Pulmonology Flashcards
(52 cards)
a pt is a 9 month old infant presents with a three day history of a mild respiratory tract infection with serious nasal discharge, fever of 101.4 and decreased appetite. PE reveals a tachypneic infant wtih audible wheezing and a respiratory rate of 65. Flaring of the alae nasi, use of excessory muscles and subcostal and intercostal retractions are noted. Expiratory wheezes are present.
what is the most likely diagnosis?
Acute bronchiolitis
how is acute bronchiolitis diagnosed?
Nasal washing for RSV culture and antigen assay
CXR = normal
what is the treatment of bronchiolitis
supportive: bronchodilators sometimes relieve symptoms
23yo female with a one week history of cough productive of whitish sputum. this was preceded one week prior by URI. she denies chills, night sweats, SOB or wheezing. temp is 99.9. what is the most likely diagnosis?
Acute bronchitis
how is acute bronchitis diagnosed?
CXR if dx is uncertain or symptoms persists despitre conservative treatment
3yo boy who is brought to the ER with sudden onset fever (104), respiratory distress and stridor. on exam the boy appears acutely ill. he is sitting, learning forward with his mouth open. He has a muffled voice and is drooling. When asked, paretns report “we dont believe in vaccinations”.
What is the most likely diagnosis?
Acute epiglotitis
what is the most common etiology causing actue epiglotitis
Haemophilus influenzae type B (Hib)
what are the 3Ds of epiglottitis
Dysphagia
Drooling
respiratory Distress
how is epiglotitis diagnosed
lateral neck x-ray: thumbprint sign
CT scan: narrow airway from tissue swelling
what is the definitive diagnostic test for epiglotitis
laryngoscopy : edematous or “cheery red” epiglottitis
what is the treatment for epiglotitis
intubating if necessary
ceftriaxone
pt brought to the ED with acute onset of dyspnea and tachypena. he has a long hx of alcoholism and was involved in a motor vehicle accident two days ago. he is hypoxic wtih crackles auscultated bilaterally and frothy pink sputum. chest XR reveals diffuse bilateral infiltrates, which spare the costophrenic angle and air bronchospasm. No cardiomegaly or pleural effusion noted. O2 sat of 70%.
What is the most likely diagnosis
acute respiratory distress syndrome
how is ARDS characterized
fluid collecting in lungs, depriving organs of oxygen
what are the dignostic tests for ARDS
CXR shows air bronchograms and bilaterally fluffy infiltrate
normal BNP, pulmonary wedge pressure, LV function and echo
how is asthma diagnosed?
Peak flow spirometry
(FEV1 to FVC ratio <80%)
a 2yo boy brought in by his father, who is concerned for a “barking cough”, mild fever, and a hoarse voice. he reports that he had a runny nose last week that since resolved. PE reveals inspiratory stridor.
What is the most liekly diagnosis?
Croup
What is see on XR with a patient with croup
AP CXR shows steeple sign
what is the treatment of severe croup
IV fluids
nebulized racemic epinepherine and steroids
how is FB aspiration treated
rigid bronchoscopy is preferred in children
flexibile bronchosocopy is diagnostic and therapeutic in adults
what are the most common causes of hemoptysis
bronchitis
tumor mass
TB
what are diagnostic tests for hemoptysis
cytology - when worried about lung cancer
fiberoptic bronchosocpy = preferred for CA
rigid bronchoscopy for cases of massive bleeding
high-resolution CT
what are carcinoid tumors
GI tract cancer metastasized to the lung (CA of appendix = M/c; appendix -> liver -> lung)
what type of cancer is the most common carcinoid tumor
adenoma
4yo boy with a severe cough followin gon week of cold symptoms, inclduing sneezing, conjunctivitis, and nocturnal cough. He presents with paroxysms of cough followed by a deep inspiration and occasional post-tussive emesis.
what is the most likely diagnosis?
pertussis
