated as outpatients.
* Helpful in:
1. complicated pneumonia is considered.
2. Fever is prolonged or any worsening.
3. No obvious source of infection.
* Not used in follow up.
## Footnote
CXR always lag the clinical response so it not used as follow up investigation.
81
In order, give the investigation could help in pediatric pneumonia diagnosis.
purely it is clinically by symptoms and signs ( in uncomplicated cases).
But may need:
* CXR
* Blood culture ( study of choice after CXR).
82
How to manage outpatient un complicated pediatric patient?
High dose of Amoxicillin 80-90mg/kg/day
83
Which is the 2nd line after Amoxicillin resistent for pediatric pneumonic patient?
Augmentin or oral cefuroxime
84
Main indication for hospitalization in pneumonic patient are:
1. Age <6 m.
2. Unresponsive to outpatient therapy within 48 h.
3. Suspected sepsis and Toxic appearing Hypoxemia (under 90%).
5. Inability to drink.
6. Severe dehydration.
7. Complicated with empyema and pleural effusion.
85
Inpatient treatment of pediactric pneumonic patient.
* Administer IV fluids and oxygen
* Antibiotic: Cefuroxime, Cefotaxime.
* Clindamycin or vancomycin ( staph)
86
Life threatening complication of forein body aspiration is:
obstruction of upper airway
which can lead to asphyxia
87
Which is the most common site t foreign bodies are stuck, and why?
Right bronchus as it wider and more straight with main bronchus than left.
88
Most common age of foreign body aspiration is ____, which diagnosed by ____ and confirmed by ___.
children <3Y
History
CXR
89
Interperitate this picture of 2Y boy came to emergency with sudden onset of continuous crying, what possible diagnosis and managment.
P-A chest x-ray showed hyperinflation of right lung with left mediastinal sheft.
Diagnosis: Foreign body aspiration.
Treatment: RIGID bronchoscopy and foreign body removal.
90
15 month-old girl was admitted to the hospital because of pneumonia and respiratory distress, on the 3rd day of admission she become toxic,grunting, tachypneic, tachycardic, requiring more oxygen, and lung sound is less audible on the right lung field.
Interperitate and give diagnosis.
Chest x-rays image shows blunting of the costophrenic and cardiophrenic angles with fluid within the horizontal fissure (white arrows).
Compression-atelectasis of the right lung
and mediastinal shift away from the effusion (black arrows).
Final Diagnosis: Right sided pleural effusion
91
When pleural effusion developed?
Pleural fluid accumulates when pleural fluid formation exceeds pleural fluid absorption.
92
Give the 2 types of pleural effusion.
Exudative and transudative
93
Explane the Transudative pleural effusion formation.
Occurs due to increased hydrostatic pressure or low plasma oncotic pressure.
94
Why exudative pleural effusion develope?
After pnemonia or any other inflammation >> increased capillary permiability.
95
Common investigations used fo pleural effusion diagnosis.
* US.
* CXR ( loss of costophrenic angle).
* CT.
96
True or False: Transudative effusions are typically associated with infections.
False: Transudative effusions are usually not associated with infections; they are more related to systemic conditions.
97
Which of the following conditions is commonly associated with transudative pleural effusion?
A) Pneumonia
B) Congestive heart failure
C) Tuberculosis
B) Congestive heart failure
98
Fill in the blank: The primary diagnostic tool for distinguishing between transudative and exudative pleural effusions is _____ analysis.
pleural fluid
99
What is the primary laboratory test used to differentiate transudative from exudative effusions?
Light's criteria
100
True or False: A pleural effusion with a high protein content is likely to be transudative.
False: A pleural effusion with a high protein content is likely to be exudative.
101
What is the main characteristic of exudative pleural effusions regarding protein concentration?
Exudative pleural effusions have a pleural fluid protein concentration greater than 3 g/dL.
102
In pediatric patients, which type of pleural effusion is more commonly observed: transudative or exudative?
Exudative pleural effusion is more commonly observed in pediatric patients.
103
What is a common cause of exudative pleural effusion in children?
Common causes include pneumonia, malignancy, and tuberculosis.
104
Fill in the blank: According to Light's criteria, a pleural effusion is considered exudative if the pleural fluid protein level is greater than _______ g/dL.
