Pulmonology, part 3 Flashcards
Pneumoconiosis/silicosis
Lung dz caused by inhalation of mineral dust.
Silicosis is caused by inhalation of dust containing crystalline silica
Pathophys of silicosis
Small particles are dangerous because they deposit distally in the bronchiole, ducts, and alveoli. The inflammation leads to fibroblast and collagen formation that leads to fibrosis
Other causes of pneumoconiosis
Asbestosis
Coal dust
Other chemical exposures
Occupation risk for pneumoconiosis
Mining or tunneling Quarrying Drilling Crushing stone Chipping Grinding/sandblasting Pottery or stone work Cement manufacturing Masonry
Tx of pneumoconiosis
Prevent exposure Quit smoking Immunize- flu and pneumococcal No known cure Lung transplant for severe pt Treat complications (airflow obstruction, cor pulmonale, resp failure)
Silicosis sx
SOB Fever Bluish skin at the earl lobes or lips As the dz progresses: Fatigue Extreme shortness of breath Loss of appetite CP Respiratory failure
Respiratory distress syndrome
Used to be called hyaline membrane disease
An acute lung dz caused by surfactant deficiency.
Seen in neonates <36 wks gestation and weighing <3 lbs
Prognosis of resp distress syndrome
Outcome has improved with use of antenatal steroids to improve pulm.
Maturity, early postnatal surfactant tx, and gentle techniques of ventilation to reduce barotrauma to the immature lungs
F/u of respiratory distress syndrome
Support IV nutrition within 24 hrs of birth once breathing is stabilized
Prevent hypothermia with a double-walled incubator
Start oral feedings with small feedings through an orogastric tube as soon as tolerated
Support circulatory status which may require blood transfusion
Start abx in all infants who present with resp distress at birth after BCx are drawn. D/c within 2-5 days if cultures are neg
Cause of immune compromise/fungal PNA
Candida
Aspergillus
Cryptococcus
Complications of fungal PNA
Disease dissemination to other sites
Blood vessel invasion, which can lead to pulmonary hemoptysis
Conditions that predispose pts to immune compromise/fungal PNA
Leukemia Lymphoma Bone marrow transplant Organ transplant Prolonged high-dose steroids HIV Congenital immune deficiency syndrome
Tx for immune compromise/fungal PNA
Amphotericin B- treat for Histoplasmosis, Coccidiodomycosis, Cryptococcosis, Candidiasis
-Then azoles after improvement
Itraconazole- treat Blastomycosis
When is viral PNA more common?
Childhood PNA
Elderly
What are the four most frequent viruses in PNA?
Influenza
RSV
Adenovirus
Parainfluenza
Presentation of viral pneumonia
Fever Chills Nonproductive cough Rhinitis Myalgias HA Fatigue
PE of viral PNA
Wheezes Crackles Increased fremitus Bronchial breath sounds Rapid antigen detection of viruses can be ordered along with viral culture
Tx of viral pneumonia
Tamiflu for influenza A and B
Ribavirin used for RSV PNA
Cidofovir is being studied for adenovirus
Ribavirin has shown some benefit with parainfluenza
What is the MC opportunistic infection in persons with HIV infection
Pneumocystis carinii pneumonia
Tx of PCP
Abx are primarily recommended and TMP-SMX has been shown to be as effective than IV abx
Mortality rate of PCP and tx duration
10-20% in pts with HIV infection
Tx with TMP-SMX is 21 days
Smear of PCP
Crinkled cyst with a crushed ping pong shape
Air entrance in pneumo
Air can enter the intrapleural space through a communication from the chest wall or through the lung parenchyma across the visceral pleura
When does primary spontaneous pneumo?
Secondary?
Occurs in people without underlying lung dz and in the absence of an inciting event
Occurs in pts with a wide variety of lung dz
