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Clin Med B 2 > Lower Respiratory infections part 1 > Flashcards

Lower Respiratory infections part 1 Flashcards

1
Q

what are HPI and ROS findings that should be assessed for in Lower respiratory tract infections
(general, EENT, cardio, abdominal, respiratory, skin)

A

differentiated ones are:
wt loss/gain
chest pain/pressure
productive v non
NVD
hemoptysis
dyspepsia
rash

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2
Q

what should be assessed on the PE of lower respiratory tract infections

A
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3
Q

what are the causes of acute bronchitis

A
  • bacterial or viral respiratory tract infection
  • heavy smoking
  • allergy
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4
Q

what is considered chronic bronchitis

A

cough for over three months over a two year period

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5
Q

how long does ACUTE bronchitis typically last

A

at least 5 days and up to 3 weeks

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6
Q

what is the most common cause of bronchitis in unhealthy immunocompromised people

A

bacteria

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7
Q

what is the MCC of bronchitis in healthy adults

A

viruses

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8
Q

what is the pathophysiology of bronchitis

A
  1. infection in conducting airway
  2. inflammation of airway
  3. exudate production
  4. bronchospasm
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9
Q

what are the two sequential phases of bronchitis

A
  1. direct inoculation of tracheobronchial epithelium (responsible for first 1-5 days)
  2. hypersensitivity of airway receptors. (responsible for 1-3 weeks) causing sloughed epithelium and increased mucous production
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10
Q

what is the difference in appearance of normal bronchi vs bronchitis

A
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11
Q

what are viral causes of acute bronchitis

A

influenza A/B
Adenovirus
Parainfluenza
RSV
Rhinovirus/Picornavirus
Coronavirus
HMNV

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12
Q

What is the MC virus that causes bronchitis

A

influenza A and B
(said in class)

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13
Q

what are bacterial causes of acute bronchitis

A

s. pneumo
H. flu
M. Cat

remember this is MC in immunocompromiised people

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14
Q

what are atypical causes of acute bronchitis

A

B pertussis (1-12%)
C pneumonia (0-6%)
M pneumonia (0-6%)
B bronchiseptica

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15
Q

who are atypical bronchitis MC in

A

mostly in non-vaccinated or immunocomped people

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16
Q

what should be included in the HPI of acute bronchitis

A
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17
Q

what are symptoms of acute bronchitis

A

cough
substernal pain
wheezing
fever
fatigue
malaise
chest tightness
SOB
dyspnea/PND/cyanosis

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18
Q

What is included on the PE for acute bronchitis

A
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19
Q

what are the general PE findings in acute bronchitis

A
  • cough w/wo bronchospasm
  • wheezing (worse in smokers and asthma)
  • rhonchi (clears with cough)
  • fever (rare, low grade)
  • chest wall tenderness
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20
Q

what illness is associated with diffuse wheezing with increased respiratory effort

A

pneumonia or asthma exacerbation

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21
Q

what illness is associated with stridor

A

Croup
foreign body.

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22
Q

what illness is associated with sustained heave across the left sternal border

A

right ventricular hypertrophy due to chronic bronchitis

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23
Q

what illness is associated with clubbing or cyanosis

A

CF
COPD
chronci bronchitis

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24
Q

what illness is associated with bullous myringitis

A

mycoplasma pneumonia

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25
Q

what illness is associated with conjunctivitis adenopathy and rhinorrhea

A

adenovirus

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26
Q

what findings are more suggestive of upper respiratory infection rather than lower respiratory infection

A

nasal congestion
rhinorrhea
erythematous throat
injected sclera
lymphadenopathy

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27
Q

what are emergent diagnoses (this card is not done)

A
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28
Q

How do you diagnose acute bronchitis

A

mostly clinically, can use a chest xray

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29
Q

what are possible lab studies that could be done to diagnose acute bronchitis

A
  • NP swab/viral panel
  • CBC with diff (WBC normal to low)
  • procalcitonin (to distinguish bacterial v non)
  • blood culture (if bacterial suspected)
  • sputum cytology
  • bronchoscopy
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30
Q

what is the treatment for acute bronchitis

A

reassurance and education with symptomatic treatment

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31
Q

what are the antitussive medications.

A

dextromethorphan
codeine
benzonatate

32
Q

What are the Central acting antitussives

A

dextromethorphan

33
Q

what is the peripheral acting antitussive

A

benzonatate

34
Q

what is the expectorant medication

A

guaifenesin

35
Q

when would you NOT want to give cough suppressants

A

when the cough is productive. this could lead to pneumonia. we want them to cough it up. (said in class)

36
Q

what does colored sputum in acute bronchitis indicate

A

NOTHING hehe

37
Q

what is the focus when you have a patient with acute bronchitis

A

RULE OUT PNEUMONIA

38
Q

which is acute bronchitis

A

the left shows left lower lobular pneumonia.

the right is acute bronchitis, which usually presents with a clear CXR

39
Q

Is acute bronchitis contagious?

A

no???

