HYHO URI/Pneumonia Flashcards
Common symtoms seen in URI/pneumonia?
- Cough with or wo sputum
- Fatigue/malaise
- Fever and dyspnea
- Rigors, pleuritic chest pain,
- Anorexia
- Preceding viral illness
How do typical vs atypical pneumonias present differently?
Typical => inflammatory response with cough
Atypical => less inflammation and less severe.
PE findings for URI?
- Increased work to breathe
- Retractions
- Adventitious breath sounds (crackles, rhonchi, wheezing)
- Hypoxemia
+ special tests that indicate URI
- Tactile fremitis
- Egophany/Bronchophany
- Dullness to percussion
DDx for NON-infectious causes of cough
- UACS (upper airway cough s=yndrome)
- Asthma/ COPD
- GERD
What is the most common cause of a chronic cough in healthy, non-smokers with a NL CXR?
UACS (allergic rhinitis and bacterial sinusitus(
What is the most sensitive and specific test used to diagnose GERD diseaes?
Is it required to diagnose GERD
24-hour esophageal pH monitoring; not required to dx GERD
What is the 1st line of treatment for GERD?
4-weeks on a PPI = diagnostic and therapeutic
After 4 weeks on a PPI, if GERD does NOT improve, what do we do?
Endoscopy
DDx for infectious cough and congestion
- 1. Common cold/URI/viral
- 2. Pharyngitis
- 3. Sinusits
- 4. Bronchitis
- 5. Influenza
- 6. Pneumonia
Acute Bronchitis
- What is it?
- Commonly presents in
- Most commonly occurs in
- Most common etiology
- 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
Bacterial causes of acute bronchitis
- Mycoplasma
- Chlamydia pneumonia
- Bordatella pertussis
What is the initial phase and protracted phase of acute bronchitis
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
MC presentation of acute bronchitis
productive, purulent sputum
in acute bronchitis, is the color of the sputum diagnostic of of the presence of a BACTERIAL infection
no
testing and treatment of acute bronchitis
- 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
prevent acute bronchitis
- wash hands, avoid tobacco/lung irritants, cough into elbow
- avoid ABX for tx bc often viral
Rhinosinusitis
- what is it
- acute/subacute/chronic
- how long does it last
- MCC in adults and children
- 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
Sx/Diagnosis of rhinosinutisis
- Purulent nasal discharge
- Maxillary dental/facial pain
- Unilaterally maxillary sinus is tender
Sx improve, then worsen.
First line therapy for rhinosinutis
Directed at infection:
Amoxicillin + trimethoprim-sulfamethazole (10-14 days)
Pharyngitis
- What is it
- MCC cause
- Clinical course
- Dx requires us to do what
- Inflammtion of pharynx and tonxils = severe throat pain
- Viral
- In adults = benign and self-limited
- RO other causes of severe throat pain
Pharyngitis
- MCC in who
- Common causes in teens/young adults
- adults
- pediatrics?
- Pediatric pts (4-7 YO)
- MCC in adolescents and young teens
- Myoplasma
- Chlamydia pneumonia
- Arcanobacterium
-
MCC in adults (15%) and pediatric (30%) patients
- GroupASTrep
Diagnosis and findings of Pharyngitis
- Abrupt onset of sore throat and fever
- Petachiae on palate/tonsil
- Tender cervical adenopathy
- NOOOOO cough
- If GAS = sandpaper liek rash)
How to diagnose GAS
1. throat culture = gold standard
- Rapid strep antigen test.
How can we diagnosde GAS without a throat culture or rapid antigen test
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
Tx of GAS pharyngitis
-
Penicillin
- if allergic => cephalosporin and macrolides.
what is the leading cause of mortality & morbidity in the world; what kind of symptoms does it cause?
pneumonia: sx range from (mild fever/productive cough => severe respiratory distress and sepsis)