Pulm Infxs Flashcards by Doug Graham

MC serious viral airway infxn of adults
Respiratory secretions
Freq in winter

Influenza (A & B)

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Signs/Sxs (Flu)

Acute/SUDDEN onset
HA, FEVER, chills, sore throat, myalgias, arthralgias
Progressive dyspnea -> resp. failure

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Dx / Tx / Prevention (Flu)

Rapid tests (nasopharyngeal) A & B
Supportive (rest, hydration, Tylenol)
Oseltamivir - within 3-4 days
Annual vaccine

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Self-limited inflamm of trachea, bronchi, bronchioles 2/2 infxn
Mucus formation
90% viral

Acute Bronchitis

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Etiology (Acute Bronchitis)

Rhinovirus, coronavirus
Mycoplasma pneum
Chlamydophila pneum
Bordetella pertussis

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Signs/Sxs (Acute Bronchitis)

Cough +/- sputum
Concurrent URI
Fever rare (unless flu or PNA)

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Dx / Tx (Acute Bronchitis)

CXR (for abnml VS / pulm findings) - NML!!!
NO ABX; no cough supp or expectorants
Reassurance, NSAIDS/APAP, decongest.

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Etiology of acute exacerbation of COPD

Infxn (70-80%): H. flu, S. pneum, flu, paraflu, coronavirus, rhinovirus
Non-infxn: smoking, meds, non-compliance, HF, allergens

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Signs/Sxs (AE COPD)

Chng sputum (volume, character)
Chng cough (freq, severity)
Inc dyspnea, RR

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Dx (AE COPD)

Sputum gram stain / cx
Viral studies (NP swab)
CXR (r/o PNA if fever, hypoxia)

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Tx (AE COPD)

O2
Bronchodilators (albut + ipratropium)
Systemic steroids
Abx (Uncomplicated: Doxy, Bactrim, Zpack; Complicated: Augmentin, Levoflox)

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1 ID cause of death

CAP

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Etiology (CAP)

Typicals: S.pneum (fever, rigors, multi-lobar consolidation), H.flu, M.cat
Atypicals: Legionella, Mycoplasma, Chlamydophila (interstitial; not consolidated)

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Signs/Sxs (CAP)
Typicals -
Atypicals -

High Fever, Rigors, Sweats, Productive Cough, Lobar consolidation
Fever, Fatigue, Non-productive Cough, Patchy infiltrates

+/-
Dyspnea, Myalgia, HA, Anorexia, Abd cramp, Tachypnea, Tachycardia, Adventitious BS

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PNA - MC
High fever
Single rigor
Productive cough - rust colored / purulent
Pleurisy
Lobar consolidation - white out on CXR
Gram + diplococci
Lancet shaped

S.pneum

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PNA
Unimmunized
Underlying obstructive lung dz (COPD)
Gram - coccobacillus

H.flu

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High fever
Hyponatremia
DIARRHEA
Appearance worse than CXR

Legionella

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Bullous myringitis
COLD AGGLUTININS
Young, healthy pop. (“walking PNA”)

Mycoplasma

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Laryngitis
Older pts
Interstitial

Chlamydophila

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Dx (CAP)

CXR +/- :
Sputum analysis
Blood cx
Antigen detection (urinary, NP swab)

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Gram - diplococci

only seen in M.cat and Gonorrhea mening.

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Tx (CAP)

OUT.PT: Doxy, Zpack (macrolide), Levoflox (FQ)
IN.PT: cover for S.PNEUM and LEGIONELLA
Ceftriaxone (gold stnd for S.pneum) 
\+ Zpack (gold stnd for Legionella); 
FQ for B-lactam allergy (? elderly)

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Mycobacterium
Slow growing, obligate, intracellular
Acid fast bacilli
Transmitted by resp droplets

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Etiology (TB Infxn)

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Exposure
Lymphatic uptake of infected macrophages
CAP-like presentation

Etiology (Latent TB Infxn)

Infected but not acutely ill Asx Cannot spread TB Have + skin test / blood test

Etiology (Active TB Dz)

= Reactivation Dz. Sxs - FEVER, NIGHT SWEATS, anorexia, WT LOSS, COUGH, pleuritic chest pain, SOB, hemoptysis Lymphadenitis of neck (scrofula) Skeletal/spinal TB (Pott's dz)

