PULMONOLOGY Flashcards
(314 cards)
1
Q
CHARGE Syndrome
A
Coloboma Heart defect Atresia, choanae Retarded growth, CNS anomalies Genital anomalies, hypogonadism Ear anomalies
2
Q
Most common congenital anomaly of the nose
A
Choanal atresia
3
Q
VACTERL Syndrome
A
Vertebral defects Anus, imperforate Cardiac defect TEF Renal defect Limb and radial anomalies
4
Q
Most frequent etiology of Respiratory problems among Filipino children
A
Infectious
5
Q
Most common cause of common colds
A
Rhinovirus
6
Q
Steeple sign
A
Viral croup/LTB
7
Q
Thumbprint sign
A
Epiglottitis
8
Q
Leaf sign
A
Epiglottitis
9
Q
Etiologic agent of viral croup/LTB
A
Parainfluenza virus
10
Q
Etiologic agent of epiglottitis
A
H. Influenzae type B
11
Q
age group most affected by viral croup
A
3 mos to 3 yrs
12
Q
Age group most affected by epiglottitis
A
3-7 years
13
Q
Barking cough, stridor
A
Viral croup/LTB
14
Q
Muffled voice, drooling
A
Epiglottitis
15
Q
Treatment of Croup (LTB)
A
Racemic epinephrine
Oral dexamethasone SD
16
Q
Treatment of acute epiglottitis
A
Secure airway, IV antibiotics (cefotaxime, ceftriaxone, meropenem)
17
Q
Foreign body most commonly obtained from respiratory tracts of children
A
Nuts
18
Q
Sore, scratchy throat, nasal obstruction, rhinorrhea,
PROMINENT ITCHING, SNEEZING, nasal eosinophilia
A
Allergic Rhinitis
19
Q
Sore, scratchy throat, nasal obstruction, rhinorrhea
UNILATERAL FOUL SMELLING DISCHARGE, BLOODY NASAL SECRETION
A
Foreign body Aspiration
20
Q
Sore, scratchy throat, nasal obstruction, rhinorrhea X 2 weeks
HEADACHE, FACIAL PAIN, PERIORBITAL EDEMA,
A
Sinusitis
21
Q
Sore, scratchy throat, nasal obstruction,
PERSISTENT rhinorrhea
Onset in the first 3 mos of life (snuffles)
A
Congenital Syphilis
22
Q
Sore, scratchy throat, nasal obstruction, rhinorrhea
History of prolonged use of DECONGESTANTS
A
Rhinitis medicamentosa
23
Q
Sore, scratchy throat, nasal obstruction, rhinorrhea
PAROXYSMS OF COUGH, BREATHLESS, SUBCONJUNCTIVAL HEMORRHAGE
A
Pertussis/whooping cough
24
Q
Etiology of Sinusitis
A
S. Pneumonia (30%)
Non-typeable H. Influenzae (20%)
M. catarrhalis (20%)
25
Paranasal Sinus Xray in Sinusitis
Air-fluid levels, opacification of sinuses
26
Treatment of Sinusitis
Antibiotics x14 days (co-amox)
27
Complications of Sinusitis
Abscess, meningitis
28
Sinuses present at birth
Maxillary
| Ethmoid
29
Sinuses pneumatized at 4 years old
Sphenoid
30
Sinuses developing at 7-8 years old
Frontal sinus
31
Antibiotic for Pertussis
Azithromycin, erythromycin, clarithromycin
32
3 stages of pertussis
Catarrhal
Paroxysmal
Convalescent
33
Stages of pertussis last how long?
2 weeks each
34
Etiology of Pertussis
Bordetella pertussis
| Gram neg coccobacilli
35
Transmission of Pertussis
Close contact via large aerosol drops
36
Pertussis period of communicability
7 days after exposure to 4 weeks after onset of paroxysms
37
Most infectious stage of pertussis
Catarrhal stage
38
Incubation period of pertussis
3-12 days
39
Prophylaxis for contacts of pertussis
Macrolide
| Regardless of age, history of immunization or symptoms
40
When to consider tonsillectomy?
