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clin med pulmonology > LRTI > Flashcards

LRTI Flashcards

1
Q

What is epiglottitis generally associated with

A

H. influenza type B

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2
Q

Which population is epiglottitis most common in

A

urban male in 40s

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3
Q

What is occurring in the body with epiglottitis

A

bacteria colonize the nasopharynx and spread locally causing supraglottic cellulitis

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4
Q

What are the 4 Ds of epiglottitis presentations in children

A

Drooling
Dysphagia
Dysphonia
Distressed respiratory effect

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5
Q

What signs are seen with adults with epiglottitis

A

Tripod position
sore throat
dysphagia
drooling

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6
Q

What are signs of toxicity from lack of air

A

Poor or absent eye contact
failure to recognize parents
cyanosis
irritability
inability to be consoled/distracted

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7
Q

What on PE should raise suspicion for epiglottitis

A

Severe throat pain with a normal appearing pharynx

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8
Q

if a child is tripoding, are they stable or unstable

A

stable.. but does mean they will probably crash soon

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9
Q

What is the dx and workup for epiglottitis

A

CBC and blood cultures
direct inspection
Culture epiglottis
lateral neck XR

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10
Q

Where should direct inspection of the epiglottis be preformed

A

In the OR to confirm diagnose and secure the airway

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11
Q

When may stridor occur outside of epiglottitis

A

Croup
bacterial tracheitis
airway foreign body

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12
Q

When may tripod position occur outside of epiglottitis

A

peritonsillar or retropharyngeal abscess

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13
Q

What type of trauma may lead to epiglottitis

A

caustic ingestion
thermal injury

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14
Q

What is the treatment for epiglottitis in children

A

Admit to hospital

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15
Q

How do you get a definitive diagnosis of epiglottitis

A

flexible fiberoptic laryngoscope

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16
Q

What will be seen with a laryngoscope in epiglottitis

A

beefy, red, stiff, edematous epiglottis

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17
Q

How long should an ETT be left in with epiglottitis

A

for 24-48 hours post stabilization of patient

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18
Q

What is the treatment of choice for epiglottitis

A

Ceftriaxone
*once extubated PO augmentin will be sent home with them

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19
Q

What is another name for laryngotracheobronchitis

A

croup

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20
Q

If a child has a fever, cough, stridor, and hoarseness, what is their likely diagnosis

A

Croup

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21
Q

What is the common cause of croup

A

parainfluenza virus

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22
Q

Which gender is more commonly effected by croup

A

Boys

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23
Q

what is the common age for croup

A

12months-2years

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24
Q

What time of year is croup most common

A

October to early spring

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25
Q

What is the most narrow part of an airway in kids under 8

A

subglottic space

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26
Q

What does a cough sound like with croup

A

Barky seal like cough

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27
Q

What are common things seen with croup

A

drooling
dysphagia
stridor w/o cough or fever
incomplete immunizations

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28
Q

What will you see on xray with croup

A

steeple sign

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29
Q

How do you diagnose croup

A

rule out other causes of stridor.. mostly a clinical diagnosis

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30
Q

What are differentials for croup in kids <6 month

A

Subglottic stenosis
vocal cord paralysis
hemangioma
foreign body aspiration
anaphylaxis

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31
Q

What are differentials for kids > 6months

A

Foreign body aspiration
bacterial tracheitis
epiglottitis
peritonsillar abcess
abscess
anaphylaxis

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32
Q

If a patient has a barky cough with or without stridor at rest, how do you treat

A

supportive measures

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33
Q

What is mild croup and how do you treat

A

barky cough w/ or w/o stridor with agitation

One dose steroids then d/c home

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34
Q

What is moderate croup and how do you treat

A

barky cough and stridor at rest, w or w/o increased work of breathing

Steroids
nebulized api with 3hour observation

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35
Q

What is severe croup and how do you treat

A

Barky cough, stridor, prominent increased work to breathe

Steroids, nebulized epi with 3 hour observation and then reassess… possible admission

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36
Q

What is the goal of croup treatment

A

reduce airway obstruction

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37
Q

What is heliox

A

Breathing gas mixture of helium and O2

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38
Q

When is bacterial tracheitis seen

A

Fall and winter months

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39
Q

What population is most effected by bacterial tracheitis

A

Males
children
6months - 14 years (peak 3-8)

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40
Q

What viruses can cause bacterial tracheitis

A

influenza
parainfluenza
RSV

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41
Q

What is bacterial tracheitis

A

Bacterial infection of trachea, generally after a viral URI

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42
Q

What are common bacterial that may cause bacterial tracheitis

A

Staph aureus
s. pneumonia
strep pyogenes
H. influenza

43
Q

What are the 2 ways bacterial tracheitis present

A

1) sx are present for 1-3 days until severe airway deterioration from overlapping infection

2)Usual treatment of croup is/has been ineffective

44
Q

What are common symptoms of bacterial tracheitis

A

Respiratory distress
appear toxic if fulminant
severe insp./exp. stridor
raspy voice but NO dysphagia

45
Q

How do you get a definitive diagnosis of bacterial tracheitis

A

Direct laryngoscopy

46
Q

How do you treat bacterial tracheitis

A

admit to ICU
aggressive airway management
Antibiotics (ceftriaxone + Nafcillin)
humidified O2

47
Q

What are red flags for respiratory failure

A

hypoxia
retractions
fatigue
AMS
decreased breath sounds

48
Q

How long are kids generally hospitalized with bacterial tracheitis

A

3-12 days

49
Q

What is the leading cause of hospital admission in infants under 1y/o

A

Bronchiolitis

50
Q

What is the most common cause of bronchiolitis

A

RSV

51
Q

What is a common complication of bronchiolitis and how do you treat it

A

Recurrent wheezing

Inhaled corticosteroids and leukotriene antagonists

52
Q

What time of year is bronchiolitis most common

A

autumn and winter

53
Q

What are risk factors for bronchiolitis

A

low birth weight
<5months
Airway anomalies
Parental smoking
Crowded living environment
Chronic lung disease

