Bronch/Pneumo

Question 1

Acute Bronchitis is?

Etiology?

Answer 1

Self-limiting URI, bronchi inflamm

(U) viral:
flu A/B
paraflu

bacterial:
b. pertussis, only one treatable w/ abx

Question 2

Acute Bronch presentation:

Cough
Productive
Fever
Chest
Wheeze
Dyspnea
Rhonchi
Rales
Consolidation

Answer 2

Cough: > 5 days
Productive: +/-
Fever: -
Chest: tender
Wheeze: +
Dyspnea: mild
Rhonchi: Clears w/ cough
Rales: -
Consolidation: -

Question 3

Acute Bronch diagnostics?

Answer 3

WBCs: N or slight ↑

CXR (only if abn vitals or fever): N or non-specific

Question 4

Acute Bronch Mgmt?

Answer 4

sxs

Question 5

Pneumonia is?

Etiology

Answer 5

Inflamm response to over-colonization of alveoli

CAP: S pneumo

Question 6

Pneumo epidemiology:

Transmission
Community Acquired

Answer 6

Transmission: aspiration, inhalation, hemato

CAP: M>F, Black>White, old and young

Question 7

Community Acquired Pneumo presentation:

Cough
Productive
Fever
Chest
Wheeze
Dyspnea
Rhonchi
Rales
Consolidation
CV

Answer 7

Cough: +
Productive: +
Fever: +
Chest: pleuritic pain
Wheeze: -
Dyspnea: +
Rhonchi: ?
Rales: +
Consolidation: +
CV: tachy

Question 8

CAP from atypical bacteria presentation?

Answer 8

confused
weak
GI

Question 9

CAP diagnostics?

Answer 9

CXR: infiltrate

Labs: leukocytosis w/ L shift

Question 10

Interstitial Filtrate is what?

Answer 10

throughout lungs

Question 11

Pneumo Severity Index?

Answer 11

Determine if hosp is necessary

STEP 1:
> 50 yo
Comorbitites
Abn vitals/ altered mental state

If any of Step 1 -> eval for Step 2

Admit if Step 2 Class IV or V (score > 90)

Question 12

CURB 65 score?

Answer 12

Determine if hosp is necessary (score > 1)

Confusion
Urea > 7
Resp rate >= 30
BP > 90 SBP or <60 DBP
65+ yo

Question 13

CAP Outpt tx:

Previously healthy, no abx w/i 3 mo:

Previously healthy, yes abx w/i 3 mo:

Answer 13

5 day course

macrolide or doxy

fluoroquin or
amox PLUS macrolide

Question 14

CAP Inpt tx?

Non-ICU

ICU

Answer 14

fluoroquin or
amox PLUS macrolide

beta-lactam PLUS azithro or fluoroquin

Question 15

CAP ICU tx if pseudomona risk?

MRSA risk?

Answer 15

(alcholic, cyst fib, CA, etc)

antipneumo/pseudo beta-lac PLUS cipro or levo

ADD vanco

Question 16

CAP inpt tx duration?

Answer 16

5 days if:
Fever gone for 48 hrs,
O2 not needed,
vitals normal

Question 17

Hospital Acquired Pneumo (HAP) definition?

Answer 17

> = 48 hrs post admission

w/o signs before admission

Question 18

Vent Assoc’d Pneumo (VAP) definition?

Answer 18

> 48 hrs post endotracheal intubation

Question 19

Health Care Assoc’d Pneumo (HCAP) definition?

Answer 19

non-hosp pt w/ lots of healthcare contact

Question 20

HAP, VAP, HCAP tx?

Answer 20

(HCAP - risk of resistance)

antipneumo/pseudo beta PLUS
fluoro PLUS
vanco

Duration: 14-21 days (may stop @ 7 if well unless p. aeruginosa [must do 14+])

Question 21

Non-resolving Pneumo approach?

Answer 21

look for other dx
Chest CT
Scopies

Question 22

Viral Pneumo etiology?

Mode of action?

Answer 22

FLU

targets resp epithelium
2º Staph (C)

Question 23

Pneumocystis jirovecii pneumo (PJP) etiology?

Answer 23

fungi

a/w HIV

Question 24

PJP sxs?

Answer 24

fever, cough, progressive dyspnea

Question 25

PJP diagnostics?

Answer 25

High LDH
Low CD4
CXR
Sputum

Question 26

PJP tx?

Answer 26

trimeth-sulfameth + steroids

Question 27

Aspiration pneumo etiology?

Answer 27

gastric juice injury ->

G-, anaerobic

Question 28

Asp pneumo diagnostics?

Answer 28

CXR: RLL infiltrate

Question 29

Asp pneumo tx?

Answer 29

piper/tazo or

ampi/sulbact