Exam 2: Bronchitis Flashcards
What constitutes acute bronchitis?
A cough lasting more than 5 days
What constitutes chronic bronchitis?
Cough and sputum production on most days of the most, at least 3 months out of the year in 2 consecutive years
What is the most common etiology of bronchitis? Examples?
Viral
Influenza A and B, parainfluenza, coronavirus, rhinovirus, HSV
What is the only bacterial cause of bronchitis in which you should treat with antibiotics?
Bordetella pertussis
Does presence of purulent sputum production indicate bacterial infection?
No
Patient presents with cough, wheezing, mild dyspnea,and is afebrile. On physical exam, there is wheezing, bronchospasm with reduced FEV1, and rhonchi. What are you suspicious of?
Acute bronchitis
What should you not hear on lung auscultation in a patient with acute bronchitis?
Crackles or signs of consolidation
When should you order a CXR for a patient with acute bronchitis?
- Fever
- tachypnea
- tachycardia
- evidence of consolidation of auscultation
- cough lasting more than 3 weeks
What medications can toy use for symptomatic relief in bronchitis?
- NSAIDs, aspirin, Tylenol
- Intranasal ipratropium
- Antitussives (avoid codeine)
- B2 agonist
- OTC products such as cough drops, tea, honey, expectorants
Whooping cough is also known as?
Pertussis
What is the etiology of pertussis?
Bordetella pertussis
What is the clinical presentation of pertussis?
Coughing fits followed by the classic whooping sound, prolonged progressive cough
What are the 3 phases of pertussis?
1) catarrhal
2) paroxysmal
3) Convalescent
What are the symptoms of the catarrhal phase of pertussis and how long does it last?
URI symptoms, fever
Lasts 1-2 weeks
What are the symptoms of the paroxysmal phase of pertussis and how long does it last?
Persistent paroxysmal cough, inspiratory whooping, post-tussive emesis
Lasts 2-6 weeks
What are the symptoms of the convalescent phase of pertussis and how long does it last?
Cough gradually resolves
Lasts weeks to months
What is the gold standard of diagnosis of pertussis?
Bacterial culture
When you suspect pertussis, how should you treat it?
Empiric therapy may be initiated while obtaining a diagnostic test for confirmation.
-Abx treatment decreases transmission, but has little effect on symptom resolution
What are the two methods for diagnosing pertussis?
Nasopharyngeal secretions (bacterial culture and PCR)
Serology
What antibiotics are recommended for pertussis treatment?
Macrolides
- Azithromycin 500mg PO followed by 250mg for 4 days
- Clarithromycin 500mg PO BID for 7 days
- Erythromycin 500mg PO QID for 14 days
What is the alternative antibiotics to macrolides to treat pertussis?
Bactrim DS PO BID for 14 days
What is the best way to prevent pertussis?
Vaccinations and Abx prophylaxis
What are the high risks populations for influenza?
Children <2, adults >65, underlying chronic disease, immunosuppressed, pregnant, obese, and residents of nursing homes
Patient presents with abrupt onset of fever, HA, myalgia, and malaise. Febrile on exam with mild cervical lymphadenopathy. What are you suspicious of?
Influenza