Lower Respiratory Infections

Question 1

PE RSP signs for LRTI

Answer 1

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

Question 2

Bacterial etiology more suspect when ?

Answer 2

symptoms prolonged - duration w/ worsening symptoms

Question 3

causes of acute bronchitis

Answer 3

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

Question 4

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

Answer 4

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

Question 5

bacterial acute bronchitis MC affects who?

Answer 5

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

Question 6

pathophys of acute bronchitis

Answer 6

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

Question 7

Two sequential phases of acute bronchitis

Answer 7

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

Question 8

the cause of kennel cough in dogs

Answer 8

B bronchiseptica

Question 9

sx of acute bronchitis

Answer 9

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

Question 10

PE findings of acute bronchitis

Answer 10

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

Question 11

stridor is indicative of

Answer 11

Obstruction in tracheobronchial tree

Question 12

Heaves are indicative of

Answer 12

RVH secondary to Chronic Bronchitis

Question 13

clubbing is indicative of

Answer 13

Chronic Bronchitis or CF

Question 14

Bullous is indicative of

Answer 14

M. pneumo

Question 15

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

Answer 15

adenovirus

Question 16

when does acute bronchitis become emergent

Answer 16

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

Question 17

diagnostic labs ordered for acute bronchitis

Answer 17

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)

Question 18

tx for acute bronchitis

Answer 18

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

Question 19

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

Answer 19

pneumonia

Question 20

CXR of acute bronchitis vs pneumonia

Answer 20

bronchitis - clear
pneumonia - consolidation

Question 21

does sputum color in acute bronchitis mean anything?

Answer 21

naur

Question 22

is bronchitis contagious?

Answer 22

yes

Question 23

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

Answer 23

hemagglutinin
neuraminidase

Question 24

what type of influenza is the most pathogenic

Answer 24

A

Question 25

pathophys time line of influenza

Answer 25

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

Question 26

flu seasons in tropics and northern hemisphere

Answer 26

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

Question 27

sx of influenza

Answer 27

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

Question 28

The criterion standard for confirming influenza virus infection is ?

Answer 28

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

Question 29

other work up for influenza

Answer 29

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.

Question 30

management of influenza

Answer 30

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

Question 31

antivirals for influenza

Answer 31

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

Question 32

which influenza antivirals are neuraminidase inhibitors

Answer 32

oseltamivir zanamivir

Question 33

which influenza antivirals have activity aginst A and B including H1N1

Answer 33

oseltamivir and zanamivir polymerase acidic (PA) endonuclease inhibitors

Question 34

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

Answer 34

within 48 hours of symptom onset

Question 35

which influenza antiviral is wt based dosing

Answer 35

tamiflu

Question 36

prevention for influenza