PULMONOLOGY Flashcards
ASTHMA CLASSIFICATION (GINA 2015)
main feature of acute bronchitis
dry hacking cough
DOC for pertussis
Macrolide
PPD INTERPRETATION
- Equal or >10 mm is (+)
- Equal or >5 mm is (+) in the presence of any or all of the ff:
- history of close contact with a known or suspected case of TB
- clinical findings suggestive of TB
- chest X ray findings suggestive of TB
- immunocompromised condition
MANAGEMENT of PTB
- INH 10 mg/kg/day PO (10-15 mkday; max 300 mg/day)
- Rif 15 mg/kg/day PO (10-20 mgkday; max 600 mg/day)
- PZA 25 mg/kg/day PO (20-40 mkday; max 2 grams/day)
- Ethambutol 15 mg/kg/day PO (15-25 mkday; max 1.2 grams/day)
- Streptomycin IM 20-40 mg IM once daily (max 1 gram/day)
PCAP C (severe) and D (very severe) both present with retractions, head bobbing, and cyanosis. The differences between the two are
the presence of the following in PCAP D: G –A- S (grunting, apnea, sensorium changes)
- Extensive areas of hemorrhagic necrosis
- Irregular areas of cavitation
- Pneumatoceles, empyema and bronchopulmonary fistulas
Staphylococcus
+/- exposure, (+) PPD, no signs/symptoms, negative chest x ray findings
TB infection
PCAP C, incomplete HiB vaccination. treatment?
ampicillin 100 mkday in 4 divided doses
What sinuses are pneumatized at 4 years old?
Sphenoid
high fever, patient is in distress, acutely ill, brassy cough, copious purulent sputum
Bacterial Tracheitis
Whooping cough, Post tussive vomiting
Bordetella
The most common complication of acute nasopharyngitis is:
Otitis media
Etiologies of pneumonia in 0-28 days
GBS, E. coli, Listeria S. pneumoniae
barking cough and hoarseness are characteristic of
LTB
- Diffuse infection with interstitial pneumonia
- Necrosis of tracheobronchial mucosa, formation of large amounts of exudate, edema, and local hemorrhage
- Involvement of lymphatic vessels and pleural
GABHS
most common cause of lobar consolidation
Pneumococcus
Incubation period of pertussis
3-12 days
PNEUMONIA, ETIOLOGY, S/SX, CXR/CBC, TX
To prevent occurrence of glomerulonephritis or rheumatic fever in children, cases of acute tonsillopharyngitis is best treated with:
Penicillin
Tuberculin sensitivity develops _____ after its administration on the forearm.
72 hours
considered the most consistent clinical manifestation of pneumonia in children
Tachypnea
TB disease
3 or more of the ff criteria:
- Exposure to an adult/adolescent with active TB disease
- (+) PPD
- Signs/symptoms suggestive of TB
- Abnormal chest x ray findings
- Laboratory findings (histological, cytological, biochemical, immunologic, and/or molecular)
SIGNS AND SYMPTOMS mentioned in #3 of TB disease (ANY 3 OR MORE):
- Cough w/ or w/o wheezing for > 2 wks
- Unexplained fever for > 2 wks
- Failure to gain weight; weight loss, weight faltering
- Failure to respond to 2 wks appropriate antibiotic therapy for LRTI
- Failure to regain previous state of health after two weeks of a viral infection
- Fatigue, reduced playfulness or lethargy
A 3 year-old boy has a positive tuberculin skin test. Which of the following is suggestive of military TB?
Hepatosplenomegaly
RECURRENT STREP PHARYNGITIS
Culture (+) strep pharyngitis that has been severe and frequent: >7 episodes in the previous year or >5 in each of the preceding 2 years → consider tonsillectomy!
PCAP C, No previous antibiotic use, complete HiB vaccination. Treatment?
Penicillin G 100 000 units in 4 divided doses
Etiologies of pneumonia in 5-15 yrs
Mycoplasma*, S. pneumoniae
2012 PAPP GUIDELINE FOR PNEUMONIA
Patchy infiltrates & ragged tracheal column
Bacterial tracheitis
PCAP A and B are both non-severe but the difference between the two is
presence of mild dehydration in PCAP B
MC pathogen for Epiglotittis
If vaccinated: Staph. aureus; if unvaccinated: Hib
What sinuses begin to develop at 7-8 years old?
