Podcast Beta
Questions and Answers
Which of the following is the most appropriate intervention?
Which of the following best describes the laboratory evaluation of a patient diagnosed with acute myeloid leukemia?
A 20-year-old woman complains of easy fatigability. What is the most likely diagnosis based on the physical examination?
What are the presentations for which a comprehensive differential diagnosis should be established?
Signup and view all the answers
Which of the following is NOT a reason for a chest x-ray (CXR) interpretation?
Signup and view all the answers
What is the method of obtaining Arterial Blood Gases (ABGs)?
Signup and view all the answers
Define acidosis in relation to arterial blood gas findings.
Signup and view all the answers
Which acid-base disorder is most likely for a patient with these ABG results: pH 7.22, PaCO2 33, HCO3 16?
Signup and view all the answers
What is the main cause of upper respiratory tract infection (URI) in children?
Signup and view all the answers
RSV stands for _____
Signup and view all the answers
Match the following diagnostics to their indications:
Signup and view all the answers
D-dimer is used to exclude the diagnosis of pulmonary embolism (PE).
Signup and view all the answers
When is pulmonary function testing (PFT) contraindicated?
Signup and view all the answers
What are the common symptoms of pneumonia?
Signup and view all the answers
What can cause blunting of the costophrenic angles on a chest X-ray?
Signup and view all the answers
Which condition is associated with widening of the mediastinum?
Signup and view all the answers
What finding on a chest X-ray is likely to signify a significant pulmonary infiltrate?
Signup and view all the answers
What is the most likely presentation in a patient who has aspirated a foreign body?
Signup and view all the answers
What is the main characteristic of pleural effusion on a chest X-ray?
Signup and view all the answers
What should be checked to evaluate for the presence of foreign bodies on a chest X-ray?
Signup and view all the answers
Which of the following findings is most indicative of potential Lyme disease after a tick bite?
Signup and view all the answers
In assessing the great vessels on a chest X-ray, what condition could indicate abnormal findings?
Signup and view all the answers
What laboratory finding is most commonly associated with acute myeloid leukemia?
Signup and view all the answers
Which evaluation technique is employed to check for infiltrates and masses on a chest X-ray?
Signup and view all the answers
In a patient exhibiting a fixed split second heart sound and a systolic ejection murmur, which condition is most likely responsible?
Signup and view all the answers
Which condition is characterized by significant bleeding alongside a low platelet count and various cell precursors in the bloodstream?
Signup and view all the answers
What is the purpose of checking the position of the gastric bubble on a chest X-ray?
Signup and view all the answers
Which group of patients requires admission for bronchiolitis treatment?
Signup and view all the answers
What is the most common bacterial cause of pneumonia in children?
Signup and view all the answers
Which of the following symptoms is indicative of pneumonia in an infant?
Signup and view all the answers
In diagnosing pneumonia, elevated white blood cell count (WBC) can assist in identifying what aspect?
Signup and view all the answers
What might be a limiting factor for performing a chest X-ray in outpatient children suspected of pneumonia?
Signup and view all the answers
What is the initial treatment approach for a patient with pneumonia who shows hypoxemia?
Signup and view all the answers
Which age group is most commonly affected by foreign body aspiration?
Signup and view all the answers
What do crackles and rhonchi on auscultation typically indicate in pneumonia patients?
Signup and view all the answers
Which diagnostic method is mainly avoided in children with suspected pneumonia due to its invasiveness?
Signup and view all the answers
What is the primary indication for performing pulmonary function tests (PFTs)?
Signup and view all the answers
In what scenario would a patient with pneumonia likely receive antibiotics?
Signup and view all the answers
Which result from a PFT indicates the presence of obstructive lung disease?
Signup and view all the answers
What is the primary purpose of a CT scan's Hounsfield Units?
Signup and view all the answers
In which scenario are pulmonary function tests (PFTs) contraindicated?
Signup and view all the answers
What characteristic of a CT scan allows for viewing small structures?
Signup and view all the answers
What role do CT windows play in CT imaging?
