Lower Respiratory Infections

Question 1

What is therapeutuc treatment for acute bronchitis

Answer 1

None: self limiting
Dont give abx
Dont give meds to suppresss cough

Question 2

What are the main culprits of acute bronchitis 3

Answer 2

Coronavirus
Rhinovirus
Influenza virus adenovirus

Question 3

What is the major bacterial cause for acute bronchitis?

Answer 3

Mycoplasma pneumonia

Question 4

What is the most common cause of acute bronchiolitis?

Answer 4

RSV

Mostly affects infants

Question 5

What is treated approach in infants with acute bronchiolitis?

Answer 5

Fever
Oral fluids
Observe closely

Question 6

What is treatment approach for acute bronchiolitis in children with an underlying pulmonary or cardiovascular disease?

Answer 6

Palivizumab- antibody to RSV

-administer monthly during fall/ winter season

Question 7

What are ADE of pavilizumab? What is route of administration?

Answer 7

Fever
Rash
Thrombocytopenia
IM or IV

Question 8

What are hallmark signs of chronic bronchitis?

Answer 8

Cough

Sputum production

Question 9

What is tx for acute exacerbations of chronic bronchitis?

Answer 9

1. Chest physiotherapy or humidifier- to loosen and get rid of mucous
2. Oxygen if necessary
3. Albuterol
4. Abx use based on anthonisen criteria

Question 10

What is anthonisen criteria?

Answer 10

Provide abx therapy if 2 of the following present:

1. Increased SOB
2. Increased sputum production
3. Purulent sputum

Question 11

What pathogen is associated with acute exacerbations of chronic bronchitis?

Answer 11

H. Flu

Question 12

What is 1 treatment for acute exacerbations of chronic bronchitis?

Answer 12

Augmentin 500-875mg in 3 doses over 2 days

Question 13

What is tx for acute exacerbations of chronic bronchitis?

Answer 13

FEV1%<50%
macrolide
2nd or 3rd gen cephalosporin
TMP/SMX

Question 14

What is preferred treatment for penicillin sensitive Strep pneumonia?

Answer 14

-Ampicillin, penicillin G, amoxicillin

Question 15

What is tx for penicillin resistant Strep pneumonia?

Answer 15

• Ceftriaxzone

- levofloxacin

Question 16

What is tx for non beta lactamase producing H flu?

Answer 16

• ampicillin IV

- amoxicillin

Question 17

What is tx for beta lactamase producing H. flu

Answer 17

• ceftriaxzone

- ampicillin sulbactam

Question 18

What is preferred tx for Mycoplasma pneumo?

Answer 18

• macrolide (ezithromycin)

- doxycycline

Question 19

What is tx for legionella pneumophilia?

Answer 19

-Fluoroquinilones or azithromycin

Question 20

What is tx for MSSA?

Answer 20

Cefazolin

Question 21

What is tx for MRSA?

Answer 21

• vancomycin

- Linezolid

Question 22

What is tx for Pseudomonas aeruginosa ?

Answer 22

anti-pseudomonal beta lactam or fluoroquinolone (levofloxacin)
-can add aminoglycoside (Gentamicin)

Question 23

What is tx for beta lactam producing gram negative bacilli?

Answer 23

-carbapenem (imipenim)

Question 24

What is tx for carbapenem resistant organisms?

Answer 24

-polymixin B + inhaled colistin

Question 25

What is most common bacterial cause of CAP?

Answer 25

Streptococcus pneumonia

Question 26

What is tx for CAP?

Answer 26

1. Chest physiotherapy 2. iv fluid 3. albuterol 4. abx depends on pathogen

Question 27

What is empiric tx for CAP/streptococcus pneumonia with no abx use in last 3 months and no comorbidities ?

Answer 27

macrolide or doxycylcine

Question 28

What is tx for CAP/resistant strep pneumo and prior abx use in last 3 months?

Answer 28

levofloxacin or beta lactam (high dose amoxicillin, ceftriaxzone) + macrolide or doxycycline

Question 29

What is tx for CAP when >25% strep pneumonia resistance regionally?

Answer 29

levofloxacin or beta lactam (high dose amoxicillin or ceftriaxzone) + macrolide or doxycycline

Question 30

What can you use when you cant give cephalosporin?

Answer 30

-fluoroquinolones

Question 31

what is tx for non ICU CAP? strep pneumo H. flu M. pneumo

Answer 31

- levofloxicin or beta lactam (high dose amoxicillin or ceftriaxzone) - + macrolide or doxicycline

Question 32

what is tx for ICU CAP?

Answer 32

-b lactam + azithromycin or levofloxacin

Question 33

TX FOR MRSA ICU CAP?

Answer 33

-b lactam + azithromycin or levofloxacin | + vancomycin

Question 34

TX for P. aeruginosa ICU CAP?

Answer 34

tazobactum/meropenem/imipenim +levofloxacin +azithromycin

Question 35

TX for H. flu ICU CAP?

Answer 35

-b lactam + azithromycin or levofloxacin +osetalmivir