week 7- resp2 Flashcards
What are the URIs?
o Rhinitis, Rhinosinusitis, Rhinopharyngitis (common cold), Pharyngitis, Tonsillitis, Epiglottitis, Laryngitis
• What are the common organisms that cause URI’s?
o Viral: rhinovirus, coronavirus, parainfluenza virus, adenovirus, respiratory syncytial virus
o Bacterial: (pharyngitis): Streptococcus pyogenes
• What are the LRIs?
o Laryngotracheobronchitis? o Acute bronchitis o Pneumonia o Lung abscess o Pulmonary tuberculosis
• What is laryngotracheobronchitis? Etiology? Age? Sex?
o Croup
o viral inflammation of the upper and lower respiratory tract causing respiratory distress
o Etiology: Parainfluenza virus type I (60% of cases) also types II-IV adenovirus; respiratory syncytial virus RSV; rhinovirus; coxsackie virus; echovirus
o Age: typically occurs in children aged 6 mos to 3 yrs
o Sex: M:F ratio 2:1.
• What are ssx of laryngotracheobronchitis?
o Prodrome: few days of mild URI with coryza, nasal congestion, sore throat, cough, low-grade fever
o then developing: hoarse voice and harsh, brassy, seal bark-like cough
o Respiratory stridor (often at night)
• What is found on PE for laryngotracheobronchitis?
o distress: from minimal to severe respiratory failure due to airway obstruction
o Mild cases: examination at rest usually is normal; may be mild expiratory wheezing
o More severe cases: inspiratory stridor at rest with nasal flaring, suprasternal and intercostals retractions.
o Lethargy or agitation from hypoxemia
o Tachypnea, tachycardia out of proportion to fever, lethargy, pallor
• What is the course of laryngotracheobronchitis? Labs? Dx? Px?
o Course: usually peaks over 3-5d, resolves in 4-7d.
o Lab: leukocytosis with left shift
o Dx: A-P X-ray of the C-spine, “steeple sign”
o Px: self-limited disease, but can very rarely result in death from complete airway obs
• What is ddx of laryngotracheobronchitis?
o other causes of SOB and stridor:
o epiglottitis: hot potato voice, high fever (emergency, don’t try to visualize!)
o foreign body: no hx URI or fever
o retropharyngeal abscess: swelling at back of throat, see on lateral xray
o diphtheria- grayish membrane over pharynx/larynx
• what is acute bronchitis? Causes?
o Self-limited inflammation the bronchus—usually from viral infection
o Influenza A and B, parainfluenza, coronaviris (types 1-3), rhinovirus, RSV
o Rare pathogens: H flu, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Pertussis
• What are ssx of acute bronchitis?
o Cough > 5 days with sputum production (often starting with URI sx)
o Sputum may be purulent from sloughing tracheobronchial and inflammatory cells
• What is found on PE for acute bronchitis?
o Generally afebrile or low grade fever
o Wheezing suggests bronchospasm
o Rhonchi indicates mucus in upper airways, clear with cough
o Normal percussion, no changes in transmitted voice tests
o Only if developing signs of pneumonia, >75 yo, abnormal vitals, presence of crackles
• What is found on Labs for acute bronchitis? Imaging? Ddx?
o Lab: CBC usually not warranted. No to mild leukocytosis
o Imaging: CXR usually not warranted.
o DDX: chronic bronchitis, pneumonia, post-nasal drip, GERD, asthma
• What is pneumonia? Pathophysiology of typical lobar pneumonia (stages)? Etiology?
o acute infection of alveolar spaces and/or interstitial tissue
o Stage 1: congestion phase
o Stage 2: red hepatization—consolidation
o Stage 3: gray hepatization—consolidation
o Stage 4: resolving stage
o Etio: Distinguish between bacterial, viral (50%) and mycoplasma
• What are the 2 classifications of pneumonia?
o Community-acquired
o Hospital-acquired (nocosomial)
• What is community-acquired pneumonia?
o 5-6 cases/1000 persons per year, worse in winter months
o Higher rates in males and in African Americans; in US, 8th most common cz of death
o Pre-disposing host conditions: level of consciousness, smoking, alcohol consumption, underlying lung disease, malnutrition, advancing age, peds, immunocompromised
o Most common organisms: Respiratory Syncytial Virus, parainfluenza virus, Influenza viruses A or B, adenovirus
o Bacterial: S pneumoniae, H flu, S aureus, Group A strep, M catarrhalis, Klebsiella pneumoniae (rare); Legionella spp., M pneumoniae, Chlamydophila pneumoniae, P. aeruginosa,
• What is hospital-acquired (nocosomial) pneumonia? Associated pneumonias? Organisms?
