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Foundations II (Cholley) > Influenza, bronchitis, pneumo > Flashcards

Influenza, bronchitis, pneumo Flashcards

1
Q

What causes influenza?

A

Influenza virus, type A & B

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2
Q

What are the type A subtypes of the influenza virus?

A
  • Hemagglutinins: H1, H2, H3

- Neuraminidases N1, N2

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3
Q

What are sx of influenza?

A
  • Abrupt onset
  • Fever, chills
  • HA
  • myalgia, malaise
  • cough, ST
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4
Q

What does influenza look like on PE?

A
  • Flushing
  • Hot, dry skin
  • MM injection
  • PND
  • Cervical LAD
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5
Q

What does “FACTS” stand for in influenza?

A
  • Fever
  • Aches
  • Chills
  • Tiredness
  • Sudden onset
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6
Q

What is performed most often to dx influenza?

A

Rapid antigen test (RAT)

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7
Q

What are high risk groups for influenza?

A
  • under 4, over 65
  • chronic illness
  • immunosuppression
  • pregnancy or post-partum
  • children < 19 on ASA
  • american indians/ natives
  • obese
  • nursing homes
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8
Q

How do you tx influenza?

A 
- Usually supportive, however can use these meds:
Neuraminidase inhibitors: influenza A/B
- Oseltamivir (Tamiflu)
- Zanamivir (Relenza)
- Peramivir (Rapivab)
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9
Q

What class of tx is NOT recommended for influenza?

A

Adamantanes: influenza A

- Amantadine, Rimantadine

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10
Q

Within what time period should you initiate tx for influenza?

A

24-48 hrs

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11
Q

Oseltamivir (Tamiflu) can cause what adverse effects?

A

N/V

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12
Q

Zanamivir (Relenza) can cause what adverse effects?

A

Bronchospasm, decreased respiratory fxn

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13
Q

What is the main complication of influenza?

A

Pneumonia

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14
Q

How should you administer the flu vaccine to pts w/ SEVERE egg allergy?

A

In a medical setting & supervised by health provider who is able to manage allergic conditions

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15
Q

What can be used for prevention of influenza?

A

Neuraminidase inhibitors:

- Pre & post exposure chemoprophylaxis

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16
Q

What is the gold standard used for dx of influenza?

A

Viral culture!

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17
Q

Define: acute bronchitis

A

self-limited inflammation of the bronchi

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18
Q

What is acute bronchitis associated w/?

A

VIRAL URI

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19
Q

What is the main cause of acute bronchitis?

A

VIRAL

  • Influenza A/B
  • Parainfluenza
  • Coronavirus
  • Rhinovirus
  • RSV
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20
Q

What bacterial organisms can cause acute bronchitis? Which one requires tx?

A
  • Mycoplasma pneumo
  • Chlamydophila pneumo
  • Bordetella pertussis (requires tx)
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21
Q

What are sx of acute bronchitis?

A
  • Cough > 5 days +/- sputum
  • Afebrile
  • Chest wall tenderness
  • Wheezing, dyspnea
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22
Q

What does acute bronchitis look like on PE?

A
  • wheezing

- rhonchi (clears w/ cough)

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23
Q

What do you use to dx acute bronchitis?

A

Dx clinically! But can use:

  • WBC
  • CXR
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24
Q

How do you manage acute bronchitis?

