Lower Respiratory Infections - Part 1 - Exam 1 Flashcards
(75 cards)
How long do you need to be coughing in order to be considered acute? subacute? chronic?
Acute: < 3 weeks (viruses, bacterial infections, COPD exacerbations)
Subacute: 3 - 8 weeks (post-infectious cough)
Chronic: > 8 weeks (COPD, GERD, PND)
What are some important history questions to ask your pt when they present with a cough?
Occupation
Smoking status (including vape, marijuana)
Environmental exposures/recent travel
Recent hospitalizations, surgeries, do they live in a facility
Family history of chronic coughing issues (asthma, cancer)
New medications
What is acute bronchitis defined as? When are the most cases present? What is the MC underlying cause?
Self-limiting inflammation of the bronchi (< 3 weeks)
usually in the fall/winter months
Viruses
What is the pathophys behind acute bronchitis?
virus/bacteria/irritant get into airway ->
inflammation of airway -> exudate production -> bronchospams/cough
What are the 2 sequential phases of acute bronchitis? How long do each last?
- Direct inoculation of tracheobronchial epithelium -> typical presentation -> lasts 1-5 days
- Hypersensitivity of the airway receptors -> responsible for persistent s/s -> last 1-3 weeks
What causes increased sputum production in hypersensitivity of airway receptors? What can this lead to?
Sloughed epithelium
Air passages clogged by debris and irritation
What are the viral causes of acute bronchitis?
Influenza A/B
Adenovirus
Parainfluenza
RSV
Rhinovirus/Picornavirus
Coronavirus
HMNV
What are the bacterial causes of acute bronchitis?
Strep pneumo
H flu
M cat
What are the atypical causes of acute bronchitis?
B pertussis (1-12%)
C pneumonia (0-6%)
M pneumonia (0-6%)
B bronchiseptica
What are some s/s that would make you think this is an emergent situation?
Pneumonia: (fever, tachypnea, tachycardia)
Pulmonary embolism: (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
T/F: It is necessary if you suspect acute bronchitis to order a CXR to confirm.
FALSE!!! clinical dx is acceptable
When would you order a CXR in acute bronchitis? What will it look like?
if the exam was unclear/unsure, in an infant, elderly population
except to see a normal CXR
What lab studies would you want to order if you suspect acute bronchitis?
NP swab +/- viral panel
CBC with diff
procalcitonin
blood culture
sputum cytology
bronchoscopy
You have a pt with acute bronchitis, what would you expect their CBC with diff to show?
lymphopenia and leukopenia
What does the procalcitonin level tell you? What are the levels specifically?
to rule in or out a bacterial infection
if the number is higher than 0.25 think bacterial infection
> 0.25 mcg/L (non-ICU)
> 0.5 mcg/L (ICU)
When would you order a sputum cytology?
will also gram stain and culture if cough persistent, ill appearing and diagnosis unclear)
Why would you order a bronchoscopy?
to exclude foreign body aspiration, TB, tumors, and other chronic diseases)
What is the tx for symptomatic acute bronchitis?
rest, hydration, cough medication, antihistamines, decongestants, albuterol if wheezing
Which antitussives are central acting? peripheral?
dextromethorphan
benzonatate
______ is the MC non-opioid agent used for cough
dextromethorphan
_____ MOA acts centrally to elevate the threshold for coughing by acting on the medullary cough center
dextromethorphan and codeine
antitussive are classified as ___________
NMDA receptor antagonist
**What antitussive it is possible to overdose on?
codeine
What drug class is benzonatate in? Is it central or peripheral?
procaine derivative
peripheral