o onset in >48hrs of hospital admission
o Ventilator-associated: onset 48-72 hrs after endotracheal intubation
o Healthcare-associated: occurs after extensive healthcare contact (IV therapy, chemotherapy, dialysis, nursing home residence)
o Organisms: E coli, Klebsiella, enterobacter spp, P aeruginosa, MRSA, H flu
• What are the 5 categories of pneumonia?
o Bacterial; viral; mycoplasma; fungal; non-infectious
• What are the common organisms for bacterial pneumonia?
o Strep pneumoniae; klebsiella pneumoniae; haemophilus pneumonia; staph aureus; legionella pneumophila
• What are characteristics of pneumonia caused by strep pneumoniae?
o Aka: Pneumococcus pneumonia; 60-80%
o Px: overall mortality 5%
o Aged 2 years to 50 years: 90-95% survive
o if < 1 yr., > 60 yr., positive blood culture, 2 or more lobes involved, use aggressive tx
o Complications: meningitis, endocarditis
o REFER if: BUN >70, WBC <5000, other underlying dz. (heart, COPD)
• What are characteristics of pneumonia caused by klebsiella pneumoniae?
o gram negative bacilli causes aggressive necrotizing lobar pneumonia
o risk factors: alcoholism, malnutrition, DM, recent tx with antibiotic, COPD, >40yo, hospitalized individuals
o Px: 40-60% if untreated
o Sx: Cough, fever, pleuritic chest pain, dyspnea; spreads quickly
o Extremely viscid exudates that can’t be expectorated—“currant jelly” sputum
o Relative bradycardia: pulse rate does not increase as much with fever (usually with
o every degree in temp rise is inc 10 in heart rate)
• What are characteristics of pneumonia caused by haemophilus influenzae?
o most commonly arises in the winter and early spring
o risk factors: asthma, COPD, smoking, immunocompromised
• What are characteristics of pneumonia caused by staph aureus?
o in IV drug abusers and other individuals with debilitations
o infx often spread hematogenously to the lungs from contaminated injection sites.
• What are characteristics of pneumonia caused by legionella pneumophila?
o gram negative bacterium: “Legionnaire’s disease”
o outbreaks from aerosolized organisms from air conditioning system or contaminated shower heads, more often in hotels and hospitals
o sx in elderly, smokers, immune compromised, alcoholics, pt. with pre-existing cardio-pulmonary, neoplastic, or renal dz (esp pts with renal transplant)
o unlike other pneumonias, Legionella pneumonia has associated GI symptoms >50% of the time: anorexia, nausea, vomiting, and diarrhea.
• What are General Signs & Sxs of bacterial pneumonias?
o cough with thick greenish or rust-colored mucus; SOB; rapid breathing; sharp pleuritic pain–worse with deep breaths (S pneumoniae esp); abdominal pain, and severe fatigue. May be profuse sweating and mental confusion.
o Pneumococcus: rigors or severe shaking chills, pleuritic chest pain
o Legionella : headache, malaise, anorexia, nausea, vomiting, and diarrhea
• What are the sputum characteristics of different bacterial pneumonias?
o Pneumococcus - bloody or rust-colored
o Pseudomonas, Haemophilus, and pneumococcal spp may produce green
o Anaerobic infections may produce foul-smelling
o Klebsiella: resembles currant jelly
• What is found on PE for bacterial pneumonias?
o Patient looks sick; high fever; tachypnea; tachycardia or bradycardia; cyanosis; pallor
o bronchial breath sounds; wheezes, rhonchi, and/or crackles; positive egophony; increased tactile fremitus; dullness to percussion; pleural friction rub (possible)
o altered mental status in severe cases
• what work-up is done for bacterial pneumonias?
o CXR (dense shadow with well-demarcated borders), CBC, CMP o CT, bronchoscopy, or thoracentesis may be needed in advanced, unresolving cases
• What is Px for bacterial pneumonias?
o Normal resolution of symptoms vary, but most pts find subjective improvement of symptoms in 3-5 day of treatment (of uncomplicated pneumonia)
o Typical duration of ssx: fever 2-4 d; cough 4-9 d; crackles 3-6 d; leukocytosis 3-4 d
• What should be considered with bacterial pneumonias with unresolving sxs?
