Pulmonary Flashcards
a 25-year-old cystic fibrosis patient complaining of chronic, frequent coughing productive of yellow and green sputum. She recently recovered from a Pseudomonas spp. pneumonia requiring hospitalization. On physical examination you notice foul breath, purulent sputum and hemoptysis along with a CXR demonstrating dilated and thickened airways with “plate-like” atelectasis (scarring).
Bronchiectasis
What is bronchiectasis? What are the most common causes?
Permanent dilation or destruction of bronchiole walls
Causes
- cystic fibrosis
- immune deficits
- recurrent infections (pneumonia, bronchitis)
What are the chest x-ray findings of bronchiectasis?
- linear “tram track” lung markings
- plate-like atelectasis
- dilated & thickened airways
Treatment of Bronchiectasis
- oxygen
- Aggressive ABX –> Pseudomonas (Zosyn, Fluoro.)
- Chest physiotherapy
- lung transplant
What is a carcinoid tumor? What are the common symptoms?
A tumor arising from neuroendocrine cells –> excess secretion of serotonin
Symptoms:
- episodic flushing
- diarrhea
- wheezing & cough
- itching
- heart failure
- Pellagra –> low niacin levels causing dementia, diarrhea, dermatitis
Where are carcinoid tumors most commonly found?
- GI (intestines, stomach, liver, pancreas)
2. Lungs
How do you diagnose a carcinoid tumor?
CT scan – definitive diagnosis
Urinalysis 5-HIAA – serotonin metabolite
Decreased Niacin
How do you treat a carcinoid tumor?
Surgery (lesions are immune to chemo and radiation)
Octreotide – decrease secretion of serotonin
Niacin supplementation
What is cor pulmonale & what are some common etiologies?
Right sided heart failure secondary to lung disorder that causes pulmonary hypertension
Etiologies:
- COPD
- pulmonary embolism
- vasculitis
- asthma
- interstitial lung disease
- ARDS (acute respiratory distress syndrome)
How do you diagnose cor pulmonale?
Echo – shows increased pressures in pulmonary arteries and right ventricle
Follow up tests done to diagnose exact etiology – ex: spirometry
How do you treat cor pulmonale?
Treat underlying conditions before permanent damage is done
Diuretics are not helpful! May be harmful!
What is idiopathic pulmonary fibrosis?
Fibrosis = scarring of the lungs
Idiopathic = unknown cause (must rule out common causes)
What is the MCC of interstitial lung disease?
Idiopathic pulmonary fibrosis
How do you treat idiopathic pulmonary fibrosis
- oxygen
- corticosteroids
Very few treatments…eventually need a lung transplant
What do you see on CXR and CT scan of a patient with idiopathic pulmonary fibrosis?
- CXR = diffuse patchy infiltrates
- Ct = honeycombing
What is pneumoconiosis?
Any fibrosis of lung tissue with a known cause – typically from environmental or occupational hazards
- coal workers
- silicosis- mining, stone workers –> “eggshell” calcifications
- asbestosis - insulation, demolition, construction
- beryliosis - nuclear power & electric plants
Signs and symptoms of pneumoconiosis?
- SOB
- chronic dry cough
- chronic hypoxia
- cor pulmonale (LE edema, JVD, hepatoplenomegaly)
Signs & symptoms of cor pulmonale
- Lower extremity edema
- neck vein distention
- hepatomegaly
- parasternal lift
- tricuspid/pulmonic insufficiency
- loud S2
How do you treat pneumoconiosis?
- oxygen
- steroids
- smoking cessation
- *vaccines**
- rehab
What is the most common cause of community-acquired pneumonia?
Streptococcus pneumoniae
Gram - cocci
What is the most common cause of hospital acquired pneumonia?
Pseudomonas
Gram - rods
Other causes of community acquired pneumoia
- strep pneumoniae
- Mycloplasma pneumonia
- H. influenzae
- Viral –> influenza (adults), RSV (kids)
- M. catarrhalis
What causes “walking pneumonia” and who does it typically affect?
Mycloplasma pneumoniae
School aged kids, college students, military recruits
Which pneumonia is caused by outbreaks related to contaminated water? What symptoms do they have?
Legionella pneumophila – gram-negative rod
contaminated water supplies –> air conditioners, cooling towers
GI symptoms = anorexia, N/V/D, increased LFTs, hyponatremia
Increased incidence in elderly, smokers, immunodeficient
Which pneumonia is commonly seen after a viral illness like the flu?
Staphylococcus aureus – gram + cocci
HAP, IV drug users, immunocompromised, elderly
bilateral with multilobar infiltrates
Which pneumonia is seen in ETOHics?
Klebsiella pneumoniae – gram-negative rods
Cavitary lesions
Which pneumonia is associated with aspiration & where is it most commonly seen?
Anaerobes
MC in right lower lobe
which pneumonia is associated with HIV pts?
Pneumocystis jirovecci – fungus
compromised host
dry cough, dyspnea on exertion, pleuritic chest pain
Where is Histoplasma capsulatum most commonly found? What kind of an organism is this?
Mississippi & Ohio river valley soil contaminated with bird / bat droppings
Fungus
Where is Coccidioides found and what kind of organism is this?
Soil of southwest Uninted States in desert areas
Fungus
What are common types of hospital acquired pneumonia?
- Pseudomonas
- E. coli
- Klebsiella
- Enterobacter
- Staph aureus
Describe community acquired pneumonia?
Acquired OUTSIDE of a hospital & pt is not a member of a long-term care facility OR develops within 48 hours of initial hospital admission
Describe hospital acquired pneumonia?
> 48 hours after hospitalization
Signs & Symptoms of typical pneumonia
- sudden onset fever
- productive cough w/ purulent sputum
- pleuritic chest pain
- rigors = chills
- tachycardia & tachypnea
(S. pneumonia, H. influenza, Klebsiella, S. Aureus)
Physical Exam of typical pneumonia
-bonchial breath sounds
-dullness on percussion
-incrased tactile fremitus
+ egophony
-inspiratory rales & crackles
Chest XR findings of typical pneumonia vs. atypical pneumonia
typical= lobar
atypical = diffuse, patchy, interstitial
Atypical pneumonia signs & symptoms
- low-grade fever
- dry, nonproductive cough
- extrapulmonary symptoms = myalgias, malaise, sore throat, headache, N/V/D
(mycoplasma pneumoniae, chlamydophila, legionella, viruses)
rusty-blood tinged sputum
strep pneumoniae
green sputum
- H flu
- Pseudomonas
currant jelly sputum
Klebsiella
Foul smelling sputum
Anaerobes
PCV13 (Prevnar) vaccine is given when?
childhood – kids <24 months old are given 4 doses
PPSC23 (Pneumovax) is given when?
age >/= 65
age 2-65 yo with chronic disease
- cardiac
- pulmonary
- diabetes
- liver disease
- chronic care facility
- immunocompromised
