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Pulm > Lower Respiratory Infections - Part 1 - Exam 1 > Flashcards

Lower Respiratory Infections - Part 1 - Exam 1 Flashcards

1
Q

How long do you need to be coughing in order to be considered acute? subacute? chronic?

A

Acute: < 3 weeks (viruses, bacterial infections, COPD exacerbations)

Subacute: 3 - 8 weeks (post-infectious cough)

Chronic: > 8 weeks (COPD, GERD, PND)

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2
Q

What are some important history questions to ask your pt when they present with a cough?

A

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

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3
Q

What is acute bronchitis defined as? When are the most cases present? What is the MC underlying cause?

A

Self-limiting inflammation of the bronchi (< 3 weeks)

usually in the fall/winter months

Viruses

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4
Q

What is the pathophys behind acute bronchitis?

A

virus/bacteria/irritant get into airway ->

inflammation of airway -> exudate production -> bronchospams/cough

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5
Q

What are the 2 sequential phases of acute bronchitis? How long do each last?

A
  1. Direct inoculation of tracheobronchial epithelium -> typical presentation -> lasts 1-5 days
  2. Hypersensitivity of the airway receptors -> responsible for persistent s/s -> last 1-3 weeks
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6
Q

What causes increased sputum production in hypersensitivity of airway receptors? What can this lead to?

A

Sloughed epithelium

Air passages clogged by debris and irritation

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7
Q

What are the viral causes of acute bronchitis?

A

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

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8
Q

What are the bacterial causes of acute bronchitis?

A

Strep pneumo
H flu
M cat

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9
Q

What are the atypical causes of acute bronchitis?

A

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

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10
Q

What are some s/s that would make you think this is an emergent situation?

A

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

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11
Q

T/F: It is necessary if you suspect acute bronchitis to order a CXR to confirm.

A

FALSE!!! clinical dx is acceptable

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12
Q

When would you order a CXR in acute bronchitis? What will it look like?

A

if the exam was unclear/unsure, in an infant, elderly population

except to see a normal CXR

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13
Q

What lab studies would you want to order if you suspect acute bronchitis?

A

NP swab +/- viral panel
CBC with diff
procalcitonin
blood culture
sputum cytology
bronchoscopy

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14
Q

You have a pt with acute bronchitis, what would you expect their CBC with diff to show?

A

lymphopenia and leukopenia

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15
Q

What does the procalcitonin level tell you? What are the levels specifically?

A

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)

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16
Q

When would you order a sputum cytology?

A

will also gram stain and culture if cough persistent, ill appearing and diagnosis unclear)

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17
Q

Why would you order a bronchoscopy?

A

to exclude foreign body aspiration, TB, tumors, and other chronic diseases)

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18
Q

What is the tx for symptomatic acute bronchitis?

A

rest, hydration, cough medication, antihistamines, decongestants, albuterol if wheezing

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19
Q

Which antitussives are central acting? peripheral?

A

dextromethorphan

benzonatate

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20
Q

______ is the MC non-opioid agent used for cough

A

dextromethorphan

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21
Q

_____ MOA acts centrally to elevate the threshold for coughing by acting on the medullary cough center

A

dextromethorphan and codeine

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22
Q

antitussive are classified as ___________

A

NMDA receptor antagonist

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23
Q

**What antitussive it is possible to overdose on?

A

codeine

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24
Q

What drug class is benzonatate in? Is it central or peripheral?

A

procaine derivative

peripheral

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25
Q

_______ inhibits pulmonary stretch receptors and decreases the reflex in the lungs which causes the urge to cough

A

benzonatate

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26
Q

What drug class is guaifenesin?

A

expectorants

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27
Q

______ increase mucous secretion or increase airway water to facilitate mucus expulsion from the airways.

A

guaifenesin

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28
Q

guaifenesin ______ sputum volume and _____ sputum viscosity

A

increases sputum volume

decreases sputum viscosity

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29
Q

What is the CI to guaifenesin?

A

hypersensitivity

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30
Q

**What should a pt with the flu lung’s sound like?

A

lungs should be normal/ have normal lung sounds

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31
Q

What are the different strains of the flu? Which 2 are more common? Which one is the worst?

A

ABCD

A and B are most common

A is worse than B

32
Q

What is the flu composed of? What are the 2 surface proteins that are critical for virulence?

A

Encapsulated, single-stranded RNA viruses

hemagglutinin and neuraminidase

33
Q

______ binds to respiratory epithelial cells, allowing cellular infection

A

Hemagglutinin

34
Q

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

A

Neuraminidase

35
Q

**Who are the number 1 carriers that transmit pertussis to babies?

A

human adults

36
Q

How is the flu spread? What is the incubation period?

A

Spreads from human to human via respiratory contact vs fomites (objects or materials which are likely to carry infection, such as clothes, utensils, and furniture)

incubation period ranges from 1 to 4 days

37
Q

Flu: Viral shedding lasts for approximately ______. Most virulent in the first _____ of symptoms

A

5 to 10 days

3 days

38
Q

In the northern hemisphere when is the peak of flu season? What is the typical season?

A

peaks in mid-February

early fall and ends in late spring the following year

39
Q

How do you dx flu?

A

clinical suspicion
then rapid flu or NP swab

40
Q

The criterion standard for confirming influenza virus infection is ______ or _______

A

reverse transcription-polymerase chain reaction (RT-PCR)

viral culture of nasopharyngeal or throat secretions

41
Q

**When would you treat someone with antivirals if you suspect the flu? What is the tx? What do you need to get before prescribing the appropriate medication?

A

Has to be within the first 48 hours of symptoms!!!

