1
Q
What is hypercapnia?
A
Inadequate alveolar ventilation, increased CO2 production
2
Q
Pattern:
Tachypnea/tachycardia, cyanosis, AMS
A
hypoxemia
3
Q
Pattern:
Agitation, confusion, flushing, tachycardia, headache
A
hypercapnia
4
Q
Pattern:
Very low pH, very high CO2, mildly high bicarbonate
A
acute respiratory acidosis
5
Q
Pattern: Low pH, very high CO2, very high bicarbonate
A
chronic respiratory acidosis
6
Q
Pattern: Very high pH, very low CO2, mildly low bicarbonate
A
acute respiratory alkalosis
7
Q
Pattern: High pH, very low CO2, very low bicarbonate
A
chronic respiratory alkalosis
8
Q
Pattern: very low pH, very low CO2, very low bicarbonate
A
metabolic acidosis
9
Q
Pattern: very high pH, mildly high CO2, very high bicarbonate
A
metabolic alkalosis
10
Q
Pattern: recurrent infections, left sided mass in lower lobe, mucoid impaction surrounded by hyperinflated lung
A
Pulmonary sequestration
11
Q
What is congenital adenomatoid malformation? How does it appear on CT?
A
overgrowth of pulmonary tissue in region of end bronchioles. presents as respiratory symptoms due to compression or infection. Translucent round lesions on chest xray
12
Q
What is a bronchogenic cyst?
A
foregut cysts with closed epithelium lined saces containing hyaline cartilage plates, most common cysts of infancy, filled with fluid or mucus that may become infected
13
Q
Pattern:
bronchial destruction, bronchial dilation, accumulation of infected secretions
A
Bronchiectasis from problems such as primary ciliary dyskinesia
14
Q
Pattern: bronchiectasis, sinusitis, situs inversus
A
Kartagener’s syndrome
15
Q
3 genes associated with primary ciliary dyskinesia
A
DNA11, DNA H5, DNA H 11
16
Q
Pattern: chronic production cough, chronic nasal congstion with mucopurulent drainage without seasonal variation, chronic otitis media, sinusitis, nasal polyposis, wheeze, recurrent penumonia, bronchiectasis, respiratory distress in term neonates, male inferitility, hdyrocephalus, situs inversis
A
Primary ciliar dyskinesia
17
Q
What is acute respiratory distress syndrome?
A
Acute inflammatory lung injury resulting in widespread pulmonary edema as a result of increased alveolar capillary permeability and epithelial destruction
18
Q
Pattern: catastrophic pulmonary or nonpulmonary event, increased shunt fraction (hypoxemia), decreased lung compliance, diffuse pulmonary infiltrates, exclusion of left heart disease
A
ARDS
19
Q
Pattern: refractory hypoxemia, tachypnea, increased work of breathing, respiratory muscle fatigue, protein rich pulmonary edema fluid
A
ARDS
20
Q
Pattern: drooling, dysphagia, dysphonia, distress, deafening
A
epiglottitis
21
Q
Steeple sign on CXR
A
croup
22
Q
Thumb print on CXR
A
epiglottitis
23
Q
Pathogen for viral croup
A
parainfluenza 1, 3
24
Q
Pathogen for bacterial tracheitis
A
staph aureus
strept
moraxella catarrhalis
25
Pattern:
| high fever, Child sitting toxic, drooling, dysphagia, muffled voice
epiglottis
26
Pattern: low-grade fever, child lying down, nontoxic, barking cough, hoarseness
Viral croup
27
Pattern: high fever, toxic, barking cough
bacterial tracheitis
28
What are 7 things to do as emergency treatment for upper airway obstruction
1. continuous observation
2. oxygen
3. cool mist treatment
4. racemic epinephrine
5. decadron
6. helium-oxygen mixtures
7. intubation or tracheostomy
29
Pattern: unusual sleep postures, enuresis, systemic HTN, pulm HTN, snoring, distured sleep/agitate arousals, dytime neurobehavioral problems
OSAS
30
Who is at high risk for OSAS
1. Craniofacial disorders/small upper airway
