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Clin Med II- Exam 2 > Bronchitis & Pneumonia > Flashcards

Bronchitis & Pneumonia Flashcards

1
Q

Bronchitis

A

cough >5 days

typically 1-3 weeks long

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2
Q

Chronic bronchitis

A

cough and sputum production most days of the month

***at least 3 months of the year in 2 consecutive . years

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3
Q

Pathophys behind acute bronchitis

A

self-limited inflammation of bronchi due to upper airway infection
associated w/ viral URI

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4
Q

Etiology of acute bronchitis

A

VIRAL! (90%)

Bacterial (mycoplasma, chlmaydia, bordetella pertussis)

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5
Q

Which bacterial infection responds to abx tx

A

bordatella pertussis

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6
Q

Sx of acute bronchitis

A 
cough (+/- sputum)
afebrile (unless influenza)
chest wall tenderness
wheezing 
mild dyspnea
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7
Q

PE for acute bronchitis

A

wheezing
bronchospasm (reduced FEV1)
rhonchi (clears w/ coughing)
(-) crackles and signs of consolidation (that is pneumo)

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8
Q

Dx for acute bronchitis

A

Clinical!
WBC: normal or elevated
CXR: normal/nonspecific

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9
Q

Crackles

A

pneumonia

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10
Q

Rhonchi

A

acute bronchitis

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11
Q

Pneumonia is unlikely if all of the following signs are absent

A

fever (>100.4)
tachynea (>24 breaths/min)
tachycardia (>100 bpm)
evidence of consolidation (crackles, egophony, fremitus)

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12
Q

Tx for acute bronchitis

A

reassurance
hydration& rest
Sx relief

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13
Q

Sx relief for acute bronchitis

A 
NSAID, ASA, acetaminophen
intranasal ipratropium
antitussive (dextromethorphan)
B2 agonists (albuterol inhaler, SVN) 
OTC (lozenges, tea, mucolytics)
smoking cessation*
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14
Q

Abx for bronchitis

A

ONLY PERTUSSIS

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15
Q

CXR for bronchitis

A

not necessary

only used to r/o pneumonia

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16
Q

Whooping cough

A

pertussis

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17
Q

Phases of pertussis

A
  1. Catarrhal: URI sx, fever (1-2 weeks)
  2. Paroxysmal: persistent paroxysmal cough, inspiratory “whooping”; POST TUSSIVE EMESIS (2-6 wks)
  3. Convalescent: cough gradually resolves (weeks - months)
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18
Q

Prodrom w/ pertussis

A

rhinorrhea, mild cough, sneezing

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19
Q

Dx of pertussis

A

nasopharyngeal secretions – BACTERIAL CULTURE = GOLD STANDAARD

PCR (faster)

Serology (more useful in later phases: 2-8 wks from cough onset)

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20
Q

Tx of pertussis goals

A

decreases transmission! little effect on sx resolution

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21
Q

Tx for pertussis

A

supportive

Macrolide

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22
Q

dosage for pertussis

A

Azithro 500 mg PO, followed by 250 mg for 4 days

Clarithro 500 mg PO BID x 7 days

Erythro 500 mg PO QID x 14 days

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23
Q

Alternative tx for pertussis

A

Bactrim PO BID x 14 days

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24
Q

Pertussis tx in peds

A

< 6 mo most need admission/isolation
Sx control
Macrolides

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25
Q

Abx prophylaxis for pertussis

A

given to close contacts

vaccination (+Tdap booster)

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26
Q

Influenza involes

A

upper and lower RT

usually self-limited

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27
Q

High risk for influenza

A 
children <2 YO
adults >65 YO
chronic disease
immunosuppressed
pregnant (up to 2 wks postpartum)
morbidly obese
nursing homes/chronic care facilities
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28
Q

Presentation of influenza

A 
fevere
h/a
myalgia
malaise
nonproductive cough
sore throat
nasal d/c
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29
Q

