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cardio and pulm > pulmonary (chapter 1: infections) > Flashcards

pulmonary (chapter 1: infections) Flashcards

1
Q

most causes of acute bronchitis

A

90% viral(rhinovirus, coronavirus, RSV,adenovirus, parainfluenza, influenza, covid, coxsackie, rhinovirus)

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2
Q

chronic lung disease bacteria in acute bronchitis

A

H. flu, S. pneumo, M. cat, mycoplasma

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3
Q

S/S of acute bronchitis

A

COUGH is hallmark! (w or w/out sputum- must be present for 5 days but usually last 1-3 weeks), dyspnea, low fever, sore throat, HA, myalgias, substernal discomfort, EXPIRATORY wheeze/rhonchi

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4
Q

CXR in acute bronchitis and acute bronchiolitis

A

neg in bronchits. may have air trapping and peribronchial thickening in acute bronchiolitis

bronchiolitis: bilateral perihilar fullness

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5
Q

Usual tx of acute bronchitis and bronchiolitis

A

supportive for bronchitis.

admit if O2 sat less than 90% or less than 3 months old. ribavirin if severe for bronchiolitis

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6
Q

tx for acute exacerbation of chr bronchitis

A

1st line is 2nd gen ceph;

2nd line is 2nd gen macrolide or bactrim

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7
Q

when should you definitely do antibx for acute bronchitis?

A

elderly, underlying cardiopulm d/s, cough for more than 7-10 days, pt that is immumocompromised

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8
Q

cause of acute bronchiolitis

*etiology

A

usually RSV; also may be paravinfluenza virus, adenovirus, rhinovirus

bronchiole obstruction and constriction, mucus hypersecretion, atelectasis

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9
Q

S/S of acute bronchiolitis

A

viral prodrome(fever, URI) for 1-2 days followed by respiratory distress(wheezing, grunting, tachypnea, nasal flaring, cyanosis, retractions, rales)

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10
Q

rhinorrhea, sneezing, wheezing, low fever, nasal flaring, tachypnea, retractions

A

S/S of acute bronchiolitis

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11
Q

Cough(w or w/out sputum,) dyspnea, fever, sore throat, HA, myalgias, substernal discomfort, EXPIRATORY wheeze/rhonchi

A

S/S of acute bronchitis

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12
Q

what to order in dx acute bronchiolitis

A

nml CBC; do nasal washings for RSV culture and antigen assay in infants. CXR

PFT: decreased FEV1, low ratio. 02 less than 95%

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13
Q

acute bronchiolitis tx

A

RSV-hospitalize and do ribavirin(hrt pts, severe, immunocompromised), especially if it is premature or severely ill; if not RSV: do supportive measures(albuterol, neb epi,IV fluids, antipyretics, chest physiotherapy, O2)

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14
Q

ages of acute epiglottitis

A

2-7 y/o in kids and 45-65 in adults

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15
Q

organism in acute epiglottitis

A

can be viral or bacterial. MOST COMMON: H FLU. Adults: group A strep, Strep pneumo, H. parainfluenzae, s. aureus

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16
Q

s/s in acute epiglottitis

A

sudden high fever, shallow respirations, resp distress, severe dysphagia, drooling, muffled voice

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17
Q

sudden high fever, shallow respitations, resp distress, severe dysphagia, drooling, muffled voice

A

s/s in acute epiglottitis

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18
Q

diagnostic tool for acute epiglottitis

A

lateral xray shows thumbprint sign(swollen epiglottis)

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19
Q

thumbprint sign

A

acute epiglottitis on lateral xray

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20
Q

tx of acute epiglottitis

A

H FLU VAC/ secure airway; broad spectrum 2nd or 3rd gen ceph like cefotaxime, ceftriazone for 7-10 days. use dexmathasone for inflammation

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21
Q

croup ages

A

6 months to 5 years

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22
Q

causes of croup

A

parainfluenza virus type 1 and 2 usually;

others is RSV, adenovirus, influenza, rhinovirus

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23
Q

S/S of croup

A

harsh, barking, seal like cough, INSPIRATORY stridor, hoarseness, low fever, aphonia, rhinorrhea

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24
Q

xray of croup

A

PA view shows subepiglottic narrowing(steeple sign)

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25
Q

tx of croup

A

none usually. can do corticosteroids, humified air or O2, neb epinephrine.

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26
Q

harsh, barking, seal like cough, INSPIRATORY stridor, hoarseness, low fever, aphonia, rhinorrhea

A

croup

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27
Q

steeple sign

A

croup

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28
Q

orthomyxovirus

A

influenza

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29
Q

flu vaccine recommendations

A
  • over 6 mnths of age: annual vac with inactivated virus
  • 6-9 y/o: need 2 doses of seasonal vaccine if it is first time
  • over 65 y/o: need a high dose of flu vaccine
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30
Q

flu symptoms

A

SUDDEN ONSET: sudden fever, myalgia, chills, dry cough, coryza, weakness. Elderly may be confused. Kids may have diarrhea.

