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CPD I > Pulmonary II > Flashcards

Pulmonary II Flashcards

1
Q

A viral inflammation of the upper and lower respiratory tract causing respiratory distress

A

Laryngotracheobronchitis “Croup”

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2
Q

At what age and gender do we see croup predominately appear?

A

Male children (2:1) from 6mo to 3yrs

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3
Q

What are the s/sx of Croup?

A

Prodrome with a mild URI, nasal congestion, sore throat, cough, low-grade fever. Continues to develop a hoarse voice/cough (seal-like); respiratory stridor at night

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4
Q

Upon PE of a pt with Croup, what would you see?

A

Respiratory distress, wheezing, inspiratory stridor, nasal flaring, lethargy or agitation from hypoxia, tachypnea, tachycardia, fever

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5
Q

What is the typical progression of Croup?

A

Usu. peaks over 3-5d and resolves in 4-7d. Self-limiting.

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6
Q

How do you dx Croup?

A

AP Xray of the cervical spine with a “steeple sign”.

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7
Q

What are the important DDx of Croup?

A

Epiglotitis - high fever, though
Diptheria - grayish membrane
Retropharyngeal abscess - swelling at back of throat

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8
Q

What are the s/sx of acute bronchitis?

A

A cough >5ds with sputum

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9
Q

Upon PE of a pt with acute bronchitis, what would you notice?

A

Low-grade or no fever, wheezing, ronchi that clears with coughing, normal percussion, no change in transmitted voice tests.

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10
Q

What would the work-up for acute bronchitis be?

A

Dx upon hx and PE. No further work-up needed unless there is a risk of pneumonia.

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11
Q

What are some DDx for acute bronchitis?

A

Chronic bronchitis, pneumonia, post-nasal drip, GERD, asthma

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12
Q

What are the four classifications of pneumonia?

A
  1. Community-acquired pneumonia
  2. Hospital-acquired pneumonia
  3. Ventilator-acquired pneumonia
  4. Healthcare-acquired pneumonia
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13
Q

In community-acquired pneumonia’s, what populations/circumstances are at greater risk?

A

African Americans, varying levels of consciousness, smoking, alcohol consumption, lung dz, malnutrition, immunocompromised individuals

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14
Q

What is the most common bacteria responsible for 60-80% of community-acquired pneumonia’s?

A

Streptococcus pneumoniae

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15
Q

What is the prognosis of a S. pneumoniae infection?

A

Overall mortality is 5% - most recover!

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16
Q

The sputum is incredibly thick in this bacterial pneumonia?

A

Klebsiella pneumoniae

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17
Q

What is a differentiating sign in a K. pneumoniae infection?

A

Relative bradychardia - HR does not increase as much with fever

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18
Q

This bacterial pneumonia arises mainly in early spring and winter.

A

Haemophilus influenzae

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19
Q

IV Drug users are at risk of acquiring what strain of bacterial pneumonia?

A

Staphylococcus aureus

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20
Q

Legionnaire’s dz is caused by what bacteria? What is it’s differentiating sx?

A

Legionella pneumophila

GI sx’s in 50% of cases (anorexia, N/V, diarrhea)

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21
Q

What are the general s/sx of bacterial pneumonias?

A

Cough with thick greenish or rust-colored mucus, dyspnea, pleuritic pain, fatigue

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22
Q

In a PE of a bacterial pneumonia, what are some findings that you would see?

A 
High fever (~102)
tachycardia or bradychardia
tachypnea
bronchial breath sounds
egophony
tactile fremitus
dullness to percussion
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23
Q

In a work-up for bacterial pneumonia, what would you include and why?

A

CXR - in case sx don’t improve in 5 days
CBC/CMP - confirm dx and response
CT or bronchoscopy - in advanced, unresolving cases

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24
Q

What is the typical prognosis of bacterial pneumonia?

A

Normal resolution and improvement in sx in 3-5 days of tx

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25
Q

If a pt is not improving after a week of tx for bacterial pneumonia, what should you consider?

A

Comorbidities (alcoholism, COPD, DM, HIV)
Age >65
Aggressive organisms (Kleb., Legionella, S. aureus)
MDR strains
Other infections (TB, Fungi)
Misdiagnosis

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26
Q

What are some common complications with bacterial pneumonia?

A

Lung abscess, pleural effusions, empyema

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27
Q

In the PE of viral pneumonia, what may you find?

A 
Few, if any in some pts, to multi-organ failure in others. 
Tachypnea and/or dyspnea
Adventitious breath sounds
Tachycardia
Pleurisy
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28
Q

What is very different in the work-up of a viral vs. bacterial pneumonia?

A

CBC values

CXR

29
Q

In “walking pneumonia” what is the causative agent?

A

Mycoplasma pneumoniae

30
Q

What are the s/sx of walking pneumonia?

A

Benign, slow progression, looks like an URI and usually resolves w/o tx.
Scant mucus prod., chills/fever, long-lasting infxn.

31
Q

What other findings may you encounter with a walking pneumonia pt?

