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PCM IV Final > HYHO URI/Pneumonia > Flashcards

HYHO URI/Pneumonia Flashcards

1
Q

Common symtoms seen in URI/pneumonia?

A
    1. Cough with or wo sputum
    1. Fatigue/malaise
    1. Fever and dyspnea
    1. Rigors, pleuritic chest pain,
    1. Anorexia
    1. Preceding viral illness
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2
Q

How do typical vs atypical pneumonias present differently?

A

Typical => inflammatory response with cough

Atypical => less inflammation and less severe.

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3
Q

PE findings for URI?

A
  1. Increased work to breathe
  2. Retractions
  3. Adventitious breath sounds (crackles, rhonchi, wheezing)
  4. Hypoxemia
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4
Q

+ special tests that indicate URI

A
  1. Tactile fremitis
  2. Egophany/Bronchophany
  3. Dullness to percussion
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5
Q

DDx for NON-infectious causes of cough

A
  1. UACS (upper airway cough s=yndrome)
  2. Asthma/ COPD
  3. GERD
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6
Q

What is the most common cause of a chronic cough in healthy, non-smokers with a NL CXR?

A

UACS (allergic rhinitis and bacterial sinusitus(

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7
Q

What is the most sensitive and specific test used to diagnose GERD diseaes?

Is it required to diagnose GERD

A

24-hour esophageal pH monitoring; not required to dx GERD

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8
Q

What is the 1st line of treatment for GERD?

A

4-weeks on a PPI = diagnostic and therapeutic

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9
Q

After 4 weeks on a PPI, if GERD does NOT improve, what do we do?

A

Endoscopy

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10
Q

DDx for infectious cough and congestion

A
  • 1. Common cold/URI/viral
  • 2. Pharyngitis
  • 3. Sinusits
  • 4. Bronchitis
  • 5. Influenza
  • 6. Pneumonia
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11
Q

Acute Bronchitis

  • What is it?
  • Commonly presents in
  • Most commonly occurs in
  • Most common etiology
A
  • inflammation of the tracheobronchial tree that causes [increased mucus production and airway hyperresponsiveness] d/t a URI (often, viral)
  • Healthy adult as a cough that lasts 1-3 weeks
  • Winter (Nov-Feb)
  • Viral
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12
Q

Bacterial causes of acute bronchitis

A
  1. Mycoplasma
  2. Chlamydia pneumonia
  3. Bordatella pertussis
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13
Q

What is the initial phase and protracted phase of acute bronchitis

A

intial phase = cough and systemic systems occur due to infection/inflammation; no fever or low grade

protracted: bronchial hyperresponsivenss causes the coughing, without pulmonary disease

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14
Q

MC presentation of acute bronchitis

A

productive, purulent sputum

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15
Q

in acute bronchitis, is the color of the sputum diagnostic of of the presence of a BACTERIAL infection

A

no

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16
Q

testing and treatment of acute bronchitis

A
  • testing: no viral culture, serology or sputum analysis is needed
  • treatment: self-limited; lasts for less than 2 weeks but the cough can last for 2> months.
    • ABX ONLLLLLY for at-risk patients or when clinical suspician is high for CAP (even though NL CXR or if you think it is caused by bacteria
    • Bronchodilators
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17
Q

prevent acute bronchitis

A
  • wash hands, avoid tobacco/lung irritants, cough into elbow
  • avoid ABX for tx bc often viral
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18
Q

Rhinosinusitis

  • what is it
  • acute/subacute/chronic
  • how long does it last
  • MCC in adults and children
A
  • inflammation of nasal mucosa + 1 or more paranasal sinusesdue to obstruction of NL draining
  • acute (<4 weeks) subacute (4-12) chronic (>12)
  • viral = improves after 7-10 days; if it does not improve after 7 days in adults or 10 days in kids => think bacterial
  • MCC
    • adults = s. pneumonia & H. influenza
    • children = H. influze and moracella catarrhallas
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19
Q

Sx/Diagnosis of rhinosinutisis

A
  1. Purulent nasal discharge
  2. Maxillary dental/facial pain
  3. Unilaterally maxillary sinus is tender

Sx improve, then worsen.

