Respiratory

Question 1

Stridor

Answer 1

Inspiration against closed glottis
High pitched sounds resulting from turbulent airflow jn the larynx or bronchial tree
Causes:
1 MCC laryngomalacia
2- 2nd MCC congenital subglottic stenosis (Tx: surgery)
Dx of 1&2 by laryngoscopy
3 vocal cord paralysis
4- F.B tx bronchoscopy
Peanut mc FB
MC site right bronchus
5- croup (parainfluenza , barking cough, horseness, stridor tx: epinephrine and steroids)
6- epiglottitis ( strep pyogens, thumb sign on xray , don’t touch intubate and IV ab)
7- trachetitis ( staph aureus , brassy cough, tx ab)
8- laryngeal tumors
9- enlarged thyroid
10- peritonsillar abcess
*** grunting expiration against closed glottis

Question 2

Bronchiolits

Answer 2

RSV

Tx: salbutamol not steroids

Question 3

Pneumonia

Answer 3

Causes:
Neonatal: GBS
<5: viral , patchy infiltration, lymphocytes tx supportive
>5 years: pneumococcus, lobar consolidation, neutrophils, tx penicllin
MC pneumonia in CF: pseudomonas
Chlamydia pneumonia: inc eosinophils, after chlamydia conjunctivitis no fever no wheeze staccato cough tx: macrolids

Question 4

Asthma

Answer 4

Chronic inflammation of airways with episodic airflow obstruction
Type 1 hypersensitivity inc IgE
Types: intermittent, persistent (mild, mod, severe)
** anticholinergic (ipratropium bromide) given Q6 hrs
SABA given q 20 mins
*** theophylline( phosphodiesterase inhibitor, inc CAMP causing bronchial dilation) SE: HTN, arrhythmia, seizure
Asthma exacerbation( viral infection is MCC)
** life threatening asthma: silent chest (complete bronchospasm), respiratory acidosis, use of accessoy muscles, cannot take a sentence
Po2<60 FEV1<30 pulse>120 hypotension ,arrhythmia