Infections of the Respiratory Tract - LRTI - waldron (incomplete)

Question 1

what pathogen is epiglottitis associated with

Answer 1

haemophilus infleunzae type B (Hib) infection and children

Question 2

what population is most common to contract epiglottitis

Answer 2

industrialized area with vaccination programs; most stereotypical patient is now urban male in his mid 40s

Question 3

What is the presentaton for children epiglottitis

Answer 3

Drooling, Dysphagia, Dysphonia, Distressed

Question 4

what are the signs of toxicity with epiclottitis

Answer 4

poor or absent eye contact; failure to recognize parents
cyanosis, irritability; inability to be consoled or distracted

Question 5

what is the presentation of epiglottitis in adults

Answer 5

like children; sore throat, fever, dysphagia, and drooling
peak usually takes >24 hours to develop
obstruction less common
no visible oropharyngeal inflammation

Question 6

what is relinquishing tripoding indicative of?

Answer 6

respiratory failure

Question 7

what is the dx/work up for epiglotitis

Answer 7

H&P, CBC,, blood cultures, lateral neck XR

Question 8

what can stridor in children result from

Answer 8

croup, bacterial tracheitis, airway FB

Question 9

What is the thumb sign

Answer 9

seen on lateral neck XR with epiglotitis

Question 10

what is the treatment for epiglotitis

Answer 10

ADMIT
dx required direct exam - laryngoscopy revealing beefy-red, stiff, edematous epiglotitus
ABX (ceftriaxone is treatment of choice)
supportive measures

Question 11

what is another name for laryngotracheobronchitis

Answer 11

croup

Question 12

what is croup

Answer 12

inflammation of larynx, trachea and bronchi
very common to cause cough, stridor, and hoarseness in children with a fever

Question 13

when is croup most common

Answer 13

October to early spring
6 months - years and peak incidence 12mos - 2 years
B>Girls

Question 14

what is the clinical presentation of croup

Answer 14

preceding 1-3 day: rhinorrhea, nasal congestion, fever
classically barky or seal-like cough, hoarse voice, high-pitched inspiratory stridor

Question 15

how is croup diagnosed / worked up

Answer 15

clinical diagnosis

Question 16

what is the treatment of croup

Answer 16

mild: one dose of steroids then d/c home with return precautions
moderate: steroids, nebulizer epi with observation min 3 hours, reassess
severe: steroids, neb epi with observation min 3 hours, reassess + possible admission

Question 17

what is the goal of croup treatment

Answer 17

reduced airway obstruction
corticosteroids - PO/IV vs nebulized

Question 18

What is bacterial tracheitis

Answer 18

bacterial croup
most common fall and winter; coincides with seasonal viral epidemics (flu, RSV)
children 6mo - 14yo peak incidence 3-8 yo; M>F

Question 19

what is the most common bacteria in bacterial tracheitis

Answer 19

S. aureus, including MRSA
Strep pneumoniae, strep pyogenes, moraxella catarrhalis, h. influenza type B

Question 20

what are the most common viruses that preced bacterial tracheitis

Answer 20

influenza A (m/c) and B
RSV, parainfluenza, measles, enterovirus

Question 21

what do the symptoms of bacterial tracheitis result from

Answer 21

airway swelling and secretions resulting in airway obstruction

Question 22

what are the presentations of bacterial tracheitis

Answer 22

m.c insidious development with viral URI prodromal symptoms
less common: fulminant respiratory distress < 24 hours after symptom onset
resipratory distress: cyanosis, lethargy, combativ
children may appear toxic
severe inspiratory and expiratory stridor
fever, productive cough, hoarse voice, no tripoding or drooling

Question 23

what is the dx/workup of bacterial tracheitis

Answer 23

clinical
XR lateral neck (if stable)
direct laryngoscopy - definitive diagnosis
bronchoscopy with cultures of secretions

Question 24

What is the treatment of bacterial tracheitis

Answer 24

admin to PICU
agressive airway management
Antibiotics initiated ASAP
Humidified oxygen

Question 25

what are red flags for respiratory failure

Answer 25

hypoxia
retractions
fatigue
AMS
decreased breath sounds

Question 26

what is the leading cause of hospital admissions in infants under 1 year of age

Answer 26

Bronchiolitis - RSV most common cause

Question 27

What are risk factors for Bronchiolitis

Answer 27

low birth weight
age < 5 months
low socioeconomic population
airway anomalies
congenital immune deficiency disorders
parental smoking
crowded living environment
chronic lung disease

Question 28

what are risk factors for severe bronchiolitis infection

Answer 28

history of prematurity
age <3 months
neuromuscular disease
congenital heart disease
chronic lung illness
immunodeficiency

