Pulmonary

Question 1

what is asthma

Answer 1

chronic inflam disorder that produces airway hyperresponsiveness, airflow limitation and persistent respiratory sx, airflow limitation is caused by acute bronchoconstriction, airway edema, mucous plug formation and airway remodeling

Question 2

what is most common chronic dz in children

Answer 2

asthma

Question 3

how does asthma present

Answer 3

Working harder to breath, persistent coughing, difficulty sucking or eating

Question 4

what is diagnose for asthma

Answer 4

medical history, hx allergies, atopy is strongest predisposing factor, perinatal, Tobacco smoke, viral resp infections, ask about patterns, triggers, PFTs, allergy testing

Question 5

what is tx for asthma

Answer 5

education, trigger avoidance, medications

Question 6

what is status asthmaticus

Answer 6

Medical emergency that requires careful eval and aggressive therapy

Question 7

what is tx for status asthmaticus

Answer 7

Frequency admin of beta agonist inhalations combined with early corticosteroid use , OXYGEN THERAPY, hydration

Question 8

when do you send status asthmaticus to ICU

Answer 8

altered sensorium, use of continuous inhaled beta agonist therapy, exhaustion, markedly decreased air entry, rising PCO2 despite tx, presence of high risk factor for a severe attack, failure to improve despite adequate therapy

Question 9

who is cystic fibrosis more common in

Answer 9

more common white, n/ europeans, carrier rate: about 4-5 % white population

Question 10

what is cystic fibrosis

Answer 10

autosomal recessive , progressive, dysfunction of ion channel responsible for movement of water and salt through epithelial cells, thick viscous mucus builds up, compromised host defenses (water and salt ions don’t move well – results increase mucus)

Question 11

what organs does cystic fibrosis attack

Answer 11

Lungs, pancreas, liver, intestines and reproductive tract, causes obstructive lung dz and exocrine gland dysfunction

Question 12

how does cystic fibrosis present

Answer 12

cough, wheezing, dyspnea, exercise intolerance, hemoptysis, anorexia, weight loss, chronic bronchitis, recurrent pneumonia progressive obstructive airway

Question 13

how does cystic fibrosis show in toddlers and small children

Answer 13

bronchiectasis, pancreatic insufficiency, growth delays (failure to thrive) and infertility

Question 14

how does CF present in pulm

Answer 14

persistent cough, productive due to hyper secretion, recurrent infections, apical crackles

Question 15

how does CF present in liver

Answer 15

hepatic insuf, prolonged neonatal jaundice

Question 16

how does CF present in pancreas

Answer 16

pancreatic insufficiency, steatorrhea, malabsorption, pancreatitis, exocrine hypersecretion

Question 17

what are some other ways CF presents

Answer 17

meconium ileus in newborns, unintentional weight loss, nasal polyps, recurrent sinusitis, chronic diarrhea, abd pain, digital clubbing, male infertility

Question 18

how to dx CF

Answer 18

sweat chloride test, CXR, PFT, sputum cultures

Question 19

what can you see in CXR in CF

Answer 19

peribronicial cuffine, tram lines, fibrosis, recurrent infiltrates

Question 20

how to tx CF

Answer 20

whole team

Question 21

what are some maintenance for CF pts

Answer 21

pneumococcal and infleuza vaccine, chest and lung PT mang

Question 22

how does pneumonia present

Answer 22

Cough, fever, rigors, dyspnea, pleurisy, respiratory distress, rales, decreased breath sounds, dullness to percussion, abnormal tactile fremitus - extra-pulmonary sx: meningitis, OM, sinusitis, pericarditis, epiglottitis, abscess

Question 23

what are some common bacteria for pneumonia

Answer 23

s. Pneumonia, h. Influenza, legionella

Question 24

what are some common atypicals for pneumonia

Answer 24

mycoplasma pneumonia, chlamydia

Question 25

what are some common virals for pneumonia

Answer 25

influenza, hantavirus

Question 26

what are some nosocomial for pneumonia

Answer 26

pseudomonas aeruginosa, S. aureus

Question 27

what is workup for pneumonia

Answer 27

CXR, CBC

Question 28

what is shown on CXR for pneumonia

Answer 28

patchy infiltrates, atelectasis, hilar adenopathy

Question 29

what is tx for pneumonia

Answer 29

broad spectrum abx for severely ill pts while awaiting confirmation of pathogen (ceftazidime, clindamycin, vanco, macrolide, bactrim)

