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clinical medicine II exam 2 > Bronchitis/PNA > Flashcards

Bronchitis/PNA Flashcards

1
Q

define an acute bronchitis

A

cough > 5 days, typically 1-3 weeks

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2
Q

define an chronic bronchitis

A

cough and sputum production at least 3 months of the year in 2 consecutive years

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3
Q

pathophysiology of acute bronchitis

A
  • self limited inflammation of the bronchi due to upper airway infection
  • often associated with URI
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4
Q

etiology of acute bronchitis

A
  • viral (90%)
  • bacterial
    • bordetella pertussis
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5
Q

is the presence of purulent sputum predictive of bacterial infection?

A

no

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6
Q

clinical presentation

  • cough
    • +/- sputum
  • usually afebrile (unless influenza)
  • chest wall tenderness
  • wheezing
  • mild dyspnea
  • PE: rhonchi (often clears with coughing); reduced FEV1
A

acute bronchitis

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7
Q

what signs should you look for to rule out PNA? When should you consider a chest radiograph?

A
  • fever > or = 38 C (100.4)
  • tachypnea: > or = 24 breaths/min
  • tachycardia > or = 100 beats/min
  • evidence of consolidation of chest exam: rales, egophony, fremitus
  • *consider chest radiograph for patients with any of these findings or cough lasting > 3 weeks
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8
Q

treatment of acute bronchitis

A
  • reassurance: 90% viral
  • symptomatic
    • NSAIDS
    • ipratropium (cough with sputum)
    • B2 agonist (wheezing)
  • smoking cessation
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9
Q

when should Abx be given for acute bronchitis

A

pertussis is the ONLY indication for Abx in the treatment of acute bronchitis

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10
Q

“whooping cough” causative agent

A
  • Bordetella pertussis
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11
Q

prodrome associated with pertussis

A
  • rhinorrhea
  • mild cough
  • sneezing
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12
Q

What are the three phases of pertussis

A
  1. catarrhal: URI symptoms, fever: 1-2 weeks
  2. paroxysmal: persistent paroxysmal cough, whooping, post-tussive emesis: 2-6 weeks
  3. convalescent: cough gradually resolves: weeks-months
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13
Q

during which stage is a person with pertussis most contagious?

A

catarrhal stage

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14
Q

how is pertussis diagnosed

A
  • nasopharyngeal secretions
    • bacterial culture: gold standard
    • PCR
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15
Q

treatment: pertussis

A
  • begin empiric therapy: Macrolide or Bactrim
  • Abx treatment decreases transmission but has little effect on symptom resolution
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16
Q

what booster vaccine is given to help prevent pertussis infection

A

Tdap, recommended as adolescent

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17
Q

are Abx for pertussis given prophylactically

A
  • yes, for
    • close contact exposure
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18
Q

if you, as a healthcare provider, diagnose someone with pertussis, what must you do

A

report diseae to state health department

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19
Q

how is influenza transmitted

A

aerosol droplets

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20
Q

high risk populations: influenza

A
  • children < 2 yo
  • adults > 65 yo
  • underlying chronic dz
  • immunosuppressed
  • pregnant
  • morbidly obese
  • residents of chronic care facilities
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21
Q

clinical presentation

abrupt onset of

  • fever
  • HA
  • myalgia
  • malaise
A

influenza

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22
Q

how is influenza diagnosed

A
  • rapid influenza diagnostic test (RIDT): 10-30 min
    • low sensitivity, high specificity
    • during periods of peak influenza activity, negative RIDTs do not reliably exclude influenza
      • make diagnosis clinically
  • RT-PCR: 2-6 hours
    • most sensitive and specific
23
Q

treatment: influenza

A
  • generally improve in 2-5 days
  • antiviral therapy within 24-48 hrs of onset
    • ​neuraminidase inhibitors: A/B
      • ​oseltamivir (tamiflu)
      • zanamivir (relenza)
    • reduces symptom duration by 1-3 days
24
Q

most common complication of influenza

A

PNA

25
Q

define PNA

A
  • acute infection of lung parenchyma
  • inflammation and consolidation of lung tissue
26
Q

define the different categories of PNA

A
  • community acquired (CAP)
  • hospital acquired (HAP)
  • ventilator associated (VAP)
  • healthcare associated (HCAP)
27
Q

highest incidence of PNA affects what populations and age groups

A
  • men, african american
  • < 4 yo; > 60 yo
28
Q

community acquired pneumonia is iniated by what cell population

A
  • alveolar macrophages initiate an inflammatory response to increase the lower respiratory tract defenses
29
Q

