1. MC viral (rhino) 2. MC bacterial strep pyogenes (Grp A)

Respiratory (43) Flashcards by Elise Wolff

Dx:

distress, dysphagia, dysphonia, drooing

epiglottitis

“thumb sig” on XR

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MCC of epiglottitis?

Hib

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MCC of bronchiolitis in children

RSV

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MCC of illness that causes “steeple sign” dt subglottic narrowing.

Croup, caused by parainfluenza virus

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MCC of pharyngitis

MC viral (rhino)

2. MC bacterial strep pyogenes (Grp A)

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differentiating factor b/w viral v. bacterial pharyngitis

both fever –> bacterial if anterior cervical LAD and/or tonsillar erythema/exudates

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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)

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dx first test for ABPA

skin prick for HSR

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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)

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major distinguishing factor b/w asthma and chronic bronchitis

asthma is reversible after bronchodilator therapy

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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)

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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

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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

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First step in management of children with epiglottitis

endotracheal intubation

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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

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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

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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

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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

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Most appropriate first test for someone suspected to have AAT

genetic

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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

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Middle age women complains of pulsatile tinnitus and gradual, painless hearing loss. Pulsating reddish-blue mass seen behind intact tympanic membrane

glomus tumors

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weber: sound hear best in normal hear
rinne: positive = air>bone conduction = sound still heard

sensorineural hearing loss

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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

seated/standing aspiration pneumonia - what lobe?

right lower lobe

supine aspiration pneumonia - what lobe?

right upper lobe

MC pathogens of OM

1. strep pneumo 2. Hi 3. 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 (@)

1. oxygen 2. SABA 3. 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