Question 29

what are the clinical presenation of bronchiolitis

Answer 29

URI: cough, fever, rhinorrhea
within 48-72 hours: lower airway involvement becomes evident
infants develop small airway obstruction leading to symptoms of respiratory distress
course of illness ~ 7-10 days
most infants improve within 14-21 days

Question 30

what is the PE for bronchiolitis

Answer 30

crackles, wheezing, rhonchi, cough, fluctuating clinical findings, rhinitis, grunting, nasal flaring, retractions - respiratory distress
obtain Pulse ox

Question 31

what is the hallmark of treatment for bronchiollitis

Answer 31

symptomatic care
- hydration, respiration, presence of hypoxia
if severe: admit and monitored

Question 32

what is the causative organism in pertussis

Answer 32

bordetella pertussis and bordetella parapertussis

Question 33

what is Bordettella

Answer 33

gram negative coccobacillus that adheres to cilated respiration epithelial cells
local inflammation changes in mucosal lining of respiratory tract
releases toxins - act locally and systemically

Question 34

what are the three stages of pertussis

Answer 34

incubation: 1-3 weeks then progresses to the stages
catarrhal phase
paroxysmal phase
Convalescent

Question 35

what is the catarrhal phase

Answer 35

similar to other URIs: fever, fatigue, rhinorrhea, conjunctival injection
lasts 1-2 weeks and is most infectious stage of the disease

Question 36

what is paroxysmal phase

Answer 36

1-6 weeks, can be up to 10 weeks
whooping cough - triggered by cold or noise, most common at night

Question 37

what is convalescent phase

Answer 37

residual cough persists for weeks to months, usually triggered by exposure to another URI or irritant

Question 38

what is the dx/workup for pertussis

Answer 38

nasopharyngeal cx and PCR make lab confirmation - not positive for 3-7 days

Question 39

what is the treatment of pertussis

Answer 39

mostly supportive: oxygen, suctioning, hydration, avoidance of respiratory irritants
strict isolation while patients are infectious (catarrhal phase and 3 weeks after onset of paroxysmal phase)

Question 40

what is post exposure prophylaxis with pertussis

Answer 40

erythromycin recommended for all household contacts

Question 41

how are patients <1 year old and not fully vaccinated treated with pertussis

Answer 41

Hosptialized regardless of the symptoms

Question 42

how are neonates with pertussis treated

Answer 42

admit to ICU - like threatening cardiopulmonary complications and arrest can occur unexpectedly

Question 43

what is the first line antibiotic treatment for pertussis

Answer 43

erythromycin 40-50mg/kg/day, max 2g/day

Question 44

what are the complications for pertussis

Answer 44

superimposed pneumonia: major cause of mortality in infants and young children
secondary pneumonia or otitis media possible
pulmonary HTN: contributes to infant mortality

Question 45

what is acute bronchitis

Answer 45

infection on the large airway due to viruses
commonly seen in flu season
common pathogens: respiratory syncytial virus, influenza virus A and B, parainfluenza, rhinovirus, etc

Question 46

what are risk factors for acute bronchitis

Answer 46

current/past smoker
hx asthma
living in polluted place
crowded
sometimes caused by allergens or irritants

Question 47

what is the clinical presentation of acute bronchitis

Answer 47

productive cough, malaise, difficulty breathing, and wheezing
production of clear or yellowish, may be purulent
lasts 10-20 days, may last 4+ weeks

Question 48

what is seen on FE with acute bronchitis

Answer 48

lungs: wheezing +/-, diffuse rhonchi +/-
clinical diagnoses based on history and physical

Question 49

what is the dx/workup of acute bronchitis

Answer 49

spirometry
airflow obstruction, bronchial hyperresponsiveness usually resolve 6 weeks

Question 50

what is the treatment of acute bronchitis

Answer 50

usually self limited: symptomatic, supportive
cough relief - codeine should be avoided; abuse potential
lifestyle modifications
abx therapy is NOT indicated

Question 51

what is a Communicable viral disease affecting upper and lower respiratory tract

Answer 51

wide spectrum of influenza viruses

Question 52

what is the gold standard diagnosis for influenza

Answer 52

PCR test or viral CX of throat secretion

Question 53

what is the key to reducing morbidity with influenza

Answer 53

vaccination

Question 54

what are the symptoms of influenza

Answer 54

runny nose, high fever, cough, sore throat
seasonal epidemics

Question 55

what are the different types of human influenza

Answer 55

type A and B

Question 56

how is influenza diagnosed

Answer 56

serologic, immunologic or molecular testing via PCR
diagnosis is usually clinical, especially influenza season

Question 57

what is the treatment of influenza

Answer 57

supportive (antipyretics, analgesics), fluids
antiviral meds: treat or prevent influenza infection - high risk populations

Question 58

what are complications of influenza

Answer 58

secondary bacterial pneumonia
acute respiratory distress syndrome
myositis
myocarditis
multi-organ failure