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internal med EOR > Pulmonary system > Flashcards

Pulmonary system Flashcards

1
Q

Acute bronchitis: etiology/background/time course

A

inflammation of mucous membranes of bronchial tubes; diminished mucociliary fxn causes bronchioles to become congested with debris
Most are VIRAL
(U) lasts 10d to 1 mo

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2
Q

Acute bronchitis: sxs

A

cough; may be dry initially & later sputum production, sore throat, rhinorrhea, HA, myalgias, extreme fatigue

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3
Q

Acute bronchitis: dx and tx

A

dx: culture of sputum, CBC, CXR-should be WNL

txL NSAIDS, ASA, decongestants (Mucinex), ICS
if due to pertussis-> Abx (macrolides)

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4
Q

Influenza: etiology/background

A

acute febrile illness secondary to influenza A or B, transmitted by respiratory droplets, prevention w/vaccine

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5
Q

Influenza: risk factors

A

Vaccinate it: >50yo, resident of LTC facility, hx of plum dz (COPD, asthma), hx of cardiovascular dz, 2nd/3rd trimester pre go, immunocompromised, health care providers

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6
Q

Influenza: signs/sxs, time course

A

abrupt onset of fever, sore throat, HA, myalgias, malaise, non-productive cough, clear nasal d/c, cervical lymphadenopathy. May see confusion/weakness in elderly
-lasts 3d to 2 weeks w/ convalescence 1-4 weeks

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7
Q

Influenza dx & tax

A

dx: viral cultures from nose or pharynx
CXR for productive cough/fever
CBC< electrolyte/glucose

tx: supportive, bedrest, anti-pyretics; Rimantadine & amantadine can shorten the course
Zanamivir & oseltamacir

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8
Q

Influenza complications

A

bacterial pneumonia

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9
Q

Community acquired pneumonia (bacterial) etiology (3)

A

Strep pneumo
H. flu
Staph aureus

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10
Q

Hospital acquired pneumonia (bacterial) etiology (3)

A

Pseudomonas
Klebsiella
E. coli

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11
Q

Ventilator acquired pneumonia (bacteria):
days 1-4 (4)
>4days (3)

A

days 1-3: S. pneumonia, H. flu, m. cat, MSSA

> 4 days: pseudomonas, acinetobacter, MRSA

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12
Q

Atypical pneumonia (bacterial) (3) & sxs

A

legionella (GI sxs: N/V/D including LDH, hyponatremic, unilateral lower lobe consolidation)
mycoplasma
chlamydia

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13
Q

Bacterial pneumonia signs & sxs

A

fever, leukocytosis, cough, sputum, night sweats, hemoptysis, weakness, dyspnea, pleuritic chest pain, hypoxemia, hypercapnea, confusion

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14
Q

Atypical pneumonia signs & sxs

A

HA, diarrhea, myalgia, arthralgia, N/V, reflux, nonproductive cough

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15
Q

Elderly pneumonia signs & sxs

A

confusion, weakness, failure to thrive, delirium, abdominal pain tachypnea

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16
Q

pleural effusion signs/sxs

A

tachypnea, crackles, dullness to percussion, inc. tactile fremitus, egophony, diaphoretic

17
Q

pneumonia dx

A

CXR (gold standard)

nasopharyngeal swal Ab, CT scan, blood cultures, urine antigen (legionella), CBC, BMP, ABGs/pulse ox, bronchoscopy

18
Q

Community acquired pneumonia (CAP) tx; severe CAP tx

A

CAP–> macrolides (azithro/clarithromycin), doxyclcline, fluoroquinolones (Cipro, Levaquin, Moxi, Gati), cephalosporins (Ceftin, Rocephin, Keflex)

Severe CAP->double abx-antipseudo cephalosporin w/quinolone or macrolide

19
Q

Aspiration pneumonia tx

A

anaerobic coverage w/quinolone with or w/o b-lactam, flagyl or clindamycin

20
Q

MRSA pneumonia tx

A

Vancomycin or Oxacillin

21
Q

Legionella pneumonia tx

A

B-lactams, mactrolides, fluoroquinolones

22
Q

Mycoplasma penumonia tx

A

macrolide, tetracycline

23
Q

When tx pneumonia, always do what?

A

f/u CXR in 1 mo to r/o lung CA

24
Q

Viral pneumonia: etiology

A

Influenza->half of all CAP, cough & fatigue
Adenovirus-very contagious, summer months
Hantavirus (contact w/rodent excrement)

25
Q

Viral pneumonia: dx, tx, complication

A

dx: CXR
supportive tx, vaccinate for influenza
comp: bacterial pneumonia

26
Q

pneumonia fungal histoplasmosis: etiology/background

A

Ohio, MIssissippi River called bird/bat droppings

27
Q

pneumonia fungal histoplasmosis: sxs

A

asx or flu-like, pulmonary sxs for 1-3 weeks, dry cough

28
Q

pneumonia fungal histoplasmosis dx

A

antigen detection, serology, bx & cultures
blood/bone marrow culture
CXR: Hilar adenopathy, patchy or nodular infiltrates in lower lung feilds

29
Q

pneumonia fungal histoplasmosis treatment

A

oral itraconazole or ketoconazole for 6012 weeks

severe infxn: Amphotericin B
chronic infxn: Ampho B or Itraconazole

AIDS: Ampho B + Itraconazole

  • NO tx for asymptomatic pts
  • NO steriods
30
Q

Pneumonia Fungal Blastomycosis: etiology/hx, sxs

A

Midwest & Southern US soil

asymptomatic but may disseminate

31
Q

Pneumonia Fungal Blastomycosis dx

A

CXT->patchy infiltrates
bronchoalveolar lavage
Characteristic broad-based budding yeast

32
Q

Pneumonia Fungal Blastomycosis tx

A

Amphotericin B in immunocomprimised

internal med EOR (1 decks)

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