Culture (+) Strep pharyngitis, severe and frequent:
>7 episodes in previous year
OR >5 episodes in each of the preceding 2 years
41
Upper Airway Obstruction
| CXR: patchy infiltrates and ragged tracheal column
Bacterial Tracheitis
42
Treatment of bacterial tracheitis
Antibiotics
43
Upper Airway Obstruction
| CXR: thumb sign
Epiglottitis
44
Upper Airway Obstruction
| CXR: subglottic narrowing
Viral croup/LTB
45
Upper Airway Obstruction
| CXR: air trapping on right lung with mediastinal shift towards right lung
Atelectasis/foreign body
46
Upper Airway Obstruction
| CXR: steeple sign
Croup (LTB)
47
```
Respiratory difficulty in bronchial asthma is due to?
A. Bronchial muscle spasm
B. Mucus hypersecretion
C. Bronchial mucosal edema
D. All
```
D. All
48
In care of asthmatic children, caution with prolonged use of which drug?
A. Prednisone
B. Epinephrine
C. Salbutamol
A. Prednisone
49
Daytime symptoms none to 2 or less/week
Controlled
50
Daytime symptoms >2/week
Partly controlled
51
Any limitation of activity
Partly controlled
52
Nocturnal awakening
Partly Controlled
53
Reliever >2/week
Partly controlled
54
Reliever 2 or less /week
Controlled
55
Uncontrolled (GINA 2006)
3/4 in any given week
- daytime symptoms
- night awakening
- need for reliever >2x/week
- activity limitation
56
GINA 2002
| Daytime symptoms <1x/week
Intermittent
57
GINA 2002
| Daytime symptoms >1x/week less than 7
Mild Persistent
58
GINA 2002
| Daytime symptoms daily
Moderate Persistent
59
GINA 2002
| Daytime symptoms daily and limits activities
Severe Persistent
60
GINA 2002
| Nighttime symptoms <2x/month
Intermittent
61
GINA 2002
| Nighttime symptoms >2x/month
Mild, persistent
62
GINA 2002
| Nighttime symptoms >1/week
Moderate, persistent
| Severe, persistent
63
GINA 2002
| PEFR/FEV1 >80% predicted
Intermittent
| Mild, persistent
64
GINA 2002
| PEFR/FEV1 60-79% predicted
Moderate, persistent
65
GINA 2002
| PEFR/FEV1 <60% predicted
Severe, persistent
66
GINA 2002
| PEFR Variability <20%
Intermittent
67
GINA 2002
| PEFR Variability 20-30%
Mild, persistent
68
GINA 2002
| PEFR Variability >30%
Moderate, persistent
| Severe, persistent
69
Mild or severe asthma?
| Agitated, confused, or drowsy
Severe
70
Mild or severe asthma?
| SpO2 94%
Mild
71
Mild or severe asthma?
| SpO2 <90%
severe
72
Mild or severe asthma?
PR >200 (0-3 yo)
PR >180 (4-5 yo)
Severe
73
Mild or severe asthma?
| Central cyanosis
Severe
74
Mild or severe asthma?
| Wheeze
Mild
75
Mild or severe asthma?