3.0
105
List the three main criteria used in Light's criteria.
1) Pleural fluid protein to serum protein ratio > 0.5.
2) Pleural fluid LDH to serum LDH ratio > 0.6.
3) Pleural fluid LDH > two-thirds the upper limit of normal serum LDH.
106
What is the significance of a pleural fluid LDH level greater than two-thirds of the upper limit of normal serum LDH according to Light's criteria?
It indicates an exudative pleural effusion.
107
Multiple Choice: Which of the following is NOT a part of Light's criteria?
A) Pleural fluid protein level
B) Pleural fluid glucose level
C) Pleural fluid LDH level.
B) Pleural fluid glucose level
108
True or False: A pleural effusion is classified as transudative if it meets one of Light's criteria.
False
109
Short Answer: What does a pleural fluid LDH to serum LDH ratio of less than 0.6 suggest?
It suggests a transudative pleural effusion.
110
Fill in the blank: Light's criteria are primarily used in the diagnosis of _______ pleural effusions.
exudative
111
True or False: Light’s criteria is 100% right in it’s result diagnosis.
False, 25% misidentify transudates as exudates.
112
Which is the parameter that could diagnose clinically suspected transudate with positive light criteria?
Protein gradient ( Protein in serum-Protein effusion)
If it is > 3.1g/dl >> Transudate.
113
Which is the most common cause of pleural effusion in pediatric patient?
HF.
114
Enumerate indication of thoracocentesis in patient with Pleural effusion due to HF.
* Unilateral.
* Fever.
* Persistence despite therapy.
115
2nd most common cause of exudative pleural effusion in pediatric is:
Malignancy ( lung- breast- Lymphoma).
116
Empyema criteria for clinically diagnosed pleural effusion are:
1. Presence of visible pus in the pleural space.
2. Positive gram stain/ culture from fluid.
3. Pleural fluid glucose < 60 mg/dl
4. Pleural fluid pH < 7.2 or < 7.
5. loculated pleural fluid.
6. LDH in pleural fluid > 1000 U\L.
117
If empyema is suspected what should do?
Drainage is required by chest tube or video assisted thoracoscopy.
118
Interperitate, and what is the diagnosis?
Right sided pneumothorax, mediastinal shift and compression atelectasis of the right lung (small white arrows).
contanuous diaphragm sign of pneumoperitoneum is seen ( small black arrow)
Final diagnosis: Rt sided tension pneumothorax and pneumomediastinum.
119
Which is the most reliable sign of tension pneumothorax?
Depression of a hemidiaphragm.
120
Enumerate causes of pneumothorax.
| Types of pneumothorax.
1. Primary spontaneous pneumothorax.
2. Secondary pneumothorax:
* Trauma
* loud music ( air pressure).
121
Define primary spontaneous pneumothorax.
* Occurs without trauma or underlying cause
* More frequently in tall, thin male, thought to have subpleural bleb.
* Smoking.
* Family history is positive in many patients.
122
Clinical picture of tention pneumothorax is:
* Hypoxemia.
* Dyspnea.
* Cyanosis.
* Shift of mediastinum to opposite side.
123
When to use chest tube in pneumothorax?
* If >5% (3cm)of pneumothorax or collapse.
* If pneumothorax is recurrent or under tension.
124
Management of the small pneumothorax is:
Oxygen and observe
if <5 % may resolve spontaneously
125
Define pulmonary abscess.
Cystic area due to necrotic lung tissue at least 2 cm in diameter.
126
What is the main causes of pulmonary abscess?
1. Primary causes: Aspiration or infection.
2. Secondary causes:
* Dysphagia in Developmental delayed patient.
* Poor airway protective reflexes.
* Poor airway clearance from neuromuscular weakness.
127
Which is the most common causitive organism of pulmonary abscess?
Staphylococcus.
128
CXR finding in pulmonary abscess.
Air fluid level.
129
Treatment of pulmonary abscess.
* **Clindamycin** is a good choice until culture and sensitivity is available.
* 2-3 weeks IV antibiotics.
* Followed by oral course for 4-6 weeks.
130
What lung sequestation means?
