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Pedia > Pulmonology > Flashcards

Pulmonology Flashcards

0
Q

A septum separating the nasal cavity from the pharynx

Newborns are nose breathers - cyanosis with bilateral obstruction, relieved by crying

Dx: inability to pass an NGT through the nostril; fiber optic rhinoscopy

Tx: airway first then surgical correction

A

CHOANAL ATRESIA

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1
Q

Organisms: RHINOVIRUS, PARAINFLUENZA VIRUS, RSV, CORONAVIRUS (children are reservoirs)

Incubation period: 2-5 days, resolved 5-7 days

SSX: sore throat, sneezing, rhinorrhea, nasal congestion, pharyngitis

Tx: supportive

Complications: otitis media, sinusitis, pneumonia

A

COMMON COLDS/RHINITIS

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2
Q

Organisms: S. PNEUMONIAE, H. INFLUENZAE TYPE B, M. CATARRHALIS (acute), anaerobes (chronic)

Anything that impairs mucociliary transport or causes nasal obstruction predisposes to sinusitis

SSX: cold symptoms > 7-10 days, purple not nasal discharge, headache, tenderness over the sinuses

X-ray: air-fluid levels, opacification of the sinuses

Tx: antibiotics x 14 days (CO-AMOXICLAV)

Complications: abscess, meningitis

A

SINUSITIS

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3
Q

Gradual onset

Moderate throat pain

Symptoms of viral URTI

Contacts with cold symptoms

Vesicles and ulcers (HSV)

Conjunctivitis (adenovirus)

Tx: symptomatic

A

Acute pharyngitis (VIRAL)

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4
Q

Headache, vomiting, abdominal pain

No URTI symptoms

Palatial petechiae and diffuse erythema of tonsils and pillars

Sandpaper rash on inguinal and antecubital areas

Dx: rapid strep Ag test, throat culture

Tx: penicillin or amoxicillin x 10 days

Complications:

  • rheumatic fever
  • post-streptococcal glomerulonephritis
  • peritonsillar/retropharyngeal abscess
A

GABHS (GROUP A BETA HEMOLYTIC STREPTOCOCCI)

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5
Q

Bacterial invasion through the capsule of the tonsils

Adolescents

Group A streptococcus and anaerobes

Fever, sore throat, dysphagia, trismus

PE: tonsils may be markedly red with swelling and uvula is displaced

CT scan: ideally

Surgical drainage and antibiotics

A

PERITONSILLAR ABSCESS

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6
Q

3-4 years old

Retropharyngeal space located between the pharynx and the cervical vertebrae and extending down into the superior mediastinum

Can result from penetrating trauma to the oropharynx, dental infection and vertebral osteomyelitis

Manifestations:
- GROUP A streptococcus, anaerobes, Staphylococcus aureus

  • fever, progressive dysphagia
  • PE: drooling, neck held in hyperextension, bulge seen behind the posterior pharyngeal wall, neck pain, muffled voice, respiratory distress
A

RETROPHARYNGEAL ABSCESS

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7
Q

Also called viral croup

Acute inflammatory disease of the larynx (within the subglottic space)

Most common etiology: PARAINFLUENZA VIRUS

SSX: prodromal URTI symptoms, low-grade fever, inspiratory stridor, hoarse voice, barking cough

Neck X-ray: subglottic narrowing - “steeple sign”

Tx:

  • mild (at home): oral fluids, cool mist or steam therapy
  • moderate: oral steroids
  • severe (admit to hospital): nebulized racemic epinephrine
  • parenteral steroids
A

LARYNGOTRACHEOBRONCHITIS

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8
Q

Serious and rapidly progressive infection of supra glottic structures

Most common etiology is H. Influenzae B

SSX: acute onset of high fever, dysphagia, drooling, muffled voice, “sniffing dog” position

Dx: examine the throat only under double set-up

X-ray: “thumbprint” or “leaf” sign

Fiberoptic laryngoscopy: direct visualization of inflamed epiglottis

Tx: secure airway (intubation or tracheostomy); under double set-up, IV antibiotics (3rd gen cephalosporin or Ampicillin-Sulbactam)

A

ACUTE EPIGLOTTITIS

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9
Q

AGE GROUP: 3 months to 3 years

STRIDOR: 88%

PATHOGEN: parainfluenza virus

ONSET: prodrome (1-7 days)

FEVER SEVERITY: low grade

ASSOCIATED SX: barking cough, hoarseness

RESPONSE TO RACEMIC EPINEPHRINE: stridor improves

CXR: “steeple sign”