Signup and view all the answers
Forced vital capacity (FVC) measurements primarily help diagnose which types of lung diseases?
Signup and view all the answers
What is the primary imaging technique for assessing lung vascular occlusions?
Signup and view all the answers
Which of the following is not a common complication associated with pulmonary function testing?
Signup and view all the answers
What distinguishes a spiral or helical CT scan from a conventional CT scan?
Signup and view all the answers
What is a potential complication when using D-dimer testing?
Signup and view all the answers
What is the primary use of a VQ scan in pulmonary diagnostics?
Signup and view all the answers
Which of the following best describes the nature of CT scans concerning their invasiveness?
Signup and view all the answers
In which scenario is D-dimer testing least likely to provide accurate results?
Signup and view all the answers
What procedure is generally used to collect sputum in patients unable to provide a sample voluntarily?
Signup and view all the answers
When would a cardiopulmonary exercise stress test be most appropriate?
Signup and view all the answers
What is a significant limitation of sputum culture in pulmonary diagnostics?
Signup and view all the answers
What does a mismatch in a VQ scan indicate?
Signup and view all the answers
How does a cardiopulmonary exercise stress test evaluate cardiac function?
Signup and view all the answers
What is the primary purpose of obtaining intravenous contrast in a CT scan?
Signup and view all the answers
Study Notes
Pulmonary DDX
- Common differential diagnosis for the following presentations: cough, dyspnea, hypoxemia, sputum production, hemoptysis, and clubbing
Chest X-Ray: Indications
- Infection: exclude pneumonia, positive Mantoux test
- Major trauma: exclude widened mediastinum, pneumothorax and hemothorax
- Acute chest pain: exclude pneumothorax, perforated viscus, aortic dissection
- Asthma/bronchiolitis: when diagnosis unclear and/or not responding to usual therapy
- Acute dyspnea: exclude heart failure, pleural effusion
- Chronic dyspnea: exclude heart failure, effusion and interstitial lung disease
- Hemoptysis
- Suspected mass, metastasis or lymphadenopathy
CXR Interpretation: AP vs PA
- Posterior-anterior (PA) view is ideal
- PA view allows for less heart magnification and better lung visualization
- Anterior-posterior (AP) view is often used in patients who cannot stand or in cases where the PA view is not possible
CXR Interpretation: Systematic Approach
- A - Assessment of Quality/Airway: Check position, inspiration, exposure, rotation, and indwelling lines/objects (ie ETT).
- B - Bones and Soft Tissues: Check for symmetry, fractures, lesions in bones. Check soft tissue for FB, edema, subcutaneous air.
- C - Cardiac: Evaluate heart size, check heart shape, calcifications, prosthetic valves.
- D - Diaphragm: Check position, look below the diabetic for free air.
- E - Effusions: Check costophrenic angles, check lateral film for small posterior effusions.
- F - Fields, Fissures & Foreign Bodies: Check for infiltrates, masses, consolidations, pneumothoraces & vascular markings. Evaluate fissures, check for FB (lines, surgical markings).
- G - Great Vessels & Gastric Bubble: Check aortic size/shape, check outline pulmonary vessels, verify gastric bubble position.
- H - Hila and Mediastinum: Evaluate hila for lymphadenopathy, calcifications & masses. Check widening of mediastinum, check tracheal deviation.
- I - Impression: Synthesis of all these findings
CXR Interpretation: Anatomical Review
- Right hemidiaphragm is slightly higher than left due to the presence of the liver.
- Loss of heart border may be due to an infiltrate.
CXR: Fluid Specifics
- Pulmonary infiltrate: Fluid or material fill the spaces within the lungs, where air should be. Etiologies include pneumonia, pulmonary edema.
- Pleural effusion: Fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Etiologies include heart failure, infection, cancer.
