7 Lungs 2 Flashcards
CBC results
Acute bronchitis: elevated lymphocytes
Bacterial pneumonia: elevated neutrophils
Auscultation results for pt with emphysema vs chronic bronchitis
Emphysema: crackles upon expiration
Chronic bronchitis: crackles upon inspiration
Klebsiella
affects alcoholics, malnourished, DM. necrotizing lobar pneumonia. Relative Bradycardia and current jelly sputum
Abnormal breath sounds
Decreased (smoker, obese, emphysema, pleural effusion), absent (collapsed lung), bronchial (loud and harsh, areas of consolidation)
Adventitious breath sounds
Ronchi, crackles, wheezing, stridor
Auscultation findings over consolidation
Egophany, bronchophony, whispered pectoriloquy
Stridor and SOB DDX
Epiglottitis–hot potato voice, high fever, drool, emergency
Foreign body–no hx of URI or fever, sudden
Retropharyngeal abscess–swelling back of throat, follow infxn
Diphtheria–grayish membrane over pharynx/larynx
Laryngotracheobronchitis
Croup. Parainfluenza virus, adenovirus, RSV
Children 6mos to 3 years. Prodrome of URI w low fever, cough then hoarse voice, seal-like cough, respiratory stridor at night
Acute bronchitis
Self limited inflammation of bronchus from viral infection. Ssx: cough > 5 days w sputum. PE: afebrile/low, wheezing, ronchi, normal percussion and transmission voice tests
Productive cough DDX
Acute bronchitis, chronic bronchitis, pneumonia, post nasal drip, GERD, asthma
Pathophysiology of typical lobar pneumonia
Stage 1: congestion
Stage 2: red hepatization
Stage 3: grey hepatization
Stage 4: resolving
Community acquired pneumonia
Risks: level of consciousness, smoking, alcohol, lung disease, malnutrition, old age, immuno compromised
Organisms: RSV, parainfluenza virus, influenza, adenovirus, S pneumoniae, H flu, S aureus, group a strep, M catarrhalis, klebsiella, legionella, M pneumoniae, Chlamydophila, P aeruginosa
Nosocomial pneumonia
Ventilator assoc, healthcare assoc (IV therapy, chemotherapy, dialysis, nursing home)
Legionella pneumophila
concomitant GI symptoms of nausea and vomiting. Outbreaks from aerosolized organisms
Sx in elderly, smokers, immunocompromised, alcoholics, pts w pre existing condition
Sputum in various bacterial pneumonias
Pneumococcus: bloody, rust colored
Pseudomonas, Haemophilus, pneumococcal: green
Anaerobic infxns: foul smelling
Klebsiella: viscid, currant jelly
Bacterial pneumonia PE findings
Look sick/pallor, high fever, tachy/bradychardia, bronchial breath sounds, Egophany, dullness, tachypnea, cyanosis, wheezes/ronchi/crackles, tactile fremitus, pleural friction rub
If bacterial pneumonia doesn’t resolve..
Comborbiites: alcoholism, COPD, CHF, CKD, malignancy, DM, HIV
Age >65 yrs, neoplastic disease
Klebsiella, legionella, S aureus, S pneumoniae, TB, fungi
Misdiagnosis of connective tissue disease, sarcoidosis, pulmonary embolism, pulmonary edema, drug induced lung disease
Viral pneumoniae SSX
Malaise, headache, myalgia, cervical LA, chest pain, sore throat, cough w scant sputum
Mycoplasma pneumonia
Walking pneumonia. Looks like URI. Don’t look sick, erythematous TM, no early findings on auscultation
Friction rub on auscultation…
Hold breath and listen again! If +… Pericardial. If - pleural
Histoplasmosis
Chronic cough, nodular lesions, crackles, wheezes, Ohio and Mississipii river valleys and Southeast, caves, PCR, calcified hilar lymph nodes
Loud sounds on inspiration DDX
Laryngotracheobronchitis, epiglottitis, retropharyngeal abscess
Pneumocystis jirovecii pneumonia
rare in general pop, affects immunocompromised. gradual onset malaise, weight loss, night sweats, dry cough
Coccidiomycosis
Deserts of SW. “sometimes it’s ripe, and the wind blows, and you get it”. Self-limited, most cases subclinical.
in immunocompromised, may disseminate–>erythema nodosum, meningitis, endocarditis, osteomyelitis
Allergic Bronchopulmonary Aspergillosis
when pts with asthma get worse. Eosinophilic pneumonia. Sputum with brown flecks
Acute pulmonary histoplasmosis PE
crackles or wheezes, pericardial friction rub, erythema multiforme/nodosum
Chronic Pulmonary Histoplasmosis PE
crackles, wheezes
Chronic Progressive Disseminated Histoplasmosis
ulcers on buccal mucosa, tongue, gingiva, larynx; vision loss; hepatosplenomegaly
Aspiration caused pneumonia
sudden onset, severe symptoms, high mortality
Lipoid aspiration
oil causes inflammation and secondary infection. CXR reveals infiltrates throughout lung–difficult to recover
Pulmonary Tuberculosis Groups with Higher Prevalence
homeless/marginally housed, correctional facilities/shelters, health care workers serving at risk pop, children exposed to at risk, foreigners/travel to endemic area, elderly
TB etiology
Mycobacterium tuberculosis. person-to-person inhalation of airborne droplet nuclei, must be constant exposure
primary TB infection
inflammatory reaction holds organisms back. Only 10% of affected develop active. If not active, not contagious!
Active TB SSx
chronic productive cough (yellow/green, am), hemoptysis, malaise, fatigue, anorexia/wt loss, low grade fever, night sweats
Active TB PE
fever, hypoxia, cachexia, tachycardia, LA, decreased breath sounds, crackles
TB Imaging
ipsilateral hilar adenopathy often w atelectasis in upper lobes.
Normal CXR does NOT r/o TB
Miliary TB
Hematogenous and lymphatic spread to target organs
Latent TB Infection and reactivation
Asymptomatic, bacteria alive and inactive, walled off. Lesions in posterior segment of RUL
TB Tests
Purified Protein Derivative–Mantoux Test
QuantiFERON Gold–IFN gamma release assay
Multi-Drug Resistant TB
develops in the course of TB treatment with inappropriate doses/incomplete dosing
TB DDX
pneumonia, lung abscess, pulmonary mycosis, CA, non-TB mycobacterium, histoplasmosis, coccidiomycosis, silicosis, sarcoidosis
Pleurisy SSx
sudden onset of pain, rapid/shallow breaths, splinting of chest, SOB, painful cough
Pleurisy PE
fever if infectious cause, limited chest motion, decreased breath sounds, pleural friction rub, dullness to percussion, decreased tactile fremitus
Pleurisy DDX
acute abdomen, intercosta neuritis, costo-chondritis, herpes, MI, pneumothorax, pericarditis
Pleural Effusion Liquid Types
lymph: chylothorax
pyogenic: empyema
blood: hemothorax
serous: hydrothorax
Pleural Empyema SSx
fever, cough, fatigure, SOB, chest pain, bad breath
if severe–>dehydrated, bloody/brown sputum, high fever, coma
Pneumothorax
air/gas in pleural cavity between visceral and parietal pleura–>collapse of lung on affected side
Spontaneous or traumatic
