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Clinical Medicine II > bronchitis, laryngitis, croup, epiglottitis, otitis media/externa (quiz 1, exam 1) > Flashcards

bronchitis, laryngitis, croup, epiglottitis, otitis media/externa (quiz 1, exam 1) Flashcards

1
Q

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 __

A
  • less tha 3 weeks
  • URI (cold)
  • resolution
  • chest cold
  • 1-2 weeks
  • productive
  • non-productive
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2
Q

acute bronchitis: PE is unremarkable, or __ may be present

A

rhonchi

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3
Q

acute bronchitis: in 5% of cases of new onset cough, underlying __ is diagnosied

A

pneumonia

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4
Q

common symptoms of acute bronchitis

A
  1. cough, productive or non productive lasting 1-3 weeks
  2. nasal congestion or drainage
  3. often occurs after resolution of ytpical URI symptoms
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5
Q

common viruses that cause acute bronchitis

A
  1. rhinoviruses
  2. coronaviruses
  3. influenza
  4. adenovirus
  5. respiratory syncytial virus
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6
Q

common bacteria that caused acute bronchitis

A
  1. Mycoplasma pneumoniae
  2. Chlamydophila pneumoniae
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7
Q

T or F: there is evidence to indicate Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae cause acute bronchitis

A

False

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8
Q

DDx of acute cough

A
  1. Pneumonia (the msot common serious condition to be considered)
  2. acute bronchitis
  3. pertussi
  4. asthma
  5. gastroesophageal reflux disease (GERD)
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9
Q

acute bronchitis: upper/lowre airway disease? or what does it suggest>

  1. inspiratory stridor
  2. rhonchi, expiratory wheezing
  3. inspriatory crackles
  4. blodo streaking of mucopurulent sputum
A
  1. upper airway dz
  2. lower airway dz
  3. suggests invovlement of lung parenchyma (pneumonia, interstital dz, edema)
  4. hemoptysis
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10
Q

acute bronchitis, DDx: in otherwise healthy individuals, pneumonia can be ruled out by

A
  1. the absence of fever
  2. the absence of rigors
  3. the absence of tachycardia
  4. the absence of tachypnea (RR>24 breaths/min)
  5. the absence of hemoptysis
  6. the absence of pleuritic chest pain (sharp localized chest pain upon deep inpiration or coughing)
  7. the absence of findings of consolidation on chest auscultation
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11
Q

acute bronchitis, DDx: further evaluation for pneumonia with a chest ex ray may be indicated if __ or __ AND any othe following are present __

A
  • fevers
  • rigors
  1. hemoptysis
  2. pleuritic chest pain
  3. tachypnea
  4. hypoxia
  5. examination findings of consolidation
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12
Q

symptoms of acute bronchitis and pneumonia

  1. tachypnea (RR>24)
  2. fever
  3. rigors
  4. consolidation on auscultation
  5. chest x-ray
  6. cough
  7. purulent sputum
  8. nasal drainage
  9. URI symptoms
  10. pleuritic chest pain
A

bronchitis; pneumonia

    • ; +
    • ; +
    • ; +
    • ; +
  5. normal ; infiltrates
    • ; +
  7. +; +/-
    • ; -
    • ; -
    • ; +
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13
Q

acute bronchitis treatment: things that reduce cough

A
  1. beta-agonsits
  2. NSAIDs
  3. first generation histamines (diphenhydramine)
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14
Q

acute bronchitis treatment: thigns that reduce mucus formation and cough related to post nasal drip

A

decongestants: psudoephedrine (Sudafed) or phenylephrine (Neo-Synephrine and others)

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15
Q

acute bronchitis treatment: some studies have suggested taht use of a(an) __ reduces cough severity and duration

A

albuterol MDI

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16
Q

true or false: cough spressants (dextromethorphan, codeine, carbetapentane, and benzonatae) have not proven to be beneficial in managing cough associated with acute brochitis?