o Comorbidities: alcoholism, COPD, CHF, CKD, Malignancy, DM, HIV
o Advancing age >65
o Aggressive organism: Klebsiella, Legionella, S Aureus
o Drug-resistant organism: eg S pneumoniae
o Non-bacterial agents: TB, fungi
o Underlying neoplastic dz
o Mis-dx of: connective tissue dz, sarcoidosis, pulmonary embolism, pulmonary edema, drug-induced lung dz
o Complications include: lung abscess, pleural effusion, empyema
• What is etiology of viral pneumonias? Ssx?
o influenza virus, RSV, parainfluenza virus, adenovirus, paramyxovirus, CMV, varicella-zoster virus, HSV, EBV, Hantavirus, and coronavirus (SARS-CoV)
o ssx: malaise, headache, myalgia, cervical LA, chest pain, sore throat, and cough with scant sputum
• what is found on PE for viral pneumonias?
o Some patients have few, if any, physical findings other than mild fever, while other patients may have respiratory and/or multi-organ failure. Other findings include the following:
o tachypnea and/or dyspnea; tachycardia; wheezing, rhonchi, crackles; sternal or intercostal retractions; decreased breath sounds; pleurisy
• what is the work-up for viral pneumonia? Px?
o Work-up: CBC, CMP, CXR (fuzzy shadows/mottling with ill-defined demarcation)
o Px: good in most patients, but it is guarded in elderly or immunocompromised
• What are the characteristics of Severe Acute Respiratory Syndrome (SARS CoV)?
o (new mutation of corona virus)
o Global epidemic in 2003; approx 800 related deaths
o Airborne droplet transmission
o SSx: high fever (>100.4C), dry cough, nasal congestion, dyspnea, chest pain, localized chest pain, ms and joint pain, diarrhea, headache
o PCR or ELISA used to identify the virus
o CXR with patchy infiltrates
o ~25% of pts with SARS have residual pulmonary fibrosis.
o Other complications: organ failure, osteoporosis, depression
• What are characteristics of Hantavirus Pulmonary syndrome?
o 2012, 8 cases from exposure to mice droppings in Yosemite park, 3 deaths
o Sx initially looks like Flu, then worsens quickly leading to pulmonary edema
• What is mycoplasma pneumonia? Etio?
o “walking pneumonia”
o Etio: M pneumoniae, (the smallest known free-living organism).
o Note: the organism is difficult to culture, requiring 7-21 days to grow, or may NOT grow
• What are the ssx of mycoplasma pneumonia?
o often very benign, slow progression, looks like URI (sore throat, fever, headache, malaise) and resolves without any treatment.
o May be violent attacks of coughing with scant mucus, chills/fever; occ. N/ V
o dry cough can persist for as long as a month; some pts can have a protracted illness/weakness lasting as long as 6 weeks.
• What is found on PE for mycoplasma pneumonia?
o nontoxic general appearance
o erythematous tympanic membranes or bullous myringitis in patients > 2 yrs
o mild pharyngeal erythema but no exudate: minimal or no cervical LA
o Auscultation: no findings early, but rhonchi, crackles, and/or wheezes several days later
o Other possible findings: otitis media, rash
• How is mycoplasma pneumonia diagnosed? Px?
o PCR detects organism DNA
o EIA serology
o NO bacteria found on gram-stained sputum sample
o CXR may have no findings or some diffuse infiltrate
o Px: most resolve after several weeks as pt regains their strength
• What I age for bacteria, viral, mycoplasma pneumonia?
o Any
o Any but typically older kids and young adults
o Any
• Sputum for B, V, M pneumonia?
o Copious; rusty, purulent, blood-streaked; many PMNs on gram stain
o Scant; thin; microscopic exam: no bacteria
o Scant, thin, sparse organisms, PMNs and M0s, clumps of resp epithelial cells
• Relations of URIs of B, V, M pneumonia?
o Precedes
o Concurrent
o Precedes
• Fever in B, V, M pneumonia? Onset? Myalgia? Toxicity?
o F: High; low/absent; varies
o O: Rapid; gradual/mild; gradual
o M: Absent; present; varies
o T: present; absent; absent
• CXR for B, V, M pneumonia?
o Pulmonary infiltrate, consolidation, unilateral
o Varies, interstitial pneumonia
o WNL, may be diffuse lower lobe infiltrate, may be consolidation
• WBC for B, V, M, pneumonia?
o 15,000+ count
o Low, WNL or slight increase
o WNL or slight inc
• What are the 4+ types of fungal pneumonias?
o Pneumocystis jiroveci (formerly P carinii)
o Coccidioidomycosis (San Joaquin Valley fever or desert rheumatism)
o Allergic Bronchopulmonary Aspergillosis
o Histoplasmosis “spelunker’s lung”
o Other: blastocystis hominis, candida