CXR: Invasiveness/Potential Complications
- Non-painful, non-invasive
- Small level of radiation, equivalent to that which naturally occurs in the environment
PFTS: Indications
- Evaluation for chronic cough, dyspnea
- Assessment & monitoring of disease severity & progression
- Monitoring for drug efficacy
- Pre-operative assessment
PFTS: Interpretation
- Forced vital capacity (FVC): Maximum air inhaled & exhaled, decreased in restrictive & obstructive lung disease.
- Forced expiratory volume in 1 sec (FEV1): Max volume of air exhaled in 1 sec, decreased in obstructive lung disease, normal or slightly decreased in restrictive lung disease.
- FEV1/FVC ratio: Decreased in obstructive, normal in restrictive.
PFTS: Invasiveness/Potential Complications
- Non-invasive but requires capacity for deep breathing
- Contraindicated in any acute event (ie MI, PE) or active TB given potential spread
CT Scan: Indications
- Lung Disease: ie complex chest infection (abscess, empyema), complex pleural disease
- Vascular Occlusions (ie PE)
- Cancer diagnosis and staging
- Trauma
CT Scan: Interpretation
- Radiation through the body creates an “electron stream” which is converted to numbers (Hounsfield Units) 🡪 those numbers are converted into the black, white and shades of gray picture we view.
- CT can take “pictures” from 1mm-10mm thick slices
- Spiral or helical CT scan is the most common
CT Scan: Invasiveness/Potential Complications
- Non-invasive but has radiation dose
- Standard is with IV contrast
- Possible contraindications: History of reaction to contrast agents, Pregnancy, Renal dysfunction
VQ Scan: Indications
- = Ventilation (V) & perfusion (Q) nuclear medicine scan
- Diagnostic for PE when CTA contraindicated but not as accurate
- Assess for viability of good lung prior to lobe resection
VQ Scan: Interpretation
- Looking for a mismatch between ventilation & perfusion
- This mismatch is suggestive of a pulmonary embolism
VQ Scan: Invasiveness/Potential Complications
- Non-invasive w/ lower radiation levels
- Patient needs to inhale radioactive isotope through non-rebreather mask & also have isotope injected IV for imaging
- Not as accurate for PE dx as CTA
D-Dimer: Indications
- = fibrin degradation byproduct
- Exclude diagnose of PE/DVT
- Part of DIC diagnosis
D-Dimer: Interpretation
- Highly sensitive but low specificity
- Part of Wells Criteria for VTE work-up
D-Dimer: Invasiveness/Potential Complications
- Serum blood draw
- In appropriate use of this lab can cause escalated imaging
Cardiopulmonary Exercise Stress Testing: Indications
- Evaluation of exercise tolerance in patients with cardiovascular disease or chronic pulmonary disease
- Unexplained dyspnea
- Evaluation children and adolescents with congenital heart disease
- Pre-operative evaluation prior to heart or lung transplantation, lung resection surgery
- Functional and prognostic evaluation of persons with
Cardiopulmonary Exercise Stress Testing: Interpretation
- Measures O2 uptake (VO2), carbon dioxide production (VCO2) and ventilation parameters during exercise
- Cardiac stress test at the same time
Cardiopulmonary Exercise Stress Testing: Invasiveness/Potential Complications
- Requires capacity for cycle or treadmill
- Potential complications: Fatigue, SOB, bronchospasm, cardiac arrhythmia, syncope
Sputum Culture: Indications
- Bronchiectasis
- Pulmonary abscess
- VAP
- Unresolving ICU PNA
- Cavitary opacities
- PNA in immunocompromised pts
Sputum Culture: Interpretation
- Can aid in taper of HAP abx therapy from empiric to culture directed
Sputum Culture: Invasiveness/Potential Complications
- Deep cough to facilitate sputum sample
- If patient unable to voluntary give sputum, obtained via bronchoscopy or ETT
WBC & Differential
- Can be helpful in identifying infection, especially with bacterial pneumonia where there may be a leukocytosis and neutrophil predominance.