31
Q

initial dx test for flu

A

rapid test of viral antigens from nasal pharyngeal swab; will have a low sensitivity

32
Q

definitive test for flu

A

DFA, viral culture(takes 3-7 days), PCR assay

33
Q

CBC in flu

A

leukopenia and proteinuria

34
Q

flu incubation period, fever, immunity

A

incubation 18-72 hours, fever last 1-7 days, immunity set within 2 weeks of vaccination

35
Q

tx for flu

A

Zanamir or Oseltamivir (rising in resistance)

36
Q

pertussis organism

A

gram neg bacillus bordetella pertussis

37
Q

pertussis vaccine

A

DTap given 5 doses in early childhood;

acellular pertussis vaccine recommended in infancy

38
Q

pertussis pts

A

Typically occurs before 2 years old; infection highest in premies, and those with cardiac, pulm, or neuromuscular disorder

39
Q

3 stages of pertussis

A

catarrhal, paroxysmal, convalescent

40
Q

catarrhal stage

A

most contagious; mild URI sx, lasts 1-2 weeks

41
Q

paroxysmal stage

A

paroxysms of cough for a few minutes with high pitched INSPIRATORY whoop and post tussive emesis, ; lasts 2-3 months; fever is rare

42
Q

convalescent

A

last few weeks, symptoms wane

43
Q

labs for pertussis

A

increased WBC with lymphocytosis(often 70%),

gold standard is nasopharyngeal culture!!

44
Q

tx for pertussis

A

treat close contacts too. Use Emcyin.

alternative: azithomycin, clarithomycin, bactrim.

45
Q

antigenic drift vs shift

A

drift: small gradual changes in surface proteins throught point mutation
shift: acute major change in the subtype

46
Q

3 types of TB

A

primary TB; progressive primary TB; latent TB

47
Q

what is primary TB

A

exposed people that mount an immune response sufficient to prevent progression from initial to clinical infection; 10% of people infected to develop the disease/ active disease kills 50% of pts

48
Q

what is progressive primary TB?

A

5% of exposed people fail to contain primary infection and progress to active TB

49
Q

how does reactivation occur with TB

A

immumosuppression, alcoholism, pre-existing lung disease, diabetes, old age

50
Q

Night sweats, dry to productive cough, w/ or w/out hemoptysis, wt loss, fatigue, dyspnea

A

TB

51
Q

TB symptoms

A

Night sweats, dry to productive cough(blood tinged sputum), w/ or w/out hemoptysis, wt loss, fatigue, dyspnea; 3 weeks duration

52
Q

fever of unknown origin, think…

A

TB

53
Q

post tussive rales, think…

A

TB

54
Q

definitive dx test of TB

A

ACID/FAST STAIN OF SPUTUM

definitive dx: mycobacterium cultures (6-8 weeks) or DNA/RNA amplication technique (1-2 days)

55
Q

Caseating granulomas

A

TB

56
Q

hallmark of TB

A

caseating granulomas

57
Q

primary TB CXR (5)

A

homogenous infiltrates, hilar/para-tracheal lymphnode enlargement, segmental atelectasis, cavitations

58
Q

reactivation TB CXR

A

fibrocavitary apical d/s;
apical and posterior segments of upper lobe
superior segment of lower lobe

59
Q

Ranke complex

A

The Ghon complex undergoes progressive fibrosis, often followed by radiologically detectable calcification

60
Q

Ghon complex

A

Ghon’s complex is a lesion seen in the lung that is caused by tuberculosis. The lesions consist of a calcified focus of infection and an associated lymph node. These lesions are particularly common in children and can retain viable bacteria, so are sources of long-term infection and may be involved in reactivation of the disease in later life.

61
Q

TB drugs

A

RIPE: rifampin, isoniazid, pyrazinamide, ethambutol

62
Q

active TB tx

A

all 4 drugs for 2 months; then INH and RIF 4 months

63
Q

latent TB tx

A

INH 9 months OR RIF 4 months OR

RIF and PZA 2 months(only if in contact with TB resistant persons)

64
Q

rifampin SE

A

hepatitis, flu sx, ORANGE URINE

65
Q

INH SE

A

hepatitits, peripheral neuropathy so must give with vit B6(pyridoxine)

66
Q

hepatitis, flu sx, ORANGE URINE

A

rifampin SE

67
Q

hepatitits, peripheral neuropathy

A

INH SE- give with vit B6(pyridoxine)

68
Q

PPD Tuberculin skin test

A

5mm positive for immunocompromised pts
10mm positive for healthcare worker or moderate risk pt
15mm positive for normal healthy low risk person

69
Q

TB usually what affect what lung fields

A

upper

70
Q

pyrazinamide SE

A

arthralgias and hepatitis

71
Q

ethambutol SE

A

optic neuritis

72
Q
  • prevention in high risk for bronchiolitis
A

palivizumab during first year of life for children <29 weeks, symptomatic chronic lung disease of prematurity, congenital hrt d/s, neuromuscular difficulties, immunodef.

**handwashing

73
Q
  • 2 most common causes of hemoptysis
A

acute bronchitis or bronchogenic ca

74
Q
A

cardio and pulm (22 decks)

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