pulmonology

Question 1

epiglottitis- epi and etiology

Answer 1

2-7yr
HIB
GABHS, Strep pneumonia and Staph

Question 2

clinical epiglottitis

Answer 2

abrupt onset- high fever, toxic, muffled speech, dysphagia with drool, sitting forward in tripod

Question 3

diagnosis epiglotitis

Answer 3

cherry red swollen epiglottis

Question 4

epiglottitis on xray

Answer 4

thumbprint on lateral

Question 5

antibiotic for epiglottitis

Answer 5

2nd or 3rd gen. cephalosporin IV

Question 6

if HIB infection and ppx

Answer 6

rifampin

Question 7

laryngotrachealbronchitis (croup)

Answer 7

inflamm. and edema of the subglottic larynx, trachea, and bronchi
viral croup –> stridor - 3 months to 3 yrs - M2:1F
spasmodic - preschool age

Question 8

viral croup can be caused by:

Answer 8

parainfluenza
RSV
rhino
adeno
influenza A and B

Question 9

clinical pres. of viral croup

Answer 9

URI 2-3 days followed by stridor and cough
barky cough, stridor, fever –> 3-7 days
stridor worse at night with agitation

Question 10

xray of viral croup

Answer 10

steeple sign

Question 11

management of croup

Answer 11

supportive
cool mist
systemic corticosteroid -
racemic epinephrine if resp. distress

Question 12

bacterial tracheitis

Answer 12

acute inflammation of the trachea - causes stridor

Question 13

causes of bacterial tracheitis -

Answer 13

staph, strep, nontypeable H. flu

Question 14

bronchiolitis

Answer 14

inflammation of the bronchioles - viral infection that causes inflammatory bronchiolar obstrucion
most common in

Question 15

bronchiolitis etiology

Answer 15

RSV

less common: para, adeno, rhino, influenza

Question 16

clinical of bronchiolitis

Answer 16

onset is gradual
tachypnea, fine rales, wheezing 
spleen and liver might enlarge
hypoxia
apnea
CXR hyperinflation - patchy infiltrates and atelectasis

Question 17

typical causes of pneumonia in 0-3 month

Answer 17

syphilis, toxo, CMV, rubella, herpes, tb
GBS
gram - rods 
listeria 
rsv
 (afebrile) chlamydi, CMV, PCP

Question 18

typical pneumonia in 3 months - 5 yrs causes

Answer 18

adenovirus, influenza A and B, para , RSV,

bacterial: strep pneumoniae, staph and HIB

Question 19

age >6 pneumonia cuase

Answer 19

mycoplasma pneumoniae and chlamydia pneumoniae
viruses - adenovirus, influenza A and B, parainflue
bacterial - strep. pneumoniae

Question 20

viral pneumonia presentation

Answer 20

URI - nasal congestion and rhinorrhea - then fever, cough, dyspnea

Question 21

bacterial pneumonia presentation

Answer 21

rapid onset and greater severity - fever, cough, dyspnea, without preceding URI

Question 22

viral pneumonia xray

Answer 22

interstitial infiltrates

Question 23

bacterial pneumonia xray

Answer 23

lobar consolidation

Question 24

chlamydia trachomatis - pnemonia

presentation, diagnosis

Answer 24

most common is afebrile - 1-3 months of age
stoccato-type cough
history of conjunctivitis after birth - >50%
eosinophilia and cxr with interstitial infiltrates - definitive diagnosis by culture

Question 25

how to manage chlamydia trachomatis pneumonia

Answer 25

erythromycin or azithromycin

Question 26

mycoplasma pneumoniae

Answer 26

most common in older children low-grade fever, chills, nonproductive cough, HA, pharyngitis, malaise cough 3-4 wks widespread rales

Question 27

diagnosis of mycoplasma pneumonia

Answer 27

positive cold agglutinins - cxr - bilateral diffuse infiltrates IgM titer for mycoplasma

Question 28

manage of mycoplasma pnemonia

Answer 28

erythromycin

Question 29

who is at risk for pertussis?

Question 30

stages of pertussis

Answer 30

``` incubation 7-10 days catarrhal stage (1-2 wks) URI + low grade fever paroxysmal stage (2-4wks) forceful coughing and whoop - inspiatory gasp heard at the very end of a coughing fit -- might vomit post cough attack - otherwise well and afebrile convalescent phase - (weeks to months) - paroxysmal cough continues but become less frequent and less severe over time ```

Question 31

diagnosis of pertussis

Answer 31

lymphocytosis

Question 32

when to give antibiotics to alter course in pertussis?

Answer 32

during the catarrhal stage or earlier

Question 33

isolation and pertussis

Answer 33

need to be on isolation until 5 days of abx

Question 34

IgE release?

Answer 34

eosinophils, histamine, mast cells, basophils

Question 35

asthma pathophys

Answer 35

smooth muscle bronchoconstriction, airway mucosal edema, increased secretions with mucous plugging, eventual airway wall remodeling and production of inflammatory mediators IgE

Question 36

cxr of asthma

Answer 36

hyperinflation peribronchial thickening patchy atelectasis

Question 37

CF etiology

Answer 37

AR - ch. 7

Question 38

pathophys for CF

Answer 38

abnormal ion-channel regulator protein - causes sodium and choride transport dysfunction in epithelial cells abnormal mucus produced in airways helps create airwy obstruction inflammation and infection

Question 39

clinical present of CF

Answer 39

``` chronic progressive pulmonary insuff. pancreatic insuff. high sweat electrolyte meconium ileus at birth(20%) FTT - recurrent chronic resp. symptoms respiratory signs PFTs decreased respiratory flow rates and decrease lung volumes pneumonia- staph and then pseudomonas nasal polyps and precurrent pneumonia ```

Question 40

diagnosis of CF

Answer 40

one or more phenotypic feature OR positive fam. history OR increased immunoreactive trypsinogen on newborn screen - sweat chloride test 2 CF mtn characteristic ion transport abnormality across the nasal epithelium

Question 41

management of CF

Answer 41

``` antibiotics pul. toilet bronchodilator pancreatic enzyme replacement - fat soluable vitamine (A, D, E, K) anti-inflammatory and immunosuppressive lung transplant psychological help ```

Question 42

CF and mutation

Answer 42

CFTR gene ch. 7

Question 43

ddx of ALTE

Answer 43

``` seizure GERD upper airway obstruction intracranial mass lesion sepsis metabolic abnormalities including electrolyte imbalance and hypoglycemia inborn errors of metabolism arrhythimia abnormal central control munchausen by proxy nonaccidental trauma ```