Respiratory Flashcards
Assessment of Respiratory System
PQRST
P- promoting, preventing, precipitating, palliating factors
Q- quality or quantity
R- region or radiation
S- severity, setting, simultaneous, similar illnesses in past
T- temporal factors
PQRST: P
- Contacts: those with similar illness
- Prevention: medications, supplements, handwashing
-Progression: increasing or decreasing in severity
-Treatment: what has been used?
PQRST: Q
quality or quanitity
- How severe are the symptoms?
PQRST: R
region or radiation
- Complaints of chest pain?
PQRST: S
-Key signs/symptoms/associated symptoms
-Similar illnesses
PQRST: T
temporal factors
- When did illness begin?
- Acute or insidious onset?
- How long?
Indications for tonsillectomy and adenoidectomy
- > 7 throat infections/past year
- > 5 throat infections/past 2 years
- > 3 throat infections/past 3 years
- recurrent peritonsllar abscess
- periodic fever with aphthous ulcers/adenopathy
- obstructive sleep apnea
What is pharyngitis?
inflammation of mucosal lining of throat - tonsils, pharynx, uvula, soft palate, nasopharynx
Viral sources of pharyngitis
- EBV
- HSV
- CMV
- enterovirus
- influenza
- parainfluenza
- HIV
Bacterial source of pharyngitis
group B strep
Clinical findings of acute viral pharyngitis
- pain
- myalgia/arthralgia
- fever
- sore throat/dysphagia
- rhinitis, cough, hoarseness, stomatitis
- gradual onset
- erythema tonsils/pharynx
- reactive cervical lymphadenopathy
Virus-Specific Findings of Pharyngitis: EBV
exudate on tonsils, soft palate
Virus-Specific Findings of Pharyngitis: adenovirus
follicular pattern on pharynx
Virus-Specific Findings of Pharyngitis: enterovirus
vesicles/ulcers on tonsils
Virus-Specific Findings of Pharyngitis: HSV
ulcers anteriorly/marked adenopathy
Virus-Specific Findings of Pharyngitis: parainfluenza/RSV
more lower tract disease
Diagnostic Studies for acute viral pharyngitis, tonsillitis, or tonsillopharyngitis
- RADT/culture
- GABHS screen if indicated: rare <3 years
Management of acute viral pharyngitis, tonsillitis, or tonsillopharyngitis
- supportive care
- adequate fluid intake
Clinical Findings for acute bacterial pharyngitis, tonsillitis, or tonsillopharyngitis
- 5 to 13 yo most common
- abrupt onset without nasal symptoms
- arthralgia, myalgia, HA
- moderate high fever, malaise
- prominent sore throat, dysphagia
- nausea, abd discomfort, vomitting
- common in late winter/early spring
- petechiae on soft palate/pharynx, swollen beefy red uvula
- yellow, blood tinged exudate
- tender enlarged anterior cervical lymph nodes
- bad breath
Diagnostic Studies for acute bacterial pharyngitis, tonsillitis, or tonsillopharyngitis
- RADT
- ASO not useful for acute infections
- STI testing if indicated
- If mononucleosis suspected: CBC, heterophile, antibody testing
Management of for acute bacterial pharyngitis, tonsillitis, or tonsillopharyngitis
- antibiotics in symptomatic child only
- supportive care
- NO steroids
- return to school when on antibiotics for 24 hours
PANDAS
a rare complication of acute bacterial pharyngitis, tonsillitis, or tonsillopharyngitis
5 Criteria to diagnose PANDAS
- OCD or tic disorder
- Perpubertal onset
- Abrupt onset; relapsing/remitting course
- Clear association with GABHS
- Neurologic abnormalities
What is rhinosinusitis?
inflammation/edema of mucous membranes in sinuses - bacterial invasion
Clinical Findings for Rhinosinusitis
- duration determines classification
- acute presentation: high fever, purulent nasal discharge
- HA, bad breath, fatigue
- facial pain, congestion, post nasal drip
Management of Rhinosinusitis
- refer chronic/recurrent to ENT
- treat with antibiotics if URI lasts > 10 days with purulent discharge, cough, or worsening fever
- NO decongestants
- NO antihistamines
- NO topical steroids
- NO saline irrigation
- analgesics
Clinical Findings of Nasal Foreign Body
- persistent/recurrent unilateral purulent discharge
- foul odor, epistaxis, obstruction, mouth breathing
What is croup?
