DX and TX Flashcards
Chronic Bronchitis
- chronic productive cough for at least 3 months a year for 2 consecutive years
- non-reversible
- smoking
- ages 50-60
- blue bloater: big belly, cyanotic, obese
Dx: spirometry
Tx: GOLD Criteria
emphysema
- loss of elastic recoil and airway collapse
- smoking
- AAT deficiency
- dyspnea, cough
-pink puffer: barrel chest, skinny
Dx: spirometry
Tx: GOLD criteria
bronchiectasis
- widening and scarring of airways
- cystic fibrosis
- thick/dark brown mucopurulent sputum
- hemoptysis
Dx: CT
Tx: mucus clearance
acute bronchitis (viral and bacteria)
- cough preceded by URI that moves to lower respiratory tract infection
- at least 5 days
- winter/fall
Dx:clinical
Tx:
viral: supportive, OTC cough med
bacterial: azithro
acute bronchiolitis
- infection and inflammation of the small airways: bronchioles
- starts from viral URI
- RSV
- infants 2 months to 2 years
- winter/fall
Dx: clinical
Tx: supportive
acute epiglottitis
- inflammation and swelling of epiglottis that causes serious rapid infection and airway obstruction
- GAS
- dysphagia, drooling, distress
- tripod position
- hot potato voice
Dx: clinical/laryngoscopy (cherry red)
Tx: airway management, ENT referral, and IV Abx (ceftriaxone)
croup
- inflammation of larynx, trachea, and subglottilc airway
- 6 months to 3 years age
- fall/early winter
- “seal like barking” cough
- virus: parainfluenza type 1
- bacteria: S. aureus
Dx: clinical
Tx: glucocorticoids (dexamethasone PO), add nebulized epi if severe
empyema
- pus in the pleural space cavity between lung and chest wall
- from PNA, lung abscess, Tb
- chest pain, fever, cough, night sweats
Dx: CXR, CT, pleural fluid analysis
Tx: tube thoracostomy + Abx
influenza
- orthomyxovirus
- spread through respiratory droplets
- fall/winter
- fever, chills, malaise, HA, URI (sore throat, swollen lymph nodes, runny nose), dry cough
Dx: PCR
Tx: supportive/oseltamivir
Covid-19
- spread through respiratory droplets
- dysregulates renin-angiotensin-aldosterone system
- most asymptomatic
- loss of smell/taste
Dx: nasopharyngeal swab SARS Cov 2 NAAT
Tx: supportive, paxlovid if severe
pertussis
- B. Pertussis
- transmitted via respiratory droplets
- rapid consecutive coughs followed by high pitched inspiration (whoop)
Dx: nasopharyngeal culture
Tx: azithromycin
RSV
- Jan/Feb
- most significant LRI cause young kids
- major risk factor: prematurity
- associated with airway reactivity later in life (asthma)
- bronchiolitis
- grunting in infant
- crackles/ prolonged inspiration
Dx:
clinical based on history: bronchiolitis, URI prodrome, tachypnea, chest retractions, wheeze, crackles
Tx: Time/supportive
tuberculosis
- M. tuberculosis (slow growing bacteria)
- airborne droplets
- common in malnourished, overcrowded populations
- malaise, fever, wight loss, productive cough with hemoptysis, crackles heard only after short cough
Dx: skin test or interferon gamma assay
Tx:
DOT therapy
6 month regimen: RIPE x2 months, then only I and R x4 months
9 month regimen: RIE x4-8 weeks, then only I and R for remaining 9 months
aspergillosis
- fungi: aspergillus fumigatus
- disease of immunocompromised or critically ill
- lungs, sinuses, brain –> MC affected
- allergic, chronic, invasive
Dx:
chest CT: nodules, wedge shaped infarcts, halo sign
definitive: tissue/culture
Tx: IV voriconazole
CAP (outpatient)
- outside hospital or within 48 hours after admission to hospital
- defect in: cough reflex, mucociliary clearance system, immune response
- fever, hypothermia, cough, inspiratory crackles, dullness to percussion
- hospital admission based on CRB-65
- ICU admission based on Major/minor criteria
Dx: CXR
Tx: azithro, doxy
CAP (outpatient high risk)
Dx: CXR
Tx: azithro, clarithro + amox, amox-clav OR resp. fluroquinolone
CAP (inpatient not ICU)
Dx:CXR (CBC, CMP, ABG if hypoxic)
Tx: azithro + ceftriaxone
OR resp. fluroquinolone
CAP (inpatient ICU)
Dx: CXR (CBC, CMP, ABG if hypoxic)
Tx: ceftriaxone + either azithro or resp. fluroquinolone
CAP (PCN allergy)
Dx: CXR
Tx: fluoroquinolone + aztreonam
mycoplasma pneumoniae
- MC atypical pneumonia
- walking pneumonia
- summer/late fall
- mollicute genus bacteria
- transmitted through resp droplets
Dx: CXR and serology
Tx: supportive (may resolve spontaneously)
can give azithro, clarithro, doxy
legionella pneumoniae
- atypical PNA
- outbreaks from contaminated water: air conditioner, portable water, cooling towers, showerheads, faucets, vents, hot tub
- usu large facilities like hotels, hospitals, apartments
- N/V/D
Dx: culture/sputum PCR
Tx: azithro, clarithro, resp. fluoroquinolone
nosocomial pneumonia
- HAP and VAP occur > 48 hrs after admission to hospital or following endotracheal tube intubation
- gram pos cocci: S. aureus
- gram neg bacilli: pseudomonas, klebsiella
- anaerobic orgs
- gastric acid may protect against pneumonia
Dx: 2 nonspecific symptoms (fever, leukocytosis, purulent sputum, worsening resp status) AND new/progressive opacity on CXR
Tx: empiric based on risk factors
anaerobic PNA and lung abscess
- aspiration PNA due to inhaling oropharyngeal and gastric microbes
- people with altered consciousness
- periodontal disease and poor dental hygiene
- cough with foul smelling purulent sputum
Dx: culture with transthoracic aspiration/thoracentesis/ bronchoscopy
Tx: piperacillin-tazobactam, amox-clav, ampicillin-sulbactam OR carbapenem
PNA in kids
- RSV: MC infants
- mycoplasma pneumoniae: MC > 5 years
- GERD
- neuro impairment
- immunocomp
Dx: ??
Tx: amox (bacterial)
asthma
- reversible, intermittent obstructive disease
- MC children
- Atopy
- WORSE @ night
- nasal mucosal swelling, polyps, secretions
TX based on: (symptoms less than 3-5 days a week, with normal (or mildly reduced) lung function
Dx:
PFT: spirometry
increase >12% after bronchodilator indicates reversibility –> asthma
Tx: As need only low dose ICS-formoterol
asthma
TX based on: symptoms most days, or waking at night once a week or more, or low lung function
Tx: low dose ICS-formoterol maintenance (daily) and reliever (as- needed ICS formoterol)
asthma
TX based on: daily symptoms, walking at night once a week or more and low lung function, or recent exacerbation
Tx: medium dose ICS-formoterol maintenance (daily) and reliever (as- needed ICS formoterol)
