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Pulmonology Flashcards

1
Q

What is the most common cause of acute bronchiolitis?

A

RSV

Nov-April

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2
Q

RSV is the most common ______?

A

RSV is the most common cause of lower respiratory tract infection in children <5

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3
Q

wheezing in child 12-24 months with signs of viral respiratory infection (rhinorrhea, sneezing, low-grade fever, nasal flaring, tachypnea, retractions)

A

Acute bronchiolitis

RSV

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4
Q

Treatment for RSV?

A

hospitalization and administration of ribavirin

-supportive measures (nebulizer albuterol, IV fluids, antipyretics, chest physiotherapy, humidified oxygen)

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5
Q

Young child (2-7); dysphagia, drooling, distress, tripod posture

A

Acute epiglottis

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6
Q

What is the X-ray finding for acute epiglottis?

A

thumb print sign

lateral neck radiograph

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7
Q

What is the most common cause of epiglottis? why has the incidence decreased?

A

H. influenzae type B vaccine

not immunized kids

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8
Q

Treatment for acute epiglottis?

A
  • secure airway (intubate)
  • ABX (cephalosporin - cfotaxime/ceftriaxone for 7-10 days)
  • supportive care
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9
Q

What is another name for croup?

A

laryngotracheobronchitis

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10
Q

Most common cause of croup?

A

parainfluenza virus type 1 and 2

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11
Q

harsh, barking, seal-like cough, stridor

A

croup

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12
Q

X-ray finding for croup?

A

steeple sign

posterior anterior show subglottic narrowing

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13
Q

Treatment for croup?

A

mild = no treatment. keep hydrated

-corticosteroids, humidified air, neb epinephrine

severe = hospitalize

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14
Q

severe paroxysmal cough, long inspiratory gasp, high-pitch whoop

A

pertussis (whooping cough)

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15
Q

cause of whooping cough (pertussis)?

A

Bordetella pertussis (gram -)

contagious

-isolation recommended

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16
Q

gold standard for diagnosing pertussis (whooping cough)?

A

nasopharyngeal secretions

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17
Q

Prevention of whooping cough (pertussis)?

A

routine vaccination

5 doses of DTaP

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18
Q

Treatment for pertussis (whooping cough)?

A

Clarithromycin (macrolide)

or azithromycin

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19
Q

ADR of clarithromycin?

A

hypertrophic pyloric stenosis

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20
Q

What is another name for Infant Respiratory Distress Syndrome (IRDS)?

A

hyaline membrane disease

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21
Q

What causes hyaline membrane disease?

A

deficiency of surfactant

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22
Q

What are typical signs of infant in respiratory distress… X-ray findings?

A

cyanosis, tachypnea, tachycardia, expiratory grunting, nasal flaring

xray: air bronchogram, diffuse bilateral atelectasis = ground glass appearance, doming of diaphragm

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23
Q

Who is at risk for having hyaline membrane disease (infant resp. distress)?

A

preterm infant (<30 weeks gestation)

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24
Q

Treatment for IRDS or hyaline membrane disease?

A

ventilation support

exogenous surfactant

mom = antenatal corticosteroid (betamethasone IM x2)

