Pulmonary Disorders Flashcards

Question

Types of **Pneumothorax: Spontaneous**

Answer 1

atraumatic and idiopathic. due to ***bleb rupture*** ***1. Primary: no underlying lung disease\*.*** *mainly affects ****_t_**all, thin men 20 - 40 yo, smokers,** _+_ family history of pneumothroax* ***2.***

Answer 2

* **_iatrogenic_:** during CPR, thoracentesis, PEEP (ventilation), subclavian line placement * _other trauma_: car accidents, etc.

Answer 3

any type of pneumothorax in which the ***positive air pressure pushes lungs, trachea, great vessels & heart to the _CONTRALATERAL SIDE_*** ## Footnote * immediately life-threatening* * MC seen during trauma, mechanical ventilation or resuscitative efforts*

Answer 4

1. ***_Chest pain_:*** *usually **_pleuritic, unilateral,_ non-exertional*** & sudden in onset; ***Dyspnea*** 2. **_PHYSICAL EXAM_** * **_Hyperresonance to percussion_*****, decreased fremitus, decreased breath sounds*** over affected side * unequal respiratory expansion, tachycardia, tachypnea * **_tension pneumothorax:_ increased JVP, pulsus paradoxus, hypotension**

Answer 5

**CXR with _expiratory view_ preferred** -- decreased peripheral lung markings (due to collapsed lung tissue) -- **_+_ companion lines** (visceral pleural line running parallel with the ribs) -- deep sulcus sign on supine chest radiograph (air collection basally and anteriorly)

Answer 6

1. **_Observation:_ *in primary spontaneous if small ( \< 15 - 20%*** *the diameter of the hemithorax or _\<_ 2 - 3 cm between the chest wall & lung on CXR). Observe at least 6 hours with repeat CXR to affirm no progression + 24 - 48 hour F/U. often spontaneously resolves w/i 10 days* * -- O₂ shown to increase air resorption 3 - 4x faster than 1.25% every day* * 2.* **_Chest tube placement (thoracostomy):_ if large or severe sx** 3. **_Needle aspiration:_ if tension pneumothorax\* followed by chest tube placement.** Needle placed in 2nd ICS @ midclavicular line on the affected side * *avoid pressure changes ex: high altitudes, smoking, unpressurized aircraft & scuba diving*

Answer 7

***highly contagious infection secondary to Bordatella pertussis*** * rarely seen due to widespread vaccination. Gram negative coccobaccillus.* * MC seen in children \< 2 yo*

Answer 8

**catarrhal phase ⇒ paroxysmal phase ⇒ convalescent phase** **1. catarrhal phase:** URI Sx lasting 1 - 2 weeks. most contagious during this phase **2. paroxysmal phase:** *severe paroxysmal coughing fits with _inspiratory whooping sound after fits_* ***_+_** **post coughing emesis*** *may develop subconjunctival hemorrhage from the increased pressure due to coughing fits* **3. convalescent phase:** resolution of cough (coughing stage may last up to 6 wks)

Answer 9

***_supportive treatment mainstay\*_*** oxygenation, nebulizers, mechanical ventilation as needed ***_antibiotics_*** used to decrease contagiousness within the 1st 7 days of Sx onset--also often given to exposed contacts **_Macrolides:_ erythromycin, azithromycin**

Answer 10

1. _PCR of nasopharnygeal swab_: GOLD STANDARD. performed in the first 3 wks of Sx onset 2. **Lymphocytosis\*** 60 - 80% lymphocytes on differential. WBC count may be as high as 50,000

Answer 11

***lower respiratory tract infection*** *of the **small ariways*** ⇒ proliferation/necrosis of the bronchiolar epithelium produces obstruction from the sloughed epithelium. increased mucus plugging & submucosal edema leading to ***_peripheral airway narrowing & variable obstruction_***

Answer 12

**_respiratory synctial virus (RSV)_** (50 - 70%) ***RSV part of parayxovirus family\**** other: adenovirus, influenza, parainfluenza, _+_ mycoplasma pneumonia, chlamydia trachomatis

Answer 13

***infants \< 2 yo MC affected (esp ~ 2 months)*** * \< 6 months of age exposure ot cigarettes, lack of breastfeeding, premature (\< 37 wks gestation) & crowded conditions* * MC in fall and spring*

Answer 14

***_fever, URI Sx 1 - 2 days ⇒ repiratory distress_*** (wheezing, tachypnea, nasal flaring, cyanosis, retractions _+_ rales)

Answer 15

_CXR:_ hyperinflation, peribroncbial cuffing, etc. nasal washings using monoclonal Ab testing ***pulse ox single best predictor of disease in children*** (\< 96% ⇒ ADMIT TO HOSPITAL)

