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116 Cards in this Set
- Front
- Back
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What are the 4 types of normal breath sounds?
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• Tracheal
• Broncial • Bronchovesicular • Vesicular |
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What are characteristics of tracheal breath sounds?
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• high-pitched and loud, with a hard and hollow quality
• inspiratory phase = expiratory phase • definite pause between phases |
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What are characteristics of bronchial breath sounds?
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• normally heard over the upper manubrium
• loud and high-ptiched (but not as harsh and hollow as tracheal breath sounds) • expiratory phase > inspiratory phase • usually a pause in between phases |
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What are characteristics of bronchovesicular breath sounds?
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• heard anteriorly in the 1st and 2nd intercostal spaces & posteriorly between the scapula
• inspiratory phase = expiratory phase • no pause between phases • soft and less harsh than bronchial sounds • higher pitched than vesicular sounds |
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What are characteristics of vesicular breath sounds?
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• audible over peripheral lung fields
• soft & low-pitched • inspiratory phase is about 3 times longer than expiratory phase • no pause between phases |
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What are the 2 categories of abnormal breath sounds?
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• continuous (wheezing & rhonchi)
• non-continuous (rales/crackles) |
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Describe wheezes
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a hissing, shrill, or whistling sound in the lungs during respiration
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What are some causes of wheezing?
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• narrowing of the airways, typically from asthma (most common)
• COPD • chronic heart failure • foreign body obstruction (aka asthmoid wheeze) • inflammation (ex. pneumonia & bronchitis) |
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Describe rhonchi
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snoring quality which suggest secretion large airways
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What can cause rhonchi?
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• mucus
• narrowing of bronchi from inflammation • spasms of smooth muscle |
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What is low-pitched rhonchi called? high-pitched w/ a whistling or squeaky quality called?
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• Low pitched » sonorous
• High pitched » sibilant |
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What are characteristics of rales/crackles?
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• short, sharp, or rough sounds
• sounds like brief bursts of popping bubbles • most commonly associated w/ the sudden opening of closed airways |
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What are causes of crackles?
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• abnormalities of the lungs (ex. pneumonia, fibrosis, early CHF)
• abnormalities of the airways (ex. bronchitis, bronchiectasis) • most often heard in pleurisy w/ fibrinous exudate |
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What is pleurisy?
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• aka pleuritis
• a general term decribing inflammation of the pleural lining |
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What are some causes of pleurisy?
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• connective tissue disorders (ex. SLE)
• infectious disease (ex. pneumonia) • neoplasms |
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Where can pain resulting from pleurisy be referred to?
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shoulder, neck, or abdomen
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What are pleural rubs?
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• an indication of pleural inflammation
• sounds like two pieces of sandpaper rubbing together throughout each inspiration and expiration |
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What is the difference between an effusion and an infiltrate?
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• effusion » the accumulation of fluid within a cavity (ex. pleural space)
• infiltrate » involves the lung parenchyma & involves the air spaces |
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What is empyema?
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• an infection that causes pus to accumulate in the pleural space
• can cause a tear in the pleural membrane, allowing infection to spread |
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What is the definition of pneumonia?
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• a condition caused by bacterial or viral infection
• characterized by inflammation of the lungfs and fluid within the air passages • often an underlying cause of pleurisy |
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What is the definition of bronchospasm?
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• a spasmodic muscular contraction of the bronchi
• usually occurs in the context of asthma |
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What are causes of bronchospasm, besides asthma?
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• acute allergic reactions
• occupation dust exposure • water inhalation |
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What does pneumocystis carinii pneumonia look like on chest xray?
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bilateral diffuse upper lobe interstitial densities along with patchy infiltrates
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What is the definition of acute bronchitis and what is the most common cause?
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• inflammation of the trachea and bronchi (tracheobronchial tree)
• MCC is viral URI |
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What is the most common bacterial etiology of acute bronchitis in nonsmokers?
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• Mycoplasma pneumoniae
* Bullous myringitis suggest Mycoplasma pneumoniae infection (although not specific) |
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What organisms cause acute bacterial exacerbation of chronic bronchitis in smokers?
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• S. pneumoniae
• H. Flu |
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What are signs and symptoms of acute bronchitis?
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• persistent cough after a URI (initially nonproductive) but becomes productive of small amounts of sputum
• purulent sputm suggests a bacterial etiology • fever & sore throat |
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What does acute bronchitis on chest xray look like?
