Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pulmonology 2 > Pulm Mop-Up > Flashcards

Pulm Mop-Up Flashcards

1
Q

What kind of virus is Respiratory Syncytial Virus?

A

Medium-sized membrane-bound RNA virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

RSV causes…

A

acute respiratory tract disease in all ages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What population is RSV most significant in?

A

Most clinically significant in infants and young children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

RSV in adults vs. children

A
  • adults – Upper Respiratory Infections

- infants and children – Upper and Lower RT infxs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does mucus build-up in RSV?

A

small airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

RSV incubation

A

2–8 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

RSV detection and shedding

A
  • virus is detected in secretions 4 days prior to clinical sxs
  • typically shedding of infectious virions is 3–8 days (can be as long as 3–4 weeks in immunocompromised)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

RSV transmission

A
  • direct contact of nasopharyngeal or ocular mucosa with infected secretions
  • nosocomial spread can occur because the virus can survive on surfaces and hands for several hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

RSV peak incidence

A

first 2 years of life (20–30% of infected infants develop lower respiratory tract disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Initial vs. subsequent RSV infections

A

Subsequent is milder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Those at greatest risk for severe RSV infection

A
  1. children < 1 year of age (especially those < 6 months of age)
  2. children born prematurely (< 35 weeks gestation)
  3. children with underlying cardiopulmonary disease (e.g., chronic lung disease of prematurity, congenital heart disease)
  4. Those with primary immune deficits
  5. Patients on immunosuppressive medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is there a RSV vaccine?

A

No - but there is prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

RSV prophylaxis

A

Synagis

  • Very hard to actually get insurance to pay
  • Reserved for high risk patients
    (e. g. premie of 32 weeks born in April will start it immediately)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

RSV clinical manifestations Infants/Young Children

A 
Rhinorrhea
Low-grade fever
Mild systemic symptoms
Cough
Wheeze

*Gradual recovery over 1 – 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

RSV diagnosis

A
  • Rapid diagnostic antigen assays from nasopharyngeal specimens are used for RSV detection, usually with a sensitivity of 80–90%
  • Because concurrent serious bacterial infections are not common, complete blood counts or blood cultures are not indicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When do you xray a child with RSV?

A

Those who likely have a secondary bacterial infection..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is acute epiglottitis?

A

Acute, rapidly progressive form of cellulitis of the epiglottis and adjacent structures

  • -H. influenzae type b (Hib)
  • -Vaccine decreased incidence by > 90% in children
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What sign do you see on film for acute epiglottitis?

A

Thumbprint sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is bronchiectasis?

A

Dilated airway with thick phlegm around it - can be from infection of inflammation - and chronic, productive cough.

20
Q

Bronchiectasis classifications

A
  1. cystic fibrosis

2. non-cystic fibrosis

21
Q

Bronchiectasis characteristics

A
  • Most common in the 6th decade of life (age 50)
  • Females > Males
  • Decreased incidence in the US due to childhood vaccines against Pertussis and effective txmt of childhood respiratory infx w/abx
22
Q

Bronchiectasis vicious circle hypothesis

A
  • -Transmural infection, generally by bacterial organisms, causes inflammation and obstruction of airways.
  • -Damaged airways and dysfunctional cilia foster bacterial colonization, which leads to further inflammation and obstruction
23
Q

Bronchiectasis physical exam

A
  • Chronic cough (90%)
  • Sputum: may be copious and purulent (90%)
  • Rhinosinusitis (60–70%)
  • Fatigue: may be a dominant symptom (70%)
  • Dyspnea (75%)
  • Chest pain: may be pleuritic (20–30%)
  • Hemoptysis (20–30%)
  • Wheezing (20%)
  • Bibasilar crackles (60%)
  • Rhonchi (44%)
  • Digital clubbing (3%)
24
Q

Bronchiectasis diff dx

A
  • CF
  • Chronic obstructive pulmonary disease
  • Asthma
  • Chronic bronchitis
  • Pulmonary TB
  • ABPA (Allergic bronchopulmonary aspergillosis)
25
Q

Bronchiectasis tests & interpretation

A

Spirometry

  • -Moderate airflow obstruction and hyperresponsive airways
  • -Forced expiratory volume in the 1st second of expiration (FEV1): < 80% predicted and FEV1/FVC < 0.7
26
Q

Bronchiectasis tests & interpretation

A

Sputum culture

  • -H. influenzae, nontypeable form (42%)
  • -P. aeruginosa (18%)
  • -Cultures may also be positive for Streptococcus pneumoniae, Moraxella catarrhalis, MAC, and Aspergillus.
  • -Of all isolates, 30–40% will show no growth
27
Q

What are the special tests for bronchiectasis?