Bronchoscopy: Indications
- Persistent cough
- Unresolving infection
- Bronchial obstruction
- Potential malignancy on imaging
- Hemoptysis
- Concern for FB
Bronchoscopy: Interpretation
- Allows view of respiratory tract
- Take samples for culture, cytology, biopsies
- Ability to remove foreign bodies
Bronchoscopy: Invasiveness/Potential Complications
- Sedated but awake
- Potential complications: bleeding, pneumothorax, infection
Oximetry: Indications
- Measures O2 saturation as light passes through blood in finger
- During/after sedation
- Acute pulmonary or cardiac complaint
Oximetry: Interpretation/ Invasiveness/Potential Complications
- Normal 95-100%
Arterial Blood Gas (ABG) Interpretation
- Step 1: Is pH abnormal?
- Step 2: Is the respiratory (PaCO2) or metabolic (HCO3-) component abnormal? Does it correlate with the pH change?
- Step 3: Is there compensation? This means the opposite system (respiratory or metabolic) is working to correct the imbalance.
- Step 4: What does PaO2 tell you? This measures the partial pressure of oxygen in the arterial blood and is a measure of how well oxygen is being transferred from the lungs to the blood.
Respiratory Acidosis
- pH low < 7.35
- PaCO2 high > 45 mmHg
- HCO3- normal (22-26 mEq/L)
- Causes: Impaired lung function, decreased respiratory rate
Respiratory Alkalosis
- pH high > 7.45
- PaCO2 low < 35 mmHg
- HCO3- normal (22-26 mEq/L)
- Causes: Hyperventilation, anxiety , pain
Metabolic Acidosis
- pH low < 7.35
- PaCO2 normal (35-45 mmHg)
- HCO3- low < 22 mEq/L
- Causes: Loss of bicarbonate, increased production of acid
Metabolic Alkalosis
- pH high > 7.45
- PaCO2 normal (35-45 mmHg)
- HCO3- high > 26 mEq/L
- Causes: Increased bicarbonate, loss of acid
ABG Interpretation Steps: Practice
- #1: Is pH abnl?______
- #2: Is respiratory (PaCO2) or metabolic (HCO3-) component abnl? Does it correlate w/ pH change?______
- #3: Is there compensation?IE does the opposite system respiratory or metabolic working to correct?______
- #4: What does PaO2 tell you?______
Board question:
A 36-year-old female is brought to the emergency department with altered mental status. Her medical record reflects that she has a history of depression and suicide attempts in the past. Physical exam is significant for tachypnea with an alcohol smell to her breath. ABG results: pH: 7.22, pCO2: 33, HCO3: 16, pO2: 93, Anion Gap: 24. Which of the following acid-base disorders is most likely?
- A. Metabolic acidosis
- B. Metabolic alkalosis
- C. Respiratory acidosis
- D. Respiratory alkalosis
Upper Respiratory Tract Infection: Essentials
- = common cold = URI
- Children highly susceptible given lack of previous infection immunity & close contact.
- Etiology MC rhinovirus, also RSV, coronavirus, coxsackie, adenovirus etc.
- Peak fall to spring season
- 1-3 days from exposure to infection
Upper Respiratory Tract Infection: Diagnosis
- Sxs: rhinorrhea, nasal congestion +/- fever, sore throat, occasional non-productive cough
- PE: Swollen, erythematous nasal turbinates
- Clinical diagnosis, no labs or diagnostics
Upper Respiratory Tract Infection: Treatment
- Resolves in 5-7 days
- No antibiotics
- 5% children will develop AOM
- Symptomatic mgmt
Bronchiolitis: Essentials
- Small bronchioles w/ increased mucus & occasional bronchospasm
- 4-6 day incubation
- Etiology usually viral LRTI, RSV is MC.
- MC in infants & young kids < 2 ya, peak 2-6 mos
Bronchiolitis: Diagnosis
- Sxs: progressive sxs, starts w/ cold like cough/rhinorrhea 🡪 raspy breathing & wheezing, fever. RSV may not have prodrome & apnea is 1st sx.