It is congenital pulmonary malformation consist of non functioning primitive tissue dose not communicate with tracheobronchial tree, has a specific blood supply.
## Footnote
Mainly Lt sided.
131
How pulmonary sequestration patient come to hospital?
Chronic cough, Recurrent pneumonia and Respiratory distress
132
Investigation of choice for pulmonary sequestration.
CT scan with contrast.
133
Treatment of pulmonary sequestration.
Surgical removal as the remnant parts could be malignent.
134
CPAM is :
Congenital pulmonary airway malformation.
135
What is the difference between CPAM and pulmonary sequestration?
* CPAM is more common than pulmonary sequestration.
* CPAM communicate with the proximal airway wherase pulmonary sequestration not connected to tracheobronchial tree.
* CPAM supplies by pulmonary artery and drai into pulmonary vein while pulmonary sequestration supplies by branch of aorta with systemic drainage or pulmonary drainage.
136
Enumerate common associated anomalies with CPAM.
* CV anomalies.
* Renal hypoplasia.
* Chromosomal abnormalities.
137
Enumerate common anomalies assoviated with pulmonary sequestration.
* Cardiac anomalies
* Diaphragmatic hrnia
* Gastric duplication
138
What is the other names of Primary ciliary dyskinesia?
Immotile ciliary syndrome.
Kartagener syndrome.
139
What is Kartagener syndrome?
A genetic disorder characterized by a triad of symptoms: situs inversus, chronic sinusitis, and bronchiectasis.
140
True or False: Kartagener syndrome is caused by defects in cilia.
True
141
Fill in the blank: Kartagener syndrome is a type of __________ disorder.
primary ciliary dyskinesia
142
Enumerate the main symptoms of primary ciliary dyskinesia.
* Chronic, year-round, productive coug.
* Broncheictasis.
* Chronic sinusitis and nasal polyposis.
* Chronic otitis media.
* Male infertility.
* Neonatal hydrocephalus.
* Situs inversus totalis.
143
A 5-month-old baby boy suffers from recurrent pneumonias. A recent chest XRAY is attached below. What is the main diagnosis and which findings is likely to occur?
Dextrocardia.
Kartagener syndrome.
Infertility.
144
What are the three main symptoms of Kartagener syndrome?
Situs inversus, chronic sinusitis, bronchiectasis.
145
What does situs inversus refer to in the context of Kartagener syndrome?
A condition where the major visceral organs are reversed or mirrored from their normal positions.
146
True or False: Individuals with Kartagener syndrome have an increased risk of respiratory infections.
True
147
What is the primary cause of the symptoms in Kartagener syndrome?
Defective ciliary movement due to mutations in genes responsible for cilia structure and function.
148
The gold standard test for diagnosis of primary ciliary dyskinesia is:
Nasal mucosal biopsy >> search for structural defects in cilia.
## Footnote
It shows Low nasal NO level.
149
Multiple Choice: Which of the following tests can help diagnose Kartagener syndrome?
A) Blood test
B) Ciliary motility assessment
C) Skin test
D) Urinalysis
B) Ciliary motility assessment
150
What is the main treatment approach for managing symptoms of Kartagener syndrome?
Symptomatic treatment with strategies to enhance mucociliary clearance, including:
* Postural drainage.
* Percussion vests.
* Positive expiratory pressure devices.
151
True or False: Kartagener syndrome is inherited in an autosomal dominant manner.
False
## Footnote
AR
152
Fill in the blank: Patients with Kartagener syndrome may also experience __________, which is the abnormal placement of the heart.
dextrocardia
153
What is cystic fibrosis?
A genetic disorder( AR) that affects the respiratory, digestive, and reproductive systems due to mutation on the long arm of chromosomme 7.
154
What is the most common life shortening AR disease?
Cystic fibrosis.
155
True or False: Cystic fibrosis is caused by a mutation in the CFTR gene.
| CFTR: cystic fibrosis transmembrane regulator protein.
True
156
Fill in the blank: The most common mutation associated with cystic fibrosis is ___.
F 508 deletion.
157
What are common symptoms of cystic fibrosis in pediatric patients?
Chronic cough, frequent lung infections, difficulty gaining weight, and salty-tasting skin.