Dx 1 (TB)

Mantoux TST = PPD (evaluates latent & active TB); look at induration, not errythema >5mm immunocompromised or recent TB contact >10mm recent immigrant, IVDU, healthcare/ prison/ homeless setting, very young, co-morbid condtion >15mm no RF

Dx 2 (TB)

Interferon-gamma release assay (IGRA) (evaluates both latent & active TB) blood test can distinguish b/n prior BCG and TB infxn

Dx 3+ (TB)

Sputum for AFB & cx - for active TB only Tissue bx - CASEATING GRANULOMAS CXR - UPPER lobe infiltrates, CAVITATION

Tx (TB)

LTBI (latent TB infxn): Isoniazid (INH) x 9 mo Active TB: 4 drug regimen Isoniazid (INH), Rifampin (RIF), Pyrazinamide (PZA), Ethambutol (EMB) x 6-8 wks Followed by...2 drugs (INH & RIF) x 16 wks

M. avium + M. intracellulare Commonly seen in AIDS pts (CD4<50), COPD TB-like sxs

MAC (Mycobacterium avium complex)

Whooping cough | Very contagious

Bordetella pertussis

3 stages of Bordetella pertussis

1) Catarrhal: URI (1-2 wks) 2) Paroxysmal: "Whooping" cough, post-tussive vomiting 3) Convalescent: lasts months

Dx & Tx (Bord pertussis)

NP swab 1st line: macrolides (erythromycin, azithro) 2nd line: sulfa

PNA | ETOH

Moraxella catarrhalis

Causes of CAP in newborns

S. agalactiae (GBS) Listeria TB

Causes of CAP in children < 5

Similar to adults but less atypicals

Causes of CAP in children > 5 - teens

More likely to have Mycoplasma or Chlamydophila

Causes of CAP in adults

``` MC - Atypicals (Mycoplasma, Chlamydophila; Legionella - less common) S. pneum - common (? %) Viruses - 20% (Flu, paraflu, RSV) H. flu E. coli, Klebsiella - more common in NH ```

Post influenza PNA "Bronchitis" Difficult to differ from bact

Viral PNA | Influenza A/B, RSV, Coronavirus (SARS)

PNA that is very dependent on geographic location and immune status

Fungal PNA

Mississippi and Ohio River Valleys Fever, Cough, CP, HA Pulm infiltrates +/- hilar lymph nodes

Histoplasma capsulatum

Midwest US Fever, Cough, Night sweats, Wt loss Lobar PNA

Blastomyces dermatitides

Desert areas Southwest (AZ) Flu-like sxs, Fatigue, Sore throat, Cough Residual pulm nodule

Coccidioides immitis

Opportunistic, unicellular fungi | AIDS defining dz; CD4

Pneumocystis jiroveci / carinii PNA (PCP)

Tx (PCP)

O2, intubate/ventilate IV abx Prophylaxis: TMP/SMX if CD4 < 200

Extrapulmonary TB

1) Miliary - disseminated (lungs, GI, CNS); CXR (buckshot pattern) 2) Vertebral (Pott's Dz.)

INH... 2 major side effects... | Tx one with...

``` peripheral neuropathy & liver problems Vit B6 (pyridoxine) ```

Peds URI c wheezing RSV, Flu, Paraflu

Acute bronchiolitis

W/U & Tx (Acute bronchiolitis)

CXR, CBC, RSV nasal swab | Supportive, ? hospitalize, Ribavirin

Peds Acute inflamm upper airway MC etiology: H. flu Rapid onset fever, stridor, drooling, tripod, toxic-appearing

Acute epiglottitis

W/U & Tx (Epiglottitis)

DO NOT EXAMINE AIRWAY Secure airway Soft tissue neck x-ray (THUMB SIGN) IVF, Abx, steroids, neb epi

Peds Viral subglottic inflamm (Paraflu) Stridor, "BARKING" cough, worse at NIGHT

Laryngotracheobronchitis (CROUP)

Dx & Tx (Croup)

Soft tissue neck x-ray (STEEPLE SIGN) | neb epi, steroid, IVF

Common winter virus in peds < 2 (PNA or bronchiolitis) | Rhinorrhea, fever, intercostal retractions, tachypnea

Resp Syncytial Virus (RSV) Supportive care

Pulm Infxs Flashcards

(55 cards)