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Pulmonology > Clin Med Bronchitis, Bronchiolitis, Croup > Flashcards

Clin Med Bronchitis, Bronchiolitis, Croup Flashcards

1
Q

Type of course for viral respiratory bronchitis

A

self-limiting

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2
Q

What are common viruses that cause acute bronchitis

A

Influenza
parainfluenza
coronavirus
rhinovirus

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3
Q

How often is acute bronchitis caused by bacterial infection

A

not really ever

*exception in airway abnormalities like intubation and tracheostomy

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4
Q

How long can acute bronchitis cough last

A

1-2 weeks, up to 4-6 weeks

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5
Q

acute bronchitis S&S

A
  1. cough (w/ or w/o sputum)
  2. upper airway congestion, rhinitis, chest congestions
  3. wheezing secondary to bronchospasm
  4. rhonchi - clears with cough
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6
Q

Bronchitis vs. pneumonia

  • fever
  • system sx
  • breath sounds
  • percussion findings
  • labs
A

Bronchitis:

  • afebrile
  • lack of systemic sx
  • rhonchi, clear with cough
  • percussion/egophany normal
  • unremarkable labs typically

Pneumonia

  • febrile
  • chills, rigors, lack of appetite
  • rhonchi, rales, decreased breath sounds
  • dullness to percussion due to consolidation
  • abnormal labs
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7
Q

How to dx. acute bronchitis

A

mostly clinical, no lab or radiology usually needed

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8
Q

Great way to distinguish between acute bronchitis and pneumonia?

A

CXR

  • bronchitis: perihilar congestion, non-specific findings
  • pneumonia: consolidations and interstitial infiltrate
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9
Q

When to order a CXR for respiratory issue?

A

Abnormal vital signs:

  • tachycardia >100
  • tachypnea >20
  • Febrile >100.5F
  • Hypoxia <92%
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10
Q

Two labs can be run for acute bronchitis

A
  • CBC but imperfect test, high or low don’t make dx

- procalitonin - helps determine viral vs. bacterial etiology, released in bacterial infections, not usually used…

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11
Q

Symptomatic tx of acute bronchitis

A
  1. NSAIDS
  2. Decongestants
  3. Antihistamines
  4. Antitussives
  5. Mucolytics
  6. Bronchodilators
  7. Steroids

**differs slightly from Dr. Letassy

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12
Q

Should use Abx to tx acute bronchitis?

A

NO

  • unless old/infirm
  • artificial airway (tracheostomy)
  • sx for more than 10 days
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13
Q

What are common upper respiratory pathogens

A

S. pnuemonia
H. Flu
M. cat

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14
Q

Bronchiolitis

  • def
  • results in what
A

Lower respiratory tract infection

- results in edema and mucous accumulation of small distal airways

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15
Q

Bronchiolitis etiology

A

Viral most common:

  • RSV
  • Rhinovirus
  • Parainfluenza
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16
Q

Bronchiolitis most common population? when?

A
  • Infants and children <2 yr

- fall and winter

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17
Q

Bronchiolitis risk factors

A
  • premature <37 weeks
  • <12 weeks old
  • congenital dz
  • immunocompromised
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18
Q

Bronchiolitis pathogenesis

A
  • Terminal bronchiolar epithelial cells are damaged by virus
  • Inflammation of small bronchi and bronchioles
  • Edema, mucous, sloughed epithelial cells crowd airway - obstruction
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19
Q

Bronchiolitis

- clinical features

A
  • typically starts as URI sx (rhinorrhea, congestion, cough)

- sx progress to fever, cough, respiratory distress

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20
Q

Signs of respiratory distress

A
  • wheezing (inspiration and expiration)
  • crackles
  • retractions (intercostal, supraclavicular, abdominal breathing)
  • nasal flaring/grunting
  • Tachypnea (50-70!!!)
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21
Q

Bronchiolitis associated complications

A
  • dehydration

- respiratory failure

22
Q

How to dx Bronchiolitis

A

CXR

  • usually only used on severe cases
  • patchy infiltrate with perihilar congestion
  • peribronchial cuffing (KNOW THIS ONE)

Lab
- RSV rapid antigen tests (quick, easy, nasopharyngeal swab)

23
Q

Bronchiolitis

- how to assess severity

A

Frequent re-eval to assess improvement or decompensation

24
Q

Bronchiolitis indications for hospitalization

A
  • toxic appearance, lethargy, dehydration
  • mod-severe respiratory distress
  • hypoxia/need for supplemental O2
25
Q

