Pulmonology
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Definition
Inflammation of the airways (trachea, bronchi, bronchioles) characterized by cough
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Etiology
>90% viral (rhinovirus, coronavirus, RSV)
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CXR will be ____ in acute bronchitis
Negative
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Treatment for acute bacterial bronchitis
Second-generation cephalosporin (ie Ceftin)
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When are antibiotics indicated in acute bronchitis
Elderly, underlying cardiopulmonary disease, cough >7-10 days, immunocompromised state
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Definition
A severe, life-threatening infection of the epiglottis*
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Most common ages
2-7 yo
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What has decreased the incidence in children
Wide-spread administration of H. flu vaccine
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Clinical findings
Patients sit upright with necks extended, higher fever, reap. distress, drooling
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Lateral neck radiograph finding
Thumbprint sign
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Treatment
Secure airway + broadspectrum 2nd or 3rd generation cephalosporin (cefotaxime or ceftriaxone) x 7-10 days
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Definition
Viral laryngotracheo-bronchitis, affects kids 6mo-5yo
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Most common cause
Parainfluenza virus types 1 & 2
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Clinical findings
Harsh, barking, seal-like cough
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PA neck film radiograph
Steeple sign
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Treatment
Mild croup doesn't need treatment
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Organism
Mycoplasma tuberculosis-acquired by inhaling organisms within aerosol droplets expelled from coughing
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Inactive TB most commonly found in
Apices of lungs
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Most common symptom
Cough
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Histologic hallmark
Bx showing caveating granulomas
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Tx for LTBI
INH x 9 months
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Tx for active TB
INH/RIF/PZA/EMB x 2 months then INH/RIF x 4 months
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Indurations greater than ___ should be treated aggresively
5mm
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Definition
Inflammation of the bronchioles (<2mm diameter), primarily in kids/infants
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Most common organism
RSV
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Treatment
Hospitalization + ribavirin + supportive measures
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Definition
Inflammation in the alveoli of the lung caused by microorganisms
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Most common cause of CAP
Strep pneumo.
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Clinical Features
cough, sputum, SOB, pleuritic chest pain, sweats, rigors
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Treatment-uncomplicated/outpatient
Doxycycline, erythromycin, macrolides (azithromycin), fluoroquinolones
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Treatment-inpatient (want to cover Legionella)
Ceftriaxone/cefotaxime + azithromycin/or fluoroquinolone
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Most common cause of atypical CAP
Mycoplasma pneumo.
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Treatment-atypical CAP
erythromycin (Mycoplasma pneumo.) or tetracycline (Chlamydia)
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Who is at highest risk for HAP?
ICU patients on mechanical ventilation
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Organism in ICU with worst prognosis
Pseudomonas auroginosa
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Most common opportunistic infection in patients with HIV
Pneumocystis jiroveci
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Treatment-HIV-related pneumonia
Bactrim (trimethroprim/sulfa.)
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When is prophylaxis recommended for HIV-pneumonia
CD4<200
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Clinical Scenario: >35yo with PNA. Rusty colored or yellow-green sputum. Acute onset F/C
Strep. pneumonia
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Clinical Scenario: <35 yo, college students. Fever, cough, +/- sputum, chills, muscle aches, Bullous myringitis
Mycoplasma pneumonia
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Clinical Scenario: PNA w/ Smokers, COPD
H. influenza
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Clinical Scenario: PNA w/ DM, immunocompromised, EtOH. Currant color sputum.
Klebsiella
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Clinical Scenario: PNA w/ Water, late summer, construction site. Diarrhea. Toxic looking
Legionella
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Clinical Scenario: PNA from Nursing homes, chronic care facility. Purulent sputum
Staphylococcus aureus
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Clinical Scenario: PNA & HIV+, AIDS, Immunocompromised. Sx out of proportion to exam. Diffuse interstitial & alveolar infiltrates
Pneumocystis jerovecii; TMP-SMX = Drug of choice
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Clinical Scenario: PNA & decreased mental status, poor dental hygiene, dentures, foul smelling sputum, bronchiectasis. Patchy infiltrates in dependant lung zones
Aspiration pneumonia
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