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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
Q

what is the etiology of pertussis?

A

bordetella pertussis

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26
Q

pertussis occurs in who mostly?

A

< 2 y/o

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27
Q

how is pertussis transmitted?

A

respiratory droplets

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28
Q

what is the incubation period for pertussis?

A

7-17 days

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29
Q

what are the three stages of pertussis?

A

catarrhal
paroxysmal
convalescent

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30
Q

what is the catarrhal stage of pertussis?

A

1-2 weeks of malaise, rhinorrhea, mild cough, mild fever, lacrimation, and conjunctival injection

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31
Q

what is the paroxysmal stage of pertussis?

A

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

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32
Q

what is the convalescent stage of pertussis?

A

1-2 weeks of gradual reduction in frequency and severity of cough

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33
Q

what is the treatment for pertussis?

A

macrolide any

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34
Q

what will you see on the CBC for pertussis?

A

elevated white count

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35
Q

what is prevention for pertussis?

A 
vaccination
DTap - infants
Tdap booster for 11-18 y/o
single tdap dose - all adults
Tdap 27-36 weeks gestation for pregnant women
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36
Q

what are common serious complications in under 1 y/o

A

apnea and hospitalization

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37
Q

what can cough lead to in pertussis?

A

subconjunctival hemorrhage, abdominal wall hernia, rib fractures, urinary incontinence, lumbar strain

38
Q

how is PNA transmitted?

A

respiratory droplet

39
Q

what are the classifications of PNA?

A

CAP
HAP
VAP

40
Q

what is the most common cause of CAP?

A

Strep pneumo

41
Q

what are atypical causes of CAP?

A

mycoplasma pneumoniae
chlamydophila pneumoniae
legionella spp.

42
Q

what is the main viral cause of CAP?

A

influenza

43
Q

what are symptoms of CAP?

A

fever, cough, myalgia, sweats, GI symptoms, mental status changes, pleurisy

44
Q

what are signs of CAP?

A 
tachypnea
tachycardia
low O2 sat
rales 
signs of consolidation
45
Q

What is the presentation of S. pneumoniae?

A

sudden onset of chills

rust colored sputum

46
Q

What is the presentation of M. pneumoniae?

A

children and adolescents
asymptomatic or mild
CXR - reticulonodular pattern and/or patchy areas of consolidation

47
Q

What is the presentation of Legionella?

A

watery diarrhea
confusion or encephalopathy
outbreaks usually from contaminated water sources

48
Q

What is the presentation of MRSA?

A

cavitary infiltrate or necrosis
gross hemoptysis
rapidly increasing pleural effusion

49
Q

What is the presentation of Klebsiella pneumoniae?

A

alcohol abuse disorder, DM, severe COPD

currant jelly sputum

50
Q

what would you see on CXR for CAP?

A

demonstrable infiltrate: lobar, interstitial, cavitation

51
Q

what is the purpose of the pneumonia severity index (PSI)?

A

helps decide whether pt should be inpatient or outpatient

52
Q

what is the CURB 65 score?

A 
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
Q

what do the CURB 65 scores tell you?

A

0 outpatient
1-2 = consider hospitalization
3-4 urgent/assess for ICU care

54
Q

what med do you give to someone with CAP and no other problems in outpatient setting?

A

macrolide or doxycycline

55
Q

what med do you give to someone with CAP and have other comorbidities like respiratory, cardiac, kidney, diabetes, etc. in outpatient setting?

A

respiratory fluroquinolone

56
Q

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?

A

respiratory fluoroquinolone OR beta-lactam plus macrolide

57
Q

what are your first-line beta-lactam choices for someone with CAP

A

high dose amoxicillin or augmentin

58
Q

if pt with CAP is allergic to PCN, what could you give them instead?

A

ceftriaxone, cefpodozime, or cefuroxime

59
Q

how long should your pt with CAP be on antibiotics in outpatient setting?

A

at least 5 days

60
Q

what is the duration of time for fever and cough/fatigue in pt with CAP?

A

3 days for fever

14 days for cough and fatigue

61
Q

what is the median time of return to work in a pt with CAP?

A

6 days

62
Q

what is the treatment for a pt with CAP admitted to hospital, non-ICU?

