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My Peds Prep > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

What 3 things should you consider for wheezing besides asthma?

A
  1. Foreign Body Aspiration
  2. Swallowing Dysfunction
  3. Bronchiolitis
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2
Q

What is the mneumonic for wheezing besides asthma?

A
  1. Aspirated drinks
  2. Babies with kinks
  3. Swallowed thinks (things)
  4. Vascular rinks (rings)
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3
Q

Who are aspirated foreign bodies more common in?

A

Older children who are mobile (still consider this in an infant)

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4
Q

Who is foreign body aspiration seen most commonly in?

A

Infants and toddlers

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5
Q

What other groups besides infants and toddlers may you see foreign body aspiration in?

A

A child with developmental disability or any child with CNS depression

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6
Q

In what time frame do most foreign body aspirations manifest in?

A

24 hours

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7
Q

What is the classic triad for foreign body aspiration?

A
  1. Cough
  2. Wheeze
  3. Decreased breath sounds
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8
Q

What things do infants and toddlers typically aspirate?

A

Food (especially hot dogs and popcorn)

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9
Q

What things objects do older children typically aspirate?

A

Objects

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10
Q

What are the clues for foreign body aspiration (whether or not they mention asthma history, signs of croup, ect.)?

A

Unlabored breathing with nonproductive cough with an expiratory wheeze heard best on the right side. History of cough of sudden onset.

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11
Q

In what % of cases of foreign body aspiration is there no recollection of an actual aspiration?

A

Nearly 50%

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12
Q

What are things to look for on CXR with foreign body aspiration?

A

Radiopaque object usually at right main stem bronchus. Hyperexpansion of one hemithorax in both inspiratory and expiratory films.

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13
Q

With foreign body aspiration what are radiographs confirmed with?

A

Bronchoscopy (this is how FB is retrieved anyways)

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14
Q

1 year old with acute onset of coughing and right sided expiratory wheeze… best test to confirm suspicions?

A

Airway fluoroscopy (in a 1 year old, most likely FB is food which is radiolucent and you can’t get a 1 year old to do inspiratory/expiratory films)

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15
Q

What should be suspected in an infant with recurrent wheezing that increases with feeding and neck flexion?

A

Vascular rings, bronchogenic cysts, tracheal stenosis, double aortic arch (can cause external tracheal or esophageal compression)

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16
Q

What are symptoms of things that cause vascular compression?

A

Recurrent wheezing (increases with feeding and neck flexion), stridor, dyspnea during feeding

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17
Q

What is the diagnosis of things causing vascular compression (like a vascular ring) best confirmed by?

A

Barium swallow study

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18
Q

Infant with recurrent coughing associated with wheezing… underlying problem?

A

Swallowing dysfunction

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19
Q

How do you confirm diagnosis of swallowing dysfunction?

A

Barium swallow study with video fluoroscopy

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20
Q

What are some treatment options for kids with swallowing dysfunction?

A
  1. Thickened feedings
  2. Feeding therapy
  3. G-tube
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21
Q

What is present when a patient is incapable of compensating for the effects of respiratory compromise?

A

Respiratory failure

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22
Q

What is more important in evaluation of respiratory failure than any lab value?

A

Respiratory effort

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23
Q

Name 3 signs of respiratory distress?

A
  1. Tachypnea
  2. Retractions
  3. Pulsus paradoxus
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24
Q

Name late signs of respiratory distress which indicate respiratory failure and need for intubation.

A
  1. Hypoxemia
  2. Grunting
  3. Agitation
  4. Decreased mentation
  5. Poor tone
  6. Cyanosis
  7. Signs of fatigue
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25
Q

If you are presented with a patient with an underlying neurological disorder who is in respiratory distress, what is the likely correct choice regarding management?

A

Elective intubation

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26
Q

Name some congenital malformations of the lower airway.

A
  1. Pulmonary sequestrations
  2. Bronchogenic cysts
  3. Congenital adenomatoid malformations
  4. Congenital lobar emphysema
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27
Q

How do congenital malformations of the lower airway present?

A

Recurrent respiratory symptoms (or just incidental findings on CXR)

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28
Q

What is typical treatment for congenital malformations of the lower airway?

