Pulmonary Flashcards
What is the clinical presentation of acute bronchitis?
cough, 1-3 weeks, median 18 days, with or without purulent sputum.
How to diagnosis acute bronchitis
Acute bronchitis should be suspected in patients with an acute onset but persistent cough (often lasting one to three weeks) who do not have clinical findings suggestive of pneumonia (eg, fever, tachypnea, rales, signs of parenchymal consolidation) and do not have chronic obstructive pulmonary disease. For most patients, the diagnosis can be made based upon the history and physical examination.
diff dx for acute bronchitis
pneumonia, postnasal drip syndrome, GERD, asthma, PE, lung cancer
management of acute bronchitis
symptom treatment; throat lozenges, hot tea, honey, smoking cessation. May use destromethorphan or guaifenesin. Albuterol only if wheezing.
clinical presentation of pertussis
paroxisms of coughing, inspiratory whoop, posttussive vomiting, possible cyanosis, sweating between paroxysms.
management pertussis
Hospitalize children if in respiratory distress, evidence of pneumonia, inability to feed, cyanosis or apnea, seizures. Otherwise supportive care. Fluid, rest. Avoid triggers for coughing–exercise, cold temps, nasopharyngeal suctioning. Macrolides (erythromycin, azithromycin, clarithromycin) in first 7 days shorten course (alternative: Bactrim).
TB clinical presentation
May be asymptomatic. Fever in 70% of patients, resolves in 10 weeks. Pleuritic chest pain, fatigue, cough, arthralgia, pharyngitis. Reactivation may cause cough, weight loss, fatigue, fever and/or night sweats, lymphadenopathy
TB complications
Hemoptysis, pneumothorax, bronchiectasis, pulmonary destruction, septic shock, malignancy, venous thromboembolism
TB differential diagnoses
Non-TB mycobacterial infection, fungal infection, sarcoidosis, lung abscess, septic emboli, lung cancer, lymphoma
TB diagnosis
Begin with hx and physical. Get lung xray. If suggestive of TB, get sputum specimans (at least three, via cough or induction, at least 8 hours apart, at least one in the early morning). Definitive diagnosis from isolation of M. tuberculosis from body secretion tissue.
TB skin test result interpretation
No risk factors: positive only if induration is 15mm or more.
Risk factors: recent immigrant within 5 years from high-prevalence country, IV drug users, residents and employees of high-congregate settings, mycobacteriology lab workers, children less than 4 years old, or exposure to someone who is high-risk: positive if induration is 10mm or greater.
Risk factors: HIV infection, recent close contact with known active TB, chest xray consistent with TB, organ transplant recipient, immunosuppressed patients: positive if induration is 5mm or greater.
Treatment TB
First-line drugs: isoniazid, rifampin, pyrazinaminde, ethambutol (RIPE therapy). Daily therapy at least 6 months.
pneumonia clinical presentation
varies widely; fever, cough, SOB, pleuritic chest pain. Tachypnea, rales, crackles, rhonchi, tactile fremitus, egophony, dullness to percussion. Severe: sepsis, respiratory distress.
pneumonia diagnosis
posteroanterior and lateral chest radiographs with lobar consolidation. Immunocompromised patients may not mount strong inflammaotry responses and may have negative chest xrays; obtain CT.
pneumonia treatment
amoxicillin plus macrolide (azithromycin or clarithromycin).
