Pulmonary Review Flashcards
1
Q
All lung disorders cause some kind of airway ______?
A
Obstruction
2
Q
Describe a complete airway obstruction
A
no airflow
3
Q
Describe a partial airway obstruction
A
Impaired airflow
4
Q
Disease examples of upper airway respiratory distress?
A
Epiglottitis, obstructive sleep apnea, tracheomalacia
5
Q
Disease examples of lower airway respiratory distress?
A
Pneumonia Asthma Acute respiratory distress syndrome Pneumothorax Cystic FIbrosis Atelectasis
6
Q
Most common respiratory disorder in daycare and preschool children?
A
Common cold
7
Q
Presents with low-grade fever, rhinitis, and usually resolves by day 10
A
Common cold
8
Q
Most common “common cold” viruses
A
Parainfluenza
RSV
Coronavirus
Human metapneumovirus
9
Q
Presents with inflammation of mucosal lining of throat, acute presentation with erythema, exudate, ulceration
A
Pharnygitis
10
Q
Presents with pain, myalgia/arhralgia, fever, sore throat/dysphagia, rhinitis, cough, hoarseness, stomatitis, gradual onset
A
Viral Pharyngitis
11
Q
Which pharyngitis presents with exudate on tonsils, soft palate?
A
EBV viral pharyngitis
12
Q
Which pharyngitis presents with follicular pattern on pharynx?
A
Adenovirus viral pharyngitis
13
Q
Which pharyngitis presents with vesicles/ulcers on tonsils?
A
Enterovirus viral pharyngitis
14
Q
Which pharyngitis presents with ulcers anteriorly/marked adenopathy?
A
HSV viral pharyngitis
15
Q
Which pharyngitis presents with more lower tract disease?
A
Parainfluenza/RSV viral pharyngitis
16
Q
Presents with petechiae on soft palate/pharynx, swollen, beefy-red uvula/tonsillopharyngeal tissue
Yellow, blood-tinged exudate
Tender, enlarged anterior cervical lymph nodes
Bad breath
Scarlatiniform rash, strawberry tongue, circumoral pallor if scarlet fever
A
Acute Bacterial Pharyngitis
17
Q
Commonly occurs in late winter/early spring in ages 5 to 14 years old
A
Acute Bacterial Pharyngitis
18
Q
Treatment for acute bacterial pharyngitis?
A
Antibiotics in symptomatic child with +RADT or culture
Supportive care
NO STEROIDS
Return to school when on antibiotics after 24 hours
19
Q
After recent bacterial pharyngitis, the patient is presenting with a new tic disorder and some obsessive thoughts. Which complication does this patient have?
A
Pediatric autoimmune neuropsychiatric disorder syndrome (PANDAS)
20
Q
Does PANDAS have acute or graduate onset?
A
Abrupt onset
21
Q
What the common age group for PANDAS complication after acute bacterial pharyngitis?
A
Prepubertal onset
22
Q
Acute presentation of high fever, purulent nasal discharge with worsening URI symptoms, headache, bad breath, fatigue, facial pain, congestion/fullness,nasal discharge, purulence/discolroed postnatal drip
A
Rhinosinusitis
23
Q
What are the criteria for antibiotics for rhinosinusitis?
A
URI lasting more than 10 days with purulent discharge, cough/worsening fever, high fever
24
Q
Brassy cough, stridor, hoarseness, respiratory distress
A
Croup
25
Mild to severe laryngeal obstruction and stridor with symptoms worse at night
Croup
26
Presents with slight dyspnea, tachypnea, retractions, mild, brassy/barky cough, stridor, low grade to high fever, epiglottis is normal, substernal retractions, prolonged inspiration, wheezing/rales
Croup
27
What will radiograph show for croup?
Subglottis narrowing "steeple sign"
28
What is the common management for croup?
```
Humidified air
Nebulized epinephrine
Corticosteroids
Bronchodilators if bronchospasm present
Heliox for severe croup
```
29
A patient presents in the ER with croup and has a fever greater than 102.2F. Should the patient be sent home with supportive care or admitted?
Hospitalization
30
A patient presents in the ER with croup and has a respiratory rate of 88 bpm. Should the patient be sent home with supportive care or admitted?
Hospitalization
31
What is the common age for epiglottitis?
1-5 years old
32
Presentation of abrupt onset of fever, severe sore throat, dyspnea, inspiratory distress without stridor, drooling
Epiglottitis
33
There is a 4 year old male presenting to the ER with drooling and severe retractions. He feels some relief with hyperextending his neck.
Epiglottitis
34
What will the radiograph show for epiglottitis?
"Thumb sign"
35
What is the best prevention for epiglottitis?