Frontal
MC pathogen for bacterial tracheitis
S. aureus
Ragged air column on lateral neck xray due to debris and sloughed off mucus membranes
Bacterial Tracheitis
PE: drooling, neck held in hyperextension, bulging of the posterior pharyngeal wall, neck pain, muffled voice, respiratory distress
RETROPHARYNGEAL ABSCESS
- 1-3 years old; similar to LTB EXCEPT the history of a viral prodrome and fever in the patient and family are often absent; causes are viral, allergic, psychologic
- mostly nighttime symptoms with mild to moderate coryza and hoarseness
- awakens with a metallic, barking cough, noisy inspiration, appears frightened
SPASMODIC CROUP
MC pathogen for LTB/ croup
parainfluenza virus
CLASSIFY ASTHMA BASED ON SEVERITY
CHARGE syndrome
- C – coloboma of the eye
- H – heart defect
• A – atresia choanae
- R – retarded growth and development or CNS anomalies
- G – genital anomalies or hypogonadism
- E – ear anomalies
The most common extrapulmonary form of tuberculosis in children is:
Scrofula
mild erythematous posterior pharynx and bulging of the posterior pharyngeal wall
Retropharyngeal abscess
Patient presents with sore, scratchy throat, nasal obstruction and rhinorrhea. Paroxysms of cough leaving the baby breathless & subconjunctival hemorrhages.
Pertussis or whooping cough
Treatment for LTB
- All levels of respiratory distress: Dexamethasone;
- moderate to severe distress: steroid and add racemic epinephrine
* Racemic epinephrine works by relaxing the muscles in the airways and tightening of the blood vessels. Thus, bronchial and tracheal secretions and airway wall edema decreases. Racemic epinephrine stimulates both α- and β-adrenergic receptors. It acts on vascular smooth muscle to produce vasoconstriction which markedly decreases blood flow at the capillary level. This shrinks upper respiratory mucosa and reduces edema.
Thump sign / leaf sign
Epiglotittis
Wheezes are heard loudest over the trachea. Persistent wheezing never seems to go away
Chondromalacia
(+) exposure to and adult/adolescent with active disease, (-) PPD, no signs/symptoms, negative chest x ray findings
TB exposure
Period of communicability of pertussis
from 7 days after exposure to 4 wks after onset of typical paroxysms; most infectious during the catarrhal stage
Staccato cough
Chlamydia
Tx of Bacterial Tracheitis
Vancomycin or Clindamycin AND a 3rd generation cephalosporin
most common over all cause of PCAP worldwide.
Viruses
- Fever, sore throat, dysphagia, trismus
- asymmetrical right tonsillar bulge with displacement of the uvula and erythematous posterior pharyngeal wall
Peritonsillar abscess
Brassy cough
Staphylococcus
Etiologies of pneumonia in 3 wks – 3 mos
RSV*, parainfluenza, Chlamydia, Mycoplasma, S. pneumoniae*,
main features of bronchiolitis
- fever, cough, and wheezing in the 1st 2 years of life; there is inflammation of the lining of epithelial cells of bronchioles causing mucus production, inflammation and cellular necrosis
- history of wheezing with exposure to ill family members, affecting young children points to this diagnosis
- Bronchiolitis is caused by obstruction and collapse of the small airways during expiration.
- Bronchiolitis is more common in boys, non-breastfed, those who live in crowded conditions, with mothers who smoked during pregnancy
PCAP A and B treatment
Oral amoxicillin - 40 - 50 mkday in 3 divided doses
Management of EPIGLOTTITIS
Intubation and antibiotics (Cefotaxime, Ceftriaxone, or Meropenem IV)
Management of bronchiolitis
SUPPORTIVE MANAGEMENT
Patient presents with sore, scratchy throat, nasal obstruction and rhinorrhea. Persistent rhinorrhea w/ onset in the first 3 mos of life (snuffles)
Congenital syphilis
(snuffles is catarrhal discharge from the nasal mucous membranes in congenital syphilis)
Barking “Seal” cough
Parainfluenza
3 stages of pertussis
Catarrhal, Paroxysmal, Convalescent
LEVELS OF ASTHMA CONTROL (GINA 2006)
“steeple sign” / Subglottic narrowing
Croup or laryngotracheobronchitis (LTB)
muffled voice, drooling, tripod position, high fever, very toxic-looking patient
EPIGLOTTITIS
Hyperinflation w/ bilateral interstitial infiltrates & peribronchial cuffing
RSV
Etiologies of pneumonia in 4 mos – 5 yrs
viruses*, S. pneumoniae*, H. influenzae type b, Mycoplasma
• What are the sinuses present at birth?
Maxillary, Ethmoid
most common bacterial cause of PCAP in children 4mos-5 years of age.
S. pneumoniae
- Attaches to respiratory epithelium
- Inhibits cellular destruction
- Sloughed cellular debris and inflammatory cells and mucus cause airway obstruction
Mycoplasma
Local edema that aids in the proliferation of organisms and spread into adjacent areas resulting in focal lobar involvement
Pneumococcus
