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92 Cards in this Set
- Front
- Back
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Bronchi; note cartilagenous plates
Bronchioles do not have them and trachea have cartilage rings |
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T= terminal bronchioles
R= respiratory bronchioles A= alveoli AD= alveolar ducts AS= alveolar sacs |
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Tertiary bronchus; note cartilage plates
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Bronchiole; note lack of cartilage plates or C rings; smooth muscle ring
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Alveolar Walls
A= alveoli C= capillaries I= type I alveolar cells II= type II alveolar cells M= alveolar macrophages |
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Community Acquired Pneumonia
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Community acquired (outside of hospital)
Acute fever, cough with mucopurlulent sputum; leukocytosis with a left shift |
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Good sputum sample
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A “good” sputum sample will have polymorphonuclear leukocytes but a low to absent number of squamous epithelial cells on gram stain
Left picture has too many squamous epithelial cells; right = gram positive diplococci consistenw tih streptococcus pneumoniae |
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Klebsiella Pneumoniae
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Commonly affects debilitated and malnourished individuals (alcoholics);
Can cause tissue necrosis (hemoptysis, dense lobar consolidation, abscess formation) Causes a thick gelatinous sputum ("CURRANT JELLY)" since the orgainsm produces a viscid capsular polysaccharide |
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Pseudomonas Aerguinosa
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Cystic fibrosis patients whoa re immunocompromisedl tendency to invade blood vessels with subsequent extrapulmonary spread
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Alcoholic with a red jelly like sputum
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Klebsiella pneumoniae
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Cystic fibrosis pt with HIV
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Pseudomonas aerguinosa
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Legionalle Pneumophilia
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Survives well in water; aerosilized organisms or aspiration of contaminated drinking water; organ transplant pts and smokers; immunocompromised pts can have mortality rates up to 50%
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Organ transplant pt with a history of smoking and also somehow an olympic swimmer (phelps)!
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Legionella Pneumophilia
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Haemophilus Influenzae
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Pleomorphic, gram negative organism
Common cause of meningitis in children up to 5 years of age prior to development of its vaccine; acute conjunctivitis in children Secretes a protease that degrades IgA |
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4 year old with meningitis; his mother does not believe in vaccines
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Haemophilus Influenzae
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Lobar Pneumoniae; gray hepatization; lwoer lobe is uniformly consolidated
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Lobar Pneumonia; This PA chest radiograph shows diffuse right upper lobe consolidation. This particular patient had lobar pneumonia due to S. pneumoniae
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Bronchopneumonia; arrows indicate patches of consolidation
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Bronchopneumonia; patchy sonsolidation in the left upper and lower lobes
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Stages of Lobar Pneumonia
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Congestion (red, boggy heavy) -> red hepatization (liver like consistency, red, firm, airless) -> gray hepatization (gray/brown and dry, fibrinosuppurative exudate) -> resolution
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Empyema
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Spread of infection to the pleural capillary; collection of pus in space between the lung and inside of chest wall
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Abscess Formation
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Associated with Klebsiella infection
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Most common cause of community acquired artpical pneumonia
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Mycoplasma Pneumoniae
Thickened alveolar walls are infiltrated with mononuclear leukocytes |
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Influenza (community acquired atypical) pneumonia is associated with what in children
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Reye's syndrome (acute encephalopathy and fatty liver in children who have ingested asprin)
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Pneumonia Symptoms
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Worsening cough, purulent or bloody sputum, dyspnea and rales
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Severe Acute Respiratory Syndrome
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Coronovirus; infects lower respiratory tract and spreads throughout the body
10% mortality |
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hospital Acquired Pneumonia
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48 hours after admission; pts on mechanical ventilators at highest risk; same s/s as community acquired
most commonly gram negative rods and staph aureus |
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Aspiration Pneumonia
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seizures, anesthesia, CS disease, decreased consciousness, NG tubes
usually more than one organism is seen; sputum can be malodorous; lung abscess is a common complication |
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With foul smelling sputum
