pulmonology Flashcards

1
Q

a 9-month old infant presents with a three-day history of a mild respiratory tract infection with serous nasal discharge, fever of 38.5 C (101.4 F), and decreased appetite. Physical exam reveals a tachypneic infant with audible wheezing and a respiratory rate of 65. Flaring of the alae nasi, use of accessory muscles, and subcostal and intercostal retractions are noted. Expiratory wheezes are present

What is the likely diagnoses?

A

acute bronchiolitis

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2
Q

how do you diagnose acute bronchiolitis?

A

nasal washing for RSV culture and antigen assay

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3
Q

If a pt has an O2 sat less than 95-96% and has confirmed bronchiolitis do you put them in the hospital?

A

yep

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4
Q

what are some other indications to hospitalize a pt with acute bronchiolitis?

A

age <3 months, RR > 70, nasal flaring, retractions, or atelectasis on CXR

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5
Q

If a pt with bronchiolitis does not need to be hospitalized what are the Txs?

A

humidified oxygen, nebulized racemic epi, steroids, beta agonists

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6
Q

What is the only treatment proven to improve bronchiolitis?

A

oxygen

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7
Q

A pt get bronchiolitis and has one of the following, severe lung disease, heart disease or immunocompromised what medication should you give?

A

Ribavirin

Palivizumab prophylaxis (once per month for five months beginning in November) for special populations (immunocompromised, premature infants, neuromuscular disorders)

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8
Q

a 5-year-old boy who is brought to the emergency department by his parents for a cough and shortness of breath. He has a past medical history of eczema and seasonal rhinitis. On physical exam, you note a young boy in respiratory distress taking deep slow breaths to try and catch his breath. He has diminished breath sounds in all lung fields with prolonged, expiratory wheezes

What is the likely diagnoses?

A

Asthma

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9
Q

How do you monitor asthma?

A

With peak flo

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10
Q

intermittent asthma is described as what?

A

less than 2 times per week or less than or equal to 2 night symptoms per month

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11
Q

Tx for intermittent asthma?

A

SABA prn

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12
Q

Mild persistent asthma is described as what?

A

symptoms more than 2 times per week or 3-4 night symptoms a month

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13
Q

Tx for mild persistent asthma?

A

Low dose ICS

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14
Q

Moderate persistent asthma is described as what?

A

Daily symptoms or more than 1 nightly episode a week

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15
Q

Tx for moderate persistent asthma?

A

low dose ICS plus LABA for step three. if on this and not working guess move to step 4 which is

medium dose ICS plus LABA

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16
Q

Severe persistent asthma is described as?

A

multiple symptoms a day and nightly

17
Q

Tx methods for severe persistent asthma?

A

High dose ICS and LABA
or
High-Dose ICS +LABA +oral steroids daily

18
Q

a 3-year-old girl with growth retardation has a long history of recurrent pneumonia and chronic diarrhea. Her mother states that he has 6-8 foul smelling stools per day. Physical exam reveals a low-grade fever, scattered rhonchi over both lung fields, crepitant rales at the left lung base and dullness to percussion. Other findings include mild hepatomegaly and slight pitting edema of the lower extremities

What diagnostics studies would you order to help diagnose this? What is you Dx?

A

CXR and sweat chloride test

Cystic fibrosis

19
Q

What will a CXR in cystic fibrosis reveal?

A

reveals hyperinflation, mucus plugging, and focal atelectasis

20
Q

Will the quantitative sweat chloride test for cystic fibrosis be elevated or decreased?

A

elevated

21
Q

What is the Tx for cystic fibrosis

A

Chest physiotherapy, high-fat diet, supplement fat-soluble vitamins (A, D, E, K)

22
Q

Persistent foul-smelling purulent unilateral nasal discharge in a young child without other respiratory symptoms should raise suspicion for what?

A

retained nasal foreign body

23
Q

Prior to removing the nasal foreign body, what kind of drops could you consider using?

A

oxymetazoline drops to try and shrink the mucus membranes

24
Q

a premature infant who is born at 30 weeks and after several hours develops rapid shallow respirations at 60/ min, grunting retractions, and duskiness of the skin. The chest X-ray reveals diffuse bilateral atelectasis, ground glass appearance, and air bronchograms

What is the likely diagnoses?

A

Hyaline membrane disease

25
Q

What is hyaline membrane disease?

A

This is a disease that affects premature infants. It occurs because when they are born their lungs are not fully developed and are not producing enough surfactant. because they do not have enough surfactant their lungs start to collapse

26
Q

True or false hyaline membrane disease is the most common cause of respiratory disease in premature infant?

A

True

27
Q

What week of gestation does this usually occur at if born?

A

less than 30 weeks

28
Q

What will a CXR of a premature infant with hyaline membrane disease show?

A

bilateral atelectasis, ground glass appearance, and air bronchograms

29
Q

What is the treatment for hyaline membrane disease?

A

antenatal steroid within 24-48 hours of birth - betamethasone IM x 2

30
Q

a 5-month old infant with a three-day history of a mild respiratory tract infection with serous nasal discharge, fever of 38.5 C, and decreased appetite. Physical exam reveals a tachypneic infant with audible wheezing and a respiratory rate of 65. Nasal flaring, use of accessory muscles, subcostal and intercostal retractions are noted. Expiratory wheezes and a cough are present

This describes a Pt presenting with?

A

RSV

31
Q

True or False: RSV is the MCC of lower respiratory tract infection in children world wide?

A

True

it is also the leading cause of pneumonia and bronchiolitis

32
Q

How can you diagnose RSV?

A

nasal washing and RSV antigen test; CXR can show diffuse infiltrates

33
Q

What are some indications for sending an RSV Pt to the hospital?

A

tachypnea with feeding difficulties, visible retractions, oxygen desaturation < 95-96%

34
Q

What are some supportive measure you can take to help relieve some of the symptoms of RSV?

A

albuterol via nebulizer, antipyretics and humidified oxygen

35
Q

How soon should RSV resolve?

A

5-7 days

36
Q

a child with lung issues or born premature/immunocompromised at birth should get what treatment to prevent RSV?

A

Synagis prophylaxis (palivizumab) = once per month for five months beginning in November