Pulmonology

Question 1

Inspiratory stridor suggests what obstruction

Answer 1

• Extrathoracic obstruction

- Croup, laryngomalacia

Question 2

Expiratory wheezing suggests what obstruction

Answer 2

• Intrathoracic obstruction

- Asthma, bronchiolitis

Question 3

Crackles or rales suggest

Answer 3

• Parenchymal disease

- Pneumonia, pulmonary edema

Question 4

Laryngomalacia

Answer 4

Softening and weakening of laryngeal cartilage that collapses into the airway, especially when in the supine position

Question 5

Common indications for laryngoscopy and bronchoscopy

Answer 5

Persistent pneumonia, cough, stridor, or wheezing

Question 6

Definition of epiglottitis

Answer 6

Acute inflammation and edema of the epiglottis, arytenoids, and aryepiglottic folds

Question 7

Epiglottitis is most common in what age group

Answer 7

Children aged 2-7 years, equal M:F

Question 8

Clinical features of epiglottitis

Answer 8

• 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

Question 9

Laryngotracheobronchitis

Answer 9

Inflammation and edema of the subglottic larynx, trachea and bronchi

Question 10

Laryngotracheobronchitis is most common in what age group

Answer 10

Children aged 3 mo - 3 years of age in late fall and winter, 2:1 male to female ratio.

Question 11

Clinical features of laryngotracheobronchitis

Answer 11

• 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

Question 12

Treatment of laryngotracheobronchitis

Answer 12

• Mostly supportive care
• Beta 2 agonists when wheezing is present
• STRIDOR AT REST: systemic corticosteroids
• RESPIRATORY DISTRESS: racemic epinephrine

Question 13

Spasmodic croup

Answer 13

• 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

Question 14

Bacterial tracheitis

Answer 14

• 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

Question 15

Bronchiolitis

Answer 15

Inflammation of the bronchioles

Question 16

Bronchiolitis is most common in what age group

Answer 16

Most common lower respiratory tract infection in the first 2 years, 2:1 male to female ratio

Question 17

Clinical features of bronchiolitis

Answer 17

• 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

Question 18

Patients that receive ribavirin for bronchiolitis

Answer 18

Aerosolized ribavirin, a nucleoside analog with in vitro activity against RSV, may be considered for very ill infants.

Question 19

Patients that receive RSV monoclonal antibodies for bronchiolitis

Answer 19

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.

Question 20

Major source for pertussis infection

Answer 20

Adolescents and adults whose immunity has waned are the major source for pertussis infection of unimmunized or underimmunized children

Question 21

3 stages of pertussis

Answer 21

• 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