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Clinical Med II > Bronchitis & Pneumonia > Flashcards

Bronchitis & Pneumonia Flashcards

1
Q

How long must a cough be present to classify it as acute bronchitis?

A

Cough > 5 days (typically 1-3 weeks)

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2
Q

How long must a cough be present to classify it as chronic bronchitis?

A

At least 3 months of the year in 2 consecutive years

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3
Q

What is the most common cause of acute bronchitis?

A

Viruses

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4
Q

What is the only bacterial cause of acute bronchitis that should be treated with antibiotics?

A

Bordetella pertussis

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5
Q

Patient presents with the following symptoms:

  • Wheezing
  • Bronchospasm
  • Rhonchi (clears with coughing)
  • NEGATIVE for crackles (rales) and signs of consolidation

What is the likely diagnosis?

A

Acute bronchitis

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6
Q

When would you consider a chest x-ray in a patient who presents with acute bronchitis-like symptoms?

A

To rule out pneumonia if cough lasts > 3 weeks
OR
Patient has one or more of the following:
- Fever (>100.4 F)
- Tachypnea (>24 breaths/min)
- Tachycardia (>100 beats/min)
- Evidence of consolidation on chest exam (crackles, egophany, fremitus)

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7
Q

What is the treatment for acute bronchitis?

A
  • Reassurance
  • Hydration & rest
  • Symptomatic relief
  • Smoking cessation
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8
Q

Should antibiotics be prescribed for acute bronchitis?

A

NO! Pertussis is the only indication for antibiotics in the treatment of acute bronchitis

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9
Q

What are the three phases of Pertussis?

A

Phase 1: Catarrhal
- URI symptoms for 1-2 weeks

Phase 2: Paroxysmal
- Persistent paroxysmal cough and inspiratory whooping for 2-6 weeks

Phase 3: Convalescent
- Cough gradually resolves over weeks to months

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10
Q

What is the gold standard for Pertussis diagnosis and when is the most optimal time to obtain it?

A

Bacterial culture from nasopharyngeal secretions

Optimal time to obtain is at cough onset and up to 2 weeks.

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11
Q

When is the most optimal time to obtain serology testing for Pertussis?

A

2-8 weeks from cough onset (later phases)

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12
Q

If Pertussis is suspected, but you are awaiting diagnostic studies, what should you do?

A

Treat empirically with antibiotics as antibiotics decreases transmission (has little effect on symptoms resolution)

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13
Q

What is the recommended treatment for Pertussis in adults?

A

Macrolides

  • Azithromycin (most common)
  • Clarithromycin
  • Erythromycin

Alternative: Bactrim

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14
Q

What is the recommended treatment for Pertussis in pediatric patients?

A 
Inpatient vs. Outpatient
- Most of those < 6 months need admission
- Isolation 
Symptom control 
Antibiotics (Macrolides)
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15
Q

How can you prevent Pertussis?

A
  • Vaccination (Tdap - booster recommended as adolescent)

- Antibiotic prophylaxis (close contact exposure)

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16
Q

What are typical symptoms associated with Pertussis?

A
  • Prolonged progressive cough

- Coughing fits followed by classic whooping sound

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17
Q

What populations that are at high-risk of having influenza progress to pneumonia?

A
  • Children < 2 y/o
  • Adults 65 years or older
  • Underlying chronic disease
  • Immunosuppressed
  • Pregnant
  • Morbidly obese
  • Residents of nursing homes/chronic care facilities
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18
Q

What is the common clinical presentation of a patient with influenza?

A

Abrupt onset of:

  • Fever
  • Headache
  • Myalgia
  • Malaise
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19
Q

What is typically found on physical exam in a patient with influenza?

A

Few findings:

  • Hot, flushed appearance
  • Febrile
  • Mild cervical lymphadenopathy
  • Chest exam usually negative, unless PNA
20
Q

What is the quickest way to diagnose influenza? What should you note about this?

A

Rapid influenza diagnostic test (RIDTs)
- Due to low sensitivity, during periods of peak influenza activity a negative rapid antigen test cannot reliably exclude influenza, so make diagnosis clinically

21
Q

Other than RIDT, what are other ways to diagnose influenza?

A

RT-PCR (2-6 hrs)
- Most sensitive and specific

Viral culture (48-72 hrs)

  • Confirmatory
  • Not for initial clinical management
22
Q

What is the treatment for influenza?

A

Generally self-limited and improves in 2-5 days

Antiviral therapy (Tamiflu, Relenza) within 48 hours of symptom onset 
- Can prescribe to high risk even after 48 hours
23
Q

What is the most common route of transmission for CAP?