158
Why cystic fibrosis patient comes with salty-testing skin?
Dysfunction in the CFTR gene ( no cl- absorbtion by it’s channels) that prevents salt on the skin from being reabsorbed into the sweat glands.
159
Multiple Choice: Which of the following is NOT a common complication of cystic fibrosis?
A) Diabetes
B) Liver disease
C) Hypertension
C) Hypertension
160
What is the primary method of diagnosing cystic fibrosis in children?
Sweat test to measure chloride levels.
161
True or False: Cystic fibrosis can be cured with medication.
False
162
What type of therapy is commonly used to help clear mucus from the lungs in cystic fibrosis patients?
Chest physiotherapy.
163
Fill in the blank: Cystic fibrosis primarily affects the ___ glands.
Exocrine
164
Multiple Choice: Which of the following treatments is often used for managing cystic fibrosis?
A) Antibiotics
B) Antidepressants
C) Antihistamines
A) Antibiotics
165
What role does nutrition play in the management of cystic fibrosis?
Proper nutrition is crucial for growth and maintaining weight due to malabsorption.
166
True or False: Cystic fibrosis affects only the lungs.
False
167
What is the life expectancy range for individuals with cystic fibrosis?
Approximately 30 to 40 years, but it varies.
168
Fill in the blank: The enzyme replacement therapy for cystic fibrosis is aimed at supplementing ___ enzymes.
Pancreatic
169
What is the purpose of CFTR modulators in cystic fibrosis treatment?
To improve the function of the defective CFTR protein.
170
How cystic fibrosis patients come?
| Clinical presentation.
* Sexual development is typically delayed 2-3 years.
* Delayed time to conception
* Azoospermia
* Sexual function is unimpaired
* DIOS (Distal Intestinal Obstruction Syndrome).
* Rectal prolapse
* Nasal polyps: Are most prevalent in the 2nd decade of life
* Biliary cirrhosis 2-3% of cases
* IDDM: CFRDM (cystic fibrosis related diabetes mellitus)
171
What is the gold standard of cystic fibrosis?
Sweat chloride
## Footnote
To confirm it should :
* >40 less 6 months of age.
* >60meq/L more 6 months old.
172
Newborn screening test for cystic fibrosis is ____.
Immunoreactive trypsinogen.
173
Possible diagnostic tools in cystic fibrosis patient are:
* Immunoreactive trypsinogen ( Newborn screening).
* Sweat chloride.
* DNA testing.
* Pancreatic function testing.
174
Possible lines of treatment in cystic fibrosis?
- Pancreatic enzyme supplements
- Multivitamins (including fat-soluble vitamins)
- Bronchodilators
- Hydrating agents (7% hypertonic saline)
- Mucolytics (DNase)
- Nebulized, inhaled, oral, or intravenous antibiotics
175
What should we do in acute exacerbation of CF?
- Hospital admission and Antimicrobial (oral and inhaled)
- IV antibiotics + Anti-inflammatory medications + Nutritional support
176
____% of cystic fibrosis patients develop Allergic bronchopulmonary aspergillosis (ABPA) which is present with ____ , diagnosed by labs as ____
15%.
respiratory distress.
IgE and eosinophalia.
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First line
treatment for ABPA includes:
systemic steroids along with
antifungals.
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Pathophysiology of OSA
Obstructive apnea occurs when the muscles that support the soft tissues in your throat, such as your tongue and soft palate, temporarily relax.
179
Common risk factors and associated conditions:
- Adenotonsillar hypertrophy.
- Obesity
- Craniofacial abnormalities, specifically midface hypoplasia and micrognathia
- Hypotonia e.g. Down syndrome
- Cerebral palsy.
180
What is the most common risk factor to OSA?
Adenotonsillar hypertrophy.
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Enumerate most clinical presentation of OSA .
- Loud nightly **snoring** with observed apnea spells
- Chronic mouth breathing with chronic nasal congestion
- Sleeps in an abnormal position with the neck extended
- Morning headaches
- Excessive daytime sleepiness is more common among older children.
- Mood changes
- ADHD-like symptoms
- Nocturnal enuresis
182
Best managment to OSA is:
1. screen for snoring.