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• chest xray should be normal
* may be necessary to r/o pneumonia |
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What is the treatment for acute bronchitis?
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• Viral » rest, fluids, & analgesics
• Bacterial » Macrolides are the DOC (Azithromycin, Clarithromycin, Erythromycin) |
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What is acute bronchiolitis?
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• a pediatric acute infectious disease of the lower respiratory tract that begins as a URI
• usually due to a viral infection • causes air trapping & V/Q mismatch |
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What is the MCC of acute bronchiolitis?
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• respiratory syncytial virus (RSV)
• causes 90% of cases |
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What are characteristics of bronchiectasis?
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• repeated infections causing damage to parts of the lung
• causes swelling & scarring of the lungs • have huge amounts of phlegm in their lungs and coughing cannot get all the phlegm out • phlegm sits in lungs creating an environment for infections |
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Bronchiectasis commonly occurs in what patients?
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• cystic fibrosis
• foreign body aspiration • immunodeficiencies • lung infection (ex. pneumonia) |
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What are signs and symptoms of bronchiectasis?
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• cough productive of large quanities of sputum, dypnea, hemoptysis (classic symptoms)
• recurrent URI and pneumonia are common • moist rales, rhonci, or wheezing • clubbing may be present |
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What does a chest xray show for a patient with bronchiectasis?
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• honeycombing of the lung
• areas of atelectasis |
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What test is the cornerstone for diagnosing bronchiectasis?
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high-resolution CT (HRCT) scanning
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What is the treatment for bronchiectasis?
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• antibiotics, bronchodilators, postural drainage, and chest percussion
• treatment of underlying conditions • oxygen • surgical resection (for patients w/ recurrent pneumonia who fail medical therapy) |
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What is the most common inherited disease in whites?
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cystic fibrosis
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What are characteristics of Cystic Fibrosis?
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• autosomal recessive disorder
• failure of epithelial cells to conduct chloride & the associated water transport abnormalities result in viscous secretion (exocrine gland dysfunction) • has chronic respiratory infections • has pancreatic enzyme insufficiency |
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What organ systems does Cystic Fibrosis affect?
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• GI tract
• lungs • pancreas • sweat |
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What test is used to diagnose Cystic Fibrosis?
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sweat chloride test
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What are symptoms of "the flu"?
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• arthralgias
• fever (can be as high as 103ºF) • generalized malaise • headache • myalgias • nonproductive cough • runny nose • sore throat * symptoms last for several days but may persist for weeks |
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What is the most common pneumonia seen in children?
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• Viral pneumonia
• associated with influenza virus, parainfluenza virus, RSV, & adenovirus |
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What is the treatment for viral pneumonia?
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• supportive care is sufficient
• Amantadine (for early treatment of influenza A pneumonia) • Tamiflu or Relenza (Tx of influenza A & B) |
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What are the 2 general types of pneumonia?
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• lobar pneumonia (occurs in one lobe of the lung)
• bronchopneumonia (tends to be patchy) |
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What is the MCC of community-aquired pneumonia?
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Streptococcus pneumoniae (pneumococcus)
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What are the most common typical organisms that cause CAP?
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• Strep pneumoniae (#1)
• Haemophilus • Staphylococcus |
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What are the most common atypical organisms that cause CAP?
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• Mycoplasma
• Legionella • Chlamydia |
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What is the definition of a nosocomial pneumonia?
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pneumonia that is contracted after 72 hrs in the hospital
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A patient is intubated and devlops a nosocomial pneumonia. What is the most likely etiology?
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Pseudomonas
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What is most common route that microbes enter the lung to produce infection?
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aspiration of oropharyngeal secretions
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Patient presents with sudden onset fever, chills, rigors, and cough (producing red-brown sputum). Also pleuritic pain and respiratory distress. What is the most likely cause?
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Streptococcus pneumoniae (Pneumococcal Pneumonia)
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What does pneumococcal pneumonia look like on chest xray?
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• lobar consolidations w/ air bronchograms after 2nd to 3rd fay
• patchy infiltrates • sometimes small pleural effusion |
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What does pneumococcal pneumonia look like on gram stain?
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gram positive diplococci
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What is the treatment of pneumococcal pneumonia?
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• PCN are DOC for sensitive organisms
• Cephalosporins (ex. Rocephin) & Fluoroquinolones (ex. Levaquin) are also effective • Macrolides (25% have resistance) • Vancomycin |
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What patients are recommended to have the pneumococcal vaccine (Pneumovax)?