Answer 16

***1. _supportive:_ humidified O2 mainstay of treatment*** *delivered by mask, tent, or hood. IV fluids. Acetaminophen/ibuprofen for fever. mechanical ventilation if severe.* ***2. Medications:** **play a limited role*** *_+_ ß agonists, _+_ nebulized racempic epi* *corticosteroids NOT indicated unless history of reactive airway disease* ***3. Ribavarin _+_ administered if severe lung or heart disease or in immunosuppressed patients***

Answer 17

***_Palivizumab prophylaxis may be used in increased risk groups_*** ***_HAND WASHING_*** RSV is highly contagious and is transmitted via direct contact with secretions and self-inoculation by contaminated hands

Answer 18

inflammation of epiglottitis that may interfere with breathing **medical emergency**

Answer 19

***_HAEMOPHILUS INFLEUNZAE TYPE B_*** **(Hib) MC\*\*\*** reduced incidence due ot Hib vaccination. may rarely be caused by *Streptococcus pneumoniae, S. aureus, GABHS* * MC in children 3 mnths - 6 yrs* * Males 2x MC* * DM is a risk factor in adults...*

Answer 20

* ***_Laryngoscopy: definitive Dx\*\*_*** *provides direct visualization but may provoke spasm* _Cherry red epiglottits with swelling_ * **_Lateral cervical radiograph: THUMB SIGN_** * * ***_if high suspicion, do not attempt to visualize the epiglottits with a tongue depressor in children_***

Answer 21

**_3 Ds_ - **_D_**ysphagie, **_D_**rooling, **_D_**istress** fever, ***odynophagia, _inspiratory stridor_****, dyspnea, hoarseness, muffled voice, **_tripoding_*** suspect in pt with rapidly developing pharyngitis, muffled voice & odynophagia (painful swallowing) out of proportion to physical findings

Answer 22

**_1. Maintaining the airway & supportive management is the mainstay of Tx_** place child in a comfortable position dexamethasone to reduce airway edema tracheal intubatiodn to protect the airway in severe cases **2. Antibiotics: 2nd/3rd cephalosporins: ceftriaxone or cefotaxime** _+_ add PCN, ampicillin, or anti-staphylococcal coverage

Answer 23

***inflammation MC secondary to acute viral infection of the UPPER AIRWAY*** *(larynx, subglottis, trachea)* *⇒* ***_subglottic larynx/trachea swelling_*** * ⇒* * stridor, BARKING cough, hoarseness*

Answer 24

**_PARAINFLUENZA type 1 MC cause\*\*_** also...adenovirus, RSV, rhinovirus, etc. Diptheria rare 15% of children experience croup in childhood (MC 6 months - 6 yrs) MC in fall/winter

Answer 25

***_Barking cough (seal-like, harsh)_*** ***stridor*** both inspiratory and expiratory (worsened by crying or agitating the child) ***hoarseness*** due to laryngitis ***dyspnea*** (especially ***worse at night***) **_+_ URI Sx** either preceding or concurrent fever

Answer 26

clinical Dx (once epiglottitis and foreign body aspiration are excluded) _Frontal **cervical radiograph**: **STEEPLE SIGN\*\***_ (subglottic narrowing of trachea) - 50%

Answer 27

1. **Mild:** (no stridor at rest, no respiratory distress): **cool, humidified air mist, hydration** **Dexamethasone provides significant relief** as early as 6 hours after single dose 2. **Moderate:** (stridor at rest with mild to moderate retractions): Dexamethasone PO or IM + supportive treatment _+_ nebulized Epi * should be observed for 3 - 4 hours of clinical intervention* 3. **_Severe:_** (stridor at rest with marked retractions) ***Dexamethasone + nebulized Epi and hospitalization***

Answer 28

Acute repiratory illnesses caused by Influenza A or B viruses. part of the orthomyxovirus family ## Footnote ***A is associated with more severe, extensive outbreaks*** *spreads primarily via airborne respiratory secretions. outbreaks occur mainly in the fall/winter*

Answer 29

**_usually abrupt onset_** of a wide range of sx: HA, fever, chills, malaise, URI Sx, pharyngitis, pneumonia ## Footnote *Myalgias MC seen in legs and lumbosacral area*

Answer 30

usually clinical ## Footnote **rapid influenza test (nasal swab) or viral culture can be performed**

Answer 31

***1. _supportive mainstay tx in healthy patients_*** (acetaminophen, rest) 2. ***antivirals usually only needed in patients with high risk of complications*** ***best if initiated _within 48 hours of sx onset_*** A. Neuraminidase Inhibitors--oseltamivir (tamiflu) (vs. A and B) B. Amantadine and Rimantidine (vs. A, not commonly used)

