Pulm #1 Flashcards
Acute bronchitis is MCC by _____, but can also be caused by bacteria such as _____
Viruses (Adenovirus, Parainfluenza, Coronavirus, Rhinovirus)
-Bacterial: S. Pneumo, M. Cattarhalis, H. Influenzae
Symptoms of acute bronchitis
- Cough (hallmark, and present for at least 5 days)
- Malaise, dyspnea, may have hemoptysis
- May have wheezing and rhonchi
Treatment for acute bronchitis
- Symptomatic management
- ABX not indicated in most patients
What is acute bronchitis?
Inflammation of the bronchi
Risk factors for epiglottitis
- DM
- Children 3 mos - 6 years
- Males
What are the causes of Epiglottitis?
- H. Influenzae B in unvaccinated or foreign immigrants
- Group A Strep or Strep Pneumo if vaccinated, cocaine use
Symptoms of Epiglottitis
- Dysphagia, Drooling, Distress
- Fever, inspiratory stridor, tripoding, hot potato voice
What is the definitive diagnostic for epiglottitis?
Laryngoscopy (cherry red epiglottis with swelling)
However, what other diagnostic can be done for epiglottitis and what do you see?
Lateral cervical radiographs: thumb or thumbprint sign
Treatment for epiglottitis
- Maintain the airway (most important component) in the OR
- ABX: Ceftriaxone or Cefotaxime
How to prevent Epiglottitis in close contacts
-Rifampin
Acute Respiratory Distress Syndrome (ARDS) is MC in ______, such as _____
Critically ill patients
- Gram negative sepsis (MC)
- Severe pancreatitis
- Near drowning
What are the three components of diagnosing ARDS
- Severe hypoxemia refractory to supplemental oxygen (PaO2/FiO2 radio < 200 mm Hg)
- Bilateral diffuse pulmonary infiltrates that spares costophrenic angles
- Pulmonary capillary wedge pressure < 18 mm Hg with right heart catheterization (Swanz-Ganz)
-Symptoms developing within 1 week
Treatment for ARDS
Symptoms of ARDS
- Noninvasive or mechanical ventilation + treat underlying cause
- -PEEP improve hypoxemia
-Often fatal
- Rapid onset of profound dyspnea 12-24 hours after precipitating event (car crash, etc.)
- Pink frothy sputum
What is linked with COPD in younger adults (<40 y/o) associated with panlobar emphysema?
Alpha-1 Antitrypsin Deficiency
What should you do diagnostically in a patient who is under 40 with COPD?
Blood tests
What risk factors are associated with Asbestosis?
- Destruction, repair or renovation of old buildings
- Insulation, ship building
Chest radiographs for Asbestosis shows
- Pleural plaques/calcifications or thickening of parietal pleura of lower lobes
- Interstitial fibrosis (honeycomb lungs) of the lower lobes
- “Shaggy heart sign” –indistinct heart border
What gives a definitive diagnosis of Asbestosis?
Lung biopsy: shows linear asbestos bodies (ferruginous bodies)
What does a PFT show for asbestosis?
Restrictive lung pattern: increased FEV/FVC1, decreased lung volumes
Complications of Asbestosis
- Bronchogenic carcinoma (most common)
- Malignant mesothelioma of the pleura (most specific)
What does a liver biopsy show in a patient with Alpha-1 Antritypsin Deficiency?
PAS-positive globules in hepatocytes
Treatment for Alpha-1 Antitrypsin Deficiency
IV pooled alpha-1 antitrypsin
Aspergillosis is a fungus that most commonly affects the lungs, sinuses, and CNS. Where is it found?
In garden and houseplant soil and compost
If Aspergillosis occurs in patients with asthma, bronchiectasis, or cystic fibrosis, it is considered allergic bronchopulmonary aspergillosis. What is one specific symptom that occurs with this type of aspergillosis?
Expectoration of brownish mucus plugs in the sputum
If there is an aspergilloma, what happens and what symptoms occur?
- Fungus colonizes a preexisting pulmonary cavitary lesion
- Hemoptysis
With allergic aspergillosis, what diagnostic will be helpful?
Increased IgE, eosinophilia
On a lung biopsy for aspergillosis, what will be seen?
