Respiratory Flashcards
Pathogenesis of croup?
Parainfluenza mostly. Sometimes RSV, influenza, others.
How does patient with croup present?
With viral prodrome, seal-like cough, inspiratory stridor
How to diagnose croup?
XR showing steeple sign
How to treat croup?
Supportive, if not responsive, treat with racemic epi and corticosteroids (especially if patient has stridor at rest)
Epiglottitis pathogenesis
H. Flu, but can also be caused by staph aureus
How does a patient with epiglottitis present?
Patient is sick as shit, 3-6 years old. Tripodding, drooling, febrile >104, rapid onset
How to diagnose epiglottitis?
XR showing thumbprint sign
How to treat epiglottitis?
DO NOT touch trachea. Take patient to OR for intubation. Give antibiotics.
Bacterial tracheitis pathogenesis?
Bacterial infection with strep pneumo or staph
How does patient with bacterial tracheitis present?
Has cold/flu like symptoms and suddenly becomes incredibly febrile with horrible sore throat and stridor.
How to diagnose bacterial tracheitis?
XR showing steeple sign, subglottic narrowing with hazy border.
How to treat bacterial tracheitis?
No response to racemic epinephrine. Culture and give antibiotics.
Retropharygneal abscess pathogenesis
Caused by bacterial infection (usually strep and staph)
How does patient with retropharyngeal abscess present?
Fever and drooling with hot potato voice. Patient likes to lie supine with neck extended.
Patient usually has unilateral lymphadenopathy.
How to diagnose retropharyngeal abscess?
Get a lateral XR, will show increased soft tissue swelling that expands up to 50% of vertebrae
How to treat retropharyngeal abscess?
I+D, culture. Give antibiotics for strep and staph, then based on culture.
Pathogenesis of peritonsillar abscess
Caused by staph and strep
Patient with peritonsillar abscess presentation?
Fever, drooling, hot potato voice. Patient has tonsillar shift with visible abscess.
How to diagnose peritonsillar abscess?
Clinical
How to treat peritonsillar abscess?
I+D and culture
Foreign body airway obstruction presentation?
Unsupervised child with sudden onset shortness of breath. Stridor if in upper airway, wheezing if in lower airway.
How to diagnose FBAO?
XR AP and lateral = coin sign
How to treat FBAO?
Rigid bronch.
Bronchiolitis pathogenesis
RSV, sometimes parainfluenza. Inflammation of bronchioles
Typical bronchiolitis presentation
Wheezing child, fever.
How to diagnose bronchiolitis?
CXR and PFTS (normal)
How to treat bronchiolitis?
Will resolve spontaneously, however if SpO2
CF pathogenesis
Autosomal recessive mutation in the CFTR gene
How does CF patient present?
Usually found on prenatal screen, salty kid with mucus plug, FTPM 2/2 mec ileus, failure to thrive, infections with pseudomonas, short stature.
How to diagnose CF?
Prenatal screen or sweat chloride test
Tx for CF?
Pulmonary toilet, NAC, pancreatic enzymes, treatment for pseudomonal pneumonia
Otitis media pathogenesis
URI bugs (H.Flu, S. pneumo, moraxella). Middle ear inflammation
How does patient with otitis media present?
Unilateral ear pain, no pain with pinna pull. Loss of light reflex, bulging TM.
How to diagnose otitis media?
Pneumatic insufflation
How to treat otitis media?
Amoxicillin
Pathogenesis of otitis externa?
Outer ear inflammation with pseudomonas (swimmers), S. aureus (digital trauma).
How does patient with otitis externa present?
Unilateral ear pain with pain on pinna pull. Erythematous canal.
How to treat otitis externa?
Spontaneous or cipro gtt
Sinusitis pathogenesis?
URI bugs infected sinuses
How does sinusitis patient present?
Congestion, nasal discharge, purulence, pain with facial tap.
How to diagnose sinusitis?
Clinical
How to treat sinusitis?
Treat only if >7d OR with cough. Treat with amoxicillin
Difference between sinusitis and a cold?
Cold lasts less than 7 days and does not have a cough.
Choanal atresia pathogenesis
Big tonsils
Choanal atresia pathogenesis
Snoring child, blue while resting, pink when crying.
How to diagnose choanal atresia?
NG tube fails to pass
How to treat choanal atresia?
Surgery
