Pulm: Block 1 Flashcards
What is the pathophysiology of COPD
How does it present and what is seen on PE?
Abnormal and permanent enlargement of airspace due to wall destruction
Older PT w/ smoking Hx w/ Dyspnea
Dec sounds
Hyperresonance
What will be seen on diagnostic studies of COPD?
What are two complications that can arise from emphysema?
Dec FEV, Inc TLC
Pneumothorax from bullae
Weight loss due to breathing efforts
What mechanism allows us to breathe?
TP: 4mmHg, inflate
TTP: -4mmHg, deflate
TRP: air flow to/from atmosphere and to/from lungs
-4mmHg in interstitial space pulls lungs during inspiration
What is the criteria to receive the term ‘blue bloater’?
What will be seen/heard on exam and PFT?
Productive cough x3mon for two consecutive years
Inc resonance Dec sounds Accessory muscle use FEv/FVC ratio <0.7 FEV <80%
What are the two causes of the Cor Pulmonale showing in Blue Bloaters?
What is the most common and four less common causes of bronchiolitis?
RV failure
PHTN
MC= RSV LC= Parainfluenza, Rhino, Influenza, Metapneumo
How is bronchiolitis Dx and Tx
What are three potential complications?
What is the most common cause of Acute Bronchitis and how does it present?
Child under 2yrs w/polyphonic wheezes and ralesafter 1-3 day URI; Tx w/ Support
Dehydration, Apnea, Aspiration pneumo
Viruses- productive cough <1wk
Tx: support, dilators
How does acute bronchitis present?
What are the 6 viruses that can cause acute bronchitis?
What 3 bacteria could cause acute bronchitis?
Cough x 5days or more
Non/purulent sputum
URI prodrome
RPM RIC
Rhino Parainfluenza Metap
RSV Influenza Corona
Bordatella pertussis
Mycoplasma pneumo
Chlamydia pneumo
How does bronchiectasis present?
What will be seen on imaging of bronchiectasis
How is the Dx confirmed?
Large amount of sputum
Crackles and wheezing
Tram tracks- dilated and thickened airway
CT: Signet ring sign (wall thickening and plugs_ and
Tree-in-bud (trapped debris)
What is the most common cause of bronchiectasis
How is it Tx?
CF
Therapy Hydrate ABD Dilator
Define Bronchiectasis
What type of airway dz is it?
What vaccine has significantly reduced the prevalence of epiglottitis?
Dilation w/ decreased airway clearance causing mucus pooling
Obstructive
HIB
What are the top three the most common causes of URIs?
How do these PTs present?
How is it Tx?
Strep Pneumo- MC, in carriers
HIB- unvaccinated Peds PT
Moraxella- smokers
Rapid onset fever/dysphagia
Stridor, Tripod, drooling
Thumb sign on x-ray
ABX (Cephtriaxone, Vanc)- safe for young, old, pregnant
What is the full term of Croup
Croup is most commonly caused by ? and in ? age PT
How is Croup Tx?
Laryngotracheitis
Parainfluenza virus, 6mon-3yrs
Cool temps
Dexameth, Racemic Epi
What respiratory sound is made in Croup PTs and what Sx is rarely seen?
What hallmark image is seen on x-ray for these PTs?
What is the difference between this fever and epiglottitis fever?
Inspiratory stridor
Rare= hypoxia
Steeple sign on PA view
Croup: low, non toxic PT
Epiglottitis: high, toxic PT
Who and how does Bacterial Tracheitis present?
How is this one different?
What meds are used to Tx Bacterial Tracheitis
What is different about these PTs Tx process?
3-5y/o w/ high fever (+102), barky cough, stridor
Toxic appearing
Pseudomembrane development
IV Ceftriaxone/Vanc
IV fluids
Sedate, Intubate, Bronchoscope
How does influenza appear in clinic?
How is Influenza Dx
How are they Tx and what med can be given to high risk PTs if Dx is made within 48hrs
HA Myalgia Fevers Sudden onset fever Non-productive cough
Reverse PCR, rarely culture
Support- PO fluids
Oseltamivir- don’t use w/ statin due to liver damage
What is the most common cause of viral pneumonia in adults?
What are the differences between the three types of this microbe
How is this microbe spread?
Influenza
A: pandemic (PT more sick)
B: epidemic
C: sporadic
Respiratory droplet
What microbe causes Whooping Cough?
How does this present?
Bordetella Pertussis
Hx of nasal congestion, Cough
Low fever
Repetitive cough, whoop, post-cough emesis
What med is used to Tx Pertussis?
What are the three stages of pertussis?
Azith. preferred <1mon
Alt: TMP/SMX if macrolide c/i
Catarrhal- 1-2wks; fever, non-productive cough, rhinorrhea
Paroxysma- 2-6wks; whooping, stridor
Convalescent- 1-2wks; reduced Sxs
What microbe is the most common cause of bacterial pneumonia?
What can be seen on PE to ID this?
Strep Pneumo
Rust colored sputum, Gram Pos
What microbe is the most common cause of pneumonia in alcoholics?
What is the most common cause of pneumonia in drug users?
Klebsiella- currant jelly sputum, bulging fissures
Staph A: gram pos cocci in clusters seen post influenza, most dangerous
What is the most common cause of pneumonia in CF, nursing homes and cyanosis?
What microbe is most common cause in COPD PTs and is usually post-URI?
Pseudomonas
H Infleunza, gram NEG pleomorphic rods
What are the two microbes most likely to cause health care associated pneumonia?
How are pneumonias Tx?
Pseudomonas
MRSA
Outpatient, healthy: Macrolide or Doxy*- few s/e, no QTc lengthening
OutPT w/ comorbidity/Inpatient: respiratory flouroquinolone
ICU: Ceftriaxone/Cefotaxime and Azith or Respiratory fluoroquinolone
What comorbidities in a pneumonia PT change the Tx protocol?
“Walking Pneumonia” can be from what six microbes?
DM, HTN, Obese, Apnea
CCC FML Chlamydia Pneumo(mild) Chlamydia Psitt. Cox Burnetti F. Tularemia Mycoplasma pneumo (young PTs) Legionella Pneumo
Most common cause of Typical CAP, follows URI/influenza and has acute onset
May follow influenza, cavitary and possible MRSA
Present in DM, ImmComp, long term care facilities and aspiration pneumonia
Chronic lung Dz PTs or PTs on mechanical vents
Strep Pneumo- rust color sputum
Staph A
Klebsiella
Pseudomonas