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DSE > Pulmonology, part 2 > Flashcards

Pulmonology, part 2 Flashcards

1
Q

DDx for acute courgh

A 
Asthma exacerbation
Chronic bronchitis
COPD exacerbation
Common cold
CHF exacerbation
GERD
PNA
Postnasal drip syndrome
Seasonal allergies
Sinusitis
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2
Q

Lab and diagnostic findings of acute bronchitis

A

Clinical dx
CXR- only if signs of PNA , or in elderly with many comorbidities
Influenza A/B nasal swab if fall/winter and signs of flu
Rapid strep if suspect it based on presentation
Sputum cultures not necessary unless PNA confirmed and concerned it is not community acquired
Mycoplasm serology if cough persists >2-3 wks, also consider risk of bordetella based on s/sx

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3
Q

Meds for acute bronchitis

A

Symptomatic tx: NSAIDs to improve malaise, Guaifenesin for cough
Albuterol inhaler if wheezing to use 2 puffs every 6 hrs prn while ill
Abx not recommended first line unless elderly pt with acute cough and have had a hospital stay within the past year, type 2 DM, or CHF, or chronic steroid
If pos influenza A or B- Tamiflu 75 mg BID x 5 days

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4
Q

Pathophys of acute bronchiolitis/RSV

A

Acute inflammation of the bronchioles that is usually caused by a viral infection (usually RSV) and also from parainfluenza, influenza, and adenovirus.

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5
Q

Demographics of acute bronchiolitis/RSV

A

This condition can occur in people of all ages, but severe sx are usually only in young infants (peak in infants 3-6 mos)

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6
Q

Prognosis of acute bronchiolitis/RSV

A

Usually self-limited.
Recovery begins with regeneration of bronchiolar epithelium after 3-4 days, however cilia do not regrow for as long as 2 wks

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7
Q

Transmission of acute bronchiolitis/RSV

A

Spread by contact with resp secretions and highly contagious

RSV starts in Nov and peaks in Jan and Feb

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8
Q

High risk of hospital admit- acute bronchiolitis/RSV

A 
Low birth weight
Premature infants
Lower socioeconomic group
Parental smoking
Chronic lung disease
Severe congenital dz
Age <3 mos
Acute resp tract infection in children <5 yo is still the leading cause of mortality
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9
Q

PE findings of acute bronchiolitis/RSV

A

Infants are fussy with difficulty feeding
Low grade fever <101.5
Increasing rhinorrhea and congestion
Adults- presents as the common cold
After 5 days, RSV in infants progresses to lower tract with cough, dyspnea, wheezing

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10
Q

Lab and diagnostic findings of acute bronchiolitis/RSV

A

In very ill pts, RSV rapid viral antigen test of nasopharyngeal secretions, ABG, CBC, blood cultures, CXR
Every pt, pulse ox and consider rapid flu testing if s/sx indicate
Only 7% develop secondary bacterial infections

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11
Q

Findings on CXR for acute bronchiolitis/RSV

A

Flattened diaphragm
Hyperinflation
Atelectasis

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12
Q

Criteria for hosp admission- acute bronchiolitis/RSV

A

Persistent oxygen saturation <92% in room air before albuterol tx
Markedly elevated RR
Dyspnea with intercostal retractions, resp distress
Chronic lung dz, esp if pt already on oxygen
Congenital heart dz
Age <3 mos when severe dz is most common
Difficulty in feeding and inability to maintain oral hydration <6 mos old

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13
Q

Meds- acute bronchiolitis/RSV

A

Only oxygen has demonstrably improved the condition of young children with bronchiolitis because it decreases the work of breathing
Albuterol neb tx
If sepsis suspected, IV amp or cefotaxime can be started until BCxs come back
Ribavirin is approved by FDA under certain criteria for hospitalized pts

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14
Q

Presentation of croup

A

Hoarseness
Seal-like barking cough
Variable degree of resp distress

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15
Q

Morbidity of croup

A

Secondary to narrowing of the larynx and trachea below the level of the glottis, causing the audible inspiratory stridor

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16
Q

Tx of croup

A

Mod-severe pts need dexamethasone, and hosp pts get nebulized racemic epi

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17
Q

Prognosis of influenza

A

In pts without comorbid dz, prognosis of influenza A and B is very good.
Avan flu has only been reported in 630 pts as of June 2013, with 375 deaths and limited to eastern Asia

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18
Q

Incubation period and complications of influenza

A

Types A, B, and C can lead to serious pulmonary infections, pneumonia and morbidity in those immune compromised
Incubation period ranges from 1-4 days
Shedding of virus continues for 5-10 days

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19
Q

Sx of influenza

A 
HA
Fever (usually high)
Extreme tiredness
Joint aches
Runny or stuffy nose
Sore throat
Aches
Coughing
Vomiting
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20
Q

Health maintenance for influenza

A

Prevention is the key

Routine annual flu vaccine for 6 mos or older

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21
Q

PE findings of influenza

A 
Fever
Sore throat
Myalgias
HA
Nasal d/c: clear rhinorrhea
Weakness and severe fatigue
Tachycardia
Red, watery eyes
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22
Q

Testing/findings for influenza

A

Rapid flu detection for influenza A and B
-Sensitivity of 62% and specificity of 98%
Avian flu- hospitalized Swab for H5N1 is available since 2009
CXR if elderly or high-risk to exclude PNA

23
Q

Tx for influenza

A

To be effective, must be started within 2 days of onset
If pt critically ill- may be started up to 5 days after onset
Can be dosed as prophylaxis
Oseltamivir 75 mg BID x 5 days
Zanamivir- NOT for those with underlying chronic airway dz
10 mg inhaled through Diskhaler BID x 5 days

