bronchitis, laryngitis, croup, epiglottitis, otitis media/externa (quiz 1, exam 1) Flashcards
acute bronchitis: a respiratory illness of __ weeks duration in which cough is the primary complaint; usually begins as a __ followed by persistence of cough after __ of other URI symptoms, hence the term __; the cough usually tends to persist __ weeks after the resolution of all other URI symptoms, and may either be __ or __
- less tha 3 weeks
- URI (cold)
- resolution
- chest cold
- 1-2 weeks
- productive
- non-productive
acute bronchitis: PE is unremarkable, or __ may be present
rhonchi
acute bronchitis: in 5% of cases of new onset cough, underlying __ is diagnosied
pneumonia
common symptoms of acute bronchitis
- cough, productive or non productive lasting 1-3 weeks
- nasal congestion or drainage
- often occurs after resolution of ytpical URI symptoms
common viruses that cause acute bronchitis
- rhinoviruses
- coronaviruses
- influenza
- adenovirus
- respiratory syncytial virus
common bacteria that caused acute bronchitis
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
T or F: there is evidence to indicate Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae cause acute bronchitis
False
DDx of acute cough
- Pneumonia (the msot common serious condition to be considered)
- acute bronchitis
- pertussi
- asthma
- gastroesophageal reflux disease (GERD)
acute bronchitis: upper/lowre airway disease? or what does it suggest>
- inspiratory stridor
- rhonchi, expiratory wheezing
- inspriatory crackles
- blodo streaking of mucopurulent sputum
- upper airway dz
- lower airway dz
- suggests invovlement of lung parenchyma (pneumonia, interstital dz, edema)
- hemoptysis
acute bronchitis, DDx: in otherwise healthy individuals, pneumonia can be ruled out by
- the absence of fever
- the absence of rigors
- the absence of tachycardia
- the absence of tachypnea (RR>24 breaths/min)
- the absence of hemoptysis
- the absence of pleuritic chest pain (sharp localized chest pain upon deep inpiration or coughing)
- the absence of findings of consolidation on chest auscultation
acute bronchitis, DDx: further evaluation for pneumonia with a chest ex ray may be indicated if __ or __ AND any othe following are present __
- fevers
- rigors
- hemoptysis
- pleuritic chest pain
- tachypnea
- hypoxia
- examination findings of consolidation
symptoms of acute bronchitis and pneumonia
- tachypnea (RR>24)
- fever
- rigors
- consolidation on auscultation
- chest x-ray
- cough
- purulent sputum
- nasal drainage
- URI symptoms
- pleuritic chest pain
bronchitis; pneumonia
- ; +
- ; +
- ; +
- ; +
- normal ; infiltrates
- ; +
- +; +/-
- ; -
- ; -
- ; +
acute bronchitis treatment: things that reduce cough
- beta-agonsits
- NSAIDs
- first generation histamines (diphenhydramine)
acute bronchitis treatment: thigns that reduce mucus formation and cough related to post nasal drip
decongestants: psudoephedrine (Sudafed) or phenylephrine (Neo-Synephrine and others)
acute bronchitis treatment: some studies have suggested taht use of a(an) __ reduces cough severity and duration
albuterol MDI
true or false: cough spressants (dextromethorphan, codeine, carbetapentane, and benzonatae) have not proven to be beneficial in managing cough associated with acute brochitis?
true
__ is the most common cause of hoarseness
laryngitis
laryngitis: HPI significant for
- hoarseness
- husky voice
- dry cough
laryngitis is usually also associated with URI symptoms of __ and __
rhinorrhea
sore throat
laryngitis: PE reveals __ and __ larynx
hyperemic
edamatous
larynitis treatement
- humidification of inhaled air
- analgesics
- vocal rest
croup: inflammation of the __ with swelling and erythema of the __
- airway
- trachea in the subglottic area
common causes of croup and peak incidences
- parainfluenza virus (types 1-3)
- fall and early winter months
croup incubation period
3-6 days
croup affects children __ with peak in __ year of life
- 6-36 months
- 2nd year of life
croup: true or false: females affeted more than males
false
croup true or false: it is usually a benign disease with low mortality rates
true
croup HPI
- low grade fever
- prodrome of URI symptoms
- barking cough
- inspriatory stridor
- dyspnea
- respiratory distress
croup HPI: symptoms last __ days and subside but can also unpredictably worsen causing respiratory failure requiring __
- 3-5 days
- intubation
croup PE
- nasal flaring
- respiratory retractions
- stridor
- absence of wheezing
mild croup defined as
- absence of stridor at rest
- minimal respiratory distress
- occasional cough
moderate croup defined as
- stridor at rest
- increased amount of respiratory distress
- behavior and mental status are normal
severe croup defined as
- stridor at rest
- retractions
- air hunger
- cyanosis
- significant respiratory distress
- mental status changes
- increasing somnolence and decreasing air entry signifying impending respiratory failure
croup treatment
- ABCs
- single dose of dexamethasone (0.15-0.6 mg/kg): has long half life (72 hours); decreases edema in laryngeal mucose within 6 hours?
- in moderate to severe, also administer nebulized epinephrine: benefits within 30 min and lasts up to 2 hours; observe for 4 hours after last epi treatment
epiglottitis symptoms
- high fever
- sore throat
- muffled voice
- dyspnea
- rapidly progressing respiratory obstruction
- appears toxic
- swallowing is difficult
- breathing is labored
- drooling: neck hyperextended in an attempt to maintain the airway
- tripod position (sitting upright, leaning forward with the chin up and mouth open while bracing on the arms)
(medical emergency with acute rapidly progressive course)
epiglotittis: __ is a late finding and suggests near comoplete airway obstruction
stridor
epiglottitis: establishign an airway by __ intubation is indicated regardless of the degree of apparent respiratory distress
nasotracheal
epiglottitis: the barking cough typical of croup is __; usually, __ other family members are ill with acute respiratory symptoms
- rare
- no

