Lower Respiratory Flashcards
Signs and symptoms of acute bronchitis
Persistent cough Increased mucous production Wheezing Lungs clear, resonant to percussion, upper airway clears with coughing High fever indicates bacterial infection
Strep pneumoniae is the most common pathogen in the following conditions:
Bronchitis Sinusitis Otitis Media Meningitis Community Acquired Pneumonia
Management of acute bronchitis
Supportive care
If suspect bacterial (high fever) treat with macrolides (azithromycin, clarithromycin), doxycycline, or Bactrim
Is asthma obstructive or restrictive disease?
Obstructive
Pathophysiology of asthma
- Increased responsiveness trachea and bronchi- narrowing airways
- Hypertrophy of smooth muscle
- Hypertrophy of mucous glands, plugging of airway by thick mucous
- Thickening of epithelial basement membrane (remodeling)
Unique feature of asthma
pulsus paradoxus (>12 mm Hg)
Ominous signs of asthma (reasons to call 911 on your asthmatic in the clinic)
Fatigue Absent breath sounds Paradoxical chest/abdominal movement Unable to remain laying down Cyanosis
What FEV1 score would lead to recommendation of hospitalization for asthmatic patient?
FEV1
What peak flow score would make you recommend hospitalization for asthmatic patient?
Peak flow 50 percent predicted after one hour of treatment
What would x-ray of asthma exacerbation show?
Hyperinflation
Management of asthma in adults
- SABA
- SABA + ICS
- SABA + ICS + LABA
- inhaled anticholinergic (ipratroprium) for significant secretions
- antileukotrienes (Singulair) may be useful for chronic asthma related to allergies
Are chronic bronchitis and emphysema obstructive or restrictive?
Obstructive
Chronic bronchitis presentation
Copious purulent sputum production
Stocky, obese, > 35 years old
Presentation of emphysema
abnormal, permanent enlargement of alveoli
mild clear sputum
thin, wasted body, > 50 years old
Chest A-P diameter increased
Typical signs/symptoms of typical versus atypical pneumonia
Typical- fever, chills, purulent sputum, lung consolidation, malaise
Atypical- URI/ENT symptoms along with lung consolidation
Atypical pneumonia pathogens
Mycoplasma pneumoniae
Legionella pneumoniae
Management of community acquired pneumonia
Healthy patients: macrolide (azithromycin, clarithromycin) or doxycycline
Patient with comorbidities: Fluoroquinolone (Levaquin, moxifloxacin)
Signs and symptoms of tuberculosis
Most patients are asymptomatic
Fatigue, low grade fever
Night sweats
Anorexia, weight loss
Screening tests for tuberculosis
AFB smear
PPD skin test (shows exposure)
Definitive diagnosis of tuberculosis
Small homogenous infiltrate in upper lobes by Chest x-ray
Culture for M. tuberculosis
Differential diagnosis for night sweats
- TB
- menopause
- AIDS
- lymphoma
- endocarditis
Management of tuberculosis
Notify health dept
Consider hospitalization for noncompliant patient or someone who is likely to expose susceptible individuals
Medications
Weekly sputum smears and cultures for 6 weeks, then monthly
Medications for tuberculosis
INH, rifampin, pyrazinamide, and ethambutol for 2 months
Then 4 more months of INH and rifampin
Weekly LFTs while on INH
Patients on ethambutol should be tested for visual acuity and red-green color perception
TB skin test results
> 5 mm is positive for: HIV, contacts of known TB, or person with chest x-ray typical for TB
10 mm is positive for: immigrants, health care workers
15 mm is positive for all others
How does a pleural effusion look on chest x-ray?
“Blunting” or “shadowing” of the costophrenic angle
Types of pleural effusions
transudates- clear
exudates- cream colored
empyema- pus
hemorrhagic- blood
Organisms that cause acute bronchitis
Viral: Rhinovirus, Coronavirus, Adenovirus
Bacterial: Strep pneumoniae, H. flu, M. catarrhalis, Mycoplasma pneumoniae
