Lower Respiratory infections part 1 Flashcards
what are HPI and ROS findings that should be assessed for in Lower respiratory tract infections
(general, EENT, cardio, abdominal, respiratory, skin)
differentiated ones are:
wt loss/gain
chest pain/pressure
productive v non
NVD
hemoptysis
dyspepsia
rash
what should be assessed on the PE of lower respiratory tract infections
what are the causes of acute bronchitis
- bacterial or viral respiratory tract infection
- heavy smoking
- allergy
what is considered chronic bronchitis
cough for over three months over a two year period
how long does ACUTE bronchitis typically last
at least 5 days and up to 3 weeks
what is the most common cause of bronchitis in unhealthy immunocompromised people
bacteria
what is the MCC of bronchitis in healthy adults
viruses
what is the pathophysiology of bronchitis
- infection in conducting airway
- inflammation of airway
- exudate production
- bronchospasm
what are the two sequential phases of bronchitis
- direct inoculation of tracheobronchial epithelium (responsible for first 1-5 days)
- hypersensitivity of airway receptors. (responsible for 1-3 weeks) causing sloughed epithelium and increased mucous production
what is the difference in appearance of normal bronchi vs bronchitis
what are viral causes of acute bronchitis
influenza A/B
Adenovirus
Parainfluenza
RSV
Rhinovirus/Picornavirus
Coronavirus
HMNV
What is the MC virus that causes bronchitis
influenza A and B
(said in class)
what are bacterial causes of acute bronchitis
s. pneumo
H. flu
M. Cat
remember this is MC in immunocompromiised people
what are atypical causes of acute bronchitis
B pertussis (1-12%)
C pneumonia (0-6%)
M pneumonia (0-6%)
B bronchiseptica
who are atypical bronchitis MC in
mostly in non-vaccinated or immunocomped people
what should be included in the HPI of acute bronchitis
what are symptoms of acute bronchitis
cough
substernal pain
wheezing
fever
fatigue
malaise
chest tightness
SOB
dyspnea/PND/cyanosis
What is included on the PE for acute bronchitis
what are the general PE findings in acute bronchitis
- cough w/wo bronchospasm
- wheezing (worse in smokers and asthma)
- rhonchi (clears with cough)
- fever (rare, low grade)
- chest wall tenderness
what illness is associated with diffuse wheezing with increased respiratory effort
pneumonia or asthma exacerbation
what illness is associated with stridor
Croup
foreign body.
what illness is associated with sustained heave across the left sternal border
right ventricular hypertrophy due to chronic bronchitis
what illness is associated with clubbing or cyanosis
CF
COPD
chronci bronchitis
what illness is associated with bullous myringitis
mycoplasma pneumonia
what illness is associated with conjunctivitis adenopathy and rhinorrhea
adenovirus
what findings are more suggestive of upper respiratory infection rather than lower respiratory infection
nasal congestion
rhinorrhea
erythematous throat
injected sclera
lymphadenopathy
what are emergent diagnoses (this card is not done)
How do you diagnose acute bronchitis
mostly clinically, can use a chest xray
what are possible lab studies that could be done to diagnose acute bronchitis
- 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
what is the treatment for acute bronchitis
reassurance and education with symptomatic treatment
what are the antitussive medications.
dextromethorphan
codeine
benzonatate
What are the Central acting antitussives
dextromethorphan
what is the peripheral acting antitussive
benzonatate
what is the expectorant medication
guaifenesin
when would you NOT want to give cough suppressants
when the cough is productive. this could lead to pneumonia. we want them to cough it up. (said in class)
what does colored sputum in acute bronchitis indicate
NOTHING hehe
what is the focus when you have a patient with acute bronchitis
RULE OUT PNEUMONIA
which is acute bronchitis
the left shows left lower lobular pneumonia.
the right is acute bronchitis, which usually presents with a clear CXR
Is acute bronchitis contagious?
no???
what are the types of influenza
ABC
what type of virus is influenza
encapsulated, single-stranded RNA viruses
what is the part of the influenza virus that makes it virulent
the surface proteins hemagglutinin and neuraminidase
what is the function of hemagglutinin
binds to respiratory epithelial cells, allowing cellular infections
what is the function of neuraminidase
cleaves the bond that holds newly replicated virions to the cell surface, permitting the infection to spread
which subtype is identified by the variants of hemagglutinin and neuraminidase
influenza A
which influenza is the most pathogenic
influenza A
how does influenza spread
human to human via aerosols
describe the incubation and transmission timeline of influenza
- 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
when is flu season?
- northern hemisphere - early fall through late spring
- tropical areas - year round
what are general symptoms of influenza
general - fever, HA, fatigue
EENT - sore throat, rhinorrhea, nasal congestion
Lungs - coughing, dyspnea
GI - NVD
MSK - myalgia, joint pain, body aches
what should be done on a PE when influenza is suspected
how do you diagnose influenza
rapid influenza swab or NP swab
criterion standard:
* reverse transcription PCR
* viral culture NP
* viral culture throat
what other diagnostic studies may be ordered for influenza
CXR - r/o pneumonia
CBC - shows leukopenia and lymphocytopenia
How do you treat influenza
- 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)
when would you hospitalize a patient with the flu
if hypoxic or if considered a high risk group such as infants, elderly and immunocompromised
what are the antivirals used for the flu
- Oseltamivir (Tamiflu)
- Zanamivir (Relenza)
- Rapivab (Peramivir) (IV only) (FDA approved in 2014)
- Baloxavir marboxil (Xofluza) indicated for high-risk
what are the neuraminidase inhibitors
oseltamivir
zanamivir
how effective is the influenza vaccination
50-70% effective against influenza A and B. 10-14 days after vaccination
which flu vaccine is live
the FluMist which is inhaled.
do NOT give to pregnant or immunocompromised.
what is the bacterial agent that causes whooping cough
bordetella pertussis
what type of bacteria is bordetella pertussis
gram negative, aerobic, encapsulated, pleomorphic coccobacilli
how is bordetella pertussis spread
aerosolized droplets, attaches to respiratory epithelium and then travels to bronchi and bronchioles
what are the differences between toxins A and B that are formed by pertussis
- B attaches to the cell surface
- A enters the cell and inactivates the regulation of cAMP leading to increased mucus and decreased phagocytic action.
what are the stages of pertussis
the whole disease lasts 6 weeks
stage 1 - catarrhal stage
stage 2 - paroxysmal stage
stage 3 - convalescence stage
what occurs during the catarrhal stage of pertussis
- lasts 1-2 weeks
- nasal Congestion
- Rhinorrhea
- Sneezing
- Low grade fever
- Tearing
- Conjunctival Erythema
what occurs during the paroxysmal stage
- lasts 1 - 10 weeks
- Paroxysms of intense coughing with “whoop”
- Posttussive vomiting and turning red with coughing
what occurs during the convalescent stage
- 2 - 3 weeks
- Chronic cough lasting for weeks
what is the typical PE for pertussis
How does the PE differ for pertussis in infants <3 mo
what is the diagnostic techniques for pertussis
- 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
what is the window of diagnosis for bordetella pertussis
what are management goals of treating bordetella pertussis
- limit paroxysms
- decrease contagiousness
- decrease severity of cough
- decrease associated s/s
- maximize rest, nutrition, recovery
what is the medication used to treat pertussis
macrolides
reduce severity of sympotms if started early.
who should be treated empirically for bordetella pertussis and how
all close contacts of infected individuals should be treated empirically! with macrolides
what is the dosage for pertussis treatment
what is the vaccination used for pertussis
