Lower Respriatory

Question 1

Most common pathogen for
Bronchitis
Sinusitis
Meningitis
Community acquired pneumonia

Answer 1

strep

Question 2

Acute Bronchitis

def

Answer 2

acute inflammation of upper airways w/ cough and sputum

Question 3

Acute Bronchitis

1. S/S
2. Physical findings

Answer 3

1. cough, HA, wheezing, viral infections can last 7-14 days.
2. No lung consolidation ==> clear auscultation, normal percussion (resonance), upper airway rhonchi clear w/ cough, afebrile (viral), febrile (bacterial)

Question 4

Acute Bronchitis

mgt

Answer 4

1. supportive: humidifies, increase fluids, cough suppressants (use judiciously), albuterol for wheezing
2. Antibiotics==> a. macrolides b. doxycycline c. bactrim
   * let fever help you decide if need to tx w/ antibiotic

Question 5

Acute Bronchitis

diagnostics

Answer 5

1. usually none (but it diagnosis unclear)

2. CXR, sputum cultures

Question 6

Causes of Acute Bronchitis

1. viral
2. bacterial

Answer 6

1. Rhinovirus, coronavirus, adenovirus

2. Mycolpalsma pneumoniae (atypical), streptococus (typical)

Question 7

Acute Bronchitis Summary

Answer 7

1. Viral causes (can last 7- 14 days)
2. No evidence of lung consolidation
3. tx w/ macrolides if bacterial (strep most common) as evidence w/ fever.

Question 8

Asthma definition

Answer 8

increase responsiveness of bronchi & trachea to stimuli causing:

• narrowing of airways
• mucosal edema
• thickening of epithelial basement membrane
• Hypertrophy of mucus glands
• plugging of airways by thick/viscid mucus *fluids improtant

Question 9

Asthma S/S

1. Ominous signs
2. others

Answer 9

1. fatigues, absent breath sounds, paradoxical chest/abdoeminal movement, unable to lie down, cyanosis
2. difficulty speaking in sentences, pulsus paradoxus > 12mm, hyper-resonance (= air taping)

Question 10

Asthma

1. diagnostics
2. when to hospitalize

Answer 10

1.

a. slight increase in WBC w/ eosinophilia
b. Pulmonary Function Tests ==> findings typical of obstructive dysfunction
c. CXR NOT necessary (unless need to r/o other problems… may show hyperinflation)
3. Hospitalize if:
a. FEVI

Question 11

Asthma

1. Tx regiem
   * pt teaching w/ ICS

Answer 11

SABA ==> ICS ==> LABA or increase ICS or other options (i.e. theophylline, inhaled anti-cholingergics
Anti-leukotrienes useful in maintaining chronic asthma (Singular/montelukaste)
*remind to wash mouth a/f ICS to prevent yeast infecitons