PULMONOLOGY Flashcards
1
Q
ASTHMA CLASSIFICATION (GINA 2015)
A
2
Q
main feature of acute bronchitis
A
dry hacking cough
3
Q
DOC for pertussis
A
Macrolide
4
Q
PPD INTERPRETATION
A
- 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
5
Q
MANAGEMENT of PTB
A
- 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)
6
Q
PCAP C (severe) and D (very severe) both present with retractions, head bobbing, and cyanosis. The differences between the two are
A
the presence of the following in PCAP D: G –A- S (grunting, apnea, sensorium changes)
7
Q
- Extensive areas of hemorrhagic necrosis
- Irregular areas of cavitation
- Pneumatoceles, empyema and bronchopulmonary fistulas
A
Staphylococcus
8
Q
+/- exposure, (+) PPD, no signs/symptoms, negative chest x ray findings
A
TB infection
9
Q
PCAP C, incomplete HiB vaccination. treatment?
A
ampicillin 100 mkday in 4 divided doses
10
Q
What sinuses are pneumatized at 4 years old?
A
Sphenoid
11
Q
high fever, patient is in distress, acutely ill, brassy cough, copious purulent sputum
A
Bacterial Tracheitis
12
Q
A
13
Q
Whooping cough, Post tussive vomiting
A
Bordetella
14
Q
The most common complication of acute nasopharyngitis is:
A
Otitis media
15
Q
Etiologies of pneumonia in 0-28 days
A
GBS, E. coli, Listeria S. pneumoniae
16
Q
barking cough and hoarseness are characteristic of
A
LTB
17
Q
- 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
A
GABHS
18
Q
most common cause of lobar consolidation
A
Pneumococcus
19
Q
Incubation period of pertussis
A
3-12 days
20
Q
PNEUMONIA, ETIOLOGY, S/SX, CXR/CBC, TX
A
21
Q
To prevent occurrence of glomerulonephritis or rheumatic fever in children, cases of acute tonsillopharyngitis is best treated with:
A
Penicillin
22
Q
Tuberculin sensitivity develops _____ after its administration on the forearm.
A
72 hours
23
Q
considered the most consistent clinical manifestation of pneumonia in children
A
Tachypnea
24
Q
TB disease
A
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
25
A 3 year-old boy has a positive tuberculin skin test. Which of the following is suggestive of military TB?
Hepatosplenomegaly
26
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!
27
PCAP C, No previous antibiotic use, complete HiB vaccination. Treatment?
Penicillin G 100 000 units in 4 divided doses
28
Etiologies of pneumonia in 5-15 yrs
Mycoplasma\*, S. pneumoniae
29
2012 PAPP GUIDELINE FOR PNEUMONIA
30
Patchy infiltrates & ragged tracheal column
Bacterial tracheitis
31
PCAP A and B are both non-severe but the difference between the two is
**presence of mild dehydration in PCAP B**
32
MC pathogen for Epiglotittis
**If vaccinated: Staph. aureus; if unvaccinated: Hib**
33
What sinuses begin to develop at 7-8 years old?
Frontal
34
MC pathogen for bacterial tracheitis
S. aureus
35
Ragged air column on lateral neck xray due to debris and sloughed off mucus membranes
Bacterial Tracheitis
36
PE: drooling, neck held in hyperextension, bulging of the posterior pharyngeal wall, neck pain, muffled voice, respiratory distress
RETROPHARYNGEAL ABSCESS
37
* 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
38
MC pathogen for LTB/ croup
parainfluenza virus
39
CLASSIFY ASTHMA BASED ON SEVERITY
40
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
41
The most common extrapulmonary form of tuberculosis in children is:
Scrofula
42
**mild erythematous posterior pharynx and bulging of the posterior pharyngeal wall**
Retropharyngeal abscess
43
Patient presents with sore, scratchy throat, nasal obstruction and rhinorrhea. Paroxysms of cough leaving the baby breathless & subconjunctival hemorrhages.
Pertussis or whooping cough
44
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.
45
Thump sign / leaf sign
Epiglotittis
46
Wheezes are heard loudest over the trachea. Persistent wheezing never seems to go away
Chondromalacia
47
(+) exposure to and adult/adolescent with active disease, (-) PPD, no signs/symptoms, negative chest x ray findings
TB exposure
48
Period of communicability of pertussis
from 7 days after exposure to 4 wks after onset of typical paroxysms; most infectious during the **catarrhal** stage
49
Staccato cough
Chlamydia
50
Tx of Bacterial Tracheitis
Vancomycin or Clindamycin AND a 3rd generation cephalosporin
51
most common over all cause of PCAP worldwide.
Viruses
52
* **Fever, sore throat, dysphagia, trismus**
* **asymmetrical right tonsillar bulge with displacement of the uvula and erythematous posterior pharyngeal wall**
Peritonsillar abscess
53
Brassy cough
Staphylococcus
54
Etiologies of pneumonia in 3 wks – 3 mos
RSV\*, parainfluenza, Chlamydia, Mycoplasma, S. pneumoniae\*,
55
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
56
PCAP A and B treatment
Oral amoxicillin - 40 - 50 mkday in 3 divided doses
57
Management of EPIGLOTTITIS
Intubation and antibiotics (Cefotaxime, Ceftriaxone, or Meropenem IV)
58
Management of bronchiolitis
SUPPORTIVE MANAGEMENT
59
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)
60
Barking “Seal” cough
Parainfluenza
61
3 stages of pertussis
Catarrhal, Paroxysmal, Convalescent
62
LEVELS OF ASTHMA CONTROL (GINA 2006)
63
“steeple sign” / Subglottic narrowing
Croup or laryngotracheobronchitis (LTB)
64
muffled voice, drooling, tripod position, high fever, very toxic-looking patient
EPIGLOTTITIS
65
Hyperinflation w/ bilateral interstitial infiltrates & peribronchial cuffing
RSV
66
Etiologies of pneumonia in 4 mos – 5 yrs
viruses\*, S. pneumoniae\*, H. influenzae type b, Mycoplasma
67
• What are the sinuses present at birth?
Maxillary, Ethmoid
68
most common bacterial cause of PCAP in children 4mos-5 years of age.
S. pneumoniae
69
* Attaches to respiratory epithelium
* Inhibits cellular destruction
* Sloughed cellular debris and inflammatory cells and mucus cause airway obstruction
Mycoplasma
70
Local edema that aids in the proliferation of organisms and spread into adjacent areas resulting in focal lobar involvement
Pneumococcus
