NURP 532 Respiratory Exam Study Guide with Complete Solutions

NURP 532 Respiratory Exam Study Guide with Complete Solutions Croup - Answer-acute viral infection of infants and children with obstruction of the larynx, accompanied by barking cough and stridor Recognize that child has stridor and stridor=airway obstruction. They may appear very ill/toxic w/ abscess, drooling Croup is common in children age 6 to 36 months, peaks in the second year of life, and is rare prior to 3 months of age. In the Northern hemisphere, incidence rises in the late fall and early winter. Parainfluenza (types I, III) account for nearly 70% of cases, but respiratory syncytial virus (RSV), influenza A, adenovirus, metapneumovirus, and measles can also cause croup stridor w/ croup - Answer--Inspiratory stridor is caused by pathology at or above the level of the vocal cords (due to collapse of upper airway soft tissue with negative pressure of inspiration), while expiratory stridor is caused by pathology below the level of the cords (due to decreased airway diameter). EMILLYCHARLOTTE 2024/2025 ACADEMIC YAER ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED FIRST PUBLISH SEPTEMBER 2024 Page 2/14 -Biphasic stridor is indicative of a fixed lesion (due to unchanging airway diameter). Croup Tx - Answer-Therapy recommendations are based on severity: Mild=(no symptoms at rest, no respiratory distress, able to remain hydrated) Home management with emphasis on hydration Consider single oral dose in office of Dexamethasone Moderate=(symptoms at rest, mild respiratory distress but normal mental status, no hypoxia) Single dose in office of Dexamethasone is indicated, may need IM Consider racemic epinephrine; must be evaluated 3-4 hours later if given Needs follow up in 24 hours Severe=(severe symptoms at rest, moderate respiratory distress, change in mental status, inability to maintain oral intake, or hypoxia) Admission Cool mist is controversial, no definitive evidence Epiglotitis - Answer-severe stridor, hyperextended neck, drooling. Prevented by HIB vaccine EMILLYCHARLOTTE 2024/2025 ACADEMIC YAER ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED FIRST PUBLISH SEPTEMBER 2024 Page 3/14 Congenital stridor - Answer-stridor that is limited to inspiration is most commonly due to laryngomalacia. Vocal cord paralysis (due to neurologic disease or intubation from trauma) is the second most common etiology. Subglottic hemangiomas in rapid phases of proliferation should also be considered. biphasic stridor - Answer-fixed obstruction would be expected. This could be evaluated with barium swallow. What physical exam findings do you expect with the flu? - Answer--Appear ill -Erythematous oropharynx -Cough but lung sounds usually normal for flu alone (but consider co-existing pneumonia, asthma/COPD exacerbations) UNCOMMON to have dyspnea; need to consider Covid-19 or complication of flu if this exists How Accurate is the Rapid Antigen Test for Flu? - Answer-Rapid tests for influenza have high specificity (greater than 90%-95%) but are only moderately sensitive (50%-70%, negative test may be false negative) when compared to culture or reverse transcription polymerase chain reaction (RT-PCR) If a negative test is not going to change your treatment, then a "clinical diagnosis" is sufficient during high circulating flu season and no testing is necessary; furthermore, a negative result should not preclude you from giving flu treatment - especially if high risk EMILLYCHARLOTTE 2024/2025 ACADEMIC YAER ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED FIRST PUBLISH SEPTEMBER 2024 Page 4/14 High risk= 65 years old, 2 years old, pregnant, asthma/COPD, diabetes, immunocompromised treatment options for flu - Answer-This patient can be treated with Oseltamivir but Zanamivir should be avoided in patients with asthma and COPD Influenza antiviral medications should be started as soon as possible after symptom onset. These medications have not been shown to be effective if administered more than 48 hours after onset of symptoms, although in someone at high risk for complications there may still be some benefit to initiate after 48 hours of symptoms Oseltamivir (Tamiflu) is approved for treatment in children as young as 2 weeks of age and is active against both influenza A and B Zanamivir (Relenza) is approved for treatment of people 7 years of age and older. It is dispensed as an inhaled powder and is active against both influenza