A

respiratory fluroquinolone OR beta-lactam plus macrolide

63
Q

what is the treatment for a pt with CAP admitted to the ICU?

A

anti-pneumoccocal beta-lactam plus azithromycin OR anti-pneumococcal beta-lactam PLUS respiratory fluoroquinolone OR respiratory fluroquinolone plus aztreonam (in PCN allergic pts)

64
Q

what ICU pts with CAP are at risk for pseudomonas?

A 
alcohol use d/o
CF
neutropenic fever
recent intubation
cancer
organ failure
septic shock
65
Q

what ICU pts with CAP are at risk for MRSA?

A

ESRD
IV drug abuse
prior antibiotic use
influenza

66
Q

if pt with CAP in the ICU is at pseudomonas risk, what are the treatment options?

A

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
Q

if pt with CAP in the ICU is at risk for MRSA, what do you add?

A

vancomycin or linezolid

68
Q

what are criteria for change to oral treatment in pts with CAP?

A

improving clinically overall
hemodynamically stable
able to take oral medications
improvement in fever, respiratory status, and WBC

69
Q

in a pt with CAP, what is the duration of treatment?

A 
minimum of 5 days and:
afebrile for 48-72 hours
supplemental O2 not needed
HR <100
RR <24
SBP 90 or greater
70
Q

what should you tell the pt with CAP to stop doing?

A

smoking

71
Q

what are complications with CAP

A 
bacteremia
sepsis
heart failure
MI
arrhythmia
72
Q

what vaccinations should a pt that 65 and older get for CAP prevention?

A

PCV13 (First) and PPSV23

influenza vaccine

73
Q

what kinds of pts that are 2-64 y/o should get the PPSV23 or PCV13?

A

pts at high risk or 19-64 y/o that smoke cigarettes

74
Q

define HAP (nosocomial)

A

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

75
Q

define VAP

A

a type of HAP that develops more than 48-72 hours after endotracheal intubation

76
Q

what causes HAP and VAP?

A

aerobic gram-neg bacilli

gram-pos cocci

77
Q

how to diagnose HAP/VAP?

A

new lung infiltrate plus evidence that the infiltrate is of infectious origin

  • new onset of fever
  • purulent sputum
  • leukocytosis
  • decline in oxygenation
78
Q

what are risk factors for MRD pathogens?

A

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
Q

what is the duration of treatment for HAP/VAP?

A

14-21 days

pts that respond to initial treatment may limit to 7 days

80
Q

what further evaluation could you do for non-resolving PNA?

A

chest CT
fiberoptic bronchoscopy
thoracoscopy
open lung biopsy

81
Q

what are examples of fungal PNAs?

A

histoplasmosis
blastomycosis
coccidiodomycosis
pneumocystis jirovecii pneumoni (HIV-related)

82
Q

what is the etiology of pneumocystis pneumonia?

A

pneumocystis jirovecii

83
Q

what is the most common opportunistic infection in patients with AIDS?

A

pneumocystis pneumonia

84
Q

what are risk factors of pneumocystis pneumonia?

A

prior PCP episode, oral thrush, recurrent bacterial PNA, unintentional weight loss, high plasma HIV RNA level

85
Q

what is the clinical presentation of a pt with pneumocystis pneumonia?

A

fever, cough, dyspnea
fatigue, chills, chest pain, weight loss
tachypnea, crackles, rhonchi, often co-infected with oral thrush

86
Q

how to treat pneumocystis pneumonia?

A

bactrim x 21 days +/- corticosteroids

87
Q

define aspiration PNA

A

displacement of gastric contents to the lung causing injury and infection

88
Q

what are risk factors for aspiration PNA

A

ALOC
CNS disease
dysphagia
tracheal/NG tube

89
Q

how does pt with aspiration PNA present?

A

cough with foul smelling purulent

poor dentition

90
Q

what can you see on CXR in someone with aspiration PNA?

A

RLL infiltrate COMMON

cavitary consolidation, air-fluid level

91
Q

how do you get a culture in a pt with aspiration PNA?

A

transthoracic aspiration
thoracentesis
bronchoscopy

92
Q

what ABX can you use to treat a pt with aspiration PNA?

A

clindamycin or augmentin

OR
PCN plus metronidazole

foundations pulm exam (10 decks)

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