Pulmonary 2 Flashcards
Laryngotracheobronchitis - Croup
Viral inflammation of the upper and lower respiratory tract causing respiratory distress.
Etiology: parainfluenza virus type 1/adenovirus/RSV/rhinovirus
Age: children 6 months-3 years
Course: few days mild URI sxs followed by development of a hoarse voice, seal bark-like cough, stridor (at night). Self-limiting (3-7 days).
Severe cases: stridor at rest with nasal flaring and intercostal retractions.
Dx: CXR - look for steeple sign
DDX: with stridor: epiglottitis, foreign body, retropharyngeal abscess, diphtheria
Acute Bronchitis
Self-limited inflammation of the bronchus. Viral infection: A or B, parainfluenza, coronavirus, rhinovirus.
Sx: cough > 5 days with sputum production, may be purulent
PE: afebrile normally, wheezing, rhonchi indicates mucus in upper airways and clears with cough, normal percussion, no changes in voice transmission tests.
No labs or imaging are usually warranted, only if it seems to be developing in pneumonia.
DDx: chronic bronchitis, pneumonia, post-nasal drip, GERD, asthma
Pneumonia Classifications
Acute infection of alveolar spaces and/or interstitial tissue. Distinguish between bacterial, viral (50%), and mycoplasma.
Classifications:
A. community-acquired pneumonia: in US 8th most common cause of death. worse in winter, higher rates in males and AA. Pre-disposing conditions: malnutrition, immunocompromised, smoking, underlying lung disease. Common organisms: RSV, parainfluenza, influenza OR bacterial (s. pneumoniae, HIB, s. aureus, group A strep).
B. 1) hospital-acquired (nosocomial) pneumonia - onset within >48 hours.
2) ventilator-associated pneumonia
3) healthcare-associated pneumonia: occurs after extensive healthcare contact.
Common organisms: E. coli, Klebsiella, enterobacter spp. p aeruginosa, MRSA, HIB
Bacterial Pneumonia
Sx: cough with thick greenish or rust colored mucus, SOB, rapid breathing, sharp pleuritic pain worse with deep breaths, ab pain, severe fatigue.
Sputum: Bloody/rust (pneumococcus); green (pseudomonas, HIB); foul-smelling (anaerobic); currant jelly (klebsiella).
Also: pneumococcus: rigors or severe shaking chills, pleuritic chest pain. Legionella: HA, malaise, anorexia, n/v, diarrhea.
PE: patient LOOKs sick.
HIGH fever, tachycardia, bronchial breath sounds, positive ego phony, dullness to percussion, pallor, cyanosis, wheezes, rhonchi, crackles, increased tactile fremtitis
Streptococcus Pneumoniae
Pneumococcus pneumonia 60-80% Prognosis: mortality 5% Age: 2-50 - 90-95% survive Complications: meningitis, endocarditis Refer if: BUN >70, WBC
Klebsiella Pneumoniae
gram negative bacilli causes aggressive necrotizing lobar pneumonia
risk factors: alcoholism, lam nutrition, DM, COPD, >40yr, hospitalized
Prognosis: 40-60% if untreated
sx: cough, fever, pleuritic chest pain, dyspnea, spreads quickly. Extremely thick exudates that cant be expectorated - currant jelly sputum. Bradycardia.
Haemophilus Influenza
most commonly arises in the winter and early spring.
risk factors: asthma, COPD, smoking, immunocompromised
Staph Aureus
in IV drug abusers and debilitated persons. infx often spread through blood to the lungs from contaminated injection sites.
Legionella Pneumonia
gram negative bacteria - “legionnaire’s disease”
outbreaks from aerosolized organisms from air conditioning system or contaminated shower heads in hotels.
Risk factors: elderly, smokers, immune compromised, alcoholics, renal dz.
Unlike the other pneumonias LP is associated with GI symptoms >50% of the time: anorexia, n/v, diarrhea.
Pneumonia workup
CXR, CBC, CMP, CT, bronchoscopy, thoracentesis may be needed in advanced, unresolving patients.
Prognosis of bacterial Pneumonia
Sxs improve within 3-5 days of treatment. Typical duration of sxs: fever (2-4 days); cough (4-9 days) ; crackles (3-6 days); leukocytosis (3-4 days)
Unresolving sxs consider comorbidities, advancing age, aggressive organism, drug resistant bacteria, misdiagnosis.
Complications: lung abscess, pleural effusion, empyema
Viral Pneumonia
Caused by influenza virus, RSV, parainfluenza virus, adenovirus, paramyxovirus, CMV, varicella zoster, HSV, EBV, coronavirus.
Sx: malaise, HA, myalgia, Chest pain, sore throat, cough with scant sputum, dyspnea
PE: few findings, mild fever. possible to be worse in some patients.
Work up: CBC, CMP, CXR
Prognosis: good in most patients
SARS - severe acute respiratory syndrome
Corona virus
Airborne droplet transmission
Sx: high fever, dry cough, nasal congestion, dyspnea, chest pain, ms/joint pain, diarrhea, HA
Dx with PSR or ELISA
CXR with patchy infiltrates
25% of patients with sARS have residual pulmonary fibrosis
Other complications: organ failure, osteoporosis, depression
Mycoplasma Pneumonia - “Walking Pneumonia”
Difficult to culture, takes 7-21 days to grow
Sx: often benign, slow progression, may look like URI and resolves without treatment.
May have violent attacks of coughing with scant mucus, chills/fever, N/V. Dry cough can persist for a month to 6 weeks.
PE: nontoxic general appearance. Erythematous TMs or bulls myringitis in some pts. Mild pharyngeal erythema but no exudate, minimal or no cervical LA. Auscultation: no findings early but rhonchi, crackles and wheezes may be heard several days later. possible rash
Dx: with PCR, EIA serology
Prognosis: most resolve after several weeks as pt. regains strength.
Pneumocystis jirovecii pneumonia
Fungal infection
Causes mobility and mortality in people that are immune compromised/HIV/AIDS patients.
Sx: insidious onset of malaise, weight loss, night sweats, and low grade fever with dry cough. No expectorating sputum, too thick
More severe sxs: dyspnea, cyanosis, distress, chest pain, productive cough.
Complications: spontaneous pneumothorax and hypoxemia. Can also affect liver, spleen and kidney.
