PULM: RTIs - Airway Disease Flashcards
what are the three croup diseases
Acute laryngitis
Laryngotracheobronchitis (viral croup)
Epiglottitis (bacterial croup)
viral croup
- most common etiologic agent?
- presentation?
- complications?
- agent - parainfluenza type I
- presentation
- mild/severe
- barking cough
- inspiratory stridor - @ night
- severe croup
- inspiratory stridor at rest
- suprasternal/intercostal retractions
- tachypenea, tachycardia
- cynaosis
- mild/severe
- complications
- bacterial superinfection
- tracheal damage/lluinal narrowing
what bacteria are likely to cause a superinfection following viral croup?
- s. aureus, s. pneuononia, h. influenza, m. catarrhalis
epiglottis?
- etiologic agent
- presentation
- complications
- agents:
- H. influenza (m/c), S**. pyogenes
- presentation:
- SEVERE/RAPID sore throat
- 4Ds: dysphasgia, dysphonia, drooling, distress
- high fever
- complications:
- septic artthritis/ meningitis / osteomyelitis
how to differentiate viral croup from epiglottitis?
- viral croup
- improvement with water saturated air (shower steam)
- radiography - positive steeple sign
- epiglottitis
- NO improvement with water saturated air (shower steam)
- radiography - positive thumb sign
- presentation - higher fever than viral croup + 4Ds
what is this radiograph showing?
steeple sign - viral croup (parainfluenza)
what is this radiograph showing?
thumb sign - epiglottitis (H. influenza)
treatment / prevention of epiglotitis?
prevention - HiB vaccine
treatment - intubation, Ab (rifampin) if not vaccinated
what is the most common cause of viral croup?
parainfluenza
acute bronchitis
- etiologic agent
- predisposing factors
- presentation
- diagnosis
- agent - virus m/c
- predisposing factors: always follow a URI
- common in IgG deficiencies, respiratory dz (ex: emphysema)
- presentation: non-productive cough that becomes purulent
- dx - radiograph key: CXR negative for filtrates / consildations
how to differentiate between acute bronchitis and pneumonia?
get chest X-ray to look for infiltrates.
negative CXR = bronchitis
bronchiolitis
- etiologic agent
- predisposing factors
- presentation
- diagnosis
- agent - viral (RSV)
- predisposing factors - children < 1 yr in age
- esp if bottle feeding or premature
- presentation
- cough/dyspnea
- wheezing/crackles
- nasal flaring
- diagnosis:
- radiography- focal atelectasis / peribronchial cuffing
- nasal washings - show RSV
discuss the different strains and virulence factors of influenza and their importance.
influenza A & B - viral RNA.
influenza A - also segmented.
viral, segmented
- drift: mutation in the viral RNA amino acids that changes the H antigen- A & B
- shift: rearrangment of the H and N proteins - A only
pneumonia is an infection of what part of the respiratory tract?
lower respiratory tract
what are the two types of pneumonia and how to differentiate them?
typical (lobar pneumonia)
- fluid accumulating within alveolar sacs
atypical (interstitial) pneumonia
- fluid accumulating in between the cells (in the walls of alveoli/bronchi)
- this causes walls thickening –> “cow-webbing” on CXR
- “walking: pneumonia
therapy for influezna?
influezna A: “- antadine”
influenza A & B:
- neuraminidase inhibitors
- viral cap dependent endonuclease protein inihibitors
whooping cough
- etioligic agent & its virulence factors
- diagnosis
- prevention
- agent - bordatella pertussis
- hemagluttinin: attachment to ciliated epithelium
- cytotoxin/pertussis toxin: kill tracheal ciliated epitheium
- cytotoxin also inc IL-1 –> fever
- dx
- whoop from inspiratory stridor - pathognomonic
- lymphocytosis
- prevention:
- DtAP vaccine
most common means of aquiring pneumonia
- inhalation
- aspiration
typical pneumonia
- presentation
- etiologic agents
two types - hospital aquired & community aquired
- agents:
- community aquired:
- s. pneumonia (m/c)
- h. influenza, klebsiella
- hospital aquired:
- s. aureus & gram - rods
- community aquired:
- presentation (for both types)
- PRODUCTIVE cough –> purulent sputum
- consolidations in CXR
- HIGH fever
- pt looks toxic
atypical pneumonia
- etiologic agents
- presentation
= intersitial pneumonia
- agents:
- mycoplasma pneumonia (m/c), SARS-Cov-2
- l_egionella, chlaydophilia_ phenomina
- presentation:
- NON-PRODUCTIVE, paroxysmal cough
- infiltrates in CXR
- lower fever
- pt looks well
aspirational pneumonia
- presentation:
- typical pneumonia + recurring chills
-
consolidations in DEPENDENT lung segments
- dependent = lung base when upright, posterior lung with supine
- +/- foul smelling sputum
- etiologies:
- community aquired: oral anaerobes + s. pneumonia
- hospita laquired: oral anaerobes + gram - rods
chronic pneumonia
- agents
- presentation
- presentation
- weeks-months onset
- night sweats
- productive cough
- +/- coin lesions (Gohn complex) - if agent m. tuberculosis
- etiologies:
- mycobacterium tuberulosis
- fungi - blasomyces, coccidiodies, histoplasma
what is shown in this radiograph?
