Lung infections Flashcards
Acute bronchitis usually due to ___? It’s clinical course is ___? Post infectious cough occurs ___? CXR appears ___?
viruses
self resolving
3-8 weeks after infection resolves
normal
In chronic bronchitis you have ____ mucus production and change of ___? Why? How is air flow reduced? CXR?
increased
character of sputum
increased mucus production/decreased clearance
increased mucus production and inflammation
unchanged/normal
Mucus production and chronic inflammation in chronic bronchitis may lead to ___?
permanent lung damage
chronic bronchitis management
bronchodilators
corticosteroids
antibiotics
What PFTs are decreased in chronic bronchitis?
FEV1 and VC
What do you see on a lung exam for chronic bronchitis?
crackles, ronchi, wheezing
describe the common infection in chronic bronchitis. What are the most common organisms?
bacterial colonization of tracheobronchial tree
H influenza
S pneumonia
M catarrhalis
when is the flu considered infectious?
one day before -> 7 days after illness onset
When do you treat the flu empirically ASAP?
What are the two medications used to treat and what is their effect?
- underlying chronic conditions
- pregnancy
- very young (65)
Tamiflu (oseltamivir)(pill) and Relenza (Zanamivir)(inhaled)
Most effective if given within 2 days after onset
Reduce severity of symptoms and length of illness by 1 day
Pneumonia CXR
Filling of airways with pus and inflammation
What are the clinical features of pneumonia and when do they present?
Acute presentation: within 2 weeks Fever, chills Dyspnea Purulent sputum Hemoptysis (possible) Pleuritic chest pain Tachypnea/tachycardia
Pneumonia lung exam findings
Rales
Occasional pleural rub
How do the clinical features of pneumonia differe in elderly patients
Fever occurs mainly in younger pop
Confusion
Cough and sputum production may be absent
What is CAP? Which organisms are most common? Which present atypically?
Community acquired pneumonia
S. Pneumonia
H influenza
Atypically:
M pneumonia
C pneumonia
L pneumophilia
How do you decide whether to hospitalize or not?
CURB-65
Confusion
Uremia (BUN> 20)
Respiratory (RR>/30)
Blood pressure (systolic // old age
Get a point for each one
0- low risk
1- consider Rx at home
Consider hospitalization 2 points (or close out pt)
Hospitalize
3- hospitalize
4,5- hospitalize, ICU
Pneumonia APs. what are the nosocomial ones? Define them.
CAP
Nosocomial:
HCAP- occurs 48 hours or more after admission
->hospitalized for at least 2 days within 90 days of the infection
->received IV, chemo or wound care 30 days prior to infection
VAP- occurs 48 - 72 hours after ventilation
HCAP most common microbio
S aureus
Pseudomonas
Klebsiella
Enterobacter
VAP
‘ESKAPE’
Enterobacter S aureus Klebsiella Acinetobacter Pseudomonas Enterococcus
Pneumonia treatment. Follow up CXR after how long?
Find out what type of pneumonia you are dealing with and treat accordingly ASAP
-> prognosis influenced by how fast antibiotics are started
Outpatient CAP:
- most commonly, azithromycin and levaquin
- doxy given less often, not effective against atypical so
In patient:
- for CAP: ceftriaxone+azithromycin or levaquin even alone
- Nosocomial: vancomycin + coverage for pseudomonas
Follow up CXR 6 - 8 weeks after initial to make sure pneumonia is clearing
Note the possible source of pneumonia: GI sxs, bradycardia, confusion, liver and renal manifestations
Legionella
Note the possible source of pneumonia: Post-influenza
S Auereus
Note the possible source of pneumonia: Aspiration
Mouth anaerobes
Note the possible source of pneumonia: Alcoholism
Aspiration (mouth anaerobes), gram -
Note the possible source of pneumonia: Sickle cell disease
Encapsulated organisms
Note the possible source of pneumonia: HIV+
Pneumocystis, tb, ‘typicals’
Note the possible source of pneumonia: Recent immigrant, incarcerated
TB
Note the possible source of pneumonia: cystic fibrosis
Most often pseudomonas, S aureus
Bronchiectasis. How is a diagnosis established?
Abnormal dilatation and desctruction of the bronchial walls
Clinically and radiographically
Clinical features of bronchiectasis. PE/Lung exam findings
Similar features with COPD:
- dyspnea
- cough with sputum, hemoptysis
Crackles>Ronchi>wheezing
Clubbing
Bronchiectasis microbio; Lady Windermere syndrome microbio
gram negs more often isolated in sputum
S aureus less common
Lady windermere syndrome: middle lobe bronchiectasis and mycobacterium avium complex infection due to voluntary cough suppression
Cystic fibrosis
Autosomal recessive
Abnormal CFTR gene on long arm of chromosome 7
- gene codes for CL- channel on epithelial cells
Defect: decreased Cl- permeability -> dehydration of secretions
CF diagnostic criteria
Family history
Positive sweat test (Cl- >60 mEq/L)
Chronic obstruction to airflow
Exocrine pancreatic insufficiency
Acute bronchitis microbio
H flu
Strep pneumonia
M pneumonia
CF manifestations
Pulmonary disease Nasal polyps Pancreatic insufficiency Glycosuria Intestinal symptoms Cirrhosis Heat prostration
CF treatment
Mucolytics Postural drainage physiotherapy Anti inflammatory Bronchodilators When needed - antibiotics Gene therapy on the rise