| Talks in words
Severe
76
Asthma maintenance
ICS
LABA
Leukotriene modifiers
77
Acute asthma meds
SABA
OCS or IV (prednisolone/methylprednisolone)
Anticholinergics — never used alone
Methylxanthines — not first line
78
Hyperinflated lung with patchy atelectasis
Bronchiolitis
79
Treatment for bronchiolitis
Nebulized albuterol and O2
80
Wheezing
History of viral infection among family members
Patient is 2 yo
Bronchiolitis
81
Wheezing, recurrent, after mild viral infection or exercise
| History of atopy
Asthma
82
Wheeze heard loudest over trachea
| Peristent, never seems to go away
Chondromalacia
83
Wheeze
Absent breath sounds on right lung
3 yo
Foreign body
84
```
Characteristic CXR in patient with staph pneumonia Except
A. Hemothorax
B. Pneumatocele
C. Pleural effusion
D. Pneumothorax
```
A. Hemothorax
85
Fever, cough and tachypnea [Pneumonia]
Poorly nourished
Unvaccinated
With onset of rashes all over the body
Measles Pneumonia
86
```
Fever, cough and tachypnea [Pneumonia]
in px with:
- Cystic fibrosis
- Chronic Granulomatous Disease
- burn px
- neutropenia
```
Pseudomonas
87
Fever, cough and tachypnea [Pneumonia]
Teen/young adult
Lives in dormitory
Non-productive cough initially
Mycoplasma
88
Fever, cough and tachypnea [Pneumonia]
With home aviarium
Works with birds
Psittacosis
89
Fever, cough and tachypnea [Pneumonia]
| Hx of eye discharge during 1st 5-14 days of neonatal period
Chlamydia
90
Child with cough, colds, fever, wheezing, stridor
| CXR: Lobar consolidation
Strep pneumoniae
91
Child with cough, colds, fever, wheezing, stridor
| CXR: hyperinflation with bilateral interstitial infiltrates and peribronchial cuffing
Bronchiolitis (RSV)
92
Child with cough, colds, fever, wheezing, stridor
| CXR: prominent areas of cavitation and multiple pneumatocoeles
Staphylococcus
93
Child with cough, colds, fever, wheezing, stridor
| CXR: right-sided hilar adenopathy
TB
94
Pneumonia
Attaches to respi epithelium
Inhibits cellular destruction
Sloughed cellular debris and inflammatory cells, and mucus cause airway obstruction
Mycoplasma
95
Pneumonia
Extensive areas of hemorrhagic necrosis
Irregular areas of cavitation
Pneumatocoeles, empyema, and bronchopulmonary fistulas
Staphylococcus
96
Diffuse infection with interstitial pneumonia
Necrosis of tracheobronchial mucosa, formation of large amounts of exudate, edema, and local hemorrhage
Involvement of lymphatic vessels and pleural
GABHS
97
Pneumonia
Local edema that aids in the proliferation of organisms that spread into adjacent areas resulting in focal lobar involvement
Streptococcus pneumoniae
98
CXR: Ragged air column sign
Bacterial tracheitis
99
Staccato cough
Chlamydia
100
Brassy cough
Staph aureus
| Bacterial tracheitis
101
Barking “seal” cough
Parainfluenza (LTB)
102
Whooping cough
B. Pertussis
103
Post tussive vomiting
B. Pertussis
104
Cough most severe in the morning
Cystic fibrosis
105
Cough with vigorous exercise
Asthma
106
Disappears with sleep
Habitual cough
107
Tight sounding cough with wheeze
Asthma
108
Cough
| Pet birds
Chlamydia psitacci
109
Cough
| Rodents
Yersinia pestis
| Hantavirus
110
Cough
| Rabbits
Francisella tularensis
111
Cough
| Pigeons
Histoplasmosis
112
Cough
| Cattle, sheep
Q fever
113
Cough in immunosuppressed px
```
Bacterial pneumonia
M. Tb
M. Avium
CMV
Pneumocystis jiroveci pneumonia
```
114
Drooling, hyperextended neck
Acute high fever
No family member ill
Acute epiglottitis
115
Sore throat, cough, mild,
hoarsness out of proportion,
Pharyngeal inflammation
Acute infectious laryngitis
116
Treatment of Acute Infectious laryngitis
Supportive
117
Age group and gender most affected by Bacterial Tracheitis
5-7 yo, Males
118
Metallic, barking cough, noisy inspiration, appears frightened
Usually afebrile
Spasmodic croup
119
More of an allergic reaction to viral antigens than a direct infection
Spasmodic Croup
120
Patient with high fever, can lie flat, no drooling or dysphagia
Mucosal swelling at level if cricoid with copious, thick purulent secretions
Bacterial Tracheitis
121
Lateral neck xray: pseudomembrane detachment in trachea
Bacterial tracheitis
122
Antibiotics for bacterial tracheitis
Vancomycin or clindamycin
| AND 3rd Gen Cephalosporin
123
Most common cause of Bacterial Tracheitis
Staph Aureus
