Bronchitis/PNA Flashcards
1
Q
define an acute bronchitis
A
cough > 5 days, typically 1-3 weeks
2
Q
define an chronic bronchitis
A
cough and sputum production at least 3 months of the year in 2 consecutive years
3
Q
pathophysiology of acute bronchitis
A
- self limited inflammation of the bronchi due to upper airway infection
- often associated with URI
4
Q
etiology of acute bronchitis
A
- viral (90%)
- bacterial
- bordetella pertussis
5
Q
is the presence of purulent sputum predictive of bacterial infection?
A
no
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
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
8
Q
treatment of acute bronchitis
A
- reassurance: 90% viral
- symptomatic
- NSAIDS
- ipratropium (cough with sputum)
- B2 agonist (wheezing)
- smoking cessation
9
Q
when should Abx be given for acute bronchitis
A
pertussis is the ONLY indication for Abx in the treatment of acute bronchitis
10
Q
“whooping cough” causative agent
A
- Bordetella pertussis
11
Q
prodrome associated with pertussis
A
- rhinorrhea
- mild cough
- sneezing
12
Q
What are the three phases of pertussis
A
- catarrhal: URI symptoms, fever: 1-2 weeks
- paroxysmal: persistent paroxysmal cough, whooping, post-tussive emesis: 2-6 weeks
- convalescent: cough gradually resolves: weeks-months
13
Q
during which stage is a person with pertussis most contagious?
A
catarrhal stage
14
Q
how is pertussis diagnosed
A
- nasopharyngeal secretions
- bacterial culture: gold standard
- PCR
15
Q
treatment: pertussis
A
- begin empiric therapy: Macrolide or Bactrim
- Abx treatment decreases transmission but has little effect on symptom resolution
16
Q
what booster vaccine is given to help prevent pertussis infection
A
Tdap, recommended as adolescent
17
Q
are Abx for pertussis given prophylactically
A
- yes, for
- close contact exposure
18
Q
if you, as a healthcare provider, diagnose someone with pertussis, what must you do
A
report diseae to state health department
19
Q
how is influenza transmitted
A
aerosol droplets
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
21
Q
clinical presentation
abrupt onset of
- fever
- HA
- myalgia
- malaise
A
influenza
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
-
neuraminidase inhibitors: A/B
24
Q
most common complication of influenza
A
PNA
25
define PNA
* acute infection of lung parenchyma
* inflammation and consolidation of lung tissue
26
define the different categories of PNA
* community acquired (CAP)
* hospital acquired (HAP)
* ventilator associated (VAP)
* healthcare associated (HCAP)
27
highest incidence of PNA affects what populations and age groups
* men, african american
* \< 4 yo; \> 60 yo
28
community acquired pneumonia is iniated by what cell population
* alveolar macrophages initiate an inflammatory response to increase the lower respiratory tract defenses
29
List the typical bacteria cause of CAP
* **streptococcus pneumoniae**
* staph aureus
* Haemophilus influenzae
* Klebsiella pneumoniae
* Moraxella catarrhalis
30
List the atypical bacteria cause of CAP
* mycoplasma pneumoniae
* chlamydophila pneumoniae
* legionella
* C. psittaci
31
what is the predominant viral cause of viral PNA
influenza
32
PNA caused by what agents are unusual in an immunocompetent host
fungal
33
risk factors: for pneumococcal PNA
* dementia
* Sz disorder
* chronic pulm/CV dz
* alcoholism
* tobacco smoker
* HIV
34
clinical presentation
* **cough**
* **fever**
* sputum production
* hemoptysis
* dyspnea
* night sweats
* pleuritic CP
typical CAP
35
what do you expect to auscultate on exam of patient with typical PNA
* increased bronchial or bronchovesicular breath sounds over involved area
* + bronchophony: spoken words are louder and clearer
* + egophony: spoken E heard as A
36
What is the CURB-65 score
* helps you gage 30 day mortality, thus where patient should go (outpatient, admitted, ICU)
* **C**onfusion
* **U**rea \> 7 mm/L, BUN \>20 mg/dL
* **R**espiratory Rate \> 30 breaths/min
* **B**lood pressure (SBP \< 90 mmHg or DBP \< 60 mmHg)
* **65** -age \> 65 yo
* \*get one point for each area
37
what CURB-65 score should a patient be admitted to hospital
* score 0-1: treat outpatient
* score 2: admit to hospital
* score \> 3: assess for ICU
38
What is the recommended outpatient treatment for **uncomplicated** (previously healthy, no Abx use within the past 3 months) CAP
* **Macrolide**
* Azithromycin or clarithromycin
* OR **Doxycycline**
* **duration: at least 5 days**
39
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**
* **Beta lactam + Macrolide**
* ****beta lactam (augmentin, cefpodoxime)
* macrolide (azithromycin, clarithromycin)
* **OR respiratory fluoroquinolone (levofloxacin)**
40
ICU inpatient treatment of CAP
* antipneumococcal **beta lactam + azithromycin**
* Or antipneumococcal **beta lactam + respiratory fluoroquinolone**
41
inpatient treatment for CAP lasts a minimum of 5 days _and_
* afebrile 48-72 hr
* supplemental O2 not needed
* HR \< 100
* RR \< 24
* SBP \> 90 mmHg
42
What vaccines can help prevent CAP
* influenza (all patients)
* pneumococcol
* \>65 yo
* 19-64 yo at increased risk
43
define hospital acquired PNA
48 hrs or more after admission and did not appear to be incubating at the time of admission
44
who is at the highest risk for hospital acquired PNA
* ICU
* pseudomonas aeruginosa
* mechanical ventilation
45
define ventilator-associated PNA
a type of HAP that develops more than 48-72 hours after endotracheal intubation
46
define healthcare associated PNA
* 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
how is HAP, VAP, HCAP diagnosed
* new or progressive infiltrate on lung imaging and at least 2 of the following
* fever
* purulent sputum
* leukocytosis
48
Pneumocystis jirovecii pneumonia (pneumocystis carinii) is associated with what condition
HIV
49
treatment of Pneumocystis jirovecii pneumonia
bactrim
50
when should prophylactic treatment be given for Pneumocystis jirovecii pneumonia
* risk factors in patients HIV +
* h/o previous PCP
* a CD4 count \<200
* oropharyngeal thrush
* preferred: bactrim
51
what organisms typically cause aspiration PNA
* aspiration PNA: displacement of gastric contents to the lugn causing injury and infection
* etiology: **gram negative** and **anaerobic** pathogens
52
risk factors for aspiration PNA
* post-operative state
* neurologic compromise (CVA, parkinsons, ALS, sedation
* anatomical defect
53
aspiration PNA, where is consoldiation normally found
RLL infiltrate common
