Pulmonology Flashcards
What is the most common cause of acute bronchiolitis?
RSV
Nov-April
RSV is the most common ______?
RSV is the most common cause of lower respiratory tract infection in children <5
wheezing in child 12-24 months with signs of viral respiratory infection (rhinorrhea, sneezing, low-grade fever, nasal flaring, tachypnea, retractions)
Acute bronchiolitis
RSV
Treatment for RSV?
hospitalization and administration of ribavirin
-supportive measures (nebulizer albuterol, IV fluids, antipyretics, chest physiotherapy, humidified oxygen)
Young child (2-7); dysphagia, drooling, distress, tripod posture
Acute epiglottis
What is the X-ray finding for acute epiglottis?
thumb print sign
lateral neck radiograph
What is the most common cause of epiglottis? why has the incidence decreased?
H. influenzae type B vaccine
not immunized kids
Treatment for acute epiglottis?
- secure airway (intubate)
- ABX (cephalosporin - cfotaxime/ceftriaxone for 7-10 days)
- supportive care
What is another name for croup?
laryngotracheobronchitis
Most common cause of croup?
parainfluenza virus type 1 and 2
harsh, barking, seal-like cough, stridor
croup
X-ray finding for croup?
steeple sign
posterior anterior show subglottic narrowing
Treatment for croup?
mild = no treatment. keep hydrated
-corticosteroids, humidified air, neb epinephrine
severe = hospitalize
severe paroxysmal cough, long inspiratory gasp, high-pitch whoop
pertussis (whooping cough)
cause of whooping cough (pertussis)?
Bordetella pertussis (gram -)
contagious
-isolation recommended
gold standard for diagnosing pertussis (whooping cough)?
nasopharyngeal secretions
Prevention of whooping cough (pertussis)?
routine vaccination
5 doses of DTaP
Treatment for pertussis (whooping cough)?
Clarithromycin (macrolide)
or azithromycin
ADR of clarithromycin?
hypertrophic pyloric stenosis
What is another name for Infant Respiratory Distress Syndrome (IRDS)?
hyaline membrane disease
What causes hyaline membrane disease?
deficiency of surfactant
What are typical signs of infant in respiratory distress… X-ray findings?
cyanosis, tachypnea, tachycardia, expiratory grunting, nasal flaring
xray: air bronchogram, diffuse bilateral atelectasis = ground glass appearance, doming of diaphragm
Who is at risk for having hyaline membrane disease (infant resp. distress)?
preterm infant (<30 weeks gestation)
Treatment for IRDS or hyaline membrane disease?
ventilation support
exogenous surfactant
mom = antenatal corticosteroid (betamethasone IM x2)
Define bronchiectasis?
abnormal, permanent dilation of the bronchi and destruction of bronchial walls (irreversible destruction of muscle and elastic tissue of bronchial tree = scarring)
What are the 3 forms of bronchiectasis?
- congenital (cystic fibrosis)
- acquired from infection (TB, fungal, abscess)
- obstruction (tumor)
What is the most common cause of bronchiectasis?
cystic fibrosis (mutation of CFTR gene or CR7)
Patient presents with chronic purulent sputum (foul smelling), hemoptysis, chronic cough, recurrent pneumonia….what test do you order?
- CT (dilated, tortuous airway)
- xray = crowded bronchial marking, basal cystic spaces, honeycombing
bronchiectasis
What is the gold standard test for bronchiectasis?
CT of chest
Treatment for bronchiectasis?
productive cough = ABX, bronchodilators, chest physiotherapy
ABX = 10-14 days (amoxicillin, augmentin, bacterium, cipro)
lung transplant
abrupt onset of fever, headache, myalgia, malaise
winter season
influenza
Treatment of influenza?
treat if symptoms are <48 hrs in duration
- Zanamivir and Oseltamivir (influenza A and B)
- amantadine and rimantadine (influenza A)
- NSAID (fever, headache, myalgia)
What should you avoid in children <18 years… Reyes syndrome?
post viral illness with ASA in kids
Describe Reye’s syndrome?
Kids and ASA
altered mental status, rash, vomiting, liver damage
Describe a lung examination for consolidation?
dullness to percussion
- egophony (e sounds like A)
- bronchophoney (spoken syllables are clear and loud)
- whispered pectoriloquy (whispered sound clearly heard)
Types of pneumonia (4)?
- Viral
- bacterial
- fungal
- PCP/PJP (HIV related)
Types of bacterial pneumonia (4)?
- Typical (lobar consolidation
- s pneumo, s aureus, group A strep - atypical (interstitial infilatrates)
- legionella, mycoplasma, chlamydia - nosocomial
- pseudomonas - Aspiration
- klebsiella
What are types of viral pneumonia (4)?
