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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
Q

What % of pts w/ acute bronchitis are given antibiotics?

A

60-90%

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26
Q

What organism causes pertussis?

A

Bordetella pertussis

- Releases toxin, damaging cilia –> swollen airway

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27
Q

What is the epidemiology of pertussis?

A

< 2 yo

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28
Q

What is the incubation period for pertussis? How long is it contagious?

A
  • Incubation = 7-17 days

- Contagious for 2 wks after onset of cough

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29
Q

What are the 3 stages of pertussis?

A
  1. Catarrhal
  2. Paroxysmal
  3. Convalescent
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30
Q

Describe the catarrhal stage of pertussis

A

1-2 wks

- Malaise, rhinorrhea, cough, fever, lacrimation/injection

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31
Q

Describe the paroxysmal phase of pertussis

A

Begins 2nd week, lasts 2-3 months

  • Cough followed by high-pitched inspiration (whoop)
  • +/- syncope or emesis
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32
Q

Describe the convalescent phase of pertussis

A

1-2 wks

- Gradual reduction in frequency/severity of cough

33
Q

How do you dx pertussis?

A
  • CBC: elevated WBC
  • Nasopharyngeal culture
  • PCR assay
34
Q

How do you tx pertussis?

A
  • Macrolides (also used for post-exposure prophylaxis)

- Trimethoprim-sulfamethoxazole

35
Q

How do you prevent pertussis?

A

Vaccinate

  • All infants = DTaP
  • Adolescents 11-18 = Tdap booster
  • Adults = single Tdap dose
  • Pregnant = Tdap w/ every pregnancy
36
Q

What are complications of pertussis?

A
  • Most serious in babies/children
  • Pneumo, OM
  • Cough –> subconjunctival hemorrhage, abd hernia, rib fx, urinary incontinance, lumbar sprain
37
Q

How is pneumonia transmitted?

A
  • Aspiration from oropharynx
  • Inhalation of droplets
  • Hematogenous
  • Extension from infected pleural or mediastinal space
38
Q

What are the 3 classifications of pneumonia?

A
  1. CAP (community)
  2. HAP (hospital)
  3. VAP (ventilator)
39
Q

What are RFs of CAP?

A
  • age (65+)
  • alcohol
  • tobacco
  • immunosuppression
  • comorbities
  • malnutrition
40
Q

What is the #1 bacterial cause of typical CAP?

A

S. pneumo (2/3)

41
Q

What bacterial organisms cause “atypical” CAP?

A
  • Mycoplasma pneumo
  • Chlamydophilia pneumo
  • Legionella spp.
42
Q

What is the #1 viral cause of CAP?

A

Influenza

43
Q

What are the main sx of pneumo?

A
  • Fever
  • Cough
  • Dyspnea
44
Q

What does pneumo look like on PE?

A
  • Fever
  • Tachypnea, tachycardia
  • Low O2
  • Rales
  • Consolidation
45
Q

What is the presentation of s. pneumo?

A
  • Sudden onset of shaking chills

- rust colored sputum

46
Q

What is the presenation of m. pneumo (“walking pneumo”)

A
  • children/adolescents
  • asx or mild
  • CXR: reticulonodular pattern or patchy consolidation
47
Q

What is the presentation of legionella?

A
  • GI disorders
  • confusion, encephalopathy
  • contaminated water sources
48
Q

What is the presentation of MRSA?

A
  • cavitary infiltrate
  • hemoptysis
  • rapidly increasing pleural effusion
49
Q

What is the presentation of klebsiella?

A
  • alcohol abuse, DM, COPD

- currant jelly sputum

50
Q

What is used to dx pneumo? What is the gold standard?

A
  • CBC: leukocytosis w/ left shift

- CXR *GOLD STANDARD: demonstrates infiltrate (lobar, interstitial, cavitation)

51
Q

What classes of pneumo must be admitted to the hospital?

A

IV & V

52
Q

What does the CURB 65 score stand for?

