Resp Flashcards
1
Q
Define croup syndrome
A
- Croup describes acute inflammatory diseases of the larynx (acute stridor), to include:
A. Viral croup (laryngotracheobronchitis)
B. Epiglottitis (supraglottitis)
C. Bacterial tracheitis
2
Q
Describe croup
A
- Infectious process
- Severe inflammation & obstruction of upper airway
- Can progress to total airway obstruction: steeple sign
3
Q
What is the pathophys of croup
A
- Infectious organism invades laryngeal mucosa
- Leads to inflammation, edema, epithelial necrosis & shedding
- Leads to cough &/or stridor
4
Q
Describe viral croup
A
- Generally affects younger children in fall & early winter
- Inflammation of entire airway, especially subglottic space
A. Can cause upper airway obstruction
5
Q
What are the sxs of croup?
A
- URI sx’s
- +/- fever
- Nasal flaring
- Retractions
- Barky cough
- Stridor
- Tachypnea
- Tachycardia
6
Q
What is the etiology of croup?
A
1. Viruses (70%) A. Parainfluenza B. Adenovirus C. RSV D. Influenza 2. Bacteria (20%) A. H. flu B. B. pertussis C. Diphtheria 3. Allergies
7
Q
What is the ddx for croup? Prognosis?
A
1. DDx A. Angioneurotic edema B. Laryngeal foreign body C. Esophageal foreign body D. Retropharyngeal abscess E. Differs from epiglottitis: -Cough -No drooling 2. Prognosis A. Uneventful course that will improve w/in a few days
8
Q
What will be seen on a neck xray for a pt with croup?
A
“Steeple sign” on neck X-ray
9
Q
What is the treatment for mild croup?
A
- Barking cough & no stridor at rest
A. Supportive therapy w/ oral hydration & minimal handling
B. Cool air
C. Steamy shower
10
Q
What is the treatment for moderate croup?
A
- Barking cough w/ stridor at rest
A. Oxygen if desaturation
B. Nebulized racemic epinephrine (2.25% solution; 0.05 mL/kg diluted in sterile saline) – rapid onset w/in 10-30 min.
C. Dexamethasone 0.6 mg/kg IM one dose or oral
D. Budesonide 2-4mg, inhaled – onset w/in 2 hours
11
Q
What are indications for hospitalization with croup?
A
- less than 1 yo
- resp > 50 /min
- Cyanosis
- Long distance travel
- 2nd trip to ER
12
Q
What is the prognosis for croup?
A
- After treatment, symptoms should resolve w/in 3 hours, then can be safely discharged
- Recurrent nebulized epinephrine needed, then hospitalization required
- Respiratory distress persists intubation is required
13
Q
Describe epiglottitis
A
- Inflammation of the epiglottis
- Can interfere w/ breathing, & constitutes a medical emergency
- With the advent of the HIB vaccine, the incidence of epiglottitis has decreased, but not eliminated
14
Q
What causes epiglottitis?
A
- Haemophilus influenzae (most common) if not immunized
- Neisseria meningitides
- Streptococcus species
15
Q
What is the ddx for epiglottitis?
A
- Angioneurotic edema
- Laryngeal foreign body
- Esophageal foreign body
- Retropharyngeal abscess
16
Q
What are the sxs of epiglottitis?
A
- Sudden onset high fever
- Dysphagia
- Drooling
- Muffled voice
- Inspiratory retractions
- Cyanosis
- Stridor
- “Sniff-dog” position
17
Q
What imaging is used for epiglottitis?
A
- Lateral neck x-ray
A. Classic “thumbprint” sign
18
Q
How is epiglottitis treated?
A
- Once diagnosis made, immediate intubation is needed
- Cultures of epiglottis & blood should be taken
IV antibiotics
A. Ceftriaxone 50-75 mg/kg every 12 hours - Extubation w/in 24-48 hours after visualization of improved epiglottis
- Switch to oral antibiotics for a total of 10 days of treatment
19
Q
What is the prognosis of epiglottitis?
A
- Prompt recognition & appropriate treatment result in rapid resolution
- Recurrence is unusual
20
Q
What is Laryngomalacia?
A
Condition where epiglottis is underdeveloped in a newborn and the cartilage cannot perform its job. Persistent stridor, dxed with larynoscopy, will be outgrow by age 2-3. worse when laying down, better when sitting up
21
Q
What are the clinical findings for fb aspiration?
A
- Sudden onset of coughing, wheezing, or respiratory distress
- Decreased breath sounds or localized wheezing
22
Q
What are the dx studies for fb aspiration?
A
- Chest x-ray can be normal up to 25% of the time
2. Inspiratory & forced expiratory CXR should be obtained
23
Q
How is fb aspiration treated?
