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Unit 2 Clin Med II > L12 Bronchitis and Pneumonia > Flashcards

L12 Bronchitis and Pneumonia Flashcards

1
Q

most common cause of bacteria acute bronchitis

A

bordetella pertussis

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2
Q

most acute bronchitis is

A

VIRAL

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3
Q

presence of purulent sputum

A

NOT predictive of bacterial infection or response to antibiotics

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4
Q

acute bronchitis physical exam

A

Rhonchi that clear with coughing

Negative for crackles/consolidation

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5
Q

crackles aka

A

rales

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6
Q

acute bronchitis is diagnosed

A

clinically

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7
Q

Perform CXR for acute bronchitis

A

cough > 3 weeks or:

Fever (>38), tachypnea (>24), tachycardia (>100), consolidation (crackles, egophony, fremitus)

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8
Q

codeine and acute bronchitis

A

avoid, potential for addiction, side effects

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9
Q

when to give antibiotics for acute bronchitis

A

pertussis

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10
Q

Bordetella pertussis

A

Whooping cough

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11
Q

Name that pertussis phase:

URI+fever, 1-2 weeks

A

Phase 1: Catarrhal

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12
Q

Name that pertussis phase:

coughing fits followed by classic whooping sound, post-tussive emesis, 2-6 weeks

A

Phase 2: Paroxysmal

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13
Q

Name that pertussis phase:

Cough gradually resolves over weeks to months

A

Phase 3: Convalescent

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14
Q

optimum timing for culture of pertussis

A

0-2 weeks after cough onset

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15
Q

optimum timing for PCR of pertussis

A

0-4 weeks after cough onset

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16
Q

optimum timing for serology of pertussis

A

2-8 weeks after cough onset

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17
Q

if pertussis is suspected

A

begin empiric therapy while waiting for diagnostic confirmation

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18
Q

why do we use antibiotics for pertussis if it has little effect on symptom resolution

A

it decreases transmission

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19
Q

antibiotics used to treat pertussis

A

Azithromycin (500 mg PO followed by 250 mg x 4 days)
Clarithromycin (500 mg PO BID x7 days)
Erythromycin (500 mg PO QID x14 days)
TMP-SMX (DS PO BID x14 days)

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20
Q

kids pertussis tx

A

admission, isolation, macrolid

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21
Q

new recommendation for Tdap

A

adolescent booster

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22
Q

other pertussis considerations

A

Abx prophylaxis for close contacts

Report to State Health Department

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23
Q

incubation of pertussis is

A

up to 21 days

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24
Q

Influenza clinical presentation

A 
abrupt onset of:
fever
headache
myalgia
malaise
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25
Q

when using Rapid influenza diagnostic test (RIDTs)

A

Negative does not reliably exclude influenza during periods of peak influenza activity

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26
Q

pneumonia results from

A

virulent organism, large inoculum, and/or impaired host defense

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27
Q

main way community acquired pneumonia is transmitted

A

aspiration from the oropharynx

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28
Q

pathophysiology of community acquired pneumonia

A

Proliferation of microbial pathogens at the alveolar level when the capacity of the alveolar macrophages to ingest or kill organisms is exceeded
Alveolar macrophages initiate an inflammatory response

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29
Q

typical bacterial community acquired pneumonia

A

streptococcus pneumoniae

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30
Q

atypical bacterial community acquired pneumonia

A

mycoplasma pneumoniae

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31
Q

viral causes of pneumonia

A

** influenza **
RSV
parainfluenza
adenovirus

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32
Q

mixed bacterial viral community acquired pneumonia

A

20% of cases

more severe, longer hospitalization

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33
Q

Fungal community acquired pneumonia

A

is unusual in an immuncompetent

34
Q

general community acquired pneumonia risk factors

A 
asthma
immunosuppression
advanced age >70
alcoholism
institutionalization
35
Q

risk factors for pneumococcal community acquired pneumonia

A 
Dementia
seizures
heart failure
cerebrovascular disease
alcoholism
smoking
 COPD
HIV+
36
Q

presetation of community acquired pneumonia

A

acute onset
fever
cough

37
Q

atypical presentation of community acquired pneumonia in younger, healthy patients

A

subacute onset, viral prodome, nonproductive cough, low grade fever, HA, myalgia/athralgia, malaise, absence of pleurisy & rigors

38
Q

Atypical presentation of community acquired pneumonia in elderly patients

A

confusion, weakness, failure to thrive, delirium, abdominal pain, tachypnea, N/V/D

39
Q

signs of consolidation

A

dullness to percussion
increased tactile fremitius
bronchophony
egophony

40
Q

signs of community acquired pneumonia

A 
fever
tachypnea >24 breaths
hypoxia
tachycardia
diaphoresis
decreased/bronchial breath sounds
crackles
consolidation
41
Q

bronchophony

A

spoken words are louder and clearer

42
Q

egophony

A

spoken E sounds like A

43
Q

CBC of community acquired pneumonia

A

leukocytosis with left shift

44
Q

CXR of community acquired pneumonia

A

infiltrate on plain chest xray is the gold standard for diagnosis
lobar consolidation
interstitial infiltrates
cavitation

45
Q

when to test sputum or blood cultures

A

very ill or risk factors for unusual organisms

46
Q

bacterial causes of community acquired pneumonia which show up on urine antigen tests

A

Legionella

S. pneumoniae

47
Q

best predictor of a good outcome for community acquired pneumonia

A

right site of care

48
Q

how long to treat community acquired pneumonia

A

at least 5 days

49
Q

median time for community acquired pneumonia:
fever to resolve
cough and fatigue resolve
return to work

A

3 days
14 days
6 days

50
Q

who gets a follow up CXR for community acquired pneumonia

when to do it?

