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Clin Med2: Pulmonology > Infections of the Respiratory Tract - LRTI - waldron (incomplete) > Flashcards

Infections of the Respiratory Tract - LRTI - waldron (incomplete) Flashcards

1
Q

what pathogen is epiglottitis associated with

A

haemophilus infleunzae type B (Hib) infection and children

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2
Q

what population is most common to contract epiglottitis

A

industrialized area with vaccination programs; most stereotypical patient is now urban male in his mid 40s

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3
Q

What is the presentaton for children epiglottitis

A

Drooling, Dysphagia, Dysphonia, Distressed

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4
Q

what are the signs of toxicity with epiclottitis

A

poor or absent eye contact; failure to recognize parents
cyanosis, irritability; inability to be consoled or distracted

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5
Q

what is the presentation of epiglottitis in adults

A

like children; sore throat, fever, dysphagia, and drooling
peak usually takes >24 hours to develop
obstruction less common
no visible oropharyngeal inflammation

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6
Q

what is relinquishing tripoding indicative of?

A

respiratory failure

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7
Q

what is the dx/work up for epiglotitis

A

H&P, CBC,, blood cultures, lateral neck XR

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8
Q

what can stridor in children result from

A

croup, bacterial tracheitis, airway FB

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9
Q

What is the thumb sign

A

seen on lateral neck XR with epiglotitis

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10
Q

what is the treatment for epiglotitis

A

ADMIT
dx required direct exam - laryngoscopy revealing beefy-red, stiff, edematous epiglotitus
ABX (ceftriaxone is treatment of choice)
supportive measures

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11
Q

what is another name for laryngotracheobronchitis

A

croup

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12
Q

what is croup

A

inflammation of larynx, trachea and bronchi
very common to cause cough, stridor, and hoarseness in children with a fever

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13
Q

when is croup most common

A

October to early spring
6 months - years and peak incidence 12mos - 2 years
B>Girls

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14
Q

what is the clinical presentation of croup

A

preceding 1-3 day: rhinorrhea, nasal congestion, fever
classically barky or seal-like cough, hoarse voice, high-pitched inspiratory stridor

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15
Q

how is croup diagnosed / worked up

A

clinical diagnosis

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16
Q

what is the treatment of croup

A

mild: one dose of steroids then d/c home with return precautions
moderate: steroids, nebulizer epi with observation min 3 hours, reassess
severe: steroids, neb epi with observation min 3 hours, reassess + possible admission

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17
Q

what is the goal of croup treatment

A

reduced airway obstruction
corticosteroids - PO/IV vs nebulized

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18
Q

What is bacterial tracheitis

A

bacterial croup
most common fall and winter; coincides with seasonal viral epidemics (flu, RSV)
children 6mo - 14yo peak incidence 3-8 yo; M>F

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19
Q

what is the most common bacteria in bacterial tracheitis

A

S. aureus, including MRSA
Strep pneumoniae, strep pyogenes, moraxella catarrhalis, h. influenza type B

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20
Q

what are the most common viruses that preced bacterial tracheitis

A

influenza A (m/c) and B
RSV, parainfluenza, measles, enterovirus

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21
Q

what do the symptoms of bacterial tracheitis result from

A

airway swelling and secretions resulting in airway obstruction

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22
Q

what are the presentations of bacterial tracheitis

A

m.c insidious development with viral URI prodromal symptoms
less common: fulminant respiratory distress < 24 hours after symptom onset
resipratory distress: cyanosis, lethargy, combativ
children may appear toxic
severe inspiratory and expiratory stridor
fever, productive cough, hoarse voice, no tripoding or drooling

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23
Q

what is the dx/workup of bacterial tracheitis

A

clinical
XR lateral neck (if stable)
direct laryngoscopy - definitive diagnosis
bronchoscopy with cultures of secretions

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24
Q

What is the treatment of bacterial tracheitis

A

admin to PICU
agressive airway management
Antibiotics initiated ASAP
Humidified oxygen