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• > 65 y/o
• pt's w/ chronic disease |
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Patient presents with fever, chills, productive cough, pleurtic pain, and pink "salmon-colored" sputum. What is the most likely etiology?
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Staphlycoccus aureaus (Staphylococcal Pneumonia)
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Staphylococcal pneumonia is generally seen in what patients?
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• hospitalized patients
• IV drug abusers • patients w/ prosthetic devices • sequlae to influenza A infection |
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What does Staphylococcal pneumonia look like on chest xray?
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• patchy bronchial infiltration (infiltrates all over; not just 1 lobe)
• parenchymal necrosis • abscess formation (25%) • pneumatoceles (benign, thin-walled, air-filled cysts) in infants |
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What does Staphylococcal pneumonia look like on gram stain?
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gram-positive cocci in "grape-like" clusters
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Patient presents with pneumonia and skin lesions. What is the most likely etiology?
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Staphylococcus aureus
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What is the treatment for Staphylococcal pneumonia?
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• penicillinase-resistant agents (Nafcillin) OR
• Vancomycin (should be used until MRSA strains are r/o by sensitivity cultures) |
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Patient has a recent history of rheumatic fever (or glomerulonephritis) and presents with a rapid progression of fever, chills, and cough. Patient also has massive empyema on chest xray. What is the most likely etiology?
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Streptococcus pyogenes
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What does Streptococcus pyogenes look like on gram stain?
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gram-positive cocci in pairs or chains
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What is the DOC of Streptococcus pyogenes?
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PCN G
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Gram-negative pneumonias are frequently found in what patients?
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• chronic alcoholics
• COPD • Cystic Fibrosis • DM • kidney disease • malignancies • neutropenia |
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Patient presents with pneumonia and has a history of COPD. What is the most likely etiology?
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• Moraxella catarrhalis
• H. Flu |
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Patient presents with pneumonia and a history of alcoholism. What is the most likely etiology?
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Klebsiella pneumoniae
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Patients with a recent history of bacteremias resulting from intestinal or urinary tract infections that develop pneumonia are most likely caused by what organism?
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E. coli
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Intubated patients OR with a history of cystic fibrosis most likely devlop pneumonia from what bacteria?
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Pseudomonas
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What are signs & symptoms of a patient with pneumonia caused by H. Flu?
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similar to pneumococcal pneumonia
• chills • cough • fever • pleurtic pain BUT • *onset is generally slower * |
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What does H. Flu look like on gram stain?
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• gram-negative coccobacilli
* H. Flu is commonly seen in the upper respiratory tract of healthy people; not diagnostic unless seen in large numbers |
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What is the DOC for H. Flu Pneumonia?
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• Ampicllin is DOC
• Cephalosporins or Bactrim (for resistant strains) |
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Patient presents with typical pneumonia symptoms (fever, chills, cough, distress) and cough produces a reddish "current jelly" sputum. What is the most likely etiology?
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Klebsiella pneumonia
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Besides alcoholics, what patients are at an increased risk for Klebsiella pneumonia and other gram-negative pneumonias?
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• elderly
• immunocompromised • infants |
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What does the gram stain show for patients with Klebsiella pneumonia (or other gram-negative pneumonias)?
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multiple encapsulated gram-negative bacilli
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What is seen on chest xray for a patient w/ Klebsiella pneumonia?
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• involvement of multiple lobes (esp. RUL)
• possible abscess formation |
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What is the treatment of Klebsiella pneumonia?
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• Cephalosporin + aminoglycoside OR
• penicillinase-resistant PCN |
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Where is Legionella most commonly found?
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organisms distributes widely in water
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Name and describe the 2 clinical presentations of Legionellosis
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• Legionnaire's Disease: presents as severe pneumonia accompanied by multisystemic disease (GI, CNS, Lung)
• Pontiac fever: acute, febrile, self-limited, viral-like illness |
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Patient presents with rapidly progressive pneumonia, dry cough, and multi-organ involvement. What is the most likely etiology?
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Legionella
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What does gram stain show on a patient with Legionella pneumonia?
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shows neutrophills and no organisms (its an atypical pneumonia)
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What tests can be performed to definitively diagnosis Legionella pneumonia?
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• indirect fluorescent antibody (positive ~ 75%)
• direct fluorescent antibody testing of respiratory secretions (most rapid method; 95% specific) |
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What is the treatment for Legionella pneumonia?