HIB immunization
36
Inflammation, necrosis, edema of respiratory epithelial cells in small airways
Bronchiolitis
37
Presents with URI symptoms, gradual development of respiratory distress, low to moderate fever, decreased appetite, tachypnea, retractions, expiratory wheezing, fine/coarse crackles
Bronchiolitis
38
What is the recommended treatment for bronchiolitis?
Hydration and antipyretics
Monitor fluid intake
Nasal suctioning
39
What is not recommended treatment for bronchiolitis?
No bronchodilators
No antibiotics
No deep airway suctioning
40
Presentation of rapid onset of hoarseness or chronic croupy cough along with unilateral wheezing and recurrent pneumonia
Foreign body aspiration
41
Which side of the lung is commonly affected with foreign body aspiration?
Right lung
42
A three year old girl presents with blood-streaked sputum and had initially coughing, gagging, and choking. What is likely her diagnosis?
Foreign body aspiration
43
Presentation of dry, hacking cough, low substernal discomfort, burning chest pain
Bronchitis
44
There is coarse breath sounds, rhonchi, rales on exam
Bronchitis
45
What is not recommended for bronchitis treatment?
Cough suppressants
| Bronchodilators
46
Presents with tachycardia, nasal flaring, grunting, retractions, tachypnea, air hunger, cyanosis, fine crackles, dullness, diminished breath sounds
Pneumonia
47
What are the common signs of bacterial pneumonia?
Fever, hypoxia, lethargy
Splinting affected side, tachypnea, retractions
Pleural effusion
48
What are the common signs of viral pneumonia?
Wheezing
| Repetitive, staccato cough
49
What is the common treatment for pneumonia?
Antipyretics
Hydration
Rest
50
Genetic disorder with chronic obstructive pulmonary disease, GI disturbances, exocrine dysfunction
Cystic fibrosis
51
What is the genetic inheritance of cystic fibrosis?
Autosomal recessive
52
Common GI issues with cystic fibrosis
Meconium ileus, pancreatic insufficiency, rectal prolapse
Thick, fat-laden stools, failure to thrive
Volvulus, duodenal inflammation, GER< AKED deficiencies
Distal intestinal obstructive syndrome
53
Chronic respiratory disease characterized by periods of coughing, wheezing, respiratory distress, bronchospasm
Asthma
54
What is the asthma triad?
Mucus, inflammation, bronchoconstriction
55
What is the most common cause of respiratory alkalosis?
Hyperventilation
56
What is the most common cause of respiratory acidosis?
Retention of CO2 from hypoventilation
57
What is the most common cause of metabolic acidosis?
Added acid or lost base
58
What is the most common cause of metabolic alkalosis?
Added base or lost acid
59
What are common examples of respiratory alkalosis causes?
```
Anxiety, pain
fever
Stimulants
CNS irritations
Excessive ventilatory support
```
60
What are the common example of respiratory acidosis causes?
CNS depression, neuromuscular disease, trauma, restrictive lung disease, COPD
61
What are the common examples of metabolic acidosis causes?
DKA
Renal disease
Lactic Acidosis
Diarrhea, intestinal fluid loss
62
What are the common examples of metabolic alkalosis causes?
Bicarb, citrate, too much Tums
| vomiting, NG suction, low potassium or chloride, diuretics
63
What Mallampati classification is this: faucial pillars, soft and hard palates, uvula visualized
Class I
64
What Mallampati classification is this: faucial pillars, soft and hard palates visualized; uvula partially masked by base of tongue
Class II
65
What Mallampati classification is this: only soft and hard palates visualized; can possibly see base of uvula
Class III
66
What Mallampati classification is this: only hard palate visualized
Class IV
67
Chest radiography shows bilateral infiltrates. Which pulmonary disease process is occuring?
Acute Respiratory Distress Syndrome
68
What are the respiratory settings recommended for ARDS?
High PEEP, low tidal volume
Avoid PIP above 30
Permissive hypercapnia (high Co2)
69
What is a "crunching sound noted over the precordium space that is noted concurrent with heart tones rather than respiration"?
Hamman's sign
70
What does Hamman's sign sign?
Pneumomediastinum
71
A patient has tachycardia, tachypnea, mill wheel murmur, muffled heart sounds, hypotension. What does this signal?
Pneumopericardium
72
You take a radiograph of your patient and note radiolucent streaks in the mediastinum. What is happening to your patient?
Pneumomediastinum
73
You take a radiograph of your patient and note air in the pericardial sac and "halo" sign. What is happening to your patient?
Pneumopericardium
74
You have a 18 year old 6'1 skinny male patient that has a history of vaping. What is he at risk for?
Spontaneous pneumothorax
75
What are the risk factors for spontaneous pneumothorax?
