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Pulmonology > Clin Med: LRTI > Flashcards

Clin Med: LRTI Flashcards

1
Q

Epiglottitis is classically associated with

A

H. influenzae type b (Hib)

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2
Q

Epiglottitis bacteria colonize where

A

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

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3
Q

Epiglottitis: Inflamed structures mechanically obstruct ______

A

airway
increasing work of breathing and leads to resp failure

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4
Q

Epiglottitis most commonly seen in

A

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

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5
Q

Epiglottitis presentation in children (4D’s)

A

drooling
dysphagia
dysphonia
distressed resp efforts
high fever

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6
Q

Epiglottitis: relinquishing of tripod position may herald

A

resp. failure

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7
Q

Epiglottitis adult presentation

A

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

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8
Q

Epiglottitis will sometimes present with what lung sound

A

stridor

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9
Q

dx of Epiglottitis requires

A

laryngoscopy revealing beefy-red, stiff, edematous epiglottis

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10
Q

Epiglottitis: on lateral neck XR you will see

A

thumb sign

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11
Q

Abx of choice for Epiglottitis

A

ceftriaxone - use empirically, pending culture

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12
Q

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

A

augmentin

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13
Q

Epiglottitis: Supportive measures

A

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

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14
Q

Laryngotracheobronchitis is aka

A

coup

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15
Q

Coup is

A

the inflammation of the larynx, trachea and bronchi

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16
Q

Coup presentation

A

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

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17
Q

Coup is m/c caused by what virus

A

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

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18
Q

Red flags with coup

A

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

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19
Q

XR sign for coup

A

steeple sign - subglottic narrowing

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20
Q

Treatment for Coup

A

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?

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21
Q

Hib vaccine is important for what infection

A

epiglottitis

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22
Q

each epi dose observation is at min

A

3 hours

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23
Q

Bacterial tracheitis is aka

A

bacterial croup

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24
Q

Bacterial tracheitis is most common in what months

A

winter and fall months

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25
Q

Bacterial infection of trachea usually precedes

A

viral URI

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26
Q

bacterial tracheitis: Most common bacteria

A

staph aureus (including MRSA)

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27
Q

Coup is a very common cause of

A

cough, stridor and hoarseness

28
Q

Epiglottitis vs coup

A

coup has a cough and no inflammation of the epiglottis

29
Q

Coup is most commonly in (months)

A

october to early spring

30
Q

Presentation of bacterial tracheitis

A

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

31
Q

Dx/ workup for bacterial tracheitis

A

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

32
Q

Bacterial tracheitis treatment

A

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

33
Q

Prevention of bacterial tracheitis by

A

vaccines: measles and influ, pneumococcus esp in immunocompromised children

34
Q

Bronchiolitis most common cause

A

RSV

35
Q

most causes of Bronchiolitis (mild) treatment is

A

supportive care only indicated
self limiting

36
Q

Common complication of Bronchiolitis

A

recurrent wheezing - treat with ICS and leukotriene antagonists

37
Q

Bronchiolitis pathophysiology

A

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

38
Q

Bronchiolitis presentation

A

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

39
Q

Course of Bronchiolitis usually is

A

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

40
Q

Clinical dx of Bronchiolitis

A

RSV “wash”
XCR - hyperinflation, interstitial inflammation, atelectasis

41
Q

Bronchiolitis treatment mild- moderate

A

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

42
Q

Bronchiolitis treatment severe

A

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

43
Q

Pertussis causative agent

A

bordetella pertussis and bordetella parapertussis

44
Q

Pertussis pathophysiology

A

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

45
Q

Pertussis treatment abx

A

erythromycin - first line
azithromycin - alternative

46
Q

Acute bronchitis is an infection of

A

the large airways due to viruses usually self limiting

47
Q

Bronchitis usually follows any

A

viral upper resp infection (URI)

48
Q

Acute bronchitis risk factors

A

current or past smoker
hx asthma
living in polluted place
crowding

49
Q

Acute bronchitis is bacterial usually caused by

A

strep pneumoniae

50
Q

Acute bronchitis pathophysiology

A

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

51
Q

Acute bronchitis presentation

A

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

52
Q

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

A

Bronchiolitis

53
Q

PE of acute bronchitis

A

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

54
Q

Acute bronchitis treatment

A

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

55
Q

Influenza is a viral disease that affects

A

upper and lower resp tract

56
Q

Influenza gold standard for dx

A

PCR testing or viral cx of throat secretions

57
Q

Influenza types that cause human infection

A

A and B

58
Q

Influenza peaks during what months

A

winter (October to March)

59
Q

Influenza complications in high-risk groups

A

PNE and death

60
Q

most healthy pts recover fully from the flu within

A

7-10 days

61
Q

Flu vaccine is recommended to

A

all individuals aged 6 months and older

62
Q

influ virus replicates in

A

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

63
Q

Influ presentation

A

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

64
Q

Flu treatment

A

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

65
Q

Flu mortality is higher in

A

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

Pulmonology (18 decks)

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