List the typical bacteria cause of CAP

A
  • streptococcus pneumoniae
  • staph aureus
  • Haemophilus influenzae
  • Klebsiella pneumoniae
  • Moraxella catarrhalis
30
Q

List the atypical bacteria cause of CAP

A
  • mycoplasma pneumoniae
  • chlamydophila pneumoniae
  • legionella
  • C. psittaci
31
Q

what is the predominant viral cause of viral PNA

A

influenza

32
Q

PNA caused by what agents are unusual in an immunocompetent host

A

fungal

33
Q

risk factors: for pneumococcal PNA

A
  • dementia
  • Sz disorder
  • chronic pulm/CV dz
  • alcoholism
  • tobacco smoker
  • HIV
34
Q

clinical presentation

  • cough
  • fever
  • sputum production
  • hemoptysis
  • dyspnea
  • night sweats
  • pleuritic CP
A

typical CAP

35
Q

what do you expect to auscultate on exam of patient with typical PNA

A
  • increased bronchial or bronchovesicular breath sounds over involved area
    • bronchophony: spoken words are louder and clearer
    • egophony: spoken E heard as A
36
Q

What is the CURB-65 score

A
  • helps you gage 30 day mortality, thus where patient should go (outpatient, admitted, ICU)
  • Confusion
  • Urea > 7 mm/L, BUN >20 mg/dL
  • Respiratory Rate > 30 breaths/min
  • Blood pressure (SBP < 90 mmHg or DBP < 60 mmHg)
  • 65 -age > 65 yo
  • *get one point for each area
37
Q

what CURB-65 score should a patient be admitted to hospital

A
  • score 0-1: treat outpatient
  • score 2: admit to hospital
  • score > 3: assess for ICU
38
Q

What is the recommended outpatient treatment for uncomplicated (previously healthy, no Abx use within the past 3 months) CAP

A
  • Macrolide
    • Azithromycin or clarithromycin
  • OR Doxycycline
  • duration: at least 5 days
39
Q

What is the recommended outpatient treatment for Complicated (recent Abx use, COPD, liver or renal disease, CA, DM, chronic heart disease, alcoholism, asplenia or immunosuppression) PNA OR Non-ICU

A
  • Beta lactam + Macrolide
    • ​beta lactam (augmentin, cefpodoxime)
    • macrolide (azithromycin, clarithromycin)
  • OR respiratory fluoroquinolone (levofloxacin)
40
Q

ICU inpatient treatment of CAP

A
  • antipneumococcal beta lactam + azithromycin
  • Or antipneumococcal beta lactam + respiratory fluoroquinolone
41
Q

inpatient treatment for CAP lasts a minimum of 5 days and

A
  • afebrile 48-72 hr
  • supplemental O2 not needed
  • HR < 100
  • RR < 24
  • SBP > 90 mmHg
42
Q

What vaccines can help prevent CAP

A
  • influenza (all patients)
  • pneumococcol
    • >65 yo
    • 19-64 yo at increased risk
43
Q

define hospital acquired PNA

A

48 hrs or more after admission and did not appear to be incubating at the time of admission

44
Q

who is at the highest risk for hospital acquired PNA

A
  • ICU
    • pseudomonas aeruginosa
  • mechanical ventilation
45
Q

define ventilator-associated PNA

A

a type of HAP that develops more than 48-72 hours after endotracheal intubation

46
Q

define healthcare associated PNA

A
  • non-hospitalized patient with extensive healthcare contact
    • residence in long term care facility
    • hospitalization for 2 or more days within prior 90 days
    • attendance at a hospital w/in 30 days
    • IV therapy, wound care, or chemo within 30 days
47
Q

how is HAP, VAP, HCAP diagnosed

A
  • new or progressive infiltrate on lung imaging and at least 2 of the following
    • fever
    • purulent sputum
    • leukocytosis
48
Q

Pneumocystis jirovecii pneumonia (pneumocystis carinii) is associated with what condition

A

HIV

49
Q

treatment of Pneumocystis jirovecii pneumonia

A

bactrim

50
Q

when should prophylactic treatment be given for Pneumocystis jirovecii pneumonia

A
  • risk factors in patients HIV +
    • h/o previous PCP
    • a CD4 count <200
    • oropharyngeal thrush
  • preferred: bactrim
51
Q

what organisms typically cause aspiration PNA

A
  • aspiration PNA: displacement of gastric contents to the lugn causing injury and infection
  • etiology: gram negative and anaerobic pathogens
52
Q

risk factors for aspiration PNA

A
  • post-operative state
  • neurologic compromise (CVA, parkinsons, ALS, sedation
  • anatomical defect
53
Q

aspiration PNA, where is consoldiation normally found

A

RLL infiltrate common

clinical medicine II exam 2 (7 decks)

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