#usmlestep2ck

March 15th 2021

Topics Covered: - Epiglottitis

- Croup

- Bronchiolitis

- Foreign Body Aspiration

- Vascular Ring

- Pneumonia

Pre-reading Quiz:

1. Stridor is heard during ________ (inspiration/expiration), whereas wheezing is heard during ________ (inspiration/expiration).

2. Treatment of ____________ is nebulized racemic epinephrine + dexamethasone.

3. CXR for __________ will show unilateral hyperinflation +/- tracheal deviation to the opposite side.

Epiglottitis

What: bacterial infection of epiglottis w/ Hib, GAS, S. pneumo, S. Aureus

Why: hematogenous spread, unvaccinated (Hib)

Treatment: Ceftriaxone + Vancomycin, Endotracheal intubation

Buzzwords 

tripod positioning

drooling, distress, dysphagia

Croup (Laryngotracheal bronchitis)

What: Parainfluenza virus >> RSV

Why: Hemagluttinin permits viral entry, Neuramidinase permits spread.

Sx: Prodromal phase w/ rhinitis/congestion, then cough in late evening

Treatment: 

Nebulized Racemic epinephrine

Dexamethasone

Humidified air

Heliox decreases work of breathing

Buzzwords:

Barky cough worse at night

Inspiratory stridor

Bronchiolitis

What: RSV in patient less than 2 years old

Why: viral infection and inflammation of bronchioles

Sx: Prodrome phase w/ rhinitis/congestion, then cough/wheezing/crackles and respiratory distress

Treatment:

Nasal suctioning

Supplemental oxygen

HFNC, CPAP

Albuterol/epinephrine, Corticosteroids if severe

Palivizumab monthly during RSV season for first year of life if (premature <29 weeks, heart/lung disease, immunocompromised)

Buzzwords

URTI > Respiratory distress

Foreign Body aspiration

What: acute onset SOB due to foreign body in airway

Treatment:

Rigid bronchoscopy

Buzzwords

Sudden onset SOB

Hyperinflation + mediastinal shift

Decreased breath sounds

Vascular Ring

What: congenital aberrant branch of aorta encircling esophagus/trachea

Sx: Inspiratory and Expiratory stridor w/ history of noisy breathing since birth OR dysphagia to solids

Dx: CTA

Buzzwords

Biphasic stridor

Worsens with crying/feeding

Improves w/ neck extension

Pre-reading Quiz Answers:

1. Stridor is heard during ________ (inspiration/expiration), whereas wheezing is heard during ________ (inspiration/expiration).

2. Treatment of _Croup_ is nebulized racemic epinephrine + dexamethasone.

THE YELLOW WALLPAPER

I recently read the short story THE YELLOW WALLPAPER written by Charlotte Perkins Gilman . The story involves mainly about how mental health was treated in those days and status of a woman on the society back then. The story is based on real reference.

Though the story was written in 1890's , how mental health is treated now - a - days is still quite relatable. A large section of society doesnot take depression as a serious illness. And when a person is diagonsed by the same instead of medications they are told to take rest and are prohibited from any kind of physical and mental exercise, same as the author was told that rest is the cure and was told by her husband not to indulge in any kind of writing as she will get more sick whereas writing was a sole thing which provided her solace and as a result in the end she was driven to absolute madness .

It's a high time that we should come together and help those suffering from this .

Let's be kind 😊.

02-06-19

5.49 am

Will read neurology today

Got a study partner and will be solving uworld too.

Yesterday was a day when I felt like a loser but I gathered all the strength to bouce back again so I woke up at 5am (following the 5am club).

Lets see how the day goes.