- coin lesions (Gohn complex)
- see in aspirational pneumonia OR chronic pneumonia that is due to a mycobacterium tuberulosis infection
most common cause of pneumonia in child < 1 month?
= neonate
- e. coli, s. agalactae
what is a common etiology of pneumonia common in alcohol abusers?
list the characteristics of this agent
klebsiella pnuemonia
- gram - rod
- fermenting (pink maconkey agar)
- urease +
- citrase +
common etiological cause pneumonia in military recruits & college students?
what are the characteristics of this agent
neisseria meningitis
- gram - diplococci
- oxidase positive
- grows on chocolate agar
- virulence factors
- protective capsule - prevents phagocytosis
- pili - promote nasopharyngeal coloniziation
- IgA protease - promotes adherence
- LOS - proinflammatory
list pneumonia agents in weird circumstances: bird fanciers, farmes
birder fanciers = chlamydophilia psittaci
farmers = coxiella burnetti
categories pneumonia agents based on onset
- acute - standard?
- subacute onset = atypical pneummonias
- mycoplasma pneumonia
- chlamydia pneumonia
- legionella pnuemnoia
- chronic onset
- m. tuberculosis
- fungi
psueodomonas is the a common cause of pneumonia in what patient populations?
- mechanical respirators (ventilators)
- malnourished
- bronchiectasis
- drugs - steroids, broad spectrum abx
cause of pneumonia in bird fanciers?
chlamhydophilia psittaci
common locations of
histoplasma
coccidioides
blasotomycoses
histoplasma: ohio/mississipi river valleys
coccidioides - southwest: san jaoquin valley / south central arizona / rio grande valley
cause of pneumonia in farmers during birthing season?
coxiella burnetti
*Q fever
what clinical manifestations point to Covid-19 pneumonia?
- higher fever
- loss of taste/smell
- lymphoPENIA
- labs: lactate dehydrogenase & ferritin
identify disease
rough skin lesions
blastomyocis pneumonia
this CXR showing is showing
- what feature?
- due to what agent?
- bulging fissure
- klebsiella pneumonia
think staph aureus (often in children)
this CXR has
- what distinguishing feature?
- points to what likely etiologic agents?
- lung abscess
- s. aureus, psuedomonas, anaerobes, gram - bacilli
the CXR is showing
- what distinguishing feature?
- points to infection by what etiologic agent?
- lung abcess
- s. aureus, p. areuginosa, anaerobes, gram - bacilli
what agent is shown?
what are its pertinent characteristics?
histoplasma - monomorphic, narrow based buds
found in soil of ohio / missippi river valleys
what is the etiologic agent and its pertinent features?
blastomycoses - pleomorphic, broad based bud
found in soil of southeastern & ohio / missippi river valleys
identify
note importan t features
coccidioides
at body temp - spherules: thick walled spheres containing endospores
at room temp - arthcoconidia
found in southwestern US, mexico, central & south america
- what etiological agents are associated with the following sputum appearances
- purulent
- mucoid
- rust colored
- green color
- thick currant / jelly like
- hemoptysis
- foul smelling
- purulent & mucoid - typical
- rust colored - s. pneumonia
- green color - psuedomonas or h. influenza
- thick currant / jelly like - klebsiella
- hemoptysis - cavitary TB or lung abcess
- foul smelling - anaerobes
what microbes are we testing for with the following stains?
- silver stain?
- acid fast stain?
- gomori methamine silver stain (GMS)?
- silver stain - legionella
- acid fast stain - mycobacterium tuberulosis
- gomori methamine silver stain (GMS)
- fungi (histo, blastomycosis, pneumocystis)
- pneumocystis
identify agent
note characteristics
strep pneumo
gram + lancet shaped diplococcus
identify cause
staph aureus
identify
explain
e. coli
e. coli & s. agalactae m/c causes of pneumonia in chidlren < 1 year old.
- it is pink (gram -), thus is e. coli
- s. agalactae would be purple (gram +)
other than pneumonia, what disease are e. coli & s. agalactae likely to cause in children
meningitis
- NAAT positive
- stacatto cough
chlamhydia
what is the agent?
“fried egg” appearance on eatons agar
mycoplasma pneumonia
what agent?
what stain?
pneumocysois jiroveci
high in immunocompromised host
GMS stain
