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LRTI Flashcards

1
Q

What is epiglottitis generally associated with

A

H. influenza type B

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2
Q

Which population is epiglottitis most common in

A

urban male in 40s

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3
Q

What is occurring in the body with epiglottitis

A

bacteria colonize the nasopharynx and spread locally causing supraglottic cellulitis

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4
Q

What are the 4 Ds of epiglottitis presentations in children

A

Drooling
Dysphagia
Dysphonia
Distressed respiratory effect

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5
Q

What signs are seen with adults with epiglottitis

A

Tripod position
sore throat
dysphagia
drooling

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6
Q

What are signs of toxicity from lack of air

A

Poor or absent eye contact
failure to recognize parents
cyanosis
irritability
inability to be consoled/distracted

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7
Q

What on PE should raise suspicion for epiglottitis

A

Severe throat pain with a normal appearing pharynx

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8
Q

if a child is tripoding, are they stable or unstable

A

stable.. but does mean they will probably crash soon

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9
Q

What is the dx and workup for epiglottitis

A

CBC and blood cultures
direct inspection
Culture epiglottis
lateral neck XR

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10
Q

Where should direct inspection of the epiglottis be preformed

A

In the OR to confirm diagnose and secure the airway

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11
Q

When may stridor occur outside of epiglottitis

A

Croup
bacterial tracheitis
airway foreign body

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12
Q

When may tripod position occur outside of epiglottitis

A

peritonsillar or retropharyngeal abscess

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13
Q

What type of trauma may lead to epiglottitis

A

caustic ingestion
thermal injury

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14
Q

What is the treatment for epiglottitis in children

A

Admit to hospital

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15
Q

How do you get a definitive diagnosis of epiglottitis

A

flexible fiberoptic laryngoscope

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16
Q

What will be seen with a laryngoscope in epiglottitis

A

beefy, red, stiff, edematous epiglottis

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17
Q

How long should an ETT be left in with epiglottitis

A

for 24-48 hours post stabilization of patient

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18
Q

What is the treatment of choice for epiglottitis

A

Ceftriaxone
*once extubated PO augmentin will be sent home with them

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19
Q

What is another name for laryngotracheobronchitis

A

croup

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20
Q

If a child has a fever, cough, stridor, and hoarseness, what is their likely diagnosis

