ch. 20 pulmonology
Terms
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- gold standard for OSA dx
- polysomnography
- OSA: can lead to...
-
1.behavioral problems
2.poor school performance - T/F: bilateral choanal atresia = surgical emergency
- true (cyanosis)
- polysomnography does what?
-
measures...
1.respiratory effort
2.air flow
3.oxygenation
4.HR - DDx for wheezing & respiratory distress
-
1.bronchiolitis
2.foreign body aspiration
3.GERD
4.TEF
5.vascular sling - T/F: arterioles sensitive to oxygen tension
- true
- diffusion defects: causes
-
1.PE
2.congenital vascular abnlities
3.prolonged atelectasis - pectus excavatum
- depression in sternum
- pectus carinatum
- outward deformity of sternum
- T/F: obesity can be a cause of restrictive lung disease
- true
- chest wall abnlities causing restrictive lung disease
-
1.pectus excavatum/carinatum
2.scoliosis
3.obesity
4.neuromuscular (Guillan, DMD) - restrictive lung disease: space-occupying lesions
-
1.pleural effusion
2.pericardial effusion
3.chylothorax
4.hemothorax
5.pneumothorax
6.tumors
7.mediastinal masses
8.cystic adenomatous malformations
9.diaphragmatic hernia
10.pulmonary sequestrations - pulmonary hemosiderosis
- abnl accumulation of hemosiderin due to diffuse alveolar hemorrhage
- T/F: recurrent aspiration typically leads to interstitial lung disease
- true
- pulmonary hemosiderosis: associated w/...
-
1.cow milk allergy
2.Goodpasture syndrome - Sx of restrictive lung disease
-
1.exercise intolerance
2.dyspnea
3.SOB
4.clubbing fingers/toes
5.pulmonary HTN - apnea
-
cessation of breathing > 20 sec
or
breathing pauses w/color changes, hypotonia, decreased responsiveness, or bradycardia - apnea of infancy does/doesn't increase risk of SIDS
- doesn't
- most common presentation in CF
- FTT
- CF: inheritance pattern
- autosomal recessive
- meconium ileus pathognomonic for...
- cystic fibrosis
- acute life-threatening complications of cystic fibrosis
-
1.hemoptysis
2.spontaneous pneumothorax - pulmonary problems categorization
-
1.obstruction
2.restrictive
3.v-q mismatch
4.abnl ventilation control - upper airway
- nose -> carina
- upper airway obstructions
-
1.choanal atresia
2.vaginal delivery trauma -> recurrent laryngeal n. damage -> vocal cord paralysis
3.subglottic stenosis (prolonged intubation)
4.laryngomalacia
5.congenital (hemangiomas, laryngeal webs, vascular rings) - small hypopharynx seen in...
- Pierre-Robin's syndrome
- T/F: bilateral choanal atresia can be life-threatening
- true (choanal atresia -> cyanosis -> life-threatening)
- vocal cord dysfunction: suspect if...
-
1.hoarse cry
2.absent cry - inability to pass NG tube: suggests...
- choanal atresia
- choanal atresia: tx
- surgery
- vascular rings: tx
- surgery
- infectious causes of upper airway obstruction in older child
-
1.epiglottitis
2.peritonsillar abscess
3.retropharyngeal abscess
4.mono
5.bacterial tracheitis
6.croup - non-infectious causes of upper airway obstruction in older child
-
1.tonsillary & adenoidal hypertrophy
2.anaphylaxis
3.nasal polyps - obstructive sleep apnea: symptoms
-
1.restless sleep
2.snoring/gasping
3.daytime sleepiness
4.decreased growth velocity
5.behavioral problems
6.poor school performance - Pickwickian's syndrome
- OSA + obesity + chronic hypercarbia
- OSA: Tx
-
CPAP
tracheostomy (refractory cases) - OSA --> ?
- cor pulmonale --> death
- asthma
-
1.reversible airway obstruction
2.inflammation
3.broncial hyperresponsiveness - bronchospasm
- smooth muscle constriction
- asthma's inflammatory responses
-
1.immediate
2.late-phase - most common reason for hospitalization in pediatrics
- asthma
- asthmatic w/AMS: suggests...
-
1.hypercarbia
2.significant hypoxemia - asthma dx tests
-
1.methacholine challenge test
2.exercise testing w/spirometry - asthmatic's XR findings
-
1.hyperinflation
2.increased bronchial markings
3.focal/segmental atelectasis - most effective form of asthma tx
- removing triggers
- exercise-induced asthma: Tx
- beta-2 agonists 15-30 min before
- leukotriene receptor antagonists: examples
-
montelukast
zafirlukast
zileuton - leukotriene receptor antagonists: target pts
- chronic moderate - severe asthmatics
- asthmatic w/nl PaCO2 + tachypnea indicates...
-
BAD SIGN - you're expecting low PaCO2 w/hyperventilation.
impending respiratory failure - asthma classification
-
1.mild intermittent
2.mild persistent
3.moderate persistent
4.severe persistent - acute asthma exacerbation: tx of choice
- inhaled bronchodilators
- oral/IV corticosteroids: begin to have effect in x hrs
- 4-6 hrs
- nasal polyps: prompts testing for...
- cystic fibrosis
-
frequent pneumonias + sinus opacification + nasal polyps + sinusitis
dx? - cystic fibrosis
-
large bulky foul smelling stools + pancreatic insufficiency + rectal prolapse
dx? - cystic fibrosis
- cystic fibrosis: Tx
-
1.chest PT
2.exercise
3.frequent coughing - cystic fibrosis pts: achieve near-nl growth via...
-
1.pancreatic enzyme replacement
2.fat-soluble vitamin supplements
3.high-calorie, high-protein diets - major contributor to morbidity & mortality in CF pts
- respiratory complications
- cf pts: hemoptysis -> x blood loss -> emergency
-
>500ml in 24 hrs
>300ml/day x 3 days - cf pts w/frank blood loss in lungs: Tx
- arterial embolization
-
cf pt w/severe chest pain + difficulty breathing
dx? - spontaneous pneumothorax
- spontaneous pneumothorax tx
- sclerosis
- apnea of infancy: tx
- tx underlying disorder