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Erythromycin (Macrolides)
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What is the most common cause of pneumonia in teens & young adults living in close contact (ex. dorms, military)?
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Mycoplasma pneumoniae
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Patient presents with gradual onset fever, headache, myalgia, and nonproductive cough. Patient also has cervical lymphadenopathy and fine rales on physical exam. What is the most likely etiology?
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Mycoplasma pneumoniae
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What does a chest xray of a patient with Mycoplasma pneumonia look like?
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• patchy infiltrates (esp. in lower lobes)
• appears much more severe than symptoms suggests |
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What blood test can be positive on a patient with Mycoplasma pneumonia?
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cold agglutinin test
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What is the treatment for Mycoplasma pneumonia?
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• Macrolides (Azithromycin or Erythromycin)
• many cases resolve spontaneously |
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What are the 3 species of Chlamydia that are pathogenic to humans?
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• Chlamydia pneumoniae
• Chlamydia psittaci (bird exposire) • Chlamydia trachomatis |
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What does a chest xray for a patient with Chlamydia pneumonia show?
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mild infiltrates
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What is the DOC for Chlamydia pneumonia?
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• Doxycycline (DOC)
• Erythromycin (as an alternative) |
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What is the MCC of interstitial pneumonia in immunocompromised patients?
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PCP (Pneumocystis Jiroveci Pneumonia)
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What is the classic triad of signs & symptoms of patients with PCP?
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• fever
• exertional dyspnea • nonproductive cough * noted in just over 50% of cases |
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Patients presents with pneumonia and a history of immunosuppresion. You are clinically suspicious for PCP. What blood test can be done to help confirm your diagnosis?
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LDH level of > 460 U/L
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What does PCP look like on chest xray?
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• bilateral diffuse symmetric finely granular infiltrates
• "ground-glass" appearance |
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What are the diagnostic methods of choice for PCP?
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sputum induction and bronchoalveolar lavage
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What are the treatments for PCP?
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• TMP/SMX (Bactrim) is DOC
• Dapsone (#2) • Pentamidine (#3) • Atavaquone (Mepron): for patients who cannot take the above |
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Patients has pneumonia and a history of exposure to cattle, goats, or sheep. What is the most likely cause?
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• Q Fever
• Brucellosis |
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Patient has pneumonia and exposure to rabbits. What is the most likely cause?
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Tuleremia
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Patient has pneumonia and exposure to birds. What is the most likely cause?
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• Psittacosis
• Histoplasmosis |
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Patient has pneumonia and exposure to rodents. What is the most likely cause?
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Hantavirus
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What can cause a pneumonia for a person who recently traveled to the southwestern US?
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Coccidiomycosis
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A pneumonia that develops from the Mississippi & Ohio River Valley OR cave diving/sperlunking?
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• Histoplasmosis
• blastomycosis |
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Patient has a pneumonia that develops from travel to a devloping country. What is a possible cause?
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tuberculosis
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What is a likely cause of pneumonia from a dog tick?
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Ehrlichiosis
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What organism is related to exposure to infected cats, cattle, sheep, or goats?
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Coxiella burnetii
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What organism may cause infection from travel to Thailand or other countries in Southeast Asia?
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Burkholderia pseudomallei
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Patient with pharyngitis or rhinitis and a history of persistent hacking, non-productive cough commonly suggests what?
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• respiratory virus (URI, influenza) OR
• Mycoplasma pneumonia |
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Patients with pneumonia and fever w/o rise in pulse suggests what?
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• Legionellosis
• Mycoplasma |
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Patients with pneumonia and foul breath suggest what?
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anaerobic infection
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Patients with pneumonia and mental confusion should raise suspicion for what?
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pneumococcal pneumonia & possibly meningitis
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What bacteria pneumonias can cause green sputum?
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• Pseudomonas
• Haemophilus • Pneumococcus |
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Clinically, what are the DOC for community-acquired pneumonia?
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• Ceftriaxone (Rocephin) 2 gm IV + Azithromycin (Zithromax) 500 mg PO OR
• Levaquin 750 mg PO (or IV) |
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What are the 3 phases of Pertussis (Whooping Cough)?
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• Catarrhal phase (URI symptoms)
• Paroxysmal phase (paroxysmal whooping cough) • Convalescent phase (chronic cough) |
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What is the treatment for Pertussis (Whooping Cough)?
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Erythromycin
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