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Asthma/COPD > Asthma/COPD > Flashcards

Asthma/COPD Flashcards

1
Q

Acute Bronchitis

A

SELF-LIMITED INFLAMMATION of the lower respiratory tract which causes swelling (inflammation) of the LARGE airways

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2
Q

Hallmark symptom of Acute Bronchitis?

A

Cough more than 1 week (1-3 weeks)

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3
Q

Do you do SIRS for acute bronchitis?

A

NO

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4
Q

What season does acute bronchitis usually occur in?

A

Fall/Winter

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5
Q

Epithelial infection of bronchi leads to ___________ of the bronchial and tracheal mucosa

A

inflammation

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6
Q

Fever is _______ in acute bronchitis

A

rare

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7
Q

Cough, in acute bronchitis, may be accompanied by ________ and _________

A

wheezing and dyspnea

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8
Q

Diagnosis of acute bronchitis is usually ________

A

clinical

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9
Q

Treatment for Acute Bronchitis

A

Often self limited BUT Macrolides are preferred (prescribed but not needed)

Azithromycin and Clarithromycin are effective an better tolerated

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10
Q

The most deadly infectious disease in the united states is _______

A

pneumonia

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11
Q

The biggest difference between CAP and HAP is that CAP is diagnosed ___________ hospital or within 48 HRS of admission

A

outside

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12
Q

Clinical findings of CAP

A

Fever
– Cough (+/- sputum)
– Dyspnea
– Chest discomfort
– Sweats/rigors
– Rhonchi/rales
– Others

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13
Q

When listening to a patient with CAP you will hear an ____________

A

altered transmission of breath sounds

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14
Q

ATYPICAL presentations of CAP include _______

A

Loss of appetite
– Confusion
– Dehydration
– Worsening signs/symptoms of other chronic illnesses
– Failure to thrive

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15
Q

You diagnose CAP by doing _______

A

Thorough physical exam (< 50% sensitive vs. radiography)
– PA/LAT CXR

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16
Q

If a patient is admitted into the hospital, then to help diagnose them with CAP you may do a ________

A

Pulse ox/ABG (if admitted)

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17
Q

The MOST COMMON found cause of CAP (pyogenic bacterial) is ________

A

Pneumococcal Pneumonia

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18
Q

The clinical findings of pneumococcal pneumonia include

A

PRODUCTIVE COUGH
– FEVER
– Rigors (early)
– Dyspnea
– Pleuritic chest pain (splinting if significant)
– Bronchial breath sounds (early)
– (hemoptysis)

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19
Q

The lab findings of a patient with pneumococcal pneumonia are _______

A

Gram stain suggestive
– Cultures (sputum/blood) – BEFORE antimicrobials
– Urine antigen test
– Procalcitonin

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20
Q

If a patient has CAP, and is previously healthy patients with no risk factors for MRSA or Pseudomonas, then you treat them with _________

A

Oral amoxicillin or doxycycline

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21
Q

If a patient with CAP has a low rate of infection and with high level macrolide-resistant
Streptococcus pneumoniae suspicion, then you treat them with _______

A

Oral macrolide (clarithromycin or azithromycin)

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22
Q

If a patient with CAP has a comorbid medical condition or has used a different antibiotic in the previous three months then you treat them with ________

A

Macrolide or doxycycline (as above) plus an oral beta-lactam
(amoxicillin/clavulanate, cefpodoxime, cefuroxime)

» Oral fluoroquinolone (moxifloxacin, gemifloxacin, levofloxacin)

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23
Q

If a patient with CAP is scheduled to be INPATIENT (NOT IN ICU), and then the treatment would be ______

A

1) Fluoroquinolone
» Oral therapy (see above)
» IV (moxifloxacin, levofloxacin) OR

–2) Macrolide plus beta-lactam
» Oral therapy (see above)
» IV (ampicillin/sulbactam, cefotaxime, ceftriaxone, ceftaroline)

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24
Q

You have an INPATIENT (NOT ICU) with CAP, who needs treatment but only by IV. They would then be treated with ________

A

Azithromycin

OR

– Fluoroquinolone + IV antipneumococcal beta-lactam (cefotaxime, ceftriaxone,
ampicillin-sulbactam)

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25
Q

You have an inpatient who has CAP (NOT ICU), who can only be treated via IV, but is ALLERGIC to beta-lactamase antibiotics. You would treat this patient with fluoroquinolone + __________ instead of antipneumococcal beta-lactam.

A

Aztreonam

(fluoroquinolone + aztreonam)

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26
Q

You have an inpatient who has CAP, and is at risk for Pseudomonas infection AND who is critically ill, at increased risk for drug resistance, (or if local incidence of monotherapy-resistant
Pseudomonas is > 10%). You should consider adding either adding ___________ to their treatment.

