Respiratory (43) Flashcards
Dx:
distress, dysphagia, dysphonia, drooing
epiglottitis
“thumb sig” on XR
MCC of epiglottitis?
Hib
MCC of bronchiolitis in children
RSV
MCC of illness that causes “steeple sign” dt subglottic narrowing.
Croup, caused by parainfluenza virus
MCC of pharyngitis
- MC viral (rhino)
2. MC bacterial strep pyogenes (Grp A)
differentiating factor b/w viral v. bacterial pharyngitis
both fever –> bacterial if anterior cervical LAD and/or tonsillar erythema/exudates
What is the dx:
asthmatic pt with recurrent exacerbations of fever, cough, dyspnea. bronchiectasis (dilation of airways), causing expectoration of brown mucus plug. Peripheral eosinophilia
aspergillus - Allergic BronchoPulmonary Aspergillosis (ABPA)
dx first test for ABPA
skin prick for HSR
dx criteria for chronic bronchitis.
classic color on exam
> 3mo for 2 years in a row of productive cough, as well as evidence of airway obstruction on PFT (FEV1/FVC blue bloaters (fat, cyanotic)
major distinguishing factor b/w asthma and chronic bronchitis
asthma is reversible after bronchodilator therapy
CT imaging reveals expiratory trapping within bronchioles, bronchial wall thickening, gropund glass ocpacities thorught all lung fields. rare cause of cough in adults.
bronchiolotis obliteras (dt inflammation or fibrosis)
abnormal enlargement and permanent destruction of airspace distal to bronchioles iwth no evidence of fibrosis. common cause of chronic cough. non cyanotic, RR high, thin with inc AP ches diameter.
CT: large bullae, flat diaphragm, enlarged airspace.
emphysema
Cough, dyspnea, excess production of foul purulent sputum for mo-years. May complain of hemoptysis, dyspnea, pleuritic chest pain, wheezing, wt loss, fatigue. Not relieved by tx for pneumonia or obsructive lung diseases (asthma/bronchitis/COP)
CXR: dilated and thickened airways.
CT: airway dilatation and bronchial thickening in presence of mucus plugs or debris and post-obstructive air trapping “signet ring sign”
bronchiectasis
First step in management of children with epiglottitis
endotracheal intubation
Intermittent asthma classifications
Sx: Nighttime awakenings: Use of SABA: Normal activity interfered with? PFTs Exacerbations/yr requiring oral systemic CS:
Sx: 80%)
Exacerbations/yr requiring oral systemic CS: 0-1
Mild persistent asthma classifications
Sx: Nighttime awakenings: Use of SABA: Normal activity interfered with? PFTs Exacerbations/yr requiring oral systemic CS:
Sx: >2x/wk but not daily
Nighttime awakenings: 3-4x/mo
Use of SABA: >2x/wk
Normal activity interfered with? minor limitations
PFTs normal
Exacerbations/yr requiring oral systemic CS: > or = 2 / yr
Moderate persistent asthma classifications
Sx: Nighttime awakenings: Use of SABA: Normal activity interfered with? PFTs Exacerbations/yr requiring oral systemic CS:
Sx: daily
Nighttime awakenings: at least 1/wk, not daily
Use of SABA: daily
Normal activity interfered with? some limitation
PFTs 60-80%
Exacerbations/yr requiring oral systemic CS: > or = 2 / year
Severe persistent asthma classifications
Sx: Nighttime awakenings: Use of SABA: Normal activity interfered with? PFTs Exacerbations/yr requiring oral systemic CS:
Sx: thorughout day Nighttime awakenings: nightly Use of SABA: several times per day Normal activity interfered with? extreme limitation PFTs or = 2 exacerabations
Most appropriate first test for someone suspected to have AAT
genetic
child with hx of recurrent OM presents with new onset unilateral conductive hearing loss (weber localizes to bad, rinne: negative = bone conduction > air = sound not heard)). PE shows white mass located behind intact TM
congenital cholesteatoma
Middle age women complains of pulsatile tinnitus and gradual, painless hearing loss. Pulsating reddish-blue mass seen behind intact tympanic membrane
glomus tumors
weber: sound hear best in normal hear
rinne: positive = air>bone conduction = sound still heard
sensorineural hearing loss
dx: a single, discrete inhalation exposure
dx: multiple exposures
single = reactive airway dysfunction syndrome (RADS)
multiple = irritant-induced asthma
bronchiolar lavage reveals what predominant cells in reactive airway dysfunction syndrome (RADS)
neutrophils
positive acid fast bacilli on sputum culture
TB
seated/standing aspiration pneumonia - what lobe?