A

Surgical removal

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29
Q

If you have a patient with clubbing of the fingers or toes, which 4 things should you consider?

A
  1. Cyanotic heart disease
  2. Chronic lung disease
  3. Cirrhosis of the liver
  4. Familial trait (with absence of other disorders)
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30
Q

What is the official term for digital clubbing?

A

Hypertrophic pulmonary osteoarthropathy

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31
Q

What is the first thing to do in deciding whether to intubate?

A

Assess respiratory effort

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32
Q

The difference in blood pressure during inspiration and expiration should not be greater than…?

A

10mmHg

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33
Q

What is pulsus paradoxus?

A

Difference in blood pressure during inspiration and expiration that is greater than 20mmHg

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34
Q

What does pulsus paradoxus suggest?

A

Pulmonary or cardiac problems

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35
Q

True or False: In assessing a child in respiratory distress, obtaining an ABG and lab work is the first thing to do

A

FALSE… assess airway (A of ABCs)

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36
Q

What is the best way to assess and confirm respiratory distress?

A

Watch for signs of anxiety (sweating and/or tachycardia)… respiratory rate is incorrect because a “normal” respiratory rate could be the transition from tachypnea to apnea

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37
Q

What results in chronic hypoxemia?

A

Any persistent condition that compromises the ability to oxygenate blood

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38
Q

What do the kidneys do when they see hypoxemia?

A

Produce erythropoietin (red cells get produced, HCT goes up)

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39
Q

A HCT of greater than 65 can cause what?

A

Headaches, joint pain, clots (pulmonary emboli), hemoptysis

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40
Q

A kid with a history of headache, joint pain, clots, or hemoptysis could point to what?

A

Chronic hypoxemia (kidneys making EPO, Hct going up)

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41
Q

What happens to platelets in chronic hypoxia?

A

Decrease (increased risk of bleeding)

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42
Q

The respiratory drive of patients with chronic lung disease is often driven by what?

A

Hypoxemia (rather than acidosis and hypercapnia)

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43
Q

True or False: Correction of hypoxia (by administering O2) in a patient suffering from chronic lung disease can put a patient at risk for respiratory arrest

A

TRUE (respiratory drive in chronic lung disease is often driven by hypoxemia)

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44
Q

What should your goals be for oxygen administration in a patient with chronic hypoxemia?

A

Lowest concentration needed to maintain an O2 saturation of 90% (CO2 measurements via ABG should be followed as well)

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45
Q

What are two things to make sure of regarding a pulse oximeter for the real world?

A
  1. Make sure pulse is correlating

2. Ensure no mechanical or artifactual problems

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46
Q

Cyanosis with depressed sensorium

A

Hypoxia

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47
Q

Flushing and agitation and headaches

A

Hypercarbia (elevated CO2 leading to cerebral vasodilation)

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48
Q

What is elevated with carbon monoxide poisoning?

A

Carboxyhemoglobin

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49
Q

In carbon monoxide poisoning, what are the pulse oximetry readings?

A

High… overestimate the level of oxyhemoglobin and oxygenation

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50
Q

True or False: Anytime there are shock-like conditions resulting in impaired peripheral perfusion, the O2 values are unreliable

A

TRUE (shock will be things like heart failure, hypovolemia, septic shock)

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51
Q

Best measure of pulmonary function or hypoxemia?

A

ABG (don’t pick capillary blood gas… has to be arterial for O2 component to be valid)

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52
Q

Central blueish discoloration of skin due to poorly oxygenated blood.

A

Cyanosis

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53
Q

How do you distinguish between pulmonary and cardiac cyanosis?

A

Hyperoxia test

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54
Q

What happens in the hyperoxia test if the cause of cyanosis is pulmonary (v. cardiac)?

A

After 10 min of 100% inspired O2, PaO2 would increase in most pulmonary diseases, but no in cardiac diseases

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55
Q

What pulmonary disease will you not see an increase in PaO2 after 10 minutes of 100% O2?

A

PPHN

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56
Q

Name 7 extrapulmonary causes of cyanosis.

