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