Tall, thin males ages 10-30 years
Smoking
Underlying lung disease or connective tissue disorder
76
Presents with ipsilateral hyperresonance to percussion, decreased air entry, and decreased vocal fremitus
Pneumothorax
77
Patient has difficulty breathing, chest tightness, and coughing that occur fewer than 2 days per week, but does not interfere with normal activities along with nighttime symptoms occur fewer than 2 days per month. What would you rate this patient's asthma symptoms?
Intermittent asthma
78
Patient has difficulty breathing, chest tightness, and coughing that occur more than 2 days a week, but doesn't occur every day and they interfere with daily activity; with nighttime symptoms occur 3-4 times per month. What would you rate this patient's asthma symptoms?
Mild persistent asthma
79
Patient has difficulty breathing, chest tightness, and coughing that occur daily and interfere with daily activities and asthma medication is used daily; with nighttime symptoms occur more than 1 time per week. What would you rate this patient's asthma symptoms?
Moderate persistent asthma
80
Patient has difficulty breathing, chest tightness, and coughing that every day and severely limit daily activities with nighttime symptoms occur often. What would you rate this patient's asthma symptoms?
Severe persistent asthma
81
Viral infection of bronchiolar epithelium usually occurs in children <2 years
Typically called by RSV, adenovirus, influenza, parainfluenza, and human metapneumovirus (hMRPV)
Bronchiolitis
82
Characterized by submucosal edema, increased mucus production, and increased airway resistance/wheezing
Bronchiolitis
83
You get a radiograph of your patient with URI symptoms and it shows patchy atelectasis, peribronchial thickening, perihilar prominence, airspace disease, and hyperinflation.
Bronchiolitis
84
Mutation of PHOX2B gene that is inherited autosomal dominant that causes inadequate respiratory drive as result of genetic defect in ANS's control of rbeathing
Congenital Central Hypoventilation Syndrome
85
Congenital defect that causes herniation of GI into thoracic cavity; that typically occurs on left side of chest
Commonly occurs with history of polyhydramnios
Congenital Diaphragmatic Hernia
86
Common infection that occurs in children 6 months to 3 years; commonly in late fall
Commonly caused by parainfluenza type 1 and 2
Laryngotracheobronchitis/Croup
87
Chest x-ray shows narrowing of subglottic area
Laryngotracheobronchitis/Croup
| "steeple sign"
88
What is the treatment for laryngotrachrobronchitis/croup?
- Cool humidified air
- Dexamethasone 0.6 mg/kg IV/IM
- Consider nebulized epinephrine solution
- Antipyretics
- Consider heliox administration
89
Autosomal recessive disorder that makes abnormal protein impairing movement of salt and water across epithelial cell wall leading to thick sticky secretions
Cystic fibrosis
90
How does cystic fibrosis affect the lungs?
Sticky mucus traps bacteria in lungs and causes inflammation and infection
91
How does cystic fibrosis affect the pancreas?
Mucus blocks pancreatic ducts which blocks excretion of pancreatic enzymes and bicarbonate leading to malabsorption and malnutrition
92
How does cystic fibrosis affect the intestines?
Malabsorption leads to poor growth and large, oily, foul-smelling stools
93
How does cystic fibrosis affect liver?
Secretions block bile ducts, but leads to liver damage
94
How does cystic fibrosis affect sinuses?
Poor drainage causes sinus disease, infection, and nasal polyps
95
How does cystic fibrosis affect the reproductive tract?
Infertility
96
How does cystic fibrosis affect sweat glands?
Increased risk of dehydration
97
Group B strep, E. coli, Staph. aureus, herpes simplex virus, Ureaplasma urealyticum are the most common cause of community acquired pneumonia in which age group?
Neonate
98
RSV is the most common cause of community acquired pneumonia in which age group?
Infants up to 1 year
99
Step. pneumoniae, Chlamydia trachomatis, Bordetella pertussis, RSV, influenza and parainfluenza virus are the most common cause of community acquired pneumonia in which age group?
1 to 3 months
100
Viral, mycoplasma, c. trachomatis, strep. pneumoniae are the most common cause of community acquired pneumonia in which age group?
3 months to 5 years
101
Strep. pneumoniae, Mycoplasma pneumoniae, and C. trachomatis are the most common cause of community acquired pneumonia in which age group?
>5 years of age
102
Caused by B. pertussis and transmitted by aerosol droplets
Pertussis
103
How long is classic duration of cough with pertussis?
6-10 weeks
104
What are the best antibiotics to treat pertussis?
Macrolides (azithromycin and erythromycin)
105
What is the accumulation of pus in the pleural space due to overgrowth of bacteria?
Empyema
