Pulmonary Review Flashcards
All lung disorders cause some kind of airway ______?
Obstruction
Describe a complete airway obstruction
no airflow
Describe a partial airway obstruction
Impaired airflow
Disease examples of upper airway respiratory distress?
Epiglottitis, obstructive sleep apnea, tracheomalacia
Disease examples of lower airway respiratory distress?
Pneumonia Asthma Acute respiratory distress syndrome Pneumothorax Cystic FIbrosis Atelectasis
Most common respiratory disorder in daycare and preschool children?
Common cold
Presents with low-grade fever, rhinitis, and usually resolves by day 10
Common cold
Most common “common cold” viruses
Parainfluenza
RSV
Coronavirus
Human metapneumovirus
Presents with inflammation of mucosal lining of throat, acute presentation with erythema, exudate, ulceration
Pharnygitis
Presents with pain, myalgia/arhralgia, fever, sore throat/dysphagia, rhinitis, cough, hoarseness, stomatitis, gradual onset
Viral Pharyngitis
Which pharyngitis presents with exudate on tonsils, soft palate?
EBV viral pharyngitis
Which pharyngitis presents with follicular pattern on pharynx?
Adenovirus viral pharyngitis
Which pharyngitis presents with vesicles/ulcers on tonsils?
Enterovirus viral pharyngitis
Which pharyngitis presents with ulcers anteriorly/marked adenopathy?
HSV viral pharyngitis
Which pharyngitis presents with more lower tract disease?
Parainfluenza/RSV viral pharyngitis
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
Acute Bacterial Pharyngitis
Commonly occurs in late winter/early spring in ages 5 to 14 years old
Acute Bacterial Pharyngitis
Treatment for acute bacterial pharyngitis?
Antibiotics in symptomatic child with +RADT or culture
Supportive care
NO STEROIDS
Return to school when on antibiotics after 24 hours
After recent bacterial pharyngitis, the patient is presenting with a new tic disorder and some obsessive thoughts. Which complication does this patient have?
Pediatric autoimmune neuropsychiatric disorder syndrome (PANDAS)
Does PANDAS have acute or graduate onset?
Abrupt onset
What the common age group for PANDAS complication after acute bacterial pharyngitis?
Prepubertal onset
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
Rhinosinusitis
What are the criteria for antibiotics for rhinosinusitis?
URI lasting more than 10 days with purulent discharge, cough/worsening fever, high fever
Brassy cough, stridor, hoarseness, respiratory distress
Croup
Mild to severe laryngeal obstruction and stridor with symptoms worse at night
Croup
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
What will radiograph show for croup?
Subglottis narrowing “steeple sign”
What is the common management for croup?
Humidified air Nebulized epinephrine Corticosteroids Bronchodilators if bronchospasm present Heliox for severe croup
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
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
What is the common age for epiglottitis?
1-5 years old
Presentation of abrupt onset of fever, severe sore throat, dyspnea, inspiratory distress without stridor, drooling
Epiglottitis
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
What will the radiograph show for epiglottitis?
“Thumb sign”
What is the best prevention for epiglottitis?
HIB immunization
Inflammation, necrosis, edema of respiratory epithelial cells in small airways
Bronchiolitis
Presents with URI symptoms, gradual development of respiratory distress, low to moderate fever, decreased appetite, tachypnea, retractions, expiratory wheezing, fine/coarse crackles
Bronchiolitis
What is the recommended treatment for bronchiolitis?
Hydration and antipyretics
Monitor fluid intake
Nasal suctioning
What is not recommended treatment for bronchiolitis?
No bronchodilators
No antibiotics
No deep airway suctioning
Presentation of rapid onset of hoarseness or chronic croupy cough along with unilateral wheezing and recurrent pneumonia
Foreign body aspiration
Which side of the lung is commonly affected with foreign body aspiration?
Right lung
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
Presentation of dry, hacking cough, low substernal discomfort, burning chest pain
Bronchitis
There is coarse breath sounds, rhonchi, rales on exam
Bronchitis
What is not recommended for bronchitis treatment?
Cough suppressants
Bronchodilators
Presents with tachycardia, nasal flaring, grunting, retractions, tachypnea, air hunger, cyanosis, fine crackles, dullness, diminished breath sounds
Pneumonia
What are the common signs of bacterial pneumonia?
Fever, hypoxia, lethargy
Splinting affected side, tachypnea, retractions
Pleural effusion
What are the common signs of viral pneumonia?
Wheezing
Repetitive, staccato cough
What is the common treatment for pneumonia?
Antipyretics
Hydration
Rest
Genetic disorder with chronic obstructive pulmonary disease, GI disturbances, exocrine dysfunction
Cystic fibrosis
What is the genetic inheritance of cystic fibrosis?