Tissue appears dusky and necrotic
-Septate hyphae with regular branching at acute (45 degree) angles
True or False: Aspergillosis is associated with increased risk of hepatocellular carcinoma
True
Treatment for both types of Aspergillosis
- Allergic: tapered oral corticosteroids + Chest physiotherapy (add Itraconazole in some cases)
- Aspergilloma: Surgical resection vs observation if asymptomatic
Aspiration PNA is MCC by ______ and has increased incidence in _____.
Anaerobes
-Peridontal disease
Aspiration PNA is most commonly in what location and why?
Right lower lobe
-Due to vertical angle of right mainstem bronchus
Symptoms of Aspiration PNA
Foul-smelling “rotten egg” sputum
Treatment for aspiration PNA
- Ampicillin-Sulbactam or Amoxicillin-Clavulanate
- Metro + either Amoxicillin or Penicillin G as alternatives
What bacteria with PNA is associated with sever alcoholics?
Klebsiella
-current jelly sputum and cavitary lesions
What is the gold standard in diagnosing Asthma?
Pulmonary function testing (PFT) shows reversible obstruction
3 components of Asthma pathophysiology
- Airway hyperreactivity
- Bronchoconstriction
- Inflammation
Risk factors for Asthma
- Atopy (strongest)
- Family history
- Air pollution
- Male gender
- Tobacco Smoke
What are the three components of Samter’s Triad?
Asthma + chronic rhino sinusitis + sensitivity to Aspirin or NSAIDs
Symptoms of Asthma
- Dyspnea
- Wheezing
- Cough (at night)
- Chest tightness
- Fatigue
What are some exam findings of a patient with asthma
- Prolonged expiratory wheeze
- Hyperresonance to percussion
- Decreased breath sounds
- Tachypnea
- Tachycardia
- Use of accessory muscles
How else can you diagnose Asthma?
-Bronchoprovocation: Methacholine challenge (> 20% decrease on FEV1) followed by bronchodilator challenge (Increase of FEV1 > 12 is expected)
What is the best and most objective way to assess exacerbation severity and patient response to treatment in asthma?
Peak expiratory flow rate
In an acute asthma exacerbation, what are three discharge criteria?
- PEFR > 70% predicted
- PEFR > 15% initial attempt
- Subjective improvement
On ABG with asthma, what is expected?
Respiratory alkalosis (from tachypnea)
Treatment for acute asthma
- SABA (Albuterol, Terbutaline, Epinephrine)
- Antimuscarinics (Ipatropium)
- Corticosteroids (Prednisone, Methylprednisone, Prednisolone)
What are some common side effects of SABA?
Tachycardia/arrhythmias
Muscle tremors
CNS stimulation
Hypokalemia
Treatment for chronic asthma
- inhaled corticosteroids
- LABA
- ICS/LABA combo (Symbicort, Advair Diskus)
What are some examples of LABA?
- Sameterol
- Formoterol
- Budesonide
MCC of post-op fever day 1
Atelectasis
How to prevent asthma exacerbations?
- Reduce risk factors such as tobacco smoke, air pollution, chemical irritants (including perfume), reduce # of lower respiratory infections
- Use spacers for inhalers
Intermittent asthma
- Symptoms: < 2 x/day
- SABA use: < 2 x/week
- Nighttime awakenings: < 2/month
- Interference with activities: None
- Lung function: Normal FEV1/FVC
- Treatment: SABA
Mild Persistent Asthma
- Symptoms: > 2 days/week, but not daily
- SABA use: > 2 days/week, but not more than 1x/day
- Nighttime awakenings: 3-4 x/month
- Interference with activities: Minor
- Lung function: Normal FEV1 > 80%
- Treatment: SABA + low-dose ICS
Moderate Persistent Asthma
- Symptoms: Daily
- SABA use: Daily
- Nighttime awakenings: > 1x/week, not nightly
- Interference with activities: Some
- Lung function: Normal FEV1 60-80%
- Treatment: Low ICS + LABA or Medium ICS
Severe Persistent Asthma
- Symptoms: Throughout the day
- SABA use: Several times a day
- Nighttime awakenings: Nightly
- Interference with activities: Extremely limited
- Lung function: FEV1 < 60%
- Treatment: High dose ICS + LABA +/- Omalizumab