right lower lobe
supine aspiration pneumonia - what lobe?
right upper lobe
MC pathogens of OM
- strep pneumo
- Hi
- Moraxella
Give ampicillin for OM when?
only first line tx if middle ear inflammation or very severe infective sx
first line is supportive
MCC of hypercalcemia (bones, groans, abdominal moans, psychiatric overtones)
SCCa - MALIGNANCY (hyperCa = >10.2)
MC ECG finding in Pulmonary Embolism
Most common is SINUS TACHYcardia
S1Q3T3 is often found
Dx: Egophony, dullness to percussion, fever, productive cough/sweats/rigors/preceding URI, pleuritic chest discomfort
pneumonia
CXR first
When does exercise induced asthma peak?
10-15min after completion of exercise
Non-vigourous infants born with meconium should be handled how?
intubation and endotracheal suctioning
clinical sx of infectious mono are present. next step in diagnosis
CBC and heterophile ab test
unexplained hypoNa is typically caused by SIADH dt….?
Small cell Ca of lung (euvolemic hypoNa)
environmental exposure:
- “honeycombing” =
- “black lung” =
- noncaseating granulomas and hilar/mediastinal lymphadenitis =
- “honeycombing” = asbestos
- “black lung” = coal (pneumoconiosis)
- noncaseating granulomas and hilar/mediastinal lymphadenitis = beryllium
Mainstay of tx for acute asthma exacerbation (@)
- oxygen
- SABA
- oral CS***
Dx: nasal polyps, aspirin intolerance, asthma
Dx: Test:
Aspirin Exacerbated Respiratory Disease (AERD) - this is Samter’s triad
Dx test is oral aspirin challenge test (or ibuprofen or NSAID - any COX-1 inhibitor)
Foamy macrophages are actually
lipid laden
MCC of lipoid pneumonia
inappropriate use of petroleum jelly or mineral oil (for constipation)
Ohio and MS river valley + lung, think what microbe
histo
Southwest USA + lung, think what microbe
coccidioides
Dx and management: 6yo w/ 11d productive cough w/ green sputum and persistent compalints of facial pain. Daycare w/ other kids w/ sx. T 100.5, HR 90, frontal sinus tenderness, purulent nasal dicharge.
Dx: bacterial rhinosinusitis
Tx: amoxicillin-clavulanate
dx? 10 days of sinusitis sx, 4 days purulent sputum, and/or persistent unilateral facial pain
dx? 10 days of sinusitis sx, 4 days purulent sputum, and/or persistent facial pain, fever >102F, sx intensify after 7d
viral rhinosinusitis (>influenza>parainfluenza)
bacterial sinusitis (strep pneumo)
bacterial sinusitis tx in:
- kid allergic to penicillin (amoxicillin)
- adult allergic to penicillin (amoxicillin)
- kid - give levofloxacin or 3rd gen cephalosporin
- adult - give doxycycline (teeth discoloration in kids)
think ____ when presented w/ asthma sx (SOB during daily jog) that fail to respond to asthma therapy and spirometry showing flattened inspiratory flow loop w/ normal FVC and FEV1/FVC ratio
vocal cord dysfunction
Dx and tx:
presence of fever, notable tonsillar exudate, tender anterior cervical adenopathy, absence of cough.
strep pharyngitis
begin antibiotics
best annual screening recommendation for pt 55-80y w/ 30-pack-yr smoking and have smoked w/in last 15y
low dose CT
difference bw healthcare-associated pneumonia (HCAP) v. CAP
HCAP = non-hospitalized pts who have extensive contact w/ healthcare facilities. (IV or wound care w/in last 30d, live in nursing care, hospitalized for >2d in past 90d, hospital HD clinic in past 30d
Dx?
blunt chest trauma.
chest pain, SOB, decrased/absent breath sounds, dullness to percussion, derased tactile fremius, decrased vocal resonance on affected side.
hemothorax (blood in pleural cavity)
MCC of congenital sensorineural hearing loss and deaefness. mom presents with mono-like infxn.
CMV
loops, salicylates, aminoglycosides (i.e. gentamycin), chemotherapy - all can cause?
ototoxicity
ECK finding in Pulm embolism
sinus tachy
s1Q3,invertedT3
First line tx of Group A strep
Penicillin V
first line tx for respiratory tract infections, human/animal bites,
second line tx for bacterial OM
amoxicillin- clavulanate
