Pulmonology Flashcards
Hx and symptomology of pulmonary dz
Dyspnea Cough Pain Wheezing Stridor Snoring Apnea Cyanosis
PE of pulmonary dz
RR
Presence of grunting
Nasal flaring
Tripod position
Cyanosis
Inspiratory stridor (extrathoracic etiology)
Expiratory wheeze (intrathoracic etiology)
When will percussion be dull?
Restrictive lung dz and
With the presence of pleural effusion, pneumonia, or atelectasis
When will percussion be hyper-resonant?
Also tympanic in obstructive dz such as asthma, emphysema or with the presence of pneumothorax
RR in a premature neonate
40-70
RR in 0-3 mos
35-55
RR in 3-6 mos
30-45
RR in 6-12 mos
25-40
RR in 1-3 yrs
20-30
RR in 3-6 yrs
20-25
RR in 6-12 yrs
14-22
RR in >12 yrs
12-18
ABG
The single most useful rapid test of pulmonary function
Overall assessment of the functional state of the resp system and clues about the pathogenesis of the dz
Nl pH in ABG
7.35-7.45
Nl CO2 in ABG
35-45
Nl pO2 in ABG
80-100
Nl HCO3
22-26
O2 Sat
95-100%
Choanal atresia
Congenital problem that presents in the neonatal period
Occurs when there is obstruction of the nasal passage- resulting in respiratory distress, esp during feedings
Inability to pass a small catheter through the nostrils is suspicious for choanal atresia and warrants CT for confirmatory diagnosis
Tx- surgical revision and airway protection
Laryngomalacia
Results from exaggerated collapse of the glottis structures during inspiration
MC cause of stridor in infants
Typically presents between 3-5 mos of age and resolves by 6-12 mos
Watchful waiting unless severe, in which case surgical repair may be warranted
Laryngitis
Often occurs in children 5 yrs and older Presents with a prodrome of URI/sore throat MC symptom is hoarseness Lab findings and exam are essentially nl Tx is supportive- vocal rest
Croup (laryngotracheobronchitis)
Common childhood dz typically presenting from 6 mos - 3 yrs
80% of cases are caused by parainfluenza virus
Seal-like, barking cough with inspiratory stridor
X-ray: Steeple sign
Tx: supportive with oxygen and racemic epi as well as steroids
Bacterial tracheitis
Presents like croup, but does not improve with supportive tx, and is refractory to racemic epi
MC pathogens are S. pneumonia and S. aurea
X-ray will also show a steeple sign, though this is typically pathognomonic for croup
If possible, send a culture
Tx: Abx including 3rd gen cephalosporins, oxacillin, and/or clinda
FB aspiration
Typically 6 mos-5 yrs Small objects esp coins Sudden onset Stridor may be heard Tx: endoscopic removal Prevention: pay attention to choking hazards on toys
Sx of FB aspiration
Resp distress
Drooling
Wheezing
Perhaps stridor
Retropharyngeal abscess
Often occurs <6 yoa MC pathogens: S. aureus and S. pyogenes Typically sudden onset with drooling, fever, and leukocytosis with bands Muffled voice is common Imaging: lateral X-ray Tx: I and D by ENT and abx
Epiglottitis
Often from 2-6 yoa Rapid onset with high fever Tripod positioning with drooling Imaging: lateral neck (thumb print sign) Tx: emergent intubation and airway protection Prevention: hib vaccine
Peritonsillar abscess
Typically in pts >10 yoa
Associated with group A strep anaerobes
These pts present with hot potato voice, rigors, drooling and are often times febrile
Tx: I and D and abx
Anaphylaxis
Typically secondary to allergic rxn
Can occur at any age
MC causative agents: peanuts, shellfish, meds (PCN, cephalosporins)
Tx: supportive- epi, O2, airway protection, Benadryl, H2 blocker
Prevention: avoidance of allergens
Spasmodic croup
Occurs most commonly from 3 mos-3 yoa
Has similar presentation to croup, however, this often results from allergy or reflux disorders
Does not respond to racemic epi
Tends to be recurrent in nature and resolve quickly
If GERD is the cause, start the pt on a PPI
Tracheomalacia
Major airway malformation- abnl collapse of the tracheal airway walls, most commonly the distal 1/3 of the trachea
Type 1 tracheomalacia
Primary trachomalacia. Developmental defect in the tracheal cartilage, often improves and resolves with airway growth (typically 4-8 wks of age)
Type 2 tracheomalacia
Secondary tracheomalacia due to extrinsic compression
Type 3 tracheomalacia
Secondary tracheomalacia due to intra-airway irritation or inflammation
Bronchiolitis
95% occur in children <12 yo
Infectious/inflammatory process of the bronchioles
Always viral illness: MC RSV
Leading cause of hospitalizations of infants
Presents with wheezing, cough, and in severe cases apnea
Bronchitis
Most cases are secondary to viral illness including rhinovirus, coronavirus, or RSV
Characterized by cough, dyspnea, fever and expiratory rhonchi or wheeze
Tx: Supportive- hydration, expectorants, analgesics, breathing txs and cough suppressants
CXR will be essentially nl; no evidence of PNA
