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Pulmonology > Lower Respiratory Tract Infections > Flashcards

Lower Respiratory Tract Infections Flashcards

1
Q

Common Infectious Agents

A
  • Rhinoviruses: (cold; exacerbations of asthma or chronic bronchitis; pneumonia in children)
  • Coronaviruses: (cold; exacerbations of asthma or chronic bronchitis; pneumonia and bronchiolitis; specific serotype caused SARS)
  • Respiratory syncytial virus: (pneumonia and bronchiolitis; croup: LTB (larygotracheobronchitis); cold; pneumonia in geriatric and immunocomprised)
  • Parainfluenza viruses: (croup, bronchiolitis, bronchitis, pneumonia; pharyngitis and cold)
  • Adenoviruses: (cold and pharyngitis (peds), often with conjunctivitis; pneumonia in peds and immunocompromised)
  • **Influenza A: ** (influenza; pneumonia)
  • **Influenza B: ** (influenza; cold; pharyngitis; pneumonia, diarrhea)
  • **Enteroviruses: ** (febrile illness; cold; pharyngitis; pneumonia)
  • **Herpes Simplex Viruses: ** (pharyngotonsillitis; tracheitis and pneumonia in immunocompromised)
  • Streptococcus pneumoniae
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae (formerly Chlamydia species)
  • Haemophilus influenza (“H. flu” not influenza; type B and non-typable)
  • Pneumocystis jirovecci (formerly P. carinii)
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2
Q

Less Common Infectious Agents

A
  • Mycobacterium tuberculosis
  • Legionella pneumophila (and other species)
  • Moraxella catarrhalis
  • Histoplasma capsulatum
  • hantavirus
  • metapneumovirus
  • cytomegalovirus
  • Bacillus anthricis (anthrax)
  • Yersinia pestis
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3
Q

Bacterial Tracheitis

A

Predominantly pediatric disease because of shape of subglottic airway–cricoid cartilage is narrowest portion of trachea

Has prodome similar to URI

Acute or subacute

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4
Q

Bacterial Tracheitis Etiology

A

MC: M. catarrhalis

Also: S. aureus, S. pyrogenes

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5
Q

Bacterial Tracheitis PE

A

Stridor

Hoarseness

Croupy cough

Respiratory distress

Sore throat

No positional changes of comfort

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6
Q

Bacterial Tracheitis Diagnostics and Management

A

Labs: elevated WBC; blood cultures; gram stain of sputum

Laryngotracheobronchoscopy only definitive means of diagnosis

Send to hospital: maintain airway and IV antibiotics

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7
Q

Acute Bronchitis

A

Inflmmatory process that may be caused by infection

Cough with purulent sputum production

Other sxs may include: rhinorrhea; nasal congestion; fever; mylagias and arthrlagias; dyspnea or SOB; sore throat

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8
Q

Acute Bronchitis PE

A

May have ronchi, wheezing, coarse breath sounds

Often unremarkable

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9
Q

Etiology of Acute Bronchitis

A

Numerous viral causes, often seasonal.

M. pneumoniae, C. pneumoniae, S. pneumoniae, H. flu, B. pertussis

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10
Q

Treatment and Complications for acute bronchitis

A

Supportive treatment

Inflammation of bronchial mucosa: corticosteroids

Mucus retention: water dilutes secretions

Airway reactivity: beta agonist or anticholinergic

Copmlications: pneumonia, chronic bronchitis, bacterial superinfection, reactive airway disease

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11
Q

Pneumonia Classification (3)

A

Community Acquired

  • Treated as outpatient
  • Treated as inpatient

Nosocomial pneumonia

  • non-ventilator dependent
  • ventilator dependent

PORT Scoring: based on demographics (age, gender), comorbidities, physical exam findings, lab and radiograph findings

CURB-65

  • Confusion
  • Uremia
  • Respiratory Rate >30
  • Blood Pressure (hypotensive)
  • >65
  • If 2 admit to hospital, if 3-5 admit to ICU
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12
Q

