Pulmonology Flashcards
Inspiratory stridor suggests what obstruction
- Extrathoracic obstruction
- Croup, laryngomalacia
Expiratory wheezing suggests what obstruction
- Intrathoracic obstruction
- Asthma, bronchiolitis
Crackles or rales suggest
- Parenchymal disease
- Pneumonia, pulmonary edema
Laryngomalacia
Softening and weakening of laryngeal cartilage that collapses into the airway, especially when in the supine position
Common indications for laryngoscopy and bronchoscopy
Persistent pneumonia, cough, stridor, or wheezing
Definition of epiglottitis
Acute inflammation and edema of the epiglottis, arytenoids, and aryepiglottic folds
Epiglottitis is most common in what age group
Children aged 2-7 years, equal M:F
Clinical features of epiglottitis
- Abrupt onset of rapidly progressive upper airway obstruction WITHOUT prodrome
- High fever and toxic appearance
- Muffled speech and quiet stridor
- Dysphagia with drooling
- Sitting forward in tripod position with neck hyperextended
- Complete airways obstruction with respiratory arrest may occur suddenly
- 90% of patients have positive blood cultures
Laryngotracheobronchitis
Inflammation and edema of the subglottic larynx, trachea and bronchi
Laryngotracheobronchitis is most common in what age group
Children aged 3 mo - 3 years of age in late fall and winter, 2:1 male to female ratio.
Clinical features of laryngotracheobronchitis
- Begins with URI prodrome for 2-3 days, followed by stridor and cough
- Symptoms include inspiratory stridor, fever, barky cough, and hoarse voice which typically lasts 3-7 days
- Respiratory stress may occur
- Stridor and cough worsen at night and with agitation
- Wheezing may occur
Treatment of laryngotracheobronchitis
- Mostly supportive care
- Beta 2 agonists when wheezing is present
- STRIDOR AT REST: systemic corticosteroids
- RESPIRATORY DISTRESS: racemic epinephrine
Spasmodic croup
- Occurs year round in preschool aged children
- Likely secondary to a hypersensitivity reaction
- Characteristic acute onset of stridor usually occurs at night
- Typically recurs and resolves without treatment
Bacterial tracheitis
- Acute inflammation of the trachea
- Uncommon cause of stridor
- S aureus > Streptococcus > nontypeable H influenza
- Abrupt onset, toxicity, high fever, and mucous and pus in the trachea
- Treat with antistaphylococcal abx and airway support
Bronchiolitis
Inflammation of the bronchioles
Bronchiolitis is most common in what age group
Most common lower respiratory tract infection in the first 2 years, 2:1 male to female ratio
Clinical features of bronchiolitis
- Onset is gradual, with upper respiratory symptoms such as rhinorrhea, nasal congestion and cough occurring initially
- Progression of respiratory symptoms takes place
- Tachypnea, fine rales, wheezing, and evidence of respiratory distress
- The spleen and liver may appear enlarged as a result of lung hyperinflation
- Hypoxemia may occur
- Apnea may occur, esp in infant and in children with a history of apnea of prematurity
- Bacterial superinfection rarely occurs
Patients that receive ribavirin for bronchiolitis
Aerosolized ribavirin, a nucleoside analog with in vitro activity against RSV, may be considered for very ill infants.
Patients that receive RSV monoclonal antibodies for bronchiolitis
Palivizumab may be given prophylactically by monthly IM injection during RSV season to prevent severe disease in infants with a history of prematurity, chronic lung disease, or cyanotic or hemodynamically significant congenital heart disease.
Major source for pertussis infection
Adolescents and adults whose immunity has waned are the major source for pertussis infection of unimmunized or underimmunized children
3 stages of pertussis
- CATARRHAL STAGE (1-2 WEEKS): characterized by upper respiratory symptoms such as rhinorrhea, nasal congestion, conjunctival redness and low grade fever
- PAROXYSMAL STAGE (2-4 WEEKS): characterized by fits of forceful coughing; infants may have cyanosis, apnea, and choking during fits; between fits, children appear well and are afebrile
- CONVALESCENT PHASE (weeks to months): recovery stage in which paroxysmal cough continue but becomes less frequent and less severe over time
