Pulmonology #5 (Bronchiolitis, Epiglottitis, Croup, PNA #1) Flashcards
MCC of bronchiolitis
RSV
Who is MC affected by bronchiolitis?
Infants 2 months to 2 years old
However, other risk factors for bronchiolitis are…
-Exposure to cigarette smoking
-Lack of breastfeeding
-Prematurity
-Crowded conditions
Symptoms of acute bronchiolitis
Viral prodrome for 1-2 days followed by respiratory distress (tachypnea, nasal flaring, retractions, cyanosis, rales)
Although bronchiolitis is mainly a clinical diagnosis. However, what diagnostic is the best predictor of disease in children?
Pulse oximetry
Treatment for bronchiolitis
Supportive measures (humidified oxygen, IVF, nebulizer saline, cool mist humidifier, antipyretics)
What is given during the first year of life for children < 29 weeks, immunodeficiency, chronic lung disease, or congenital heart disease to prevent bronchiolitis?
Palivizumab
Risk factors for epiglottitis/supraglottitis
Males
DM
3 months-6 years old
Historically, _____ was the MCC of epiglottitis. However, with vaccinations, ______ should be suspected if the patient is immunized.
H. Influenzae B (Hib)
Streptococcal species (GABHS)
Symptoms of Epiglottitis (3 D’s)
Dysphagia
Drooling
Distress
-Fever, inspiratory stridor, odynophagia, hot potato voice, tripoding
What gives the definitive diagnosis of epiglottitis?
Laryngoscopy (cherry red epiglottis with swelling)
However, on lateral cervical radiographs, what is seen?
Thumb or thumbprint sign: swollen enlarged epiglottis
What should you NOT do in children that you suspect this diagnosis?
Try to visualize with a tongue depressor
What is the MOST important step in management of a patient with epiglottitis?
maintain the airway
OR is the best setting for intubation
What is given to all close contacts of epiglottitis?
Rifampin
What ABX are options for epiglottitis?
Ceftriaxone or Cefotaxime
MCC of Croup
Parainfluenza virus 1
Symptoms of Croup
-Harsh, seal-like barking cough
-Inspiratory stridor
-Hoarseness (in older kids and adults)
-Dyspnea
-Fever
-URI: Coryza
-Symptoms worse at night
Although croup is a clinical diagnosis, what is seen on frontal cervical radiographs?
Steeple sign: subglottic narrowing of the airway (rarely done, though)
Treatment for Croup, based on severity
Mild (no stridor at rest): supportive. Dexamethasone provides rapid relief of symptoms. Discharge home.
Moderate (stridor at rest with retractions): Dexamethasone + Nebulizer Epinephrine. Observe for 3-4 hours.
Severe (marked retractions): Dexamethasone + Nebulized Epi + Hospitalization
MCC of Pneumonia
Strep Pneumoniae
What are the 3 Atypical causes of PNA?
Chlamydia PNA
Mycoplasma Pneumoniae
Legionella PNA
Symptoms of TYPICAL PNA
-Fever
-Productive cough
-Rigors (Strep Pneumo)
-Pleuritic chest pain
What is a common symptom of Strep Pneumo PNA?
Rigors
Symptoms of ATYPICAL PNA
-Fever
-Dry, nonproductive cough
-Extrapulmonary symptoms (myalgias, malaise, nausea, vomiting, diarrhea)
True or False: With atypical PNA, the pulmonary exam is often normal.
True, but may have crackles/rales
What are some physical exam findings of a patient with typical PNA?
Signs of consolidation (Bronchial breath sounds, dullness to percussion, increased tactile fremitus, ego phony, crackles/rales)
What are the common symptoms of a patient with Strep Pneumo PNA?
Rigors, chills, blood-tinged (rusty) sputum
What is seen on a gram-stain for Strep Pneumo
Gram-positive diplococci
The second MCC of CAP, _______, has increased risk in extremes of age, immunocompromised, underlying pulmonary disease (CF, COPD, Asthma), and alcoholism.
H. Influenzae
Staph A, often associated with _________, or _______, shows as gram positive cocci in clusters on a gram stain.
Superimposed infection after a viral infection
or hospital acquired PNA
What does Staph Aureus show up as on CXR?
Bilateral, multi lobar infiltrates or abscesses (cavitary lesions)
What type of PNA is seen in chronic alcoholism or sick patients with chronic diseases (DM, etc.)
Klebsiella Pneumoniae
What symptoms does a patient with Klebsiella PNA have?
Purple-colored, currant jelly sputum
What is seen on CXR in a patient with Klebsiella PNA?
Cavitary lesions or lobar consolidations
Klebsiella PNA is seen as ______ on gram-stain
Gram-negative rods
MCC of atypical PNA
Mycoplasma PNA
Risk factors for mycoplasma PNA?
Young, healthy (college students, military recruits, school-aged kids)
Symptoms of Mycoplasma PNA
-Extrapulmonary symptoms: pharyngitis and URI symptoms followed by dry, nonproductive cough
-Bullous myringitis: fluid filled blisters on TM
What are some complications of mycoplasma PNA?
-Cold autoimmune hemolytic anemia (IgM)
-SJS, TEN
-Erythema Multiforme
What is the diagnostic of choice for mycoplasma PNA?
PCR (cold agglutinins)
-Gram stain is not useful because it has no cell wall
What is seen on CXR in Mycoplasma PNA?
reticulonodular pattern MC
Diffuse, patchy infiltrates
Treatment for Mycoplasma PNA
Macrolides (Azithromycin, Clarithromycin) or Doxycycline
How is Legionella PNA transmitted?
Outbreaks related to contaminated water sources (air conditioners, portable water, cooling towers, etc.) No person to person transmission.
Symptoms of Legionella PNA
Fever, chills, dyspnea, chest pain, myalgias, etc.
Extrapulmonary symptoms: GI symptoms such as diarrhea, nausea, vomiting.
Hyponatremia and increased LFT’s.
Neurologic symptoms: headache, confusion, AMS.
How do you diagnose Legionella PNA?
Nucleic acid detection (PCR, urine antigen, culture)
Treatment for Legionella PNA
Macrolides or respiratory Fluoroquinolones (Levofloxacin, Moxifloxacin, Gemifloxacin)