A

Anti-pseudomonal fluoroquinolone (ciprofloxacin or levofloxacin)

OR

Aminoglycoside (gentamicin, tobramycin, amikacin)

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27
Q

You have inpatient (NOT ICU) who has CAP, and is at risk for MRSA. You should consider treating her with _________

A

Vancomycin

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28
Q

CAP should be treated for a minimum of ___ days

A

5

(Continue until afebrile for 48-72 hours)

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29
Q

Pneumococcal pneumonia (PP) should be treated with _______

A

Amoxicillin (or cefpodoxime, cefdinir)

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30
Q

If a patient has PP, and has a penicillin allergy, then they should be treated

A

Macrolides or Flouoquinolones
* azithromycin*
* clarithromycin
* levofloxacin*
* moxifloxacin

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31
Q

Your inpatient has PP and needs IV therapy. You treat them with ______

A

Ceftriaxone

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32
Q

Your inpatient with PP, who needs IV therapy, has a PCN allergy or is highly resistant to PCN. You would treat them with ________

A

Vancomycin

OR

Fluoroquinolone (levofloxacin)

33
Q

Haemophilus influenzae

A

– May see in smokers and COPD, following a URI

– Labs: Gram stain (obviously!) and culture of sputum, blood, pleural fluid

34
Q

Treatment for Haemophilus influenzae

A

Amoxicillin/clavulanate
cefotaxime
ceftriaxone,
cefuroxime
Azithromycin
TMP-SMZ

35
Q

Klebsiella pneumoniae

A

– Associated with alcohol abuse, DM, hospital-acquired

– Labs: Gram stain and culture of sputum, blood, pleural fluid

36
Q

Treatment for Klebsiella pneumoniae

A

3rd Gen cephalosporin

37
Q

Escherichia coli

A

– Usually HOSPITAL acquired

– Labs: Gram stain and culture of sputum, blood, pleural fluid

38
Q

Treatment for Klebsiella pneumoniae

A

3rd gen cephalosporin, TMP/SMX

39
Q

Pseudomonas aeruginosa

A

– Hospital-acquired, cystic fibrosis, bronchiectasis

– Labs: Gram stain and culture of sputum, blood

40
Q

Treatment for Pseudomonas aeruginosa

A

Antipseudomonal beta-lactam plus an aminoglycoside.

Ciprofloxacin + aminoglycoside or
antipseudomonal beta-lactam

41
Q

Mycoplasmal Pneumonia

A

– Caused by Mycoplasma pneumoniae

– DIFFICULT to CULTURE

– Significant cause of “atypical pneumonia”

– Spread by respiratory droplets
– Longer incubation period
– Child-borne into family
– Closed populations can have significant spread
– Usually affects 5-20 year olds

42
Q

Mycoplasmal Pneumonia

A

Generally SELF-limited
– INSIDIOUS onset (fever, malaise, headache, cough)
– COUGH (relatively NON-productive) worsens with pneumonia
– Chest soreness/usually not pleurtic pain
– Fever/mild chill

43
Q

Clinical Findings of Mycoplasmal Pneumonia

A

“WALKING pneumonia”

– +/- redness of pharynx
no adenopathy

– Chest exam unimpressive
(ausculation/percussion)

– Minimal exam findings
in contrast to x-ray

44
Q

Mycoplasmal Pneumonia is treated as a ______ diagnosis

A

clinical

45
Q

Treatment for Mycoplasmal Pneumonia (MP)

A

Not necessary for mycoplasmal URIs
– Pneumonia usually self-limited and not life-threatening
– Antimicrobials can shorten duration/reduce spread
Macrolides & tetracyclines (not in kids)
– X-ray findings take longer to resolve

46
Q

IF you need to prescribe antibiotics for MP then what do you treat it with?

A

Macrolides & tetracyclines (not in kids)

47
Q

What other drugs are effective against MP?

A

Fluoroquinolones

– Examples: Doxycycline in older children/adults or Azithromycin

48
Q

S. aureus Pneumonia

A
  • Gram (+) cocci in clumps

Long-term care resident, hospital-acquired, influenza
epidemics, cystic fibrosis, bronchiectasis, IVDU

  • Labs: Gram stain and culture of sputum, blood, pleural fluid
49
Q

Treatment for MSSA S. aureus Pneumonia

A

Nafcillin, Oxacillin, or cephalosporin
(cefazolin)

50
Q

Treatment for MRSA S. aureus Pneumonia

A

Vancomycin, Linezolid

51
Q

Legionnaires’ Disease (LD)

A

Usually Legionella pneumophila

– Usually in immunocompromised, smokers, or those with chronic lung
disease

– Outbreaks – contaminated water

52
Q

Clinical Finding of LD

A

Scant sputum
– Pleuritic chest pain
– Toxic appearance (SICK)
– Fever
– Initially may find only scattered rales
– Later more evidence of consolidation
– Varied clinical presentation (sorry)

53
Q

Lab Findings of LD

A

Gram stain (sputum): PMNs – NO organisms
– Culture (80-90% sensitivity)
– Associated non-specific tests
Hyponatremia, elevated LFTs/CK
* Proteinuria, pyuria, hematuria, leukocytosis, leukopenia, thrombocytopenia

54
Q

Diagnostic Test for LD?