40
Q

what are the types of influenza

A

ABC

41
Q

what type of virus is influenza

A

encapsulated, single-stranded RNA viruses

42
Q

what is the part of the influenza virus that makes it virulent

A

the surface proteins hemagglutinin and neuraminidase

43
Q

what is the function of hemagglutinin

A

binds to respiratory epithelial cells, allowing cellular infections

44
Q

what is the function of neuraminidase

A

cleaves the bond that holds newly replicated virions to the cell surface, permitting the infection to spread

45
Q

which subtype is identified by the variants of hemagglutinin and neuraminidase

A

influenza A

46
Q

which influenza is the most pathogenic

A

influenza A

47
Q

how does influenza spread

A

human to human via aerosols

48
Q

describe the incubation and transmission timeline of influenza

A
  • transmission may occur as early as 1 day prior to symptoms.
  • incubation period ranges 1-4 days
  • viral shedding lasts 5-10 days
  • most virulent in first 3 days of symptoms
49
Q

when is flu season?

A
  • northern hemisphere - early fall through late spring
  • tropical areas - year round
50
Q

what are general symptoms of influenza

A

general - fever, HA, fatigue
EENT - sore throat, rhinorrhea, nasal congestion
Lungs - coughing, dyspnea
GI - NVD
MSK - myalgia, joint pain, body aches

51
Q

what should be done on a PE when influenza is suspected

A
52
Q

how do you diagnose influenza

A

rapid influenza swab or NP swab

criterion standard:
* reverse transcription PCR
* viral culture NP
* viral culture throat

53
Q

what other diagnostic studies may be ordered for influenza

A

CXR - r/o pneumonia
CBC - shows leukopenia and lymphocytopenia

54
Q

How do you treat influenza

A
  • supportive care
  • NSAIDS/acetominophin for fever and myalgias
  • antiviral drugs, neuraminidase inhibitors or polymerase acidic endonuclease inhibitors (must be started w/i 48 hrs of sympotms)
55
Q

when would you hospitalize a patient with the flu

A

if hypoxic or if considered a high risk group such as infants, elderly and immunocompromised

56
Q

what are the antivirals used for the flu

A
  • Oseltamivir (Tamiflu)
  • Zanamivir (Relenza)
  • Rapivab (Peramivir) (IV only) (FDA approved in 2014)
  • Baloxavir marboxil (Xofluza) indicated for high-risk
57
Q

what are the neuraminidase inhibitors

A

oseltamivir
zanamivir

58
Q

how effective is the influenza vaccination

A

50-70% effective against influenza A and B. 10-14 days after vaccination

59
Q

which flu vaccine is live

A

the FluMist which is inhaled.
do NOT give to pregnant or immunocompromised.

60
Q

what is the bacterial agent that causes whooping cough

A

bordetella pertussis

61
Q

what type of bacteria is bordetella pertussis

A

gram negative, aerobic, encapsulated, pleomorphic coccobacilli

62
Q

how is bordetella pertussis spread

A

aerosolized droplets, attaches to respiratory epithelium and then travels to bronchi and bronchioles

63
Q

what are the differences between toxins A and B that are formed by pertussis

A
  • B attaches to the cell surface
  • A enters the cell and inactivates the regulation of cAMP leading to increased mucus and decreased phagocytic action.
64
Q

what are the stages of pertussis

A

the whole disease lasts 6 weeks
stage 1 - catarrhal stage
stage 2 - paroxysmal stage
stage 3 - convalescence stage

65
Q

what occurs during the catarrhal stage of pertussis

A
  • lasts 1-2 weeks
  • nasal Congestion
  • Rhinorrhea
  • Sneezing
  • Low grade fever
  • Tearing
  • Conjunctival Erythema
66
Q

what occurs during the paroxysmal stage

A
  • lasts 1 - 10 weeks
  • Paroxysms of intense coughing with “whoop”
  • Posttussive vomiting and turning red with coughing
67
Q

what occurs during the convalescent stage

A
  • 2 - 3 weeks
  • Chronic cough lasting for weeks
68
Q

what is the typical PE for pertussis

A
69
Q

How does the PE differ for pertussis in infants <3 mo

A
70
Q

what is the diagnostic techniques for pertussis

A
  • clinical - suspicion high in children with cough for more than 2 weeks.
  • CXR likely normal (not needed)
  • CBC - leukocytosis and lymphocytosis
  • PCR in NP secretions
  • GOLD STANDARD - bacterial culture of NP secretions to confirm BP infection
71
Q

what is the window of diagnosis for bordetella pertussis

A
72
Q

what are management goals of treating bordetella pertussis

A
  • limit paroxysms
  • decrease contagiousness
  • decrease severity of cough
  • decrease associated s/s
  • maximize rest, nutrition, recovery
73
Q

what is the medication used to treat pertussis

A

macrolides
reduce severity of sympotms if started early.

74
Q

who should be treated empirically for bordetella pertussis and how

A

all close contacts of infected individuals should be treated empirically! with macrolides

75
Q

what is the dosage for pertussis treatment

A
76
Q

what is the vaccination used for pertussis

A

Clin Med B 2 (44 decks)

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