Pulmonary

Question 1

Lower respiratory tract infection of the small airways leading to mucus plugging and peripheral airway narrowing and variable obstruction

Answer 1

RSV - Acute bronchiolitis

Question 2

Most common cause of acute bronchiolitis

Answer 2

RSV - respiratory syncytial virus

Question 3

Most common age group affected by RSV

Answer 3

< 6 mo (especially around 2 months)

Question 4

Risk factors for RSV

Answer 4

Cigarette exposure
Lack of breastfeeding
Premature crowded conditions

Question 5

Complications of RSV

Answer 5

Otitis media - most common acute

Asthma - most common later in life

Question 6

Fever, URI symptoms for 1-2 days followed by respiratory distress (wheezing, tachypnea, nasal flaring, cyanosis, retractions)

Answer 6

RSV - acute bronchiolitis

Question 7

Diagnosis of RSV / acute bronchiolitis

Answer 7

CXR - hyperinflation, peribronchial cuffing
Nasal washings using monoclonal Ab testing
Pulse ox

Question 8

Best predictor of disease in children with RSV

Answer 8

Pulse ox < 96% - admit

Question 9

Management of RSV

Answer 9

Supportive: O2 mainstay
Albuterol, racemic epi if albuterol not effective
Ribavirin if severe

Question 10

Prevention of RSV

Answer 10

Palivizumab prophylaxis in high risk groups

Hand washing preventative

Question 11

Inflammation most commonly secondary to acute viral infxn of the upper airway leading to subglottic larynx/trachea swelling

Answer 11

Laryngotracheitis (croup)

Question 12

Signs/symptoms of laryngotracheitis (croup)

Answer 12

1. Barking cough (seal-like, harsh)
2. Stridor (both inspiratory and expiratory)
3. Hoarseness
4. Dyspnea (especially worse at night)
5. +/- preceding URI sx

Question 13

Diagnosis of laryngotracheitis (croup)

Answer 13

1. Clinical

2. Frontal cervical radiograph - steeple sign

Question 14

Steeple Sign

Answer 14

Laryngotracheitis (croup)

Question 15

Management of mild croup (no stridor at rest, no respiratory distress)

Answer 15

Cool humidified air mist, hydration
Dexamethasone
Supplemental oxygen if < 92%

Question 16

Management of moderate croup (stridor at rest with mild-mod retractions)

Answer 16

Dexamethasone PO or IM +/- nebulized epinephrine

Should be observed 3-4 hours

Question 17

Management of severe croup (stridor at rest with marked retractions)

Answer 17

Dexamethasone + nebulized epinephrine and hospitalization

Question 18

Most common cause of CAP

Answer 18

Streptococcus pneumoniae

Haemophilus influenzae

Question 19

Klebsiella pneumonia is seen in ___________ and is associated with _________

Answer 19

Alcoholics

Cavitary lesions

Question 20

Most common viral cause of pneumonia in infants/small children

Answer 20

RSV Parainfluenza

Question 21

Most common viral cause of pneumonia in adults

Answer 21

Influenza

Question 22

Most common causes of hospital acquired pneumonia

Answer 22

Pseudomonas
E. coli
Klebsiella
Staph aureus (MRSA)

Question 23

When to hospitalize for pneumonia

Answer 23

Multilobar
Neutropenia
Comorbidities

Question 24

Still considered community acquired if pt develops pneumonia within __________ of initial hospital admission

Answer 24

48 hours

Question 25

Physical exam signs of pneumonia

Answer 25

Dullness on percussion Egophony Increased tactile fremitus Inspiratory rales (crackles)

Question 26

Mycoplasma pneumonia (atypical) is associated with

Answer 26

Bullous myringitis

Question 27

Legionella pneumonia is associated with

Answer 27

GI symptoms | Increased LFTs

Question 28

Diagnosis of pneumonia

Answer 28

1. CXR/CT | 2. Sputum culture (gram stain)

Question 29

Rusty (blood-tinged sputum in pneumonia)

Answer 29

Strep pneumoniae

Question 30

Currant jelly sputum in pneumonia

Answer 30

Klebsiella

Question 31

Management of CAP outpatient

Answer 31

Macrolide or doxycycline

Question 32

Management of CAP inpatient

Answer 32

B lactam + macrolide or doxycycline OR fluoroquinolone

Question 33

Management of HAP

Answer 33

B lactam + AG or FQ

Question 34

Reverse hyperirritability of the tracheobronchial tree, leading to airway inflammation and bronchoconstriction