epiglottitis: large, cherry red, swollen epiglottits by laryngoscopy
epiglottitis vs. croup: pathogen
- epiglottitis: most common is H. influenza (bacteria)
- croup: parainfluenza virus
epiglottitis vs. croup: symptoms
- epiglottitis: RAPID onset of sore throat, muffled voice, high fever, and drooling
- croup: barking cough, URI symptoms, hoarseness, fever, inspiratory stridor
epiglottitis vs croup: x-ray
- epiglottitis: thumbprint sign on lateral neck x-ray
- croup: <50% steeple sign on anterior neck x-ray
epiglottits vs. croup: diagnosis
- epiglottitis: assume a critical airway and DO NOT examine the oropharynx unless able to intubate STAT
- H & P, seasonal helpful (fall/winter)
epiglottitis vs croup: treatment
- epiglottitis: 3rd generation cephalosporin (IV), steroids
- croup: steroids, epi neb

croup: narrowing (steeple sign) of the tracheal air shadow

epiglottitis: thumb sign

epiglottitiis: normal

epiglottitis: normal
acute otitis media: most prevalen in children between
6 and 24 months
acute otitis media: __ accumulation breeds bacteria: impaired mucociliary clearance of __ from the middle ear resulting from __ tube dysfunction; children are higher risk for __ tube dysfunction because their __ tubes are shorter, more horizontal, and more prone to __ by adenoid tissue than those in adults
- fluid
- fluid
- eustachian
- eustachian
- eustachian
- obstruction
risk factors of acute otitis media
- age
- attendance at day care
- exposure to second hand smoke
- not being breast fed (feeding position)
- craniofacial abnormalities
- having biologic siblings or parents with a hx of problems with AOM
acute otitis media; __ in the middle ear causes pain
pressure, not bacteria (the inability to effictively drain the eustachian tube results in increased pressure in the middle ear)
acute otitis media bacterial causative agents
- Streptococcus Pneumoniae
- Haemophilus influenza
- Moraxella Cattarrhalis
acute otitis media viral causive agents
- Respiratory Syncytial Virus (RSV)
- Rhinovirus
- Influenza virus
acute otitis media HPI
- often follows an upper respiratory tract infection (URI) by 1-7 days
- fever
- poor feeding
- pain
- irritability
- vomiting
- ear pulling
acute otitis media PE
- TM: bulging, red, landmarks not visualized, immobile (positiion, color, translucency, mobility)

normal TM convex, mobile, translucent

acute otitis media: bulging, hyperemic TM; landmarks not as clearly visualized; immobile
acute otitis media treatment
- DOC: amoxicillin
- Cephalosporin or macrolide if PCN allergy
- analgesics for pain
acute otitis media treatment: if recent antibiotic use or tx failure on day 3, use
- amoxicilin/clavulanate (Augmentin)
- Cefuroxime (Ceftin) or Ceftriaxone
chronic otitis media: recurring or persistent infeciton, or inflammation for several __
months
chronic otitis media risk factors
- multiple ear infections
- allergies
- trauma
- swelling of the adenoids
chronic otitis media HPI
- hearing loss
- otorrhea
- pressure
- ear ache
chronic otitis media PE
- infection
- air-fluid levels
- discharge
- perforation
chronic otitis media treatment
- Abx
- surgery (myringotomy/repair/adenoids)
chronic otitis media complications:
- mastoiditis
- deafness
serous otitis media OR otitis media with effusion (OME): fluid behind TM in absence of __ or features of __
- acute infection
- inflammation
serous OM or otitis media with effusino (OME): results from
prolonged blockage of eustacian tubes
serous OM or otitis media with effusion: can be __ after successful treatment of AOM; requries only monitoring every __
- residual
- 3-6 months
serous OM or otitis media with effussion: hearing and language testing for symptoms > __; __ with ventilation tubes may be needed
- 3 months
- tympanostomy
otitis externa: inflammation of the
skin in the outer ear canal
otitis external: commonly caused by __ trapped in teh canal from __
- water
- swimming in lakes or pools (swimmer’s ear)
otitis externa pathogens
- Staphylococcus aureus
- Pseudomonas aeruginosa
otitis externa symptoms
- pain
- purulent discharge
- pain elicited with traction on pinna or tragus
otitis externa treatment
antibiotic/corticosteroid
otitis externa complications
- mastoiditis (slow response to tx and tenderness over mastoid process)
- malignant otitis media (invasive infectino of the external auditory canal causing osteomyelitis of the temporal bone)