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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
What is the most common etiology for Atypical PNA?
Bacterial | - Mycoplasma pneumoniae
26
What are some symptoms associated with the clinical presentation of typical pneumonia?
Acute onset: - High-grade fever - Cough - Pleuritic chest pain - Rigors
27
What are some symptoms associated with the clinical presentation of atypical pneumonia?
Subacute onset: - Viral prodrome - Low-grade fever - Nonproductive cough - Malaise - NO pleurisy or rigors
28
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)
CAP
29
What diagnostic test is the gold standard for diagnosis of CAP? What will be seen on imaging to confirm the diagnosis?
Chest x-ray will show infiltrates with possible consolidation or cavitation.
30
What does the CURB-65 score stand for?
- 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
At what CURB-65 score should you admit to the hospital? What about for ICU care?
2-5 - Admit to hospital 3-5 - Assess for ICU care
32
How long should antibiotics be prescribed in general in CAP patients that are being treated on an outpatient basis?
Empirically treat with antibiotics for at least 5 days
33
Should you obtain a follow-up chest x-ray in CAP patients that were treated outpatient?
- Not needed routinely | - Obtain 7-12 weeks post treatment in patients who are > 40 y/o or are smokers
34
What constitutes Uncomplicated CAP? What antibiotics should these patients be prescribed?
Previously healthy with no antibiotic use within the past 3 months Macrolide (Azithromycin) OR Doxycycline
35
What constitutes Complicated CAP? What antibiotics should these patients be prescribed?
Recent antibiotic use; co-morbidities; immunosuppression) Combination of Beta-lactam (Augmentin) PLUS Macrolide (Azithromycin) OR Respiratory fluoroquinolone (levofloxacin)
36
Define HAP.
48 hours or more after admission and did not appear to be incubating at the time of admission.
37
Define VAP.
A type of HAP that develops more than 48-72 hours after endotracheal intubation.
38
How is HAP/VAP diagnosed?
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
What type of pneumonia is associated with HIV? What else does it have a strong correlation with?
Pneumocystis jirovecii pneumonia (PCP) Strong correlation with low CD4 count
40
The following findings are associated with what type of pneumonia? - High LDH - Low CD4 - Reticular, ground glass opacities on CXR
Pneumocystis jirovecii pneumonia (PCP)
41
What is the treatment for Pneumocystis jirovecii pneumonia (PCP)?
Bactrim Prophylaxis in high risk HIV+ patients: - history of previous PCP - CD4 count < 200 - Oropharyngeal thrush
42
What is one of the leading causes of opportunistic infection in HIV-infected individuals?
Pneumocystis jirovecii pneumonia (PCP)
43
What symptoms are associated with Pneumocystis jirovecii pneumonia (PCP)?
Gradual onset: - Fever - Nonproductive cough - Progressive dyspnea
44
What is aspiration pneumonia?
Displacement of gastric contents to the lung causing injury and infection.
45
What are risk factors for aspiration pneumonia?
- Post-operative state - Neurologic compromise - Anatomical defect
46
What is the most common diagnostic finding on CXR to support aspiration pneumonia?
Right lower lobe infiltrate on chest x-ray
47
What antibiotics should be given for aspiration pneumonia?
``` - Piperacillin OR - Ampicillin OR - Clindamycin OR - Moxifloxacin ```

Clinical Med II (17 decks)

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