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41 Cards in this Set
- Front
- Back
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croup
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bug --> parainfluenza
presentation --> barking cough, hoarseness, inspiratory stridor diagnosis --> clinical treatment --> warm moist, nebulized epi, corticosteroids complications --> hypoxia |
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epiglotitis
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bug --> strep pyogenes, strep neumoniae, staph, mycoplasma
medical emergency presentation --> sudden onset high fever, difficulty swalloing, drooling, toxic-appearance, stridor diagnosis --> clinical looking cherry-red swollen epiglotis treatment --> consult ENT and intubate + antibiotics complications --> death |
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bacterial tracheitis
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bug --> staph
presentation --> brassy cough, high fever, respiratory distress, no drooling or dysphagia diagnosis --> clinical + laryngoscopy complicaions --> airway obstruction |
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spasmodic croup
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bug --> viral
presentation --> coryza and hoarseness + sudden onset afebrile croup-like; improves within hours, lasts 2-3 days diagnosis --> clinical treatment --> supportive |
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acute infecitous laryngitis
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bug --> diptheria
presentation --> hoarseness and loss of voice out of proportion to systemic findings, sore throat |
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differential diagnosis of upper airway obstruction
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croup
epiglotitis bacterial tracheitis spasmodic croup acute infectious laryngitis foreign body aspiration retropharyngeal abscess extrinsic compression angioedema |
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laryngomalacia
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congenital anomaly presents with stridor at 2 weeks of life
MCC of stridor clinical suspicion confirmed with laryngoscopy treat with surgery |
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congenital subglottic stenosis
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recurrent persistent croup
2nd MCC of stridor initial test --> x-ray confirm --> laryngoscopy surgery |
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vocal cord paralysis
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associated with meningomyelocele, Chiari, hydrocephalus or acquired
bilateral --> airway obstruction unilateral --> aspiration, cough, choking, weak cry diagnosis --> flexible brnchoscopy resolves in 6-12 months; may require temporal tracheostomy |
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airway foreign body
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presentation --> acute choking, coughing, wheezing, respiratory distress, decreased breath sounds
diagnosis --> chest x-ray reveals air trapping; confirm with bronchoscopy therapy --> removal by bronchoscopy |
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acute bronchitis
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presentation --> dry hacking persistent cough may be purulent; coarse and fine crackles
differential --> exclude pneumonia treatment --> supportive |
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bronchiolitis
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bug --> RSV (50%), parainfluenza, adenovirus, mycoplasma
presentation --> paroxysmal wheezy cough, dyspnea, tachypnea, apnea, fine crackles; most common in <2y/o diagnosis --> clinical; chest x-ray shows patchy atelectasis treatment --> supportive care +- beta2-agonist; no steroids |
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small airway diseases
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bronchiolitis
acute bronchitis |
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stridor differential diagnosis
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laryngomalacia
congenital subglottic stenosis vocal cord paralysis croup |
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upper respiratory infection diffferenatial
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croup
acute infectious laryngitis acute bronchitis bronchiolitis |
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pneumonia etiology
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0-28 days --> GBS, gram-, listeria
3 wk- 3 mo --> C. trachomatis, RSV, parainfluenza 4 mo-4 y --> viruses; RSV; parainfluenza, influenza, adenovirus >5 y/o --> bacteria; mycoplasma, pneumocococcus, C. pneumoniae |
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viral Vs bacterial pneumonia
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onset --> acute in bacterial; several days of URI in viral
temperature --> very high in bacterial URI --> present in viral toxicity --> bacterial rales --> scattered in viral; localized in bacterial WBC --> increased in bacterial chest x-ray --> streaking in viral; lobar in bacterial |
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pneumonia diagnosis
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clinical + x-ray + WBC
definitive --> isolation of virus or antigens in respiratory secretions for viruses; blood culture, pleural fluid or lung for bacteria (not sputum) |
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x-ray in pneumonia
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viral --> hyperinflation with bilateral interstitial infiltrates and peribronchial cuffing
pneumococus --> lobar consolidation mycoplasma or chlamydia pneumoniae --> unilateral lower-lobe interstitial pneumonia looks worse than presentation |
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chlamydia trachomatis pneumonia
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1-3 months
no fever or wheezing staccato cough eosinophilia |
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pneumonia treatment
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empiric amoxicillin for outpatient mild cases
