pulmonology Flashcards
a 9-month old infant presents with a three-day history of a mild respiratory tract infection with serous nasal discharge, fever of 38.5 C (101.4 F), and decreased appetite. Physical exam reveals a tachypneic infant with audible wheezing and a respiratory rate of 65. Flaring of the alae nasi, use of accessory muscles, and subcostal and intercostal retractions are noted. Expiratory wheezes are present
What is the likely diagnoses?
acute bronchiolitis
how do you diagnose acute bronchiolitis?
nasal washing for RSV culture and antigen assay
If a pt has an O2 sat less than 95-96% and has confirmed bronchiolitis do you put them in the hospital?
yep
what are some other indications to hospitalize a pt with acute bronchiolitis?
age <3 months, RR > 70, nasal flaring, retractions, or atelectasis on CXR
If a pt with bronchiolitis does not need to be hospitalized what are the Txs?
humidified oxygen, nebulized racemic epi, steroids, beta agonists
What is the only treatment proven to improve bronchiolitis?
oxygen
A pt get bronchiolitis and has one of the following, severe lung disease, heart disease or immunocompromised what medication should you give?
Ribavirin
Palivizumab prophylaxis (once per month for five months beginning in November) for special populations (immunocompromised, premature infants, neuromuscular disorders)
a 5-year-old boy who is brought to the emergency department by his parents for a cough and shortness of breath. He has a past medical history of eczema and seasonal rhinitis. On physical exam, you note a young boy in respiratory distress taking deep slow breaths to try and catch his breath. He has diminished breath sounds in all lung fields with prolonged, expiratory wheezes
What is the likely diagnoses?
Asthma
How do you monitor asthma?
With peak flo
intermittent asthma is described as what?
less than 2 times per week or less than or equal to 2 night symptoms per month
Tx for intermittent asthma?
SABA prn
Mild persistent asthma is described as what?
symptoms more than 2 times per week or 3-4 night symptoms a month
Tx for mild persistent asthma?
Low dose ICS
Moderate persistent asthma is described as what?
Daily symptoms or more than 1 nightly episode a week
Tx for moderate persistent asthma?
low dose ICS plus LABA for step three. if on this and not working guess move to step 4 which is
medium dose ICS plus LABA
Severe persistent asthma is described as?
multiple symptoms a day and nightly
Tx methods for severe persistent asthma?
High dose ICS and LABA
or
High-Dose ICS +LABA +oral steroids daily
a 3-year-old girl with growth retardation has a long history of recurrent pneumonia and chronic diarrhea. Her mother states that he has 6-8 foul smelling stools per day. Physical exam reveals a low-grade fever, scattered rhonchi over both lung fields, crepitant rales at the left lung base and dullness to percussion. Other findings include mild hepatomegaly and slight pitting edema of the lower extremities
What diagnostics studies would you order to help diagnose this? What is you Dx?
CXR and sweat chloride test
Cystic fibrosis
What will a CXR in cystic fibrosis reveal?
reveals hyperinflation, mucus plugging, and focal atelectasis
Will the quantitative sweat chloride test for cystic fibrosis be elevated or decreased?
elevated
What is the Tx for cystic fibrosis
Chest physiotherapy, high-fat diet, supplement fat-soluble vitamins (A, D, E, K)
Persistent foul-smelling purulent unilateral nasal discharge in a young child without other respiratory symptoms should raise suspicion for what?
retained nasal foreign body
Prior to removing the nasal foreign body, what kind of drops could you consider using?
oxymetazoline drops to try and shrink the mucus membranes
a premature infant who is born at 30 weeks and after several hours develops rapid shallow respirations at 60/ min, grunting retractions, and duskiness of the skin. The chest X-ray reveals diffuse bilateral atelectasis, ground glass appearance, and air bronchograms
What is the likely diagnoses?
Hyaline membrane disease
What is hyaline membrane disease?
This is a disease that affects premature infants. It occurs because when they are born their lungs are not fully developed and are not producing enough surfactant. because they do not have enough surfactant their lungs start to collapse
True or false hyaline membrane disease is the most common cause of respiratory disease in premature infant?
True
What week of gestation does this usually occur at if born?
less than 30 weeks
What will a CXR of a premature infant with hyaline membrane disease show?
bilateral atelectasis, ground glass appearance, and air bronchograms
What is the treatment for hyaline membrane disease?
antenatal steroid within 24-48 hours of birth - betamethasone IM x 2
a 5-month old infant with a three-day history of a mild respiratory tract infection with serous nasal discharge, fever of 38.5 C, and decreased appetite. Physical exam reveals a tachypneic infant with audible wheezing and a respiratory rate of 65. Nasal flaring, use of accessory muscles, subcostal and intercostal retractions are noted. Expiratory wheezes and a cough are present
This describes a Pt presenting with?
RSV
True or False: RSV is the MCC of lower respiratory tract infection in children world wide?
True
it is also the leading cause of pneumonia and bronchiolitis
How can you diagnose RSV?
nasal washing and RSV antigen test; CXR can show diffuse infiltrates
What are some indications for sending an RSV Pt to the hospital?
tachypnea with feeding difficulties, visible retractions, oxygen desaturation < 95-96%
What are some supportive measure you can take to help relieve some of the symptoms of RSV?
albuterol via nebulizer, antipyretics and humidified oxygen
How soon should RSV resolve?
5-7 days
a child with lung issues or born premature/immunocompromised at birth should get what treatment to prevent RSV?
Synagis prophylaxis (palivizumab) = once per month for five months beginning in November
