Pulmonary 2 Flashcards
Laryngotracheobronchitis etiology?
Parainfluenza virus type I (60% of cases) also types II-IV
adenovirus; respiratory syncytial virus RSV; rhinovirus; coxsackie virus; echovirus
Laryngotracheobronchitis SSxs?
prodrome - mild URI with coryza, nasal congestion, sore throat, cough, low-grade fever
then – developing hoarse voice and harsh, brassy, seal bark-like cough with possible stridor (often at night)
Laryngotracheobronchitis PE?
distress from minimal to severe respiratory failure due to airway obstruction
Mild cases: examination at rest usually is normal; may be mild expiratory wheezing
More severe cases: inspiratory stridor at rest with nasal flaring, suprasternal and intercostals retractions.
Lethargy or agitation from hypoxemia
Tachypnea, tachycardia out of proportion to fever, lethargy, pallor
Course: usually peaks over 3-5d, resolves in 4-7d.
Laryngotracheobronchitis Labs/Imaging?
leukocytosis with left shift
A-P X-ray of the C-spine shows “steeple sign”
Prognosis: self-limited disease, but can very rarely result in death from complete airway obs
Laryngotracheobronchitis DDX?
Other causes of SOB with stridor:
Epiglottitis - hot potato voice, high fever (emergency, don’t try to visualize!)
foreign body - no hx URI or fever
retropharyngeal abscess - swelling at back of throat, see on lateral xray
diphtheria - grayish membrane over pharynx/larynx
Acute bronchitis Etiology?
Influenza A and B, parainfluenza, coronaviris (types 1-3), rhinovires, RSV
Rarely: H flu, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Pertussis
Acute bronchitis SSxs?
Cough > 5 days with sputum production (often starting with URI sx)
Sputum may be purulent from sloughing tracheobronchial and inflammatory cells
Acute bronchitis PE?
Generally afebrile or low grade fever
Wheezing suggests bronchospasm
Rhonchi indicates mucus in upper airways, clear with cough
Normal percussion, no changes in transmitted voice tests
Acute bronchitis DDX?
chronic bronchitis, pneumonia, post-nasal drip, GERD, asthma
Pneumonia pathophysiology stages?
congestion
red hepatization
gray hepatization
resolving
Community acquired pneumonia pathogens?
VIRAL: RSV, parainfluenza virus, Influenza A/B, adenovirus
BACTERIAL: S pneumoniae, H flu, S aureus, Group A strep, M catarrhalis, Klebsiella pneumoniae (rare) Legionella spp., M pneumoniae, Chlamydophila pneumoniae, P. aeruginosa,
Hospital acquired pneumonia pathogens?
E coli, Klebsiella, enterobacter spp, P aeruginosa, MRSA, H flu
Bacterial pneumonia SSxs?
cough with thick greenish or rust-colored mucus
SOB
rapid breathing
sharp pleuritic pain–worse with deep breaths
abdominal pain
severe fatigue
May be profuse sweating and mental confusion..
Bacterial pneumonia PE?
Patient looks sick high fever tachypnea tachycardia or bradycardia cyanosis bronchial breath sounds wheezes, rhonchi, and/or crackles positive egophony increased tactile fremitus dullness to percussion pleural friction rub (possible) pallor altered mental status in severe cases
Bacterial Pneumonia workup?
CXR (dense shadow with well-demarcated borders), CBC, CMP, CT, bronchoscopy, thoracentesis
What conditions should be considered if pneumonia is unresolving?
Comorbidities: alcoholism, COPD, CHF, CKD, Malignancy, DM, HIV, Advancing age >65
Aggressive organism: Klebsiella, Legionella, S Aureus
Drug-resistant organism: eg S pneumoniae
Non-bacterial agents: TB, fungi
Underlying neoplastic dz
Misdiagnosis of: connective tissue dz, sarcoidosis, pulmonary embolism, pulmonary edema, drug-induced lung dz
What are possible complications of pneumonia?
lung abscess, pleural effusion, empyema
Streptococcus pneumoniae characteristics?
60-80% of bacterial pneuomia
Sxs – rigors, severe shaking, pleuritic chest pain, blood/rust colored sputum
Prognosis: overall mortality 5%
Aged 2 years to 50 years- 90-95% survive
if < 1 yr., > 60 yr., positive blood culture, 2 or more lobes involved, use aggressive tx
Complications: meningitis, endocarditis
REFER if: BUN >70, WBC <5000, other underlying dz. (heart, COPD)
Klebsiella pneumoniae characteristics?
Gram negative bacilli causes aggressive necrotizing lobar pneumonia
Risk factors: alcoholism, malnutrition, DM, recent tx with antibiotic, COPD, >40yo, hospitalization
Prognosis: 40-60% if untreated
Sx: Cough, fever, pleuritic chest pain, dyspnea; spreads quickly
Extremely viscid exudates that can’t be expectorated—“currant jelly” sputum
Relative bradycardia: pulse rate does not increase as much with fever (usually with every degree in temp rise is inc 10 in heart rate)
Haemophilus influenza pneumonia characteristics?
Most commonly arises in the winter and early spring
Risk factors: asthma, COPD, smoking, immunocompromised
Sxs – green sputum
Staphylococcus aureus pneumonia characteristics?
Most common in IV drug abusers and other individuals with debilitations infx often spread hematogenously to the lungs from contaminated injection sites.
Legionella pneumophila pneumonia characteristics?
gram negative bacterium - “Legionnaire’s disease”
outbreaks from aerosolized organisms from air conditioning system or contaminated shower heads, more often in hotels and hospitals
common in elderly, smokers, immune compromised, alcoholics, pt. with pre-existing cardio-pulmonary, neoplastic, or renal dz (esp pts with renal transplant)
unlike other pneumonias, Legionella pneumonia has associated GI symptoms >50% of the time (anorexia, nausea, vomiting, and diarrhea)
