Pulmonary system

Question 1

Acute bronchitis: etiology/background/time course

Answer 1

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

Question 2

Acute bronchitis: sxs

Answer 2

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

Question 3

Acute bronchitis: dx and tx

Answer 3

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

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

Question 4

Influenza: etiology/background

Answer 4

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

Question 5

Influenza: risk factors

Answer 5

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

Question 6

Influenza: signs/sxs, time course

Answer 6

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

Question 7

Influenza dx & tax

Answer 7

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

Question 8

Influenza complications

Answer 8

bacterial pneumonia

Question 9

Community acquired pneumonia (bacterial) etiology (3)

Answer 9

Strep pneumo
H. flu
Staph aureus

Question 10

Hospital acquired pneumonia (bacterial) etiology (3)

Answer 10

Pseudomonas
Klebsiella
E. coli

Question 11

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

Answer 11

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

> 4 days: pseudomonas, acinetobacter, MRSA

Question 12

Atypical pneumonia (bacterial) (3) & sxs

Answer 12

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

Question 13

Bacterial pneumonia signs & sxs

Answer 13

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

Question 14

Atypical pneumonia signs & sxs

Answer 14

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

Question 15

Elderly pneumonia signs & sxs

Answer 15

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

Question 16

pleural effusion signs/sxs

Answer 16

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

Question 17

pneumonia dx

Answer 17

CXR (gold standard)

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

Question 18

Community acquired pneumonia (CAP) tx; severe CAP tx

Answer 18

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

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

Question 19

Aspiration pneumonia tx

Answer 19

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

Question 20

MRSA pneumonia tx

Answer 20

Vancomycin or Oxacillin

Question 21

Legionella pneumonia tx

Answer 21

B-lactams, mactrolides, fluoroquinolones

Question 22

Mycoplasma penumonia tx

Answer 22

macrolide, tetracycline

Question 23

When tx pneumonia, always do what?

Answer 23

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

Question 24

Viral pneumonia: etiology

Answer 24

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

Question 25

Viral pneumonia: dx, tx, complication

Answer 25

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

Question 26

pneumonia fungal histoplasmosis: etiology/background

Answer 26

Ohio, MIssissippi River called bird/bat droppings

Question 27

pneumonia fungal histoplasmosis: sxs

Answer 27

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

Question 28

pneumonia fungal histoplasmosis dx

Answer 28

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

Question 29

pneumonia fungal histoplasmosis treatment

Answer 29

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

Question 30

Pneumonia Fungal Blastomycosis: etiology/hx, sxs

Answer 30

Midwest & Southern US soil

asymptomatic but may disseminate

Question 31

Pneumonia Fungal Blastomycosis dx

Answer 31

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

Question 32

Pneumonia Fungal Blastomycosis tx

Answer 32

Amphotericin B in immunocomprimised