A

Otitis media and rash

32
Q

What fungal infxn was diagnostic for HIV/AIDS?

A

Pneumocystis jirovecii

33
Q

What is a fungal respiratory infxn that occurs in the SW US, Mexico, and S. America?

A

Coccidioidomycosis

34
Q

Usually, what is the progression of Coccidioidomycosis?

A

Self-limiting and often subclinical, usu resolving in 1-3 weeks

35
Q

If Coccidioidomycosis becomes more systemic in an immunocompromised individual, what are key PE findings?

A

Erythema nodosum, and non-specific pulmonary findings

36
Q

What types of allergic responses do we see in Allergic Bronchopulmonary Aspergillosis?

A

Type I and II Eosinophilic pneumonia

37
Q

What is the common concomitant with Allergic Bronchopulmonary Aspergillosis?

A

Asthma

38
Q

What is the work up for Allergic Bronchopulmonary Aspergillosis?

A

CBC, RAST skin test, CXR

39
Q

What is “Spelunkers Lung”?

A

Histoplasmosis

40
Q

What are the three types of Histoplasmosis?

A
  1. Acute pulmonary histoplasmosis: Lung ausc - crackles and wheezes; Heart ausc - pericarditis in ~5% of cases; skin - erythema multiforme or nodosum
  2. Chronic pulmonary histoplasmosis
  3. Chronic progressive disseminated histoplasmosis: involvement of the mouth, eyes, and hepatosplenomegaly
41
Q

What is the work-up for histoplasmosis?

A

Sputum culture, PCR, CXR

42
Q

What is the prognosis of histoplasmosis?

A

Acute - good outcome

Chronic or progressive - protracted course; recovery for years

43
Q

What are two non-infectious causes of pneumonia?

A

Aspiration and Lipoid Aspiration

44
Q

What are the key s/sx of lung abscesses?

A

Hx of unresolving pneumonia, sour-tasting sputum, night sweats, weight loss

45
Q

What is the dx test for lung abscesses?

A

CXR or CT

46
Q

What are some groups that have a high prevalence of TB?

A

Homeless pop, healthcare workers, children exposed to adults with active TB, foreign-born pop, elderly, medically underserved

47
Q

What is the time frame of developing an active TB infection?

A

Within 2 two years of primary infxn

48
Q

In the primary TB infection, what percentage go on to develop active dz? What are the rest classified as?

A

10%

Latent Infxn

49
Q

What are the s/sx of an active TB infxn?

A 
Chronic productive cough
Hemoptysis
Malaise, Fatigue
Anorexia/Wt loss
NIGHT SWEATS
50
Q

When TB becomes systemic, what is it called and what organs does it typically accumulate?

A

Miliary TB

Lymph nodes, kidney, bones, meninges, pericardium, liver, GI, skin, adrenals

51
Q

What are the two screening tests used for latent (or active) TB infxn?

A

PPD and QuantiFERON TB Gold

52
Q

What are the limitations of the PPD skin test?

A

Compliant to return 48-72hrs to read

False positive for those who have received the BCG Vaccine

53
Q

What are the advantages of the QuantiFERON-TB Gold?

A

Requires a single blood draw
Results in 24hrs
No reader bias
Not susceptible to BCG vaccination false-positives

54
Q

What is the mortality rate of MDR TB?

A

80%

55
Q

What are some DDxs of TB?

A

Pneumonia, abscesses, CA, non-TB mycobacterium

56
Q

Inflammation of the pleura that may lead to a pleural effusion and has characteristic sharp pain?

A

Pleurisy

57
Q

What are the s/sx of pleurisy?

A

Sudden onset of sharp pain
“Splinting” - hold chest wall when breathing
Painful cough
When effusion occurs, dyspnea increases but pain lessens

58
Q

What are key PE findings in pleurisy?

A

Pleural friction rub (24-48hrs after pain onset)

59
Q

What work-ups would you do to detect if the pleurisy has developed an effusion?

A

CXR, Ultrasound, CT scan

60
Q

What are some DDx of pleurisy?

A 
Acute abdomen
Intercostal neuritis
Costo-chondritis
Herpes
MI
Pericarditis
61
Q

What are the two classifications of effusions?

A

Transudate and exudate

62
Q

What are the 4 types of pleural fluid?

A
  1. Lymph: chylothorax
  2. Pyogenic (pus): empyema
  3. Blood: hemothorax
  4. Serous: hydrothorax
63
Q

What is the volume needed in a pleural effusion for findings to begin appearring in a PE?

A

300ml

64
Q

What are the two Dx procedures that will determine what kind of pleural fluid the effusion is and it’s cause?

A

Thoracentesis and CMP

65
Q

What is a pleural empyema?

A

Infective organism enters the pleural cavity through an incision, bloodstream, or trauma

66
Q

What are the two types of pneumothorax?

A

Spontaneous and traumatic

67
Q

What are key PE findings in a pneumothorax?

A

NO breath sounds on affected side

Tympany on percussion

68
Q

What is a danger of not getting a pneumothorax surgically repaired?

A

50% recurrence within 2yrs

CPD I (7 decks)

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