PULMO Flashcards
The most common infectious cause of acute exacerbation of bronchitis
Respiratory viruses
Respiratory viruses such as influenza A and B, parainfluenza, respiratory syncytial virus, and coronavirus have all been attributed to acute bronchitis.
Chronic Bronchitis
Productive cough for 3 months each year for 2 consecutive years, often with dyspnea and partially reversible airway obstruction.
Acute exacerbation of Chronic Bronchitis
Change in the characteristic of a productive cough that has lasted for more than 3 months for 2 consecutive years
Hallmarks of upper respiratory cough syndrome previously termed “postnasal drip.”
Rhinorrhea and repetitive throat clearing
Fever is common in patients with ________________ and is less common with ________________
Fever is common in patients with viral respiratory illnesses and is less common with pertussis infection
Acute Bronchitis
cough of at least 5 days duration and can persist up to 20 days
risk factor for penicillin resistance
Immunosuppression from alcoholism or
cancer
Poor prognostic factors in Elderly
fever greater than 38.3◦C
leucopenia
immunosuppression
gram-negative or staphylococcal infection
cardiac disease
bilateral infiltrates
Chronic alcoholism
S. aureus
S. pneumoniae
Klebsiella pneumoniae
Pseudomonas aeruginosa
distinguishing a chronic obstructive pul- monary disease (COPD) exacerbation from congestive heart failure (CHF)
B-type natriuretic peptide level
ACUTE COUGH
<3 weeks
Associated with self-limited URTI or bronchial infection
URTI: rhinitis, sinusitis, pertussis
LRTI: bronchitis, pneumonia
Allergic reaction
Asthma
Environmental irritants
Transient airway hyperresponsiveness
Foreign body
Hallmark of acute bronchitis
PRODUCTIVE COUGH
SUBACUTE COUGH
3-8 weeks
postviral airway inflammation with bronchial hyperresponsiveness
mucus hypersecretion
upper airway cough syn- drome (postnasal discharge),
asthma
Most likely cause of subacute cough
Postinfectious cough
CHRONIC COUGH
> 8 weeks
MCC of Chronic cough
(1) smoking, often with chronic bronchitis; (
2) upper airway cough syndrome (formerly postnasal discharge);
(3) asthma;
(4) gastroesophageal reflux; and
(5) angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker therapy
Feeling of difficult, labored, or uncomfortable breathing “Shortness of breath,” “breathlessness,” or “not getting enough air”
Dyspnea
Rapid breathing
Tachypnea
Dyspnea in the recumbent position
Orthopnea
Orthopnea that awakens the patient from sleep
Paroxysmal nocturnal dyspnea
Dyspnea associated with lying on one side (lateral decubitus position) but not the other side
Patient lies on the side of the more affected lung where gravity increases blood flow to the worse lung and reduces it to the better lung
Trepopnea
Dyspnea in the upright position
Results from:
Loss of abdominal wall muscular tone
Right-to-left intracardiac shunting (patent foramen ovale)
Platypnea
Hyperventilation; minute ventilation in excess of metabolic demand
Hyperpnea
Combined the subjective sensation of dyspnea with signs indicating difficulty breathing
Respiratory distress
Occurs when the lungs and ventilatory muscles cannot move enough air in and out of the alveoli to adequately oxygenate arterial blood and eliminate carbon dioxide
Ventilatory or respiratory failure
excludes heart failure
BNP (<100 picograms/mL) or NT pro-BNP (<300 picograms/mL)
Treatment of Hiccups
SWIF the hiccups
Sugar
Water
Ice
Foreign body
*Swallow a teaspoon of sugar
*Drink water quickly
*Sip ice water
*Remove foreign body from ear
approved for treatment of intractable hiccups
Chlorpromazine
Pleural fluid (ml) required to be detectable on an upright chest xray
150-200ml
limit therapeutic thoracentesis acute drainage to 1.0 – 1.5 L to prevent
Reexpansion pulmonary
edema
Light Criteria
1 or more = EXUDATE
PROTEIN (P/S) = >0.5
LDH (P/S) = >0.6
LDH (P>S) = >2/3
**Serum albumin difference: >1.2g/dl or 12g/L
HIGH Protein (Transudative vs Exudative)
Exudative
LOW Protein (Transudative vs Exudative)
Transudative
Massive or severe hemoptysis
100 mL to >1000 mL per 24 hours
Midpoint value: 600 mL per 24 hours
most commonly affected in hemoptysis
BRONCHIAL ARTERIES
Intubation in Hemoptysis
Larger-diameter ET to allow for bronchoscopy
Affected lung is in a dependent position to prevent spilling of blood into the unaffected side
Preferentially intubate the main bronchus of the unaffected lung
Visualization of the more peripheral and upper lobes
NOT provide optimal suctioning and does NOT allow for local treatment
Fiberoptic bronchoscopy
Cannot fully view the upper lobes and peripheral lesions
Greater suctioning
ability than fiberoptic bronchoscopy
Rigid bronchoscopy
Tamponade the bronchus of the AFFECTED lung
FORGARTY CATHETER
Most effective treatment of massive hemoptysis
bronchial artery embolization
Most common pathogen causing pneumonia in alchoholics
S. Pneumoniae
Most common cause of acquired immune deficiency AIDS-related death in pregnant women
Pnemocystis Pneumonia
Acute pulmonary infection in a patient who is not
hospitalized or residing in a long-term care facility ≥14 d before presentation
Community-acquired pneumonia
New infection occurring ≥48 h after hospital admission
Hospital-acquired pneumonia
New infection occurring ≥48 h after endotracheal intubation
Ventilator-acquired pneumonia
Healthcare–associated pneumonia
Patients hospitalized for ≥2 d within the past 90 d
Nursing home/long-term care residents
Patients receiving home IV antibiotic therapy
Dialysis patients
Patients receiving chronic wound care Patients receiving chemotherapy Immunocompromised patients
Rust-colored; gram-positive encapsulated diplococci
Streptococcus pneumoniae
Purulent; gram-positive cocci in clusters
Patchy, multilobar infiltrate; empyema, lung abscess
Staphylococcus aureus
Brown “currant jelly”;
thick, short, plump, gram-negative, encapsulated, paired coccobacilli
Upper lobe infiltrate, bulging fissure sign, abscess formation
Klebsiella pneumoniae
Gram-negative coccobacilli
Patchy infiltrate with frequent abscess formation
Short, tiny, gram-negative encapsulated coccobacilli
Gradual onset, fever, dyspnea, pleuritic chest pain; especially in elderly and COPD
Patchy, frequently basilar infiltrate, occasional pleural effusion
Haemophilus influenzae
Multiple patchy nonsegmented infiltrates, progresses to consolidation, occasional cavitation and pleural effusion
Few neutrophils and no predominant bacterial species
Legionella pneumophila
Gram-negative diplococci found in sputum
Diffuse infiltrates
Indolent course of cough, fever, sputum, and chest pain; more common in COPD patients
Moraxella catarrhalis
Patchy subsegmental infiltrates
Few neutrophils, organisms not visible
Chlamydophila pneumoniae
Interstitial infiltrates (reticulonodular pattern), patchy densities, occasional consolidation
Few neutrophils, organisms not visible
Mycoplasma pneumoniae
