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Pulmonology Flashcards

1
Q

What is acute bronchiolitis caused by?

A

RSV - commonly in fall and winter months

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2
Q

Who does acute bronchiolitis present in?

A

infants and young children

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3
Q

What are the symptoms of acute bronchiolitis?

A

tachypnea, respiratory distress, wheezing

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4
Q

How is acute bronchiolitis diagnosed?

A

nasal washing for RSV culture and antigen assay

-CXR = normal

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5
Q

What is the treatment of acute bronchiolitis?

A
  • hospitalization if O2 situation <95-96%, age <3 months, RR > 70, nasal flaring, retractions, or atelectasis on CXR
  • supportive = humidified O2, antipyretics, beta-agonist, nebulized racemic epinephrin, and steroids
  • the only treatment demonstrated to improve bronchiolitis is oxygen
  • ribavirin is given if sever lung or heart disease and in immunocompromised patients
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6
Q

What is given prophylaxis for acute bronchiolitis for special populations?

A

palivizumab - once per month for 5 months beginning in November (immunocompromised, premature infants, neuromuscular disorders)

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7
Q

What is asthma?

A

a chronic, reversible inflammatory airway disease with recurrent attacks of breathlessness and wheezing

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8
Q

How is asthma diagnosed and monitor?

A

with peak flow

  • spirometry with pre and post-therapy (albuterol inhalation) readings
  • decreased FEV1/FVC (75-80%)
  • > 10% increase of FEV1 with bronchodilator therapy
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9
Q

What are the findings of spirometry for asthma?

A
  • decreased FEV1 to FVC ratio <80% (you would expect the amount of air exhaled during the first second (FEV1) to be the greatest amount)
  • in asthma, since there is an obstruction (inflammation) you will have a decreased FEV1 and therefore a reduced FEV1 to FVC ration
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10
Q

What is the treatment of mild intermittent asthma?

A

(<2x/week or <2 night/month) - SABA prn

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11
Q

What is the treatment of mild persistent asthma?

A

(>2x per week or 3-4 night/month) - low dose ICS daily

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12
Q

What is the treatment of moderate persistent asthma?

A

(daily sx or >1 night/week)

  • low dose ICS + LABA daily
  • medium dose ICS + LABA daily
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13
Q

What is the treatment of severe persistent asthma?

A

(sx severo times/day + nightly)

  • high dose ICS + LABA daily
  • hight dose ICS + LABA + oral steroids
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14
Q

What is the treatment for acute asthma?

A

oxygen, nebulized SABA< ipratropium bromide, and oral steroids

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15
Q

What is croup?

A

an infection of the upper airway, which obstructs breathing and causes a characteristic barking cough

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16
Q

What is croup caused by?

A

parainfluenza virus

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17
Q

Who is croup common in?

A

children 6 months - 3 years, fall and early winton months

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18
Q

What are the sings and symptoms of croup?

A
  • baring cough and stridor

- steeple sign on PA CXR (narrowing trachea in the subglottic region)

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19
Q

What is the treatment of croup?

A
  • supportive (air humidifier), antipyretics

- severe: IV fluids and nebulized racemic epinephrine, steroids

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20
Q

What is cystic fibrosis?

A

an autosomal recessive mutation in the CFTR gene

-abnormally thick mucus, difficultly clearing mucus

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21
Q

What is the presentation of cystic fibrosis?

A

recurrent repertory infections (especially pseudomonas), steatorrhea

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22
Q

How is cystic fibrosis diagnosed?

A

quantitive sweat chloride test

-CXR may revel hyperinflation, mucus plugging, and focal atelectasis

23
Q

What is the treatment of cystic fibrosis?

A
  • maintenance: chest physiotherapy, high-fat diet, supplement fat-soluble vitamins (A,D,E,K)
  • acute exacerbations: antibiotics
24
Q

When does a foreign body aspiration occur?

