pulmonary (chapter 1: infections) Flashcards
most causes of acute bronchitis
90% viral(rhinovirus, coronavirus, RSV,adenovirus, parainfluenza, influenza, covid, coxsackie, rhinovirus)
chronic lung disease bacteria in acute bronchitis
H. flu, S. pneumo, M. cat, mycoplasma
S/S of acute bronchitis
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
CXR in acute bronchitis and acute bronchiolitis
neg in bronchits. may have air trapping and peribronchial thickening in acute bronchiolitis
bronchiolitis: bilateral perihilar fullness
Usual tx of acute bronchitis and bronchiolitis
supportive for bronchitis.
admit if O2 sat less than 90% or less than 3 months old. ribavirin if severe for bronchiolitis
tx for acute exacerbation of chr bronchitis
1st line is 2nd gen ceph;
2nd line is 2nd gen macrolide or bactrim
when should you definitely do antibx for acute bronchitis?
elderly, underlying cardiopulm d/s, cough for more than 7-10 days, pt that is immumocompromised
cause of acute bronchiolitis
*etiology
usually RSV; also may be paravinfluenza virus, adenovirus, rhinovirus
bronchiole obstruction and constriction, mucus hypersecretion, atelectasis
S/S of acute bronchiolitis
viral prodrome(fever, URI) for 1-2 days followed by respiratory distress(wheezing, grunting, tachypnea, nasal flaring, cyanosis, retractions, rales)
rhinorrhea, sneezing, wheezing, low fever, nasal flaring, tachypnea, retractions
S/S of acute bronchiolitis
Cough(w or w/out sputum,) dyspnea, fever, sore throat, HA, myalgias, substernal discomfort, EXPIRATORY wheeze/rhonchi
S/S of acute bronchitis
what to order in dx acute bronchiolitis
nml CBC; do nasal washings for RSV culture and antigen assay in infants. CXR
PFT: decreased FEV1, low ratio. 02 less than 95%
acute bronchiolitis tx
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)
ages of acute epiglottitis
2-7 y/o in kids and 45-65 in adults
organism in acute epiglottitis
can be viral or bacterial. MOST COMMON: H FLU. Adults: group A strep, Strep pneumo, H. parainfluenzae, s. aureus
s/s in acute epiglottitis
sudden high fever, shallow respirations, resp distress, severe dysphagia, drooling, muffled voice
sudden high fever, shallow respitations, resp distress, severe dysphagia, drooling, muffled voice
s/s in acute epiglottitis
diagnostic tool for acute epiglottitis
lateral xray shows thumbprint sign(swollen epiglottis)
thumbprint sign
acute epiglottitis on lateral xray
tx of acute epiglottitis
H FLU VAC/ secure airway; broad spectrum 2nd or 3rd gen ceph like cefotaxime, ceftriazone for 7-10 days. use dexmathasone for inflammation
croup ages
6 months to 5 years
causes of croup
parainfluenza virus type 1 and 2 usually;
others is RSV, adenovirus, influenza, rhinovirus
S/S of croup
harsh, barking, seal like cough, INSPIRATORY stridor, hoarseness, low fever, aphonia, rhinorrhea
xray of croup
PA view shows subepiglottic narrowing(steeple sign)
tx of croup
none usually. can do corticosteroids, humified air or O2, neb epinephrine.
harsh, barking, seal like cough, INSPIRATORY stridor, hoarseness, low fever, aphonia, rhinorrhea
croup
steeple sign
croup
orthomyxovirus
influenza
flu vaccine recommendations
- 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
flu symptoms
SUDDEN ONSET: sudden fever, myalgia, chills, dry cough, coryza, weakness. Elderly may be confused. Kids may have diarrhea.
initial dx test for flu
rapid test of viral antigens from nasal pharyngeal swab; will have a low sensitivity
definitive test for flu
DFA, viral culture(takes 3-7 days), PCR assay
CBC in flu
leukopenia and proteinuria
flu incubation period, fever, immunity
incubation 18-72 hours, fever last 1-7 days, immunity set within 2 weeks of vaccination
tx for flu
Zanamir or Oseltamivir (rising in resistance)
pertussis organism
gram neg bacillus bordetella pertussis
pertussis vaccine
DTap given 5 doses in early childhood;
acellular pertussis vaccine recommended in infancy
pertussis pts
Typically occurs before 2 years old; infection highest in premies, and those with cardiac, pulm, or neuromuscular disorder
3 stages of pertussis
catarrhal, paroxysmal, convalescent
catarrhal stage
most contagious; mild URI sx, lasts 1-2 weeks
paroxysmal stage
paroxysms of cough for a few minutes with high pitched INSPIRATORY whoop and post tussive emesis, ; lasts 2-3 months; fever is rare
convalescent
last few weeks, symptoms wane
labs for pertussis
increased WBC with lymphocytosis(often 70%),
gold standard is nasopharyngeal culture!!
tx for pertussis
treat close contacts too. Use Emcyin.
alternative: azithomycin, clarithomycin, bactrim.
antigenic drift vs shift
drift: small gradual changes in surface proteins throught point mutation
shift: acute major change in the subtype
3 types of TB
primary TB; progressive primary TB; latent TB
what is primary TB
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
what is progressive primary TB?
5% of exposed people fail to contain primary infection and progress to active TB
how does reactivation occur with TB
immumosuppression, alcoholism, pre-existing lung disease, diabetes, old age
Night sweats, dry to productive cough, w/ or w/out hemoptysis, wt loss, fatigue, dyspnea
TB
TB symptoms
Night sweats, dry to productive cough(blood tinged sputum), w/ or w/out hemoptysis, wt loss, fatigue, dyspnea; 3 weeks duration
fever of unknown origin, think…
TB
post tussive rales, think…
TB
definitive dx test of TB
ACID/FAST STAIN OF SPUTUM
definitive dx: mycobacterium cultures (6-8 weeks) or DNA/RNA amplication technique (1-2 days)
Caseating granulomas
TB
hallmark of TB
caseating granulomas
primary TB CXR (5)
homogenous infiltrates, hilar/para-tracheal lymphnode enlargement, segmental atelectasis, cavitations
reactivation TB CXR
fibrocavitary apical d/s;
apical and posterior segments of upper lobe
superior segment of lower lobe
Ranke complex
The Ghon complex undergoes progressive fibrosis, often followed by radiologically detectable calcification
Ghon complex
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.
TB drugs
RIPE: rifampin, isoniazid, pyrazinamide, ethambutol
active TB tx
all 4 drugs for 2 months; then INH and RIF 4 months
latent TB tx
INH 9 months OR RIF 4 months OR
RIF and PZA 2 months(only if in contact with TB resistant persons)
rifampin SE
hepatitis, flu sx, ORANGE URINE
INH SE
hepatitits, peripheral neuropathy so must give with vit B6(pyridoxine)
hepatitis, flu sx, ORANGE URINE
rifampin SE
hepatitits, peripheral neuropathy
INH SE- give with vit B6(pyridoxine)
PPD Tuberculin skin test
5mm positive for immunocompromised pts
10mm positive for healthcare worker or moderate risk pt
15mm positive for normal healthy low risk person
TB usually what affect what lung fields
upper
pyrazinamide SE
arthralgias and hepatitis
ethambutol SE
optic neuritis
- prevention in high risk for bronchiolitis
palivizumab during first year of life for children <29 weeks, symptomatic chronic lung disease of prematurity, congenital hrt d/s, neuromuscular difficulties, immunodef.
**handwashing
- 2 most common causes of hemoptysis
acute bronchitis or bronchogenic ca
