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foundations pulm exam > flu, bronchitis, PNA > Flashcards

flu, bronchitis, PNA Flashcards

1
Q

how is the flu transmitted?

A

respiratory droplet and contact

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2
Q

etiology of influenza?

A

influenza virus, type A&B

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3
Q

how long is incubation period for flu?

A

1-4 days

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4
Q

what are symptoms of the flu?

A 
abrupt onset
headache
fever/chills
myalgia
malaise
cough
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5
Q

what physical exam findings do you see with flu?

A

hot, dry skin
PND
mild cervical LAD
negative chest exam

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6
Q

what is first line diagnostic test for flu?

A

RAT

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7
Q

what indications are there for flu treatment?

A

illness requiring hospitalization
progress, severe, or complicated illness
high risk for complications

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8
Q

who are high risk flu groups?

A 
extremes of age
chronic illnesses
immunosuppression
pregnancy or post-partum (2 weeks)
children <19 y/o on chronic ASA therapy
american indians and alaskan natives
morbidly obese (BMI >40)
nursing home residents
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9
Q

what medication treats the flu?

A

antiviral meds: neuraminidase inhibitors for influenza A/B
oseltamivir (tamiflu)
zanamivir (relenza)
peramivir (rapivab)

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10
Q

when should you initiate medication tx?

A

within first 24-48 hours

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11
Q

what are adverse effects of tamiflu?

A

N/V

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12
Q

what are adverse effects of relenza?

A

bronchospasm, decreased respiratory function

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13
Q

what are complications of flu?

A 
pneumonia
sinusitis
otitis media
rhabdomyolysis
CNS involvement
cardiac complication
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14
Q

who needs the flu vaccine?

A

+6 months and up

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15
Q

how many flu shots does a first-time child get?

A

two vaccines administered 4 weeks or more apart

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16
Q

can someone with egg allergy receive a flu vaccine?

A

yes, if the allergy is severe, they can get the vaccine in a medical setting

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17
Q

do adults 65+ get the same flu vaccine as someone younger?

A

no, they get a HIGHER dose vaccine

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18
Q

what is the gold standard for influenza dx?

A

viral culture

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19
Q

what is the main cause of acute bronchitis

A

viral

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20
Q

what is the bacterial cause of acute bronchitis that needs treatment?

A

bordetella pertussis (need ABX)

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21
Q

what is the clinical presentation of acute bronchitis?

A 
cough > 5 days (usually 1-3 weeks)
afebrile
chest wall tenderness
wheezing
mild dyspnea
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22
Q

what do you see on physical exam for acute bronchitis

A

wheezing
rhonchi (clears with coughing)
negative for rales and signs of consolidation

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23
Q

any specific diagnostics for acute bronchitis?

A

no

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24
Q

how do you manage acute bronchitis?

A

symptomatic treatment?

