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Respiratory Flashcards

(56 cards)

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1
Q

Assessment of Respiratory System

A

PQRST
P- promoting, preventing, precipitating, palliating factors
Q- quality or quantity
R- region or radiation
S- severity, setting, simultaneous, similar illnesses in past
T- temporal factors

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2
Q

PQRST: P

A
  • Contacts: those with similar illness
  • Prevention: medications, supplements, handwashing
    -Progression: increasing or decreasing in severity
    -Treatment: what has been used?
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3
Q

PQRST: Q

A

quality or quanitity
- How severe are the symptoms?

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4
Q

PQRST: R

A

region or radiation
- Complaints of chest pain?

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5
Q

PQRST: S

A

-Key signs/symptoms/associated symptoms
-Similar illnesses

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6
Q

PQRST: T

A

temporal factors
- When did illness begin?
- Acute or insidious onset?
- How long?

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7
Q

Indications for tonsillectomy and adenoidectomy

A
  • > 7 throat infections/past year
  • > 5 throat infections/past 2 years
  • > 3 throat infections/past 3 years
  • recurrent peritonsllar abscess
  • periodic fever with aphthous ulcers/adenopathy
  • obstructive sleep apnea
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8
Q

What is pharyngitis?

A

inflammation of mucosal lining of throat - tonsils, pharynx, uvula, soft palate, nasopharynx

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9
Q

Viral sources of pharyngitis

A
  1. EBV
  2. HSV
  3. CMV
  4. enterovirus
  5. influenza
  6. parainfluenza
  7. HIV
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10
Q

Bacterial source of pharyngitis

A

group B strep

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11
Q

Clinical findings of acute viral pharyngitis

A
  1. pain
  2. myalgia/arthralgia
  3. fever
  4. sore throat/dysphagia
  5. rhinitis, cough, hoarseness, stomatitis
  6. gradual onset
  7. erythema tonsils/pharynx
  8. reactive cervical lymphadenopathy
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12
Q

Virus-Specific Findings of Pharyngitis: EBV

A

exudate on tonsils, soft palate

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13
Q

Virus-Specific Findings of Pharyngitis: adenovirus

A

follicular pattern on pharynx

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14
Q

Virus-Specific Findings of Pharyngitis: enterovirus

A

vesicles/ulcers on tonsils

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15
Q

Virus-Specific Findings of Pharyngitis: HSV

A

ulcers anteriorly/marked adenopathy

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16
Q

Virus-Specific Findings of Pharyngitis: parainfluenza/RSV

A

more lower tract disease

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17
Q

Diagnostic Studies for acute viral pharyngitis, tonsillitis, or tonsillopharyngitis

A
  1. RADT/culture
  2. GABHS screen if indicated: rare <3 years
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18
Q

Management of acute viral pharyngitis, tonsillitis, or tonsillopharyngitis

A
  1. supportive care
  2. adequate fluid intake
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19
Q

Clinical Findings for acute bacterial pharyngitis, tonsillitis, or tonsillopharyngitis

A
  • 5 to 13 yo most common
  • abrupt onset without nasal symptoms
  • arthralgia, myalgia, HA
  • moderate high fever, malaise
  • prominent sore throat, dysphagia
  • nausea, abd discomfort, vomitting
  • common in late winter/early spring
  • petechiae on soft palate/pharynx, swollen beefy red uvula
  • yellow, blood tinged exudate
  • tender enlarged anterior cervical lymph nodes
  • bad breath
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20
Q

Diagnostic Studies for acute bacterial pharyngitis, tonsillitis, or tonsillopharyngitis

A
  1. RADT
  2. ASO not useful for acute infections
  3. STI testing if indicated
  4. If mononucleosis suspected: CBC, heterophile, antibody testing
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21
Q

Management of for acute bacterial pharyngitis, tonsillitis, or tonsillopharyngitis

A
  1. antibiotics in symptomatic child only
  2. supportive care
  3. NO steroids
  4. return to school when on antibiotics for 24 hours
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22
Q

PANDAS

A

a rare complication of acute bacterial pharyngitis, tonsillitis, or tonsillopharyngitis

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23
Q

5 Criteria to diagnose PANDAS

Study These Flashcards
A
  1. OCD or tic disorder
  2. Perpubertal onset
  3. Abrupt onset; relapsing/remitting course
  4. Clear association with GABHS
  5. Neurologic abnormalities
24
Q

What is rhinosinusitis?

