Pulmonology Flashcards
1
Q
Croup (laryngotracheobronchitis)
A
- 6mo-3y, fall or early winter, M>F
- MC pathogen: parainflu 1, 2, or 3 (2 milder than 1, 3 = sporadic and severe
- sxs: URI prodrome (nasal dc, congestion, coryza), gradual onset, progresses over 12-48h, low fever, seal-like barking cough (resolves in 3d), hoarseness
- signs: insp stridor, subcostal retractions
- dx: AP x-ray of neck = steeple sign
2
Q
mild, moderate, and severe croup
A
- Mild: no stridor at rest (may be present with crying or upset), barking cough, hoarse cry, mild to no chest wall or subcostal retractions
- tx: supportive care (humidifier or cool mist, antipyretics, oral fluids), AND single dose of PO dex OR nonpharm management
- moderate: stridor at rest, mild retractions, other sxs/signs of resp distress, no agitation
- severe: significant stridor at rest, severe retractions (indrawing of sternum), anxious, agitated, or pale and fatigued child
- moderate and severe tx: supportive care (anxiety can worsen airway obstruction, humidified air or O2, antipyretics, PO intake, instruct parent to hold or comfort child as anxiety can worsen airway obstruction), dex, racemic epi (can be repeated q15-20min), or L-epi
3
Q
acute brionchiolitis etiology, RF, sxs
A
- nonspecific inflamm injury that affects the lower resp tract
- pathogen: RSV (MCC in children, late fall/winter), rhinovirus (spring, fall), parainfluenza type 3 (early spring, fall)
- mostly fall/winter <2yo
- RF: premature, low birth weight, age <12wk, CHD, CLD, immunodeficient, severe neuromuscular dz
- sxs: preceding 1-3d URI (nasal congest, dc, cough), low fever, resp distress or SOB (insidious onset), dry cough, rhinorrhea, irritability, feeding difficulty
- signs: end-insp crackles, high-pitched insp wheezing, prolonged exp phase, tachycard, tachypnea, hyperresonant, cyanosis/pallor, hypoxemia, retractions, nasal flaring, grunting, sunken fontabelle, low UOP in kids
4
Q
acute bronchiolitis dx and tx
A
- dx: mainly clinical dx, CXR (not require, but shows hyperinflation and interstitial infiltrates, peribronchial thickening, PCR confirms dx, RAT for RSV or other viruses
- tx: self-limited, O2 (nasal canula), IVF, PO or NG feedings
- prophylaxis: palivizumab
5
Q
management of brionchiolitis by severity
A
- nonsevere (O2 >93%, no apnea, minimal accessory m use, tx at home): supportive care, anticipatory guidance (suction nose, monitor fluid intake and output, FU with PCP), antibiotics for otherwise healthy infants
- severe: requires treatment in ER, ICU, or inpatient setting - bronchodilator, nebulized hypertonic saline or roids
- when to admit: toxic appearance, poor feeding, lethargy, dehydration, mod/severe resp distress, apnea, hypoxemia +/- hypercapnia, parents unable to care for child at home
- prophylaxis: hand hygiene, palivizumab, annual flu vax
6
Q
respiratory syncytial virus etiology, RF, sxs
A
- paramyxoviridae fam, single-stranded, RNA, highest incidence in infants 1-6mo, peak in jan/feb
- transmission: inoc of nasopharyngeal or ocular mucosa, fomites, direct contact
- RF: infants <6mo, underlying CLD, premature, CHD, down syndrome, imunocompromised, asthma, high altitude, adult with cardiopulm dz or COPD
- sxs infants/children: LRTI/bronchiolitis, PNA, apnea, wheezing, hyponat dt SIADH
- sxs adults: URI or tracheobronchitis, wheezing, SOB, URI
- general sxs: rhinorrhea, low-grade fe er, mild systemic sxs, cough, wheezing, dyspnea
- signs: tachypnea, weheezing, rales, rhonchi
7
Q
RSV dx and tx
A
- dx: CLINICAL, CXR (diffuse infiltrates), sputum cx or throat swab (PCR), BAL
- tx: supportive care, hand washing, most recover gradually over 1-2wks
- neb ribavirin (nucleoside analog, reservved for immunocompromised pts with severe illness, recommended in adults with stem cell transplant, CI in preg)
8
Q
MC PNA pathogens by age group and txs
A
- neonates (<1mo): E. coli, GBS, S. aureus, Listeria, C. trachomatis