2. Down syndrome
3. Cerebral palsy
4. neuromuscular disorders
5. chronic lung disease
6. central hypoventilation syndromes
7. genetic/metabolic storage disorders
31
Breathing pattern during REM and non-REM
REM - erratic
| Non-rem - regular
32
Pattern:
Increased work of breaking, abnormal use of respiratory muscle, prolonged expiratory phase of respiration, pulsus paradoxus, altered mental status
Lower airway disease
33
ABG analysis for hypoxemia
SaO2
34
ABG analysis for hypocapnia
PaCO2
35
ABG analysis for hypercapnia
PaCO2 >50mmHg
36
Describe patient and symptom with RSV associated apnea
1. H/o or premature brith and neonatal apnea
| 2. Post-conceptional age at hospitalization
37
Overwhelmingly most common reason for cardiopulmonary arrest in children
primary respiratory
38
Cardiopulmonary arrest occurs most often in children of what age range
39
Pattern: cyanotic at rest in newborn, upon stimulation, baby begins to cry and cyanosis resolves
choanal atresia
40
Most common type of tracheo-esophageal fistula
Esophageal atresia with distal TEF - 85%
41
Pattern: maternal hydramnios, excessive mucus, respiratory distress, failure to pass NG tube
Atresia with fistula
42
Can tracheoesophageal fistula result in tracheomalacia?
yes
43
What are the three most common vascular rings?
1. Double aortic arch
2. Right aortic arch with ligamentum arteriosum
3. Aberrant right subclavian artery
44
What are diagnostic tests for vascular rings?
Barium swallow
Bronchoscopy
Angiography
MRI scanning
45
Definition of BPD
Oxygen dependence, typical ground glass radiographic abnormalities, respiratory symptoms beyond 28 days of life
46
What is the CXR pattern for BPD?
Ground glass transform cystic lucencies
47
Pathophysiological characteristics of BPD?
1. Increased lung field
2. Diffuse airway inflammation
3. Decreased alveolarization
4. Altered pulmonary vascular development
5. Minimal fibrosis
6. Airway hyperreactivity
48
Clinical manifestations of BPD
1. Tachypnea
2. Shortness of breath
3. Crackles and wheezes
4. Tracheomalacia or subglottic stenosis
5. Irritability
6. Cyanotic spells
7. Failure to thrive
8. GERD
9. Pulm HTN
10. Aversive oral motor behavior
49
Rx of BPD
supplemental oxygen >95%, diuretics, aerosolized bronchodilators, aerosolized corticosteroids (budesonide), GERD, nutritional support
50
Pattern:
| Cough, fever, tachypnea, chest pain, sputum production, hemoptysis, weight loss
pulmonary abscess
51
Pattern: fever, tachypnea, marked hypoxemia, difuse alveolar disease, bronchoalveolar lavage
pneumocystis jiroveci
52
Most significant morbidity and mortality in drowning
HIE
53
Principal respiratory complication in drowning and near drowning
pulmonary edema secondary to upper airway obstruction
54
What do you do for a child you suspect has hydrocarbon aspiration?
CXR, observe, DO NO induce emesis, hospitalization for signs of respiratory distress, oxygen, supportive care, mechanical ventilation
55
Pattern:
| Child around adult wit URI, sporadic, paroxysmal cough, no whoop, thick, tenacious mucus, perihilar infiltrates
Pertussis
56
What is Rx for pertussis?
Erythromycin
57
What conditions are associated with congenital central hypoventilation syndrome?
Hirschsprung's disease, ganglioneuroma, neuroblastoma, hypothalamic dysfunction, seizures, Phox 2 B gene
58
What are Rx for congenital central hypoventilation?
Respiratory stimulants, tracheostomy and PPV, non-invasive ventilation, diaphragm pacing
59
What 4 conditions is associated with diffuse alveolar hemorrhage?