A

Used to determine inpt vs outpt tx for pneumo

  • Confusion
  • Urea > 7 (BUN > 20)
  • RR ≥ 30
  • BP
  • 65 yo or older
53
Q

What does each CURB-65 score mean?

A
  • Score of 0-1 = tx outpt
  • Score of 2 = admit to hospital
  • Score 3-5 = assess for ICU
  • Mortality increases w/ higher score
54
Q

In healthy pts w/ no abx use within the past 3 months, what tx is used for CAP?

A

Macrolide or doxycycline

55
Q

In pts w/ RFs for macrolide resistance or abx use within past 3 months, what tx is used for CAP?

A
  • Respiratory fluoroquinolone OR

- Beta-lactum (high dose amox or augmentin) + macrolide

56
Q

What is the duration of tx for CAP?

A

At least 5 days

57
Q

How do you tx pts w/ CAP in the ICU?

A 
- beta-lactam + azithromycin 
OR
- beta-lactam + resp. fluoro 
OR
- resp. fluoro + aztreonam (in PCN allergic pts)
58
Q

What are RFs for pseudomonas?

A
  • alcohol
  • cystic fibrosis
  • CA
  • recent intubation
  • septic shock
  • organ failure
59
Q

What are RFs for MRSA?

A
  • end stage renal dz
  • IVDA
  • prior abx use
  • influenza
60
Q

What is considered 1st line tx for CAP pts w/ pseudomonas risk?

A

antipneumo, antipseudo beta-lactam + cipro or levo

61
Q

How do you tx CAP pts w/ MRSA risk?

A

Add vanco or linezolid

62
Q

What are complications of CAP?

A
  • Bacteremia
  • Sepsis
  • Cardiac: HF, MI, arrhythmia
63
Q

How do you prevent CAP?

A
  1. Smoking cessation
  2. Vaccination
    - Influenza: all pts
    - PPSV23: 65 or older, high risk pts, & smokers
    - PCV13: 2 or younger, high risk, & smokers
64
Q

Define: HAP

A

48hrs or more after admission & did not appear to be incubating at the time of admission

65
Q

Define: VAP

A

Type of HAP that develops more than 48-72 hrs after intubation

66
Q

What are the common pathogens involved in HAP & VAP?

A
  • aerobic gram - : E. coli, klebsiella, enterobacter, pseudo, acinetobacter
  • gram + : staph
67
Q

What is the duration of tx for HAP & VAP?

A

14-21 days

68
Q

What organisms cause fungal pneumo?

A
  • Histoplasmosis
  • Blastomycosis
  • Coccidiodomycosis
  • P. jirovecci
69
Q

What organism causes pneumocystic pneumo?

A
  • P. jirovecii

* Most common opportunitic infection in AIDS pts

70
Q

How do pts w/ pneumocystis pneumo present?

A
  • Fever, cough, dyspnea
  • Fatigue, chills, CP, weight loss
  • tachypnea, crackles, rhonchi, thrush
71
Q

How do you dx pneumocystis pneumo?

A
  • Hypoxia
  • Elevated LDH level
  • CXR
72
Q

How do you tx pneumocystis pneumo?

A

TMP-SMX for 21 days

73
Q

Define: aspiration pneumo

A

Displacement of gastric contents to lung –> injury & infection

74
Q

What organisms cause aspiration pneumo?

A

Gram negative, anaerobic

75
Q

What are RFs for aspiration pneumo?

A
  • altered consciousness
  • CNS dz
  • impaired swallowing
  • tracheal or NG tube
  • anatomical defect
76
Q

How do pts w/ aspiration pneumo present?

A

Cough w/ foul smelling purulent

77
Q

How do you dx aspiration pneumo?

A
  • Culture

- CXR: RLL infiltrate common

78
Q

What abx are used to tx aspiration pneumo?

A
  • Clindamycin or augmentin

- PCN + metronidazole

Foundations II (Cholley) (25 decks)

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