A
  1. Heart disease with right to left shunting
  2. Shock
  3. Methemoglobinemia
  4. CNS depression
  5. Cold exposure
  6. Polycythemia
  7. Breath holding spells
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57
Q

6 month old infant, hands and feet intermittently blue since birth, when hands and feet not blue, they are mottled… what is the cause?

A

Episodic acrocyanosis (no workup, just reassurance)

If this was true cyanosis needing workup (methemoglobinemia, EKG, O2 sat, ect.) you would see central blueness of lips or face

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58
Q

What is a condition in which the iron in the hemoglobin molecule is defective, making it unable to effectively carry O2 to the tissues?

A

Methemoglobinemia

Hgb is not transporting O2

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59
Q

How do you get methemoglobinemia?

A

It can be congenital or acquired

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60
Q

Which condition causes cyanosis in the absence of cyanotic heart disease?

A

Methemoglobinemia

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61
Q

What is treatment for methemoglobinemia?

A
  1. Eliminating the triggering agent

2. IV methylene blue

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62
Q

What are the 3 things you initially do to work up a chronic cough?

A
  1. Sweat chloride testing
  2. TB skin testing
  3. CXR
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63
Q

If you have a kid with a chronic cough and normal sweat chloride, TB testing, and CXR, what’s next?

A

Spirometry

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64
Q

What does spirometry help rule out with chronic cough?

A

Asthma

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65
Q

What age can you start doing spirometry?

A

When they can cooperate (usually around 6)

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66
Q

What is the 100 day cough?

A

Pertussis

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67
Q

What is a loud, brassy barking and/or honking cough that can be produced on command?

A

Psychogenic cough

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68
Q

What happens with a psychogenic cough at night?

A

Disappears during sleep

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69
Q

Harsh, dry chronic cough with fever, weight loss, night sweats

A

TB and fungal infections (even chest malignancies)

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70
Q

What are some conditions that impair the effectiveness of coughing?

A
  1. Cerebral Palsy
  2. Muscle Weakness
  3. Vocal cord dysfunction
  4. CNS disease
  5. Thoracic deformities
  6. Pain
    (Takes TNT to clear lungs when coughing isn’t effective… Thoraco Neuro (CP/CNS disease) Tied up with weakness and pain)
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71
Q

Cough suppressants?

A

NO… no benefit over a placebo in children

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72
Q

Name signs and symptoms consistent with CF

A
  1. Failure to thrive
  2. Steatorrhea
  3. Low serum albumin
  4. Low sodium
  5. Pseudomonas infections
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73
Q

What is the abnormal level for a CF sweat test?

A

60mEq or greater is diagnostic

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74
Q

Best way to confirm suspected CF diagnosis?

A

Sweat test… False negatives are rare and usually due to inadequate sample or technique (don’t be tempted to pick DNA analysis or genetic testing)

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75
Q

How is CF inherited?

A

AR (carriers show no signs)

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76
Q

What are the odds of a healthy sibling of someone with CF being a carrier?

A

2/3

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77
Q

If a sibling of someone with CF marries someone from the general population, what are the odds of them having a kid with CF?

A

(2/3) [chance of a sibling carrier] * (1/25) [chance of picking a carrier out of the general Caucasian population] * (1/4) [change of child being double recessive] = 1 in 150

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78
Q

What is the carrier rate for CF in the general Caucasian population?

A

1 in 25

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79
Q

If 2 carriers of CF are married, what is the risk of having a child with CF?

A

1/4 (double recessive trait)

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80
Q

Hypoproteinemia, anemia, steatorrhea, recurrent pulmonary symptoms in an infant?

A

CF

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81
Q

Are respiratory or GI symptoms more prevalent in infants with CF?

A

GI symptoms are more prevalent

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82
Q

What is the metabolic derangement seen in infants with CF?

A

Hypochloremic alkalosis

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83
Q

Which vitamin deficiency is a major problem with CF?

A

Vitamin E deficiency

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84
Q

When should vitamin E supplementation be started in patients with CF?

A

Before age 5

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85
Q

What can vitamin K malabsorption lead to (specific to CF kiddos)?