Idiopathic pulmonary hemosiderosis, lung immaturity, Cow's milk sensitivity, pulmonary capillary hemangiomatosis
60
What other organ dysfunction is associated with alveolar hemorrhage?
nephritis, myocarditis, celiac disease, collagen vascular disease: SLE, purpuric rash: HSP
61
Pattern:
Idiopathic pulmonary hemosiderosis
62
Pattern: upper lobe opacities, sputum has eosinophilia, RAST A. fumigatus positive, incrased serum igE, cystic fibrosis pt.
allergic bronchopulmonary aspergillosis
63
Pattern:
| Very loud bark or honk, single cough, absent during sleep
psychogenic cough
64
Pleural protein levels and pleural/serum protein ratio for transudate and exudate
Transudate 3gm/dL >0.5
65
Pattern:
| Sterile milky appearance, lymphocytic predominance, increased triglycerides and fat
chylothorax
66
Indications for bronchoscopy
Noisy breathing (stridor, chronic wheezing, voice disturbance-hoarse, decreased amplitude), persistent moist cough, persistent radiographic abnormality, congenital anomaly, recurrent penumonia, atelectasis, retained foreighn body, hemoptysis, intersititial lung disease, PNA in immunocompromised host, tracheostomy evaluation, post-lung transplantation evaluation
67
95% of chronic cough in kids are caused by what?
asthma, GER, upper airway cough syndrome (allergic rhinitis, nonallergic rhinitis, and sinusitis
68
What typically precedes a psychogenic cough?
An uncomplicated URI viral illness and then cough lingers
69
Most common cause of congenital stridor
Laryngomalacia
70
Difference in symptoms of laryngomalacia and tracheomalacia
Laryngomalacia - congenital stridor
Tracheomalacia - expiratory wheezing or inspiratory cessation of airflow with airway collapse unless positive distending pressure is applied
71
Symptom to tracheal hemangioma
expiratory wheezing from airway obstruction
72
What is the purpose of exhaled nitric oxide measurement useful for?
Measure NO lever as a marker of airway inflammation
73
What are the most commonly used measurements of lung function that can be obtained with spirometry?
```
FVC
FEV1
FEV1/FVC
PEF (Peak expiratory flow)
FEF25-75 airflow during the middle half of the effort
```
74
What are the risk factors for development of ARDS?
Sepsis, trauma, aspiration, penumonia, near-drowning, and multiorgan dysfunction
75
Outline phases of ARDS
1. Exudative phase - pulmonary edema, profound hypoxemia and atelectasis (recovery in 3 to 7 days)
2. Fibroproliferative state - persistent hypoxemia, decreased lung compliance, and development of penumothoraces
3. Recovery phase - resolution of hypoxemia and improved lung compliance (complete resolution take 6 to 12 months)
4. Sequelae - Lifelong restrictive lung disease, lung cysts, or decreased exercise tolerance
76
Define acute respiratory distress syndrome
lung inflammation with increased vascular permeability with acute onset, bilateral infiltrates, absence of left atrial hypertension and PaO2/FiO2
77
Mortality rate for ARDS and what is the main cause
30 to 40% - death usually not due to lung failure alone but from multiorgan system failure
78
Best test for measuring cyanosis and hypoxemia
arterial blood gas
79
When should co-oximetry be done
suspicion of presence of abnormal hemoglobins (carboxyhemoblogin or methemoglobin)
80
When is admiinistration of 100% oxygen and assssment of response used
in the neonatal period to distinguish pulmonary from cardiac disease
81
What are most common infectious pathogens for epiglottitis?
Strep PNA, group A beta hemolytic strept, staph aureus
82
Initial treatment for epiglottitis
direct examination under anesthesia in case tracheostomy is needed should be performed
83
Rectal prolapse can be seen in what disorders?
