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Exam 2: Bronchitis Flashcards

1
Q

What constitutes acute bronchitis?

A

A cough lasting more than 5 days

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2
Q

What constitutes chronic bronchitis?

A

Cough and sputum production on most days of the most, at least 3 months out of the year in 2 consecutive years

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3
Q

What is the most common etiology of bronchitis? Examples?

A

Viral

Influenza A and B, parainfluenza, coronavirus, rhinovirus, HSV

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4
Q

What is the only bacterial cause of bronchitis in which you should treat with antibiotics?

A

Bordetella pertussis

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5
Q

Does presence of purulent sputum production indicate bacterial infection?

A

No

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6
Q

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?

A

Acute bronchitis

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7
Q

What should you not hear on lung auscultation in a patient with acute bronchitis?

A

Crackles or signs of consolidation

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8
Q

When should you order a CXR for a patient with acute bronchitis?

A
  • Fever
  • tachypnea
  • tachycardia
  • evidence of consolidation of auscultation
  • cough lasting more than 3 weeks
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9
Q

What medications can toy use for symptomatic relief in bronchitis?

A
  • NSAIDs, aspirin, Tylenol
  • Intranasal ipratropium
  • Antitussives (avoid codeine)
  • B2 agonist
  • OTC products such as cough drops, tea, honey, expectorants
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10
Q

Whooping cough is also known as?

A

Pertussis

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11
Q

What is the etiology of pertussis?

A

Bordetella pertussis

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12
Q

What is the clinical presentation of pertussis?

A

Coughing fits followed by the classic whooping sound, prolonged progressive cough

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13
Q

What are the 3 phases of pertussis?

A

1) catarrhal
2) paroxysmal
3) Convalescent

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14
Q

What are the symptoms of the catarrhal phase of pertussis and how long does it last?

A

URI symptoms, fever

Lasts 1-2 weeks

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15
Q

What are the symptoms of the paroxysmal phase of pertussis and how long does it last?

A

Persistent paroxysmal cough, inspiratory whooping, post-tussive emesis

Lasts 2-6 weeks

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16
Q

What are the symptoms of the convalescent phase of pertussis and how long does it last?

A

Cough gradually resolves

Lasts weeks to months

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17
Q

What is the gold standard of diagnosis of pertussis?

A

Bacterial culture

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18
Q

When you suspect pertussis, how should you treat it?

A

Empiric therapy may be initiated while obtaining a diagnostic test for confirmation.
-Abx treatment decreases transmission, but has little effect on symptom resolution

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19
Q

What are the two methods for diagnosing pertussis?

A

Nasopharyngeal secretions (bacterial culture and PCR)

Serology

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20
Q

What antibiotics are recommended for pertussis treatment?

A

Macrolides

  • Azithromycin 500mg PO followed by 250mg for 4 days
  • Clarithromycin 500mg PO BID for 7 days
  • Erythromycin 500mg PO QID for 14 days
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21
Q

What is the alternative antibiotics to macrolides to treat pertussis?

A

Bactrim DS PO BID for 14 days

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22
Q

What is the best way to prevent pertussis?

A

Vaccinations and Abx prophylaxis

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23
Q

What are the high risks populations for influenza?

A

Children <2, adults >65, underlying chronic disease, immunosuppressed, pregnant, obese, and residents of nursing homes

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24
Q

Patient presents with abrupt onset of fever, HA, myalgia, and malaise. Febrile on exam with mild cervical lymphadenopathy. What are you suspicious of?

A

Influenza

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25
Q

What is important to remember about rapid influenza diagnostic tests?

A

During periods of peak influenza activity, negative rapid antigen tests do no reliably exclude influenza

26
Q

What are the 3 methods of diagnosing influenza and how long does each take?

A
  • Rapid influenza diagnostic test (10-30 minutes)
  • PT-PCR (2-6 hours)
  • VIral culture (48-72 hours)
27
Q

When does antiviral therapy need to be initiated for influenza in order for it to be effective? What is the effect?

A

If started within 48 hours of symptom onset, will reduce symptom duration by 1-3 days

28
Q

What drugs are used to treat influenza?

A

Neuraminidase inhibitors (Oseltamivir and Zanamivir)

29
Q

What is the most common complication of influenza?

30
Q

What is it called when you have an acute infection of pulmonary parenchyma with inflammation and consolidation of lung tissue from an infectious agent?