A

true

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17
Q

__ is the most common cause of hoarseness

A

laryngitis

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18
Q

laryngitis: HPI significant for

A
  1. hoarseness
  2. husky voice
  3. dry cough
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19
Q

laryngitis is usually also associated with URI symptoms of __ and __

A

rhinorrhea

sore throat

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20
Q

laryngitis: PE reveals __ and __ larynx

A

hyperemic

edamatous

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21
Q

larynitis treatement

A
  • humidification of inhaled air
  • analgesics
  • vocal rest
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22
Q

croup: inflammation of the __ with swelling and erythema of the __

A
  • airway
  • trachea in the subglottic area
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23
Q

common causes of croup and peak incidences

A
  • parainfluenza virus (types 1-3)
  • fall and early winter months
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24
Q

croup incubation period

A

3-6 days

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25
Q

croup affects children __ with peak in __ year of life

A
  • 6-36 months
  • 2nd year of life
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26
Q

croup: true or false: females affeted more than males

A

false

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27
Q

croup true or false: it is usually a benign disease with low mortality rates

A

true

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28
Q

croup HPI

A
  1. low grade fever
  2. prodrome of URI symptoms
  3. barking cough
  4. inspriatory stridor
  5. dyspnea
  6. respiratory distress
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29
Q

croup HPI: symptoms last __ days and subside but can also unpredictably worsen causing respiratory failure requiring __

A
  • 3-5 days
  • intubation
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30
Q

croup PE

A
  1. nasal flaring
  2. respiratory retractions
  3. stridor
  4. absence of wheezing
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31
Q

mild croup defined as

A
  • absence of stridor at rest
  • minimal respiratory distress
  • occasional cough
32
Q

moderate croup defined as

A
  • stridor at rest
  • increased amount of respiratory distress
  • behavior and mental status are normal
33
Q

severe croup defined as

A
  • stridor at rest
  • retractions
  • air hunger
  • cyanosis
  • significant respiratory distress
  • mental status changes
  • increasing somnolence and decreasing air entry signifying impending respiratory failure
34
Q

croup treatment

A
  1. ABCs
  2. single dose of dexamethasone (0.15-0.6 mg/kg): has long half life (72 hours); decreases edema in laryngeal mucose within 6 hours?
  3. 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
35
Q

epiglottitis symptoms

A
  1. high fever
  2. sore throat
  3. muffled voice
  4. dyspnea
  5. 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)

36
Q

epiglotittis: __ is a late finding and suggests near comoplete airway obstruction

A

stridor

37
Q

epiglottitis: establishign an airway by __ intubation is indicated regardless of the degree of apparent respiratory distress

A

nasotracheal

38
Q

epiglottitis: the barking cough typical of croup is __; usually, __ other family members are ill with acute respiratory symptoms

A
  • rare
  • no
39
Q
A

epiglottitis: large, cherry red, swollen epiglottits by laryngoscopy

40
Q

epiglottitis vs. croup: pathogen

A
  • epiglottitis: most common is H. influenza (bacteria)
  • croup: parainfluenza virus
41
Q

epiglottitis vs. croup: symptoms

A
  • epiglottitis: RAPID onset of sore throat, muffled voice, high fever, and drooling
  • croup: barking cough, URI symptoms, hoarseness, fever, inspiratory stridor
42
Q

epiglottitis vs croup: x-ray

A
  • epiglottitis: thumbprint sign on lateral neck x-ray
  • croup: <50% steeple sign on anterior neck x-ray
43
Q

epiglottits vs. croup: diagnosis

A
  • epiglottitis: assume a critical airway and DO NOT examine the oropharynx unless able to intubate STAT
  • H & P, seasonal helpful (fall/winter)
44
Q

epiglottitis vs croup: treatment

A
  • epiglottitis: 3rd generation cephalosporin (IV), steroids
  • croup: steroids, epi neb
45
Q
A

