Exam 5

Question 1

Name the different Anatomic defenses

Answer 1

Nose (hair fibers)
nasopharyngeal airway (narrow, twisting channels)
larynx (glottis)
tracheobronchial tree (branches)
mucociliary escalator (move secretions),

Question 2

Name the different Defensive Airway Reflexes

Answer 2

Laryngeal closure (vagus, recurrent and superior laryngeal nerves)
cough reflex (rapid, mass movement from supraglottic area)
inspiratory and expiratory muscle strength, & glottic closure- to increase airway pressure for explosive elimination)

Question 3

Name the different defenses in the Alveolar Dead Space

Answer 3

Macrophages to phagocytose, recruit, and repair (stimulating fibroblast and collagen)

Alveolar fluid: IgG, IgA (larynx), alpha-1 antitrypsin (neutralize proteases) and surfactant (kill bacteria)

Recruited cells: Neutrophils, monocytes, B & T cells

Question 4

Acute bronchitis is a ______-______ infection with ________ treatment

Answer 4

Acute bronchitis is a self-limiting infection with symptomatic treatment

Question 5

Describe the clinical features of TB (primary, reactive and extra-pulmonary)

Answer 5

Primary TB: Occurs early after infection. Can be mistaken for pneumonia. TB pleuritis presents as pleuritic chest pain and causes as unilateral, lymphocyte-rich, exudate pleural effusion.

Reactivation TB: Opacities seen upper lobes. Symptoms: three or more weeks of productive cough, fever, malaise, chest pain, and weight loss.

Extrapulmonary TB: Reactivation can occur at any site. Spinal TB = Pott’s disease. Miliary TB = disseminated TB occurring during reactivation.

Question 6

Describe the Radiographic Features of primary, reactive and miliary TB.

Answer 6

Primary TB: Middle and/or lower lobe opacities and hilar lymphadenopathy

Reactivation TB: Unilateral or bilateral upper lobe opacities → trachea shift from fibrosis

Miliary TB: Diffuse micronodular lesions

Question 7

What is the dx for TB?

Answer 7

Latent TB: Tuberculin SKin Test (TST) or Interferon-Gamma Release Assays (IGRA)

Active Pulmonary TB: Sputum Smear and acid-fast stain; Nucleic Acid Amplification (NAA); Mycobacterial Culture ← gold standard

Question 8

What are the Treatment Strategies for TB?

Answer 8

“RIPE” taken under the observation of a public health worker- direct observed therapy (DOT)

Question 9

What are the clinical features and management of Bronchiolitis?

Answer 9

Inflammation in the lower airways (bronchioles) generally applied to first-time wheezing associated w/ a viral respiratory infection.

Peak Age: 2-3 months old.

Etiology: Respiratory syncytial virus (RSV).

Symptoms: Mild URI-like then cough, wheezing chest wall retractions and respiratory distress. May or may not have fever.

Chest x-ray: shows air-trapping, peribronchial thickening, subsegmental opacities and rarely, lobar collapse.

Tx: Supportive, O2 reduce anxiety, IV fluids, and antipyretic therapy.

Question 10

What are the clinical features and management of Laryngotracheobronchitis (Croup)?

Answer 10

Extrathoracic upper airway obstruction.

Etiology: Viral infections (parainfluenza and RSV) → subglottic edema

Occurrence: Winter months

Age: 6 months - 3 years

Symptoms: URI for 2-3 days then barky cough, stridor, and hoarseness. Lack fever. No sore throat. NO DROOLING. Can present w/increased inspiratory effort

Chest x-ray: steeple sign representing narrowing subglottis

Tx: Aerosolized racemic epi and steroids

Question 11

What are the clinical features and management of Epiglottitis?

Answer 11

Inflammation of the epiglottis- a medical emergency due to high risk of sudden upper airway obstruction

Etiology: H. influenzae type B

Age: 1-5 years old

Symptoms: Sudden onset and rapid progression of stridor, high fever, muffled (rather than hoarse) voice, dysphagia, and drooling, refusal to eat, drink, or sleep, prefers to sit in “sniff position”, anxiety

Chest x-ray: “Thumb” sign

Dx: Observe epiglottis only if in operating room. Requires ET tube intubation and abx