Pulmonology

Question 1

Hx and symptomology of pulmonary dz

Answer 1

Dyspnea
Cough
Pain
Wheezing
Stridor
Snoring
Apnea
Cyanosis

Question 2

PE of pulmonary dz

Answer 2

RR
Presence of grunting
Nasal flaring
Tripod position
Cyanosis
Inspiratory stridor (extrathoracic etiology)
Expiratory wheeze (intrathoracic etiology)

Question 3

When will percussion be dull?

Answer 3

Restrictive lung dz and

With the presence of pleural effusion, pneumonia, or atelectasis

Question 4

When will percussion be hyper-resonant?

Answer 4

Also tympanic in obstructive dz such as asthma, emphysema or with the presence of pneumothorax

Question 5

RR in a premature neonate

Answer 5

40-70

Question 6

RR in 0-3 mos

Answer 6

35-55

Question 7

RR in 3-6 mos

Answer 7

30-45

Question 8

RR in 6-12 mos

Answer 8

25-40

Question 9

RR in 1-3 yrs

Answer 9

20-30

Question 10

RR in 3-6 yrs

Answer 10

20-25

Question 11

RR in 6-12 yrs

Answer 11

14-22

Question 12

RR in >12 yrs

Answer 12

12-18

Question 13

ABG

Answer 13

The single most useful rapid test of pulmonary function

Overall assessment of the functional state of the resp system and clues about the pathogenesis of the dz

Question 14

Nl pH in ABG

Answer 14

7.35-7.45

Question 15

Nl CO2 in ABG

Answer 15

35-45

Question 16

Nl pO2 in ABG

Answer 16

80-100

Question 17

Nl HCO3

Answer 17

22-26

Question 18

O2 Sat

Answer 18

95-100%

Question 19

Choanal atresia

Answer 19

Congenital problem that presents in the neonatal period
Occurs when there is obstruction of the nasal passage- resulting in respiratory distress, esp during feedings
Inability to pass a small catheter through the nostrils is suspicious for choanal atresia and warrants CT for confirmatory diagnosis
Tx- surgical revision and airway protection

Question 20

Laryngomalacia

Answer 20

Results from exaggerated collapse of the glottis structures during inspiration
MC cause of stridor in infants
Typically presents between 3-5 mos of age and resolves by 6-12 mos
Watchful waiting unless severe, in which case surgical repair may be warranted

Question 21

Laryngitis

Answer 21

Often occurs in children 5 yrs and older
Presents with a prodrome of URI/sore throat
MC symptom is hoarseness
Lab findings and exam are essentially nl
Tx is supportive- vocal rest

Question 22

Croup (laryngotracheobronchitis)

Answer 22

Common childhood dz typically presenting from 6 mos - 3 yrs
80% of cases are caused by parainfluenza virus
Seal-like, barking cough with inspiratory stridor
X-ray: Steeple sign
Tx: supportive with oxygen and racemic epi as well as steroids

Question 23

Bacterial tracheitis

Answer 23

Presents like croup, but does not improve with supportive tx, and is refractory to racemic epi
MC pathogens are S. pneumonia and S. aurea
X-ray will also show a steeple sign, though this is typically pathognomonic for croup
If possible, send a culture
Tx: Abx including 3rd gen cephalosporins, oxacillin, and/or clinda

Question 24

FB aspiration

Answer 24

Typically 6 mos-5 yrs
Small objects esp coins
Sudden onset
Stridor may be heard
Tx: endoscopic removal
Prevention: pay attention to choking hazards on toys

Question 25

Sx of FB aspiration

Answer 25

Resp distress Drooling Wheezing Perhaps stridor

Question 26

Retropharyngeal abscess

Answer 26

``` Often occurs <6 yoa MC pathogens: S. aureus and S. pyogenes Typically sudden onset with drooling, fever, and leukocytosis with bands Muffled voice is common Imaging: lateral X-ray Tx: I and D by ENT and abx ```

Question 27

Epiglottitis

Answer 27

``` Often from 2-6 yoa Rapid onset with high fever Tripod positioning with drooling Imaging: lateral neck (thumb print sign) Tx: emergent intubation and airway protection Prevention: hib vaccine ```

Question 28

Peritonsillar abscess

Answer 28

Typically in pts >10 yoa Associated with group A strep anaerobes These pts present with hot potato voice, rigors, drooling and are often times febrile Tx: I and D and abx

Question 29

Anaphylaxis

Answer 29

Typically secondary to allergic rxn Can occur at any age MC causative agents: peanuts, shellfish, meds (PCN, cephalosporins) Tx: supportive- epi, O2, airway protection, Benadryl, H2 blocker Prevention: avoidance of allergens

Question 30

Spasmodic croup

Answer 30

Occurs most commonly from 3 mos-3 yoa Has similar presentation to croup, however, this often results from allergy or reflux disorders Does not respond to racemic epi Tends to be recurrent in nature and resolve quickly If GERD is the cause, start the pt on a PPI

Question 31

Tracheomalacia

Answer 31

Major airway malformation- abnl collapse of the tracheal airway walls, most commonly the distal 1/3 of the trachea

Question 32

Type 1 tracheomalacia

Answer 32

Primary trachomalacia. Developmental defect in the tracheal cartilage, often improves and resolves with airway growth (typically 4-8 wks of age)

Question 33

Type 2 tracheomalacia

Answer 33

Secondary tracheomalacia due to extrinsic compression

Question 34

Type 3 tracheomalacia

Answer 34

Secondary tracheomalacia due to intra-airway irritation or inflammation

Question 35

Bronchiolitis

Answer 35

95% occur in children <12 yo Infectious/inflammatory process of the bronchioles Always viral illness: MC RSV Leading cause of hospitalizations of infants Presents with wheezing, cough, and in severe cases apnea

Question 36

Bronchitis

Answer 36

Most cases are secondary to viral illness including rhinovirus, coronavirus, or RSV Characterized by cough, dyspnea, fever and expiratory rhonchi or wheeze Tx: Supportive- hydration, expectorants, analgesics, breathing txs and cough suppressants CXR will be essentially nl; no evidence of PNA