A

Prolonged prothrombin time

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86
Q

Name GI manifestations of CF in the neonatal period

A
  1. Meconium ileus
  2. Meconium peritonitis
  3. Unconjugated hyperbilirubinemia
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87
Q

The newborn screen is what % sensitive for the detection of CF?

A

95%

88
Q

Presented with newborn with symptoms suspicious for CF and normal newborn screen… is CF ruled out?

A

NO

89
Q

True or False: Newborn screening is diagnostic of CF

A

FALSE

90
Q

How many infants with an abnormal newborn screen for CF actually have CF after further testing?

A

1 in 20

91
Q

What is the only true diagnostic test for CF?

A

Sweat chloride testing

92
Q

What pre-natal finding can be seen with meconium ileus?

A

Polyhydramnios

93
Q

What can you see in abdominal films with meconium ileus?

A

Ground glass appearance (due to decreased bowel gas)

94
Q

How might meconium peritonitis present on XR?

A

Pseudocyst (calcified meconium)

95
Q

Which presents sooner with CF…GI or Pulm manifestations?

A

GI

96
Q

Which type of exacerbations are more life-threatening in CF, GI or Pulm?

A

Pulm

97
Q

Name 4 bacteria seen with CF?

A
  1. S. Aureus
  2. H. Influenzae
  3. P. Aeruginosa
  4. Burkholderia cepacia (advanced CF)
98
Q

Which bacteria in CF is associated with worsening lung function and poor overall outcome?

A

Burkholeria cepacia

99
Q

What is treatment of an acute exacerbation in CF?

A

Aminoglycoside and penicillin derivative like piperacillin

100
Q

What is used to eradicate infection in CF?

A

Trick Question…Infections are controlled with antibiotics, but never completely eradicated

101
Q

Name 3 lung manifestations of CF.

A
  1. Cor Pulmonale
  2. Pneumothoraces
  3. Hemoptysis
102
Q

True or False: Kids with CF should be encouraged to complete high school and pursue college/career?

A

True

103
Q

True or False: Infants and children with CF should receive all routine immunizations, including yearly influenza vaccination

A

True

104
Q

What happens when pulmonary vascular resistance exceeds systemic resistance?

A

Persistent fetal circulation

105
Q

What results in right to left shunting of blood at the cardiac level?

A

Persistent fetal circulation (when pulmonary vascular resistance exceeds systemic resistance)

106
Q

What circumstances is right to left shunting of blood at the cardiac level common in?

A

Pulmonary diseases that increase pulmonary vascular resistance

107
Q

How will an infant with right to left shunting often present?

A

Respiratory distress shortly after delivery, lower O2 sats in lower extremities compared to upper (desaturated blood reaches descending aorta and below)

108
Q

What is seen on chest exam for an infant with right to left shunting?

A

Precordial lift or prominent precordial impulse (due to increased workload of the right ventricle)

109
Q

Name 4 signs of cor pulmonale.

A
  1. Lower body edema
  2. Hepatomegaly
  3. Gallop rhythm
  4. Clubbing
110
Q

What are most cases of cor pulmonale caused by?

A

Pulmonary hypertension

111
Q

If pulmonary hypertension reversible?

A

No

112
Q

What is one potentially reversible cause of cor pulmonale?

A

Severe upper airway obstruction (surgically correctable and reversible)

113
Q

What can be seen in many chronic lung diseases (like CF)?

A

Cor pulmonale

114
Q

What is a condition in which cilia don’t function normally?

A

Primary ciliary dyskinesia (dysmotile cilia syndrome)

115
Q

How is primary ciliary dyskinesia inherited?

A

Autosomal Recessive

116
Q

What 2 issues can ciliary dysfunction lead to?

A
  1. Chronic sinusitis

2. Bronchiectasis

117
Q

What is responsible for the heart being positioned on the left side of the chest during fetal development?

A

Cilia

118
Q

What GU problem can ciliary dyskinesia cause?

A

Male infertility

119
Q

How is primary ciliary dyskinesia diagnosed?

A

Biopsy

120
Q

What is a type of primary ciliary dyskinesia associated with a mirror-image orientation of the heart and other internal organs (Situs Inversus)?