2. Polysomnography.
3. Adeno-tonsillectomy is the first line of therapy.
4. Non invasive positive airway pressure.
183
The diagnostic test of choice for OSA is:
Polysomnography.
184
What is the most common association of SIDS?
GERD.
185
The second most common association of SIDS is:
Seizure.
186
3rd most common association of SIDS:
RSV and Pertussis.
187
True or False: SIDS is a leading cause of death in infants between 1 month and 1 year old.
True
188
Fill in the blank: The exact cause of SIDS is ______.
unknown
189
Which sleeping position is recommended to reduce the risk of SIDS?
Placing the baby on their back
190
What is one risk factor associated with SIDS mostly in winter?
Parental smoking
191
Multiple Choice: Which age group is most affected by SIDS?
A) 0-1 month
B) 1-3 months
C) 3-6 months
D) 6-12 months
B) 1-3 months
## Footnote
Lack-immunization.
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What is one gestational factor that can increase the risk of SIDS?
Pregnancy complication ( placenta previa, abruption)
193
Fill in the blank: The use of a _______ is not recommended for infants to sleep on due to SIDS risk.
soft mattress
194
What does the acronym ABC stand for in safe sleep practices?
Alone, on their Back, in a Crib
195
True or False: SIDS rates have decreased in recent years due to increased awareness and safe sleep practices.
True
196
What is one potential protective factor against SIDS?
Using a pacifier during sleep and naptime
197
Multiple Choice: Which of the following is NOT a recommendation for reducing SIDS risk?
A) Sleep on the back
B) Use a firm sleep surface
C) Share a bed with parents
D) Keep the crib free of soft objects
C) Share a bed with parents
198
What is the role of prenatal care in SIDS prevention?
To identify and address risk factors before the baby is born.
199
Fill in the blank: SIDS is sometimes referred to as _______.
crib death
200
Male, low birth weight or even premature baby should givin more attention in his 1st year of aga as these characters are increase risk of ____
SIDS.
201
What does BRUE stand for?
Brief Resolved Unexplained Event
202
Explane BRUE.
B: Brief:< 1 min usually 20-30 sec..
R: Resolved >> normal physical exam.
U: Unexplained >> diagnosis of exclusion.
E: Event >> Altered colour, breathing, response or tone.
203
What is the most common events in BRUE.
* pale or cyanosed.
* Altered breathing or apnea.
* Decrease response.
* Hypotonic or Hypertonic.
204
True or False: BRUE is a diagnosis for infants under one year of age.
True
205
Which of the following is NOT a symptom of BRUE?
a) Apnea
b) Altered responsiveness
c) Seizures
c) Seizures
206
What is the typical age range for infants experiencing BRUE?
Under 1 year of age
207
Fill in the blank: BRUE is characterized by a sudden change in ____ and ____ in infants.
breathing; responsiveness
208
What are the two categories of BRUE based on risk factors?
Low-risk and High-risk
209
List one high-risk factor that could categorize a BRUE as high-risk.
Age less than 60 days
210
True or False: Infants with BRUE should always undergo extensive testing.
False
211
What is the recommended management for a low-risk BRUE?
Observation 1-4 hrs
and reassurance with follow up <24 hrs.
212
Which condition must be ruled out when diagnosing BRUE?
Underlying medical conditions
213
Differential diagnosis of BRUE.
* Airway obstruction
* Laryngospasm.
* Reflux
* CHD.
* Arrhythmia.
* Infection.
* Sepsis.
* Hypoglycemia.
* Metabolic disorder.
* Toxins.
214
True or False: BRUE events are typically long-lasting.
False
215
What type of follow-up is suggested for infants who have experienced a BRUE?
Routine pediatric follow-up
216
Multiple choice: Which of the following is a common outcome after a BRUE episode?
a) Neurological damage
b) Resolution of symptoms
c) Chronic illness
b) Resolution of symptoms
217
True or False: For diagnosis BRUE must meet all criteria.
True.
218
The common red flags for BRUE are:
* <60 days old.
* Born at <32/40 w.
* >1 Episode
* Abnormal history or examination.
* Significient PMH.
* Unwell child.
* Feeding difficulties.
* FH sudden death.
* Social concerns or NAI.
219
BRUE is previously called:
ALTE.