A

Aspiration of upper airway material from the oropharynx to lower airway

24
Q

What is the most common etiology for Typical PNA?

A

Bacterial

- Streptococcus pneumoniae

25
Q

What is the most common etiology for Atypical PNA?

A

Bacterial

- Mycoplasma pneumoniae

26
Q

What are some symptoms associated with the clinical presentation of typical pneumonia?

A

Acute onset:

  • High-grade fever
  • Cough
  • Pleuritic chest pain
  • Rigors
27
Q

What are some symptoms associated with the clinical presentation of atypical pneumonia?

A

Subacute onset:

  • Viral prodrome
  • Low-grade fever
  • Nonproductive cough
  • Malaise
  • NO pleurisy or rigors
28
Q

The following physical exam findings are most consistent with what diagnosis?

  • Tachypnea: RR > 24
  • Hypoxia
  • Fever
  • Decreased or bronchial breath sounds
  • Crackles (or rales)
  • Signs of consolidation (increased tactile fremitus, bronchophony, egophony)
29
Q

What diagnostic test is the gold standard for diagnosis of CAP? What will be seen on imaging to confirm the diagnosis?

A

Chest x-ray will show infiltrates with possible consolidation or cavitation.

30
Q

What does the CURB-65 score stand for?

A
  • Confusion
  • Urea > 7 mmol/L, BUN > 20 mg/dL
  • Respiratory rate > 30 breaths/minute
  • Blood pressure (SBP < 90 mmHg or DBP < 60 mmHg)
  • 65 - Age > 65 years old
31
Q

At what CURB-65 score should you admit to the hospital? What about for ICU care?

A

2-5 - Admit to hospital

3-5 - Assess for ICU care

32
Q

How long should antibiotics be prescribed in general in CAP patients that are being treated on an outpatient basis?

A

Empirically treat with antibiotics for at least 5 days

33
Q

Should you obtain a follow-up chest x-ray in CAP patients that were treated outpatient?

A
  • Not needed routinely

- Obtain 7-12 weeks post treatment in patients who are > 40 y/o or are smokers

34
Q

What constitutes Uncomplicated CAP?

What antibiotics should these patients be prescribed?

A

Previously healthy with no antibiotic use within the past 3 months

Macrolide (Azithromycin)
OR
Doxycycline

35
Q

What constitutes Complicated CAP?

What antibiotics should these patients be prescribed?

A

Recent antibiotic use; co-morbidities; immunosuppression)

Combination of Beta-lactam (Augmentin) PLUS Macrolide (Azithromycin)
OR
Respiratory fluoroquinolone (levofloxacin)

36
Q

Define HAP.

A

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

37
Q

Define VAP.

A

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

38
Q

How is HAP/VAP diagnosed?

A

New or progressive infiltrate on lung imaging AND at least 2 of the following clinical features:

  • Fever
  • Purulent sputum
  • Leukocytosis

Sputum Gram stain and culture are indicated

39
Q

What type of pneumonia is associated with HIV?

What else does it have a strong correlation with?

A

Pneumocystis jirovecii pneumonia (PCP)

Strong correlation with low CD4 count

40
Q

The following findings are associated with what type of pneumonia?

  • High LDH
  • Low CD4
  • Reticular, ground glass opacities on CXR
A

Pneumocystis jirovecii pneumonia (PCP)

41
Q

What is the treatment for Pneumocystis jirovecii pneumonia (PCP)?

A

Bactrim

Prophylaxis in high risk HIV+ patients:

  • history of previous PCP
  • CD4 count < 200
  • Oropharyngeal thrush
42
Q

What is one of the leading causes of opportunistic infection in HIV-infected individuals?

A

Pneumocystis jirovecii pneumonia (PCP)

43
Q

What symptoms are associated with Pneumocystis jirovecii pneumonia (PCP)?

A

Gradual onset:

  • Fever
  • Nonproductive cough
  • Progressive dyspnea
44
Q

What is aspiration pneumonia?

A

Displacement of gastric contents to the lung causing injury and infection.

45
Q

What are risk factors for aspiration pneumonia?

A
  • Post-operative state
  • Neurologic compromise
  • Anatomical defect
46
Q

What is the most common diagnostic finding on CXR to support aspiration pneumonia?

A

Right lower lobe infiltrate on chest x-ray

47
Q

What antibiotics should be given for aspiration pneumonia?

A 
- Piperacillin 
OR
- Ampicillin 
OR
- Clindamycin 
OR
- Moxifloxacin

Clinical Med II (17 decks)

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