Question 30

what oral abx for less severe pneumonia m/c

Answer 30

amoxicillin, agumentin

Question 31

what is tx for viral pneumonia

Answer 31

supportive, Ribavirin or tamiflu if indicated

Question 32

what usually precedes a viral pneumonia

Answer 32

URI

Question 33

what is seen on CXR in viral pneumonia

Answer 33

perihelia streaking, interstitial markings, lobar findings less likely

Question 34

what is aspiration pneumonia

Answer 34

Acute onset of fever, cough, respiratory distress, hypoxemia

Question 35

which lobe is more often affected in aspiration pneumonia

Answer 35

right side

Question 36

what are types of aspiration

Answer 36

foreign body, URI, LRI

Question 37

what is complete obstruction of URI

Answer 37

inability to vocalize - cyanosis, respiratory distress

Question 38

what is incomplete obstruction of URI

Answer 38

drooling, stridor, ability to vocalize

Question 39

what age group is more common for foreign body

Answer 39

6mo - 4 years

Question 40

what type of imaging is used for foreign bodies

Answer 40

inspiratory and forced expiratory XRs -- ball valve effect - mediastinal shift away from object , chest fluoroscopy

Question 41

how to do you tx foreign body

Answer 41

bronchoscopy to remove object

Question 42

what can present in lower resp tract aspiration

Answer 42

acute cough or wheezing, asymmetric breath sounds or localized wheezing,

Question 43

what can develop from lower resp tract aspiration

Answer 43

abscess, bronchiectasis, recurrent pneumonia

Question 44

what is tx for aspiration

Answer 44

complete: immediate interventions partial: no distress -- cough, distress - tx

Question 45

what age do you do head down back blows

Answer 45

< 1 year

Question 46

how does bronchitis present

Answer 46

like pneumonia, cough, SOB, fever, discomfort in chest, rhonchi, wheezes, usu vital

Question 47

what does CXR show for bronchitis

Answer 47

normal

Question 48

what is eti of acute bronchitis

Answer 48

RSV - leading cause of hopsital admission in infants under 1 year

Question 49

how does acute bronchitis present

Answer 49

1-2 days of fever, rhinorrhea, cough, followed by wheezing, tachypnea, respiratory distress

Question 50

what labs are done for acute bronchitis

Answer 50

RSV wash, CXR

Question 51

what is tx for acute bronchitis

Answer 51

hospitalization in younger infants , FLUIDS

Question 52

what is eti for acute bronchiolitis

Answer 52

RSV, often wintertime

Question 53

how does acute bronchiolitis present

Answer 53

same as acute bronchitis

Question 54

what does CXR show for acute bronchiolitis

Answer 54

hyperinflation, peribronchial cuffing, increased interstitial markings, segmental atelectasis

Question 55

what is dx for acute bronchiolitis

Answer 55

nasal swab for RSV

Question 56

how do you tx acute bronohiolitis

Answer 56

prevention, hospitalization in infants, fluids, supportive, bronchodilators (?)

Question 57

what are complications of acute bronchiolitis

Answer 57

asthma, underlying chronic illness

Question 58

what is pertussis eti

Answer 58

bordetella pertussis

Question 59

what is catarrhal stage of pertussis

Answer 59

URI sx, duration 1-2 weeks, most infectious stage of illness

Question 60

what is paroxysmal stage of pertussis

Answer 60

repeated coughs followed by forceful inspiration creating “whoop”, fever comes and goes, non-toxic appearing between fever’ post tussive vomiting common, duration 1-6 weeks up to 10 weeks

Question 61

what is convalescent stage of pertussis

Answer 61

residual cough persistent for weeks to months, usally triggered by exposure to another URI or irritant

Question 62

what are some labs for pertussis

Answer 62

naso swab, PCR, culture, after 4-5 weeks coughing may be neg, CXR

Question 63

what may show on CXR in pertussis

Answer 63

shaggy heart border

Question 64

what is tx for pertussis

Answer 64

abx - catarrhal stage, erythromycin, zithromax, supportive