Pneumonia

A

Lower respiratory tract infection in a person with symptoms of an acute infection, with or without infiltrate on CXR

Results in abnormal pulmonary function

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13
Q

Typical pneumonia etiology

A

Strep pneumo

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14
Q

Atypical pneumonia etiology

A

M. pneumoniae

C. pneumoniae

Legionella pneumophila

Influenza virus

Adenovirus

MC in young adults

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15
Q

Indications for CXR in adults

A

One of:

  • Temperature >100
  • HR > 100bpm
  • RR >20

Or two of:

  • Decreased breath sounds
  • Crackles
  • Absence of asthma
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16
Q

Pneumonia RFs

A

Recent viral infection

Hx of pneumonia

Immunosupression

Disordered swallowing (aspiration)

EtOHism

Smoking

COPD

Illicit drug use

Recent major surgery

Seizures

Hospitalization

17
Q

Clinical presentation of pneumonia

A

Temperature >110.4

Rigors, sweats

Cough (+/-sputum, +/-hemoptysis)

Dyspnea

Fatigue

Myalgias

Pleuritic chest pain

Typically have abnormal PE

18
Q

Pneumonia PE

A

Ill appearing

febrile

tachypnea

tachycardia

abnormal chest exam: crackles, wheezing, rhonchi, signs of consolidation; bronchial breath sounds “hollow” b/c not surrounded by aerated lung tissue

decreased O2 sat

Very young may not have pulmonary symptoms

Elderly may have a paucity of sxs; change in cognitive status

19
Q

Diagnostic Factors Pneumonia

A

Labs: WBC, sputum gram stain, PCR, antibody titers

CXR: establish diagnosis and identify complications

Conisder CT for those whose dx is questionable

20
Q

Bronchiectasis

A

Bronchiectasis is the consequence of inflammation most commonly caused by infection.

Inflammatory mediators are released and damage epithelium, resulting in pathologic dilation of the medium sized airways.

Dilated airways serve as a reservoir for colonization which continues the cycle

21
Q

Bronchiectasis Etiology

A

bacterial infection

aspiration

CF

autoimmune diseases

alpha 1 antitrypsin deficiency

viral infection (influenza and adenovirus)

22
Q

Bronchiectasis PE

A

Coarse breath sounds, rhonchi, rales, wheezing

Advanced disease: right ventricular failure, cor pulmonale (R ventricular hypertrophy), clubbing

23
Q

Bronchiectasis Dx

A

HRCT

CXR–occasionally diagnostic

PFTs–obstructive pattern

24
Q

Lung Abscess

A

Subacute infection of the lung parenchyma (necrotic)

MC in elderly

MC secondary to aspiration; clinically signifciant 1-2 weeks later

Can also be a seondary abscess from comorbid infection

25
Q

Common Comorbidities with Lung Abscess

A

Oral cavity disease

Altered LOC (EtOH, coma, seizures, etc)

Esophageal diseasea (reflux, esophageal obstruction)

Bronchial obstruction (tumor, foreign body)

Immunocompromised (steroids, malnutrition, chemo)

26
Q

Lung Abscess Common Etiology

A

MC polymicrobiol from oral flora

Also: Pseudomonas, Klebsiella, S. aureus, S. pneumo

27
Q

Diagnosis of Lung Abscess

A

CXR

28
Q

Empyema

A

Parapneumonic, purulent effusion

MC a complication of pneumonia

Also from penetrating trauma, chest tube placement, percutaneous decompression of pneumothorax

29
Q

Empyema etiology

A

Streptococcus

Staphlococci

enterobacteria

enterococcus

30
Q

Empyema Staging

A

Early or acute: thin serous or cloudy fluid, often sterile. Resorptive capacity of the pleural space is exceeded

Fibrinopurulent or intermediate stage: more thick and opaque fluid with positive cultures

Organizing or late stage: an organizing peel with entrapment around the lung

31
Q

Empyema Dx and Tx

A

Imaging to locate effusion

Antibiotics

Evacuation of fluid

Fibrinolytics

Surgical removal

Pulmonology (17 decks)

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