empiric parenteral cefuroxime for hospitalized if viral --> withold treatment if mild; if worsens add antibiotics for mycoplasma of chlamydia --> erythromycin |
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cystic fibrosis pathogenesis
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mutation of CFTR gene renders epithelial cells incapable of secreting chloride with failure to clar mucous secretions produced
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systems mostly affected by cystic fibrosis
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respiratory tract
pancreas intestical glands genitourinary tract |
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intestinal manifestations of cystic fibrosis
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meconium ileus --> in 15-20% of newborns (dilated loops with air fluid levels and ground glass on x-ray)
pancreatic insufficiency --> malabsorption with failure to thrive, frequent bulky greasy stools, ADEK deficiency, DM, pancreatitis hepatobilliary --> obstruction leads to icterus, ascites hepatomegaly rectal prolapse |
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respiratory manifestations of cystic fibrosis
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presentation --> cough and purulent mucus (bronchiectasis), PFT abnormalities, cor pulmonale, death
exam --> increased A-P diameterhyperresonance, rales, clubbing, expiratory wheezing |
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genitourinary presentation of cystic fibrosis
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delayed sexual development
azoospermia, hernias, hydrocele, cryptorchidia secondary amenorrhea, cervicitis, infertility |
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cystic fibrosis diagnosis
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best test --> two sweat tests > 60mEq/L
pancreatic tests --> 72-hour fecal fat collection, trypsin in stools PFT --> obstructive by 5 years then restrictive micro --> staph and pseudomonas in sputum genetic testing newborn screen |
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newborn screen for cystic fibrosis
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1) immunoreactive trypsinogen in blood
2) confirmation with sweat or DNA testing |
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cystic fibrosis management
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clear airways --> salbutamol saline aerosol + human recombinant DNAse (mucolytic); chest physical therapy
antibiotics --> tobramycin (outpatient); tobramycin + piperacillin (inpatient) ibuprofen slows disease; no steroids nutritional --> pancreatic enzymes + ADEK vitamins |
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sudden infant death syndrome definition
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sudden death unexplained by autopsy, forensics or medical history
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sudden infant death syndrome differential diagnosis
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infections
congenital anomaly unintentional injury trumatic child abuse intentional suffocation |
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sudden infant death syndrome reduction of risk
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supine while sleep
cribs with safety standards no soft surfaces or bedding avoid overheating |
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asthma presentation
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diffuese wheezing, expiratory then inspiratory
prolonged expiratory phase decreased breath sounds accesory muscles tachypnea rales/bronchi increased work of breathing |
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asthma diagnosis
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clinical diagnosis in children
lab tests and provocation tests are not required but may be used to follow patient LFT --> gold standard; FEV1/FVC <0.8 with improved FEV1 after beta agonist images --> hyperinflation and flattening of diaphragms; peribronchial thickening |
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mild intermittent asthma
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daytime --> <2x/week
nightime --> >2x/month PFT --> FEV1 >= 80% treatment --> short-acting beta agonist (albuterol, levalbuterol) |
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mild persistent asthma
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daytime >= 2x/week
nightime >= 2x/month PFT --> FEV1 >= 80% treatment --> inhaled steroids + beta agonist for breakthrough |
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moderate persistent asthma
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daytime --> daily
nightime --> >1x/week PFT --> FEV1 60-80% treatment --> inhaled steroids + long-acting beta agonist (salmeterol) +- short-acting beta agonist for breakthrough |
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severe persistent asthma
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daytime --> continually; limited activities
nightime --> frequent LFT --> <= 60% treatment --> high-dose inhaled steroid + salmeterol (long-acting) + albuterol + systemic steroids |
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asthma rapid-onset medications
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beta 2 agonists --> albuterol, levalbuterol (inhaled)
anticholinergics --> ipratropium (less potent than beta 2; use as add-on) |
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long-term asthma medications
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NSAID --> cromolyn; mild-moderate asthma; alternative
long-acting beta agonists --> salmeterol; used in ICS inhaled corticosteroids --> 1st gen: beclomethasone, flunisolide, triamcinolone; 2nd gen: budesonide, fluticasone, mometasone leukotrienes --> inhibitors: zileuton; antagonists: montelukast, zafirlukast systemic steroids --> prednisone, prednisolone |
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emergency management of asthma
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O2
inhaled albuterol +- ipratropium +- corticosteroids PO/IV go home if sustained improvement, SaO2 > 92% after 4 hours in room air if no improvement --> hospitalize and add IV steroids |
