Pulmonology Flashcards
(135 cards)
0
Q
Narrowest portion of airway in pediatrics
A
Cricoid cartilage
1
Q
Narrowest portion of airways in adults
A
Vocal cords
2
Q
Clinical significance of airway diameter
A
Adult has widder diameter than pediatrics. Patient with narrow airway will develop resistance thus leading to HYPOXEMIA
3
Q
1st line of defense in the respiratory tract:
A
Vibrissae
Ciliated lining epithelium
Physiologic mechanism
Immunologic mechanis
4
Q
Boundary between the upper and lower airways
A
Glottis or Larynx
5
Q
What are the three paired cartilages of the larynx?
A
Artyenoid
Cuneiform
Corniculate
6
Q
What are the unpaired cartilages of the Larynx?
A
Epiglottis
Thyroid
Cricoid
7
Q
Anything found inside the thoracic cavity is part of the ____
A
Lower respiratory tract
8
Q
Anything found outside the thoracic cavity is part of the ____
A
Upper respiratory tract
9
Q
Cough receptor is found mostly at the ___
A
Airways
10
Q
Cough receptor may even be present at the ___
A
Middle ear
Base of the lungs
11
Q
Good treatment to be given
A
Oxygen Fluid Drugs with one pharmacological action Fever relief Chest physiotherapy
12
Q
Oil based is not good for internal applications because it can cause ____
A
Lipoid bronchitis
13
Q
This is known as deep tissue neck infection which is located ____ to the esophageal wall
A
Retropharyngeal abscess
Posterior
14
Q
The nodes that drain from the retropharyngeal abscess
A
Nasopharynx
Paranasal sinus
Middle ear
15
Q
Retropharyngeal abscess is seen in which age group?
A
3-4 years old
16
Q
Causative agents of Retropharyngeal abscess
A
Group A strep
Anaerobes
S. Aureus
17
Q
Differentials of Retropharyngeal abscess
A
Foreign body aspirate
Epiglottitis
Meningitis
18
Q
Clinical manifestation of Retropharyngeal Abscess
A
High grade fever Irritability Decrease food intake or dysphagia Drooling Sorethroat Neck pain Muffled voice Stridor Distress Cyanosis
19
Q
Physical finding examination of Retropharyngeal abscess
A
Foward buldge in the pharyngeal wall
20
Q
Complication of retropharyngeal abscess
A
Upper airway obstruction
Aspiration pneumonia
Extension to the mediastinum
21
Q
Treatment for retropharyngeal abscess
A
3rd gen cephalosporin + ampicillin-sulbactam or clindaymycin
22
Q
Foreign body aspiration is commonly seen in what age group
A
Older infants and toddlers less than 5 years old
23
Q
More severe inflammatory reactions if _____ because it can cause ____
A
Organic material
Pneumonitis
24
When will a FBA be a medical emergency
If it causes airway obstruction
25
This property can determine the clinical manifestation of an FBA
Size
26
FBA clinical manifestation
Choking
| Coughing + wheezing
27
Location of the majority of the FBA
Right bronchus
28
FBA 3 stages of signs
Paroxysmal stage of coughing, choking, and gagging and airway ostruction
Asymptomatic interval
Complications of obstruction, erosion, infection
29
FBA management
Bronchoscopy
Antibiotics
Steroid
Surgery
30
4 croup syndromes manifestations
Bark like or brassy cough
Hoarseness
Stridor
Respiratory distress
31
4 croups syndromes
Epiglottitis
Acute laryngeotracheobronchitis
Acute laryngitis
Bacterial tracheitis
32
The most common cause of epiglottitis
H. Influenzae type B
33
Other causes of epiglottitis
S. Pyogenes
S. Pneumoniae
S. Aureus
34
The age group in epiglottitis which dont preclude adulthood
2-4 years old
35
Hyperextension of the neck is seen in ___
Epiglottitis
36
Obstruction in the epiglottis will manifest ___
Dysphonia
Dysphagia
Dyspnea
Drooling
37
In epiglottitis the attempt to breathe will cause them to assume the ___
Tripod position
38
Lateral xray of the neck of the epiglottitis will manifest what sign?
Thumb sign
39
The DOC for epiglottitis
Ampicillin
40
If patient is resistant to Ampicillin for epiglottitis what will you give?
Ceftriaxone
41
For household who are exposed to epiglottitis you give?
