Pulmonology Flashcards
intermittent scratchy, bubbly noises
heard predominantly on inspiration
crackles (rales)
What can cause crackles?
bronchiolititis
pulmonary edema
pneumonia
asthma
continuous high pitched
musical sound
predominantly on expiration
wheezes
What can causes wheezing?
asthma
bronchiolitits
foreign body
continuous, low pitched
non musical sound (snoring)
rhonchi
What can cause rhonchi?
pneumonia
cystic fibrosis
high pitched, harsh
blowing sound
heard predominantly on inspiration
stridor
What can cause stridor?
croup
laryngomalacia
subglottic stenosis
allergic rxn
vocal cord dysfunction
s/s of viral croup?
Inspiratory stridor
Hoarseness
Cough: barking; “seal-like”
URI sxs
usually afebrile
Etiology of viral croup?
1: Parainfluenza Virus Type 1
RSV and adenoviruses
What dx tool can be used to eval severity of croup? What does it assess?
Westley croup score
LOC, cyanosis, stridor, air entry, retractions
What might you see on xray in pt with viral croup?
steeple sign
Management of croup?
mild: supportive
mod: corticosteroids (Dexamethasone IM/IV or Prednisone PO x 3 days), Nebulized racemic epi
Sever: airway supportive, steroids, nebulized epi, +/- admit
organism that causes epiglottitis?
HIB
S/S of epiglottitis?
3 D’s: dysphagia, drooling & distress
Tri-pod posturing (“sniffing dog position”)
fever, inspiratory retractions, muffled voice, dyspnea
xray for pt with epiglottitis?
thumb sign on lateral neck film
Management of epiglottitis?
airway support
blood cx & epiglottis cx > then, IV abx
3rd gen cephalosporin + Vancomycin
+/- corticosteroids
What is bronchiolitis?
Lower respiratory tract infection that affects the small airways (bronchioles) in pt’s < 2
organism that causes bronchiolitis?
usually viral: RSV MC
high risk pts for bronchiolitis?
Gestational age <37 weeks Age <12 weeks Chronic pulmonary disease Congenital heart disease Immunodeficiency Congenital and anatomic defects of the airways Neurologic disease
s/s of bronchiolitis?
URI sxs for 2-3 days
Lower respiratory tract sxs develop next peaking on day 3-5
Breathing pattern is shallow, rapid with nasal flaring
irritability, poor feeding, vomiting
wheezing & crackles on exam
coughing, tachypnea, labored breathing, hypoxia
dx of bronchiolitis
clinical but may swab for RSV
management of bronchiolitis
supplemental O2
hydration
nasal suctioning
s/s of RSV
Diffuse wheezing & tachypnea following URI sx
low grade fever
crackles, prolonged expiration, wheezing, retractions
congestions, lots of mucus
xray findings in pt with RSV?
hyperinflation, peribronchial thickening
Tx of RSV?
supportive
Tx of RSV in immunocompromised pt?
Ribavirin- antiviral (used for Hep C & RSV)
Palivizumab (Synagis)- RSV immune globulin- prophylaxis
What is Infant Respiratory Distress Syndrome (RDS) “Hyaline Membrane Disease”?
Deficiency of surfactant production + surfactant inactivation by protein leak into airspaces
s/s of Infant Respiratory Distress Syndrome (RDS) “Hyaline Membrane Disease”?
Resp distress at birth
hypoxemia on ABG
Diminished air movement despite vigorous respiratory effort
xray fingins in infant respiratory distress syndrome?
Ground-glass appearance”
Tx for infant respiratory distress syndrome?
supplemental O2
nasal CPAP
early intubation
steroids
surfactant replacement (Beractant-Survanta)
presentation of pna?
Usually fever, cough, +/- preceding URI
May be subtle- esp. in infants
Poor feeding, irritability, restlessness
What causes afebrile pna of infancy? What does this occur?
chlamydia & other maternal infx
2wks-3 mos
PE findings for pna?
Tachypnea, tachycardia, fever (not always)
Increased work of breathing
(retractions, nasal flaring etc.)
Grunting= imminent respiratory failure
Lungs: crackles (rales), rhonchi, decreased air mvmt
+/- ‘ill appearance’, dehydration, lethargy, irritable
xray findings for pna?
air space disease or consolidation in a lobar distribution = bacterial pneumonia
interstitial or peribronchial infiltrates = viral pneumonia (or infection)
When should you admit for pna?
if < 3-6 mo old or hypoxemic
Tx for pna?
empirically
S. pneumo: Amoxicillin 90 mg/kg per day divided BID x 10 days
if atypical suspected: use Macrolide
How is pertussis transmitted?
respiratory droplets
What are the 3 phases of pertussis?
Catarrhal: URI sxs, fever
Paroxysmal: persistent whooping cough
Convalescent: cough gradually resolves
Gold standard for dx of pertussis? Other tests?
PCR & culture of nasal secretions
+/- serology
CBC: leukocytosis
Tx of pertussis?
Abx: Macrolides, TMP-SMX
Prophylaxis for the household regardless of immunization status!