- PE: prolonged expiratory phase, ↑ work of breathing (intercostal retractions, nasal flaring)
- Auscultation: diffuse wheeze & crackles
Bronchiolitis: Diagnosis
- Labs not required for dx
- Pulse oximetry check
- Nasopharyngeal swab for common pathogens done to confirm infection
- CXR if obtained shows hyperinflation, flattened diaphragms
Bronchiolitis: Treatment
- Admit if: High risk, marked respiratory distress, hypoxemia, apnea, inability to tolerate oral feeds.
- Supportive therapy: Respiratory monitoring, antipyretics, hydration, upper airway suctioning, O2 prn.
Pneumonia: Essentials
- LRTI of airways & parenchyma w/ consolidation of alveolar spaces
- MC Streptococcus pneumoniae.
- Also RSV, parainfluenza, influenza, adenovirus
- Mycoplasma pneumoniae > 5 ya
Pneumonia: Diagnosis
- Sxs: cough, wheezing, hemoptysis, chest pain, abdominal pain, failure to thrive, F/C
- PE: Fever, tachypnea, retractions, splinting. Auscultation: crackles, rhonchi over consolidation.
- CBC: ↑ WBC, utilize diff to help delineate etiology
Pneumonia: Diagnosis
- Clinical dx in outpatient children
- Hospitalized pts: CXR, blood cultures
Pneumonia: Treatment
- Admit w/ hypoxemia, inability to maintain hydration or moderate respiratory distress. Pts < 6 mos old w/ bacterial PNA or care concerns.
- When bacterial, tx w/ abx therapy
Foreign Body Aspiration: Essentials
- Usually < 3 ya
- Most commonly lodge in the right main bronchus
- Most often small food & toys
Foreign Body Aspiration: Diagnosis/Treatment
- Sxs: cough, stridor, hemoptysis, may have history of choking, witnessed event
- PE: localized wheezing or unilateral absence of breath sounds
- Imaging: Radiopaque objects visualized, note focal air trapping
- Bronchoscopy for FB removal
Dermatology Review
-
A 25-year-old male reports he went hiking a week ago. At the end of the day, his friend noticed a tick on him and removed it. The patient now reports fever, chills and body aches and has a skin lesion where the tick bit him. The lesion has a red border with central clearing. Which of the following is the most appropriate intervention?
-
C. Doxycycline
-
A. Acetaminophen
-
B. Ceftriaxone
-
D. Erythromycin
-
E. Rifampin
Hematology Review
-
Which of the following best describes the laboratory evaluation of a patient diagnosed with acute myeloid leukemia?
-
D. Pancytopenia with circulating blasts and presence of Auer rods
-
A. Elevated WBC > 10,000, Philadelphia chromosome
-
B. Isolated lymphocytosis, lymphocytes appear small & immature
-
C. Pancytopenia & hairy cells
Cardiology Review
-
A 20-year-old woman complains of easy fatigability. Physical examination reveals a systolic ejection murmur best heard over the pulmonic region and a fixed split second heart sound. Which of the following is the most likely diagnosis?
