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PANCE PULM (10%) > Infectious Disorders > Flashcards

Infectious Disorders Flashcards

1
Q

Acute vs chronic bronchitis

A

acute: < 3 wks, viral (only bact if no improvement)
chronic: > 3 mos, smokers/COPD

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2
Q

acute bronchitis tx

A

supportive: antipyretics, short-act bronchodilator (SABA), antitussive (dextromethorphan = best evidence, peds > 2)

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3
Q

acute bronchitis tx

A

like COPD exacerbation. If change in sputum color/amount from baseline, resp fxn decline, or increased DOE: abx (augmentin, cephs, macrolides)

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4
Q

Post-tussive emesis = suspicion for ? in peds

A

pertussis - give azithromycin & isolate x 5 days

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5
Q

acute bronchiolitis epi/ppx

A
  • 1st episode of wheezing in peds < 1-2 yrs w/ NO other eti (PNA, atopy)
  • mostly < 2 mos old
  • ppx w/ synagis if high risk during 1st RSV season
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6
Q

acute bronchiolitis agents

A 
RSV (MC)
rhinovirus
flu, paraflu
adenovirus
human metapneumovirus
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7
Q

acute bronchiolitis s/s, wu, mgmt

A
  • URI, conjuctivitis/OM, wheezing/tachypnea/retractions/crackles
  • dx = clinical, CXR (hyperinflation, interstitial pneumonitis, infiltrates), ELISA for RSV is available
  • supportive (humidifier, O2 PRN if sev, bronchodils/steroids)
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8
Q

Acute epiglottitis agents

A
  • H. flu
  • strep pneumo/pyogenes
  • staph aureus
  • trauma
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9
Q

acute epiglottitis s/s, ddx

A
  • abrupt onset of high F, sore throat, stridor, dysphagia, drooling, trismus, tripoding/sniffing
  • croup, peritonsillar abscess, FB, diptheria
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10
Q

acute epiglottitis wu/mgmt

A
  • lateral XR (“thumb sign”)

- trans to ED, abx, stabilize airway!

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11
Q

croup agents/ddx

A
  • parainfluenza (MC), RSV, human metapneumovirus

- epiglottitis, neoplasm, bact tracheitis, pharyngeal abscess, FB

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12
Q

croup s/s, wu, mgmt

A
  • 18 mos old, stridor, hoarseness, barking cough, low F, rales, rhonchi, wheezing, worse at night
  • CXR (“steeple sign”)
  • supportive (cool humidifier), ED for inhaled epi if sev or stridor at rest, steroids)
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13
Q

flu s/s, ppx

A
  • abrup onset, F > 101.5, myalgias, HA, malaise, painful/dry cough, sore throat, rhinitis (cols = slow/insidious)
  • ppx: vacc at 6 mos (live if 2-49 & healthy)
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14
Q

flu wu/tx

A
  • nasopharyngeal swab (for epi purposes)
  • supportive, ipratropium inhlr for secretions, +/- steroids, antivirals (for A/B only w/ hosp/sev/progressive dz, < 2/>65, institution/HC workers W/IN 48 HRS OF SX ONSET)
  • 2ndary staph aureus PNA may follow
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15
Q

pertussis ppx

A

Dtap for peds

Tdap for adults

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16
Q

pertussis s/s

A
  • initial: cold-like, rhinorrhea, lacrimation, dry cough w/ episodes of sev cough, low F, pot-tussive emesis
  • paroxysmal stage: cough more sev, persist up to 10 wks, +/- whoop
  • convalescent stage: cough dec & disappears over 2-3 wks, may recur w/ subsequent URIs
17
Q

pertussis wu/mgmt/prog

A
  • nasopharyngeal swab cx/PCR for Bordetella
  • macrolides = DOC, septra = alt
  • may be infectous x several wks if untx’d
18
Q

RSV facts/mgmt

A
  • highly contagious
  • trans via aerosols/fomites (objects)
  • MC cz of fatal acute resp inf in infant/young peds
  • very serious if preemie, chronic lung dz, heart defects, asthma, immunocomp’d, old
  • supportive, +/- hospital w/ fluid/resp support, albuterol trial, steroids if older peds
19
Q

TB s/s, wu

A
  • latent/primary: asx
  • active: cough, F, wt loss, night sweats, hemoptysis, fatigue, dec appetite, CP
  • if high suspicion, send to ED (w/ mask)
  • CXR (active): infiltrates in mid/lower, hilar adenopathy, CAVITATION (caseating granuloma), empyema
  • PPD, AFB smear (Acid- Fast Bacilli)
20
Q

active TB tx

A
  • initial x 2 mos: isoniazid, rifampin, pyrazinamide, ethambutol
  • continue x 4-7 mos: isoniazid, rifampin
21
Q

latent TB tx

A
  • isoniazid x 9 mos OR rifampin x 4 mos
22
Q

TB monitoring

A
  • sputum smears & cx during tx
  • vision checks & color vision testing w/ ethambutol
  • CMP, CBC, bili (for tox/adr)
23
Q

TB drug ADRs

A
  • isoniazid:
  • rifampin:
  • pyrazinamide:
  • ethambutol:
24
Q

PNA vacc

A
  • 23 (pneumovax): 1 yr s/p PCV at 65 y.o. (q 5 yrs? if immunocomp’d/at risk)
  • 13 (PCV): at 2, 4, 6, 12-15 mos; at 65 y.o. if no prev dose
25
Q

PNA CXR findings (lag behind PE!)

A
  • Lobar: s pneumo, H flu, legionella (check urine)
  • patchy infils (bronchopna): s aureus, atyps, viral
  • fine dense granular infils (intersitial pna): influenza, CMV, PCP
  • abscess: anaerobes
  • nodular: fungal
26
Q

PNA outpt mgmt

A
  • macrolide

- if comorbid: cover s pneumo, enterics, m cat w/ levo or macrolide + B lactam (ceftriaxone)

27
Q

how to determine in vs out pt mgmt

A

PORT

CURB-65: confusion, urea (BUN), RR, BP, 65+ y.o.

28
Q

when pt goes to ED for PNA

A

RR > 30, HR > 125, SBP < 90, comorbidities

29
Q

PNA prog

A

F clears x 2-4 days tx

CXR clears x 30 d (6 mos if old)

30
Q

HAP

A
  • 48 hr s/p admission or recently hosp’d pt
31
Q

add’l wu if ICU, EtOH, or pleural eff pt

A

blood & sputum cx, legionella & pneumococcal antigen

32
Q

Non-HCAP mgmt

A
  • Non-ICU: B-lactam (rocephin, ertapenem, amp-sulbactam) + macrolide (atyps) or monotx w/ FQ
  • ICU: add vanc if MRSA, anti-psudomonal for COPD/freq steroid/abx users w/ B-lactam + FQ
  • clinical improvement w/in 72 hrs
  • fu CXR for pts > 50 y.o. at 7-12 wks
33
Q

Empiric HAP/HCAP/VAP mgmt

A
  • cover MRSA w/ vanc or linezolid
  • cover pseudomonas & gram negs w/ Zosyn, cefepime, ceftazidine, aztreonam (only for sev PCN allergy b/c not as effective)
  • add’l coverage for gram negs & atyps w/ cipro, levo, gentamicin, tobramycin, or carbapenem

PANCE PULM (10%) (8 decks)

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