Answer 34

Asthma

Question 35

Most common chronic childhood disease

Answer 35

Asthma

Question 36

Samter's Triad

Answer 36

1. Asthma 2. Nasal polyps 3. ASA/NSAID allergy

Question 37

Classic triad of asthma

Answer 37

1. Dyspnea 2. Wheezing 3. Coughing (esp at night)

Question 38

Prolonged expiration with wheezing, hyperresonance to percussion

Answer 38

Asthma

Question 39

Diagnosis of asthma

Answer 39

1. PFT - gold standard (reversible obstruction) 2. Bronchoprovocation- methacholine challenge 3. Peak Flow Rate - best for assessing severity 4. Pulse Ox 5. ABG 6. CXR

Question 40

Admission criteria for asthma

Answer 40

PEFR < 50% predicted ER visit within 3 days of exacerbation Status asthmaticus Post treatment failure AMS

Question 41

Adjuncts for asthma management

Answer 41

IV magnesium - indicated in severe asthma | Omalizumab - used in severe, uncontrolled asthma

Question 42

Diagnosis of foreign body aspiration

Answer 42

1. Bronchoscopy - allows for removal | 2. CXR

Question 43

Disease of premature infants secondary to insufficiency of surfactant production and lung structural immaturity

Answer 43

Infant respiratory distress syndrome (hyaline membrane disease)

Question 44

Infant respiratory distress syndrome (hyaline membrane disease) leads to

Answer 44

Atelectasis and perfusion without ventilation

Question 45

Most common single cause of death in first month of life

Answer 45

Hyaline membrane disease (infant respiratory distress syndrome)

Question 46

Surfactant production begins around ________ weeks. By _____ weeks, enough surfactant is produced

Answer 46

24-28 weeks | 35 weeks

Question 47

Risk factors for hyaline membrane disease (IRDS)

Answer 47

Caucasian Male Cesarean delivery (cortisol production - stress) Perinatal infection Multiple births Maternal diabetes (high insulin delays surfactant production)

Question 48

Signs/symptoms of hyaline membrane disease (IRDS)

Answer 48

``` Presents shortly postpartum with respiratory distress Tachypnea Tachycardia Chest wall retractions Expiratory grunting Nasal flaring Cyanosis ```

Question 49

Diagnosis of hyaline membrane disease (IRDS)

Answer 49

1. CXR - reticular ground-glass opacities + air bronchograms 2. ABG - hypoxia 3. Post mortem histopathology - waxy appearing layers lining collapsed alveoli

Question 50

Management of hyaline membrane disease (IRDS)

Answer 50

Exogenous surfactant given to open alveoli (via endotracheal tube). CPAP

Question 51

Prevention of hyaline membrane disease (IRDS)

Answer 51

Corticosteroids given to mature lungs if premature delivery expected (24-36 weeks)

Question 52

Irreversible bronchial dilation secondary to transmural inflammation of medium-sized bronchi

Answer 52

Cystic fibrosis (bronchiectasis)

Question 53

Most common cause of bronchiectasis if not due to cystic fibrosis

Answer 53

H influenza

Question 54

Most common cause of bronchiectasis if due to cystic fibrosis

Answer 54

Pseudomonas

Question 55

Most common cause of bronchiectasis in US

Answer 55

Cystic fibrosis

Question 56

Daily chronic cough with thick, mucopurulent, foul-smelling sputum, pleuritic chest pain, patient's often develop pneumonia

Answer 56

Cystic fibrosis

Question 57

Most common cause of massive hemoptysis

Answer 57

Cystic fibrosis | Acute bronchitis and lung carcinoma most common causes of hemoptysis in general

Question 58

Physical exam with cystic fibrosis

Answer 58

Persistent crackles at the bases common | Wheezing, rhonchi, clubbing

Question 59

Diagnosis of cystic fibrosis

Answer 59

1. CT scan - study of choice (tram-track appearance), mucopurulent plugs 2. PFT - obstructive pattern 3. CXR 4. Sputum culture 5. Bronchoscopy

Question 60

Management of cystic fibrosis

Answer 60

Antibiotics cornerstone of tx Empiric (ampicillin, amoxicillin, TMP-SMX) Bronchodilators, anti-inflammatory agents Surgery