A

Kartagener Syndrome

121
Q

If they note heart signs on the right side of the chest, what are they getting at?

A

Situs inversus -> Kartagener

122
Q

Name 9 causes of pleural effusions.

A
  1. Pneumonia
  2. Liver failure
  3. Renal disease (nephrotic syndrome)
  4. Congenital heart disease
  5. Trauma
  6. Viral disease
  7. Malignancy
  8. Sickle cell anemia
  9. Meningitis
123
Q

What are the electrolyte concentrations in a chylothorax close to?

A

Serum electrolytes

124
Q

What is a typical triglyceride count in a chylothorax?

A

Over 110

125
Q

Is the lymphocyte count increased or decreased in a chylothorax?

A

Increased

126
Q

What the protein count typically greater than in a chylothorax?

A

3

127
Q

What pulmonary complication might you see in a post-op patient after cardiac surgery?

A

Chylothorax

128
Q

Is a transudate or exudate seen with inflammation?

A

Exudate

129
Q

What should you think of (transudate v. exudate) when you have a pleural effusion in the setting of pneumonia, cancer, trauma, or inflammatory disease?

A

Exudate

130
Q

What are the LDH and protein values seen in an exudate?

A
  1. Pleural LDH are at least 2/3 of the serum LDH

2. Protein is at least 3

131
Q

What is the LDH and protein values seen in a transudate?

A
  1. Pleural LDH is less than 2/3 pleural LDH

2. Protein is less than 3

132
Q

What setting are transudates typically seen in?

A

CHF

133
Q

What is a collection of pu in the pleural space?

A

Empyema

134
Q

What should you think of in the setting of pneumonia not improving on appropriate antibiotics?

A

Empyema

especially is some initial clinical improvement is seen after treatment

135
Q

What is the most accurate test for determining if an effusion is exudate v. transudate?

A

pH

136
Q

What is the pH in a transudate?

A

pH >7.45 (or higher than blood pH)

137
Q

What is the pH in an exudate?

A

pH <7.3

138
Q

How are empyemas treated?

A

Place a chest tube and start IV antibiotics

139
Q

How long should IV antibiotic be contniued with an empyema?

A

Fever has resolved, 48 hours after chest tube pulled

140
Q

Tachypnea, tachycardia, and unilateral decreased breath sounds…?

A

Pneumothorax

141
Q

What specific scenario can you see a small spontaneous pneumothorax?

A

Marijuana smoking in a tall, thin, adolescent

142
Q

What can be done for a small pneumothorax?

A
  1. Observe

2. O2

143
Q

If you need to decompress a pneumothorax, what are your 2 options?

A
  1. Needle aspiration

2. Chest tube placement

144
Q

If you have someone with a suspected pneumothorax that has tracheal shift and decreased BP, what do you suspect?

A

Tension pneumothorax

145
Q

What is done for a tension pneumothorax?

A

Emergency needle decompression and chest tube placement

146
Q

What common pediatric respiratory condition may lead to pneumothorax?

A

Asthm

147
Q

What clinical scenario can pneumothorax be seen in?

A

Intubation and ventilation

148
Q

True or False: Degree of pain correlates directly with the extent of the pneumothorax?

A

False

149
Q

True or False: Intubation is important in management of pneumothorax

A

False- this will rarely be the first thing you do or answer they want

150
Q

Possible causes of respiratory deterioration in an intubated patient?

A 
TOMB:
Tension Pneumothorax
Oxygen source interruption
Moved ET tube
Broken equipment
151
Q

What is a common cause of sudden deterioration of an infant on a ventilator?

A

Mechanical failure

152
Q

What is permanent dilation of a small segment of airway along with inflammation?

A

Bronchiectasis

153
Q

What is the most common cause of bronchiectasis?

A

CF

154
Q

What type of respiratory infections are seen with bronhiectasis?

A

Lower respiratory tract infections

155
Q

What is seen on CXR in bronchiectasis?

A

Typically specific areas of atelectasis (like a right middle lobe atelectasis)

156
Q

What condition do you think of when they state coughing symptom are worse with changes in position- like after lying down?

