Pulmonology Flashcards
Most common congenital syndrome associated with it is CHARGE syndrome
Choanal Atresia
CHARGE syndrome
Coloboma Heart anomalies Choanal atresia Retarded growth Genital hypoplasia Ear abnormalities
Most common cause of common colds
Rhinovirus
What are the sinuses present at birth?
Ethmoid and Maxillary
Cough and colds for 10-14days, purulent nasal discharge, headache, sinus tenderness
Sinusitis
Gradual onset, moderate throat pain, symptoms of viral URTI (conjunctivitis, coryza, cough)
Contacts with colds symptoms
Acute Viral Pharyngitis
Sore throat and fever with headache, vomiting, abdominal pain
Palatal petechiae, diffuse erythema of tonsils and pillars
Sandpaper rash in inguinal and antecubital areas
Acute Bacterial (GABHS) Pharyngitis
Antibiotics for GABHS
Penicillin or Amoxicillib for 10 days
Culture (+) strep pharyngitis that has been severe and frequent: >7 episodes in the previous year OR >5 in each of the preceding 2 years
Recurrent Strep Pharyngitis
Consider Tonsillectomy
Bacterial invasion through the capsule of the tonsils
Usually affects adolescents
Fever, sore throat, dysphagia, trismus
Asymmetric tonsillar bulge with displaced uvula
Peritonsillar abscess
Drooling, neck held in hyperextension, bulging of the posterior pharyngeal wall, neck pain, muffled voice, respiratory distress
Fever, irritability, refusal to move neck, dysphagia, decreased oral intake
Retropharyngeal abscess
Most common etiology of Laryngotracheobronchitis
Parainfluenza Virus
Rhinorrhea, pharyngitis, cough and low grade fever (1-3days),
Inspiratory stridor, hoarse voice, barking cough
Laryngotracheobronchitis
Subglottic narrowing or Steeple sign
Laryngotracheobronchitis
Management for Laryngotracheobronchitis
Racemic Epinephrine Oral dexamethasone (single dose)
Serious and rapidly progressive infection of supraglottic structures
Acute Epiglottitis (Supraglottitis)
Most common etiology of Epiglottitis in UNVACCINATED children
H. Influenza type B
Most common etiology of Epiglottitis in VACCINATED children
Staphylococcus Aureus
Acute onset of high fever, dysphagia, dyspnea, drooling, muffled voice, sniffing dog or tripod position
Cherry red epiglottis
Acute Epiglottitis
Thumb sign or leaf sign on lateral neck x-ray
Acute epiglottitis
Treatment for Acute epiglottitis
Secure airway IV antibiotics (Cefotaxime, Ceftriaxone, Meropenem)
More of an allergic reaction to viral antigens than direct infection
Symptoms are mostly at night with mild to moderate hoarseness, coryza and hoarseness
Awakens with Metallic barking cough
Spasmodic Croup
Most common cause of Bacterial Tracheitis
Staph Aureus
High fever, brassy cough, can lie flat, does not drool, no dysphagia
Often follows a viral respiratory infection
Bacterial Tracheitis
Most commonly aspirated food
Peanut
Sudden onset of respiratory distress, hoarseness, localized wheezing, localized absence of breath sounds
Foreign Body Aspiration
Acute inflammation of the small airways in children
Bronchiolitis
Most common cause of Bronchiolitis
Respiratory Syncitial Virus
Low grade fever, rhinorrhea, cough, wheezing, hyperresonance to percussion, prolonged expiratory phase
CXR: hyperinflation, interstitial infiltrates
Bronchiolitis
Dry hacking cough then after several days sputum becomes purulent
Low grade fever, nasopharyngitis, conjunctivitis, rhinitis
Acute bronchitis
Most common etiology of Pneumonia
Neonates: Group B Streptococcus
3wks-4y/o: Respiratory Syncitial Virus
>5y/o: M. Pneumoniae and S. pneumoniae
Fever, cough, tachypnea
O2 saturation <92%
Pneumonia
Cough, wheezing, stridor
Diffuse streaky infiltrates; lymphocytosis
Supportive treatment
Viral Pneumonia
Cough, high fever, dyspnea, dullness to percussion
Lobar consolidation; neutrophilia
Bacterial Pneumonia
Less ill-looking, nonproductive cough
Interstitial pattern in xray, and usually on lower lobes
Walking pneumonia
Mycoplasma
Staccato cough
Maternal history of infection
Hyperinflation “ground glass” appearance; eosinophilia
Tx: erythromycin PO for 14 days
Chlamydia
Treatment for non-severe cases of pneumonia without previous use of antibiotic
Amoxicillin 40-50 mg/kg/day TID for 3-7days
Alternative: Azithromycin or clarithromycin
Treatment for severe cases of pneumonia without previous use of antibiotic AND requiring hospitalization
Complete Hib vaccination: Penicillin G
Incomplete Hib vaccination: Ampicillin
> 15y/o: IV non-antipseudomonal beta lactam plus extended macrolide or respiratory fluoroquinolone
3 components of asthma attack
Bronchospasn
Airway edema
Increased mucus production
A reversible obstructive airway disease involving both small and large airways
Increased residual lung volumes
Decreased FEV1/FVC ratio
Bronchial Asthma
Management of acute asthma attacks
Short-acting inhaled beta2 agonist
Oral or IV steroids
Anticholinergics - never used alone
Methylxanthines - NOT first line
(+) exposure to an adult or adolescent with active disease
(-) PPD
No signs/symptoms
Negative CXR
TB exposure
(+) exposure to an adult or adolescent with active disease
(+) PPD
No signs/symptoms
Negative CXR
TB infection
3 or more of the ff criteria: (+) exposure to an adult or adolescent with active disease (+) PPD signs/symptoms suggestive PTB Abnormal CXR Laboratory findings
Tb disease
