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What are the Atypical pneumonias and why are they called atypical?
M. Pneumoniae, C. pneumoniae, or Legionella. They are atypical because they are not able to be gram stained negative or positive.
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What is the common respiratory infection in a smoker?
H. Influenzae
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What are the common organisms in CAP?
S. pneumoniae and respiratory viruses
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What does physical assessment of CAP reveal?
Dullness to percussion, increased tactile fremitus, bronchial or tubular breath sounds, late inspiratory crackles.
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What is the most common pathogen implicated in acute bronchitis?
Respiratory virus causes 90 percent
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What is the second most common bacteria implicated in acute bronchitis?
Bacterial pathogens are M. Pneumoniae, C. Pneumoniae, or B. Pertussis
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If acute bronchitis has bacterial suspicion, what antibiotic would you start?
Macrolide or tetracycline
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Protracted Cough relief for acute bronchitis?
Atrovent or short course of prednisone
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Most cough after acute bronchitis lasts for how long?
Up to 18 days
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What is the definition of Asthma?
Chronic airway inflammation with bronchospasm causing obstruction. Basically obstruction, hyperresponsiveness, and inflammation
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When does cough often happen in asthma?
At night around 1am, after exercise, airborne irritants, menses, emotions.
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What is needed to diagnose asthma?
Spirometry
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Reversible or non reversible airflow obstruction?
Asthma shows reversibility. But chronically undertreated, the airway obstruction can become fixed
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Mast cell stabilizers need to be administered how often and how long to see improvement?
Three times a day and need to treat for 3 weeks before see clinical effect
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What percentage of inhaled corticosteroid is absorbed systemically?
About 20 percent
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Moderate persistent asthmatic who is poorly controlled will have symptoms how often? And how often do they use their SABA?
Will have daily symptoms and using SABA daily
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Mild persistent asthmatic who is poorly controlled will have symptoms how often? And how often do they use their SABA?
Will have symptoms more than 2 times per days and using SABA almost daily
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If an asthmatic has exacerbations requiring oral corticosteroids two or more times a year, are they intermittent, mild, moderate or severe asthmatics?
Only intermittent asthmatics will have symptoms less than 2 times a year. Otherwise, it is mild, moderate or severe.
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What PFT changes in FEV1 and FEV FVC ratio will you see in an intermittent asthmatic?
Normal FEV1 greater than 0.80 predicted. Normal FEV FVC ratio
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What PFT changes in FEV1 and FEV FVC ratio will you see in a mild asthmatic?
Normal FEV1 greater than 0.80 predicted. Normal FEV FVC ratio
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What PFT changes in FEV1 and FEV FVC ratio will you see in a moderate asthmatic?
FEV1 less than 0.80 but greater than 0.60 predicted. FEV FVC ratio reduced by 5%
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What PFT changes in FEV1 and FEV FVC ratio will you see in a severe asthmatic?
FEV1 less than 0.60 predicted. FEV FVC ratio reduced greater than 5%
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What can the side effects be of chronic ICS?
Cataracts, glaucoma, immune suppression, osteoporosis
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What are the obstructive lung diseases?
Asthma, COPD (chronic bronchitis and emphysema), bronchiectasis
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What are the restrictive lung diseases?
Decreased lung compliance causes reduction in lung volumes. Pulmonary fibrosis, pleural disease, diaphragm problems
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What are the air trapping lung diseases and what are the physical findings?
Asthma and COPD both trap air. PE hyper-resonance, decreased tactile fremitus, wheeze, low diaphragms, increased AP chest diameter
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What are the drug-drug interactions with Theophylline?
Macrolides, Fluoroquinolones, cimetidine, tegretol, dilantin
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Is a medrol dose pack acceptable in asthmatic or lung disease person with need for steroid?
Not good. Doesnt provide enough steroid to be effective
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What is the definition of COPD?
Preventable and treatable disease with some significant extra-pulmonary effects including Right sided heart enlargement due to increased pulmonary artery pressures.
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What is the airflow limitation of COPD?
Not fully reversible limitation, thus, chronic obstructive. The airflow limitation is usually progressive and associated with abnormal inflammatory response of the lung to noxious particles or gasses
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What is the most sensitive indicator of early airflow limitation?
FEV1 to FVC ratio is considered the most sensitive indicator of early airflow limitation. Typically if ratio is less than 0.70. The degree of limitation is reflected in the spirometry
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What are the COPD classifications?
Mild, moderate, severe, very severe
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What FEV1 FVC ratio must all COPD patients have to provide spirometric evidence of airway obstruction?
FEV1 FVC ratio of 0.70
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What therapy should a moderate COPD be on and what is their FEV1 percent of predicted?
Moderate stage COPD (Stage II) should be on one or more LA bronchodilator, (consider LA anticholinergic plus LABA), plus rehab
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What therapy should a severe COPD be on and what is their FEV1 percent of predicted?
Severe stage COPD (Stage III) should be on one or more LA bronchodilator, (consider LA anticholinergic plus LABA) PLUS and ICS plus rehab
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Indications for Oxygen therapy and length of use and what COPD stage is it indicated in?
Indicated in bad stage III, and Stage IV. Need to be using at least 15 hours per day. Low flow Oxygen will ask as a venous vasodilator, which will decrease cardiac preload and help in right heart failure and cor pulmonale or PCV.
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What is the saturation requirement to receive long term oxygen therapy?
