Lung infections 2 Flashcards
What is acute bronchitis?
Inflammation of the trachea bronchi, and bronchioles
What type of infection is acute bronchitis typically associated with (bacterial or viral?)?
Viral
What bacterial agents may be responsible for acute bronchitis?
(1) Haemophilus influenzae
(2) Pneumococcus
(3) Mycoplasma pneumonia
How is acute bronchitis diagnosed (what clinical feature is absent)?
(1) Cough with purulent sputum
(2) Low-grade fever
(3) Chest discomfort
(4) Possible hemoptysis
(5) Dyspnea
(6) PMNs and bacterial organisms in sputum (usually from normal lung flora)
No infiltrate on chest x-ray
How is acute bronchitis treated?
Acute bronchitis is self-limiting
(1) Cough suppressants
(2) Anti-pyretics
Antibiotics not indicated in the majority of cases
What is post-infectious cough and what is its cause?
(1) Persistent dry cough and wheezing lasting 3-8 weeks after acute infection
(2) Damage to airway epithelium causes sensory nerves (C-fibers) to stimulate airway smooth muscle
What are the characteristics of chronic bronchitis?
(1) Patients have more mucus than normal because of increased production or decreased clearance
(2) Inflammation and extra mucus reduce air flow
(3) Mucus production and inflammation over time leads to progressive and permanent lung damage
What are the clinical features of acute exacerbation of chronic bronchitis?
(1) Increased volume or change in character of sputum
(2) Increased frequency or severity of cough
(3) Increased dyspnea
(4) Variable constitutional symptoms
(5) Unchanged chest radiograph
(6) Variable decrease in pulmonary function (FEV-1 and vital capacity)
(7) Increased respiratory rate
(8) Crackles, ronchi, or wheezes on lung exam
How is acute exacerbation of chronic bronchitis managed?
(1) Bronchodilators
(2) Corticosteroids
(3) Possible antibiotics
What are the bacterial causes of chronic bronchitis?
(1) H. influenzae
(2) S. pneumoniae
(3) M. catarrhalis
What are the clinical features of the flu?
(1) Temperature of 101F or above
(2) Cough
(3) Muscle ache
(4) Headache
(5) Sore throat
(6) Chills
(7) Tiredness
(8) Feeling lousy all over
When is the flu infectious?
One day before appearance of symptoms to 7 days after onset of illness
What drugs are used to treat influenza?
2
(1) Oseltamivir (Tamiflu)
2) Zanamivir (Relenza
What are the clinical features of pneumonia?
(1) Acute presentation (within 2 weeks)
(2) Fever, chills
(3) Dyspnea
(4) Purulent sputum, possible hemoptysis
(5) Pleuritic chest pain
(6) Tachypnea/tachycardia
(7) Rales, pleural rub on lung exam
What are clinical features of pneumonia in elderly patients?
(1) Fever, less common in younger patients
(2) Tachypnea - common feature
(3) Delerium and confusion
(4) Possible absence of cough, sputum, and pleuritic chest pain
(5) Incomplete radiologic signs
What pathogens are most commonly responsible for community acquired pneumonia?
(1) S. pneumoniae
(2) H. influenzae
Atypical pneumonias:
(3) M. pneumoniae
(4) C. pneumonia
(5) Legionella pneumophila
What is CURB-65?
Criteria for patient hospitalization
1) C = confusion
(2) U = uremia (BUN >20
(3) R = RR > 30/min
(4) B = BP (S 65 yrs
What are the three types of APs?
(1) CAP - community-acquired pneumonia
(2) VAP - ventilator-associated pneumonia
(3) HCAP - health care-associated pneumonia
How do organisms responsible for CAP and HCAP differ?
CAP - Strep pneumonia, H. influenzae, atypicals
HCAP - Pseudomonas aeruginosa, Staph aureus, Klebsiella, Enterobacter
What antibiotics can be used to treat outpatient CAP?
Either:
(1) Azithromycin
(2) Doxycycline
(3) Levaquin
What antibiotics can be used to treat inpatient CAP?
Either:
(1) Ceftriaxone + azithromycin
(2) Levaquin
What antibiotics can be used for to treat HCAP?
(1) Vancomycin + (2) coverage for pseudomonas
What is important to confirm the clearance of pneumonia?
Chest x-ray about 6-8 weeks after treatment
How will pneumonia caused by Legionella present?
(1) GI symptoms
(2) Bradycardia
(3) Confusion
(4) Renal and liver manifestations
What organism is commonly responsible for post-influenza pneumonia?
Staph aureus
What organisms should be considered for pneumonia in aspiration or alcoholism?
Mouth anaerobes
What organisms can cause pneumonia in sickle cell patients?
Encapsulated organisms
What organisms can cause pneumonia in cystic fibrosis patients?
(1) Staph aureus
(2) Pseudomonas
What is bronchiectasis?
3
(1) An acquired disorder of (2) the major bronchi and bronchioles that (3) is characterized by permanent abnormal dilatation and destruction of bronchial walls
What is required for bronchiectasis to occur?
4
(1) Infectious insult with
(2) impairment of drainage, (3) airway obstruction, and/or (4) defect in host defense
What is the etiology of bronchiectasis?
(1) Post-infectious
(2) Congenital (primary ciliary dyskinesia (PCD) and cystic fibrosis)
(3) Immunodeficiency
(4) Systemic illness (rheumatoid arthritis)
(5) Sequelae of aspiration
What are the clinical features of bronchiectasis?
Shared features with COPD: (1) Cough with sputum production (2) Dyspnea (3) Hemoptysis Physical findings: (4) Crackles > rhonchi > wheezing (5) Digital clubbing Lung function: (6) Inflamed and easily collapsible airways
What are the most commonly isolated organisms in sputum in patients with bronchiectasis?
(2)
(1) Gram-negative bacteria
(2) Non-tuberculous mycobacteria
What is Lady Windermere Syndrome?
Middle lobe bronchiectasis and Mycobacterium avium complex (MAC) infection due to voluntary cough suppression
What are the diagnostic criteria for cystic fibrosis?
4
(1) Positive sweat test (Cl > 60 mEq/L)
(2) Chronic obstruction to flow of air
(3) Exocrine pancreatic insufficiency
(4) Family history
What are some common clinical features of CF?
4
(1) Pulmonary disease
(2) Pancreatic insufficiency
(3) Intestinal symptoms
(4) Nasal polyps
What is the genetic defect involved in CF?
3
(1) Abnormal gene on the long arm of chromosome 7
(2) Defective CF transmembrane regulator (CFTR)
(3) Decreased Cl- permeability due to lack of Cl- channel, leading to dehydration of secretions
How is CF treated?
8
(1) Mucolytics
(2) Postural drainage/physiotherapy
(3) Anti-inflammatory agents
(4) Bronchodilators
(5) Antibiotics when needed
(6) Pancreatic enzymes
(7) Immunizations
(8) Gene therapy
