pulmonology Flashcards
epiglottitis- epi and etiology
2-7yr
HIB
GABHS, Strep pneumonia and Staph
clinical epiglottitis
abrupt onset- high fever, toxic, muffled speech, dysphagia with drool, sitting forward in tripod
diagnosis epiglotitis
cherry red swollen epiglottis
epiglottitis on xray
thumbprint on lateral
antibiotic for epiglottitis
2nd or 3rd gen. cephalosporin IV
if HIB infection and ppx
rifampin
laryngotrachealbronchitis (croup)
inflamm. and edema of the subglottic larynx, trachea, and bronchi
viral croup –> stridor - 3 months to 3 yrs - M2:1F
spasmodic - preschool age
viral croup can be caused by:
parainfluenza RSV rhino adeno influenza A and B
clinical pres. of viral croup
URI 2-3 days followed by stridor and cough
barky cough, stridor, fever –> 3-7 days
stridor worse at night with agitation
xray of viral croup
steeple sign
management of croup
supportive
cool mist
systemic corticosteroid -
racemic epinephrine if resp. distress
bacterial tracheitis
acute inflammation of the trachea - causes stridor
causes of bacterial tracheitis -
staph, strep, nontypeable H. flu
bronchiolitis
inflammation of the bronchioles - viral infection that causes inflammatory bronchiolar obstrucion
most common in
bronchiolitis etiology
RSV
less common: para, adeno, rhino, influenza
clinical of bronchiolitis
onset is gradual tachypnea, fine rales, wheezing spleen and liver might enlarge hypoxia apnea CXR hyperinflation - patchy infiltrates and atelectasis
typical causes of pneumonia in 0-3 month
syphilis, toxo, CMV, rubella, herpes, tb GBS gram - rods listeria rsv (afebrile) chlamydi, CMV, PCP
typical pneumonia in 3 months - 5 yrs causes
adenovirus, influenza A and B, para , RSV,
bacterial: strep pneumoniae, staph and HIB
age >6 pneumonia cuase
mycoplasma pneumoniae and chlamydia pneumoniae
viruses - adenovirus, influenza A and B, parainflue
bacterial - strep. pneumoniae
viral pneumonia presentation
URI - nasal congestion and rhinorrhea - then fever, cough, dyspnea
bacterial pneumonia presentation
rapid onset and greater severity - fever, cough, dyspnea, without preceding URI
viral pneumonia xray
interstitial infiltrates
bacterial pneumonia xray
lobar consolidation
chlamydia trachomatis - pnemonia
presentation, diagnosis
most common is afebrile - 1-3 months of age
stoccato-type cough
history of conjunctivitis after birth - >50%
eosinophilia and cxr with interstitial infiltrates - definitive diagnosis by culture
how to manage chlamydia trachomatis pneumonia
erythromycin or azithromycin
mycoplasma pneumoniae
most common in older children
low-grade fever, chills, nonproductive cough, HA, pharyngitis, malaise
cough 3-4 wks
widespread rales
diagnosis of mycoplasma pneumonia
positive cold agglutinins -
cxr - bilateral diffuse infiltrates
IgM titer for mycoplasma
manage of mycoplasma pnemonia
erythromycin
who is at risk for pertussis?
stages of pertussis
incubation 7-10 days catarrhal stage (1-2 wks) URI + low grade fever paroxysmal stage (2-4wks) forceful coughing and whoop - inspiatory gasp heard at the very end of a coughing fit -- might vomit post cough attack - otherwise well and afebrile convalescent phase - (weeks to months) - paroxysmal cough continues but become less frequent and less severe over time
diagnosis of pertussis
lymphocytosis
when to give antibiotics to alter course in pertussis?
during the catarrhal stage or earlier
isolation and pertussis
need to be on isolation until 5 days of abx
IgE release?
eosinophils, histamine, mast cells, basophils
asthma pathophys
smooth muscle bronchoconstriction, airway mucosal edema, increased secretions with mucous plugging, eventual airway wall remodeling and production of inflammatory mediators IgE
cxr of asthma
hyperinflation
peribronchial thickening
patchy atelectasis
CF etiology
AR - ch. 7
pathophys for CF
abnormal ion-channel regulator protein - causes sodium and choride transport dysfunction in epithelial cells
abnormal mucus produced in airways helps create airwy obstruction inflammation and infection
clinical present of CF
chronic progressive pulmonary insuff. pancreatic insuff. high sweat electrolyte meconium ileus at birth(20%) FTT - recurrent chronic resp. symptoms respiratory signs PFTs decreased respiratory flow rates and decrease lung volumes pneumonia- staph and then pseudomonas nasal polyps and precurrent pneumonia
diagnosis of CF
one or more phenotypic feature OR positive fam. history OR increased immunoreactive trypsinogen on newborn screen
- sweat chloride test
2 CF mtn
characteristic ion transport abnormality across the nasal epithelium
management of CF
antibiotics pul. toilet bronchodilator pancreatic enzyme replacement - fat soluable vitamine (A, D, E, K) anti-inflammatory and immunosuppressive lung transplant psychological help
CF and mutation
CFTR gene ch. 7
ddx of ALTE
seizure GERD upper airway obstruction intracranial mass lesion sepsis metabolic abnormalities including electrolyte imbalance and hypoglycemia inborn errors of metabolism arrhythimia abnormal central control munchausen by proxy nonaccidental trauma