A
  • Sweat test for CF
  • Purified protein derivative (PPD) test for TB
  • Skin test for Aspergillus
  • HIV screen (immunocompromised component)
28
Q

What are the special tests for bronchiectasis?

A
  • Serum immunoglobulins to test for humoral immunodeficiency
  • Protein electrophoresis to test for α1-antitrypsin deficiency
  • Barium swallow to look for abnormalities of deglutition, achalasia, esophageal hypomotility
  • pH probe to characterize reflux
  • Screening tests for rheumatologic diseases
29
Q

What would you see on bronchiectasis chest radiograph?

A

Nonspecific; increased lung markings or may appear normal

30
Q

What is the most important bronchiectasis diagnostic tool?

A

CT

31
Q

What do you see on bronchiectasis CT?

A

Bronchi are dilated and do not taper, resulting in “tram track sign”; parallel opacities seen on scan.
Varicose constrictions and balloon cysts may be seen.

32
Q

Focal vs. upper lobe bronchiectasis considerations.

A
  • For focal bronchiectasis, rule out endobronchial obstruction.
  • For exclusively upper lobe bronchiectasis, consider CF and ABPA.
33
Q

Qualifications for acute exacerbation (bronchiectasis)

A
  • requires 4 out of 9
  • change in sputum production – increase
  • increased dyspnea
  • increased cough
  • fever
  • increased wheezing
  • malaise, fatigue, lethargy
  • reduced pulmonary function
  • radiographic changes
  • changes in chest sounds
34
Q

Treatment of chronic bronchiectasis

A
  • maintain hydration
  • frequent exacerbations may be treated with prolonged and aerosolized antibiotics
  • role of mucolytics, antiinflammatory agents, and bronchodilators is still unclear
35
Q

First line acute exacerbation (bronchiectasis)

A
  1. Antibiotics: guided by sputum culture and sensitivity
  2. Bronchodilators: chronic use of β2-agonists (e.g., albuterol) reverses airflow obstruction.
  3. Inhaled corticosteroids: insufficient evidence exists to recommend use of inhaled steroids with stable bronchiectasis
36
Q

What sign is on CT for bronchiectasis?

A

Cylindrical bronchiectasis, CT

“signet ring” sign

37
Q

What is hyaline membrane disease?

A

AKA Surfactant Deficiency

  • 93% incidence in infants born at or before 28 weeks’ gestational age
  • Male is the predominant sex
  • 8th leading cause of infant death
38
Q

Diff dx of hyaline membrane disease

A
  • Early-onset group B streptococcal pneumonia and/or sepsis
  • Transient tachypnea of newborn
  • Meconium aspiration pneumonia
39
Q

Hyaline membrane disease diagnostic tests & interpretation

A
  • CBC and blood cx- r/o sepsis and pneumonia
  • Electrolytes: Monitor for hypoglycemia/hypocalcemia
  • Arterial blood gases (ABGs)
  • Hypoxemia (which responds to supplemental oxygen)
  • Features of respiratory and metabolic acidosis
  • Chest x-ray (CXR): diffuse reticulogranular pattern (ground-glass appearance)
  • Air bronchograms
  • Low lung volumes
40
Q

Hyaline membrane disease ECHO

A

Consider if murmur is present

  • -To evaluate for patent ductus arteriosus (PDA)
  • -Contribution to lung disease due to L → R shunting
41
Q

When would you use humidified oxygen-enriched gas in hyaline membrane disease?

A

if the baby is breathing on their own.

42
Q

When would you use CPAP in hyaline membrane disease?

A

if infant is active and breathing spontaneously

43
Q

When would you use positive-pressure ventilation per ETT in hyaline membrane disease?

A

If respiratory failure occurs (i.e., respiratory acidosis, apnea, or hypoxia despite nasal CPAP)

44
Q

Management/monitoring of hyaline membrane disease

A
  • Transcutaneous monitors to measure CO2 tension as necessary
  • Constant pulse oximetry
  • Umbilical artery catheter placement for continuous BP monitoring and sampling ABGs
45
Q

Where does foreign body aspiration land?

A

Right mainstem bronchus

Pulmonology 2 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions