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IDMM > Lower RTI > Flashcards

Lower RTI Flashcards

1
Q

Acute bronchitis

-etiology

A

bronchitis without pneumonia is ALWAYS viral

90% viral

  • influenza viruses
  • RSV
  • other respiratory viruses

10% bacterial

  • mycoplasma pneumoniae
  • chlamydophila pneumoniae
  • bordetella pertussis
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2
Q

The Flu

  • epidemiology (what time of year, who gets it, how many of us get it)
  • major epidemics result of…
A
  • winter months
  • everyone gets it, but death highest among elderly and infants
  • 10-20% attack rate

-Major epidemics are the result of rearrangement of the segmented genome (antigenic shift)

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3
Q

The Flu

  • etiology
  • H and N significance
A
  • Influenza virus
  • Hemagglutinin binds sialic acid on cell surface
  • Neuraminidase cleaves new virions from cell surface
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4
Q

The Flu

-course of infection

A
  • shedding 24-48h before symptoms
  • sudden onset symptoms: fever, headache, myalgias, malaise, cough, rhinnorhea (like the cold, but worse)
  • 2-7 days of symptoms
  • viral shedding stops 6-7 days after symptom onset
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5
Q

The Flu

-Management

A
  • supportive therapy

- antiviral therapy (oseltamivir) for high risk

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6
Q

The Flu

-Prevention

A
  • Immunisation
  • Chemoprophylaxis in nursing homes (oseltamivir)
  • Droplet precautions
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7
Q

COPD

-general definition

A
  • irreversible air flow limitation, usually associated with an inflammatory response
  • chronic bronchitis +/- emphysema
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8
Q

Acute exacerbations of chronic bronchitis

-define chronic bronchitis, and an acute exacerbation

A
  • Chronic bronchitis: productive cough for at least 3/12 for 2yrs
  • Acute exacerbations: increased sputum volume, purulence +/- dyspnea
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9
Q

Acute exacerbation of chronic bronchitis

-prevention

A

COPD patients should receive the flu vaccine each year and pneumococcal vaccine (q6 yrs)

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10
Q

Acutre exacerbation of chronic bronchitis

-etiology

A

50% viral

Mild:
Haemophilus spp.
S. pneumoniae
M. cattarhalis

Moderate:
above + enterobacteriaciae

Severe:

above + P. aeruginosa

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11
Q

Acute exacerbation of chronic bronchitis

-management

A
  • If antibiotics are given, amoxicillin for mild, amoxil-clav for moderate and levofloxacin for severe
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12
Q

Bronchiolitis

-epidemiology (who gets it? when?

A
  • Infants and children

- fall—>spring

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13
Q

Bronchiolitis

-etiology

A
  • RSV (50-80%)
  • Influenza (6-25%)
  • Rhinovirus (16-25%)
  • Parainfluenza (7-18%)
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14
Q

Bronchiolitis

  • S/S
  • Diagnosis
A
  • prominent cough, lethargy, inc. RR, signs of respiratory distress
  • Can be seen on CXR unlike bronchitis

Diagnosis is clinical, but can do a viral nasopharyngeal swab

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15
Q

Bronchiolitis

-Management

A

-supportive care

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16
Q

Pneumonia

  • definition
  • CAP vs. HAP vs. HCAP vs. VAP
A
  • inflammation of the alveoli, usually caused by viruses or bacteria
  • Communit-acquired pneumonia
  • Hospital acquired pneumonia
  • Health-care associated pneumonia: non-hospital health care source
  • Ventilator pneumonia
17
Q

Pneumonia

  • etiology in children and adults
  • atypical pathogens
A

Children: RSV, Influenza, S. pneumoniae, H. influenzae, S. aureus

Adults: more often bacterial–> S. pneumoniae most common (others exist)

Typical:
S. pneumoniae
H. influenza

Atypical:
Mycoplasma penumoniae
Chlamydophila pneumoniae
Legionella pneumophila

Viral:
Influenza

Oppotunistic:
PJP
TB
fungal

18
Q

Pneumonia

-predisposing conditions

A
  • alcoholism
  • diabetes
  • CHF
  • COPD
  • smokers
  • aspiration prone
  • post-influenza
  • cystic fibrosis (pseudomonas esp
19
Q

Pneumonia

-diagnosis

A

Treatment depends on the ability to identify the pathogen!!

  • Physical
  • History
  • Sputum smear and culture
  • CXR
  • CT
20
Q

Pneumonia

-empiric therapy for outpatient CAP, inpatient CAP, nursing home CAP, HAP, VAP

A

Outpatient

  • must use Ab that covers S. pneumoniae
  • Amoxicillin
  • If concerned about atypical pathogens add doxy or clarithromycin
  • NOT macrolides (resistance of S. pneumo)

Inpatient
- use ceftriaxone

Nursing home patient
-Amoxil-clavulanate

HAP
-ceftriaxone

VAP
-pipercillin-tazobactam (want to cover P. aeruginosa)

21
Q

Atypical pneumonia

-mycoplasma pneumoniae diagnosis and treatment

A

Diagnosis: serology and CXR
Treatment: erythromycin (macrolide)

22
Q

Atypical pneumonia

-legionella pneumophila diagnosis

A

Diagnosis: consider in patients not responding to B-lactams and possible exposure (A/C, hot tubs, resp equipment). Urine antigen test

Treatment: quinolones or macrolides

23
Q

Empyema

-definition

A
  • collection of pus in the pleural space
24
Q

Empyema

-etiology

A
  • S. pneumoniae/pyogenes/aureus

- Anaerobes

25
Q

Empyema

-management

A
  • drain pleural space, gram stain and C&S this fluid

- empiric therapy: ceftriaxone +metronidazole

26
Q

Lung abscess

-definition

A

-a cavity in the lung when microbial infection leads to necrosis of lung tissue

27
Q

Lung abscess

-etiology

A
  • usually mouth flora (oral anaerobes e.g. streptococci)
  • TB
  • fungi
  • malignancy
28
Q

Lung abscess

-treatment

A

-clindmycin
OR
-penicillin +metronidazole

29
Q

Chronic pneumonia

-general causative agents

A

Bacteria
Mycobacteria
Fungi
Parasites

rarely seen

30
Q

TB natural history

-S/S

A
  • inhalation of TB
  • Primary active disease OR
  • Latent infection –> reactivation

Most TB is pulmonary:

  • cough
  • hemoptysis
  • weight loss
  • night sweats
  • low grade fever
  • dypnea

Can also have:

  • pericarditis
  • meningitis
  • SSTI
  • Bone and joint infection
31
Q

TB

-diagnosis

A
  • Ziehl-Neelson stain of sputum

- Fluorescent stain (bacilli, bright, beaded)

IDMM (33 decks)

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