Clin Med: LRTI

Question 1

Epiglottitis is classically associated with

Answer 1

H. influenzae type b (Hib)

Question 2

Epiglottitis bacteria colonize where

Answer 2

nasopharynx and spread locally causing supraglottic cellulitis (inflammation of epiglottis and surrounding structures including larynx)

Question 3

Epiglottitis: Inflamed structures mechanically obstruct ______

Answer 3

airway
increasing work of breathing and leads to resp failure

Question 4

Epiglottitis most commonly seen in

Answer 4

children but not as much since vaccine of Hib
now m/c in males in their 40s

Question 5

Epiglottitis presentation in children (4D’s)

Answer 5

drooling
dysphagia
dysphonia
distressed resp efforts
high fever

Question 6

Epiglottitis: relinquishing of tripod position may herald

Answer 6

resp. failure

Question 7

Epiglottitis adult presentation

Answer 7

ST
fever
dysphagia
drooling
no visible oropharyngeal inflammation
severe ST pain with a normal appearing pharynx should raise suspicion of epiglottitis

Question 8

Epiglottitis will sometimes present with what lung sound

Answer 8

stridor

Question 9

dx of Epiglottitis requires

Answer 9

laryngoscopy revealing beefy-red, stiff, edematous epiglottis

Question 10

Epiglottitis: on lateral neck XR you will see

Answer 10

thumb sign

Question 11

Abx of choice for Epiglottitis

Answer 11

ceftriaxone - use empirically, pending culture

Question 12

Epiglottitis: Upon extubation, d/c home with PO abx usually –>

Answer 12

augmentin

Question 13

Epiglottitis: Supportive measures

Answer 13

cool mist humidification with O2
IV fluids - no PO fluids
corticosteroids??
reduce anxiety

Question 14

Laryngotracheobronchitis is aka

Answer 14

coup

Question 15

Coup is

Answer 15

the inflammation of the larynx, trachea and bronchi

Question 16

Coup presentation

Answer 16

classic barky or seal like cough, hoarse voice, high-pitched inspiratory stridor

Question 17

Coup is m/c caused by what virus

Answer 17

parainfluenza virus (other: RSV, rhinovirus, enterovirus, influ, adenovirus)

Question 18

Red flags with coup

Answer 18

drooling
dysphagia
toxic appearance
stridor without cough or without fever
incomplete immunizations

Question 19

XR sign for coup

Answer 19

steeple sign - subglottic narrowing

Question 20

Treatment for Coup

Answer 20

mild - one dose steroids then d/c home with return precautions
moderate - steroids, neb epi with obs. min 3 hours, reassess
severe - steroids, neb epi with obs. min 3 hours, reassess, admission?

Question 21

Hib vaccine is important for what infection

Answer 21

epiglottitis

Question 22

each epi dose observation is at min

Answer 22

3 hours

Question 23

Bacterial tracheitis is aka

Answer 23

bacterial croup

Question 24

Bacterial tracheitis is most common in what months

Answer 24

winter and fall months

Question 25

Bacterial infection of trachea usually precedes

Answer 25

viral URI

Question 26

bacterial tracheitis: Most common bacteria

Answer 26

staph aureus (including MRSA)

Question 27

Coup is a very common cause of

Answer 27

cough, stridor and hoarseness

Question 28

Epiglottitis vs coup

Answer 28

coup has a cough and no inflammation of the epiglottis

Question 29

Coup is most commonly in (months)

Answer 29

october to early spring

Question 30

Presentation of bacterial tracheitis

Answer 30

severe inspiratory and expiratory stridor productive cough fever hoarse voice but no dysphagia no tripoding or drooling

Question 31

Dx/ workup for bacterial tracheitis

Answer 31

clinical dx XR lateral neck if stable - will see "candle dripping" hazy around trachea direct laryngoscopy - definitive dx bronchoscopy - cultures of secretions based on severity

Question 32

Bacterial tracheitis treatment

Answer 32

admit to ICU aggressive airway management - ET intubation in ~75% of pts antibiotics initiated ASAP - ceftriaxone plus nafcillin humidified O2