124
Other causes of bacterial tracheitis
```
MRSA,
S. pneumoniae,
S. Pyogenes
M. Catarrhalis
Nontypeable H. influenzae
Anaerobic organisms
```
125
Toxic patient with no signs of classic epiglottitis (cherry red epiglottis)
Bacterial tracheitis
126
Most common
| Delivery room emergency for neonates
Failure to initiate and maintain effective respirations
127
Most common pattern of idiopathic apnea
```
Mixed apnea (50-75%)
With obstructive apnea preceding central apnea
```
128
Most common cause of respiratory distress among term infants via CS
Transient tachypnea of the newborn
129
Most common cause of pneumothorax
Over-inflation resulting in alveolar rupture
130
Most common cause of pseudomediastinum
Lower respiratory infection in <7 yo
| Asthma in older children
131
Most common cause of extubation failure in children
Post extubation upper airway obstruction
132
Most common complications of tracheotomy
Pseudomediastinum and pneumothorax
133
Most common cause of respiratory insufficiency
Head trauma
134
Most common mechanism of mechanism of arterial hypoxemia in lung disease
Ventilation-perfusion mismatch
135
Most common cause of postneonatal infant mortality
Sudden infant death syndrome
136
Most common cause of septal deviation noted at birth
Trauma from delivery
137
Most common site of epistaxis
Kiesselbach’s plexus
138
Most common complication of cold
Acute otitis media
139
Most common cause of bacterial infection in pharynx
GABHS
140
Most common cause of cough in children
Airway reactivity (asthma)
141
Most common form of acute upper respiratory obstruction
Croup
142
Most common isolated pathogen in bacterial tracheitis
S. Aureus
143
Most common congenital laryngeal anomaly
Laryngomalacia
144
Most common cause of secondary tracheomalacia
Aberrant innominate artery
145
Most common cause of stridor in infants and children
Laryngomalacia
146
Most common cause of bronchial foreign body
Nuts
147
Most common cause of airway obstruction requiring tracheostomy in infants
Laryngotracheal stenosis
148
Most common factor contributing to laryngeal injury
Oversized endotracheal tube
149
Most common cause of chronic hoarseness in children
Vocal nodules
150
Most common respiratory tract neoplasms in children
Papillomas
151
Most common HPV types associated with laryngeal disease
HPV 6 and 11
152
Most common underlying problem associated with recurrent pneumonias in hospitalized children
Oropharyngeal incoordination
153
Most common parasite causing transient pulmonary infiltrates with eosinophilia syndrome
Ascaris lumbricoides (formerly Löffler Syndrome)
154
Most common causes of parapneumonic effusion and empyema
S. aureus
S. pneumoniae
S. pyogenes
155
Most common presenting symptom of pulmonary embolism in adolescents
Unexplained and persistent tachypnea
156
Most common pulmonary malignancy in children
Metastatic lesions
157
Most common cause of pleural effusion in children
Bacterial Pneumonia
158
Most common cause of empyema
Streptococcus pneumoniae
| S. aureus in developing nations and postraumatic empyema
159
Stridor
Upper airway obstruction
160
Wheeze
Lower airway obstruction
161
Coarse crackles, rales
Lung tissue disease
162
Rhonchi
Lower airway obstruction OR lung tissue disease
163
In most children, the only evidence of primary TB is:
Recent conversion of PPD to positive
164
Tuberculin sensitivity develops after how many hours from administration?
72 hours
165
Most common extrapulmonary form of TB in children
Scrofula
166
```
A 3 yr old boy has positive TST. which of the ff suggests MILIARY TB?
A. Infection of hilar lymph node
B. Weight loss
C. Hepatosplenomegaly
D. Chronic cough
```
C. Hepatosplenomegaly
167
Primary Complex (Ghon Complex) components
Primary pulmonary focus
Regional lymph nodes
Peritracheal lymph nodes
Localized pleurisy between the middle and lower lobes
168
Time entry between tubercle bacilli and tissue hypersensitivity ranges from?
3-12 weeks
169
(+) exposure to active disease
(-) PPD
(-) SSx
(-) CXR
TB exposure
170
(+) exposure to active disease
(+) PPD
(-) SSx
(-) CXR
TB infection
171
(+) exposure to active disease
(+) PPD
(+) SSx
(+) CXR
TB disease
172
(-) exposure to active disease
(+) PPD
(-) SSx
(-) CXR
TB infection
173
```
How many for TB disease?
