pulmonology

Question 1

epiglottitis

Answer 1

acute inflammation and edema of epiglottis
- 2-7 year old
Cause: HIB before immunization, now strep pneumo
Sx: upper airway obstruction
- high fever, muffled speech, dysphagia with drooling, tripod position
Dx: leuko with left shift, thumbprint on lateral radiograph of neck, cherry red epiglottis
Tx: medical Emergency, intubation nasotracheal

Question 2

laryngotracheobronchitis (croup)

Answer 2

inflammation and edema of subglottic larynx, trachea, and bronchi
Cause: viral - most common cause of stridor, spasmodic is year round in preschool children
- parainfluenza, RSV, rhino, adeno, flu, m pneumo
Sx: URI 2-3 days then stridor and cough, barky cough, hoarse voice, worsens at night, wheezing can occur, steeple sign on AP neck
Dx: clinical
Tx: cool mist and fluids, stridor at rest can get steroids, respiratory distress with racemic epi, albuterol, hospitilization if resp distress

Question 3

bacterial tracheitis

Answer 3

acute inflammation of trachea
Cause: staph aureus, strep
Sx: tox, high fever, mucous and pus in trachea
Tx: abx and airway management

Question 4

bronchiolitis

Answer 4

inflammation of bronchioles
- most common lower respiratory tract infxn, under 2, nov to april
Cause: RSV
- less common para, adeno, rhino, flu, m pneumo
Sx: URI, tachypnea, rales, wheezing, spleen and liver may enlarge
- hypoxemia, apnea, hyperinflation with air trapping, pathcy infiltrates, atelectasis
Tx: supportive, bronchodilators, racemic epi, RSV ribavirin

Question 5

causes of acute wheezing

Answer 5

asthma, hypersensitivity rxn, bronchiolitis, pneumonia, foreign body aspiration, aspiration of stomach contents, environmental irritants

Question 6

chronic lung disease (bronchopulmonary dysplasia)

Answer 6

oxygen dependency beyond 28 days of life
- premature children who have respiratory distress and have acute lung injury
Sx: diminished oxygenation and hypercarbia, tachypnea/wheezing/sputum/respiratory distress episodes, frequent respiratory tract infections
Dx: hyperinflation and atelectasis on CXR
Tx: O2, bronchodilators, fluid restrictions, prevent complications

Question 7

foreign body aspiration

Answer 7

3 months - 5 years
- seeds, popcorn, hot dog, candy grapes, toys
Sx: choking
- cough, hoarseness, inspiratory stridor
- asymmetric findings on auscultation, partial ball valve obstruction, atelectasis
- localized wheezing, persistent pneumonia
Dx: clinical, not always radiopaque
- inspiratory and expiratory films, bilat decubitus films