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aa Step 2CK: Internal & Peds > Pulmonary- CF, Infection, Pulmonary Effusion > Flashcards

Pulmonary- CF, Infection, Pulmonary Effusion Flashcards

1
Q

Define cystic fibrosis (CF)

A

An autosomal recessive disorder caused by a mutation in the genes that code for chloride transport (CFTR).
This cause damage in the chloride and water transport across apical surface of epithelial cell. Leading to abnormally thick mucus in the lungs, and damage to the pancreatic, liver, sinuses, GI and GU.

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2
Q

Signs and symptoms of CF

A
  • Chronic Lung disease
  • Recurrent infection
  • “salty-tasting” baby
  • Pancreatic insufficiency/ pancreatitis
  • Biliary cirrhosis
  • Cor Pulmonale
  • GI: Distal obstruction, rectal prolapse, meconium ileum, esophageal varices, Meconium ileus
  • GU: azoospermia, missing vas deferent. thick cervical mucus, infertility
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3
Q

Diagnostic tests CF

A

Most accurate: Sweat chloride test. Levels >60 mEq/L on repeat establish diagnosis.

genotyping CFTR

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4
Q

Tx CF

A 
Chest physical therapy 
Annual vaccines 
Abx (cover staph, H. flu, p. aero) 
Inhaled rhDNA (break down DNA in mucus)
Bronchodilators 
Vitamine supplements 
Pancreatic enzyme replacement

F508 varient: elexacaftor, tezacaftor and ivacaftor

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5
Q

How is pneumonia diagnosed?

A

Diagnosed based on clinical findings (fever rales, or rhonchi) plus elevated WBC and abnormal CXR.

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6
Q

Characteristics of typical pneumonia:

  • Prodrome
  • Fever
  • Age
  • CXR
  • Antibiotic
A
  • Prodrome: Short (<2days)
  • Fever: High (>102)
  • Age: >40
  • CXR: one distinct lobe involved
  • Abx: Ceftriaxone
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7
Q

Characteristics of atypical pneumonia:

  • Prodrome
  • Fever
  • Age
  • CXR
  • Antibiotic
A
  • Prodrome: long (>3 days)
  • Fever: low (<102)
  • Age: <40
  • CXR: diffuse/ multi lobe involvement
  • Antibiotic: Macrolides, Doxy or Quinolones
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8
Q

What determines community acquired pneumonia (CAP)

A

Occurring prior to hospitalization or within 48hr of admission. Can be typical or atypical

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9
Q

Causal organisms of CAP

A 
S. pneumoniea (most common)
H. Flu
S. aureus 
Klebsiella
Anaerobes
Mycoplasma pneumoniea
Chlamydophilia pneumoniea 
Legionella
Chamydia Psttaci
Coxiella Burnetii
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10
Q

What causal organism is associated with COPD?

A

H. flu

Moraxella sp.

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11
Q

What causal organism is associated with recent viral infection (flu)?

A

Staph aureus

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12
Q

What causal organism is associated with Alcoholism or diabetes?

A

Klebsiella
S. aureus

(other enteric bugs- aspiration)

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13
Q

What causal organism is associated with Poor dentation/ aspiration?

A

Anaerobes

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14
Q

What causal organism is associated with Young, healthy patients/ collage students?

A

Mycoplasma pneumoniea

Chlamydia sp.

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15
Q

What causal organism is associated with Hoarseness

A

Chlamydophilia Pneumoniea

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16
Q

What causal organism is associated with Contaminates water sources, air conditioning, ventilation system or aerosolized water?

A

Legionella

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17
Q

What causal organism is associated with Bird or bird dropping?

A

Chlamydia psittaci

Histoplasmosis

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18
Q

What causal organism is associated with Veterinarians, farmers, birthing animals?

A

Coxiella burnetti

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19
Q

What causal organism is associated with CF?

A

Pseudamonas sp

Staph aureus

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20
Q

What causal organism is associated with immigrant?

A

TB

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21
Q

What causal organism is associated with Known TB with pulmonary cavitation?

A

Aspergillus sp.

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22
Q

What causal organism is associated with HIV/AIDS?

A

Pneumocystic jirovecii
Cytomegalovirus
S. pneumoniea (still most common cause among HIV)

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23
Q

What causal organism is associated with children less than 1?

A

RSV

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24
Q

What causal organism is associated with children 2-5?

A

Parainfluenza (croup)

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25
Q

What are clinical features of klebsiella pneumonia?

A

Hemoptysis from necrotizing disease

“currant jelly” sputum

26
Q

What are clinical features of anaerobic pneumonia?

A

foul-smelling sputum

“rotten-eggs”

27
Q

What are clinical features of mycoplasma pneumonia?

A

Dry cough, bulbous myringitis, rarely sever

28
Q

What are clinical features of legionella?

A 
GI symptoms (abdominal pain, diarrhea)
CNS symptoms (headache, confusion)
29
Q

What are clinical features of pneumocystis?

A

AIDS with <200 CD4 cells

30
Q

Diagnostic testing for community acquired pneumonia?

A

BIT: CXR

Sputum culture
Leukocytosis

31
Q

Organism specific diagnostic test: mycoplasma pneumoniea

A

PCR
cold agglutinins
serology
special sulter media

32
Q

Organism specific diagnostic test: Chlamydophila pneumoniea, Chlamydia Psittaci or Coxiella burnetii

A

rising serologic titers

33
Q

Organism specific diagnostic test: Legionella

A

Urine antigen

culture on charcoal-heat agar

34
Q

Organism specific diagnostic test: P. jiroveci (PCP)

A

bronchoalveolar lavage

35
Q

What is the most important step in the initial management of pneumonia?