- influenza
- RSV (kid <2 - bronchiolitis)
- adenovirus (lasts 7 days, GI symptoms, military recruits)
- parainfluenza
How do you get Hanta virus?
rodent feces contact
-causes ARDS (not pneumonia)
What is viral pneumonia priced with?
a cold
Most common cause of community acquired pneumonia?
S. pneumoniae
What pneumoniae has rust-colored sputum?
s. pneumoniae (most common)
Prevention of s. pneuma pneumonia?
pneumococcal vaccination
Treatment of CAP?
- outpatient health: fluroquinolone (levo/cipro); doxycycline; macrolide (clarithromycin/azithromycin)
- outpatient + comorbidities: above + beta-lactam (ceftriaxone, cefotaxime)
- inpt (non ICU): beta-lactam + macrolide
inpt ICU: beta-lactam + macrolide or fluoroquinolone
What pneumonia has salmon colored sputum?
s. aureus
xray: infilrates
What are examples of what a chest X-ray may look like with pneumonia?
- lobar or segmental infiltrates
- air bronchograms
- pleural effusions
What bacteria is common with hospital-acuqired pneumonia?
present 48 hrs after hospital admission
pseudomonas aeruginosa (nosocomial)
post ventilator - ICU
Treatment for hospital acquired pneumonia?
empiric ABX (ceftriaxone; fluoroquinolone, imipenem, cefepime)
need 2 antibiotics
- piperacillin/tazobactam + levo or cipro
- piperacillin/tazobactam + tobramycin
- levo or cipro + tobra
presentation of atypical pneumonia?
(mycoplasma/chlamydia/legionella)
-low-grade fever, mild pulm symptoms. nonproductive cough, myalgia, fatigue
What pneumonia is spread by contaminated water? (from A/C)
legionella
-high fever, dry cough, dyspnea, systemic symptoms (GI - diarrhea)
Treatment for legionella pneumonia?
macrolide (azithromycin, erythromycin)
fluoroquinolone (cipro or levo)
most common cause of atypical pneumonia?
mycoplasma (walking pneumonia)
What age group is likely to have mycoplasma pneumonia?
young adults, college setting, military recruits
Treatment for mycoplasma pneumonia?
- macrolide (azithromycin)
- doxycycline
pneumonia with currant jelly sputum, alcoholic and nursing home patient, right upper lobe abscess (aspiration)
klebsiella pneumonia
Treatment for klebsiella?
- cephalosporin
- aminoglycoside (gentamicin)
- fluoroquinolone (levo/cipro)
When would you consider a fungal pneumonia?
if patient is immunocompromised
AIDS, steroid use, organ transplant drugs, malignancy, sarcoidosis, SLE, DM, cirrhosis, IV drug user
Treatment for fungal pneumonia?
itraconazole or fluconazole
What is associated with fungal pneumonia and meningitis?
cryptococcus (soil)
+ immunocompromised
Treatment for meningitis?
amphotericin B
What is associated with fungal pneumonia and bird/bat dropping?
histoplasma (mississippi to ohio river)
What is the most common opportunistic cause of HIV related pneumonia?
pneumocysitis carinii (PCP) or pneumocystis jiroveci (PJP)
HIV (low CD4 count)
most common cause of bacterial pneumonia + HIV + streptococcus
symptoms for pneumocystis pneumonia (HIV)
fever, tachypnea, dyspnea, dry cough
get chest X-ray
lymphopenia and low CD4
sputum staining
Treatment for HIV related pneumonia?
Bactrim ***
prophylaxis daily if high risk = CD4 count <200
dry cough - progress to productive cough, hemoptysis, 3 weeks
fever, drenching night sweats, wt loss
appear very ill
recent travel
tuberculosis (TB)
What is Ghon complex associated with?
tuberculosis
Ghon (calcified lymph + lesion)
What is the skin test for TB?
PPD
Negative:
-<15 (nonexposed)
What do you do if you get a +PPD?
order a chest X-ray
-if chest X-ray negative then treat with INH x 9 months (isoniazid)
What does RIPE stand for?
tuberculosis R - rifampin I - isoniazid P - pyrazinamid E - ethambutol
Isoniazid ADR?
tuberculosis
- hepatitis
- peripheral neuropathy
- coadminister with Vit 6 (pyridoxine)
Rifampin ADR?
tuberculosis
- hepatitis
- flu syndrome
- orange body fluid
Ethambutol ADR?
tuberculosis
- optic neuritis
- (red-green vision loss)
Pyrazinamide ADR?
tuberculosos
- hepatotoxicity
- GI upset
- gout
if you have high suspicion for TB what do you do?
- start INH/RIF/EMB/PZA
- 2 month culture
1. negative = continue for 6 months
2. + no resistance = chest X-ray (6 or 9 months)
3. +,+resistance = chest xray (6 or 9 months)
what do you do if you have low suspicion/screening for TB?
PPD (skin test)
+ = look at parameters <5,10,15
chest xray
-negative = INH 6 month