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25
what is the etiology of pertussis?
bordetella pertussis
26
pertussis occurs in who mostly?
< 2 y/o
27
how is pertussis transmitted?
respiratory droplets
28
what is the incubation period for pertussis?
7-17 days
29
what are the three stages of pertussis?
catarrhal paroxysmal convalescent
30
what is the catarrhal stage of pertussis?
1-2 weeks of malaise, rhinorrhea, mild cough, mild fever, lacrimation, and conjunctival injection
31
what is the paroxysmal stage of pertussis?
begins in 2nd week and can last 2-3 months; paroxysmal cough (sudden bursts of rapid, consecutive coughs followed by a deep high pitched inspiration +/- syncope or emesis
32
what is the convalescent stage of pertussis?
1-2 weeks of gradual reduction in frequency and severity of cough
33
what is the treatment for pertussis?
macrolide any
34
what will you see on the CBC for pertussis?
elevated white count
35
what is prevention for pertussis?
``` vaccination DTap - infants Tdap booster for 11-18 y/o single tdap dose - all adults Tdap 27-36 weeks gestation for pregnant women ```
36
what are common serious complications in under 1 y/o
apnea and hospitalization
37
what can cough lead to in pertussis?
subconjunctival hemorrhage, abdominal wall hernia, rib fractures, urinary incontinence, lumbar strain
38
how is PNA transmitted?
respiratory droplet
39
what are the classifications of PNA?
CAP HAP VAP
40
what is the most common cause of CAP?
Strep pneumo
41
what are atypical causes of CAP?
mycoplasma pneumoniae chlamydophila pneumoniae legionella spp.
42
what is the main viral cause of CAP?
influenza
43
what are symptoms of CAP?
fever, cough, myalgia, sweats, GI symptoms, mental status changes, pleurisy
44
what are signs of CAP?
``` tachypnea tachycardia low O2 sat rales signs of consolidation ```
45
What is the presentation of S. pneumoniae?
sudden onset of chills | rust colored sputum
46
What is the presentation of M. pneumoniae?
children and adolescents asymptomatic or mild CXR - reticulonodular pattern and/or patchy areas of consolidation
47
What is the presentation of Legionella?
watery diarrhea confusion or encephalopathy outbreaks usually from contaminated water sources
48
What is the presentation of MRSA?
cavitary infiltrate or necrosis gross hemoptysis rapidly increasing pleural effusion
49
What is the presentation of Klebsiella pneumoniae?
alcohol abuse disorder, DM, severe COPD | currant jelly sputum
50
what would you see on CXR for CAP?
demonstrable infiltrate: lobar, interstitial, cavitation
51
what is the purpose of the pneumonia severity index (PSI)?
helps decide whether pt should be inpatient or outpatient
52
what is the CURB 65 score?
``` inpatient/outpatient Confusion Urea >7 (BUN > 20 mg/dL) RR > 30 breaths/min BP (SBP <90 or DBP 60 or less) 65 and older ```
53
what do the CURB 65 scores tell you?
0 outpatient 1-2 = consider hospitalization 3-4 urgent/assess for ICU care
54
what med do you give to someone with CAP and no other problems in outpatient setting?
macrolide or doxycycline
55
what med do you give to someone with CAP and have other comorbidities like respiratory, cardiac, kidney, diabetes, etc. in outpatient setting?
respiratory fluroquinolone
56
if a patient with CAP has used an ABX within the past 3 months or has macrolide resistant S. pneumo, what are your medication choices?
respiratory fluoroquinolone OR beta-lactam plus macrolide
57
what are your first-line beta-lactam choices for someone with CAP
high dose amoxicillin or augmentin
58
if pt with CAP is allergic to PCN, what could you give them instead?
ceftriaxone, cefpodozime, or cefuroxime
59
how long should your pt with CAP be on antibiotics in outpatient setting?
at least 5 days
60
what is the duration of time for fever and cough/fatigue in pt with CAP?
3 days for fever | 14 days for cough and fatigue
61
what is the median time of return to work in a pt with CAP?
6 days
62
what is the treatment for a pt with CAP admitted to hospital, non-ICU?
respiratory fluroquinolone OR beta-lactam plus macrolide
63
what is the treatment for a pt with CAP admitted to the ICU?
anti-pneumoccocal beta-lactam plus azithromycin OR anti-pneumococcal beta-lactam PLUS respiratory fluoroquinolone OR respiratory fluroquinolone plus aztreonam (in PCN allergic pts)
64
what ICU pts with CAP are at risk for pseudomonas?
``` alcohol use d/o CF neutropenic fever recent intubation cancer organ failure septic shock ```
65
what ICU pts with CAP are at risk for MRSA?
ESRD IV drug abuse prior antibiotic use influenza
66
if pt with CAP in the ICU is at pseudomonas risk, what are the treatment options?
antipneumococcal, antipseudomonal beta lactam PLUS ciprofloxacin or levofloxacin OR above beta-lactam PLUS aminoglycoside PLUS azithromycin OR above beta-lactam PLUS aminoglycoside PLUS respiratory fluroquinolone
67
if pt with CAP in the ICU is at risk for MRSA, what do you add?
vancomycin or linezolid
68
what are criteria for change to oral treatment in pts with CAP?
improving clinically overall hemodynamically stable able to take oral medications improvement in fever, respiratory status, and WBC
69
in a pt with CAP, what is the duration of treatment?
``` minimum of 5 days and: afebrile for 48-72 hours supplemental O2 not needed HR <100 RR <24 SBP 90 or greater ```
70
what should you tell the pt with CAP to stop doing?
smoking
71
what are complications with CAP
``` bacteremia sepsis heart failure MI arrhythmia ```
72
what vaccinations should a pt that 65 and older get for CAP prevention?
PCV13 (First) and PPSV23 | influenza vaccine
73
what kinds of pts that are 2-64 y/o should get the PPSV23 or PCV13?
pts at high risk or 19-64 y/o that smoke cigarettes
74
define HAP (nosocomial)
48 hours or more after admission and did not appear to be incubating at the time of admission
75
define VAP
a type of HAP that develops more than 48-72 hours after endotracheal intubation
76
what causes HAP and VAP?
aerobic gram-neg bacilli | gram-pos cocci
77
how to diagnose HAP/VAP?
new lung infiltrate plus evidence that the infiltrate is of infectious origin - new onset of fever - purulent sputum - leukocytosis - decline in oxygenation
78
what are risk factors for MRD pathogens?
antimicrobial therapy in previous 90 days current hospitalization 5 days or greater admission from nursing home high frequency of ABX resistance in community immunosuppresive disease
79
what is the duration of treatment for HAP/VAP?
14-21 days | pts that respond to initial treatment may limit to 7 days
80
what further evaluation could you do for non-resolving PNA?
chest CT fiberoptic bronchoscopy thoracoscopy open lung biopsy
81
what are examples of fungal PNAs?
histoplasmosis blastomycosis coccidiodomycosis pneumocystis jirovecii pneumoni (HIV-related)
82
what is the etiology of pneumocystis pneumonia?
pneumocystis jirovecii
83
what is the most common opportunistic infection in patients with AIDS?
pneumocystis pneumonia
84
what are risk factors of pneumocystis pneumonia?
prior PCP episode, oral thrush, recurrent bacterial PNA, unintentional weight loss, high plasma HIV RNA level
85
what is the clinical presentation of a pt with pneumocystis pneumonia?
fever, cough, dyspnea fatigue, chills, chest pain, weight loss tachypnea, crackles, rhonchi, often co-infected with oral thrush
86
how to treat pneumocystis pneumonia?
bactrim x 21 days +/- corticosteroids
87
define aspiration PNA
displacement of gastric contents to the lung causing injury and infection
88
what are risk factors for aspiration PNA
ALOC CNS disease dysphagia tracheal/NG tube
89
how does pt with aspiration PNA present?
cough with foul smelling purulent | poor dentition
90
what can you see on CXR in someone with aspiration PNA?
RLL infiltrate COMMON | cavitary consolidation, air-fluid level
91
how do you get a culture in a pt with aspiration PNA?
transthoracic aspiration thoracentesis bronchoscopy
92
what ABX can you use to treat a pt with aspiration PNA?
clindamycin or augmentin OR PCN plus metronidazole

foundations pulm exam (10 decks)

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