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20
Q

First line therapy for rhinosinutis

A

Directed at infection:

Amoxicillin + trimethoprim-sulfamethazole (10-14 days)

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21
Q

Pharyngitis

  • What is it
  • MCC cause
  • Clinical course
  • Dx requires us to do what
A
  • Inflammtion of pharynx and tonxils = severe throat pain
  • Viral
  • In adults = benign and self-limited
  • RO other causes of severe throat pain
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22
Q

Pharyngitis

  • MCC in who
  • Common causes in teens/young adults
    • adults
    • pediatrics?
A
  • Pediatric pts (4-7 YO)
  • MCC in adolescents and young teens
    1. Myoplasma
    2. Chlamydia pneumonia
    3. Arcanobacterium
  • MCC in adults (15%) and pediatric (30%) patients
    • ​GroupASTrep
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23
Q

Diagnosis and findings of Pharyngitis

A
  1. Abrupt onset of sore throat and fever
  2. Petachiae on palate/tonsil
  3. Tender cervical adenopathy
  4. NOOOOO cough
  5. If GAS = sandpaper liek rash)
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24
Q

How to diagnose GAS

A

1. throat culture = gold standard

  1. Rapid strep antigen test.
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25
Q

How can we diagnosde GAS without a throat culture or rapid antigen test

A

CENTOR criteria

  • give a pt for:
    • fever of 100.4 or higher
    • no cough,
    • enlarged/tender cervical adenopathy,
    • swollen/exudative tonsils
  • one extra point of
    • ​pt is 3-14 YO
  • deduct one pt if
    • ​pt is >45YO
  • 0-1 = no more testing; no ABC
  • 2-3= perform rapid strep or throat culture and treat with ABX if +
  • 4+ = give empiric ABX treatment
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26
Q

Tx of GAS pharyngitis

A
  1. Penicillin
    1. if allergic => cephalosporin and macrolides.
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27
Q

what is the leading cause of mortality & morbidity in the world; what kind of symptoms does it cause?

A

pneumonia: sx range from (mild fever/productive cough => severe respiratory distress and sepsis)

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28
Q

What is CAP (community aquired pneumonia) vs nocosomial infection?

A
  • acute infection of the lung parenchyma that occurs OUTSIDE of the healthcare setting (nursing home, dialysis center, recently hospitalized)
  • Nocosomial = occurs in health care setting (hospital acquired pneumonia (HAP) or ventillatory-associated pneumonia VAP)
    *
29
Q

What is hospital aquired pneumonia

A

pneumonia acquired >48 hours after hospital admission.

30
Q

what is VAP (ventillator acquired pneumonia)

A

acquired >48 hours after endotracheal intubation.

31
Q

RF to pneumonia

A
    1. elderly
    1. known COPD
    1. HF or kidney failure
    1. DM
32
Q

what are sx and signs of pneumonia

A
  • sx = dyspnea, high fever, rigors, pleuritic CP, AMS
  • signs = abnormal VS = high fever, HR > 100 bpm; RR > 24 ;hypotension and hypoxia
33
Q

if pt presents with acute cough < 3 weeks and has sx, signs or RF to pneumonia, what do we do?

A

Obtain PA and lateral CXR

34
Q

MC bacterial of of pneumonia

A

s. pneumonia

35
Q

most severe cases of community acquired pneumonia are due to:

A

1. S. pneumo

2. Legionalla

36
Q

what do you see on diagnostic testing with CAP

A

1. Leukocytosis with a left shift or leukopenia

2. Elevated inflammatory markers: ESR/CRP/procalcitonin

3. Infilatrate on CXR if often required to dx; if immunocomponrised and cant produce a immune repsonse => CT.

37
Q

DDX for noninfectious illnesses that can mimic CAP or co-occur and cause a [pulmonary infiltrate and cough]

A
  • 1. CHF with pulmonary edema
  • 2. PE
  • 3. Pulmonary hemorrhage
  • 4. Atelectasis
38
Q

Strep. pneumonia

  • classically targets
  • classic lab findings
  • responds to what abx
A
  • elderly, young and immunocompromised
  • high LFTs, hyponatremia, leukocytosis
  • Penicillin, macrolides, fluoroquinolones
39
Q

what cause of bacterial pneumonia can cause [empyema and EXTENSIVE infiltrate on CXR]

40
Q

pneumonia caused by MRSA is MC in what settings

A
  1. healthcare related pneumonoia and recent hospitailiation
  2. recent ABX use (esp. fluroquinoogones) within the past 3 months
  3. Immunosupression
41
Q

pneumonia due to community-acquired methicillin resistant stap. aerus (CA-MRSA) most commonly occurs in whom?

A
  1. Younger, heathier people with ho skin/ST infection, contact sports, IV/IM drugs, crowded living conditions or MSM
42
Q

what cause of bacterial pneumonia is often very severe, causing necrotizing and cavitary pneumonias, empyema, hemoptysis, septic shock and respiratory failure

43
Q

what cause of pneumonia is MC in alcoholics or aspiration, causing a currant jelly hemoptysis

A

klebsiella

44
Q

What cause of pneurmonia causes [severe disease, mult infiltrates and systemic illness[ in ill patients, elderly, CF, hospitalized, ABX use and severe COPD

A

pseudomonas

45
Q

pseudomonas is NOT a ____ and common for it to be what?