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

46
Q
A

epiglottitis: thumb sign

47
Q
A

epiglottitiis: normal

48
Q
A

epiglottitis: normal

49
Q

acute otitis media: most prevalen in children between

A

6 and 24 months

50
Q

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

A
  • fluid
  • fluid
  • eustachian
  • eustachian
  • eustachian
  • obstruction
51
Q

risk factors of acute otitis media

A
  1. age
  2. attendance at day care
  3. exposure to second hand smoke
  4. not being breast fed (feeding position)
  5. craniofacial abnormalities
  6. having biologic siblings or parents with a hx of problems with AOM
52
Q

acute otitis media; __ in the middle ear causes pain

A

pressure, not bacteria (the inability to effictively drain the eustachian tube results in increased pressure in the middle ear)

53
Q

acute otitis media bacterial causative agents

A
  1. Streptococcus Pneumoniae
  2. Haemophilus influenza
  3. Moraxella Cattarrhalis
54
Q

acute otitis media viral causive agents

A
  1. Respiratory Syncytial Virus (RSV)
  2. Rhinovirus
  3. Influenza virus
55
Q

acute otitis media HPI

A
  1. often follows an upper respiratory tract infection (URI) by 1-7 days
  2. fever
  3. poor feeding
  4. pain
  5. irritability
  6. vomiting
  7. ear pulling
56
Q

acute otitis media PE

A
  1. TM: bulging, red, landmarks not visualized, immobile (positiion, color, translucency, mobility)
57
Q
A

normal TM convex, mobile, translucent

58
Q
A

acute otitis media: bulging, hyperemic TM; landmarks not as clearly visualized; immobile

59
Q

acute otitis media treatment

A
  1. DOC: amoxicillin
  2. Cephalosporin or macrolide if PCN allergy
  3. analgesics for pain
60
Q

acute otitis media treatment: if recent antibiotic use or tx failure on day 3, use

A
  1. amoxicilin/clavulanate (Augmentin)
  2. Cefuroxime (Ceftin) or Ceftriaxone
61
Q

chronic otitis media: recurring or persistent infeciton, or inflammation for several __

A

months

62
Q

chronic otitis media risk factors

A
  1. multiple ear infections
  2. allergies
  3. trauma
  4. swelling of the adenoids
63
Q

chronic otitis media HPI

A
  1. hearing loss
  2. otorrhea
  3. pressure
  4. ear ache
64
Q

chronic otitis media PE

A
  • infection
  • air-fluid levels
  • discharge
  • perforation
65
Q

chronic otitis media treatment

A
  1. Abx
  2. surgery (myringotomy/repair/adenoids)
66
Q

chronic otitis media complications:

A
  1. mastoiditis
  2. deafness
67
Q

serous otitis media OR otitis media with effusion (OME): fluid behind TM in absence of __ or features of __

A
  • acute infection
  • inflammation
68
Q

serous OM or otitis media with effusino (OME): results from

A

prolonged blockage of eustacian tubes

69
Q

serous OM or otitis media with effusion: can be __ after successful treatment of AOM; requries only monitoring every __

A
  • residual
  • 3-6 months
70
Q

serous OM or otitis media with effussion: hearing and language testing for symptoms > __; __ with ventilation tubes may be needed

A
  • 3 months
  • tympanostomy
71
Q

otitis externa: inflammation of the

A

skin in the outer ear canal

72
Q

otitis external: commonly caused by __ trapped in teh canal from __

A
  • water
  • swimming in lakes or pools (swimmer’s ear)
73
Q

otitis externa pathogens

A
  1. Staphylococcus aureus
  2. Pseudomonas aeruginosa
74
Q

otitis externa symptoms

A
  1. pain
  2. purulent discharge
  3. pain elicited with traction on pinna or tragus
75
Q

otitis externa treatment

A

antibiotic/corticosteroid

76
Q

otitis externa complications

A
  1. mastoiditis (slow response to tx and tenderness over mastoid process)
  2. malignant otitis media (invasive infectino of the external auditory canal causing osteomyelitis of the temporal bone)

Clinical Medicine II (11 decks)

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