PE for influenza

A

hot, flushed
febrile
mild cervical LAD

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30
Q

Dx for influenza

A

RIDT (10-30 min) - more sensitivity
RT-PCR (2-6 hrs) - most sensitive and specific
Viral culture (48-72 hrs) - confirmatory; not used for clinical management

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31
Q

Negative RIDT

A

during periods of peak influenza activity, negative test does not exclude influenza (make dx clinically)

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32
Q

Tx for influenza

A

usually improves 2-5 days

antiviral 24-48 hrs of sx onset (Neuraminidase inhibitors: oseltamivir, zanamivir)

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33
Q

Antiviral therapy

A

reduces sx duration by 1-3 days

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34
Q

Most common complication of influenza

A

Pneumonia

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35
Q

acute infection of pulmonary parenchyma

A

pneumonia

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36
Q

What is pneumonia?

A

inflammation and consolidation of lung tissue from infectious agent; result of virulent organism, large inoculum and/or impaired host defense

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37
Q

Classification of pneumonia

A

typical vs. atypical

CAP, HAP, VAP

38
Q

Highest incidence of pneumonia

A

<4 yo
>60 yo
M>F
African Americans > Caucasians

39
Q

Transmission of CAP

A

ASPIRATION from oropharynx * (most common)
inhale droplets
hematogenous spread
extension from infected pleural or mediastinal space

40
Q

Pathophys behind CAP

A

proliferation of bacteria in alveoli when macrophages ability is exceeded;
alveolar macrophages initiate an inflammatory response to increase the lower respiratory tract defenses

41
Q

Most common cause of typical pneumo

A

Streptococcus pneumoniae

42
Q

Most common cause of atypical pneumonia

A

Mycoplasma pneumonia

43
Q

Causes of atypical pneumo

A

bacterial, viral, fungal

bacterial: mycoplasma, chlamydophila, legionella, C. psittaci

44
Q

Viral etiology of pneumona

A

influenza
RSV
Parainfluenza
adeno

45
Q

Fungal causes of pneumonia

A

histoplasmosis
blastomycosis
coccidiodomycosis
Cryptococcus

*unusual in immunocompetent host

46
Q

Presentation of pneumonia

A 
acute onset *
fever *
cough *
sputum production
hemoptysis
dyspnea
night sweats
pleuritic chest pian
chest pain, chills, rigors
47
Q

PE for pneumonia

A 
fever
tachypnea: RR>24
hypoxia
tachycardic
diaphoresis
decreased/bronchial breath sounds
crackles (rales)
Consolidation signs
48
Q

Consolidation signs

A

dullness to percussion
increased tactile fremitus
bronchophony
egophony

49
Q

(+) bronchophony

A

“99” is louder and clearer

50
Q

(+) egophony

A

E heard as “A”

51
Q

Dx of pneumonia

A

Leukocytosis w/ left shift (15k-30k)

CXR: infiltrate (lobar consolidation, interstitial infiltrates, cavitation)

52
Q

Gold standard for pneumonia

A

infiltrate on CXR

53
Q

Dx for CAP

A

CT- not routinely recommended
Microbio testing (sputum, blood culture): very ill/risk factors for unusal organisms
Urine antigen test: legionella and s. pneumo
PCR tests: research studies
Procalcitonin and CRP: inflammatory markers - help distinguish between bacterial and viral

54
Q

Testing for legionella or S. pneumo

A

Urine antigen test

55
Q

Helps distinguish b/w bacterial and viral pneumo

A

procalcitonin and CRP

56
Q

Complications of pneumo

A 
bacteremia
sepsis
abscess
empyema
respiratory failure
57
Q

Severity index and admission

A

Class I-II: probably not
Class III: observation unit
Class IV and V: admit to hospital

58
Q

CURB-65 score for pneumonia

A 
Confusion
urea > 7, BUN >20
RR >30
BP (sys <90 or DBP <60)
65 YO or more
59
Q

CURB-65 and recommendation

A

0 &1: outpatient
2: admit
3-5 assess for ICU care

60
Q

Outpatient uncomplicated pneumo tx

A

Macrolide: azithro 500 mg PO day 1, 250 mg PO x 4 days

OR

Doxycycline (100 mg BID x 7-10 days)