A

VIRAL CROUP

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10
Q

AGE GROUP: 3-7 years

STRIDOR: 8%

PATHOGEN: H. Influenzae type B

ONSET: rapid (4-12 hours)

FEVER SEVERITY: high grade

ASSOCIATED SX: muffled voice, drooling

RESPONSE TO RACEMIC EPINEPHRINE: none

CXR: “thumbprint/leaf sign”

A

EPIGLOTTITIS

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11
Q

Aspirated FBs may lodge in the larynx, trachea or bronchi
- larynx (1 yr)

Most commonly aspirated food: peanut

Most common cause of death in food aspiration: hotdogs and bread

SSX: sudden onset of respiratory distress, cough, hoarseness, cyanosis, localized wheezing, localized absence of breath sounds

CXR: lung remains overgerated on expiratory film (ball-valve mechanism)

Rigid bronchoscopy diagnostic and therapeutic

May be mistakenly diagnosed as asthma or pneumonia

A

FOREIGN BODY ASPIRATION

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12
Q

Acute inflammation of the small airways in children

A

BRONCHIOLITIS

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13
Q

Classification according to location:

  • pneumonitis - inflammation of the interstitium
  • lobar pneumonia - with consolidation of one or more lobes
  • bronchopneumonia - inflammation of the bronchioles with mucopurulent exudate

Most commonly viral in childhood

SSX: clinical triad - fever, cough & tachypnea

Etiologies in young infant:

  • 0-28 days: GBS, E. Coli, Listeria S. Pneumoniae
  • 3 weeks-3 months: RSV, Parainfluenza
  • Chlamydia, Mycoplasma, S. pneumoniae, S. Aureus

Etiologies in older infants and children:

  • 4 months-4 years: viruses, S. Pneumoniae, H. Influenzae type b, Mycoplasma
  • 5-15 years: Mycoplasma, S. Pneumoniae
A

PNEUMONIA

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14
Q

SSX: cough, wheezing, stridor

CXR, CBC: diffuse streaky infiltrates; lymphocytosis

Tx: supportive

A

Viral Pneumonia

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15
Q

SSX: cough, high fevers, dyspnea, dullness to percussion

CXR, CBC: lobar consolidation; neurophilia

Tx:

  • (0-2mo) AMPICILLIN + AMINOGLYCOSIDE
  • (2mos-5yrs) CEFTRIAXONE or CEFUROXIME or CEFUROXIME + AMPICILLIN or AMOCLAV
A

Bacterial Pneumonia

16
Q

SSX: less ill-looking, non-productive cough

CXR, CBC: interstitial pattern, usually lower lobes

Tx: (>5 yrs) ERYTHROMYCIN, CLARITHROMYCIN, or AZITHROMYCIN

A

Mycoplasma “walking pneumonia”

17
Q

SSX: 6 weeks to 6 months, “staccato”, cough, maternal he of infection

CXR, CBC: hyperinflation, “ground-glass” appearance, eosinophilia

Tx: erythromycin PO x 14 days

A

Chlamydia (pneumonia)

18
Q

Mycobacterium tuberculosis

Most specific confirmation is isolation of the organism

Sputum specimens for culture for those who can expectorate

Induce sputum with a jet nebulizer and chest percussion followed by nasopharyngeal suctioning: for culture and smear staining

Gastric aspirates: AFB culture

Young children: early AM gastric acid obtained before the child has arisen & peristalsis has emptied the stomach of the pooled secretions

3 consecutive AM gastric aspirates yield the organism in

A

Pulmonary tuberculosis

19
Q

Primary complex (Ghon complex)

A
  1. Primary pulmonary focus
  2. Regional lymph nodes
  3. Peritracheal lymph nodes
  4. Localized pleurisy between the middle & lower lobes
20
Q

Diagnostic criteria for PTB

A

Exposure to TB sputum (+) adults

(+) PPD test

Signs and symptoms (any 2 or more)

Chet x Ray findings

Isolation of the organism

21
Q

Sign and symptoms of PTB

A

(Any 2 or more)

Cough with or without wheezing for >2 weeks

Unexplained fever for >2 weeks

Failure to gain weight: weight loss

Unexplained poor appetite

Painless cervical lymphadenopathy

Failure to respond to 2 weeks appropriate antibiotic therapy for LRTI

22
Q

Classification of PTB

A

Class I
TB exposure: (+) exposure to and adult/adolescent with active disease, (-) PPD, no signs/symptoms, negative chest X Ray findings

Class II
TB exposure: +/- exposure, (+)PPD, no signs/symptoms, negative chest X ray findings