Acute, inflammatory disease of larynx, trachea, bronchi
Clinical Findings of Croup
- brassy, barking cough
- stridor
- URI with acute onset of hoarse, barking cough
- mild to severe laryngeal obstruction, stridor
- symptoms worse at night
- epiglottis appears normal
- prolonged inspiration
- wheezing/rales if lower airway involvement
- fever
- slight dyspnea
Diagnostic Studies for croup
- clinical diagnoses
- subglottic narrowing on radiograph
Management of Croup
- humidified air
- nebulized epinephrine
- corticosteroids
- NO cold medicines
- bronchodilators
- O2 if sat below 92%
- heliox for severe croup
Indications/Treatment for Hospitalization for Croup
- RR 70-90
- temp higher than 102.2
- racemic epi in conjunction with steroids
- hydration & IV fluids
What is epiglottitis?
inflammation of epiglottis by H. influenzae type B, usually from 1-5 years
Clinical Findings of Epiglottitis
- abrupt onset of fever
- severe sore throat
- dyspnea
- inspiratory distress without stridor
- drooling, aphonia, high fever
- rapidly progressive resp obstruction
- severe retractions
- hyperextension of neck
Diagnostic Studies for Epiglottitis
- blood cultures
- lateral neck radiograph before physical exam with provider capable of intubation present
Management of Epiglottitis
- acute otolaryngologic emergency
- establish airway; start antimicrobials IV
- resp support (O2)
Prevention of Epiglottitis
flu vaccine
What is bronchiolitis?
Inflammation, necrosis, edema of resp epithelial cells in small airways
* Viral illness, primarily RSV
Clinical Findings of Bronchiolitis
- URI symptoms
- gradual development of resp distress
- low grade to moderate fever
- decreased appetite
- coryza, conjunctivitis, pharyngitis, otitis media
- tachypnea, retractions
- wheezing, crackles
Management of Bronchiolitis
- no bronchodilators
- nebulized hypertonic saline for hospitalized infants
- no antibiotics
- supportive care: hydration, antipyretics
- O2 if low sat
- nasal suctioning, avoid deep airway suctioning
Prevention of Bronchiolitis
- Palivizumab for high risk infants
- educate parents about limiting exposure
Laryngeal FB
- rapid onset of hoarseness/chronic croupy cough
- unilateral wheezing, recurrent pneumonia
Tracheal FB
- brassy cough hoarseness, dyspnea, cyanosis
- homophonic wheeze
Bronchial FB
- most in right lung
- blood streaked sputum
- initial episode of coughing, gagging, choking
- limited chest expansion, decreased vocal fremitus, atelectasis
- crackles, rhonchi, wheezes
Management of FB aspiration
- Refer to pulm for bronchoscopy
- Treat secondary lung infections, bronchospasms
What is bronchitis?
- nonspecific inflammation of bronchioles
- Caused by influenza, RSV, adenovirus, or parainfluenza
Clinical Findings of Bronchitis
- dry, hacking cough
- low substernal discomfort, burning chest pain
- fam hx of asthma, CF, atopy, infections, irritants
- hx of prematurity, GERD
- variable rhinitis
- low grade or no fever
- nasophayngeal infection, conjunctivitis
- coarse breath sounds, rhonchi, rales
Management of Bronchitis
- supportive care
- analgesia, hydration
- antivirals if influenza
- NO cough suppressants
- NO bronchodilators
** Chronic bronchitis may require steroids or bronchodilators
Personal History Nonbacterial and Bacterial Pneumonia: Neonate
- hx of group B strep or C. trachomatis infection in mother
- prenatal drug use/ lack of prenatal care
- C. trachomatous
Personal History Nonbacterial and Bacterial Pneumonia: infant
- slower onset of resp symptoms
- determine mother’s HIV status or exposure to TB
Personal History Nonbacterial and Bacterial Pneumonia: Child/Adolescent
- immunization, travel history, TB status
- sick contacts
- possible FB
- hx of mild URI
- abrupt high fever
- restlessness, shaking chills, apprehension, SOB, malaise, pleuritic chest pain
Physical Examination of Nonbacterial and Bacterial Pneumonia
- resp distress
- apena, tachycardia
- nasal flaring, grunting, retractions
- tachypnea, air hunger, cyanosis
- fine crackles, dullness, diminished breath sounds
Clinical Findings Specific to Bacterial Pneumonia
- fever, hypoxia, lethargy
- splinting affected side, tachypnea, retractions
- pleural effusion
Clinical Findings Specific to Viral Pneumonia
- wheezing
- downward displacement of liver/spleen
Clinical Findings Specific to Atypical Pneumonia
- repetitive staccato cough - C. trachomatis