25
what are red flags for respiratory failure
hypoxia retractions fatigue AMS decreased breath sounds
26
what is the leading cause of hospital admissions in infants under 1 year of age
Bronchiolitis - RSV most common cause
27
What are risk factors for Bronchiolitis
low birth weight age < 5 months low socioeconomic population airway anomalies congenital immune deficiency disorders parental smoking crowded living environment chronic lung disease
28
what are risk factors for severe bronchiolitis infection
history of prematurity age <3 months neuromuscular disease congenital heart disease chronic lung illness immunodeficiency
29
what are the clinical presenation of bronchiolitis
URI: cough, fever, rhinorrhea within 48-72 hours: lower airway involvement becomes evident infants develop small airway obstruction leading to symptoms of respiratory distress course of illness ~ 7-10 days most infants improve within 14-21 days
30
what is the PE for bronchiolitis
crackles, wheezing, rhonchi, cough, fluctuating clinical findings, rhinitis, grunting, nasal flaring, retractions - respiratory distress obtain Pulse ox
31
what is the hallmark of treatment for bronchiollitis
symptomatic care - hydration, respiration, presence of hypoxia if severe: admit and monitored
32
what is the causative organism in pertussis
bordetella pertussis and bordetella parapertussis
33
what is Bordettella
gram negative coccobacillus that adheres to cilated respiration epithelial cells local inflammation changes in mucosal lining of respiratory tract releases toxins - act locally and systemically
34
what are the three stages of pertussis
incubation: 1-3 weeks then progresses to the stages catarrhal phase paroxysmal phase Convalescent
35
what is the catarrhal phase
similar to other URIs: fever, fatigue, rhinorrhea, conjunctival injection lasts 1-2 weeks and is most infectious stage of the disease
36
what is paroxysmal phase
1-6 weeks, can be up to 10 weeks whooping cough - triggered by cold or noise, most common at night
37
what is convalescent phase
residual cough persists for weeks to months, usually triggered by exposure to another URI or irritant
38
what is the dx/workup for pertussis
nasopharyngeal cx and PCR make lab confirmation - not positive for 3-7 days
39
what is the treatment of pertussis
mostly supportive: oxygen, suctioning, hydration, avoidance of respiratory irritants strict isolation while patients are infectious (catarrhal phase and 3 weeks after onset of paroxysmal phase)
40
what is post exposure prophylaxis with pertussis
erythromycin recommended for all household contacts
41
how are patients <1 year old and not fully vaccinated treated with pertussis
Hosptialized regardless of the symptoms
42
how are neonates with pertussis treated
admit to ICU - like threatening cardiopulmonary complications and arrest can occur unexpectedly
43
what is the first line antibiotic treatment for pertussis
erythromycin 40-50mg/kg/day, max 2g/day
44
what are the complications for pertussis
superimposed pneumonia: major cause of mortality in infants and young children secondary pneumonia or otitis media possible pulmonary HTN: contributes to infant mortality
45
what is acute bronchitis
infection on the large airway due to viruses commonly seen in flu season common pathogens: respiratory syncytial virus, influenza virus A and B, parainfluenza, rhinovirus, etc
46
what are risk factors for acute bronchitis
current/past smoker hx asthma living in polluted place crowded sometimes caused by allergens or irritants
47
what is the clinical presentation of acute bronchitis
productive cough, malaise, difficulty breathing, and wheezing production of clear or yellowish, may be purulent lasts 10-20 days, may last 4+ weeks
48
what is seen on FE with acute bronchitis
lungs: wheezing +/-, diffuse rhonchi +/- clinical diagnoses based on history and physical
49
what is the dx/workup of acute bronchitis
spirometry airflow obstruction, bronchial hyperresponsiveness usually resolve 6 weeks
50
what is the treatment of acute bronchitis
usually self limited: symptomatic, supportive cough relief - codeine should be avoided; abuse potential lifestyle modifications abx therapy is NOT indicated
51
what is a Communicable viral disease affecting upper and lower respiratory tract
wide spectrum of influenza viruses
52
what is the gold standard diagnosis for influenza
PCR test or viral CX of throat secretion
53
what is the key to reducing morbidity with influenza
vaccination
54
what are the symptoms of influenza
runny nose, high fever, cough, sore throat seasonal epidemics
55
what are the different types of human influenza
type A and B
56
how is influenza diagnosed
serologic, immunologic or molecular testing via PCR diagnosis is usually clinical, especially influenza season
57
what is the treatment of influenza
supportive (antipyretics, analgesics), fluids antiviral meds: treat or prevent influenza infection - high risk populations
58
what are complications of influenza
secondary bacterial pneumonia acute respiratory distress syndrome myositis myocarditis multi-organ failure

Clin Med2: Pulmonology (13 decks)

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