Class III
TB disease: 3 or more of the ff criteria
- exposure to an adult/adolescent with active TB disease
- signs/symptoms suggestive of TB
- abnormal chest x ray findings
- laboratory findings
Class IV
TB inactive: 
- with or without history of previous TB
- with or without previous chemotherapy
- has radiologic evidence of healed/calcified TB
- (+) PPD
- no signs and symptoms
- (-) smear or culture for TB
23
Q

PPD interpretation

A

Equal or >10mm is (+)

Equal or >5mm is (+) in the presence of any or all of the ff:

  • history of close contact with a known or suspected case of TB
  • clinical findings suggestive of TB
  • chest x ray findings suggestive of TB
  • immunocompromised condition
24
Q

Management of PTB

A
  • INH 10mg/kg/day PO (6months)
  • Rifampicin 15mg/kg/day PO (6 months)
  • PZA 25mg/kg/day PO (2 months)
  • Ethambutol 15-25mg/kg/day PO (>6years old)
  • Streptomycin IM 20-30mg/kg/day
25
Q

A reversible obstructive airway disease involving both small and large airways

  • increases residual lung volumes
  • decreases FEV1/FVC ratio

SSX: family history of asthma or atrophy, recurrent cough and wheezing with exposure to certain “triggers” (viral infection, weather changes, exercise, alleregens, emotions), responds to TX WITH BRONCHODILATORS

CXR: hyperinflation; helps to exclude structural abnormalities of the airway or chronic infection

Pulmonary function tests: increased residual lung volumes, decreased FEV1/FVC ratio
- not genuinely done esp. for <5 years old due to inability of these children to perform reproductive expiratory maneuvers

A

BRONCHIAL ASTHMA

26
Q

3 components of an asthma attack

A

Bronchospasm

Airway edema

Increased mucus production

27
Q

Exacerbation of asthma

A

Acute or subspacute deterioration in symptom control that is sufficient to cause distress or risk to health

Any of the ff:

  • increase in wheeze or shortness of breath
  • increase in coughing, esp. at night
  • lethargy or reduced exercise tolerance
  • impairment of daily activities
  • poor response to reliever medication
28
Q

Management of acute attacks

A

Short-acting inhaled beta2-agonist

Oral or IV steroids (Prednisone/Methylprednisolone)

Anticholinergics (Ipratropium bromide) - never used alone

Methyxanthines (theophylline, aminoohylline) - NOT first line

29
Q

Management in between attacks

A

Inhaled corticosteroids

Long-acting inhaled beta2-agonist

Leukotriene modifiers (Montelukast)

30
Q

Levels of asthma control

A

Characteristic: DAYTIME SYMPTOMS

Controlled (all of the following): NONE (less than 2x/week)

Partly controlled (any measure present in any week): more than 2x/week

Uncontrolled (3 or more of features of partly controlled asthma in any week): more than 2x/week (last minutes or hours or recur)

31
Q

Level of asthma control

A

Characteristic: LIMITATION OF ACTIVITIES

Controlled (all of the following): NONE (less than2x/week)

Partly controlled (any measure present in any week): ANY (may cough, wheeze during exercise, vigorous play, or laughing)

Uncontrolled (3 or more of features of partly controlled asthma in any week): ANY (may cough, wheeze during exercise, vigorous play, or laughing)

32
Q

Levels of asthma control

A

Characteristic: NOCTURNAL SYMPTOMS or AWAKENING

Controlled (all of the following): NONE (no nocturnal coughing during sleep)

Partly controlled (any measure present in any week): ANY (typically coughs during sleep or wakes with cough, wheezing, and/or dyspnea)

Uncontrolled (3 or more of features of partly controlled asthma in any week): ANY (typically coughs during sleep or wakes with cough, wheezing, and/or dyspnea)

33
Q

Levels of asthma control

A

Characteristic: NEED FOR RELIEVER/RESCUE TEATMENT

Controlled (all of the following): 2 days/week

Partly controlled (any measure present in any week): >2days/week

Uncontrolled (3 or more of features of partly controlled asthma in any week): >2 days/week

34
Q

Initial assessment of ACUTE ASTHMA

A

Symptoms

  • Altered consciousness
  • oximetry on presentation (SAO2)
  • talks in sentences/words
  • pulse rate
  • central cyanosis
  • wheeze intensity
35
Q

No altered consciousness

Equal or more than 94% pulse oximetry

Talks in sentences

Pulse rate <100 bpm

Absent central cyanosis

Variable wheeze intensity

A

Mild acute asthma

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