Pulmonary Preview

Pulmonary Preview and Lecture Video

This is a preview of the Pulmonary Section of the full PANCE/PANRE Review Course. The full Section has 115 questions, and a full  Lecture Video (1:20:04).

Pulmonary Lecture Slides Preview

Title:  Pulmonary Lecture Preview Slide Show

Details:  This is a preview of the Pulmonary Lecture Slide Show from the full PANCE/PANRE course.

Total Length:  16 slides.  Full lecture is 130 slides

Full Lecture Can Be Accessed:   Lecture Slides


Pulmonary Questions Preview (10 Questions)


Title:  Pulmonary Preview Questions

Details:  This is a preview of the questions from the full PANCE/PANRE Review Course.

Total Length:  20 slides.  Full course has 230 slides

Full  Questions Can Be Accessed:  Questions and Answers


Pulmonary Lecture Video Preview (0:09:38)

Title:  Preview Pulmonary Lecture Video

Details:  This is a preview of the full Lecture Video.

Total Length:  9 minutes, 38 seconds.  Full lecture video is 1 hour, 20 minutes

Full Lecture Video Can Be Accessed:  Lecture Video


Pulmonary Preview Lecture Notes

Pulmonary Blueprint
PANCE Blueprint

Infectious Disorders
Acute Bronchitis-
Acute Bronchitis is generally viewed as a self limiting condition, due to upper airway infection

Patients usually present with a productive cough lasting more than 5 days but less than 3 weeks

Chronic bronchitis is a productive cough for most the days for at least 3 months in each of two successive years

Acute Bronchitis is generally caused by a virus

Acute Bronchitis

Usual causes of acute bronchitis are influenza A and B, parainfluenza, coronavirus, rhinovirus, RSV, and human metapneumovirus.

It has been suggested that bacterial pathogens that cause pneumonia (Strep Pneumoniae, Haemophilus Influenza, Staph Aureus, Moraxella Catarrhalis) can cause bronchitis, but there have been no studies to prove this.

Other organisms that rarely cause acute bronchitis include:  mycoplasma pneumoniae, Bordetella Pertussis, Chlamydophilia Pneumoniae

Symptoms are productive cough, wheezing and may have an associated fever.

Acute Bronchitis
Treatment is directed a symptom control.  Albuterol for wheezing and prednisone as needed for an adjunct.

Indications for chest x ray include a HR greater than 100, RR greater than 24,  temperature greater than 38 degrees C, or oxygen saturation less than 94% on room air on healthy adults

Acute Bronchiolitis
Acute Bronchiolitis is defined as a syndrome that occurs in children less than 2 years of age and presents as rhinorrhea followed by lower respiratory infection with inflammation that results in wheezes and/or crackles

Acute Bronchiolitis typical is caused by viral pathogens but on occasion can be caused by Mycoplasma Pneumoniae

Risk factors for developing severe disease with bronchiolitis include:  prematurity, age less than 12 weeks, chronic pulmonary disease, congenital and anatomic defects of the airways, congenital heart disease, immunodeficiency, and neurologic disease

Acute Bronchiolitis
Indications for Hospitalization of Acute Bronchiolitis patients:
1.  Signs of respiratory distress nasal flaring, retractions, grunting, RR>70, dyspnea or cyanosis
2.  Toxic appearance, poor feeding, lethargy
3.  Apnea
4.  Hypoxemia
5.  Parents who are unable to care for the child at home

Management includes management of hydration and oxygenation.  Bronchodilator therapy and glucocorticoids are indicated if wheezing (studies currently published refute this but most clinicians are skeptical.) Nasal suctioning is also helpful

As a rule of thumb, antibiotics generally are not indicated in the treatment of acute bronchiolitis

Acute Epiglottitis
Epiglottis is inflammation of the epiglottis and adjacent supraglottic structures

Infectious epiglottitis is cellulitis of the epiglottis and its adjacent structures.  It can result from direct invasion or from bacteremia

Once the infection begins, swelling rapidly progresses to involve the entire supraglottic larynx and swelling is halted by the tightly bound epithelium at the level of the vocal cords

Airway obstruction can result in cardiopulmonary arrest.