A

URINE antigen testing
– Sputum PCR
– Sputum culture
– Serologic (antibody): Need seroconversion

55
Q

Treatment for LD?

A

1ST: Azithromycin, levofloxacin

2ND: clarithromycin, , moxifloxacin

56
Q

Treatment for Viral Pneumonia (VP)

A

Oseltamivir (oral) or zanamivir (inhaled) (dont give if a person has asthma) vs. influenza A (peramivir IV) or B (

  • Within 48 hours
57
Q

Etiologies of VP?

A

Influenza, RSV, adenovirus, parainfluenza virus

58
Q

Aspiration Pneumonia (AsP)

A

Difficulty swallowing

  • NEUROMUSCULAR disorder/ALTERED sensorium
59
Q

Examples of Aspiration Pneumonia

A

tracheobronchial fistulas (cancers) esophageal obstruction
neurologic disorders (stroke)
severe GERD

60
Q

Clinical Findings of AsP

A

– LESS ACUTE presentation (over days)
– RHONCHI in lower lobes

61
Q

Diagnosis of AsP

A

– HIGH clinical index of SUSPICION
– TRACHEAL SECRETIONS with FOOD particles or LIPID-laden
macrophages
– TUBE feeding: check secretions for GLUCOSE
– Swallowing studies
– Esophageal pH monitoring

– Parenchymal bronchopneumonia
– Pleural involvement: initially usually none
* Can occur with anaerobic infection
– Unresolved/inadequate treatment → lung abscess/empyema
– Bronchoscopy: not routinely done

62
Q

Treatment for admitted CAP aspiration pneumonia

A
  • clindamycin (IV) or ampicillin-tazobactam (IV)
63
Q

A patient with CAP is Seriously ill (i.e. intubated, inpatient, LTC), how will you treat them?

A
  • Piperacillin-tazobactam
  • Ticarcillin-clavulanate
  • Imipenem
64
Q

A patient with CAP has MRSA, how will you treat them?

A

Add vancomycin (IV) or linezolid

65
Q

Empirical Treatment OF Pneumonia is based on:

A

– Location (outpatient, inpatient, or ICU)

– Other factors (cardiopulmonary disease, likelihood of more specific
bacteria)

66
Q

What is CURB-65?

A

CAP Inpatient Management (CURB-65)
– Confusion
– Uremia (BUN > 19 mg/dL)
– RR ≥ 30
– BP (< 90 systolic or ≤ 60 diastolic)
– Age ≥ 65

67
Q

Duration of Therapy for Empiric Treatment

A

Most respond in 3 days
– If on IV, can switch to oral if improving
– 5 days minimum (depends on response)

68
Q

Hospital Acquired Pneumonia

A

– Develops > 48 hrs after admission
– Increases hospital stay/cost
– 25% of ICU infections

69
Q

When do you treat a patient who has HAP, with antibiotics?

A

Within 4 days → usually antibiotic susceptible

– Late → more often MDR

70
Q

Most common pathogens in HAP?

A

S. aureus (Gram +)
P. aeruginosa (Gram -)

71
Q

Gram neg organisms important in HAP?

A

P. aeruginosa

Escherichia coli

K. pneumoniae

  • Can be polymicrobial
72
Q

Clinical Findings of HAP

A

– New/worsening infiltrates

– Signs of infection

  • Fever, leukocytosis, purulent sputum, worsening respiratory status

– Normally should have 2 of 3

73
Q

Diagnosis of HAP

A

Detailed H&P
– CXR
– Lab Studies
– Cultures (blood, lower respiratory secretions)

74
Q

Treatment for HAP (no risk factors for MDR/MRSA/Pseudomonas/gram neg)

A
  • piperacillin-tazobactam
  • cefepime
  • levofloxacin
  • imipenem
  • meropenem
75
Q

If a patient has a risk of MRSA then what do you add?

A

Vancomycin or linezolid

76
Q

If a patient is at risk for Pseudomonas, then what do you add?

A

Levofloxacin, ciprofloxacin, gentamicin, or tobramycin

77
Q

Pathology of Lung Abcess

A

Aspiration or decreased ciliary action
* Examples: decreased consciousness, alcoholism, seizures, general
anesthesia, stroke, etc.
* Anaerobic infections: from oral disease, sinus infection, bronchiectasis
* Septic emboli: IVDU (S. aureus

78
Q

Clinical Findings of Lung Abcess

A

INSIDIOUS onset
– Clues: dependent lung segments, aspiration risk factors, periodontal
disease
– 1-2 weeks: necrosis with abscess formation or empyema
– Putrid sputum in 50% of patients/hemoptysis

Asthma/COPD (4 decks)

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