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Flashcards in Pulmonology Deck (75)
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1
Q

What is the most common cause of acute bronchiolitis?

A

RSV

Nov-April

2
Q

RSV is the most common ______?

A

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

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

4
Q

Treatment for RSV?

A

hospitalization and administration of ribavirin

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

5
Q

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

A

Acute epiglottis

6
Q

What is the X-ray finding for acute epiglottis?

A

thumb print sign

lateral neck radiograph

7
Q

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

A

H. influenzae type B vaccine

not immunized kids

8
Q

Treatment for acute epiglottis?

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

What is another name for croup?

A

laryngotracheobronchitis

10
Q

Most common cause of croup?

A

parainfluenza virus type 1 and 2

11
Q

harsh, barking, seal-like cough, stridor

A

croup

12
Q

X-ray finding for croup?

A

steeple sign

posterior anterior show subglottic narrowing

13
Q

Treatment for croup?

A

mild = no treatment. keep hydrated

-corticosteroids, humidified air, neb epinephrine

severe = hospitalize

14
Q

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

A

pertussis (whooping cough)

15
Q

cause of whooping cough (pertussis)?

A

Bordetella pertussis (gram -)

contagious

-isolation recommended

16
Q

gold standard for diagnosing pertussis (whooping cough)?

A

nasopharyngeal secretions

17
Q

Prevention of whooping cough (pertussis)?

A

routine vaccination

5 doses of DTaP

18
Q

Treatment for pertussis (whooping cough)?

A

Clarithromycin (macrolide)

or azithromycin

19
Q

ADR of clarithromycin?

A

hypertrophic pyloric stenosis

20
Q

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

A

hyaline membrane disease

21
Q

What causes hyaline membrane disease?

A

deficiency of surfactant

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

23
Q

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

A

preterm infant (<30 weeks gestation)

24
Q

Treatment for IRDS or hyaline membrane disease?

A

ventilation support

exogenous surfactant

mom = antenatal corticosteroid (betamethasone IM x2)

25
Q

Define bronchiectasis?

A

abnormal, permanent dilation of the bronchi and destruction of bronchial walls (irreversible destruction of muscle and elastic tissue of bronchial tree = scarring)

26
Q

What are the 3 forms of bronchiectasis?

A
  • congenital (cystic fibrosis)
  • acquired from infection (TB, fungal, abscess)
  • obstruction (tumor)
27
Q

What is the most common cause of bronchiectasis?

A

cystic fibrosis (mutation of CFTR gene or CR7)

28
Q

Patient presents with chronic purulent sputum (foul smelling), hemoptysis, chronic cough, recurrent pneumonia….what test do you order?

A
  • CT (dilated, tortuous airway)
  • xray = crowded bronchial marking, basal cystic spaces, honeycombing

bronchiectasis

29
Q

What is the gold standard test for bronchiectasis?

A

CT of chest

30
Q

Treatment for bronchiectasis?

A

productive cough = ABX, bronchodilators, chest physiotherapy

ABX = 10-14 days (amoxicillin, augmentin, bacterium, cipro)

lung transplant

31
Q

abrupt onset of fever, headache, myalgia, malaise

winter season

A

influenza

32
Q

Treatment of influenza?

A

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
Q

What should you avoid in children <18 years… Reyes syndrome?

A

post viral illness with ASA in kids

34
Q

Describe Reye’s syndrome?

A

Kids and ASA

altered mental status, rash, vomiting, liver damage

35
Q

Describe a lung examination for consolidation?

A

dullness to percussion

  • egophony (e sounds like A)
  • bronchophoney (spoken syllables are clear and loud)
  • whispered pectoriloquy (whispered sound clearly heard)
36
Q

Types of pneumonia (4)?

A
  • Viral
  • bacterial
  • fungal
  • PCP/PJP (HIV related)
37
Q

Types of bacterial pneumonia (4)?

A
  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
Q

What are types of viral pneumonia (4)?

A
  1. influenza
  2. RSV (kid <2 - bronchiolitis)
  3. adenovirus (lasts 7 days, GI symptoms, military recruits)
  4. parainfluenza
39
Q

How do you get Hanta virus?

A

rodent feces contact

-causes ARDS (not pneumonia)

40
Q

What is viral pneumonia priced with?

A

a cold

41
Q

Most common cause of community acquired pneumonia?

A

S. pneumoniae

42
Q

What pneumoniae has rust-colored sputum?

A

s. pneumoniae (most common)

43
Q

Prevention of s. pneuma pneumonia?

A

pneumococcal vaccination

44
Q

Treatment of CAP?