Sa02 less than 88%. Or 89% with cor pulmonale, RHF, PCV with hct greater than 56.
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What is the signs and symptoms and definition of COPD exacerbation?
Change in patient baseline dyspnea, cough and or sputum beyond their typical day to day variability sufficient enough to warrant a change in management
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Treatment of COPD exacerbation?
LABA and ICS if not already on. Consider Prednisone 40 qd for 10 days. Consider Budesonide (Pulmicort)
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COPD exacerbation and antibiotic use?
If dyspnea increases along with altered sputum characteristics, such as increased purulence or change in volume. Consider CXR if fever to rule out pneumonia.
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Signs of inhalation anthrax infection include?
Fever, malaise, widened mediastinum on CXR (due to bleeding into mediastinum) NO Productive Cough noted.
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What is the sign of an impending respiratory failure in Asthmatic?
RR over 25 and tachycardia or bradycardia, cyanosis and anxiety
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What is heard with Egophony?
EEE heard normal sound as louder in upper airways and softer in lower lobes
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Tactile fremitus is noted by?
Having patient say 99. Will feel stronger vibrations over area of consolidation
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Whispered pectoriloquy?
Whisper 123 should be loud in upper and soft in lower. If opposite, then it is abnormal.
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How long is TB therapy given?
Minimally 6 months, until culture is negative
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How long is TB therapy given in HIV?
Minimally 12 months until culture negative
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When is 5mm induration positive for TB?
HIV, prior positive CXR, or close contact with TB infected person.
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When is 10mm induration positive for TB?
Immunocompromised, health care worker, IVDA, lived in country of high TB prevalence
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When is systemic corticosteroids started in COPD exacerbation?
If FEV1 is less than 0.50 predicted. Prednisone 40 mg x 10 days
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What is it called when viable TB bacteria remains dormant in a granuloma?
Latent TB infection. No active disease, not contagious
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What percentage of Latent TB infected people will go on in their lifetime to have reactive of the disease and cause post primary TB?
Only 10 percent. But 50 percent of those that do get disease, it happens in first 2 years
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How soon after contact with TB bacteria will a TB test show a positive result?
Will see positive result in 2 to 10 weeks after exposure
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What are the clinical signs and symptoms of Active TB infection?
Malaise, wt loss, fever, night sweats, chronic cough, NOT ALWAYS do they have Blood Tinged Sputum or Hemoptysis.
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What are the symptoms of pneumonia?
90% have cough, 66% dyspnea, 66% sputum, 50% pleuritic chest pain
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What presentation does an elderly person have who has pneumonia?
Not many symptoms. May even only see increased resp. rate
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What type of pneumonia is seen in those with long term corticosteroid use?
CAP caused by pseudomonas Aeruginosa
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what pathogen will you always need to cover for CAP?
Streptococcus pneumoniae
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What is another name for pertussis?
Whooping Cough
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What causes pertussis?
Bordetella Pertussis, a gram negative rod
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What are the stages of Pertussis?
Catarrhal stage with cold like symptoms. Highly infective. Lasts 1 to 2 weeks. Paroxysmal stage. Now with just cough, thick sputum stagnation, characteristic whooping sound on inspiration, followed by cough paroxysms. Lasts 1 to 10 weeks. Convalescent stage with less severe symptoms.
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What if pregnant and positive for TB?
Treat. Use R I E only.
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What is important to note in smokers who are on theophylline?
Smoking increases clearance rate of theophylline. Heavy smokers will metabolize theophylline twice as fast as non smokers. Caffeine also will decrease theophylline clearance rate.
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What is pneumoconiosis?
Occupational associated restrictive lung disease from exposure to coal dust, graphite dust, carbon, stone cutting, mining
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What is silicosis?
Inhaled quartz from stone cutters, miners,
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What is Histoplasmosis?
Systemic functional respiratory disease due to soil fungus from bird droppings
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What are some examples of nonallergic asthma triggers?
Smoke, exercise, intense emotions, cold air, strong smells, air pollutants
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What is the Schamroth sign?
Positive clubbing of fingers when you put nail beds together and lose diamond shaped space. A prominent distal angle between ends of nails
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What is seen in the Biots breathing pattern and who it is seen in?
3 or 4 normal breaths followed by apneic period. Seen in head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis
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What is seen in Cheyne-stokes breathing pattern?
Commonly seen in severe CHF, renal failure, meningitis, drug OD and increased ICP
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What is seen in Kussmauls breathing pattern?
Hyperventilation with increased respiratory rate and respiratory depth
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What is seen in a sibilant wheeze vs. sonorous wheeze?
Sibilant wheeze is often in acute asthma with narrowed airways. Has a musical quality and is high pitched. Sonorous wheeze is a lower pitched moaning, snoring wheeze. Often clears with cough and is caused by secretions in large airways.
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What are the causes of a secondary spontaneous pneumothorax?
Emphysema, HIV PCP, Lung Abscess, CF, TB
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What is a Hammans sign?
Heart in spontaneous mediastinal emphysema or pneumomediastinum. A Crunch is heart when auscultated over the mediastinum with coincides with systole and diastole
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What are the symptoms of a Legionella infection?
Dry cough, dyspnea, fever chills, malaise, HA, confusion, anorexia, diarrhea, myalgias and arthralgias. Gradual onset
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Pregnant asthmatics, what can she expect?
0.30 get better, 0.30 unchanged, 0.30 get worse
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