A

Bronchiectasis

157
Q

What is the most helpful diagnostic test for bronchiectasis?

A

CT chest

158
Q

What are some causes of bronchiectasis besides CF?

A

Dyskinesia (primary ciliary dyskinesia
Immunodeficiency, Infection
Lobar pneumonia, right middle lobe syndrome, enlarged lymph nodes causing compression
Aspergillosis, Vaccine preventable illnesses (measles/pertussis)
TB
Extrinsic compression caused by enlarged lymph nodes

159
Q

What are intrinsic (prenatal) risk factors for SIDS?

A

African American
Male
Premature (< 37 weeks)
Prenatal maternal smoking and/or alcohol use

160
Q

What are extrinsic (postnatal) risk factors for SIDS?

A 
Prone/Side sleeping
Sleeping on adult mattress, couch, playpen, or soft bedding
Bed-sharing
URI
Maternal smoking after birth
161
Q

What % of SIDS infants have a known risk factor?

A

99%

162
Q

True or False: Apnea monitors are useful in reducing the risk of SIDS?

A

FALSE- No evidence for this

163
Q

What is the only indication for a home apnea monitor for an infant?

A

Apnea of prematurity that responds to stim when occuring

164
Q

What tool may be protective against SIDS?

A

Pacifiers

May consider during naptime in first year of life (usually after 1st month for breastfeeding)

165
Q

What is it called when an infant has an episode where they stop breathing, develop cyanosis or pallor, become unresponsive, but are resuscitated successfully?

A

BRUE (used to be ALTE)

166
Q

2 month old found limp, cyanotic, and apneic. Revived with mouth-to-mouth. In ED, exam findings normal…?

A

BRUE

167
Q

What is typically required for a baby coming to the ED with a BRUE?

A

Hospitalization, Observation, and Workup

168
Q

What are some features that may make discharge from ED after a BRUE appropriate?

A
  1. First episode
  2. Episode brief and self-resolving
  3. In setting of something like nasal congestion or reflux
  4. No previous significant history of medical illness
169
Q

What are some things on the differential for a BRUE?

A

NAILS
Neuro (CNS anomaly, seizure)
Abuse/Trauma
Infection (RSV, pertussis, sepsis, meningitis, …)
Lung problems (aspiration, apnea, GERD)
Sugar is low (metabolic disorders, hypoglycemia)

170
Q

True or False: Apnea or BRUE is a risk factor or can precede SIDS?

A

False: These are completely separate

171
Q

What are 4 most likely causes of hemoptysis in children?

A

1, Infection (pneumonia or TB)

  1. CF (bronchiectasis)
  2. Foreign body aspiration
  3. Hemosiderosis
172
Q

Presented with acute hemoptysis… best next step?

A

Anything diagnostic… have to identify source of bleeding

173
Q

What are some appropriate choices for diagnostic tests for hemoptysis?

A
  1. pH
  2. CBC
  3. Coags
  4. CXR
  5. Visualize airway
174
Q

If hemopytsis fluid is acidic, where did it likely come from?

A

Stomach

175
Q

If hemopytsis fluid is alkaline, where did it likely come from?

A

Lungs

176
Q

What are the 4 main causes of pneumonia in infants (3 weeks to 12 months)?

A
  1. Chlamydia
  2. RSV
  3. Parainfluenza
  4. Pertussis
177
Q

How is chlamydia pneumonia transmitted to an infant?

A

During delivery

178
Q

Do infants with chlamydia pneumonia have fever?

A

No

179
Q

What is seen on CXR for infants with Chlamydia pneumonia?

A

Interstital infiltrates

180
Q

How does RSV typically present?

A

Bronchiolitis with wheezing

181
Q

When is RSV most commonly seen (time of year)?

A

Late fall

182
Q

When is parainfluenza bronchiolitis typically seen?

A

Fall through spring

183
Q

Does pertussis pneumonia commonly present with fever?

A

No

184
Q

What is the description of the cough in pertussis?

A

Paroxysmal

185
Q

What cause of pneumonia seen in infants can lead to aspiration pneumonia?