A

Symptomatic tx

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25
What % of pts w/ acute bronchitis are given antibiotics?
60-90%
26
What organism causes pertussis?
Bordetella pertussis | - Releases toxin, damaging cilia --> swollen airway
27
What is the epidemiology of pertussis?
< 2 yo
28
What is the incubation period for pertussis? How long is it contagious?
- Incubation = 7-17 days | - Contagious for 2 wks after onset of cough
29
What are the 3 stages of pertussis?
1. Catarrhal 2. Paroxysmal 3. Convalescent
30
Describe the catarrhal stage of pertussis
1-2 wks | - Malaise, rhinorrhea, cough, fever, lacrimation/injection
31
Describe the paroxysmal phase of pertussis
Begins 2nd week, lasts 2-3 months - Cough followed by high-pitched inspiration (whoop) - +/- syncope or emesis
32
Describe the convalescent phase of pertussis
1-2 wks | - Gradual reduction in frequency/severity of cough
33
How do you dx pertussis?
- CBC: elevated WBC - Nasopharyngeal culture - PCR assay
34
How do you tx pertussis?
- Macrolides (also used for post-exposure prophylaxis) | - Trimethoprim-sulfamethoxazole
35
How do you prevent pertussis?
Vaccinate - All infants = DTaP - Adolescents 11-18 = Tdap booster - Adults = single Tdap dose - Pregnant = Tdap w/ every pregnancy
36
What are complications of pertussis?
- Most serious in babies/children - Pneumo, OM - Cough --> subconjunctival hemorrhage, abd hernia, rib fx, urinary incontinance, lumbar sprain
37
How is pneumonia transmitted?
- Aspiration from oropharynx - Inhalation of droplets - Hematogenous - Extension from infected pleural or mediastinal space
38
What are the 3 classifications of pneumonia?
1. CAP (community) 2. HAP (hospital) 3. VAP (ventilator)
39
What are RFs of CAP?
- age (65+) - alcohol - tobacco - immunosuppression - comorbities - malnutrition
40
What is the #1 bacterial cause of typical CAP?
S. pneumo (2/3)
41
What bacterial organisms cause "atypical" CAP?
- Mycoplasma pneumo - Chlamydophilia pneumo - Legionella spp.
42
What is the #1 viral cause of CAP?
Influenza
43
What are the main sx of pneumo?
- Fever - Cough - Dyspnea
44
What does pneumo look like on PE?
- Fever - Tachypnea, tachycardia - Low O2 - Rales - Consolidation
45
What is the presentation of s. pneumo?
- Sudden onset of shaking chills | - rust colored sputum
46
What is the presenation of m. pneumo ("walking pneumo")
- children/adolescents - asx or mild - CXR: reticulonodular pattern or patchy consolidation
47
What is the presentation of legionella?
- GI disorders - confusion, encephalopathy - contaminated water sources
48
What is the presentation of MRSA?
- cavitary infiltrate - hemoptysis - rapidly increasing pleural effusion
49
What is the presentation of klebsiella?
- alcohol abuse, DM, COPD | - currant jelly sputum
50
What is used to dx pneumo? What is the gold standard?
- CBC: leukocytosis w/ left shift | - CXR *GOLD STANDARD: demonstrates infiltrate (lobar, interstitial, cavitation)
51
What classes of pneumo must be admitted to the hospital?
IV & V
52
What does the CURB 65 score stand for?
Used to determine inpt vs outpt tx for pneumo - Confusion - Urea > 7 (BUN > 20) - RR ≥ 30 - BP - 65 yo or older
53
What does each CURB-65 score mean?
- Score of 0-1 = tx outpt - Score of 2 = admit to hospital - Score 3-5 = assess for ICU * Mortality increases w/ higher score
54
In healthy pts w/ no abx use within the past 3 months, what tx is used for CAP?
Macrolide or doxycycline
55
In pts w/ RFs for macrolide resistance or abx use within past 3 months, what tx is used for CAP?
- Respiratory fluoroquinolone OR | - Beta-lactum (high dose amox or augmentin) + macrolide
56
What is the duration of tx for CAP?
At least 5 days
57
How do you tx pts w/ CAP in the ICU?
``` - beta-lactam + azithromycin OR - beta-lactam + resp. fluoro OR - resp. fluoro + aztreonam (in PCN allergic pts) ```
58
What are RFs for pseudomonas?
- alcohol - cystic fibrosis - CA - recent intubation - septic shock - organ failure
59
What are RFs for MRSA?
- end stage renal dz - IVDA - prior abx use - influenza
60
What is considered 1st line tx for CAP pts w/ pseudomonas risk?
antipneumo, antipseudo beta-lactam + cipro or levo
61
How do you tx CAP pts w/ MRSA risk?
Add vanco or linezolid
62
What are complications of CAP?
- Bacteremia - Sepsis - Cardiac: HF, MI, arrhythmia
63
How do you prevent CAP?
1. Smoking cessation 2. Vaccination - Influenza: all pts - PPSV23: 65 or older, high risk pts, & smokers - PCV13: 2 or younger, high risk, & smokers
64
Define: HAP
48hrs or more after admission & did not appear to be incubating at the time of admission
65
Define: VAP
Type of HAP that develops more than 48-72 hrs after intubation
66
What are the common pathogens involved in HAP & VAP?
- aerobic gram - : E. coli, klebsiella, enterobacter, pseudo, acinetobacter - gram + : staph
67
What is the duration of tx for HAP & VAP?
14-21 days
68
What organisms cause fungal pneumo?
- Histoplasmosis - Blastomycosis - Coccidiodomycosis - P. jirovecci
69
What organism causes pneumocystic pneumo?
- P. jirovecii | * Most common opportunitic infection in AIDS pts
70
How do pts w/ pneumocystis pneumo present?
- Fever, cough, dyspnea - Fatigue, chills, CP, weight loss - tachypnea, crackles, rhonchi, thrush
71
How do you dx pneumocystis pneumo?
- Hypoxia - Elevated LDH level - CXR
72
How do you tx pneumocystis pneumo?
TMP-SMX for 21 days
73
Define: aspiration pneumo
Displacement of gastric contents to lung --> injury & infection
74
What organisms cause aspiration pneumo?
Gram negative, anaerobic
75
What are RFs for aspiration pneumo?
- altered consciousness - CNS dz - impaired swallowing - tracheal or NG tube - anatomical defect
76
How do pts w/ aspiration pneumo present?
Cough w/ foul smelling purulent
77
How do you dx aspiration pneumo?
- Culture | - CXR: RLL infiltrate common
78
What abx are used to tx aspiration pneumo?
- Clindamycin or augmentin | - PCN + metronidazole

Foundations II (Cholley) (25 decks)

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