A

The most important step is usually determining the severity of the disease so that it can be decided where to place the patient and the initial treatment.

36
Q

Characteristics of pneumonia requiring hospitalization

A 
Hypotension
RR >30
BUN >30
Pulse >125
Confusion
Temp >40 
Age >65

Hypoxia or hypotension alone is sufficient

37
Q

What is the CURB-65 pneumonia score?

A

CURB-65 score can help to determine whether to admit a patient. Give 1 point for each of the following:

Confusion
Urea (serum) > 7 mmol/L (20 mg/dL)
RR ≥ 30/min
BP:  ≤ 90/60 mm Hg
65+ yo

0-1: may be treated as an outpatient.
≥ 2: Hospitalization is indicated.
≥ 3 consider ICU

38
Q

Characteristics of a non complicated outpatient treated pneumonia

A

CURB65 ≤ 1
Previously healthy
No Abx in the last 3 months (TMP-SMX excluded)
Mild Symptoms

39
Q

Empiric Tx for non complicated outpatient treated pneumonia

A

Amoxicillin/ Clavulanate
Macrolide: Azithro or Clarity
Doxycyline

40
Q

Characteristics of complicated outpatient treated pneumonia

A

Comorbidities

Abx use in the last 3 months (TMP-SMX excluded)

41
Q

Empiric Tx for complicated outpatient treated pneumonia

A 
Respiratory Fluoroquinolones
 	Levofloxacine, Moxifloxacin
 	Less effective: ciprofloxacine
B-lactams + macrolide or doxy
 	Amoxicillin, Cefuroxime, Cefpodoxime
42
Q

Empiric Tx for inpatient treatment of pneumonia

A

Respiratory Fluoroquinolones
Levofloxacine, Moxifloxacin
Less effective: ciprofloxacine
Ceftriaxone and azithromycine

43
Q

Define hospital acquired pneumonia?

A

After hospitalization in the last 90 days
>48hr after admission
in association with dialysis or infusion center

44
Q

What organisms are common in hospital acquired pneumonia?

A

Much high incidence of gram-neg bacilli

E.coli, Pseudamonas

45
Q

What drugs are antipneumococal, antipseudomonal B-lactam?

A 
1. Cephalosporins
	Cefepime, ceftazidine 
2. Penicillins 
 	Pipercillin-tazobactam, ticarcillin
3. Carbapenems
 	Imipenem, meropenem, doripenem
46
Q

Empiric Tx of low risk MRSA- hospital acquired pneumonia?

A

Monotherapy:

  • Antipneumococcal, antipseudomonal β-lactam
  • Levofloxacin
47
Q

Empiric Tx of low risk MRSA+ hospital acquired pneumonia

A 
Combination therapy: 
1. Linezolid or Vancomycin
2. Plus 1 of the following:
	Antipneumococcal, antipseudomonal B-Lactams
	Fluoroquinolones  
	Azetronam
48
Q

Empiric Tx of high mortality risk hospital acquired pneumonia (sepsis, ventilator, structural lung disease)

A

Combination therapy:
1. Linezolid or Vancomycin
2. Plus 2 of the following (avoid 2 B-lacatams)
Antipneumococcal, antipseudomonal B-Lactams
Fluoroquinolones
Aminoglycoside
Azetronam

49
Q

What is the mechanism of ventilator associated pneumonia?

A

Mechanical ventilations interferes with mucociliary clearance and ability to cough.
PEEP damaging to ability to clear colonization.
Incidence: 5% per day on ventilator

50
Q

Characteristics of VAP

A
  • > 48hrs after intubation
  • Fever and/ or rising WBC
  • New infiltrate on CXR
  • Increased respiratory secretions
  • Worsening oxygenation (worsened respiratory status)
51
Q

What feature would indicate CGD and not CF in recurrent pulmonary pneumonia with B cepacia?

A

CGD have granuloma and perirectal infection involvement.

52
Q

Diagnosis confirmation VAP

A

Clinical is not enough. Sampling of lower respiratory tract is required.

53
Q

Ddx: ARDS vs VAP in trauma patients

A

ARDS: within 72hrs of event. no fever or secretions

VAP: >48hrs of intubations, fever and secretions.

Both: increased O2 and infiltrates.

54
Q

Ddx: Fat embolism vs VAP

A

Fat embolism: 24-72 hrs, no infiltrates,no secretions

VAP: 48+hrs intubation, infiltrates, fever, secretions

55
Q

Ludwig angina

A

rapidly progressive cellulitis of the submandibular nd sublingual spaces. Generally spread from dental infections in the mandibular molars.

56
Q

S&S Ludwig angina

A

Neck as “woody” “brawny”
Tongue elevated and displaced
No lymphadenopathy

57
Q

Immediate complication of Ludwig angina

A

Acute airway obstruction.

bilateral edema displaces the tongue posteriorly causing obstruction of the pharynx

58
Q

S&S Chronic pulmonary aspergillosis

A

> 3months: weight loss, cough, hemoptysis, dyspnea
Cavitary lesion W/ debris/ fungus ball
Positive aspergillus IgG Serology

59
Q

Chronic pulmonary aspergillosis

A

Immunocompentent patients with a history of pulmonary disease develop fungus cavities at sites of lung damage

60
Q

Tx chronic pulmonary aspergilosis

A

Resect aspergilloma
Azole medication (itraconazole, voriconazole)
Embolization

61
Q

Characteristics of empyema

A 
Exudative effustion
Loculation
Low glucose < 60 
Low pH <7.2 
High protein

aa Step 2CK: Internal & Peds (71 decks)

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