Oseltamivir (Tamiflu) 75 mg bid X 5 days (adolescent/adult)

BMP to check renal function

42
Q

What is the prophylactic tx for flu?

A

Oseltamivir (Tamiflu) 75 mg qd X 10 days (adolescent/adult)

43
Q

Which flu antiviral is indicated for high-risk pts?

Oseltamivir (Tamiflu)
Zanamivir (Relenza)
Rapivab (Peramivir) (IV only)
Baloxavir marboxil (Xofluza)

A

Baloxavir marboxil (Xofluza)

44
Q

T/F: oseltamivir and zanamivir have activity against influenza A and B viruses (including H1N1)

A

True!! Adamantes were used to treat flu A (no coverage for B) but no longer used/recommended for flu

45
Q

How effective is the flu vaccine at preventing infection? When does it start taking effect?

A

Vaccination provides approximately 50 - 70% efficacy against Influenza A and B

Immunity is effective after 10 to 14 days

46
Q

What type of vaccine is the flu? What type of vaccine is the nasal spray vaccine?

A

inactivated virus

live, attenuated influenza virus

47
Q

Who is indicated for the nasal spray vaccine?

A

Indicated only for healthy people aged 2-49 years who are not pregnant

48
Q

What is the MC form of pertussis? What pt population tends to get it a more severe form?

A

bordetella pertussis

pts under 2 years old

49
Q

T/F: You only need to get one dose of the pertussis vaccine to be immune for life.

A

FALSE!! does NOT provide lifelong immunity and need to get booster shots

50
Q

What is pertussis caused by? What is the milder form? Gram + or -?

A

Bordetella pertussis and Bordetella parapertussis (milder form)

gram (-) aerobic, encapsulated, coccobacilli

51
Q

**Why does pertussis sound like a “whooping cough?”

A

Attaches to the respiratory epithelium, starting in the nasal passages and then down to the bronchi and bronchioles - produces toxins, destroys respiratory cells, causes microaspirations

aka the pathophys

52
Q

In pertussis, toxin ___ attaches to the cell surface. toxin ____ enters the cell and inactivates the regulation of cAMP. What happens as a result?

A

B

A

↑ mucus production
↓ phagocytic killing

53
Q

What happens in pertussis as a result of invasive adenylate cyclase?

A

↑ production of cAMP
↑ mucus formation

54
Q

If you have NEVER had a flu vaccine and you are between the ages of ____ and ____, what is the recommendation?

A

6 months and 8 years need to get 2 flu vaccines at least 4 weeks apart

55
Q

pertussis is a _____ disease divided into 3 stages. Name the 3 stages. How long does each stage last?

A

6 week disease

catarrhal, paroxysmal, and convalescent stages

each lasting 1-2 weeks

56
Q

What are the s/s of catarrhal stage pertussis?

A

1 - 2 weeks
Nasal Congestion
Rhinorrhea
Sneezing
Low grade fever
Tearing
Conjunctival Erythema

57
Q

What are the s/s of paroxysmal stage pertussis?

A

1 - 10 weeks

Paroxysms of intense coughing with “whoop”
Posttussive vomiting and turning red with coughing

58
Q

What are the s/s of convalescent stage pertussis?

A

2 - 3 weeks
Chronic cough lasting for weeks

59
Q

What is the worst stage in pertussis?

A

Stage 2: Paroxysmal Stage

60
Q

What will the lungs should like with a pt who has pertussis? What is a common facial PE finding?

A

Rhonchi on auscultation which improve with cough

Conjunctival hemorrhages and facial petechiae from coughing

61
Q

When should you suspect pertussis in a child?

A

cough more than 2 weeks!

in an endemic area

no vaccination

Posttussive emesis; inspiratory whoop; paroxysms of coughing

62
Q

What does a CXR look like on a pt with pertussis? CBC?

A

CXR is likely normal

leukocytosis and/or lymphocytosis is possible

63
Q

**What is the gold standard to dx pertussis?

A

bacterial culture of nasopharyngeal secretions confirm Bordetella pertussis infection

64
Q

Pertussis will have _____ detected in NP secretion

A

Polymerase chain reaction (PCR) detection in NP secretions

65
Q

The NP swab/PCR will be positive for pertussis around _____ weeks from start of cough. Once you start abx, when will a pt test negative?

A

4 weeks

Become negative w/in 5 days of antibiotic therapy

66
Q

______ can be done in the later phases to confirm the diagnosis of pertussis

A

Enzyme immunoassays

67
Q

What is abx tx for pertussis?

A

Azithromycin!!

68
Q

**What is the abx tx for pertussis in an infant who is less than 1 month old? Why?

A

Azithromycin preferred in infants < 1 mo: (risk of IHPS with E-mycin) Infantile hypertrophic pyloric stenosis which can lead to an obstruction and violent vomiting

69
Q

______ is the alternative abx for pertussis in adults who cannot tolerate macrolides

A

Bactrim (TMP-SMX)

70
Q

Why do you avoid Bactrim in infants who are less than 2 months old?

A

risk for kernicterus (elevated bilirubin)

71
Q

Should you treat close contacts of people infected with pertussis? If so, with what?

A

YES!! empirically treat with azithromycin

72
Q

**What is the dosing schedule for azithromycin for a pertussis infection?

A

Azithromycin 500 mg on day 1, 250 mg ­subsequently qd for 5 days

73
Q

______ is a pertussis complication that is more likely in infants

A

Pneumonia

74
Q

What pertussis vaccine is recommended for young children? for adults? When should pregnant women receive _____ vaccine

A

DTap is for chilDren

Tdap is for adulTs

Tdap between 27-36th week of pregnancy

75
Q
A

Pulm (11 decks)

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