Pulmonology

Question 1

intermittent scratchy, bubbly noises

heard predominantly on inspiration

Answer 1

crackles (rales)

Question 2

What can cause crackles?

Answer 2

bronchiolititis

pulmonary edema

pneumonia

asthma

Question 3

continuous high pitched
musical sound

predominantly on expiration

Answer 3

wheezes

Question 4

What can causes wheezing?

Answer 4

asthma

bronchiolitits

foreign body

Question 5

continuous, low pitched

non musical sound (snoring)

Answer 5

rhonchi

Question 6

What can cause rhonchi?

Answer 6

pneumonia

cystic fibrosis

Question 7

high pitched, harsh

blowing sound

heard predominantly on inspiration

Answer 7

stridor

Question 8

What can cause stridor?

Answer 8

croup

laryngomalacia

subglottic stenosis

allergic rxn

vocal cord dysfunction

Question 9

s/s of viral croup?

Answer 9

Inspiratory stridor

Hoarseness

Cough: barking; “seal-like”

URI sxs

usually afebrile

Question 10

Etiology of viral croup?

Answer 10

1: Parainfluenza Virus Type 1

RSV and adenoviruses

Question 11

What dx tool can be used to eval severity of croup? What does it assess?

Answer 11

Westley croup score

LOC, cyanosis, stridor, air entry, retractions

Question 12

What might you see on xray in pt with viral croup?

Answer 12

steeple sign

Question 13

Management of croup?

Answer 13

mild: supportive
mod: corticosteroids (Dexamethasone IM/IV or Prednisone PO x 3 days), Nebulized racemic epi

Sever: airway supportive, steroids, nebulized epi, +/- admit

Question 14

organism that causes epiglottitis?

Answer 14

HIB

Question 15

S/S of epiglottitis?

Answer 15

3 D’s: dysphagia, drooling & distress

Tri-pod posturing (“sniffing dog position”)

fever, inspiratory retractions, muffled voice, dyspnea

Question 16

xray for pt with epiglottitis?

Answer 16

thumb sign on lateral neck film

Question 17

Management of epiglottitis?

Answer 17

airway support

blood cx & epiglottis cx > then, IV abx

3rd gen cephalosporin + Vancomycin

+/- corticosteroids

Question 18

What is bronchiolitis?

Answer 18

Lower respiratory tract infection that affects the small airways (bronchioles) in pt’s < 2

Question 19

organism that causes bronchiolitis?

Answer 19

usually viral: RSV MC

Question 20

high risk pts for bronchiolitis?

Answer 20

Gestational age <37 weeks
Age <12 weeks
Chronic pulmonary disease
Congenital heart disease
Immunodeficiency
Congenital and anatomic defects of the airways
Neurologic disease

Question 21

s/s of bronchiolitis?

Answer 21

URI sxs for 2-3 days

Lower respiratory tract sxs develop next peaking on day 3-5

Breathing pattern is shallow, rapid with nasal flaring

irritability, poor feeding, vomiting

wheezing & crackles on exam

coughing, tachypnea, labored breathing, hypoxia

Question 22

dx of bronchiolitis

Answer 22

clinical but may swab for RSV

Question 23

management of bronchiolitis

Answer 23

supplemental O2

hydration

nasal suctioning

Question 24

s/s of RSV

Answer 24

Diffuse wheezing & tachypnea following URI sx

low grade fever

crackles, prolonged expiration, wheezing, retractions

congestions, lots of mucus

Question 25

xray findings in pt with RSV?

Answer 25

hyperinflation, peribronchial thickening

Question 26

Tx of RSV?

Answer 26

supportive

Question 27

Tx of RSV in immunocompromised pt?

Answer 27

Ribavirin- antiviral (used for Hep C & RSV) Palivizumab (Synagis)- RSV immune globulin- prophylaxis

Question 28

What is Infant Respiratory Distress Syndrome (RDS) 
“Hyaline Membrane Disease”?

Answer 28

Deficiency of surfactant production + surfactant inactivation by protein leak into airspaces

Question 29

s/s of Infant Respiratory Distress Syndrome (RDS) 
“Hyaline Membrane Disease”?

Answer 29

Resp distress at birth hypoxemia on ABG Diminished air movement despite vigorous respiratory effort

Question 30

xray fingins in infant respiratory distress syndrome?

Answer 30

Ground-glass appearance”

Question 31

Tx for infant respiratory distress syndrome?

Answer 31

supplemental O2 nasal CPAP early intubation steroids surfactant replacement (Beractant-Survanta)

Question 32

presentation of pna?

Answer 32

Usually fever, cough, +/- preceding URI May be subtle- esp. in infants Poor feeding, irritability, restlessness

Question 33

What causes afebrile pna of infancy? What does this occur?

Answer 33

chlamydia & other maternal infx 2wks-3 mos

Question 34

PE findings for pna?

Answer 34

Tachypnea, tachycardia, fever (not always) Increased work of breathing (retractions, nasal flaring etc.) Grunting= imminent respiratory failure Lungs: crackles (rales), rhonchi, decreased air mvmt +/- ‘ill appearance’, dehydration, lethargy, irritable

Question 35

xray findings for pna?

Answer 35

air space disease or consolidation in a lobar distribution = bacterial pneumonia interstitial or peribronchial infiltrates = viral pneumonia (or infection)

Question 36

When should you admit for pna?

Answer 36

if < 3-6 mo old or hypoxemic

Question 37

Tx for pna?

Answer 37

empirically S. pneumo: Amoxicillin 90 mg/kg per day divided BID x 10 days if atypical suspected: use Macrolide

Question 38

How is pertussis transmitted?

Answer 38

respiratory droplets

Question 39

What are the 3 phases of pertussis?

Answer 39

Catarrhal: URI sxs, fever Paroxysmal: persistent whooping cough Convalescent: cough gradually resolves

Question 40

Gold standard for dx of pertussis? Other tests?

Answer 40

PCR & culture of nasal secretions +/- serology CBC: leukocytosis

Question 41

Tx of pertussis?

Answer 41

Abx: Macrolides, TMP-SMX Prophylaxis for the household regardless of immunization status!