Question 33

Prevention of bacterial tracheitis by

Answer 33

vaccines: measles and influ, pneumococcus esp in immunocompromised children

Question 34

Bronchiolitis most common cause

Answer 34

RSV

Question 35

most causes of Bronchiolitis (mild) treatment is

Answer 35

supportive care only indicated self limiting

Question 36

Common complication of Bronchiolitis

Answer 36

recurrent wheezing - treat with ICS and leukotriene antagonists

Question 37

Bronchiolitis pathophysiology

Answer 37

virus infects airway epithelial cells, induces inflammatory reaction leading to ciliary dysfunction and cell death

Question 38

Bronchiolitis presentation

Answer 38

initial sx: URI - cough, fever, rhinorrhea mild dx ~ only tachypnea severe dx - retractions, grunting, cyanosis

Question 39

Course of Bronchiolitis usually is

Answer 39

7-10 days most infants improve within 14-21 days

Question 40

Clinical dx of Bronchiolitis

Answer 40

RSV "wash" XCR - hyperinflation, interstitial inflammation, atelectasis

Question 41

Bronchiolitis treatment mild- moderate

Answer 41

mild = symptomatic care mild-moderate = with nasal saline, antipyretics, cool mist humidifier, consider nasal cannula

Question 42

Bronchiolitis treatment severe

Answer 42

admitted and monitored humidified O2 and neb hypertonic saline O2 prep for mech vent due to resp failure

Question 43

Pertussis causative agent

Answer 43

bordetella pertussis and bordetella parapertussis

Question 44

Pertussis pathophysiology

Answer 44

organism adheres to ciliated resp epithelial cells --> local inflammation --> release of toxins

Question 45

Pertussis treatment abx

Answer 45

erythromycin - first line azithromycin - alternative

Question 46

Acute bronchitis is an infection of

Answer 46

the large airways due to viruses usually self limiting

Question 47

Bronchitis usually follows any

Answer 47

viral upper resp infection (URI)

Question 48

Acute bronchitis risk factors

Answer 48

current or past smoker hx asthma living in polluted place crowding

Question 49

Acute bronchitis is bacterial usually caused by

Answer 49

strep pneumoniae

Question 50

Acute bronchitis pathophysiology

Answer 50

inflammation of bronchial wall leading to mucosal thickening - secondary to various triggers - usually viral

Question 51

Acute bronchitis presentation

Answer 51

productive cough, malaise, difficulty breathing, wheezing Prodrome of URI high grade fevers unusual

Question 52

What is the leading cause of hosp admission in infants under 1 year of age

Answer 52

Bronchiolitis

Question 53

PE of acute bronchitis

Answer 53

lungs: +/- wheezing, +/- diffuse rhonchi no other findings suggestive of PNE

Question 54

Acute bronchitis treatment

Answer 54

usually self limited symptomatic support - cough support abx therapy not indicated lifestyle modification - smoking cessation, allergen/irritant avoidance

Question 55

Influenza is a viral disease that affects

Answer 55

upper and lower resp tract

Question 56

Influenza gold standard for dx

Answer 56

PCR testing or viral cx of throat secretions

Question 57

Influenza types that cause human infection

Answer 57

A and B

Question 58

Influenza peaks during what months

Answer 58

winter (October to March)

Question 59

Influenza complications in high-risk groups

Answer 59

PNE and death

Question 60

most healthy pts recover fully from the flu within

Answer 60

7-10 days

Question 61

Flu vaccine is recommended to

Answer 61

all individuals aged 6 months and older

Question 62

influ virus replicates in

Answer 62

epithelial cell lining of upper and lower resp tracts causes inflammation of the upper resp tree and trachea

Question 63

Influ presentation

Answer 63

high fever, coryza, body aches "like I got hit by a bus"

Question 64

Flu treatment

Answer 64

self limiting supportive care, fluids antiviral meds - not needed in healthy individuals, mild infection

Question 65

Flu mortality is higher in

Answer 65

children and seniors, esp with pre-existing lung diseases, DM