Pulmonology #6 (Respiratory Infections) Flashcards
What happens if you try to treat children under 18 with Aspirin?
Reye Syndrome!! has a 30% fatality rate
Symptoms of influenza
-Abrupt onset of headache, fever, chills, malaise, myalgias (involving legs)
-Dry cough, eye pain, GI symptoms
What diagnostics can be done for influenza?
rapid nasal swab or viral cultures
Treatment for influenza…
Who gets antivirals?
Supportive: Acetominophen
Antivirals: is hospitalized or 65 years or older
–Oseltamivir within 48 hours of symptom onset (not given under 12 years old)
–If in a long-term facility, all residents get it regardless of vaccine history
What are contraindications to BOTH flu vaccines?
Anaphylaxis to vaccine
Guillan-barre Syndrome within 6 weeks after a flu vaccine
High fever
Infants < 6 months of age
Who can get the inactivated flu vaccine?
How about the live attenuated vaccine?
Inactivated: 6 months or older (including pregnancy)
Live: 2-49 years old
What are contraindications to the live attenuated flu vaccine?
Immunocompromised, pregnancy, 50 years or older, or have taken antivirals within the last 48 hours
What are the three phases of Pertussis (Whooping Cough)?
What phase are the children most contagious in?
Who does this normally occur in?
1) Catarrhal Phase: URI symptoms lasting 1-2 weeks
2) Paroxysmal Phase: severe coughing fits with inspiratory whooping after cough. Post-tussive emesis.
3) Convalescent Phase: resolution of cough
Catarrhal most contagious
Children under 2 years old
Treatment for Pertussis
-Supportive: oxygen, nebulizer
-Macrolides if needed
What is the vaccine schedule for pertussis?
DTap in 5 doses: 2, 4, 6, 15-18 months, 4-6 years old.
Booster at 11-18 years old.
What is the MCC of lower respiratory infection in children?
What is the key diagnostic to determine prognosis?
RSV
Pulse oximetry
Acute bronchitis is inflammation of the bronchi. It is MCC by ________.
What are some symptoms of this condition?
Viruses
Cough: present for at least 5 days, 1-3 weeks
-Malaise, dyspnea, hemoptysis
-Follows a URI
-Wheezing, Fever
How do you prevent acute bronchitis?
What’s the treatment?
H. Flu vaccine
Supportive: fluids, rest, humidifier
Acute bronchiolitis is infection of the bronchioles (smaller airways). This is MC in ______ and the MCC is ______
Children under 2 years old
RSV is the MCC
Symptoms of acute bronchiolitis
What is the treatment?
Viral prodrome for 1-2 days followed by respiratory distress
Supportive: IVF, humidified oxygen
-Handwashing is preventative
What can you give to prevent bronchiolitis?
Palivizumab if born < 29 weeks or has congenital heart disease
Acute epiglottitis (Supraglottitis) is MC in _______ and what is the MCC? Remember this cause may have changed due to a vaccine.
What’s another cause in adults?
MC in 3 months - 6 years
H. Influenzae B MCC until vaccines (Hib).
If immunized, suspect Group A Strep
Cocaine is a cause in adults
Symptoms of supraglottitis
Dysphagia, Drooling, Distress
-Odynophagia, fever, inspiratory stridor, tripping, hot potato voice
-Refuses to lie supine
What is the definitive diagnostic for supraglottitis?
What is seen on XR?
What should you NOT do?
Laryngoscopy: cherry red epiglottis with swelling
Soft tissue lateral cervical XR: thumb or thumbprint sign (enlarged epiglottis)
Do not try to visualize with tongue depressor
Treatment for supraglottitis?
Maintain airway first (OR best setting for intubation)
Prevention with Hib vaccine
ABX: Ceftriaxone or Cefotaxime
What can you give to close contacts to prevent acute epiglottitis?
Rifampin
MCC of Laryngotracheitis (Croup)
Parainfluenza Virus Type 1
Symptoms of Croup
-Upper airway involvement (harsh, seal-like barking cough)
-Inspiratory stridor
-Hoarseness
-Low grade fever
-Symptoms worse at night
-Coryza (URI symptoms)
What is seen on front cervical radiographs with Croup?
Steeple sign (subglottic narrowing of airway)
Treatment for Croup if…
Mild
Moderate
Severe
Mild (no stridor at rest): Supportive, Dexamethasone for symptoms
Moderate (stridor at rest with mild retractions): Dexamethasone and Nebulized Epi
Severe: Dexa + Epi + Hospitalization
MC foreign body aspirated by children?
Treatment
Peanuts
Rigid bronchoscopy
Costochondritis and Tietze Syndrome are VERY similar in presentation, etiologies, and treatment. What are the etiologies, treatment, and differences in symptoms?
Etiologies: idiopathic, postural or posttraumatic (coughing, straining)
Treatment: NSAIDs
Symptoms: Pleuritic chest pain worse with inspiration. Reproducible point chest wall tenderness with palpation. Palpable edema ONLY in Tietze Syndrome (none in Costochondrititis)
What is acute respiratory distress syndrome?
What is the biggest risk factor for this condition?
Severe inflammation of the lung tissue that impairs gas exchange secondary to acute injury –> pulmonary edema –> capillaries get leaky –> oxygen doesn’t transfer within the lungs
Gram-negative Sepsis
Symptoms of ARDS
-Acute dyspnea and hypoxemia
-Frothy red sputum
-Tachypnea
-Diffuse crackles
-Severe hypoxemia refractory to suppemental oxygen (Low O2 that doesn’t improve)
What diagnostics are done for ARDS?
CXR: diffuse bilateral pulmonary infiltrates (like CHF but spares costophrenic angles)
PCWP < 18mmHg with right heart catheterization (in CHF it is > 18)
Treatment for ARDS
-Intubation and PEEP improves hypoxemia
What is hyaline membrane disease/Respiratory distress syndrome?
Occurs in premature infants due to insufficient production of surfactant
True or False: Hyaline membrane disease is MCC of death in the first month of life?
True
By _____, enough surfactant is produced in the lungs.
Symptoms of hyaline membrane disease
35 weeks
-Presents shortly after birth with respiratory distress.
-Tachypnea
-Tachycardia
-Chest wall retractions
-Nasal flaring, cyanosis, respiratory grunting
Treatment for hyaline membrane disease
-Antenatal glucocorticoids given if premature birth expected (before 34 weeks)
-Exogenous surfactant via endotracheal tube to open alveoli
-CPAP oxygen +/- intubation
Sleep apnea is involuntary cessation of breathing during sleep. Risk factors for this condition include….
There are two types. Explain them.
Obesity***, Males, Older age
Central: reduced CNS respiratory drive
Obstructive: physical airway obstruction
Symptoms of sleep apnea
-Snoring, unrestful sleep, hypersomnia, nocturnal choking
-Large neck circumference
-Crowded oropharynx
-Micrognathia (lower jaw undersized)
Diagnostics for sleep apnea
-In lab polysomnography (first line): 15 or more events/hour
-Epworth Sleepiness Scale
Treatment for sleep apnea
-Behavioral changes: weight loss, no alcohol, changes in position to sleep
-CPAP
-Oral appliances
-Tracheostomy is definitive