A

Croup

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21
Q

What is the common cause of croup

A

parainfluenza virus

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22
Q

Which gender is more commonly effected by croup

A

Boys

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23
Q

what is the common age for croup

A

12months-2years

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24
Q

What time of year is croup most common

A

October to early spring

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25
What is the most narrow part of an airway in kids under 8
subglottic space
26
What does a cough sound like with croup
Barky seal like cough
27
What are common things seen with croup
drooling dysphagia stridor w/o cough or fever incomplete immunizations
28
What will you see on xray with croup
steeple sign
29
How do you diagnose croup
rule out other causes of stridor.. mostly a clinical diagnosis
30
What are differentials for croup in kids <6 month
Subglottic stenosis vocal cord paralysis hemangioma foreign body aspiration anaphylaxis
31
What are differentials for kids > 6months
Foreign body aspiration bacterial tracheitis epiglottitis peritonsillar abcess abscess anaphylaxis
32
If a patient has a barky cough with or without stridor at rest, how do you treat
supportive measures
33
What is mild croup and how do you treat
barky cough w/ or w/o stridor with agitation One dose steroids then d/c home
34
What is moderate croup and how do you treat
barky cough and stridor at rest, w or w/o increased work of breathing Steroids nebulized api with 3hour observation
35
What is severe croup and how do you treat
Barky cough, stridor, prominent increased work to breathe Steroids, nebulized epi with 3 hour observation and then reassess... possible admission
36
What is the goal of croup treatment
reduce airway obstruction
37
What is heliox
Breathing gas mixture of helium and O2
38
When is bacterial tracheitis seen
Fall and winter months
39
What population is most effected by bacterial tracheitis
Males children 6months - 14 years (peak 3-8)
40
What viruses can cause bacterial tracheitis
influenza parainfluenza RSV
41
What is bacterial tracheitis
Bacterial infection of trachea, generally after a viral URI
42
What are common bacterial that may cause bacterial tracheitis
Staph aureus s. pneumonia strep pyogenes H. influenza
43
What are the 2 ways bacterial tracheitis present
1) sx are present for 1-3 days until severe airway deterioration from overlapping infection 2)Usual treatment of croup is/has been ineffective
44
What are common symptoms of bacterial tracheitis
Respiratory distress appear toxic if fulminant severe insp./exp. stridor raspy voice but NO dysphagia
45
How do you get a definitive diagnosis of bacterial tracheitis
Direct laryngoscopy
46
How do you treat bacterial tracheitis
admit to ICU aggressive airway management Antibiotics (ceftriaxone + Nafcillin) humidified O2
47
What are red flags for respiratory failure
hypoxia retractions fatigue AMS decreased breath sounds
48
How long are kids generally hospitalized with bacterial tracheitis
3-12 days
49
What is the leading cause of hospital admission in infants under 1y/o
Bronchiolitis
50
What is the most common cause of bronchiolitis
RSV
51
What is a common complication of bronchiolitis and how do you treat it
Recurrent wheezing Inhaled corticosteroids and leukotriene antagonists
52
What time of year is bronchiolitis most common
autumn and winter
53
What are risk factors for bronchiolitis
low birth weight <5months Airway anomalies Parental smoking Crowded living environment Chronic lung disease
54
What are the risk factors for severe bronchiolitic infections
Premature birth <3months neuromuscular disease congenital heart disease chronic lung illness immunodeficiency
55
What will occur in the lungs with bronchiolitis
air trapping increased mucus production atelectasis labored breathing / decreased ventilation
56
What is the course of infection with bronchiolitis
Initial URI sx Within 48-72hrs lower airway in involved respiratory distress illness lasts 7-10 days and most infants improve in 14-21 days as long as they're hydrated
57
What are mild respiratory distress symptoms with bronchiolitis
tachypnea
58
What is severe respiratory distress symptoms in bronchiolitis
retraction'grunting cyanosis
59
What will be seen on PE with bronchiolitis
crackles/wheezing/rhonchi grunting nasal flaring retractions
60
How do you get a clinical diagnosis of bronchiolitis
RSV wash
61
What are differentials for bronchiolitis
asthma bacterial pneumonia GERD croup foreign body aspiration pertussis
62
What is the hallmark treatment for bronchiolitis
symptomatic care
63
How do you treat mild-moderate bronchiolitis symptoms
nasal saline antipyretics cool-mist humidifier
64
How do you treat severe bronchiolitis symptoms
beta agonist (albuterol) neb of hypertonic saline mechanically ventilate w/ resp failure
65
How can you try to prevent bronchiolitis
passive immunization against RSV (palivizumab)
66
What is the prognosis of bronchiolitis
self limited
67
What are the causative organisms for pertussis
bordetella pertussis Bordatella parapertussis
68
How is pertussis spread
airborne droplets (highly contagious)
69
What are some presentations of pertussis
petechiae above nipple line from increased thoracic pressure from coughing
70
What test is used for diagnosis of pertussis
Nasopharyngeal culture and PCR takes 3-7 days
71
What is a classic pertussis finding on Xray
shaggy right heart border
72
What may be seen on labs with pertussis
leukocytosis
73
What are key differentiating factors for pertussis
persistent cough without fever typical progression through 3 phases
74
What is the tx of pertussis
mostly supportive Strict isolation through contagious phase
75
What is the post exposure prophylaxis for family members of those with pertussis
erythromycin
76
Which patients with pertussis should be hospitalized
pneumonia hypoxic CNS complications unable to tolerate hydrationPO
77
Which patients do you hospitalize with pertussis regardless of symptoms
patients <1y/o who are not fully vaccinated
78
What antibiotics can be used with pertussis
Erythromycin (first line)
79
If a patient with pertussis has a fever in the paroxysmal phase, what are you concerned for and why
Pneumonia because fever should resolve in catarrhal phase
80
What are common complications of pertussis
Superimposed pneumonia Otitis media Pulmonary HTN
81
What is acute bronchitis secondary to
virsuses *bacterial infection highly uncommon
82
When is acute bronchitis commonly seen
during flu season
83
Which population is at higher risk for acute bronchitis
current/past smoker hx asthma living in polluted place crowding
84
If acute bronchitis is bacterial, what is the cause
p. pneumonia
85
What is the predominant complaint of acute bronchitis
cough
86
What kind of mucus will patients have with acute bronchitis
clear/yellowing +/- purulent
87
What is the other name for pertussis
Whooping cough
88
How long does a cough with acute bronchitis typically last
10-20 days (avg around 18days)
89
How do you treat acute bronchitis
symptomatic treatment -hot tea/honey -mucolytic -b-agonist
90
What is the gold standard for diagnosing influenza
PCR or viral culture of throat secretions
91
How many types of flu are there and which variations infect humans
4 variations A&B infect humans
92
When do incidences of of flu generally peak
October - march
93
Which patients are at higher risk with influenza
Age >65 or 6mo-6yr Chronic CV/ resp conditions CKD Diabetes Immunocompromised pregnancy
94
At what age can you begin the flu vaccine
over 6months of age
95
If a patient has an egg allergy and only develops hives, should they still get the flu vaccine
yes * just observe for 10-15 minutes post vaccination
96
Can pregnant women and elderly receive flu vaccine
Safe for pregnancy standard vaccine not effecting >65
97
What is unique to influenza A
Genetically labile with high rates of mutations
98
How do immune reaction and interferon response present
high fever, coryza, body aches
99
Where does the virus replicate in the body
upper and lower respiratory passages peaking at 48 hours
100
What is the cornerstone of treatment for influenza
supportive w/ fluids
101
Which variation of influenza can neuraminidase inhibitors be used
both A and B
102
Which variation of influenza can adamantanes be used
Influenza A only
103
What are complications of influenza
secondary bacterial pneumonia ARDS Myositis myocarditis multi organ failure

clin med pulmonology (12 decks)

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