(+) exposure to active disease
(+) PPD
(+) SSx
(+) CXR
(+) lab findings
```
3 or more
174
How many to Signs and symptoms for (+)
Cough, +/- wheezing >2 weeks
Unexplained fever >2 weeks
Failure to gain weight or weight loss
Failure to respond to 2 wks approp antibiotic for LRTI
Failure to improve after 2 wks of viral infection
Fatigue, lethargy
3 or more
| 1 in a child with close contact to known active case
175
Anatomic areas for Pulmonary TB
Lung parenchyma and tracheobronchial tree
176
PPD 10 mm or more
Positive TST
177
(+) TST
| PPD >5 mm plus any of which?
(+) exposure to active or suspected disease
(+) SSx
(+) CXR
Immunocompromised condition
178
Category I
New PTB
| New EPTB except CNS, bones, joints
179
Category Ia
New EPTB of CNS, bones, joints
180
Category II
Retreatment PTB
| Retreatment EPTB except CNS, bones, joints
181
Category IIa
Retreatment EPTB of CNS,bones, joints
182
Regimen Category I
2 HRZE/4 HR
183
Regimen Category Ia
2 HRZE/ 10 HR
184
Regimen Category II
2 HRZES/ 1 HRZE/ 5 HRE
185
Regimen Category IIa
2 HRZES/ 1 HRZE/ 9 HRE
186
Presumptive TB
Cxr findings suggestive of PTB regardless of Age
187
Preventive Therapy for TB
| DOH guidelines
Isoniazid prophylaxis to:
- HIV +
- <5 yo with bacteriologically confirmed contact regardless of TST
- <5 yo with clinically diagnosed contact IF (+) TST
188
Dose of Isoniazid prophylaxis
10 mg/kg/day OD for 6 mos
189
Alternative to Isoniazid prophylaxis
Isoniazid + Rifampicin for 3 months
190
3 elements of Primary TB disease
Ghon focus
Lymphadenitis
Lymphangitis
191
TB incubation period
3 months to 2 years
192
Most consistent manifestation of pneumonia in children?
Tachypnea
193
Pneumonia indicators
| 3 mos to 5 yo
Tachypnea or retractions
194
Pneumonia indicators
| 5 to 12 yo
Fever, tachypnea, crackles
195
Pneumonia indicators
| Over 12 yo
Fever, tachypnea, tachycardia
| Plus one abnormal chest finding: decreased BS, rhonchi, crackles or wheeze
196
Most common cause of neonatal pneumonia
GBS
E. coli
Listeria
S. pneumoniae
197
Most common cause of pneumonia
| 3 wks to 3 mos
```
RSV,
parainfluenza,
chlamydia,
Mycoplasma
S. Pneumoniae
S. Aureus
```
198
Most common cause of pneumonia
| 4 mos to 4 yra
Viruses
S. Pneumoniae
Hib
Mycoplasma
199
Most common cause of pneumonia
| 5 to 15 yo
Mycoplasma (walking pneumonia)
| S. Pneumoniae
200
Identify type of Pneumonia:
cough, wheezing stridor
CXR: diffuse, streaky infiltrates
Viral Pneumonia
201
Identify type of Pneumonia:
Cough, high fever, dyspnea
Dullness to percussion
CXR: lobar consolidation
Bacterial Pneumonia
202
Identify type of Pneumonia:
Less ill-looking
Nonproductive cough
CXR: interstitial pattern, usually lower lobes
Mycoplasma “walking pneumonia”
203
Identify type of Pneumonia:
6 wks to 6 mos old
CXR: hyperinflation, “ground glass appearance”
Chlamydia
204
Identify type of Pneumonia:
| CBC: neutrophilia
Bacterial
205
Identify type of Pneumonia:
| CBC: eosinophilia
Chlamydia
206
Treatment of Viral Pneumonia
Supportive
207
Treatment of bacterial Pneumonia
| 0-2 mos
Ampicillin + Aminoglycoside
208
Treatment of bacterial Pneumonia
| 2 mos to 5 yrs
Ceftriaxone or Cefuroxime
| + Azithromycin
209
Treatment of Walking Pneumonia
>5 yrs old
| Erythromycin, Clarithromycin, Azithromycin
210
Treatment of chlamydia Pneumonia
Erythromycin PO x 14 days
211
Treatment of PCAP A and B
Oral amoxicillin
212
Treatment of PCAP C
No previous antibiotic use, Complete Hib Vaccine
pen g
213
Most common cause of pneumonia across all age group
Viruses
214