A

NOT a CAP

ABX resistance = treat with >1 ABX

46
Q

what type of pneumonia occurs in [elderly, sickle cells, splenectomy, immunocompromsied]

A

haemophailus influnza

47
Q

what type of pneuimonia occurs in children due to hepB vaccine

A

haemophilus influenza

48
Q

atypical pneumonas

A

1. legionella

2. Clamydophilia

3. Mycoplasma

49
Q

What atypical pneumonia is the most common atypical agent in the elderly and what unique symptoms does it cause?

A
  • Legionella
  • GI symptoms and hyponatremia
50
Q

Legionella

    • how does it when occur differ from others?
  2. -If suspected, do what?
  3. -Associated with what?
  4. CXR fingings**
A
  1. all year; others decrease in summer
  2. get UA to detect antigen
  3. -itis (sinusitis, pancreatitis, myocarditis, pyelonephritis)
  4. patchy infiltrate, hilar adenopathy, pleural effusion
51
Q

how does chlamydophilia differ from legionella

A

similar CXR; but NO GI sx and milder sx.

52
Q

pneumonia that has sore throat and HA, occuring in cycles (every 4-8 years)

other key sx?

A

mycoplasma

bullous myringitis and NO GI sx

53
Q

treatment of CAP uncomplicated outpatient

A

macrolide (azithromycin/clarithromycin) or tetracyclin (doxycycline)

54
Q

treatment of CAP uncomplicated outpatient in pts with significant comorbidities/failed 1st-line treatment

A

[macrolide + penicilin/lactamase] OR [fluoroquinolone - levofloxacin/moxifloxaxin)

55
Q

what should aid in disposition (how we handle pneumonia

A

clinical decision tool (PSI/PORT score or Curb-65) + clinical judments

56
Q

what does CURB-65 measure

A
  • Confusion
  • Uremia > 7
  • RR > 30
  • BP (systolic <90 or diastolic <60)
  • >65 YO
57
Q

what pts with pneumonia get ambulatory care (outpatient)

A

healthy with NL vital signs (PSI of 1-2 or CURB of 0 or 1 if >65)

58
Q

PSI/PORT of

  • 1-3
  • 4-5
A

1-3 = outpatient

4-5 = inpatient

59
Q

what pts get admitted to hostpital with pneumonia

A

1. O2 sat <92% on RA

2. PSI >3

3. CURB-65 of >2 if over 65

60
Q

what pts get admitted to ICU with pneumonia

A
  1. Respiratory failure that needs mechanical ventillation, sepsis, AMS, hypotension that requires vasopressor
  2. Persistant high fever
  3. RR >30
  4. WBC >4000
61
Q

With ABX, most patients with pneumonia recover in ______; 50% will still have what sx after 30 days?

A

3-5 days with ABX

  • CP, malaise, dyspnea, cough
62
Q

3 pillars to prevent CAP

A
  • 1. Stop smoking
  • 2. Influenza vaccines for ALL pts
  • 3. Pneumococcal vaccine for AT-RISK pts
63
Q

intial manipulative treatment goal of pneumonia

A
  1. decrease parenchymal lung congestion
  2. decrease sympathetic hyper-reactivity of lung parenchyma
  3. Increase motion of thoracic cage and diaphram
64
Q

effective pneumonia treatment aims to optimize what 4 things?

A
  1. motion of thoracic cage
  2. function of the diaphragm
  3. increase lymphatic drainage (OPEN THORACIC INLET 1st)
  4. stabilize autonomics
65
Q

Pneumonia

  1. Sympathetics
  2. Parasympathetics
  3. Motor
A
  1. sympathetics = T2-7; increase tone will thicken secretions & dilate bronchiole dilation
  2. parasympathetics = OA, AA, C2 ; increase tone will thin secretions and constrict bronchioles
  3. Motor = c3-5 = phrenic nerve to diaphram
    1. irriation is due to decreased excurion and overuse
66
Q

Chapmain Pts for lung

  1. Bronchi
A
  1. Anterior: 2-3rd ICS at sternocostal junction
  2. Posterior: T2, between the SP and tip of SP
67
Q

Chapmain Pts for lung

2, Upper lung

  1. Lower lung
A
  1. Upper lung =
    1. Anteiror = 3/4th ICS at sternocostal junction
    2. Posterior
      1. Space in between TP of T3/4
      2. between the SP and tip of TP
  2. Lower lung
    1. Anterior = 4/5 ICS at sternocostal junction
    2. Posterior
      1. space in between TP of T4/5
      2. Between SP and tip of TP
68
Q

CXR =

  1. lower/middle lobe infiltrates
  2. diffuse bilateral symmetric infiltrates
  3. Upper lobe
A
  1. CAP
  2. CAP; if influenza season = consider influenza pneumonia
  3. CAP or TB

PCM IV Final (12 decks)

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