Chapter 64: Acute Bronchitis and Upper Respiratory Tract Infection

Question 1

Self-limited respiratory infection causing inflam- mation of the large airways characterized by cough without evidence of pneumonia

Answer 1

Acute bronchitis

Question 2

Infection of the upper respiratory tract, primarily affecting the nasal mucosa causing congestion, rhinorrhea, and sneezing

Answer 2

Common colds

Question 3

A respiratory illness with fever, myalgias, cough, and fatigue.

Answer 3

Influenza

Question 4

Most common causative agents of acute bronchitis?

Answer 4

Viruses

Question 5

Most common bacterial isolates in acute bronchitis?

Answer 5

H. influenza and S. pneumoniae

Question 6

How many days of symptoms for you to consider acute bronchitis?

Answer 6

more than 5 days to 4 weeks

Question 7

To differentiate bacterial from viral etiology of lower respiratory infections? What will you order?

Answer 7

calcitonin and rapid point-of-care molecular viral testing

Question 8

Patient with acute bronchitis should avoid B2-agonist except?

Answer 8

with evidence of airflow obstruction (wheezing)

Question 9

use to provide modest relief of cough with acute bronchitis

Answer 9

Benzonatate and guiafenesin

Question 10

When is the peak activity of common colds?

Answer 10

Autumn months (up to 8 times in children)

Question 11

Most common causative agent of common colds

Answer 11

Rhinovirus

Question 12

What is the incubation period of common colds?

Answer 12

10-12 hours

Question 13

Topical nasal decongestants that provide moderate benefit in reducing nasal airway resistance in common colds

Answer 13

Oxymetazoline

Question 14

At what age were you able to give cough and colds preparations without harm?

Answer 14

more than 6 years old

Question 15

This etiologic agent can cause seasonal, endemic, and pandemic infections of influenza

Answer 15

Orthomyxoviridae

Question 16

This etiologic agent account for most seasonal influenza epidemic

Answer 16

Influenza viruses A and B

Question 17

What is the incubation period of influenza?

Answer 17

1-4 days

Question 18

Complications of influenza

Answer 18

• Bacterial pneumonia
• Viral pneumonia
• Severe hypoxemic respiratory failure

Question 19

Prominent symptoms of influenza?

Answer 19

Fever and intense myalgia

Question 20

When is the testing for influenza is preferred?

Answer 20

onset of symptoms and use swab or aspirates

Question 21

What type of obese is at higher risk for complications of influenza infection?

Answer 21

morbidly obese (BMI =/>40kg/m2)

Question 22

What age group is at higher risk for complications of influenza infection?

Answer 22

Children <5y (especially <2y) and adults =/>65y

Question 23

Neuraminidase inhibitors for influenza A and B

Answer 23

• Oral oseltamivir 75mg bid x 5 days
• Inhaled zanamivir 10mg bid x 5 days
• Intravenous peramivir 600mg tiv single dose

Question 24

Antivirus approved in 2018 that inhibits endonuclease involved in viral RNA replication

Answer 24

Baloxavir 40mg/tab single dose then 2 tabs OD if patient weighs over 80kg

Question 25

When is the best time to start antiviral in patients with influenza?

Answer 25

first 48 hours of symptoms

Question 26

What is the causative agent of pertussis (whooping cough)?

Answer 26

gram-negative rod B. pertussis

Question 27

What age group is the usual sources of infection?

Answer 27

school-age children

Question 28

A vaccine for pertussis that effective for about 10 years and is used in developing country

Answer 28

Whole-cell pertussis

Question 29

Acellular vaccine

Answer 29

The acellular diphtheria, tetanus, and pertussis vaccine (DTaP), developed to remove toxins from the cell membrane, does not protect as long as the whole-cell vaccine and is typically used in the developed world

Question 30

The typical immunization schedule for pertussis?

Answer 30

2, 4, 6 and 18 months of age with a booster at age 5. Adolescent should recieve a DTaP booster

Question 31

If an adult patient is unimmunized. What is the recommended immunization?

Answer 31

one dose of DTaP

Question 32

True or False:

There is no lifelong immunity after a clinical episode of pertussis?

Answer 32

True

Question 33

When to consider that patient is with pertussis?

Answer 33

cough of >2 weeks in duration

Question 34

True or False:

If elderly patient with >2 weeks of cough and presented with pneumonia in xray. Would it suggest a pertussis infectin?

Answer 34

False

Pertussis in adults is not associated with pneumonia

Question 35

What is the treatment for pertussis?

Answer 35

• Azithromycin 500mg/tab on day 1 then 250mg/tab on day 2-5

- Trimethoprim-Sulfamethoxazole 160mg/800mg BID for 14 days