Rifampicin for 1 day
42
A serious case of Croup
Acute lanryngotracheobronchitis
43
The common cause of croup
Parainfluenza virus
44
Other causes of croup
Influenza
Adenovirus
RSV
Measle
45
The age group usually affected by croup
3 months to 5 years peak at 2 years
46
Neck xray in patients with Croup
Steeple sign or Pencil sign
47
Drugs that is used in managing Croup
Racemic epinephrine
Dexamethasone
Budesonide
48
What of the etiology of Acute Laryngitis
Parainfluenza virus
49
Age onset of Acute Laryngitis
2-4 years old
50
Mode of transmission of Acute Laryngitis
Droplet nuclei
51
A child with frequent throat infection is predisposed to ____
RHD
52
Management of Acute Laryngitis
No DOC
| supportive teatment with Lozenges and Ginger
53
This Croup syndrome doesnt involve the epiglottis
Bacterial tracheitis
54
The most common etiology of bacterial tracheitis
S. aureus
55
Minor causes of bacterial tracheitis
M. catarrhalis
H. influenza
Anaerobe
56
Age group onset of bacterial tracheitis
5-7 years old
57
How to differentiate bacterial tracheitis with others?
Can lie flat
No drooling
No dysphagia
58
Is xray suggestive of bacterial tracheitis
NO
59
The treatment for bacterial tracheitis
Vancomycin
| Beta lactamase resistance antibiotics (meth, naf, -cillin)
60
Parenchymal disease
CAP
61
What is the course of CAP
Acute onset, few hours to 1-2 days
62
Etiology of CAP in the following:
Developing countries:
Developed countries:
Philippines:
Bacterial
Viral
Mixed
63
Etiology of CAP in these age group: NEWBORN
A - group A strep (local)
B - group B strep (worldwide)
Treatment: Ampicillin
E - E. coli
Treatment: Gentamycin
64
Etiology of CAP in these age group: 2-11 months
C. trachomatis with history of conjunctivitis
Treatment: Macrolides
CMV
P. carinii (with HIV)
65
Patient presents with cough, crackles, playful and suck well but NO FEVER
Afebrile pneumonia syndrome
66
Etiology of CAP in these age group: PRESCHOOL
```
RSV
Parainfluenza
Influenza A and B
Rhinovirus
Adenovirus
S. pneumonia (>2y/o)
H. influenza (up to 2 years old)
S. aureus
```
67
Etiology of CAP in these age group: SCHOOL AGED GROUP
Mycoplasma pneumoniae
Parainfluenza
Influenza
S. pneumonia
68
4 stages of pneumonia
Consolidation
Red hepatization
Gray hepatization
Resolution
69
Name the usual agents involved in LOBAR PNEUMONIA
H. influenza
| S. pneumonia
70
Name the usual agents involved in BRONCHO-PNEUMONIA
H. influenza
S. pneumonia
S. aureus
71
Name the usual agents involved in INTERSTITIAL PNEUMONIA
Mycoplasma
Chlamydia
Viral
72
Bacterial pneumonia usually produce what kind of fever?
High grade fever
73
Cough IS ALWAYS present in pneumonia except in ?
Neonates
74
The most important clinical predictor of pneumonia ?
Tachypnea
75
```
Fill in the Resipratory rate of the following:
>5 y/o
1mo - 12mo
13mo - 5y/o
Neonate
```
>30
>50
>40
>60
76
Bacterial pneumonia associated with skin infection, etiology:
S. aureus
S. pneumonia
H. influenza
77
Bacterial pneumonia associated with eye infection + rash, etiology:
Measles
78
Two manifestations that is more common in viral pneumonia than bacterial pneumonia:
Wheezing
| Grunting
79
Two common etiology of Atypical pneumonia
Mycoplasma
| Chlamydia
80
Delayed resolution of sx
Atypical pneumonia
81
DOC for atypical pneumonia and in case of refractory to ampicillin you will used?
Macrolide
| 2nd gen of Cephalosporin
82
In chest xray atypical pneumonia will usually present as ___
Interstitial pneumonia
83
Gold standard in the diagnosis of bacterial pneumonia
Culture of lung aspirate
84
Gold standard in the detection of viral pneumonia
Tissue culture
| Viral antigen
85
Tracheal aspirate must only be done within __ of intubation
1 hour
86
Is sputum culture and gram stain suggested in children?
NO. Unable to expectorate
87
Is blood culture suggestive in determining pneumonia?