Autosomal recessive
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
Chronic respiratory disease characterized by periods of coughing, wheezing, respiratory distress, bronchospasm
Asthma
What is the asthma triad?
Mucus, inflammation, bronchoconstriction
What is the most common cause of respiratory alkalosis?
Hyperventilation
What is the most common cause of respiratory acidosis?
Retention of CO2 from hypoventilation
What is the most common cause of metabolic acidosis?
Added acid or lost base
What is the most common cause of metabolic alkalosis?
Added base or lost acid
What are common examples of respiratory alkalosis causes?
Anxiety, pain fever Stimulants CNS irritations Excessive ventilatory support
What are the common example of respiratory acidosis causes?
CNS depression, neuromuscular disease, trauma, restrictive lung disease, COPD
What are the common examples of metabolic acidosis causes?
DKA
Renal disease
Lactic Acidosis
Diarrhea, intestinal fluid loss
What are the common examples of metabolic alkalosis causes?
Bicarb, citrate, too much Tums
vomiting, NG suction, low potassium or chloride, diuretics
What Mallampati classification is this: faucial pillars, soft and hard palates, uvula visualized
Class I
What Mallampati classification is this: faucial pillars, soft and hard palates visualized; uvula partially masked by base of tongue
Class II
What Mallampati classification is this: only soft and hard palates visualized; can possibly see base of uvula
Class III
What Mallampati classification is this: only hard palate visualized
Class IV
Chest radiography shows bilateral infiltrates. Which pulmonary disease process is occuring?
Acute Respiratory Distress Syndrome
What are the respiratory settings recommended for ARDS?
High PEEP, low tidal volume
Avoid PIP above 30
Permissive hypercapnia (high Co2)
What is a “crunching sound noted over the precordium space that is noted concurrent with heart tones rather than respiration”?
Hamman’s sign
What does Hamman’s sign sign?
Pneumomediastinum
A patient has tachycardia, tachypnea, mill wheel murmur, muffled heart sounds, hypotension. What does this signal?
Pneumopericardium
You take a radiograph of your patient and note radiolucent streaks in the mediastinum. What is happening to your patient?
Pneumomediastinum
You take a radiograph of your patient and note air in the pericardial sac and “halo” sign. What is happening to your patient?
Pneumopericardium
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
What are the risk factors for spontaneous pneumothorax?
Tall, thin males ages 10-30 years
Smoking
Underlying lung disease or connective tissue disorder
Presents with ipsilateral hyperresonance to percussion, decreased air entry, and decreased vocal fremitus
Pneumothorax
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
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
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
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
Viral infection of bronchiolar epithelium usually occurs in children <2 years
Typically called by RSV, adenovirus, influenza, parainfluenza, and human metapneumovirus (hMRPV)
Bronchiolitis
Characterized by submucosal edema, increased mucus production, and increased airway resistance/wheezing
Bronchiolitis
You get a radiograph of your patient with URI symptoms and it shows patchy atelectasis, peribronchial thickening, perihilar prominence, airspace disease, and hyperinflation.
Bronchiolitis
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
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
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
Chest x-ray shows narrowing of subglottic area
Laryngotracheobronchitis/Croup
“steeple sign”
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
Autosomal recessive disorder that makes abnormal protein impairing movement of salt and water across epithelial cell wall leading to thick sticky secretions
Cystic fibrosis
How does cystic fibrosis affect the lungs?
Sticky mucus traps bacteria in lungs and causes inflammation and infection
How does cystic fibrosis affect the pancreas?
Mucus blocks pancreatic ducts which blocks excretion of pancreatic enzymes and bicarbonate leading to malabsorption and malnutrition
How does cystic fibrosis affect the intestines?
Malabsorption leads to poor growth and large, oily, foul-smelling stools
How does cystic fibrosis affect liver?
Secretions block bile ducts, but leads to liver damage
How does cystic fibrosis affect sinuses?
Poor drainage causes sinus disease, infection, and nasal polyps
How does cystic fibrosis affect the reproductive tract?
Infertility
How does cystic fibrosis affect sweat glands?
Increased risk of dehydration
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
RSV is the most common cause of community acquired pneumonia in which age group?
Infants up to 1 year
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
Viral, mycoplasma, c. trachomatis, strep. pneumoniae are the most common cause of community acquired pneumonia in which age group?
3 months to 5 years
Strep. pneumoniae, Mycoplasma pneumoniae, and C. trachomatis are the most common cause of community acquired pneumonia in which age group?
> 5 years of age
Caused by B. pertussis and transmitted by aerosol droplets
Pertussis
How long is classic duration of cough with pertussis?
6-10 weeks
What are the best antibiotics to treat pertussis?
Macrolides (azithromycin and erythromycin)
What is the accumulation of pus in the pleural space due to overgrowth of bacteria?
Empyema
