Bronchitis and Pneumonia

Question 1

Acute bronchitis def

Answer 1

self-limited inflammation of the bronchi

often a/w viral URI

Question 2

Etiology of acute bronchitis (name likely agents)

Answer 2

VIRAL!!! influenza A and B, parainfluenze, coronavirus, rhinovirus, RSV
Bacterial? Mycoplasma pneumonia, Chlamydophila pneumonia, BORDATELLA PERTUSSIS

Question 3

Acute bronchitis DDx

Answer 3

chronic bronchitis, pneumonia, postnasal drip, GERD, asthma, CHF, bronchogenic tumors

Question 4

Acute bronchitis clinical presentation

Answer 4

cough>5days (usu 1-3 weeks) + or - productive
usually afebrile (unless etiol. is influenze
chest wall tenderness
WHEEZING
MILD DYSPNEA

Question 5

Acute bronchitis physical exam

Answer 5

wheezing, rhonchi (clears w/coughing), negative for rales and signs of consolidations

Question 6

Acute bronchitis labs

Answer 6

WBC: normal to mildly elevated
CXR: normal or nonspecific findings
is a CXR needed?
other

Question 7

What is procalcitonin? how does it help you as a clinican?

Answer 7

Procalcitonin=prohormone for calcitonin

• part of inflammatory cascade, elevated in bacterial infections (>.25 ug/L in non-ICU pts, >.5ug/L in ICU pts)
• after elevated baseline, drop of >80% is reasonable for discontinuing antibiotics

Question 8

Management of acute bronchitis

Answer 8

symptomatic tx
antitussives (codeine, DXM)?
B2 agonists?
OTC products (expectorants/mucolytics, antihistamines, decongestants)?

Question 9

Is acute bronchitis viral or bacterial?

Answer 9

VIRAL, yet 60-90% are given antibiotics, don’t give in

Question 10

Pneumonia: how is this transmitted?

Answer 10

aspiration from oropharynx
inhalation of contaminated droplets
hematogenous spread
extension from infected pleural or mediastinal space

Question 11

pathophys of pneumonia

Answer 11

• proliferation of microbial pathogens at alvolar level when capacity of alveolar macrophages to ingest or kill microorganisms is exceeded
• alveolar macrophages initiate an inflammatory response to increase the lower respiratory tract defenses

Question 12

4 classifications of pneumonia

Answer 12

1. community acquired (CAP)
2. hospital acquired (HAP)
3. ventilator associated (VAP)
4. health care associated (HCAP)

Question 13

CAP incidence by gender, race and age

Answer 13

men>women
African americans>Caucasians
incidence highest at extremes
gen pop: 12 cases per 1000 ppl
M60 y/o: 20 per 1000