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Lung Abscess; note focus of parenchymal lung destruction
Complications: extension into pleural cavity, hemorrhage, brain abscess or meningitis |
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Lung Abscess
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Note the large cavity with air fluid level in the right upper lobe
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Fungal infection in midwestern states located in the Ohio and Mississippi River valleys
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Histoplasmosis (bird/bat droppings, targets macrophages)
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Histoplasmosis
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Bird/bat droppings; targets macrophages; bad in immunocompromised patients
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Histoplasmosis; note yeast forms filling phagocytes in a lympho node of a person with disseminated histoplasmosis
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Blastomysis location
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Soil inhabiting, dimorphic fungus
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Blastomycosis; yeast cell that divides by broad based budding; thick walls
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Coccidiomycosis
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Exists as a mold in soil and spherule in tissue
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Coccidiomycosis
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Exists as a mold in soil and spherule in tissue
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Thick walled nonbudding spherules; often filled with endospores
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Coccidiomycosis arthrospore
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Coccidiomycosis spherule; Endospores form within spherules in tissue; when the spherules rupture the endospores disseminate and form new spherules
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Obstructive Diseases
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Resistance to outflow due to obstruction
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COPD
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COPD
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Applied to pts who have emphysema, chronic bronchitis, or a combo of the two
A. Chronic bronchitis (excessive secretions) B. Thickened airway by edema or muscle hypertrophy C. Emphysema;; destruction of lung parenchyma = loss of radial traction |
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Emphysema
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Irreversible enlargement of airspaces; macrophages suck up smoke; damage airspace
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Emphysema Classification
A = alveolus RB = respiratory bronchiole TB = terminal bronchiole |
Centriacinar: heavy smokers
Paracinar: alpha-1 antitrypsin deficiency Distal acinar (paraseptal): distal portoin of acinus predominantly involved Irregular: acinus irregularly involved, associated with scarring |
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Normal lung
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Emphysema; loss of alveolar walls and dilated airspaces
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Subpleural bullae which can occur in emphysema
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Left: centriacinar emphysema; E = damage surrounded by spared alveolar spaces
right is Paracinar emphysema which is involving the entire pulmonary lobole |
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Emphysema morphology
a. normal b. centriacinar c. centriacinar d. paracinar e. paracinar |
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Pink Puffers
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emphysema;
these pts experience dyspnea, minimal, nonproductive cough (cuz its not bacterial, barrel chested and pursed lips Bc of their higher respiratory rate and increased minute volume they maintain arterial hemoglobin sats and are called pink puffers |
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Emphysema; flattening diaphragm
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Chronic Bronchitis Pathogenesis
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Tobacco smoke irritation -> hypersecretion of mucous and hypertrophy of submucosal glands (goblet cell hyperplasia)
Can be obstructive to the airway |
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Reid Index
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Measure of the size of mucous glands
ratio of thickness of mucous gland layer to thickness of the wall between the epithelium and cartilage; normally 0.4 or less; in chronic bronchitis it is more than 0.5 |
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Pulmonary Edema; intraalveolar fluid, engorged capillaries, hemosiderin laden macrophages (heart failure cells)
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Pulmonary Edema; intraalveolar fluid, engorged capillaries, hemosiderin laden macrophages (heart failure cells)
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Pulmonary Edema
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Fluid accumulation in lungs bc of starling forces (hydrostatic pressure from LSHF, stenosis)) or endothelial injury or increased capillary permeability (infection, drugs, shock);
Gross: wet, heavy lungs usually worse in lower lobes |
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Congestive Heart Failure
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Insufficient cardiac output to meet the metabolic demand of the body's tissues and organs
Forward failure = decreased organ perfusion Backward failure = passive congestion of organs |
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Left Sided Heart Failure
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Causes pulmonary congestion/edema
Sx: SOB, exertoinal dyspnea which progresses to orthopnea, paroxysmal nocturnal dyspnea, dyspnea at rest |
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Cor Pulmonale
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pulmonary heart disease is enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lungs.