Low yield but MUST DO IN CONCOMITTANT SEPSIS
88
CAP complications:
Pleural effusion
Pneumothorax
Atelectasis
89
Normal pleural fluid per hemithorax
1-2ml
90
Fill in the following:
Pneumothorax Pleural effusion Consolidation
Percussion:
Tactile fremitus:
Hyperressonant Dull Dull
None Decreased Increased
91
Differentiate between PF CHON and LDH between Transudate and Exudate:
CHON LDH
| Transudate: 3g/dl >200IU
92
Transudate are secondary to ___ and examples are:
Inflammation
CHF
Tb
Kidney disease
93
Exudate are secondary to ___ and examples are:
Infection
| Pneumonia
94
Serum analysis of CHON and LDH for pleural effusion
CHON LDH
| Transudate: 0.5 >0.6
95
Etiology of a SEROUS pleural effusion and their treatment:
Infant: H. influenza -> ampicillin
Preschool: Strep -> penicillin
96
Etiology of a PURULENT pleural effusion and their treatment:
Staph -> oxacillin
97
Indication of Tb pleural effusion:
Protein >5g/dl
98
Hemothorax indication:
Hematocrit is >50%
99
The most common cause of PF in neonates
Chylothorax
100
Indication of Chylothorax
TAG >110 mg/dl
101
The most common cause of pneumothorax in adults?
Stab or trauma
102
Major components of air in pneumothorax
Nitrogen
103
The most common cause of pneumothorax in children?
Infection due to alveolar rupture
104
Patient experince an abrupt onset of dyspnea and CHEST PAIN, what is your diagnosis?
Pneumothorax
105
What is the PATHOGNOMONIC sign of a PNEUMOTHORAX?
Absent of lung markings
106
Pneumothorax management for the following:
Mild
Massive
Emergency
Mild: 100% oxygen principle fo denitrogenation
Massive: chest tube thoracostomy
Emergency: direct needle aspiration
107
Imperfect expansion or collapse of a segment or lobe of a lung
Atelectasis
108
Three etiology of atelectasis:
External pressure
Intrabronchial obstruction
Reduced amplitude of expansion
109
The most common cause of Atelectasis
Intrabronchial obstruction
110
The cause of external pressure:
External compression within the thoracic cavity
111
The usual cause if intrabronchial obstruction in atelectasis
Mucus plug
112
Nitrogen is absorbed within __
2-3 hours
113
Oxygen is absorbed within ___
6-10 mins
114
All distal to the occluded airway will be ___
Collapsed
115
Usually in atelectasis if only one segment is involved it is ___
Asymptomatic
116
The most commonly collapsed segment in atelectasis
RLL and LLL
117
The most common segment collapsed in atelectasis due to PTB?
RML
118
The kind of angle of the horizontal fissure in consolidation? atelectasis?
Obtuse or same
| Acute
119
Typical findings of Atelectasis in CXR?
```
Opacity:
Wedge shape
Triangle shape
Fan shape
Pyramid shape
```
120
Only atelectasis will cause the mediastinal shift to the?
Same side
121
Management of atelectasis
Antibiotics and Bronchodilators in pneumonia
Bronchoscopy in Foreign body
Corticosteroid in asthma
Tb drugs in PTB
122
Gold period for observation of Atelectasis
8 weeks
123
Etiology of bronchitis
Parainfluenza virus
| Adenovirus
124
Only seen in bronchitis as clinical manifestation
Vomitting
125
Auscultation in bronchitis is usually but can also manifest
Normal
| Wheezing, crackles, rhonchi
126
Resolvement of bronchitis is usually in ___
2-3 weeks
127
In some cases of bronchitis there is ___ in bronchial markings
Increased
128
Etilogy of Bronchiolitis
RSV
Parainfluenza
Adenovirus
No bacterial cause
129
Usually bronchiolitis is seen in __
Infancy 1-2 yo, peaks at 6-12months
130
Triad of bronchiolitis
Tachypnea
Chest retraction
Wheezing
131
The most important differential diagnosis of bronchiolitis is ___
Asthma
132
The CXR findings of bronchiolitis
Flattening, imperfect dome diaphragm
Widening intercostal spaces
Hyperlucency
133
Drugs to be given in bronchiolitis
Ribavirin
Corticosteroids
Bronchiodilators
134
Is antibiotic recommended in bronchiolitis?
NO, negative bacterial etiology