A

smokers
>40 years old
7-12 weeks post treatment

51
Q

uncomplicated means

A

previously healthy, no abx use in last 3 months

52
Q

DOC for community acquired pneumonia

A

azithromycin 500 mg day 1 + 4 days 250 mg
-OR-
doxycylcine 100 mg BID 7-10 days

53
Q

complicated means

A 
recent abx use
COPD
liver/renal disease
cancer
DM
CHD
alcoholism
asplenia
immunosuppression
54
Q

tx for outpatient complicated community acquired pneumonia

A

beta lactam plus macrolide
-or-
respiratory fluoroquinolone

55
Q

complicated outpatient community acquired pneumonia beta lactam

A

amoxicillin-clavulanate 500 mg BID

in combination with a macrolide

56
Q

complicated outpatient community acquired pneumonia macrolide

A

azithromycin
in combination with a beta lactam
dosing not given?

57
Q

complicated outpatient community acquired pneumonia respiratory fluoroquinolone

A

levofloxacin 750 mg daily x5 days

58
Q

inpatient community acquired pneumonia patients at risk for pseudomonas

A 
alcoholism
CF
neutropenic fever
recent intubation
cancer
 organ failure
septic shock
59
Q

inpatient community acquired pneumonia patients at risk for MRSA

A

end stage renal disease
IVDU
prior abx use
influenza

60
Q

if an inpatient community acquired pneumonia patient isn’t at risk for MRSA or pseudomonas, tx:

A

same as outpatient but FLUOROQUINOLONE preferred

61
Q

when to end inpatient community acquired pneumonia treatment

A 
minimum 5 days AND: 
afebrile 48-72 hours
HR<100
RR <24
SBP > 90 mmHg
supplemental O2 not needed
62
Q

who gets pneumococcal vaccines

A

Patients >65 years old

Patients 19-64 at increased risk: cardiopulmonary disease, sickle cell, smokers, splenectomy, liver disease

63
Q

nosocomial means

A

acquired in a hospital

64
Q

hospital acquired pneumonia

A

pneumonia 48 hours+ after admission which did not appear to be incubating at time of admission

65
Q

Ventilator acquired pneumonia

A

A type of hospital acquired pneumonia that develops more than 48-72 hours after endotracheal intubation

66
Q

highest risk for hospital acquired pneumonia

A

ICU

mechanical ventilation

67
Q

highest risk for hospital acquired pneumonia pseudomonas aeruginosa

A

ICU

68
Q

how to diagnose hospital acquired pneumonia

A

CXR: new/progressive infiltrate
+ 2 of the following

Fever
\+
purulent sputum → gram stain &amp; culture
\+
Leukocytosis
69
Q

who to do a sputum culture and gram stain on in hospital acquired pneumonia

A

everyone

70
Q

Pneumocystis jirovecii pneumonia was previously called

A

pneumocystis carinii: PCP

71
Q

Pneumocystis jirovecii pneumonia is considered a

A

fungus

72
Q

Associated with HIV+ and low CD4 count

A

Pneumocystis jirovecii pneumonia

73
Q

Symptoms: Fever, nonproductive cough, progressive dyspnea, extra-pulmonary lesions

A

Pneumocystis jirovecii pneumonia

74
Q

Risk factors for Pneumocystis jirovecii pneumonia in HIV, prophylaxis is indicated:

A

History of previous PCP
CD4 < 200
Oropharyngeal thrush

75
Q

preferred Pneumocystis jirovecii pneumonia treatment/prophylaxis

A

trimethoprim-sulfamethoxazole

76
Q

alternate Pneumocystis jirovecii pneumonia treatments

A

TMP-dapson
clindamycin-primaquine
pentamidine
steroids

77
Q

Pneumocystis jirovecii pneumonia treatment with the best side effect profile

A

Pentamidine

78
Q

alternative Pneumocystis jirovecii pneumonia prophylaxis

A

dapsone

aerosolized pentamidine

79
Q

aspiration pneumonia is

A

Displacement of gastric contents to the lung causing injury & infection → gram negative anaerobes

80
Q

aspiration pneumonia risk

A

Risk: post-operative state, neurologic compromise (CVA, parkinsons, ALS, sedation), anatomical defect or aberrancy

81
Q

CXR: Right lower lobe infiltrate

A

aspiration pneumonia

82
Q

4 equally acceptable Aspiration pneumonia treatments

A

Piperacillin/tazobactam
Ampicillin/sulbactam
Clindamycin
Moxifloxacin

Unit 2 Clin Med II (7 decks)

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