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PANCE 2.0 > Pulmonology #5 (Bronchiolitis, Epiglottitis, Croup, PNA #1) > Flashcards

Pulmonology #5 (Bronchiolitis, Epiglottitis, Croup, PNA #1) Flashcards

1
Q

MCC of bronchiolitis

A

RSV

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2
Q

Who is MC affected by bronchiolitis?

A

Infants 2 months to 2 years old

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3
Q

However, other risk factors for bronchiolitis are…

A

-Exposure to cigarette smoking
-Lack of breastfeeding
-Prematurity
-Crowded conditions

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4
Q

Symptoms of acute bronchiolitis

A

Viral prodrome for 1-2 days followed by respiratory distress (tachypnea, nasal flaring, retractions, cyanosis, rales)

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5
Q

Although bronchiolitis is mainly a clinical diagnosis. However, what diagnostic is the best predictor of disease in children?

A

Pulse oximetry

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6
Q

Treatment for bronchiolitis

A

Supportive measures (humidified oxygen, IVF, nebulizer saline, cool mist humidifier, antipyretics)

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7
Q

What is given during the first year of life for children < 29 weeks, immunodeficiency, chronic lung disease, or congenital heart disease to prevent bronchiolitis?

A

Palivizumab

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8
Q

Risk factors for epiglottitis/supraglottitis

A

Males
DM
3 months-6 years old

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9
Q

Historically, _____ was the MCC of epiglottitis. However, with vaccinations, ______ should be suspected if the patient is immunized.

A

H. Influenzae B (Hib)

Streptococcal species (GABHS)

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10
Q

Symptoms of Epiglottitis (3 D’s)

A

Dysphagia
Drooling
Distress

-Fever, inspiratory stridor, odynophagia, hot potato voice, tripoding

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11
Q

What gives the definitive diagnosis of epiglottitis?

A

Laryngoscopy (cherry red epiglottis with swelling)

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12
Q

However, on lateral cervical radiographs, what is seen?

A

Thumb or thumbprint sign: swollen enlarged epiglottis

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13
Q

What should you NOT do in children that you suspect this diagnosis?

A

Try to visualize with a tongue depressor

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14
Q

What is the MOST important step in management of a patient with epiglottitis?

A

maintain the airway

OR is the best setting for intubation

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15
Q

What is given to all close contacts of epiglottitis?

A

Rifampin

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16
Q

What ABX are options for epiglottitis?

A

Ceftriaxone or Cefotaxime

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17
Q

MCC of Croup

A

Parainfluenza virus 1

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18
Q

Symptoms of Croup

A

-Harsh, seal-like barking cough
-Inspiratory stridor
-Hoarseness (in older kids and adults)
-Dyspnea
-Fever
-URI: Coryza
-Symptoms worse at night

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19
Q

Although croup is a clinical diagnosis, what is seen on frontal cervical radiographs?

A

Steeple sign: subglottic narrowing of the airway (rarely done, though)

20
Q

Treatment for Croup, based on severity

A

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

21
Q

MCC of Pneumonia

A

Strep Pneumoniae

22
Q

What are the 3 Atypical causes of PNA?

A

Chlamydia PNA
Mycoplasma Pneumoniae
Legionella PNA

23
Q

Symptoms of TYPICAL PNA

A

-Fever
-Productive cough
-Rigors (Strep Pneumo)
-Pleuritic chest pain

24
Q

What is a common symptom of Strep Pneumo PNA?

A

Rigors

25
Q

Symptoms of ATYPICAL PNA

A

-Fever
-Dry, nonproductive cough
-Extrapulmonary symptoms (myalgias, malaise, nausea, vomiting, diarrhea)

26
Q

True or False: With atypical PNA, the pulmonary exam is often normal.

A

True, but may have crackles/rales

27
Q

What are some physical exam findings of a patient with typical PNA?

A

Signs of consolidation (Bronchial breath sounds, dullness to percussion, increased tactile fremitus, ego phony, crackles/rales)

28
Q

What are the common symptoms of a patient with Strep Pneumo PNA?

A

Rigors, chills, blood-tinged (rusty) sputum

29
Q

What is seen on a gram-stain for Strep Pneumo

A

Gram-positive diplococci

30
Q

The second MCC of CAP, _______, has increased risk in extremes of age, immunocompromised, underlying pulmonary disease (CF, COPD, Asthma), and alcoholism.

A

H. Influenzae

31
Q

Staph A, often associated with _________, or _______, shows as gram positive cocci in clusters on a gram stain.

A

Superimposed infection after a viral infection

or hospital acquired PNA

32
Q

What does Staph Aureus show up as on CXR?

A

Bilateral, multi lobar infiltrates or abscesses (cavitary lesions)

33
Q

What type of PNA is seen in chronic alcoholism or sick patients with chronic diseases (DM, etc.)

A

Klebsiella Pneumoniae

34
Q

What symptoms does a patient with Klebsiella PNA have?

A

Purple-colored, currant jelly sputum

35
Q

What is seen on CXR in a patient with Klebsiella PNA?

A

Cavitary lesions or lobar consolidations

36
Q

Klebsiella PNA is seen as ______ on gram-stain

A

Gram-negative rods

37
Q

MCC of atypical PNA

A

Mycoplasma PNA

38
Q

Risk factors for mycoplasma PNA?

A

Young, healthy (college students, military recruits, school-aged kids)

39
Q

Symptoms of Mycoplasma PNA

A

-Extrapulmonary symptoms: pharyngitis and URI symptoms followed by dry, nonproductive cough
-Bullous myringitis: fluid filled blisters on TM

40
Q

What are some complications of mycoplasma PNA?

A

-Cold autoimmune hemolytic anemia (IgM)
-SJS, TEN
-Erythema Multiforme

41
Q

What is the diagnostic of choice for mycoplasma PNA?

A

PCR (cold agglutinins)

-Gram stain is not useful because it has no cell wall

42
Q

What is seen on CXR in Mycoplasma PNA?

A

reticulonodular pattern MC

Diffuse, patchy infiltrates

43
Q

Treatment for Mycoplasma PNA

A

Macrolides (Azithromycin, Clarithromycin) or Doxycycline

44
Q

How is Legionella PNA transmitted?

A

Outbreaks related to contaminated water sources (air conditioners, portable water, cooling towers, etc.) No person to person transmission.

45
Q

Symptoms of Legionella PNA

A

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.

46
Q

How do you diagnose Legionella PNA?

A

Nucleic acid detection (PCR, urine antigen, culture)

47
Q

Treatment for Legionella PNA

A

Macrolides or respiratory Fluoroquinolones (Levofloxacin, Moxifloxacin, Gemifloxacin)

PANCE 2.0 (62 decks)

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