Most common cause of bacterial pneumonia across all age group
S. pneumoniae
215
Inflammation of lung parenchyma
Pneumonia
216
Inflammation of interstitium
Pneumonitis
217
With consolidation of one or more lobes
Lobar pneumonia
218
Inflammation of bronchiole with mucopurulent exudate
Bronchopneumonia
219
Recurrent pneumonia
2 or more episodes in one year OR
3 or more episodes overall
With radiographic clearing in between
220
Treatment of PCAP C
| incomplete or unknown Hib vaccine
Ampicillin
221
Treatment of PCAP C
| >15 yo
As adult
IV non antipseudomonal Beta lactam with BLIC
Plus extended macrolide or fluoroquinolone
222
Treatment of PCAP A and B
| allergic or suspected atypical
Azithromycin or clarithromycin
223
Classify PCAP
| mild dehydration
B
224
Classify PCAP
| moderate dehydration
C
225
Classify PCAP
| No dehydration
A
226
Classify PCAP
| Severe dehydration
D
227
Classify PCAP
| No malnutrition
Nonsevere
| A Or B
228
Classify PCAP
| Moderate malnutrition
C
229
Classify PCAP
| Severe malnutrition
D
230
Classify PCAP
| Pallor
C or D
231
Classify PCAP
| RR 3-12 mos: >70
D
232
Classify PCAP
| RR 3-12 mos: 50-60
A or B
233
Classify PCAP
| RR 3-12 mos: >60-70
C
234
Classify PCAP
| RR 1-5 yrs: >50
C or D
235
Classify PCAP
| RR 1-5 yrs: 40-50
A or B
236
Classify PCAP
| RR 1-5 yrs: 68
C or D
237
Classify PCAP
| RR 3-12 mos: 64
C
238
Classify PCAP
| RR 3-12 mos: 55
A or B
239
Classify PCAP
| RR >5 yrs: 30-35
A or B
240
Classify PCAP
| RR >5 yrs: 37
C or D
241
Classify PCAP
| RR >5 yrs: 33
A Or B
242
Classify PCAP
| RR >5 yrs: >35
C or D
243
Classify PCAP
| Intercostal retractions
C or D
244
Classify PCAP
| Subcostal retractions
C or D
245
Classify PCAP
| Supraclavicular retractions
D
246
Classify PCAP
| Head bobbing
C or D
247
Classify PCAP
| Cyanosis
C Or D
248
Classify PCAP
| Grunting
D
249
Classify PCAP
| Apnea
D
250
Classify PCAP
| Irritable
C
251
Classify PCAP
| Lethargic
D
252
Classify PCAP
| O2 Sat 90
C Or D
253
Classify PCAP
| O2 sat >95
A Or B
254
Site of Care
| PCAP A
OPD
255
Site of care
| PCAP C
Ward
256
Site of Care
| PCAP B
OPD
257
Site of care
| PCAP D
ICU
258
Bacterial invasion through capsules of tonsils
Peritonsillar abscess
259
Drooling, neck hyperextended, bulging of posterior pharyngeal wall, neck pain, muffled voice, reapiratory distress
Retropharyngeal abscess
260
Asymmetric tonsillar bulge, displaced uvula
Peritonsillar abscess
261
Most common age group for peritonsillar abscess
Adolescents
262
Most common age group for retropharyngeal abscess
3-4 yo
| M>F
263
Most common cause of peritonsillar abscess
Group A strep
| Anaerobes
264
Most common cause of retropharyngeal abscess
Group A strep
Anaerobes
S. aureus
Others: klebsiella, h. Influenzae
265
Fever, sore throat, dysphagia, trismus
Peritonsillar abscess
266
Ideal diagnostic for peritonsillar abscess
CT Scan
267
Treatment of choice for peritonsillar abscess
Surgical drainage
| Antibiotics
268
Treatment of choice for retropharyngeal abscess
IV antibiotics: 3rd gen cephalosporin with ampi-sul or clindamycin
Surgical drainage
269
16 yo F, 3 days cough and sore throat. Now with fever, cough and trismus, some dysphagia. PE: assymetric tonsillar bulge and displaced uvula and erythematous posterior pharyngeal wall. T 38.8
Peritonsillar abscess
270
NB girl, Respiratory distress shortly after birth, hence intubated. PE shows coloboma on right eye and low set ears. An NGT cannot be passed through. There was no cleft or other mass lesions. What is the next most appropriate diagnostic step?