A
  • when a foreign body enters the airways and causes chocking
  • objects can enter the esophagus through the mouth, or enter the trachea through the mouth or nose
25
What most often is the foreign body?
food and can be life-threatening, 80% in mainstream or lobar bronchus right > left
26
What are the risk factors of a foreign body?
institutionalization, advanced age, poor dentition, alcohol, sedative use
27
What is the presentation of a foreign body?
- depends on the location of obstruction | - inspiratory stridor (if high in the airway) or wheezing and decreased breath sounds (if low in the airways)
28
What does the CXR of a foreign body show?
expiratory radiograph may reveal regional hyperinflation of the affected side -ABG - necessary for appropriately evaluating ventilation, may be useful for following the progression of respiratory failure when it is a concern
29
What is the treatment for a foreign body?
- remove foreign body with bronchoscope | - rigid bronchoscopy preferred in children while flexible is diagnostic and therapeutic in adults
30
What are the complications of foreign body?
pneumonia, acute respiratory distress syndrome, asphyxia
31
What is the presentation of a nasal foreign body?
- persistent foul-smelling purulent unilateral nasal discharge in a young child without other respiratory symptoms should raise suspicion for a retained nasal foreign body - even without a history of witnessed foreign body insertion
32
What is the treatment of a nasal foreign body?
prior to removal consider using oxymetazoline drops to shrink the mucous membrane
33
What are the precautions of foreign body in ear?
- aggressive flushing can cause perforation of the tympanic membrane, so caution is advised while irrigating - after each flush, it is prudent to recheck the external canal for retained foreign body (FB) fragments, which can occur with an insect - irrigation of the external ear can be uncomfortable for the child consider treating with topical pain agents such as benzocaine-anti-pyrene - insects must be immobilized prior to removal, drown insects with mineral oil or viscous lidocaine before attempting removal - removal of foreign body which requires direct visualization prior to removal either via warm irrigation with a syringe or instruments like an alligator forceps
34
What are the characteristics of ocular foreign body?
- metallic foreign bodies may leave a rust ring | - if you can't remove the foreign body easily then refer to the ophthalmologist
35
What is the dx of ocular foreign body?
full inspection of lids, conjunctiva, and cornea - slit-lamp examination will assist in identification and removal -X-ray or CT of may be necessary if there is any evidence of penetration of the globe
36
What is the tx of ocular foreign body?
- if the corneal foreign body is detected, an attempt can be made to remove it by irrigation after the instillation of topical anesthetic - this is particularly helpful in the case of multiple superficial foreign bodies (sand) - an attempt can then be made to remove the foreign body with a swab, using direct visualization - intraocular foreign bodies require immediate surgical removal by an ophthalmologist - systemic and topical antimicrobials (effective against Bacillus cereus if the injury involved contamination with soil or vegetation) are indicated
37
What is a rust ring?
after removal of foreign body containing iron, there is often a residual rust ring and reactive infiltrate - patients with rust ring should be treated as patients with corneal abrasions - rust ring itself is not harmful and will usually reabsorb gradually
38
Who does hyaline membrane disease affect?
premature infants
39
When does hyaline membrane disease occur?
when infants are born before the lungs are producing adequate amounts of surfactant - surfactant helps to prevent the lungs from collapsing - as the airways collapse, infants will struggle most and more to breathe until they become acidotic and multisite organ failure begins
40
What is the most common cause of respiratory disease in preterm infant?
preterm infant
41
What causes hyaline membrane disease?
a deficiency in surfactant resulting in poor lung compliance and atelectasis
42
How is hyaline membrane disease dx?
CXR will demonstrate diffuse bilateral atelectasis causing a "ground glass appearance" and air bronchograms
43
What is the tx of hyaline membrane disease?
given antenatal steroid pithing 24-48 hours of birth - betamethasone IM x2 - artificial surfactant can be given through the endotracheal tube - mechanical ventilation with positive pressure
44
What is the most common cause of viral pneumonia?
- kids = RSV (comes on fast) | - Adults = flu
45
How is viral pneumonia dx?
CXR = bilateral interstitial infiltrates | -rapid antigen testing for flu, RSV nasal swab, cold agglutinin titer negative
46
What is the tx of viral pneumonia?
flu with Tamil (A and B) if sx's began <48 hours | -symptomatic tx = beta 2 agonists, fluids, rest
47
What are the signs and symptoms of bacterial pneumonia?
fever, dyspnea, tachycardia, tachypnea, cough, +/- sputum
48
How is bacterial pneumonia dx?
patchy, segmental lobar, multiobar consolidation | -blood cultures x2, sputum gram statin
49
What is the tx of bacterial pneumonia?
``` outpatient = doxy, macrolides inpatient = ceftriaxone + azithromycin/respiratory FQs ```
50
What is the MC cause of lower respiratory tract infection in children worldwide?
respiratory syncytial virus | -virtually all children get it by age 3
51
What is the leading cause of pneumonia and bronchiolitis?
respiratory syncytial virus
52
What are the symptoms fo respiratory syncytial virus?
Rhinorrhea, wheezing/coughing that persists for months, low-grade fever, nasal flaring/retractions, nail bed cyanosis
53
How is respiratory syncytial virus dx?
nasal washing, RSV antigen test, CXR can show diffuse infiltrates
54
What is the treatment of respiratory syncytial virus?
- indications for hospitalization = tachypnea with feeding difficulties, visible retractions, oxygen desaturation <95-96% - supportive measures include albuterol via nebulizer, antipyretics and humidified oxygen, steroids (controversial), resolves in 5-7 days - vaccine for children with lung issues or born premature/immunocompromised at birth should get Synagis prophylaxis (palivizumab) = once per month for five months beginning in November

Peds EOR (12 decks)

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