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Nutmeg Liver
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Passive congestion of the portal system from right sided CHF; passive congestion around central veins = darker red/brown lobular center with pale peripheral zone
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Nutmeg Liver; seen in chronic passive congestion due to RCHF; dark areas = accumulated red blood cells in centrilobular area
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Nutmeg liver; congestion around central vein with pale peripherals
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Primary Cardiomyopathies
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Disorders confiend to heart muscle; cardiac enlargement with dilation of all four chambers resulting in progressive CHF
Associated with dystrophin mutations |
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Secondary Cardiomyopathies
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myocardium is involved as part of a systemic or multiorgan disorder; cardiac enlargement with dilation in all four chambers resulting in progressive CHF
Associated with dystrophin mutations |
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Doxarubicin
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Chemotherapeutic drug; causes dose dependent cardiotoxicity = dilated cardiomyopathy
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Dilated Cardiomyopathy
Arrow shows mural thrombus Note variable myocyte hypertrophy and intestitial fibrosis |
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Restrictive Cardiomyopathy
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Caused by dz that produce restriction of cardiac filling during diastole (decrease in ventricular compliance) (amyloidosis, sarcoidosis, endomyocardial fibroelastosis, Loeffler endomyocarditis)
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Endocardial Fibroelastosis
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Endomyocadial fibrosis; cause of restrictive cardiomyopathy
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Cardiac Sarcoidosis; cause of restrictive cardiomyopathy
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Hypertrohic Cardiomyopathy; note septum bulging into left ventricular outflow tract
note disarray and branching of myocytes; also there is intestitial fibrosis |
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Hypertrophic Cardiomyopathy Pathophysiology
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HCM due to mutations in genes that encode sarcomeric proteins
Most common = B-MHC (beta myosin heavy chain) |
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Dz that causes sudden cardiac death in athletes
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Hypertrophic Cardiomyopathy
There may be a harsh systolic ejection murmur caused by ventricular outflow obstruction |
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PUlmonary Hypertension
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Mutation in BMPR2 signaling inhibits proliferation and favors apoptosis; mutation = smooth muscle survival and proliferation
Caused by recurrent PEs = increased pulmonary resistance = may lead to cor pulmonale (pulmonary heart dz/RCHF) |
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Pulmonary htn; medial hypertrophy of muscular and elastic arteries
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Pulmonary Embolism; infarcts extend to periphery of lung in shape of a wedge
955 arise from DVT; saddle emboli can = sudden death |
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w sudden onset of dyspnea, hypoxemia and hypotension
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Pulmonary Embolism in both main pulmonary arteries
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How can multiple PE result in pulmonary hypertension?
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Emboli often resolve by contraction and fibrinolysis; unresolved emboli can = pulm htn, vascular sclerosis and chronic cor pulmonale
a small emolus may harbinger a larger one |
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Acute Respiratory Distress Syndrome/Acute Lung Injury
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Diffuse damage of alveolar epithelium and capillaries, resulting in progressive respiratory failure that is unresponsive to oxygen tx; likely due to uncontrolled neutrophil activation
CXR: Bilateral lung opacity ("white out") |
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ARDS
Lungs are hevy and firm Note alveolar hyaline membranes are composed of fibrin rich fluid mixed with necrotic epithelial cell debris Note that many of the alveoli are lined by hyaline membranes |
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ARDS; bilateral lung opacity (white out)
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Pneumothorax; air in pleural cavities
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Spontaneous Pneumothorax
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Young adults with rupture of emphysematous blebs; air in pleural cavity
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Tension Pnemothorax
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Life threatening shift of thoracic organs across midline; rupture acts as one way valve and air enters pleural cavity but does not exit
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most common cause of epiglottitis
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bacterial infection of epiglottis/surrounding tissues; respiratory obstruction;
H. influenzae |
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Child with fever, sore throat, dysphagia and drooling; child sits upright, leans forward and hyperextends the neck
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Epiglottitis
Laryngoscopy visualizes "cherry red" epiglottis |
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Epiglottitis; thumb sign
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most common pathogenic cause of croup
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Parainfluenza viruses (esp type 1)
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Croup; Steeple sign; narrowing of the airway
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Croup
Steeple's sign |
Pts 6 months - 3 yrs of age; inflammation of the larynx, trachea, bronchi, bronciholes, and lung parenchyma
Obstruction due to inflammation and swelling becomes pronounced in the subglottic region Most commonly caused by parainfluenza virus Often preceded by URI; barking cough/hoarseness, worse at night Inspiratory stridor |