Flexible bronchoscopy
272
Case. A 4 year old is rushed to the ER due to difficulty breathing. T = 39C. 12 hrs prior, complained of sore throat and mild fever. Patient is noted drooling and neck is slightly held hyperextended, what is the likely diagnosis? Next best step?
Acute epiglottitis, secure airway with intubation
273
4 year old male, coughing and wheezing worse at night, intermittently over the past year but progressively worsening. Mother noted difficulty breathing hence brought to ER.
HR 106, RR 46, T 37
(+) wheezing bilateral lung fields, occasional rhonchi, prolonged expiratory phase
What is the likely diagnosis?
Bronchial asthma
275
4 yo male, worsening cough now with purulent sputum starting 3 days ago with clear nasal discharge and frequent intermittent dry hacking cough. HR 90, RR 33, T 37.2
PE: erythematous congested nasal mucosa, slight erythematous posterior pharynx, some occasional coarse crackles, scattered high pitched wheezing, no nasal flaring, no retractions
Diagnosis?
Bronchitis
276
Case. A 3 yr old is brought to the ER due to acute onset of noisy breathing. Patient is coughing from time to time, no cyanosis. Points to neck complaining of pain. Mother noted patient was apparently well and was playing with toys prior. What is the most likely diagnosis?
Foreign body aspiration
277
3 yo, M, 2 days gradual decreasing oral intake, irritability, fever 38.5, muffled “hot potato” voice. HR 108, RR 33, T 38.7 with minimal movement and neck stiffness. Mild erythematous posterior pharynx, bulging of posterior pharyngeal wall. Chest PE, no crackles, occasional rhonchi. What is the most likely diagnosis?
Retropharyngeal abscess
279
5 yo male, 2 days history of runny nose and mild dry cough, fever 39C. Brought in for consult due to brassy cough and hoarse voice with copious purulent sputum.
HR 102, RR 58, T 39
Semi-recumbent, looking anxious, slightly erythematous posterior pharynx. (+) rhonchi
What is the most likely diagnosis?
Bacterial tracheitis
281
A 3 year old child, intermittent episodes of continuous cough until child turns purple followed by deep loud inspiration. 1 week prior, noted to have sneezing and rhinorrhea.
What is the most likely diagnosis? What is the appropriate antibiotic?
Pertussis, azithromycin
281
An 8 mo old boy was brought to ER due to fast breathing and wheezing. Mother is a smoker with history of bronchial asthma. Mother noted runny nose 2 days prior and mild, undocumented fever. PE reveals wheezing on both lung fields. What is the most likely diagnosis?
Bronchiolitis
281
3 yo male, 2 days history of runny nose and mild dry cough, fever 38C. His older brother has cough and colds 5 days prior. Brought in for consult due to barking cough and hoarse voice.
HR 102, RR 43, T 38
Seen sitting upright, looking anxious, slightly erythematous posterior pharynx and stridor.
What is the most likely diagnosis?
LTB
281
A 9 month old male was brought to the clinic due to cough and difficulty breathing. The mother noted he initially had a runny nose with clear nasal discharge and dry cough 3 days prior. HR 158, RR 68, T 38.8 (+) nasal flaring, subcostal retractions and crackles, bilateral and decreased breath sounds at right lung field.
What is the most likely diagnosis?
Pneumonia
281
A 9 month old male was brought to the clinic due to cough and difficulty breathing. The mother noted he initially had a runny nose with clear nasal discharge and dry cough 3 days prior. HR 158, RR 68, T 38.8 (+) nasal flaring, subcostal retractions and crackles, bilateral and decreased breath sounds at right lung field.
