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Respiratory Medicine > Graneto DSA > Flashcards

Graneto DSA Flashcards

1
Q

Labs in bacterial tracheitis

A

may demonstrate a leukocytosis Left shift

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2
Q

What accounts for 90% of stridor with fever affecting children most commonly from 6 months to 3 years?

A

Laryngotracheobronchitis (croup)

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3
Q

if retropharyngeal abscess presents in older child, it is following what in many instances?

A

penetrating trauma to posterior oropharynx

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4
Q

When should you give steroids for croup?

A

as early as possible (dexamethasone)

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5
Q

This is an infection of the subglottic region and is more likely to cause respiratory failure than croup and epiglottitis combined

-give pseudomembrane formation

A

Bacterial tracheitis

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6
Q

How may patients with upper airway compromise breathe

A

through an open mouth, which suggest dysphagia with inability to swallow secretions, or the general presence of air hunger

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7
Q

Definite diagnosis of bacterial tracheitis occurs with visualization of what?

A

normal epiglottis and presence of pus, inflammation, and in some cases a pseudomembrane in subglottic region upon intubation

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8
Q

What are the most common causes of acute upper airway obstruction?

A
  • croup
  • epiglottitis
  • foreign-body obstruction
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9
Q

Most peritonsillar abscesses are from what microbes

A
  • Group A strep
  • Peptostreptococcus
  • Fusobacterium
  • other mouth flora
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10
Q

What do you do if a child younger than 1 has complete obstruction

A

4 back blows followed by chest thrusts

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11
Q

What is by far the most reliable sign of respiratory failure in an infant or child?

A

an ineffective respiratory effort and an altered level of consciousness

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12
Q

What is treatment for croup aimed at

A

solely at relieving symptoms

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13
Q

What do you give any child with respiratory distress?

A

supplemental oxygen

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14
Q

Start all patients with suspected retropharyngeal abscess on what antibiotic

A

clindamycin plus a 3rd gen cephalosporin as empiric treatment

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15
Q

In patients with moderate croup score, whatt will usually result in symptomatic improbement for up to 2 hours

A

use of oxygen and racemic epinephrine delivered by nebulizer

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16
Q

What are lab findings common with retropharyngeal abscess

A

leukocytosis with elevated acute phase reactants

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17
Q

What can occur with staphylococcal tracheitis

A

Toxic Shock syndrome

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18
Q

What is definitive therapy for retropharyngeal abscess?

A

intraoperative drainage of the abscess in the OR

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19
Q

In most suspected cases of retropharyngeal abscess, what will identify any soft tissue infections and abscess formation

A

CT scan of neck

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20
Q

What do you do if a child older than 1 has complete obstruction

A

repetitive abdominal thrusts

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21
Q

What does “hot potato” phonation represent

A

splinting of the palatine muscles during normal speech

22
Q

Agents responsible for croup

A
  • Parainfluenza types 1, 2, and 3 (most common)
  • adenovirus
  • RSV
  • influenza
23
Q

What is the hallmark of upper airway compromise?

A

Stridor

24
Q

Most common symptoms and signs of hypoxemia in children?

A
  • agitation
  • irritability
  • failure to maintain feeding effort
25
Q

Some cases of Peritonsillar abscess are superinfection of an existent _____

A

Epstein-Barr infection

26
Q

what do you give a patient with epiglottitis after intubation

A

ceftriaxone IV

27
Q

What may prevent the progression of croup to complete obstruction by decreasing the amount of swelling of laryngeal mucosa

A

corticosterioids

28
Q

Describe antibiotic treatment of bacterial tracheitis

A

Begin broad spectrum that includes coverage of S. aureus with a third gen cephalosporin such as ceftriaxone along with vancomycin until culture results are known

29
Q

These are seen predominantly in children younger than 3 years secondary to suppurative cervical lymphadenopathy

A

Retropharyngeal abscesses

30
Q

most common age group for epiglottitis?

A

2 to 5

31
Q

Classic presentation for croup

A

children usually present after several days of nonspecific upper respiratory infection (URI) symptoms with a characteristic brassy or barking cough
-temperatures common

32
Q

Age group for peritonsillar abscess

A

children older than 8

33
Q

discharge patients with mild croup if what?

A
  • parents are reliable
  • child is well hydrated and taking adequate fluids
  • child is older than 6 months
34
Q

presentation of retropharyngeal Abscess

A
  • commonly cervical lymphadenitis and trismus
  • stiff neck or torticollis
  • often initially thought to be meningitis
35
Q

What may be necessary in addition to oxygen, epi, and corticosterioids, if croup is severe?

A
  • maybe antibiotics

- maybe intubation

36
Q

Age group for foreign body aspiration

A

children under 5

37
Q

Cyanosis of respiratory origin tends to be what?

A

central

38
Q

Are blood cultures useful in bacterial tracheitis?

A

rarely

39
Q

position of comfort with epiglottitis

A

sitting upright, mouth open, with head, neck and jaw in extension

40
Q

most common microbes causing bacterial tracheitis

A
  • S. aureus
  • S. pneumonii
  • H. influenza
  • psuedomonas
  • Moraxella
41
Q

What is seen on a lateral neck radiograph with bacterial tracheitis

A

subglottic and tracheal narrowing with a ragged tracheal border secondary to the pseudomembrane

42
Q

A secondary effect of cyanosis may be the development of what?

A

somnolence

43
Q

in a young infant, stridor is most often the result of a congenital anomaly of what 3 things?

A
  • tongue (macroglossia)
  • Larynx (laryngomalacia)
  • trachea (tracheomalacia)
44
Q

Chest X ray with bacterial tracheitis

A

may demonstrate concomitant pneumonia

45
Q

position of comfort for lower airway disease

A

assume “tripod position” consisting of upright posture, leaning forward, and support of the upper thorax by use of extended arms

46
Q

microbes causing retropharyngeal abscess

A
  • Group A hemolytic step
  • Staph
  • more frequently MRSA
47
Q

Position of comfort for children with stridor

A
  • upright
  • lean forward
  • generate own jaw thrust maneuver to open upper airway
48
Q

What is the most common response of a child to increased respiratory needs?

A

tachypnea

49
Q

before sending a child home with mild croup, give dose of what?

A

oral decadron

50
Q

usual evolution of croup

A

worsening of symptoms for 3 to 5 days followed by resolution over a period of days

51
Q

presentation of of peritonsilar abscess

A
  • increasing dysphagia
  • ipsalateral ear pain
  • progression to trismus, dysarthria and toxicity
  • Drooling common
  • “hot potato” phonation
52
Q

Lateral neck radiographs for retropharyngeal abscess

A

Prevertebral soft tissue swelling greater than 7 mm at the level of the second cervical vertebrae or greater than 14 mm at the level of the 6th vertebrae and a normal epiglottis and aryepiglottic folds

Respiratory Medicine (37 decks)

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