31
Q

What is the most common etiology of typical CAP?

A

S. Pnuemoniae

32
Q

What are the 4 routes of transmission for CAP?

A
  • Aspiration from the oropharynx (most common)
  • inhalation of contaminated droplets
  • hematogenous spread
  • Extension from infected pleural or mediastinal space
33
Q

What is the most common cause of atypical CAP?

A

Mycoplasma pneumoniae

34
Q

Fungal CAP is unusual in what populations?

A

Immunocompetent hosts

35
Q

What is the typical clinical presentation of CAP?

A

Abrupt onset of fever, cough, sputum production, dyspnea, night sweats, and pleuritic chest pain

36
Q

What will be seen on CXR in a patient with CAP?

A

Infiltrate on plain chest radiograph with possible lobar consolidation, interstitial infiltrates, and cavitation

37
Q

What will be seen on CBC in a patient with CAP?

A

Leukocytosis (15-30) with a left shift

38
Q

What are the possible complications of PNA?

A

Bacteremia, sepsis, abscess, empyema, and respiratory failure

39
Q

What is CURB-65 used for and what are the components?

A

Used to evaluate severity of PNA

Confusion
Urea >7, BUN >20
Respiratory rate >30
Blood pressure  (SBP <90 or DBP <60)
65-age >65 years old
40
Q

At what CURB-65 score would you admit to the hospital? Admit to ICU?

A

Hospital: 2
ICU: 3

41
Q

How long should antibiotics be given for CAP?

A

At least 5 days

42
Q

What is uncomplicated CAP?

A

Previously healthy patient with no antibiotic use within the last 3 months

43
Q

What antibiotics should you give for uncomplicated CAP?

A
  • Macrolide (azithromycin 500mg on day one, followed by 4 days of 250mg per day)
  • Or doxycycline 100mg BID for 7-10 days
44
Q

What is complicated CAP?

A

Patient with recent antibiotic use, COPD, renal or liver disease, CA, DM, chronic heart disease, alcoholism, asplenia, or immunosuppresion

45
Q

What antibiotics should be given for complicated CAP?

A
  • Combination of Beta lactam and a macrolide (Augmentin 500mg BID and azithromycin)
  • Or respiratory fluoroquinolone (Levofloxacin 750mg daily for 5 days)
46
Q

What are the complications for CAP when you should consider pseudomonas risk?

A

Alcoholism, cystic fibrosis, neutropenia fever, CA, recent intubation, organ failure, and shock

47
Q

What are the complications of CAP when you should consider MRSA?

A

ESRD, IVDA, prior Abx use, and flu

48
Q

When is inpatient treatment indicated for CAP?

A

-Minimum of 5 days of antibiotics and afebrile for 48-72 hours, supplemental O2 not needed, Heart rate less than 100, RR less than 24, and SBP greater than 90

49
Q

What is HAP?

A

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

50
Q

What patients are at highest risk for HAP?

A

ICU patients and Pseudomonas Aeruginosa has worst prognosis

51
Q

What is VAP?

A

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

52
Q

How is HAP or VAP diagnosed?

A

-New or progressive infiltrate on lung imaging and at least two of the following: fever, purulent sputum, or leukocytosis

53
Q

What tests are indicated with HAP and VAP?

A

Sputum gram stain and culture

54
Q

What PNA is associated with HIV?

A

Pneumocystis Jirovecii PNA

55
Q

What are the clinical findings with Pneumocystis Jirovecii PNA?

A
  • High LDH
  • low CD4
  • CXR with reticular ground glass opacities
  • Sputum
56
Q

What is the treatment for Pneumocystis Jirovecii PNA?

57
Q

What is the aspiration PNA?

A

Displacement of gastric contents into the lung causing injury and infection

58
Q

What is the etiology of aspiration PNA?

A

Gram negative and anaerobic pathogens

59
Q

What are the risk factors for aspiration PNA?

A
  • Post op state
  • neurologic compromise
  • Anatomical defect
60
Q

What is the gold standard for diagnosis of CAP?

61
Q

What antibiotics are given for aspiration PNA?

A

Piperacillin/ tazobactam, or Ampillcin/sulbactam OR Clindamycin OR moxifloxacin

62
Q

What is the leading cause of opportunistic infection in HIV patients?

A

Pneumocystis Jirovecii PNA

Clinical Medicine 2 (22 decks)

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