Answer 32

acute bronchitis is defined by a **_cough which persists for MORE THAN 5 days_** (fever is unusual; if your patient has a fever, consider PNA) 95% will be viral cause

Answer 33

M. Cattarhalis (common bacterial cause of acute bronchitis) H. influenzae S. pneumoniae

Answer 34

*Mycobacterium tuberculosis* chronic infection leading to **granuloma formation** **inhalation of airborne droplets** ⇒ mycobacterium reaches the alveoli & are ingested by alveolar macrophages

Answer 35

**fever, night sweats, anorexia, weight loss**

Answer 36

***reactivation of latent TB with waning immune defenses*** *5 - 10% lifetime incidence* ***MC localized in apex/upper lobes with cavitary lesions*** ***THESE PATIENTS ARE CONTAGIOUS***

Answer 37

Purified Protein Dertivative (PPD): ***examine 48 - 72 hours for transverse induration (redness is NOT considered positive)*** _POSITIVE IF:_ **\> 5 mm: HIV +**, or immunosuppressed (ex. prednisone 15 mg/day \> 1 mnth) close contacts of patients with active TB CXR consistent with old/healed TB (calcified granuloma) **\> 10 mm:** all other high risk populations/high prevalence populations (prison, homeless) **\> 15 mm:** pts with no risk factors

Answer 38

**1. (GOLD STANDARD) _Acid-fast smear & sputum cultures x 3 days:_** TB ruled out after 3 negative smears **2. CXR are indicated to excluse active TB (newly + PPD) and used as yearly screening in patients with known + PPD**

Answer 39

* **_Reactivation:_** apical (upper lobe) * **_Primary TB:_** middle/lower lobe * **_Miliary TB (widespread dissemination):_** CXR shows small **millet-seed** like nodular lesion (2 - 4 mm)

Answer 40

**Potts Dz** is Tb to the spine **Scrofula** is Tb to the cervical lymph nodes

Answer 41

**Rifampin (RIF)** (orange-colored secretions) **Isoniazid (INH)** (hepatitis, *_peripheral neuropathy prevented by pyridoxine B6)_* **Pyrazinamide (PZA)** (hepatitis and hyperuricemia, photosensitive rash) **Ethambutol (EMB)** (optic neuritis) or **Streptomycin (STM)** (ototoxicity and nephrotoxicity) *_INH prophylaxis given to children \< 4 yo with exposure to contacts with active disease_*

Answer 42

Mycobacterium avium and intracellulare _Transmission:_ soil/water (NOT person to person) Sx occur RARELY in immunocompetent pts. **seen in HIV when _CD4 \< 50\*\*_**

Answer 43

1. **_Pulmonary Infection:_** in immunocompetent: cough with sputum, fever, weight loss, **bronchiectasis** 2. **_Disseminated:_** (in HIV pts) FUO, sweating, weight loss, fatigue, diarrhea, dyspnea, RUQ pain 3. **_Lymphadenitis in children:_** cervical submandibular/maxillary

Answer 44

**_Dx:_** Acid-fast bacillus staining & culture **_Management:_** _Clarithromycin + Ethambutol_ at least 12 months

Answer 45

Pinworms!!

Answer 46

**perianal itching especially nocturnal** | (eggs are laid at night)

Answer 47

**_Dx:_** *scotch tape test (early in AM)* to look for eggs under a microscope **_Management:_** **Albendazole or Mebendazole** none are used in children _\<_ 2 yo

Answer 48

autosomal recessive disorder that results in the **abnormal production of mucus by almost all exocrine glands, causing obstruction of those glands and ducts** lungs are generally histologically normal at birth, but **most pts develop pulmonary disease beginning in infancy or early childhood** **non-pulmonary** - pancreatitis and steatorrhea - **pts will need supplementation of fat-soluble vitamins** the course is characterized by episodic exacerbations with infection and progressive decline in pulmonary function -- **mean survival is about 31 years**

Answer 49

**elevated quantitative sweat chloride test** performed on two different days **increased NaCl \> 60 mEq/L** a normal result does not exclude the diagnosis, if strongly suspected, **DNA testing can provide definitive Dx** **CXR may reveal hyperinflation, mucus plugging and focal atelactasis** **_Management_:** in the first few months of life, respiratory infection is common with **Staph aureus** and **Haemophilus influenzae** AFTER THAT **Pseudomonas** aeruginosa **becomes the major causative organism for infections** therapies focus on: * clearing the airway of secretions -- **chest physiotherapy** * reversing bronchoconstriction * treating respiratory infections **(treat for pseudomonas)** *