-
C. Atrial septal defect
-
A. Aortic stenosis
-
B. Ventricular septal defect
-
D. Mitral regurgitation
-
E. Tricuspid regurgitation
CXR Interpretation: Anatomical Review
- Check position of the endotracheal tube
- Look below the diaphragm for free air
- Check costophrenic angles for blunting which may indicate a small pleural effusion
- Check the lateral film for small posterior effusions
- Evaluate for infiltrates
- Identify any masses, consolidations, pneumothoraces, and vascular markings
- Assess the fissures
- Check for foreign bodies like lines or surgical markings
- Evaluate the aortic size and shape
- Check the outline of the pulmonary vessels
- Verify the position of the gastric bubble
- Evaluate the hila for lymphadenopathy, calcifications, and masses
- Check for widening of the mediastinum which can be associated with a variety of conditions
- Check for tracheal deviation: this can indicate a mass effect or tension pneumothorax
- Summarize all findings in the impression for comprehensive understanding
CXR: Fluid Specifics
- Pulmonary infiltrate: fluid or material filling the lung spaces
- Pleural effusion: fluid accumulating between the two pleural layers, surrounding the lungs
CXR: Invasivness/Potential Complications
- Non-invasive and painless
- Can be performed bedside or in the X-ray unit
- Patients should be still in a gown, take a deep breath, and hold it with arms above their heads
- Involves a small level of radiation, equivalent to environmental levels
PFTS: Indications
- Evaluation of chronic cough and dyspnea
- Assessment and monitoring of disease severity and progression
- Monitoring drug efficacy
- Pre-operative assessment
PFTS: Interpretation
- Forced vital capacity (FVC): maximum air inhaled and exhaled
- Decreased FVC suggests restrictive or obstructive lung disease
- Forced expiratory volume in 1 second (FEV1): maximum volume of air exhaled in one second
- Decreased FEV1 strongly suggests obstructive lung disease
- Normal or slightly decreased FEV1 may suggest restrictive disease
- FEV1/FVC ratio: decreased ratio suggests obstructive disease, normal ratio suggests restrictive disease
PFTS: Invasivness/Potential Complications
- Non-invasive but requires the ability to take deep breaths
- Contraindicated in acute events like myocardial infarction, pulmonary embolism, or active tuberculosis due to potential spread
CT Scan: Indications
- Lung disease like complex chest infections (abscess, empyema), or complex pleural disease
- Vascular occlusions, like pulmonary embolism
- Cancer diagnosis and staging
- Trauma
CT Scan: Interpretation
- Radiation through the body creates an electron stream that is converted to numbers (Hounsfield Units), which are then displayed as a black, white, and gray image, representing density data
- CT scans can take pictures from 1 mm to 10 mm thick slices
- 1 mm: small structures like the inner ear
- 10 mm: large structures in the abdomen and chest
- Spiral or helical CT scan is the most common type
- CT windows: display settings (ie. lung window, bone window) that manipulate the appearance of the image
- The mouse allows you to center the window on the desired tissue and adjust the ability to distinguish objects with varying contrast
CT Scan: Invasivness/Potential Complications
- Non-invasive but involves a radiation dose
- Standard CT scans involve IV contrast
- Contrast: iodine that causes varying degrees of x-ray absorption, improving visualization
- Possible contraindications to contrast:
- History of reaction to contrast agents
- Pregnancy
- Renal dysfunction
VQ Scan: Indications
- Ventilation (V) and perfusion (Q) nuclear medicine scan
- Used to diagnose pulmonary embolism when CTA is contraindicated
- Assess the viability of good lung tissue before lobe resection
VQ Scan: Interpretation
- Looks for a mismatch between ventilation and perfusion
VQ Scan: Invasivness/Potential Complications
- Non-invasive with low radiation levels
- Patients inhale a radioactive isotope through a non-rebreather mask and also have an isotope injected intravenously for imaging
- Not as accurate for pulmonary embolism diagnosis as CTA
D-Dimer: Indications
- Fibrin degradation byproduct
- Used to exclude the diagnosis of pulmonary embolism or deep vein thrombosis
- Part of disseminated intravascular coagulation (DIC) diagnosis
D-Dimer: Interpretation
- Highly sensitive but low specificity, meaning it has a high number of false positives
- Part of the Wells Criteria for VTE work-up
D-Dimer: Invasivness/Potential Complications
- Serum blood draw
- Inappropriate use of this lab test can lead to escalated imaging and unnecessary investigations
