Kiss My Asthma
Prolonged use of inhaled steroids may cause these findings/conditions:
Oral Candidiasis (thrush, can be prevented with spacer use and rinsing mouth after), Changes in growth velocity, Dermal thinning and increased ease of skin bruising, cataracts (rare), suppression of HPA axis function (rare)
This congenital d/o involves generalized or localized weakness of the tracheal wall.
Generalized or localized weakness in the bronchi is called?
Tracheomalacia
Bronchomalacia
2yo boy presents with:
high-pitched barking cough, inspiratory stridor, subglottic narrowing on AP neck x-ray
What is the Diagnosis?
Laryngotracheobronchitis (croup)
3yo M p/w hx of waking up in the middle of the night with a barking cough and mild stridor. The next day, the child is perfectly healthy. That night, the symptoms reoccur. The next day, the child is healthy again. The family says this has occurred for 3 nights.
What is the most likely diagnosis?
Spasmodic croup (noninfectious)
When discussing lung volumes and PFTs, what is typically considered abnormal?
<80% of predicted
FYI: TLC is decreased in restrictive lung disease; Forced expiratory volume in 1 sec (FEV1) and the ratio of it to forced vital capacity (FEV1/FVC) are used to assess for obstructive lung disease. Airway obstruction is diagnosed when the ratios is <0.7 (70%)
A kindergartner with asthma is admitted to the hospital because of an acute asthma exacerbation.
What is the most likely cause of the acute asthma exacerbation in this child?
Viral infection
3yo F p/w rectal prolapse and nasal polyps.
What is the most likely diagnosis?
Cystic fibrosis (CF)
6mo old presents in January with:
Temp 100F, runny nose, poor feeding
PE: scattered wheezes & intermittent inspiratory crackles. CXR shows hyperinflation.
What is the diagnosis?
Bronchiolitis
Most commonly due to RSV
2yo M presents with:
Choking, wheezing, coughing, diminished breath sounds on the right, CXR unremarkable.
What is the most likely etiology of his symptoms?
Aspiration of a foreign body
2wk old infant p/w inspirational stridor, which is much worse when child upset.
What is the most likely diagnosis?
Laryngomalacia
17yo girl with known asthma p/w:
cough, wheezing, and chest tightness with URI & exercise. ED visit 2 yrs ago for asthma exacerbation. Spirometry PFT showed: FEV1 = 74%, FEV1/FVC = 79%, and change in FEV1 post-bronchodilator = 35%
What is the severity of her asthma based on her PFT?
Moderate persistent asthma
For Peds patients >/= FEV1 >60% but <80% predicted range for moderate persistent asthma. For a 17yo pt, normal FEV1/FVC is 85%.
6-hour old newborn p/w the following:
Respiratory failure, heart failure, and abnormalities of pulmonary venous drainage
What is the most likely diagnosis?
Scimitar Syndrome (rare)
Congenital pulmonary venolobar syndrome is a rare disorder in which the pulmonary venous blood from all or part the right lung returns to the inferior vena cava just above or below the diaphragm.
2yo with high fever, brassy cough, stridor
She is given treatment for croup but does not respond, and she deteriorates rapidly. She is intubated in the ED.
What is the most likely diagnosis?
Bacterial Tracheitis
15yo M p/w abrupt onset of fever, cough with wheezing, joint pains, and rash,
What is the most likely bacterium causing this illness?
Mycoplasma pneumoniae
17yo M has the following:
sinusitis, bronchiectasis, situs inversus
What is the most likely diagnosis?
Primary Ciliary dyskinesia (PCD), Kartagener Syndrome
An 8-year-old girl presents with persistent cough that primarily occurs during the day. She has a history of asthma and has been treated 2–3 times a week with nebulized albuterol for mild wheezing. On examination, the patient is afebrile and has good air movement bilaterally with no active wheezing. She is noted to have a mild cough with forced expiration. What should be the next intervention?
Add daily inhaled corticosteroid to regimen.
This congenital d/o is a common cause of neonatal death. Infants present with respiratory distress and severe hypoxemia and hypercarbia. Associated with oligohydramnios, premature ROM, and subsequent premature labor. Can also occur secondary to congenital diaphragmatic hernia.
Pulmonary hypoplasia
15yo M with a current history of active influenza A presents with abrupt onset of fever, tachypnea, tachycardia, cyanosis, and CXR shows distinct pneumatoceles.
What is the most likely bacterium causing this illness?
Staph aureus
8yo girl p/w iron deficiency anemia that was initially diagnosed 1 yr ago, progressive dyspnea, fatigue, recurrent cough with new onset hemoptysis, and sputum that shows hemosiderin-laden alveolar macrophages.
What is the likely diagnosis?
Idiopathic pulmonary hemosiderosis (IPH)
17yo AA F presents for evaluation after receiving a CXR in the ED for possible PNA that turned out to be a viral infection. However, the CXR shows that she has significant bilateral hilar and mediastinal adenopathy. She is completely asymptomatic and denies fever, night sweats, or weight loss. CXR shows no infiltrates. TB, fungal disease and malignancy have been ruled out.
Diagnosis?
Sarcoidosis
Treatment for this type of asthma may include montelukast (leukotriene receptor antagonist, which may require days to weeks to start working) or pre-treatment with inhaled short acting beta agonist.
Exercise-induced bronchoconstriction
SABA pre-treatment is typically 10-20 mins prior to exercise and usually reduces the severity of symptoms.
This type of malformation occurs with many distinct congenital disorders, and most commonly with hereditary hemorrhagic telangiectasia (HHT) aka Osler-Weber-Rendu Syndrome.
Pulmonary arteriorvenobs malformations (PAVM:including pulmonary arteriovenous fistulas, aneurysms, and telangectasias)
13yo F p/w an initial hx of sore throat that is negative for GAS by culture and hoarseness. 2-3 wks later, she develops PNA. What is the most likely diagnosis of her biphasic disease?
Chlamydia Pneumoniae
15yo F with asthma presents with recurrent episodes of malaise, coughing up brownish mucous plugs, occasional hemoptysis, peripheral eosinophilia, and high IgE. She improves with corticosteroid therapy, but 2-3 months later, the signs and symptoms recur.
What is likely causing the recurrent episodes?
Allergic bronchopulmonary aspergillosis (ABPA)
18yo M with hx of hemoptysis for several months, iron deficiency anemia, new onset CKD, biopsy shows linear deposition of IgG and C3 on alveolar and glomerular basement membranes. ANCA negative.
What is the diagnosis?
Antiglomerular basement membrane (Anti-GBM) antibody disease (Goodpasture syndrome)