Pulm Flashcards
Pt has fever + pleuritc pain + productive cough and no hospitalization within 48hrs? most common bug?
community acquired pneumonia
most common: strep pneumoniae, C pneumonaie, H flu, legionella, viruses
Pt has sore throat + HA + non productive cough + dyspnea? Bug?
atypical pneumonia
mycoplasma
chlamydia
Pt has fever + productive cough after being hospitalized how many hrs? Bug?
hospital acquired pneumonia
w/in 48hrs
bug: gram neg - e coli, pseudomonas, staph aureus
What are the 2 types of vaccine? When to vaccinate?
influenza -
pneumococcal- 65yo+
What PE to expect from community acquired pneumonia?
dullness to percussion
egophony
When to order culture for pneumonia?
if CXR shows cavitations
What lab to order for pneumonia? What to expect?
CXR - consolidations
What type of crackles will be heard with pneumonia?
late inspiratory crackles
What type of pulse - temperature indicates atypical pneumonia?
normal pulse but high fever
Alcoholic with pneumonia - bug?
klebsiella
Immigrant w/ pneumonia -bug?
TB
Pt lives in nursing home w/ pneumonia - bug?
pseudomonas
Pt has HIV retrosternal chest pain that is worse with inspriation, been going on for weeks? What to expect on CT?
pneumocystitis jiroveci
CT- ground glass appearance
How to tx pneumocystitis jiroveci?
bactrim
Pt who had organ transplant or renal failure, smokers are at risk for what bug w/ pneumonia?
legionella
How to tx community acquired pneumonia? How long?
1) macrolide - azithromycin
2) doxycyline
3) fluorquinolones - levofloxacin or macrolide w/ beta
5 days or until afebrile for 48hrs
How to tx hospital acquired pneumonia?
fluroquinolone
OR
macrolide + beta lactam
What are complications of pneumonia?
pleural effusion
pleural empyema
Where to look for aspirated pneumonia, FB, lung abscess?
RIGHT LUNG
What are the bugs for neonatal 0-1mo? -Pneumonia
group b strep
e coli
What are the bugs for infants 1-6mo? -Pneumonia
chlamydia trachomatis
RSV
What are the bugs for children 6mo-5yo? -Pneumonia
RSV
parainfluenza
What are the bugs for children 5-15yo? -Pneumonia
mycolasma pneumonia
influenza virus A
What are the bugs for young adults 16-30yo? -Pneumonia
mycoplasma pneumoniae
What are the bugs for older adults 30yo+? -Pneumonia
strep penum
haemophilus influenzae
Common bug if pt is in ICU w/pneumonia?
s. pneumoniae legionella H fl Enterobacateriae S aureus pseudomonas
How to tx ICU pt w/pneumonia?
azithormycin
fluorquinolone + anti pneumoococcal beta lactam
How to determine if pt needs to be hospitalized w/pneumonia?
CURB 65
- Confusion
- Urea nitrogen, blood >19
- RR >30/min
- BP systolic
What are the different phases of TB?
early
latent
progressive
What is the most common bug for TB?
mycobacterium tuberculosis
What are the different phases of TB?
primary
progressive
latent
What is primary TB?
when TB first enters the lungs and manifests/walls off to make their home –> also spreads via lymphatics and blood –> after the first infxn it is not detectable
What is secondary TB?
happens when the body is suppressed/weak –> REACTIVATION (b/c the body had it’s first infxn with primary TB) –> actually shows SIGNS and SX of TB –> manifests where the lungs have the MOST O2 (apical parts of the lungs)
What are sx of TB?
fever night sweats wt loss malaise dry cough --> productive apical rales: post tussive
What is latent TB?
same as primary - cannot tell if latent or primary b/c it is asymptomatic
What are RF for TB?
close contact
immigrants
HIV
What imaging for TB and what to expect?
CXR - upper lob infiltrates w/ cavitations; milary pattern
What labs to order for TB?
sputum cultures x3mornings - acid fast
What pt may have false positive for mantoux TST?
immigrants that may have BCG vaccination
What are the types to screen for TB?
mantoux TST
interferon gamma release assay
How to read the mantoux TST? Who does this apply to?
5mm- HIV , close contact with TB
10 mm - foreign born, IV drug users, children, homeless, prisoners, health care workers
15mm - never been exposed to health settings, NO RF
How to tx TB?
4 drug therapy- RIPE
1) Rifampin
2) Isoniazid
3) Rifampin
4) Ethambutol
Pt has sudden onset of fever+ chills + HA + nonproductive cough + sore throat + photophobia? Tx?
influenza
supprotive
zanamivir (do not use in asthma) /oseltamivir - antiviral very ineffecctive
Sx for mononucleosis? Bug?
flu like sx + splenomegaly + maculopapular rash + petechaie
EBV
How to dx mononucleosis?
monospot
How to tx mononucleosis?
supportive
When does a cough need further investigation?
3mo
Pt has rhinorrhea, myalgias, HA, fever, cough - yellow sputum? Is this viral or bacterial?
viral NO yellow pustum
What sx for bacterial URI?
fever, cough, yellow sputum
Pt has cough after URI? Tx?
acute bronchitis
supportive, +/- bronchodilators, codeine
What URI bug for acute bronchitis?
influenza A, B
What is common cold called?
acute rhinosinusitis
What bugs for acute rhinosinusitis?
rhinoviruses
coronavirus
What are sx of influenza?
fast on fast off
systemic sx dec and resp incr
fever, HA, chills, mayalgia, photophobia
Tx of influenza? Complication?
zanamivir - NOT for asthmatics