A
- Admission to hospital is required
- Rigid bronchoscopy under general anesthesia
- Clear related mucus & bronchospasms
A. After removal, ß-adrenergic nebulization treatments begin
B. Chest physiotherapy
24
Q
What organisms cause CAP?
A
- Strep pneumoniae (most common)
- Haemophilus influenzae
- Chlamydia pneumoniae
- Bordetella pertussis
- Mycoplasma pneumoniae
- Legionella pneumophila
- Staphylococcal pneumoniae
25
What are the clinical findings for CAP?
1. Fever >39°C
2. Tachypnea
3. Cough
4. Crackles
5. Decreased breath sounds
26
What are the lab test results for CAP?
1. Elevated WBC w/ left shift
2. Blood cultures
3. Low WBC (
27
What complications are possible from CAP?
1. Staphylococcal
2. Pneumococcal
A. Empyema
3. Strep pneumonia
4. Haemophilus influenzae
A. Meningitis
B. Otitis media
C. Sinusitis
D. septicemia
28
How is CAP treated in a kid less than 5 yo?
1. Amoxil 80-100 mg/kg/d in divided doses
2. Ceclor (cefaclor) 20 mg/kg/d in 3 divided doses
3. Zithromax (azithromycin) 10mg/kg day 1, 5 mg/kg days 2-4
4. Careful outpatient f/u w/in 1 - 5 days
29
How is CAP treated in a kid >5yo?
Zithromax (azithromycin) 10mg/kg day 1, 5 mg/kg days 2-4
30
When should a pt with CAP be admitted?
```
1. Age
A. less than 3 months
2. Severity of illness
3. Suspected organism
4. Parent compliance
```
31
What causes viral pneumonia?
1. RSV
2. Parainfluenza (1, 2, & 3) viruses
3. Influenza (A & B)
4. Human metopneumovirus
32
What are the clinical findings for viral pneumonia?
1. URI precedes onset
2. Cough
3. Wheezing
4. Stridor
5. Tachypnea
6. Retractions
7. Grunting
8. Nasal flaring
33
What are the wbc in CAP?
Normal to slightly elevated
| Not useful to determine between viral or bacterial infection
34
What are the rapid viral methods for viral pneumonia?
Fluorescent antibody tests
Enzyme-linked immunosorbent assay
Polymerase chain reaction (PCR)
35
What are the cxr results for viral pneumonia?
1. Perihilar streaking
2. Increased interstitial markings
3. Peribronchial cuffing
4. Patchy bronchopneumonia
36
What complications can arise from viral pneumonia?
Bacterial tracheitis
Bronchiolitis obliterans
Chronic respiratory failure
Asthma
37
How is viral pneumonia treated?
1 Supportive care
2. Hospitalization if severely ill
3. Antibiotics maybe started as very hard to distinguish between viral and bacterial pneumonia
4. Uneventful recovery in most children
38
What is hte most common cause of serious acute respiratory illness in infants and young children?
1. Bronchiolitis
| 2. Applies to children
39
What organisms cause bronchiolitis?
1. RSV (most common)
2. Parainfluenza
3. Human metopneumovirus
4. Influenza
5. Adenovirus
40
What are the sxs for bronchiolitis?
1. 1-2 days of fever, rhinorrhea, & cough
2. Followed by wheezing or crackles, tachypnea, hypoxia, and respiratory distress
3. Shallow breathing
4. Nasal flaring, cyanosis, retractions & rales can be present
5. Prolongation of expiratory phases is noted w/ wheezing
6. Sometimes apnea is seen
41
How is bronchiolitis dxed?
1. Viral nasal wash
2.WBC
A Normal
B. Mild lymphocytosis
42
What complications can arise form bronchiolitis?
Super-infection
| Streptococcus pneumoniae leading to pneumonia
43
What are the ddx for bronchiolitis?
Pneumonia
Asthma
CHF
44
How is bronchiolitis prevented?
Proper handwashing
| Reduce exposure to environmental factors
45
How is bronchiolitis treated?
1. Most can be treated as outpatient w/supportive measures
| 2. Infants
46
What is the prognosis for bronchiolitis?
1. Very good in most infants
2. Improved supportive care and Palivizumab (Synagis) injection has decrease high-risk infant mortality
A. Tx RSV in high risk pt
B. Monthly IM dose during season
C. 15 mg/kg , max 3-5 dose
47
Define bronchiectasis
Permanent dilation of bronchi resulting from airway obstruction by retained mucus secretions or inflammation in response to chronic/repeated infection
48
What causes bronchiectasis?
