Common Outpatient conditions Flashcards

1
Q

treatment for acute bronchitis

A
  • cough suppressants such as codeine or dextromethophan
  • short acting beta-agnoists (controls symptoms - bronchospasm, wheeze, dyspnea and cough)
  • PO NSAIDS- Improves the associated contitutional sxs
  • antibiotics not recommended (acute bronchitis caused by pertussis infection is only indication)
  • decongestants (toopical & oral) - effective for nasal congestion
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2
Q

prevention of acute bronchitis?

A
  • influenza vaccine
  • zinc
  • pneumococcal vaccine indicated for chronic bronchitis
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3
Q
  • cough for up to 3 weeks
  • most commonly 2nd to common cold
  • but first step is to determine etiology
A

Acute cough

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4
Q
  • cough for more than 8 weeks
  • differential large, but also not emergency
  • most common etiologies: upper airway cough syndrome, asthma, and gastroesophogeal reflux disease
A

chronic cough

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5
Q

Top 4 chronic cough causes?

A

Upper airway cough syndrome
asthma
GERD
ACE inhibitors

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6
Q
  • # 1 cause of chronic cough in nonsmoking immunocompotent pt w/ normal CXR
  • dx: based on H&P
  • PE: draining posterior pharynx, nasal discharge, throat clearing, oropharyngeal cobblestoning
  • TX: PO or topical decongestant, 1st gen antihistamine, +/- SABA inhaler
A

upper airway cough syndrome

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7
Q
  • acid reflux stimulates the afferent limb of cough refelx or esophageal-brochial cough reflex
  • though sxs could be silent
  • therapy: oral PPI recommended
  • if poor respose to therapy- 24hr esophageal monitoring
A

GERD

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8
Q
  • cause cough in 5-20% of patients on these medications
  • women more often than men
  • not dose related
  • cough starts 1-6 weeks after initiation
  • tx: D/C medication, start ARB
A

ACE inhibitor

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9
Q
  • constantly occuring/ localized outbreaks
  • these are small changes in the virus that happen continually over time. Antigenic drift produces new virus strains that may not be reconized by the body’s immune system
  • ex. pts was infected with a particular flu viral, develops antibodies and gets infected with a new virus and antibody doesn’t recognize new virus
  • one of the main reason why you can get the flu multiple times
A

antigenic drift

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10
Q
  • occasionaly occurs/ more widespread
  • abrupt, major change in a virus, resulting in new hemagluttinin and/or new hemagglutinin and neuraminidase proteisn in viruses that infect hums
  • Results in a new virus subtype or a virus with a hemag. or hemagglutinin and neuramindase combo that has emerged from an animal pop. that is different from the subtype in humans
  • people have little or no protectin against the new virus
A

anteginc shift

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11
Q

High risk population for influenza

A
  • residents of nursing homes and chronic care facilites
  • adults >65 years of age
  • pregnant women and women up to two weeks postpartum. the risk of complicated influenza increased by trimester
  • individuals with chronic medical conditions
  • native americans and alaska natives
  • morbidly obese individuals
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12
Q

how do people infected with the influenza present?

A
  • abrupt onset of fever, HA, myalgia and malaise
  • accompanied by: URI, non-productive cough, ST, PND and rhinorrhea
  • febrile, oropharyngeal hyperemia, cervical adenopathy(more prominent in younger patients), chest exam unremarkable
  • sxs last, on average 2-5 days, possible a week or more
  • complications: #1 pneumonia (strep pneumo is most common but staph is #2
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13
Q

Influenza antiviral treatment

A

Neuraminidase inhibitors

  • < 1% resistanace found
  • reduces sxs by 1 day

Adamantines

  • due to high level of resistance- not used to treat influenza 2013

These medication should not be used to treat other respiratory viruses

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14
Q
  • MOA: interfere with the release of these new influenza virsues from infected cells. Which prevents new round of infection from starting
  • Medications: oseltamivir (tamiflu), Zanamivir
  • ADRS: GI (N/V) and rash, rare neuropsych effects (delirium, hallucinations, confusion)
A

Neuraminidase inhibitors

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15
Q
  • MOA: prevents viral replication by blocking the viral M2 protein ion channel, preventing fusion of the virus and host-cell membranes (prevents the uncoating of the viruse proceeding its entry into cells)
  • class is active only for influenza A, but high rate of viral resistance to this class
A

Influenza antiviral treatment

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16
Q
  • Route: IM or intradermal

recommended for

  • All individuals > 50y/o
  • healthy pregnant adults up to 49 y/o
  • immunocompromised hosts
  • pts with chronic neurologic disease (MS)

Does no interfere with immune response to IIVS or lAIVs
Side effects: injection site pain and slight increased risk of Guillain-Barre

A

Inactivated influenza vaccines

17
Q

Route: intranasal

Recommended for:

  • Healthy non-pregnant adults to 49 y/o
  • C/I in immunocompromised

Administer simultaneously with other LAIVs or wait 4 weeks between

Side effects: intranasal- rhinorrhea, congestion, HA and sore throat

A

Live attenuated influenza vaccine

18
Q
  • can be used to prevent influenza in high risk children not fully immunized
  • can be administerd simultaneously with IIV to cover till immune response
  • should not be given for 14 days after LAIV given
  • can be given for pre and post-exposure prophylaxis
A

chemoprophylaxis

19
Q
  • viral infection of the upper respiratory system, including the nose, throat, sinuses, eustachian tubes, trachea, larynx and bronchial tubes
  • 30-50% are caused by a group known as rhinoviruses
  • almos all clear up in less than two weeks without complications
  • sept-april with highest incidence in children 3-10 y/o
  • incubation period: 24-72hrs
  • frequent trigger for asthma and COPD exacerbations
A

Viral URI

20
Q

what are physical exam findings of the common cold?

A
  • conjunctival injection
  • nasal mucosal edema
  • nasal congestion
  • pharyngeal erythema
  • +/- adenopathy
    clear lung exam
21
Q

treatment of the common cold?

A
  • mainstay- symptomatic therapy
  • reassure and advise that it could take upt ot 14 days to fully resovle
22
Q

pharmacologic treatment options for common cold?

A
  • Ipratroprium bromide NS (atrovent) QID: for symptoms of sneezing and rhinorrhea relief, no affect on nasal congestion
  • cromolyn sodium NS: mild improvement in rhinorrhea, throat pain and cough
  • PO antihistamines: significant improvement in sneezing and rhinorrhea
  • antitussives: mroe beneficial for chronic cough, not acute URI sxs
  • decongestants: effective for nasal congestion
23
Q
  • Characterized by self-limited inflammation of the bronchi and clinically expressed as cough, which may include sputum production
  • generally caused by a virus
  • PE: diffuse wheezing due to bronchospasm, ronchi on auscultation (clears after cough), rhinorrhea, conjunctivitis, +/- adenopathy
A

Acute Bronchitis