- Avoid ordering D-dimer tests when the results are likely to be positive (ie. post-operative, trauma, infectious)
Cardiopulmonary Exercise Stress Testing: Indications
- Evaluation of exercise tolerance in patients with cardiovascular disease or chronic pulmonary disease
- Unexplained dyspnea
- Evaluation of children and adolescents with congenital heart disease
- Pre-operative evaluation prior to heart or lung transplantation, lung resection surgery
- Functional and prognostic evaluation of persons with
Cardiopulmonary Exercise Stress Testing: Interpretation
- Measures oxygen uptake (VO2), carbon dioxide production (VCO2), and ventilation parameters during exercise
- Cardiac stress testing can be performed simultaneously
Cardiopulmonary Exercise Stress Testing: Invasivness/Potential Complications
- Requires the ability to cycle or use a treadmill
- Potential complications: fatigue, shortness of breath, bronchospasm, cardiac arrhythmia, syncope
Sputum Culture: Indications
- Bronchiectasis
- Pulmonary abscess
- Ventilator-associated pneumonia (VAP)
- Unresolving intensive care unit (ICU) pneumonia
- Cavitary opacities
- Pneumonia in immuncompromised patients
Sputum Culture: Interpretation
- Can assist in tapering antibiotic therapy from empiric to culture-directed treatment
- Not ideal for all pathogens
Sputum Culture: Invasivness/Potential Complications
- Requires a deep cough to facilitate sputum sample
- If a patient is unable to produce sputum voluntarily, it can be obtained via bronchoscopy or endotracheal tube
WBC and Differential: Indications
- Indicate the presence of infection
- Indicate the presence of inflammation
- Help differentiate between bacterial and viral etiologies
Bronchiolitis: Treatment
- Admission criteria:
- High-risk patients: premature, lung or heart disease, immunodeficiency
- Marked respiratory distress
- Hypoxemia
- Apnea
- Inability to tolerate oral fluids
- Supportive therapy
- Respiratory monitoring
- Antipyretics
- Hydration
- Upper airway suctioning
- Oxygen as needed
Pneumonia: Essentials
- Lower respiratory tract infection of the airways and parenchyma with alveolar consolidation
- Most common cause: Streptococcus pneumoniae
- Other causes: respiratory syncytial virus (RSV), parainfluenza, influenza, adenovirus, Mycoplasma pneumoniae (greater than 5 years of age)
Pneumonia: Diagnosis
- Symptoms: cough, wheezing, hemoptysis, chest pain, abdominal pain, failure to thrive, fever and chills
- Neonates: fever and hypoxemia
- Infants: apnea
- Physical examination: fever, tachypnea, retractions, splinting, auscultation findings of crackles or rhonchi over consolidation
- Hospitalized patients: chest x-ray, blood cultures
Pneumonia: Treatment
- Admission criteria: hypoxemia, inability to maintain hydration, or moderate respiratory distress
- Patients less than 6 months old with bacterial pneumonia or concerns about care
- Bacterial pneumonia: treat with antibiotic therapy
Foreign Body Aspiration: Essentials
- Usually occurs in children younger than 3 years old
- Foreign bodies most commonly lodge in the right main bronchus
- Most frequent foreign bodies: small food items and toys
Foreign Body Aspiration: Diagnosis/Treatment
- Symptoms: cough, stridor, hemoptysis
- May have a history of choking or a witnessed event
- Physical examination: localized wheezing or unilateral absence of breath sounds
- Imaging: radiopaque objects visible, note focal air trapping
- Bronchoscopy: used for foreign body removal
Dermatology Review
- A red-bordered rash with central clearing is consistent with Lyme disease. Lyme disease is caused by a tick-borne bacteria.
- The most appropriate intervention for Lyme disease is doxycycline.
- Other options include:
- Acetaminophen: can manage fever
- Ceftriaxone: effective for Lyme disease but not the first-line treatment
- Erythromycin: not the first-line treatment, but can be used
- Rifampin: not the appropriate treatment for Lyme disease
Hematology Review
- Acute myeloid leukemia is characterized by pancytopenia (low red blood cells, white blood cells, and platelets), circulating blasts, and the presence of Auer rods.
Cardiology Review
- A fixed split second heart sound and a systolic ejection murmur best heard over the pulmonic region are consistent with an atrial septal defect.
Questions?
- Radiopaedia is a website with comprehensive medical imaging resources and information.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz focuses on the differential diagnoses related to pulmonary presentations, including cough and dyspnea. It also covers indications for chest X-rays and the systematic approach for interpreting AP and PA views. Test your knowledge on critical respiratory conditions and imaging techniques.
