Pulmonary II Flashcards by Professor Albus Dumbledore

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

Laryngotracheobronchitis “Croup”

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

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

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What are the s/sx of Croup?

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

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

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What is the typical progression of Croup?

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

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How do you dx Croup?

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

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What are the important DDx of Croup?

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

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What are the s/sx of acute bronchitis?

A cough >5ds with sputum

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

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

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What would the work-up for acute bronchitis be?

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

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What are some DDx for acute bronchitis?

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

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What are the four classifications of pneumonia?

Community-acquired pneumonia
Hospital-acquired pneumonia
Ventilator-acquired pneumonia
Healthcare-acquired pneumonia

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

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

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

Streptococcus pneumoniae

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What is the prognosis of a S. pneumoniae infection?

Overall mortality is 5% - most recover!

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The sputum is incredibly thick in this bacterial pneumonia?

Klebsiella pneumoniae

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

Relative bradychardia - HR does not increase as much with fever

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This bacterial pneumonia arises mainly in early spring and winter.

Haemophilus influenzae

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

Staphylococcus aureus

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

Legionella pneumophila

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

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What are the general s/sx of bacterial pneumonias?

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

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

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

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

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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What is the typical prognosis of bacterial pneumonia?

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

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

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

What are some common complications with bacterial pneumonia?

Lung abscess, pleural effusions, empyema

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

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

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

CBC values | CXR

In "walking pneumonia" what is the causative agent?

Mycoplasma pneumoniae

What are the s/sx of walking pneumonia?

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

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

Otitis media and rash

What fungal infxn was diagnostic for HIV/AIDS?

Pneumocystis jirovecii

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

Coccidioidomycosis

Usually, what is the progression of Coccidioidomycosis?

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

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

Erythema nodosum, and non-specific pulmonary findings

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

Type I and II Eosinophilic pneumonia

What is the common concomitant with Allergic Bronchopulmonary Aspergillosis?

Asthma

What is the work up for Allergic Bronchopulmonary Aspergillosis?

CBC, RAST skin test, CXR

What is "Spelunkers Lung"?

Histoplasmosis

What are the three types of Histoplasmosis?

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

What is the work-up for histoplasmosis?

Sputum culture, PCR, CXR

What is the prognosis of histoplasmosis?

Acute - good outcome | Chronic or progressive - protracted course; recovery for years

What are two non-infectious causes of pneumonia?

Aspiration and Lipoid Aspiration

What are the key s/sx of lung abscesses?

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

What is the dx test for lung abscesses?

CXR or CT

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

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

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

Within 2 two years of primary infxn

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

10% | Latent Infxn

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

``` Chronic productive cough Hemoptysis Malaise, Fatigue Anorexia/Wt loss NIGHT SWEATS ```

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

Miliary TB | Lymph nodes, kidney, bones, meninges, pericardium, liver, GI, skin, adrenals

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

PPD and QuantiFERON TB Gold

What are the limitations of the PPD skin test?

Compliant to return 48-72hrs to read | False positive for those who have received the BCG Vaccine

What are the advantages of the QuantiFERON-TB Gold?

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

What is the mortality rate of MDR TB?

80%

What are some DDxs of TB?

Pneumonia, abscesses, CA, non-TB mycobacterium

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

Pleurisy

What are the s/sx of pleurisy?

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

What are key PE findings in pleurisy?

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

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

CXR, Ultrasound, CT scan

What are some DDx of pleurisy?

``` Acute abdomen Intercostal neuritis Costo-chondritis Herpes MI Pericarditis ```

What are the two classifications of effusions?

Transudate and exudate

What are the 4 types of pleural fluid?

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

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

300ml

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

Thoracentesis and CMP

What is a pleural empyema?

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

What are the two types of pneumothorax?

Spontaneous and traumatic

What are key PE findings in a pneumothorax?

NO breath sounds on affected side | Tympany on percussion

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

50% recurrence within 2yrs