Bronchiolitis

- Non-severe case tx

A

Symptomatic tx

  • nasal suctioning (very common)
  • up fluids, monitor I&O
  • Tylenol/ibuprofen for fever
26
Q

Bronchiolitis what 2 drugs are not indicated

A

albuterol

steroids

27
Q

Bronchiolitis

- how long do sx last

A

3-5 days

self-limiting

28
Q

Bronchiolitis

- severe treatment

A
  • Albuterol nebulized solution (2.5mg - 5mg)
  • Nebulized hypertonic saline: secretion mobilization
  • supplemental O2, intubation if necessary
  • supportive care: IV, nutrition, monitorin
29
Q

What is not indicated for severe Bronchiolitis tx but is often used

A

Oral steroids:

  • Decadron (dexamethasone)
  • Orapred (prednisone)
30
Q

Bronchiolitis prevention

A
  • standard precautions (hand washing, etc.)

- immunoprophylaxis: Palivizumab

31
Q

Palivizumab

  • what is it
  • reserved for what population
A
  • humanized monoclonal antibody vs. RSV glycoprotein

- premature infants and children or who have bronchopulmonary dysplasia

32
Q

Croup

- def

A

Variety of upper respiratory conditions that produce a characteristic cough, inspiratory stridor, hoarseness

33
Q

Croup

  • etiology
  • common population
  • when
A
  • Most often viral, parainfluenza most common virus
  • children 3-36 months
  • fall and winter months
34
Q

Croup

- length of illness

A

3 days

35
Q

Croup

- clinical feature

A

Anatomical narrowing of trachea in subglottic region of upper airway

36
Q

Croup S&S

A
  • barking cough
  • stridor (inspiratory)
  • congestion, rhinorrhea, fever
  • respiratory distress
37
Q

What used to score severity of croup?

A

Westley Croup Score

  • determines score: mild, moderate, severe, impending respiratory failure
  • gives guidelines of action based on score
38
Q

What are the 5 criteria used in Westley Croup score?

A
  1. LOC
  2. Cyanosis
  3. Stridor
  4. Air Entry
  5. Retractions
39
Q

How to dx croup

A

Don’t need CXR

- CXR will show “steeple” sign (subglottic airway narrowing)

40
Q

How to treat mild croup

A

symptomatically

  • cool mist humidifiers
  • fever reduction
  • oral fluids
  • cool air (freezer/outside)

Decadron (Dexamethasone) - long half life = only need one dose

41
Q

Decadron/dexamethasone dose

A

0.6 mg/kg

max 10 mg

42
Q

How to tx moderate to severe croup

A
  • Decadron/Dexamethasone
  • Nebulized (racemic) epinephrine
  • intubation if respiratory failure likely
  • symptomatic control (O2, fluids, cool mist)
43
Q

Nebulized racemic epinephrine dose

A

0.05 ml/kg per dose

max 0.5 ml

44
Q

Nebulized racemic epinephrine dose

- what is it

A

systemic alpha and beta adrenergic agonist

- relaxation of smooth muscles of bronchial tree (beta 2 activation)

45
Q

Nebulized racemic epinephrine dose monitoring

A

half life only 1-2 hrs

must monitor to watch for rebound effects

46
Q

How to distinguish Croup from epiglottis from retropharyngeal abscess
- fever

A

Croup - sometimes
epiglottitis - yes
abscess - sometimes

47
Q

How to distinguish Croup from epiglottis from retropharyngeal abscess
- barking cough

A

Croup - yes
epiglottitis - no
abscess - no

48
Q

How to distinguish Croup from epiglottis from retropharyngeal abscess
- difficulty swallowing

A

Croup - no
epiglottitis - yes
abscess - yes

49
Q

How to distinguish Croup from epiglottis from retropharyngeal abscess
- drooling

A

Croup - no
epiglottitis - yes
abscess - yes

50
Q

How to distinguish Croup from epiglottis from retropharyngeal abscess
- throat pain

A

Croup - no
epiglottitis - yes
abscess -yes

51
Q

How to distinguish Croup from epiglottis from retropharyngeal abscess
- trismus (lockjaw)

A

Croup - no
epiglottitis - no
abscess - yes

Pulmonology (11 decks)

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