Occurs either from preceding illness (severe pneumonia or foreign body aspiration) or from an underlying systemic disorder (CF, PCD, chronic aspiration, or immunodeficiency)
49
What causes bronchiectasis?
1. Streptococcus pneumoniae
2. Staph aureus
3. Haemophilus influenzae
4. Pseudomonas aeruginosa
50
What are the sxs of bronchiectasis?
1. Chronic cough
2. Purulent sputum
3. Fever
4. Weight loss
5. Recurrent respiratory infections
6. Dyspnea on exertion
7. Finger clubbing
8. Rales, rhonchi, decrease air entry is noted
51
What is the ddx for bronchiectasis?
Foreign body aspiration
| Allergic bronchopulmonary aspergillosis
52
How is bronchiectasis dxed?
1. CXR
A. Increased bronchovascular markings or atelectasis
2. High-resolution CT scan of the lungs
A. Best to determine the extent of the disease
3. PFT
A. Airflow obstruction
B. Air trapping
53
How is bronchiectasis treated?
1. Aggressive antibiotic therapy during pulmonary exacerbations
2 Routine airway clearance
3. Surgical removal of lung affected that is showing poor response to medical treatment
54
What is the prognosis for bronchiectasis?
1. Underlying cause
2. Severity
3. Extent of lung involvement
4. Response to medical management
55
Describe pertussis
1. Highly communicable infection
| 2. 50% of children
56
What causes pertussis?
Pathogen – Bordetella pertussis
| Gm (-) coccobacillus
57
What is the pathophys of pertussis?
1. Incubation period averages 7-14 days
2. Invades mucosa of the nasopharynx, trachea, bronchi, & bronchioles
3. Increases secretion of mucus
4. Disease can last up to 6 weeks
5. Transmission by aspiration
58
What are the 3 stages of pertussis?
1. Catarrhal (1-2 weeks)
2. Paroxysmal Coughing (2-4 weeks)
3. Convalescence (1-2 weeks)
59
What are the sxs of the catarrhal stage?
1. Sneezing
2. Coryza
3. Irritating cough
4. Fever is rare
60
What are the sxs of the Paroxysmal Coughing stage?
1. Paroxysmal cough ending in loud inspiration “whoop”
2. 10-30 consecutive coughs causing exhaustion
3. Vomiting from gag reflex
4. Gradually improves
61
What are the sxs of the Convalescence stage?
Usually begin within 4 weeks
Decrease paroxysmal coughing
Vomiting decreases
Patient looking and feeling better
62
What are the lab findings for pertussis?
1. WBC 20,000-30,000 w/ 70%-80% lymphocytes
2. Nasoparyngeal swabs are (+) in 80%-90% of cases in the catarrhal & early paroxysmal stages
CXR
3. Thickened bronchi and “shaggy” heart border
63
What are the ddx for pertussis?
1. Bacterial Pneumonia
2. Tuberculous Pneumonia
3. Chlamydial Pneumonia
4. Viral Pneumonia
5. Cystic Fibrosis
6. Foreign Body Aspiration
64
What are the complications for pertussis?
1. Bronchopneumonia
2. Atelectasis
3. Otitis media
4. Chronic Bronchiectasis
5. Apnea
6. Sudden Death
7. Seizure
65
How is pertussis prevented?
```
DTaP in early infancy
Booster dose (Tdap) between 11 & 18 years & q 10 yr
```
66
How is pertussis treated?
1. **Azithromycin (10 mg/kg qd x 5 days birth-6 mo)
2. Erythromycin > 1 mo age (40-50 mg/kg/day in 4 divided doses for 14 days)
3. Clarithromycin > 1 mo (15 mg/kg/d in 2 in 2 divided doses x 7 d
4. Post-exposure prophylaxis
A. Treat all household contacts, even if immunizations are UTD
67
What is the prognosis for pertussis?
1. Good w/ appropriate Tx
| 2. Poor in infants
68
Describe SIDS
1. Sudden death of an infant
69
What is the incidence of SIDS?
1. Incidence 2 in 1,000 live births before education to reduce prone sleeping w/ the “Back to Sleep” campaign
to 1 in 1,000 live births since
2. New evidence shows in sudden unexpected deaths of infants (SUDI) due to accidental suffocation & unsafe sleep surfaces
70
When do most sids deaths occur?
1. Most deaths occur between 2-4 months
| 2. Most deaths occur between midnight & 8 am, when parent is asleep
71
What are the risk factors for SIDS?
1. More common among ethnic & racial minorities & socio-economically disadvantaged populations
2. Risk ratio - 3:2 male to female
3. Highest risk:
A. Low birth weight
B. Teenage or drug-addicted mothers
C. Multiparity
D. Crowded living conditions
E. Maternal smoking
F. (+) FH of SIDS
