Pulmonary Flashcards
Lower respiratory tract infection of the small airways leading to mucus plugging and peripheral airway narrowing and variable obstruction
RSV - Acute bronchiolitis
Most common cause of acute bronchiolitis
RSV - respiratory syncytial virus
Most common age group affected by RSV
< 6 mo (especially around 2 months)
Risk factors for RSV
Cigarette exposure
Lack of breastfeeding
Premature crowded conditions
Complications of RSV
Otitis media - most common acute
Asthma - most common later in life
Fever, URI symptoms for 1-2 days followed by respiratory distress (wheezing, tachypnea, nasal flaring, cyanosis, retractions)
RSV - acute bronchiolitis
Diagnosis of RSV / acute bronchiolitis
CXR - hyperinflation, peribronchial cuffing
Nasal washings using monoclonal Ab testing
Pulse ox
Best predictor of disease in children with RSV
Pulse ox < 96% - admit
Management of RSV
Supportive: O2 mainstay
Albuterol, racemic epi if albuterol not effective
Ribavirin if severe
Prevention of RSV
Palivizumab prophylaxis in high risk groups
Hand washing preventative
Inflammation most commonly secondary to acute viral infxn of the upper airway leading to subglottic larynx/trachea swelling
Laryngotracheitis (croup)
Signs/symptoms of laryngotracheitis (croup)
- Barking cough (seal-like, harsh)
- Stridor (both inspiratory and expiratory)
- Hoarseness
- Dyspnea (especially worse at night)
- +/- preceding URI sx
Diagnosis of laryngotracheitis (croup)
- Clinical
2. Frontal cervical radiograph - steeple sign
Steeple Sign
Laryngotracheitis (croup)
Management of mild croup (no stridor at rest, no respiratory distress)
Cool humidified air mist, hydration
Dexamethasone
Supplemental oxygen if < 92%
Management of moderate croup (stridor at rest with mild-mod retractions)
Dexamethasone PO or IM +/- nebulized epinephrine
Should be observed 3-4 hours
Management of severe croup (stridor at rest with marked retractions)
Dexamethasone + nebulized epinephrine and hospitalization
Most common cause of CAP
Streptococcus pneumoniae
Haemophilus influenzae
Klebsiella pneumonia is seen in ___________ and is associated with _________
Alcoholics
Cavitary lesions
Most common viral cause of pneumonia in infants/small children
RSV Parainfluenza
Most common viral cause of pneumonia in adults
Influenza
Most common causes of hospital acquired pneumonia
Pseudomonas
E. coli
Klebsiella
Staph aureus (MRSA)
When to hospitalize for pneumonia
Multilobar
Neutropenia
Comorbidities
Still considered community acquired if pt develops pneumonia within __________ of initial hospital admission
48 hours
Physical exam signs of pneumonia
Dullness on percussion
Egophony
Increased tactile fremitus
Inspiratory rales (crackles)
Mycoplasma pneumonia (atypical) is associated with
Bullous myringitis
Legionella pneumonia is associated with
GI symptoms
Increased LFTs
Diagnosis of pneumonia
- CXR/CT
2. Sputum culture (gram stain)
Rusty (blood-tinged sputum in pneumonia)
Strep pneumoniae
Currant jelly sputum in pneumonia
Klebsiella
Management of CAP outpatient
Macrolide or doxycycline
Management of CAP inpatient
B lactam + macrolide or doxycycline OR fluoroquinolone
Management of HAP
B lactam + AG or FQ
Reverse hyperirritability of the tracheobronchial tree, leading to airway inflammation and bronchoconstriction
Asthma
Most common chronic childhood disease
Asthma
Samter’s Triad
- Asthma
- Nasal polyps
- ASA/NSAID allergy
Classic triad of asthma
- Dyspnea
- Wheezing
- Coughing (esp at night)
Prolonged expiration with wheezing, hyperresonance to percussion
Asthma
Diagnosis of asthma
- PFT - gold standard (reversible obstruction)
- Bronchoprovocation- methacholine challenge
- Peak Flow Rate - best for assessing severity
- Pulse Ox
- ABG
- CXR
Admission criteria for asthma
PEFR < 50% predicted
ER visit within 3 days of exacerbation
Status asthmaticus
Post treatment failure AMS
Adjuncts for asthma management
IV magnesium - indicated in severe asthma
Omalizumab - used in severe, uncontrolled asthma
Diagnosis of foreign body aspiration
- Bronchoscopy - allows for removal
2. CXR
Disease of premature infants secondary to insufficiency of surfactant production and lung structural immaturity
Infant respiratory distress syndrome (hyaline membrane disease)
Infant respiratory distress syndrome (hyaline membrane disease) leads to
Atelectasis and perfusion without ventilation
Most common single cause of death in first month of life
Hyaline membrane disease (infant respiratory distress syndrome)
Surfactant production begins around ________ weeks. By _____ weeks, enough surfactant is produced
24-28 weeks
35 weeks
Risk factors for hyaline membrane disease (IRDS)
Caucasian
Male
Cesarean delivery (cortisol production - stress)
Perinatal infection
Multiple births
Maternal diabetes (high insulin delays surfactant production)
Signs/symptoms of hyaline membrane disease (IRDS)
Presents shortly postpartum with respiratory distress Tachypnea Tachycardia Chest wall retractions Expiratory grunting Nasal flaring Cyanosis
Diagnosis of hyaline membrane disease (IRDS)
- CXR - reticular ground-glass opacities + air bronchograms
- ABG - hypoxia
- Post mortem histopathology - waxy appearing layers lining collapsed alveoli
Management of hyaline membrane disease (IRDS)
Exogenous surfactant given to open alveoli (via endotracheal tube).
CPAP
Prevention of hyaline membrane disease (IRDS)
Corticosteroids given to mature lungs if premature delivery expected (24-36 weeks)
Irreversible bronchial dilation secondary to transmural inflammation of medium-sized bronchi
Cystic fibrosis (bronchiectasis)
Most common cause of bronchiectasis if not due to cystic fibrosis
H influenza
Most common cause of bronchiectasis if due to cystic fibrosis
Pseudomonas
Most common cause of bronchiectasis in US
Cystic fibrosis
Daily chronic cough with thick, mucopurulent, foul-smelling sputum, pleuritic chest pain, patient’s often develop pneumonia
Cystic fibrosis
Most common cause of massive hemoptysis
Cystic fibrosis
Acute bronchitis and lung carcinoma most common causes of hemoptysis in general
Physical exam with cystic fibrosis
Persistent crackles at the bases common
Wheezing, rhonchi, clubbing
Diagnosis of cystic fibrosis
- CT scan - study of choice (tram-track appearance), mucopurulent plugs
- PFT - obstructive pattern
- CXR
- Sputum culture
- Bronchoscopy
Management of cystic fibrosis
Antibiotics cornerstone of tx
Empiric (ampicillin, amoxicillin, TMP-SMX)
Bronchodilators, anti-inflammatory agents
Surgery