Acute or chornic diarrheal illness, intestinal infections and malabsorptive disorders, heavy parasitic infstations enterobiasis (pinworm), amebiasis, trichuriasis (whipworm)
84
Signs of cystic fibrosis in infants
hypoproteinemia, anemia, hypochloremic metabolic alkalosis, recurrent pulmonary symptoms
85
Describe how sweat test is done
application of pilocarpine to stimulate sweat production followed by measurement of the chloride concentration in the sweat
86
What is a positive result of sweat test and what conditions can give you false-positive results
>60mEq/L, Addison disease, hypotheyroidism, glycogen storage
| False negative - malnourished infant or if inadequate sweat volume is obtained
87
Pattern: watery diarrhea, abdominal pain, bloating
giardia
88
What is elevated in stool in protein-losing enteropathy that can be seen in CF?
alpha-1-antitrypsin
89
Pattern: stridor, wheezing, dyspnea exacerbated by feeding
vascular ring
90
Complications of untreated vascular ring
recurrent pneumonia and progressive difficulty with feeding
91
What is best test for vascular ring
barium swallow
92
Can bronchopleural fistulas self heal?
No
93
Rx for broncopleural fistualas
insertion or continuation of chest tubes, decreasing mechnical ventilator support to the lowest pressures needed to allow spontaneous healking, differential lung ventilation, application of sealants through a bronchoscope and surgical closure
94
Congenital lung malformation - reduction in bronchioloe number and alveoli
pulmonary hypoplasia
95
Congenital lung malformation: absense of vascular and lung tissue
pulmonary agenesis
96
Congenital lung malformation: presence of rudimentary bronchus but absence of vascular and lung tissue
pulmonary aplasia
97
congenital lung: malformation: dysplastic lung tissue
congenital cystic adenomatoid malformation
98
congenital lung malformation: idiopathic hyperinflation of one or more lobes
congenital lobar emphysema
99
Congenital lung malformation: lung tissue that has a system arterial supply instead of pulmonary arterial supply and generally lacks bronchial communication
pulmonary sequestration
100
Pattern: chronic cough, recurrent respiratory infections, dullness to percussionw ith decreased aeration over the affected area, crackles frequently audible during infection, radiograph show air-filled cystic lesion during active infections
pulmonary sequestration
101
Pattern: exercise-induced dyspnea not responsive to B-agonist treatment
Vocal cord dysfunction
102
Test for wheezing from birth or perinatal period that is not asthma
CXR, barium swallow for congenital abnormalities
103
Pattern: microcytic anemia, bilateral alveolar opacities, hemosiderin laden macs on sputum analysis
diffuse alveolar hemorrhage
104
Pattern: hemoptysis with pulmonary capillaritis
inflammation in pulmonary capillary bed, SLE, Goodpasture, granulamosis with polyangiitis and HSP
105
Pattern: d/dx hemoptysis without capillaritis
Cardiac - AVM, PH
| Noncardiac - celiac, coagulation, acute idiopathic pulmonary hemorrhage of infancy
106
If vascular malformation seen on barium esophagram what workup next?
CT or MRI
107
Pattern: mass of tissue in lungs with own blood supply
sequestration
108
Pattern: malformation that communicates with racheobronchial tree and blood supply is from the bronchial circulation
CCAMs
109
Threshold for dx of OSA
apnea index >1
| AHI >1.5
110
Who is at risk for anesthesia complication?
Children with AHI =/> 24
111
What factors lower affinity of hemoglobin to oxygen
acidosis, higher temperature, and elevated levels of 2,3-bispohsphoglyceric acid
112
Dx of choanal atresia
cannot pass firm catheter in nostrils to a depth of 3-4cm
113
What two symptoms are associated with cleft tongue?
1) oral-facial-digital syndrome
| 2) mohr syndrome
Own peds boards
flashcards
Decks in class (26)
# Cards
-
Endocrinology242
-
Oncology93
-
Hematology60
-
Poisoning47
-
Immunology0
-
Neonatology0
-
Renal103
-
Fluids And Electrolyte68
-
Pulmonary113
-
Rheum, collagen, multi-organ23
-
GI298
-
Cardiology170
-
Dermatology175
-
From questions156
-
Nephrology5
-
Development209
-
Genetics161
-
Critical care and Emergency96
-
Infectious disease160
-
Orthopedics64
-
General pediatrics101
-
Adolescent49
-
Coagulation103
-
Immunizations56
-
Rheumatology60
-
ENT0