Where should patient sent?
Regular ward
282
A 9 month old male was brought to the clinic due to cough and difficulty breathing. The mother noted he initially had a runny nose with clear nasal discharge and dry cough 3 days prior. HR 158, RR 68, T 38.8 (+) nasal flaring, subcostal retractions and crackles, bilateral and decreased breath sounds at right lung field.
CXR: bilateral interstitial infiltrates. What is the classification?
PCAP C
283
```
An 8 year old male comes in to the clinic for check up. He feels well and has no symptoms. He has come in contact with his sick grandfather who was recently diagnosed with PTB. TST is 10 mm induration with 5 mm erythema. CXR neg. What is the next best?
A. Supportive
B. None, neg TST
C. INH for 9 mos
D. HRZE 4 mos, then 2 mos HR
```
C. INH 9 mos
284
```
Changes in voice, cry, or (+) barking cough
Stridor
Poor chest rise
Poor air entry
Drooling, snoring, gurgling sounds
```
Upper airway obstruction
285
Tachypnea
Wheezing (usu expiratory)
Prolonged expiratory phase with increased expiratory effort
Cough
Lower airway obstruction
286
```
Tachypnea
Grunting
Crackles and decreased air movement
Diminished breath sounds
Tachycardia
```
Lung parenchymal disease
287
```
Irregular rr and pattern
Variable respiratory effort
Shallow breathing with inadequate effort
Central apnea
Normal or decreased air movement
```
Disordered control of breathing
288
Ddx Upper airway obstruction
Croup
Anaphylaxis
Foreign body aspiration
289
Ddx lower airway obstruction
Bronchiolitis
| Asthma
290
Ddx Lung Parenchymal Disease
```
Pneumonia
Pulmonary edema
Trauma
Infiltrative disease
Toxins
```
291
Ddx disordered control of breathing
Neuromuscular disease
Metabolic
Drug overdose
Increased ICP
292
Reflex response of the lower respiratory tract to stimulation of irritant or cough receptors in the airway mucosa
Cough
293
Inspiratory continuous lung sound
Stridor
294
Inspiratory discontinuous
Crackles, rales
295
Expiratory continuous high pitched
Wheeze
296
Expiratory or inspiratory
| Continuous, low-pitched
Rhonchi
297
Inability to generate intrathoracic pressure necessary to inflate the lungs without surfactant
Hyaline Membrane Disease (RDS)
298
Effects of surfactant deficiency
Increased surface tension causing alveolar collapse
Progressive atelectasis,
V/Q mismatch and hypoxia
Failure to develop effective FRC
299
TRUE OR FALSE?
| RDS incidence is inversely proportion to AOG
TRUE
300
CXR: ground glass appearance
RDS
301
CXR: Fine reticular granularity of lung parenchyma
RDS (hyaline membrane disease)
302
Low lung volumes and air bronchograms in first 24 hours of life
RDS
303
Manage of RDS
Surfactant replacement within 15 mins of birth if <26 wks AOG
Intubation
304
INSURE Technique
Intubate
SURfactant
Extubate to CPAP
305
Prevention of RDS
Antenatal corticosteroids for mothers at risk of preterm birth
306
Benign, self limited respiratory distress syndrome of term and late preterm infants
Transient tachypnea of the newborn
307
Central mechanism of TTN
Delayed fluid resorption
| Delayed clearance of lung fluid
308
Most common perinatal respiratory disorder
| 40% of Respiratory distress after birth
TTN
309
Ethiopathogenesis of TTN
Lung fluid inhibits gas exchange leading to increased work of breathing and compensatory tachypnea, hypoxia develops due to poorly ventilated alveoli
310
Why are infants born by CS at higher risk?
Not exposed to stress (lack of cathecolamine surge and active Na+ reabsorption in the lung),
and absence of uterine contraction (contractions result in high transpulmonary pressure leading to lung efflux)
311
Tachypnea soon after birth or within first 6 hours of delivery
TTN
312
Retractions, nasal flaring, expiratory grunting or cyanosis relieved by O2
TTN
313
Barrel chest (increased A-P diameter)
TTN
314
Hyperinflation
| Palpable liver and spleen
TTN