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25
Define bronchiectasis?
abnormal, permanent dilation of the bronchi and destruction of bronchial walls (irreversible destruction of muscle and elastic tissue of bronchial tree = scarring)
26
What are the 3 forms of bronchiectasis?
- congenital (cystic fibrosis) - acquired from infection (TB, fungal, abscess) - obstruction (tumor)
27
What is the most common cause of bronchiectasis?
cystic fibrosis (mutation of CFTR gene or CR7)
28
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
29
What is the gold standard test for bronchiectasis?
CT of chest
30
Treatment for bronchiectasis?
productive cough = ABX, bronchodilators, chest physiotherapy ABX = 10-14 days (amoxicillin, augmentin, bacterium, cipro) lung transplant
31
abrupt onset of fever, headache, myalgia, malaise winter season
influenza
32
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)
33
What should you avoid in children <18 years... Reyes syndrome?
post viral illness with ASA in kids
34
Describe Reye's syndrome?
Kids and ASA altered mental status, rash, vomiting, liver damage
35
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)
36
Types of pneumonia (4)?
- Viral - bacterial - fungal - PCP/PJP (HIV related)
37
Types of bacterial pneumonia (4)?
1. Typical (lobar consolidation - s pneumo, s aureus, group A strep 2. atypical (interstitial infilatrates) - legionella, mycoplasma, chlamydia 3. nosocomial - pseudomonas 4. Aspiration - klebsiella
38
What are types of viral pneumonia (4)?
1. **influenza** 2. RSV (kid <2 - bronchiolitis) 3. adenovirus (lasts 7 days, GI symptoms, military recruits) 4. parainfluenza
39
How do you get Hanta virus?
rodent feces contact -causes ARDS (not pneumonia)
40
What is viral pneumonia priced with?
a cold
41
Most common cause of community acquired pneumonia?
S. pneumoniae
42
What pneumoniae has rust-colored sputum?
s. pneumoniae (most common)
43
Prevention of s. pneuma pneumonia?
pneumococcal vaccination
44
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
45
What pneumonia has salmon colored sputum?
s. aureus | xray: infilrates
46
What are examples of what a chest X-ray may look like with pneumonia?
- lobar or segmental infiltrates - air bronchograms - pleural effusions
47
What bacteria is common with hospital-acuqired pneumonia? present 48 hrs after hospital admission
pseudomonas aeruginosa (nosocomial) | post ventilator - ICU
48
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
49
presentation of atypical pneumonia?
(mycoplasma/chlamydia/legionella) -low-grade fever, mild pulm symptoms. nonproductive cough, myalgia, fatigue
50
What pneumonia is spread by contaminated water? (from A/C)
legionella -high fever, dry cough, dyspnea, systemic symptoms (GI - diarrhea)
51
Treatment for legionella pneumonia?
macrolide (azithromycin, erythromycin) fluoroquinolone (cipro or levo)
52
most common cause of atypical pneumonia?
mycoplasma (walking pneumonia)
53
What age group is likely to have mycoplasma pneumonia?
young adults, college setting, military recruits
54
Treatment for mycoplasma pneumonia?
- macrolide (azithromycin) | - doxycycline
55
pneumonia with currant jelly sputum, alcoholic and nursing home patient, right upper lobe abscess (aspiration)
klebsiella pneumonia
56
Treatment for klebsiella?
- cephalosporin - aminoglycoside (gentamicin) - fluoroquinolone (levo/cipro)
57
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
58
Treatment for fungal pneumonia?
itraconazole or fluconazole
59
What is associated with fungal pneumonia and meningitis?
cryptococcus (soil) | + immunocompromised
60
Treatment for meningitis?
amphotericin B
61
What is associated with fungal pneumonia and bird/bat dropping?
histoplasma (mississippi to ohio river)
62
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
63
symptoms for pneumocystis pneumonia (HIV)
fever, tachypnea, dyspnea, dry cough get chest X-ray lymphopenia and low CD4 sputum staining
64
Treatment for HIV related pneumonia?
Bactrim *** prophylaxis daily if high risk = CD4 count <200
65
dry cough - progress to productive cough, hemoptysis, 3 weeks fever, drenching night sweats, wt loss appear very ill recent travel
tuberculosis (TB)
66
What is Ghon complex associated with?
tuberculosis Ghon (calcified lymph + lesion)
67
What is the skin test for TB?
PPD Negative: -<15 (nonexposed)
68
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)
69
What does RIPE stand for?
``` tuberculosis R - rifampin I - isoniazid P - pyrazinamid E - ethambutol ```
70
Isoniazid ADR?
tuberculosis - hepatitis - peripheral neuropathy - coadminister with Vit 6 (pyridoxine)
71
Rifampin ADR?
tuberculosis - hepatitis - flu syndrome - orange body fluid
72
Ethambutol ADR?
tuberculosis - optic neuritis - (red-green vision loss)
73
Pyrazinamide ADR?
tuberculosos - hepatotoxicity - GI upset - gout
74
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)
75
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

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