A

Pertussis

186
Q

What are 3 common causes of pneumonia in pre-school (1-4) children?

A
  1. Viral
  2. S. Pneumo
  3. Mycoplasma (typically kid that is close to entering school)
187
Q

What are some of the viruses that can cause pneumonia in pre-school children?

A

RSV, parainfluenza, human metapneumovirus, influenza, rhinovirus

188
Q

What the most common treatable form of pneumonia in preschool children?

A

S. Pneumoniae

189
Q

What are 4 causes of pneumonia commonly seen in school age children?

A
  1. Mycoplasma pneumoniae
  2. Chlamydophilia pneumoniae
  3. S. Pneumoniae
  4. Mycobacterium tuberculosis
190
Q

What is the most treatable form of pneumonia in school age children?

A

Mycoplasma pneumoniae

191
Q

Which two types of pneumonia in school age children present similarly?

A

Mycoplasma and chlamydophilia

192
Q

Which type of pneumonia can lead to complications (like an empyema) in school age children?

A

S. Pneumoniae

193
Q

Which group of children has a higher risk for mycobacterium tuberculosis pneumoniae?

A

Pregnant teens

194
Q

True or False: You need labs to diagnosis pneumonia?

A

False

195
Q

When are CXR not indicated to diagnose pneumonia?

A

If it is minor enough that it can be treated as an outpatient

196
Q

Which type of pneumonia typically presents with abrupt onset of productive cough and fever, with a somewhat toxic picture preceded by URI symptoms?

A

S. Pneumoniae

197
Q

Which type of pneumonia can present with abdominal pain and vomiting (possible even mimicking an acute abdomen)?

A

S. Pneumoniae

198
Q

How does mycoplasma pneumonia present?

A

Low grade fever, insidious onset

199
Q

What is seen on CXR for mycoplasma pneumonia?

A

Non-focal infiltrates

200
Q

How does viral pneumonia present?

A

Upper respiratory symptoms (nasal congestion/rhinorrhea). May be afebrile or have a very low grade fever.

201
Q

Name 3 major complications of pneumonia.

A
  1. Necrotizing pneumonia
  2. Lung abscess
  3. Effusion
202
Q

What causes necrotizing pneumonia?

A

Toxins produced by the bacteria, leading to necrosis, and liquification of lung tissue

203
Q

How is necrotizing pneumonia diagnosed?

A

XR

204
Q

What 2 drugs can be used to treat necrotizing pneumonia?

A
  1. Vancomycin

2. Clindamycin

205
Q

What pneumonia complication should you be concerned about in a child at risk for aspiration (seizures or neurological disorders)?

A

Lung Abscess

206
Q

What is done to treat a sterile effusion?

A

Nothing

207
Q

What can a purulent effusion lead to?

A

Empyema

208
Q

What findings on exam may be concerning for a purulent effusion?

A
  1. Dullness on chest percussion
  2. Decreased air movement
  3. Generalized findings: Ill appearance, tachypnea, chest discomfort
209
Q

True or False: Effusions should be surgically drained?

A

?- This is controversial so probably not right answer

210
Q

What are the two features of true recurrent pneumonia?

A
  1. More than 1 confirmed positive XR in 1 year

2. More than 3 episodes of pneumonia in a lifetime (no symptoms between episodes)

211
Q

What is something that may be mistaken as recurrent pneumonia?

A

Recurrent asthma with associated atelectasis on XR being mischaracterized as pneumonia

212
Q

Patient with diagnosis of pneumonia confirmed on XR- Best diagnostic study to confirm diagnosis?

A

Blood cultures

  • Don’t pick sputum or nasopharyngeal cultures.
  • Pleural fluid or culture of lung tissue would be definitive, but probably too invasive
213
Q

True or False: Childhood-onset scoliosis can impair pulmonary function?

A

True

-Thus, treatment is indicated to minimize impact on pulmonary function

214
Q

Does adolescent-onset scoliosis have concern for impairment of pulmonary function?

A

Not necessarily

215
Q

True or False: Pectus excavatum does not typically result in any pulmonary issues?

A

True (primarily cosmetic concern)

My Peds Prep (34 decks)

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