A
  • 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
Q

What pneumonia has salmon colored sputum?

A

s. aureus

xray: infilrates

46
Q

What are examples of what a chest X-ray may look like with pneumonia?

A
  • lobar or segmental infiltrates
  • air bronchograms
  • pleural effusions
47
Q

What bacteria is common with hospital-acuqired pneumonia?

present 48 hrs after hospital admission

A

pseudomonas aeruginosa (nosocomial)

post ventilator - ICU

48
Q

Treatment for hospital acquired pneumonia?

A

empiric ABX (ceftriaxone; fluoroquinolone, imipenem, cefepime)

need 2 antibiotics

  • piperacillin/tazobactam + levo or cipro
  • piperacillin/tazobactam + tobramycin
  • levo or cipro + tobra
49
Q

presentation of atypical pneumonia?

A

(mycoplasma/chlamydia/legionella)

-low-grade fever, mild pulm symptoms. nonproductive cough, myalgia, fatigue

50
Q

What pneumonia is spread by contaminated water? (from A/C)

A

legionella

-high fever, dry cough, dyspnea, systemic symptoms (GI - diarrhea)

51
Q

Treatment for legionella pneumonia?

A

macrolide (azithromycin, erythromycin)

fluoroquinolone (cipro or levo)

52
Q

most common cause of atypical pneumonia?

A

mycoplasma (walking pneumonia)

53
Q

What age group is likely to have mycoplasma pneumonia?

A

young adults, college setting, military recruits

54
Q

Treatment for mycoplasma pneumonia?

A
  • macrolide (azithromycin)

- doxycycline

55
Q

pneumonia with currant jelly sputum, alcoholic and nursing home patient, right upper lobe abscess (aspiration)

A

klebsiella pneumonia

56
Q

Treatment for klebsiella?

A
  • cephalosporin
  • aminoglycoside (gentamicin)
  • fluoroquinolone (levo/cipro)
57
Q

When would you consider a fungal pneumonia?

A

if patient is immunocompromised

AIDS, steroid use, organ transplant drugs, malignancy, sarcoidosis, SLE, DM, cirrhosis, IV drug user

58
Q

Treatment for fungal pneumonia?

A

itraconazole or fluconazole

59
Q

What is associated with fungal pneumonia and meningitis?

A

cryptococcus (soil)

+ immunocompromised

60
Q

Treatment for meningitis?

A

amphotericin B

61
Q

What is associated with fungal pneumonia and bird/bat dropping?

A

histoplasma (mississippi to ohio river)

62
Q

What is the most common opportunistic cause of HIV related pneumonia?

A

pneumocysitis carinii (PCP) or pneumocystis jiroveci (PJP)

HIV (low CD4 count)

most common cause of bacterial pneumonia + HIV + streptococcus

63
Q

symptoms for pneumocystis pneumonia (HIV)

A

fever, tachypnea, dyspnea, dry cough

get chest X-ray

lymphopenia and low CD4

sputum staining

64
Q

Treatment for HIV related pneumonia?

A

Bactrim ***

prophylaxis daily if high risk = CD4 count <200

65
Q

dry cough - progress to productive cough, hemoptysis, 3 weeks

fever, drenching night sweats, wt loss

appear very ill

recent travel

A

tuberculosis (TB)

66
Q

What is Ghon complex associated with?

A

tuberculosis

Ghon (calcified lymph + lesion)

67
Q

What is the skin test for TB?

A

PPD
Negative:
-<15 (nonexposed)

68
Q

What do you do if you get a +PPD?

A

order a chest X-ray

-if chest X-ray negative then treat with INH x 9 months (isoniazid)

69
Q

What does RIPE stand for?

A
tuberculosis
R - rifampin
I - isoniazid
P - pyrazinamid
E - ethambutol
70
Q

Isoniazid ADR?

A

tuberculosis

  • hepatitis
  • peripheral neuropathy
  • coadminister with Vit 6 (pyridoxine)
71
Q

Rifampin ADR?

A

tuberculosis

  • hepatitis
  • flu syndrome
  • orange body fluid
72
Q

Ethambutol ADR?

A

tuberculosis

  • optic neuritis
  • (red-green vision loss)
73
Q

Pyrazinamide ADR?

A

tuberculosos

  • hepatotoxicity
  • GI upset
  • gout
74
Q

if you have high suspicion for TB what do you do?

A
  • 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
Q

what do you do if you have low suspicion/screening for TB?

A

PPD (skin test)

+ = look at parameters <5,10,15

chest xray
-negative = INH 6 month