24
Q

Pertussis remains a significant cause of morbidity and mortality in ________

A

Infants younger than 2 yrs old

25
Characteristics of pertussis
Inexorable spasms of coughing, with a protracted course Contagious dz can be spread from coughs or sneezes Begins with mild cold-like sx After week or 2 can lead to more serious problems Can be preventable through vaccine
26
Stage 1 of pertussis
``` Catarrhal stage May last 1-2 wks Runny nose Low-grade fever Mild, occasional cough Highly contagious ```
27
Stage 2 of pertussis
Paroxysmal stage Lasts from 1-6 wks; may extend to 10 wks Fits of numerous, rapid coughs followed by "whoop" sound Vomiting and exhaustion after coughing fits- called paroxysms
28
Stage 3 of pertussis
Convalescent stage Lasts about 2-3 wks Susceptible to other respiratory infections for many Recovery is gradual. Coughing lessens but fits of coughing may return
29
What role does the pleural space play?
Plays an important role in respiration by providing a vacuum in the space keeping the visceral and parietal pleura in close proximity. The small volume of pleural fluid (usually 2-10 mL) serves as a lubricant to facilitate movement of the pleural surfaces against each other
30
What is a pleural effusion?
An abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption
31
Causes of pleural effusion
Range from cardiopulmonary disorders to symptomatic inflammatory or malignant diseases requiring urgent evaluation and tx.
32
Transudative pleural effusion
<30 g protein/L
33
Pathogenesis and causes of transudate pleural effusion
Increased hydrostatic pressure d/t cardiac failure | Decreased oncotic pressure d/t vena caval obstruction or hypoalbuminemia
34
Exudative pleural effusion
>30 g protein/liter
35
Pathogenesis and causes of exudative pleural effusion
Infections d/t bacterial, including TB, and other organisms Neoplasm d/t metastatic carcinoma, primary carcinoma of lung, mesothelioma of the pleura Pulmonary infarction d/t thromboembolic dz Autoimmune dz d/t rheumatoid dz, SLE Abdominal dz d/t pancreatitis, subphrenic abscess, Meig's syndrome
36
Hx findings of pleural effusion- general
Dyspnea Cough-mild and nonproductive CP- usually with exudative
37
Hx findings of pleural effusion- CHF
Lower ext edema Orthopnea PND
38
Hx findings of pleural effusion d/t TB or lung CA
Night sweats Hemoptysis Weight loss
39
Hx findings of pleural effusion- PNA causing pleural effusion
Acute fever Purulent sputum production Pleuritic chest pain
40
PE of pleural effusion
``` Dullness to percussion Decreased tactile fremitus Asymmetrical chest expansion Diminished breath sounds Egophany Pleural friction rub CHF- jugular venous distention, S3 gallop, edema Liver dz- jaundice CA- Lymphadenopathy ```
41
Work up for pleural effusion
CXR- PA and lateral to detect effusion Thoracentesis for new and unexpected effusions -Purulent fluid: empyema -Milky, opalescent fluid: lymphatic obstruction by cancer or trauma -Grossly bloody: trauma, cancer, or asbestos related Nl fluid is clear plasma with pH of 7.6
42
Hospital tx of pleural effusion
Treat underlying cause -Indications for urgent drainage of effusions include purulent fluid, pleural fluid with pH < 7.2, loculated effusions, and bacteria on Gram stain Surgery is required for effusions that cannot be drained adequately by needle or small-bore catheters
43
Pulmonary artery HTN
A mean pulmonary arterial pressure >25 mm Hg at rest, and is characterized by a progressive and sustained increase in pulmonary vascular resistance that eventually leads to right ventricular failure
44
What are the MCCs of secondary pulmonary HTN
Cardiac disorders Pulmonary disorders Both in combination
45
Primary pulmonary HTN
Rare | Characterized by elevated pulmonary artery pressure with no apparent cause
46
Hx pulmonary HTN
``` Dyspnea upon exertion Fatigue Lethargy Syncope with exertion CP Cough- less common ```
47
PE of pulmonary HTN
Intensity of pulmonic component of second heart sound P2 R ventricular heave A rt-sided 4th heart sound and L parasternal heave R ventricular failure may be associated with high-pitched systolic murmur of tricuspid regurg, hepatomegaly and edema
48
RFs of pulmonary HTN
``` Past hx of heart murmur Hx of pulmonary embolism Heavy alcohol consumption Hepatitis Severe sleep apnea Morbid obesity ```
49
Cor pulmonale
An enlargement of the right ventricle due to high blood pressure in the lungs usually caused by chronic lung disease
50
Workup pulmonary HTN/cor pulmonale
``` EKG- signs of RV dysfunction Echo- to estimate the pulmonary artery pressure and assess ventricular function CXR If no cardiac dz- PFT Consider spiral chest CT and/or VQ scan CBC CMP PT aPTT ABgs ESR RF ANA ```
51
Tx/follow-up of pulmonary HTN/cor pulmonale: general
Tx of the underlying dz. Effective therapy should be instituted in the early stages, before irreversible changes in pulmonary vasculature occur. Afterwards, specific interventional therapy, specific medical therapy, or general supportive therapy
52
Tx/follow-up of pulmonary HTN/cor pulmonale: atrial septal defect and mitral stenosis
Surgical repair
53
When is lung transplant a tx for pulmonary HTN?
Reserved for pts with severe primary pulmonary arterial HTN | 5 yr suvival post transplant is 50%

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