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A

inflammation/edema of mucous membranes in sinuses - bacterial invasion

25
Clinical Findings for Rhinosinusitis
- duration determines classification - acute presentation: high fever, purulent nasal discharge - HA, bad breath, fatigue - facial pain, congestion, post nasal drip
26
Management of Rhinosinusitis
- refer chronic/recurrent to ENT - treat with antibiotics if URI lasts > 10 days with purulent discharge, cough, or worsening fever - NO decongestants - NO antihistamines - NO topical steroids - NO saline irrigation - analgesics
27
Clinical Findings of Nasal Foreign Body
- persistent/recurrent unilateral purulent discharge - foul odor, epistaxis, obstruction, mouth breathing
28
What is croup?
Acute, inflammatory disease of larynx, trachea, bronchi
29
Clinical Findings of Croup
- brassy, barking cough - stridor - URI with acute onset of hoarse, barking cough - mild to severe laryngeal obstruction, stridor - symptoms worse at night - epiglottis appears normal - prolonged inspiration - wheezing/rales if lower airway involvement - fever - slight dyspnea
30
Diagnostic Studies for croup
- clinical diagnoses - subglottic narrowing on radiograph
31
Management of Croup
- humidified air - nebulized epinephrine - corticosteroids - NO cold medicines - bronchodilators - O2 if sat below 92% - heliox for severe croup
32
Indications/Treatment for Hospitalization for Croup
- RR 70-90 - temp higher than 102.2 - racemic epi in conjunction with steroids - hydration & IV fluids
33
What is epiglottitis?
inflammation of epiglottis by H. influenzae type B, usually from 1-5 years
34
Clinical Findings of Epiglottitis
- abrupt onset of fever - severe sore throat - dyspnea - inspiratory distress without stridor - drooling, aphonia, high fever - rapidly progressive resp obstruction - severe retractions - hyperextension of neck
35
Diagnostic Studies for Epiglottitis
1. blood cultures 2. lateral neck radiograph before physical exam with provider capable of intubation present
36
Management of Epiglottitis
- acute otolaryngologic emergency - establish airway; start antimicrobials IV - resp support (O2)
37
Prevention of Epiglottitis
flu vaccine
38
What is bronchiolitis?
Inflammation, necrosis, edema of resp epithelial cells in small airways * Viral illness, primarily RSV
39
Clinical Findings of Bronchiolitis
- URI symptoms - gradual development of resp distress - low grade to moderate fever - decreased appetite - coryza, conjunctivitis, pharyngitis, otitis media - tachypnea, retractions - wheezing, crackles
40
Management of Bronchiolitis
- no bronchodilators - nebulized hypertonic saline for hospitalized infants - no antibiotics - supportive care: hydration, antipyretics - O2 if low sat - nasal suctioning, avoid deep airway suctioning
41
Prevention of Bronchiolitis
- Palivizumab for high risk infants - educate parents about limiting exposure
42
Laryngeal FB
- rapid onset of hoarseness/chronic croupy cough - unilateral wheezing, recurrent pneumonia
43
Tracheal FB
- brassy cough hoarseness, dyspnea, cyanosis - homophonic wheeze
44
Bronchial FB
- most in right lung - blood streaked sputum - initial episode of coughing, gagging, choking - limited chest expansion, decreased vocal fremitus, atelectasis - crackles, rhonchi, wheezes
45
Management of FB aspiration
- Refer to pulm for bronchoscopy - Treat secondary lung infections, bronchospasms
46
What is bronchitis?
- nonspecific inflammation of bronchioles - Caused by influenza, RSV, adenovirus, or parainfluenza
47
Clinical Findings of Bronchitis
- dry, hacking cough - low substernal discomfort, burning chest pain - fam hx of asthma, CF, atopy, infections, irritants - hx of prematurity, GERD - variable rhinitis - low grade or no fever - nasophayngeal infection, conjunctivitis - coarse breath sounds, rhonchi, rales
48
Management of Bronchitis
- supportive care - analgesia, hydration - antivirals if influenza - NO cough suppressants - NO bronchodilators ** Chronic bronchitis may require steroids or bronchodilators
49
Personal History Nonbacterial and Bacterial Pneumonia: Neonate
- hx of group B strep or C. trachomatis infection in mother - prenatal drug use/ lack of prenatal care - C. trachomatous
50
Personal History Nonbacterial and Bacterial Pneumonia: infant
- slower onset of resp symptoms - determine mother's HIV status or exposure to TB
51
Personal History Nonbacterial and Bacterial Pneumonia: Child/Adolescent
- immunization, travel history, TB status - sick contacts - possible FB - hx of mild URI - abrupt high fever - restlessness, shaking chills, apprehension, SOB, malaise, pleuritic chest pain
52
Physical Examination of Nonbacterial and Bacterial Pneumonia
- resp distress - apena, tachycardia - nasal flaring, grunting, retractions - tachypnea, air hunger, cyanosis - fine crackles, dullness, diminished breath sounds
53
Clinical Findings Specific to Bacterial Pneumonia
- fever, hypoxia, lethargy - splinting affected side, tachypnea, retractions - pleural effusion
54
Clinical Findings Specific to Viral Pneumonia
- wheezing - downward displacement of liver/spleen
55
Clinical Findings Specific to Atypical Pneumonia
- repetitive staccato cough - C. trachomatis
56

Pediatrics (12 decks)

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