54
Q

What are the risk factors for severe bronchiolitic infections

A

Premature birth
<3months
neuromuscular disease
congenital heart disease
chronic lung illness
immunodeficiency

55
Q

What will occur in the lungs with bronchiolitis

A

air trapping
increased mucus production
atelectasis
labored breathing / decreased ventilation

56
Q

What is the course of infection with bronchiolitis

A

Initial URI sx
Within 48-72hrs lower airway in involved

respiratory distress

illness lasts 7-10 days and most infants improve in 14-21 days as long as they’re hydrated

57
Q

What are mild respiratory distress symptoms with bronchiolitis

A

tachypnea

58
Q

What is severe respiratory distress symptoms in bronchiolitis

A

retraction’grunting
cyanosis

59
Q

What will be seen on PE with bronchiolitis

A

crackles/wheezing/rhonchi
grunting
nasal flaring
retractions

60
Q

How do you get a clinical diagnosis of bronchiolitis

A

RSV wash

61
Q

What are differentials for bronchiolitis

A

asthma
bacterial pneumonia
GERD
croup
foreign body aspiration
pertussis

62
Q

What is the hallmark treatment for bronchiolitis

A

symptomatic care

63
Q

How do you treat mild-moderate bronchiolitis symptoms

A

nasal saline
antipyretics
cool-mist humidifier

64
Q

How do you treat severe bronchiolitis symptoms

A

beta agonist (albuterol)
neb of hypertonic saline
mechanically ventilate w/ resp failure

65
Q

How can you try to prevent bronchiolitis

A

passive immunization against RSV (palivizumab)

66
Q

What is the prognosis of bronchiolitis

A

self limited

67
Q

What are the causative organisms for pertussis

A

bordetella pertussis
Bordatella parapertussis

68
Q

How is pertussis spread

A

airborne droplets (highly contagious)

69
Q

What are some presentations of pertussis

A

petechiae above nipple line from increased thoracic pressure from coughing

70
Q

What test is used for diagnosis of pertussis

A

Nasopharyngeal culture and PCR
takes 3-7 days

71
Q

What is a classic pertussis finding on Xray

A

shaggy right heart border

72
Q

What may be seen on labs with pertussis

A

leukocytosis

73
Q

What are key differentiating factors for pertussis

A

persistent cough without fever

typical progression through 3 phases

74
Q

What is the tx of pertussis

A

mostly supportive

Strict isolation through contagious phase

75
Q

What is the post exposure prophylaxis for family members of those with pertussis

A

erythromycin

76
Q

Which patients with pertussis should be hospitalized

A

pneumonia
hypoxic
CNS complications
unable to tolerate hydrationPO

77
Q

Which patients do you hospitalize with pertussis regardless of symptoms

A

patients <1y/o who are not fully vaccinated

78
Q

What antibiotics can be used with pertussis

A

Erythromycin (first line)

79
Q

If a patient with pertussis has a fever in the paroxysmal phase, what are you concerned for and why

A

Pneumonia

because fever should resolve in catarrhal phase

80
Q

What are common complications of pertussis

A

Superimposed pneumonia
Otitis media
Pulmonary HTN

81
Q

What is acute bronchitis secondary to

A

virsuses

*bacterial infection highly uncommon

82
Q

When is acute bronchitis commonly seen

A

during flu season

83
Q

Which population is at higher risk for acute bronchitis

A

current/past smoker
hx asthma
living in polluted place
crowding

84
Q

If acute bronchitis is bacterial, what is the cause

A

p. pneumonia

85
Q

What is the predominant complaint of acute bronchitis

A

cough

86
Q

What kind of mucus will patients have with acute bronchitis

A

clear/yellowing +/- purulent

87
Q

What is the other name for pertussis

A

Whooping cough

88
Q

How long does a cough with acute bronchitis typically last

A

10-20 days (avg around 18days)

89
Q

How do you treat acute bronchitis

A

symptomatic treatment
-hot tea/honey
-mucolytic
-b-agonist

90
Q

What is the gold standard for diagnosing influenza

A

PCR or viral culture of throat secretions

91
Q

How many types of flu are there and which variations infect humans

A

4 variations

A&B infect humans

92
Q

When do incidences of of flu generally peak

A

October - march

93
Q

Which patients are at higher risk with influenza

A

Age >65 or 6mo-6yr
Chronic CV/ resp conditions
CKD
Diabetes
Immunocompromised
pregnancy

94
Q

At what age can you begin the flu vaccine

A

over 6months of age

95
Q

If a patient has an egg allergy and only develops hives, should they still get the flu vaccine

A

yes
* just observe for 10-15 minutes post vaccination

96
Q

Can pregnant women and elderly receive flu vaccine

A

Safe for pregnancy

standard vaccine not effecting >65

97
Q

What is unique to influenza A

A

Genetically labile with high rates of mutations

98
Q

How do immune reaction and interferon response present

A

high fever, coryza, body aches

99
Q

Where does the virus replicate in the body

A

upper and lower respiratory passages

peaking at 48 hours

100
Q

What is the cornerstone of treatment for influenza

A

supportive w/ fluids

101
Q

Which variation of influenza can neuraminidase inhibitors be used

A

both A and B

102
Q

Which variation of influenza can adamantanes be used

A

Influenza A only

103
Q

What are complications of influenza

A

secondary bacterial pneumonia
ARDS
Myositis
myocarditis
multi organ failure

clin med pulmonology (12 decks)

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