Lectures 19 + 20 - Lung Infections Clinical

Question 1

Acute bronchitis is characterized as inflammation of the _____, ______, and ______. It is almost always caused by a _____.

Answer 1

Trachea

Bronchi

Bronchioles

Virus

Question 2

Though viral acute bronchitis can present similarly to pneumonia, how will CXR compare?

Answer 2

CXR will NOT show opacity (so no consolidation) for Acute Bronchitis.

Question 3

Chronic Bronchitis is characterized by excess _____ production and inflammation; patients often have trouble expectorating the excess _____ because the _______ cascade is damaged.

Answer 3

Mucous

Mucous

Mucocilliary cascade

Question 4

What can patients experience for 3-8 weeks after acute infection subsides? Remember it is stimulated by a sloughing off of the airway epithelium and exposure of _____ fibers that cause contraction of the airway smooth muscle.

Answer 4

They can experience a persistent cough.

C-fibers

Question 5

An acute exacerbation of chronic bronchitis is characterized by a change in the _____ and ______ of sputum and/or increased ______ of breath.

Answer 5

Volume and character of sputum

Shortness of breath

Question 6

When are antibiotics indicated for chronic bronchitis?

Answer 6

On acute exacerbation with increased volume and change in character of sputum.

Question 7

Oseltamivir and Zanamivir are both antivirals for the Flu. How are they administered?

Answer 7

Oseltamivir is a pill, while Zanamivir is inhaled.

Question 8

Elderly patients with pneumonia can sometimes present with ______ and confusion WITHOUT fever or cough.

Answer 8

Delerium and confusion

Question 9

______ and ______ are the 2 most common causes of Atypical pneumonia. They require _______ or Quinolones for treatment.

Answer 9

Mycoplasma and Legionella

Macrolides or Quinolones

Question 10

CURB-65 is a mnemonic that provides a score to determine how patients should be treated for pneumonia.

C = \_\_\_\_\_\_
U = \_\_\_\_\_\_ (BUN > \_\_)
R = \_\_\_\_\_\_
B = Blood pressure is low (Systolic less than or equal to \_\_\_\_\_; Diastolic less than or equal to \_\_\_\_\_)
65 = Age greater than or equal to 65. 

Patients with a score of ____ should be considered for hospitalization. Anything over that should definitely be hospitalized.

Answer 10

C = Confusion
U = Uremia (BUN > 20)
R = Respiratory rate greater than or equal to 30/min)
B = low BP (systolic less than or equal to 90; diastolic less than or equal to 60)
65 = Age greater than 65

2

Question 11

Community Acquired Pneumonia (CAP) is more commonly caused by Strep pneumoniae, H. influenza, Staph aureus, Mycoplasma, and Legionella. Healthcare Associated Pneumonia (HCAP) is more commonly caused by resistant gram ______ bacteria.

Answer 11

Gram Negative

Question 12

The cutoffs for Positive PPD tests vary among different groups of people.

For Immunocompromised, HIV, and patients with recent TB contact –> greater than or equal to ___mm is positive

For recent immigrants, people in high risk environments, and children less than ____ years old –> greater than or equal to ____mm is positive.

For general public –> greater than or equal to ____mm is positive.

Answer 12

5mm

4years old

10mm

15mm

Question 13

Latent TB is often treated daily with ______ and Vit B6 for 6-9 months.

Answer 13

Isoniazid

Question 14

_____ stain is used to identify fungal organisms.

Answer 14

Silver

Question 15

Cytomegalovirus (CMV) pneumonia often occurs in patients who are ________ and can occur as a co-infection. Look for “owl eye” cells on histology.

Answer 15

Immunocompromised

Question 16

Pneumocystis jirovecii occurs in patients who are _______. These patients often present with _______. It is treated with _______-________ (aka _____) for 21 days. If pO2 < 70, treat with ______.

Answer 16

Immunocompromised

Hypoxemia

Trimethoprim-sulfamethoxalzole

Bactrim

Steroids

Question 17

_____ ______ should be considered among the main causative organisms in patients presenting with symptoms of pneumonia post-influenza illness.

Answer 17

Staph aureus

Question 18

Recent immigrants or incarcerated individuals are more susceptible to ______ infection.

Answer 18

TB

Question 19

Gram ______ organisms should be considered in alcoholic patients presenting with pneumonia.

Answer 19

Gram Negative

Question 20

Patients with Sickle Cell disease are more susceptible to _______ pathogens. Remember the spleen is typically responsible for helping the body eliminate these organisms. These include Strep. pneumoniae, H. influenza type ___, N. meningitidis, and Giardia spp.

Answer 20

Encapsulated pathogens

H. influenza type B

Question 21

Patients with CF are more susceptible to _____ and ______.

Answer 21

Staph. aureus

Pseudomonas spp.

Question 22

Patients with ________ infection (one of the causative agents for Atypical pneumonia) often present with GI symptoms, bradycardia, confusion, and renal and liver manifestations.

Answer 22

Legionella

Question 23

Treatment for CAP should cover typical and atypical agents, while treatment for Nosocomial pneumonia requires ______ and coverage for ______.

Answer 23

Vancomycin and coverage for pseudomonas

Question 24

Bronchiectasis is an acquired disorder of the major bronchi and bronchioles that is characterized by PERMANENT abnormal ______ and destruction of the bronchial walls. This occurs via infection AND at least one of the following: Impairment of ______. Airway ______. A defect in host _____.

Answer 24

Dilation

Impairment of drainage

Airway Obstruction

Defect in host Defense

Question 25

In patients with Bronchiectasis that present with a persistant cough WITHOUT purulent sputum, consider non-______ _______, which requires _____-____ stain to identify.

Answer 25

Non-tuberculus Mycobacteriua (Mycobacterium avium complex - MAC)

Acid-fast

Question 26

To diagnose a patient with CF, look for a family hx of the disease and perform a ____ test. Positive result is considered [Cl-] > _____mEq/L.

Answer 26

Sweat test

> 60 mEq/L