61
Q

Tx for complicated pneumo

A

beta-lactam + macrolide:
Augmentin 500 mg BID + azithromycin

OR

Respiratory fluorquinolone (levofloxacin 750 mg daily x 5 days)

62
Q

Education to pt on pneumo sx

A 
abx at least 5 days
3 days for fever to resolve
14 days for cough and fatigue
1/3 have sx at 28 days
return to work in 6 days
63
Q

F/u for pneumo

A

CXR not needed routinely

64
Q

When to do f/u CXR in pneumonia

A

7-12 weeks post tx in pts >40 yo or smokers

65
Q

Risk for pseudomonas

A 
alcoholism
CF
neutropenic fever
recent intubation
cancer
organ failure
septic shock
66
Q

MRSA risk

A

end stage renal disease
IV drug abuse
prior abx use
influenza

67
Q

When to d/c inpatient

A

min 5 days abx and:

  • afebrile 48-72 hrs
  • supplemental O2 not needed
  • HR <100 bpm
  • RR <24
  • SBP >90 mmHg
68
Q

When to have pneumococcal vaccine

A

> 65 yo

19-64 yo at increased risk (cardiopulm disease, SS, tobacco abuse, splenectomy, liver disease)

69
Q

Uncomplicated outpt tx

A

macrolide or doxy

70
Q

Complicated out patient or non-ICU

A

macrolide + beta-lactam
OR
resp. fluroquinolone

71
Q

ICU

A

beta-lactam + azithro
OR
beta-lactam + fluoroquinolone

If PCN allergy: fluoroquinolone + aztreonam

72
Q

What is HAP?

A

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

73
Q

Risk for HAP

A

ICU (pseudomonas aeruginosa - worst prognosis)

Mechanical ventilation

74
Q

VAP

A

HAP that develops 48-72 hrs after endotracheal intubation

75
Q

Tx for HAP or VAP

A

broad spectrum abx

76
Q

Dx of HAP/VAP

A

new/progressive infiltrate on imaging AND 2 of the following:

  • fever
  • purulent sputum
  • leukocytosis

Sputum gram stain + culture indicated

77
Q

Best tx of VAP

A 
avoid acid-blocking meds
decontamination of oropharynx
selective decontamination of gut
probiotics
positioning
subglottic drainage
78
Q

Further eval for non-resolving pneumo

A

chest CT
fiberoptic bronchoscopy
thoracoscopy
open lung bx

79
Q

Pneumocystis jirovecci aka

A

pneumocystis carinii; PCP; pneumocystis pneumonia

80
Q

What is PCP

A

fungi

81
Q

what is PCP associated w/

A

HIV (CD4 count low)

82
Q

Sx of PCP

A

fever
cough- nonproductive
progressive dyspnea
extra-pulmonary lesions

83
Q

Testing for PCP

A

high LDH
Low CD4
CXR
sputum

84
Q

Tx for PCP

A

Bactrim

85
Q

Alternative tx for PCP

A

TMP-dapsone
clindamycin-primaquine
pentamidine (best SE profile)
steroids

86
Q

Prophylaxis for PCP in HIV

A

hx of previous PCP
CD4 <200
oropharyngeal thrush

87
Q

Prolphyaxis tx

A

bactrim

alt: dapsone, pentamidine

88
Q

What is aspiration pneumonia?

A

displacement of gastric contents to the lung causing injury and infecftion; gram-negative and anaerobic pathogens

89
Q

Risk factors for aspiration pneumo

A 
post-op
neuro comprovis (CVA, parkinson's, ALS, sedation)
anatomical defect or aberrancy
90
Q

CXR in aspiration pneumo

A

RLL infiltrate common

91
Q

Aspiration pneumo tx

A

supportive

abx: piperacillin/tazobactam OR ampicillin/subactam OR clinda OR moxifloxacin

Clin Med II- Exam 2 (7 decks)

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