Pulm #2 Flashcards
What is bronchiectasis?
Permanent and irreversible dilation of the bronchial airways
MCC of bronchiectasis in the US
Cystic Fibrosis
Recurrent lung infections cause bronchiectasis. What is the main cause if due to CF and what is the main cause if NOT due to CF?
CF: Pseudomonas
Non CF: H. Influenzae
What is the pathophysiology of bronchiectasis?
-Dilatation of the airways and impairment of mucociliary escalator leads to repeat infections, airway obstruction, and peribronchial fibrosis
Symptoms of bronchiectasis
- Persistent productive cough with thick sputum
- Hemoptysis
- Crackles, wheezing, rhonchi
What is the preferred imaging of choice in bronchiectasis and what do you see?
- High resolution CT scan
- -Thickened bronchial walls, airway dilation, lack of tapering of airway (tram-track appearance) and signet ring sign
However, what is the GOLD standard for imaging for bronchiectasis?
-Pulmonary function test: obstructive pattern (decreased FEV1, decreased FEV1/FVC <70%)
Treatment for bronchiectasis
- Chest physiotherapy
- ABX often needed: Macrolides, Cephalosporins, Fluoroquinolones. Antibiotic cycling used (1 weekly each month)
Bronchogenic carcinoma is the leading cause of cancer deaths in the US. However, it is the ______most common cancer diagnosed in the US
Second (after prostate in men and breast in women
Where does bronchogenic carcinoma MC Met to?
-brain, bone, liver, lymph nodes, and adrenals
Risk factors for bronchogenic carcinoma
- Smoking (MC)
- Asbestosis
- Radon exposure (miners)
- TB
- Genetic susceptibility
The US Preventative Services Task Force recommends annual low-dose CT screening for who?
55-80 who have no symptoms of lung cancer + 30 PPY smoking history who currently smoke or have quit within 15 years
What is the MC primary lung cancer in smokers, nonsmokers, women, and men?
Adenocarcinoma
Characteristics of adenocarcinoma
- Typically peripheral
- Asymptomatic in early disease; hemoptysis, weight loss, cough, dyspnea
Treatment for adenocarcinoma of the lungs
Surgical resection
Symptoms of Squamous Cell Carcinoma
- CCCP
- -Centrally located
- -HyperCalcemia
- -Cavitary Lesions
- -Pancoast Syndrome: shoulder pain, paresthesias, Horner’s Syndrome
Treatment for Squamous Cell Carcinoma
Chemotherapy but often metastatic at the time of presentation
What is chronic bronchitis defined as?
-Productive cough for at least 3 months a year for 2 consecutive years
Etiologies of chronic bronchitis
Smoking (MC), air pollution, hazardous dust
Pathophysiology of chronic bronchitis
Chronic inflammation leads to mucous gland hyperplasia, goblet cell mucus production, dysfunctional cilia
Symptoms of chronic bronchitis
- Chronic cough
- Sputum production
- Dyspnea
- Cyanosis and obesity (blue bloaters)
- Crackles, rhonchi, wheezing
Diagnostics for chronic bronchitis
- PFT: gold standard (decreased FEV1/FVC, decreased FEV1)
- CXR: pulmonary hypertension
- ECG: cor pulmonale
- CBC: increased hemoglobin and hematocrit
- ABG: respiratory acidosis
Health Maintenance for chronic bronchitis
1) Quit smoking
2) vaccines (Pneumococcal and flu)
3) pulmonary rehab
4) Surgery
5) Azithromycin has been shown to have anti-inflammatory properties in the lungs
Treatment for chronic bronchitis
- Quit smoking
- Combo therapy with anticholinergics + B2 agonists
- ICS - never used alone. Add to LABA
- O2
What is the only therapy shown to decrease mortality in chronic bronchitis
Oxygen
What is cystic fibrosis?
-Autosomal recessive defect that prevents chloride transport (water movement out of cell) –> build up of thick mucus in the lungs, pancreas, liver, intestines –> obstructive disease and exocrine gland dysfunction
What gene is affected with cystic fibrosis?
Chromosome 7, CFTR gene
Symptoms of cystic fibrosis
- Meconium ileus
- Failure to thrive
- Bronchiectasis
- Malabsoprtion of vitamins ADEK
- Diarrhea
- Infertility due to azoospermia
- Pancreatitis
- Sinusitis
Most accurate diagnosis for Cystic Fibrosis
- Elevated sweat chloride: 60 mmol/L or more on two occasions after Pilocarpine (induces sweating)
- PFT: Obstructive pattern
Treatment for CF
- Airway clearance treatment: bronchodilators, decongestants
- Pancreatic enzyme replacement: ADEK
- ABX often needed: Macrolides, Cephalosporins, Augmentin
- Lung and pancreatic transplant
- Pneumococcal and Flu Vaccines
Which type of Influenza is associated with more severe outbreaks?
Influenza A
Risks for influenza
- Age > 65
- Pregnancy
- Immunocompromised
- Children are important vectors for the disease
Symptoms of influenza
- Abrupt onset of headache, fever, chills, malaise, URI symptoms, pharyngitis, PNA
- Myalgias involving legs and lumbosacral areas
Diagnostics for influenza
- Usually clinical
- Rapid influenza test (nasal swab) or viral culture
Treatment for Influenza
- Supportive: Acetaminophen, Rest
- Antivirals only needed if > 65 or at high risk for complications (Oseltamivir) within 48 hours of symptom onset
Who can get the inactivated influenza vaccination?
-All individuals 6 months or older (including pregnancy)
Who can get the live attenuated vaccination and who cannot?
Can: ages 2-49
Cannot: immunocompromised, pregnancy, age 50 or older, if taken an antiviral within the last 48 hours, close caregivers of immunocompromised patient
Pertussis (Whoopng cough) is a highly contagious infection secondary to ________, a gram ________
Bordatella Pertussis
Gram negative coccobacillus
Three phases of Pertussis
- Catarrhal: URI symptoms lasting 1-2 weeks
- Paroxysmal: Severe coughing fits with inspiratory whooping after cough fits. Post-cough emesis. Lasts 2-4 weeks
- Convalescent: resolution of the cough (lasts up to 6 weeks)
Which stage of Pertussis is the most contagious?
Catarrhal
Diagnostics for Pertussis
- Clinical diagnosis
- However, when available, order throat culture and PCR nasal swab
Treatment of Pertussis
- Supportive is mainstay
- Macrolides are DOC to reduce contagiousness
- Bactrim second line
- Azithromycin if patient < 1 month old
When is the DTaP vaccination given?
2, 4, 6, 15-18 months
4-6 years old
11-18 years old booster
What is the gold standard diagnostic for Pertussis?
PCR of nasopharyngeal swab
MCC of Laryngotracheitis (Croup)
Parainfluenza Type I
Symptoms of Croup
- Upper airway involvement
- Harsh, seal like barking cough
- Inspiratory stridor, hoarseness
- Coryza (inflammation of nasal cavity)
Diagnostics for Croup
- Clinical diagnosis
- Frontal cervical radiographs: Steeple sign (rarely done)
Treatment for Croup (Mild, Moderate, Severe)
Mild (no stridor at rest, no respiratory distress): Supportive. Dexamethasone provides significant and quick relief. Discharged home
Moderate (stridor at rest with mild retractions): Dexamethasone PO or IM + supportive. Nebulized epinephrine. Observe for 3-4 hours.
Severe (stridor at rest with marked retractions): Dexamethasone + nebulizer Epinephrine and hospitalization
What is the inhaler of choice for COPD?
Ipratropium Bromide