- tx: amp + gent or amp + cefotaxime
- 2w-4mo: C. trachomatis, S. pnumo, CMV, mycoplasma hominis, ureaplasma
- tx: erythro, azithro, or cefotaxime
- 6w-4y LOBAR: S. pneumo
- tx: amox, clinda, ceftriaxone or cefotaxime
- >4y LOBAR: S. pneumo
- tx: [amox, clinda, ceftriaxone or cefotaxime] AND macrolide (clarith, azith)
- 6w-4y ATYPICAL: B. pertussis
- tx: erythro, azithro, clarithro
- >4y ATYPICAL: mycoplasma, chlamydia, or influenza
- tx: clarith, azith, eryth, doxy, zanamivir or oseltamivir
9
Q
tachypnea definitions by age
A
- <2mo: >60
- 2-12mo: >50
- 12mo-5y: >40
- >5: >20
10
Q
community acquired PNA in children: etiology, RF, sxs
A
- typically follows URI that permits invasion of LRT by other pathogens, triggering an immune response and inflamm
- MCC bact PNA in children: S. pneumo
- viruses = 50% of cases in kids <5; MC viral cause = RSV
- transmission: resp droplets
- sxs: cough +/- sputum, SOB, apnea, fever, abd pain, V, anorexia
- signs: tachypnea, inc work of breathing, retractions, nasal flaring, grunting, dullness to percussion, egophony, bronchial breath sounds, insp crackles, rhonchi, wheezing, inc fremitus, whispered pectoriloguy, head bobbing, nuchal rigidity, fever, hypoxemia
11
Q
community acquired PNA in kids: dx and tx
A
- dx: CXR (bilat hilar interstitial infiltrates), WBC elevated/nl, ESR/CRP, serum procalcitonin (distinguishes bacterial from viral), PCR
- tx:
- 1-6mo:
- bact (nonchlamydial) → hospitalize (ceftriaxon, cefotaxime)
- chlamydia → outpt/inpt = azithro
- >6mo:
- uncomplicated (not mycoplas or chlamyd or s. aureus) → outpt = amox, augmentin, levo, clinda, macrolide; inpt = amp, PCN, cefotaxime, ceftriaxone
- mycoplas or chlamyd → inpt = azithro, erythro, levo
- >5yo:
- typical → outpt = amox, cefdinir, levo, macrolide
- atypical → outpt = erythro, azithro, clarithro, doxy
- 18+: atypical → outpt = levo, moxi
- aspiration: outpt →augmentin, clinda
- 1-6mo:
12
Q
foreign body aspiration
A
- hx: playing with small toys
- nasal: seeds and beads → MCC of halitosis
- sxs: acute choking or coughing episode, rhinorrhea, bleeding, halitosis, foul smell
- signs: exp wheeze, unilateral, asymmetrical dec breath sounds, localized wheeze
- dx: AP exp XR: tracheal deviation and mediastinal shift AWAY from affected side, hyperinflation, and air trapping in affected lung
- tx: EMERGENT rigid bronchoscopy
13
Q
asthma
A
- characteristics: airway inflammation, airway hyperresponsiveness, reversibleairflow obstruction, may begin at any age, dyspnea common when rapid changes in temp or humidity
- extrinsic: Atopic: produce IgE dt enviro triggers (eczema, hay fever), become asthmatic young
- intrinsic: not related to atopy of enviro factors
- want to see increased FEV1 >12% with albuterol
- can also see decrease in FEV1 >20% with methacholine or histamine challenge
- increase in diffusion capacity of lung for DLCO
14
Q
asthma characteristics and signs
A
- Triggers: pollens, house dust, molds, cockroaches, cats, dogs, cold air, viral infxns, tobacco smoke, meds (BB, ASA), exercise
- sxs: SOB, wheezing, chest tightness, cough (occurs in 30 mins to exposure to triggers, sxs worse at night)
- signs: wheezing (inspiration and expiration) is the MC finding
15
Q
asthma dx and tx
A
- Dx: CXR for first time wheezers, PFTs required to dx, spirometry before and after bronchodilators - increase in FEV1 ro FVC by 12%
- Tx 1:
- SABA for acute attacks (onset 2-5 min, lasts 4-6h
- LABA (salmeterol) for nighttime asthma and exercise induced
- ICS: moderate to severe asthma, use reg to decrease airway hyperresp.
- Tx 2:
- Montekukast: proph for mild exercised induced and control of mild-moderate, allows for reduction in steroid and B2
- Cromolyn sodium: proph before exercise
- Avoid BB in asthmatics
17
Q
asthma classification
A
- Intermittent, mild persistent, moderate persistent, severe persistent