Acute Epiglottitis
Epiglottis can be caused by bacteria, viral, or fungal etiologies

The most common pathogen of epiglottis is Haemophilus Influenza Type B (HIB)

We have seen a dramatic decreased in the frequency of epiglottis because of the HIB vaccine

In immunocompromised patients candidia or pseudomonas can cause epiglottitis

Other non infectious etiologies include:  thermal injury, foreign body ingestion, and caustic ingestion

Acute Epiglottitis
Clinical symptoms include:  respiratory distress, signs of upper airway obstruction, stridor, sitting in the tripod or sniffing position, and drooling.

Fever, severe sore throat, odynophagia, and drooling are common

Chest x ray or soft tissue neck may reveal a “thumb print” sign

Acute Epiglottitis
Labs should be deferred until the airway is secured.  Labs should include CBC and Blood Culture

Two main parts of management of epiglottis include securing the airway and instituting antibiotics.  Recommended empiric treatment includes third generation cephalosporins with clindamycin or vancomycin.

Croup is also known as laryngotracheobronchitis (LTB)

Croup presents clinically with inspiratory stridor, bark cough, and a hoarse voice.

Most common ages afflicted are between the ages of 6 months and 3 years of age

Most common offending organism is the parainfluenza virus

Typically presents acutely rather than slow onset
The mainstays of treatment of croup are glucocorticoids and racemic epinephrine
The Wrestly Croup Score determines treatment and it is based on physical exam
Severe croup can progress to respiratory failure where there is fatigue, listlessness, marked retractions, decreased breath sounds, decreased LOC, cyanosis, pallor, and tachycardia disproportionate to fever.   Rarely this patients may need mechanical ventilation.  Capillary blood gas should be obtained

Mild Croup can be treated at home.  Cool mist can provide symptomatic relief

Children have a tendency to get worse at night.  If the child looks bad or may need admission, consider admission especially if in night or evening hours

Indications for admission of Croup patients include:  need for racemic epinephrine continuously, need for oxygen, moderate retractions, degree of response to initial therapy, if they look toxic, poor oral intake, if less than 6 months, return visit in 24 hours, poor parenteral care at home

Usually resolves itself within 3-7 days

Influenza is an acute respiratory illness caused by the Influenza A and B viruses

Transmission of the virus is by respiratory secretions

Generally speaking, viral shedding can be detected 24-48 hours before the onset of symptoms, but much lower during the symptomatic period of the illness

Uncomplicated influenza presents with fever, headache, myalgias, nasal congestion, non productive cough, and sore throat.  Physical exam is usually unremarkable

Pneumonia is the most common complication of influenza

Myositis and rhabdomyolysis are also complications of influenza

CNS complications of influenza include:  encephalopathy, encephalitis, transverse myelitis, aseptic meningitis, and Guillain Bare Syndrome

Two classes of antiviral drugs available for treatment of influenza-
1.  Neuraminidase inhibitors such as zanamivir and oseltamivir are active against influenza A and B
2.  The adamantanes such as amantadine and rimantadine that are active against influenza A

These agents can shorten the duration of the illness 12 hours to 3 days.  Most studies have shown benefit when instituted 24-48 hours from the onset of symptoms

Institution of any antivirals is recommended when: illness requiring hospitalization, age over 65, pregnant women or post partum less than 2 weeks, or progressive, severe or complicated illnesses-High priority age groups for influenza vaccine:  pregnancy, immunocompromised patients, healthcare workers and household contacts

NCCPA Topic List  Pulmonary Blueprint

Infectious Disorders
Acute bronchitis
Acute bronchiolitis
Acute epiglottitis
• Bacterial
• Viral
• Fungal
• HIV-related
Respiratory syncytial virus infection

Neoplastic Disease
Carcinoid tumors
Lung cancer
Pulm  nodules
Obstructive Pulm Disease
Chronic bronchitis
Cystic fibrosis
Pleural Diseases
Pleural effusion

Pulm. Circulation
Cor pulmonale
Pulm. embolism
Pulm. hypertension
Restrictive Pulm Disease
Idiopathic pulm fibrosis
Other Pulm Disease
Acute respiratory distress syndrome
Hyaline membrane disease
Foreign body aspiration


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