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Pulmonary: Clin Med II B > Lower Respiratory Infections > Flashcards

Lower Respiratory Infections Flashcards

1
Q

PE RSP signs for LRTI

A

Inspection /Palpation Percussion / Auscultation
No nasal flaring, no retractions. CTAB, no W/R/R.

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2
Q

Bacterial etiology more suspect when ?

A

symptoms prolonged - duration w/ worsening symptoms

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3
Q

causes of acute bronchitis

A
  1. Bacterial or viral respiratory infection of the respiratory tract
  2. heavy smoking
  3. Allergy due to dust, pollen, mold, etc.
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4
Q

what pathogenic cause accounts for 90-95% of cases in healthy adults

A

viruses
(Rhino, Adeno, Flu A/B, RSV, Coronavirus, Echovirus, Coxsackie A/B, and Parainfluenza)

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5
Q

bacterial acute bronchitis MC affects who?

A

unhealthy/compromised
(M. pneumo, Strep pneumo, H. flu, M. catarrhalis, and B. pertussis)

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6
Q

pathophys of acute bronchitis

A
  1. Infection in conducting airway
  2. Inflammation of airway
  3. Exudate production
  4. Bronchospasm
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7
Q

Two sequential phases of acute bronchitis

A
  1. Direct inoculation of tracheobronchial epithelium
    - Responsible for typical symptomatology
    - Lasts 1-5 days
  2. Hypersensitivity of the airway receptors
    - Responsible for persistent symptomatology
    - Lasts 1-3 weeks (peak 7-14 day)
    - Sloughed epithelium = ↑ sputum production
    - Air passages clogged by debris and irritation
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8
Q

the cause of kennel cough in dogs

A

B bronchiseptica

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9
Q

sx of acute bronchitis

A

cough - Nonproductive / mucopurulent
Substernal Pain
Wheezing
Fever - 38.3 - 38.9 C
Fatigue
Malaise
Chest Tightness
SOB
Dyspnea / PND
Cyanosis

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10
Q

PE findings of acute bronchitis

A

during PE you find
Most generally cough with or without bronchospasm
Wheezing variable (worse in smokers and asthmatics)
Rhonchi (clears with cough)
Sputum variable
Low grade Fever (rare, depending on causative factor)
Chest wall tenderness
Findings more suggestive of URTI
Nasal congestion, rhinorrhea, erythematous throat, injected sclera
Lymphadenopathy

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11
Q

stridor is indicative of

A

Obstruction in tracheobronchial tree

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12
Q

Heaves are indicative of

A

RVH secondary to Chronic Bronchitis

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13
Q

clubbing is indicative of

A

Chronic Bronchitis or CF

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14
Q

Bullous is indicative of

A

M. pneumo

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15
Q

Conjunctivitis, adenopathy, and rhinorrhea in acute bronchitis is indicative of?

A

adenovirus

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16
Q

when does acute bronchitis become emergent

A

Pneumonia: (fever, tachypnea, tachycardia)
PE: (dyspnea, tachypnea, thoracic pain, tachycardia)
Pulmonary edema: (tachypnea, dyspnea, rales)
Status asthmaticus: (expiratory rhonchi, prolonged expiration, wheezing, beware: silent chest)
Pneumothorax: (stabbing thoracic pain, asymmetric thoracic motion, unilateral attenuation of breath sounds, hypersonic percussion sound)
Foreign Body Aspiration: (dyspnea, inspiratory stridor)
CHF

17
Q

diagnostic labs ordered for acute bronchitis

A
  1. NP swab / viral panel - Influenza, COVID
  2. CBC w/ diff
  3. Procalcitonin (to distinguish bacterial vs. nonbacterial)
    - > 0.25 mcg/L (non-ICU)
    - > 0.5 mcg/L (ICU)
  4. Blood CX (if bacterial suspected)
  5. Sputum cytology, gram stain, culture (if cough persistent, ill appearing and diagnosis unclear)
  6. Bronchoscopy (to exclude foreign body aspiration, TB, tumors, and other chronic diseases)
18
Q

tx for acute bronchitis

A

Reassurance & Education
Symptomatic Treatment
- Rest, Hydration
- Cough meds - Antitussives, Expectorants
- Antihistamines (diphenhydramine)
- Decongestants (phenylephrine)
- B2 Agonists (albuterol) - if wheezing

19
Q

HR >100, RR >24, oral temp >38℃, and abnormal lung exam is indicative for what condition

A

pneumonia

20
Q

CXR of acute bronchitis vs pneumonia

A

bronchitis - clear
pneumonia - consolidation

21
Q

does sputum color in acute bronchitis mean anything?

A

naur

22
Q

is bronchitis contagious?

A

yes

23
Q

The surface proteins ____ and _____ are critical for virulence of influenza

A

hemagglutinin
neuraminidase

24
Q

what type of influenza is the most pathogenic

A

A

25
Q

pathophys time line of influenza

A

incubation period 1 - 4 days
Transmission 1 day before onset of sx
Viral shedding lasts for approx 5 - 10 d
Most virulent in the first 3 days of sx

26
Q

flu seasons in tropics and northern hemisphere

A

tropical - throughout the year
northern - starts in early fall, peaks in mid-February, and ends in the late spring of the following year

27
Q

sx of influenza

A

F, HA, fatigue
sore throat, rhinorrhea, nasal congestion
cough, dyspnea
N/V/D
myalgia, joint pain, body aches

28
Q

The criterion standard for confirming influenza virus infection is ?

A

reverse transcription-polymerase chain reaction (RT-PCR)
viral cx of nasopharyngeal or throat secretions

29
Q

other work up for influenza

A
  1. CXR r/p penumonia
    - Early radiographic findings include no or minimal bilateral symmetrical interstitial infiltrates.
    - Later, bilateral symmetrical patch infiltrates become visible
  2. Focal infiltrates indicate superimposed bacterial pneumonia
  3. CBC may show leukopenia and lymphocytopenia
  4. Ask about exposures, day care, school, work environment, etc.
30
Q

management of influenza

A
  1. Supportive care
    - Rest and hydration
    - Supplemental oxygen
  2. Hospitalization if evidence of hypoxia or in high-risk groups (infants, elderly, immunocompromised)
  3. NSAIDs or acetaminophen for fever and myalgias
  4. Isolation and good hygiene to prevent spread
31
Q

antivirals for influenza

A
  1. Oseltamivir (Tamiflu) 75 mg bid X 5 days (adolescent/adult)
  2. Zanamivir (Relenza)
  3. Rapivab (Peramivir) (IV only) (FDA approved in 2014)
  4. Baloxavir marboxil (Xofluza) (FDA approved in fall of 2018) - indicated for high-risk
32
Q

which influenza antivirals are neuraminidase inhibitors

A

oseltamivir
zanamivir

33
Q

which influenza antivirals have activity aginst A and B including H1N1

A

oseltamivir and zanamivir
polymerase acidic (PA) endonuclease inhibitors

34
Q

influenza antivirals must be administered when in order to be effective as tx

A

within 48 hours of symptom onset

35
Q

which influenza antiviral is wt based dosing

A

tamiflu

36
Q

prevention for influenza

A

Pulmonary: Clin Med II B (10 decks)

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