LRI- MJ Flashcards
What is a major cause of morbidity from acute illness in the U.S.?
Respiratory tract infections
What represents the single most common reason patients seek medical attention?
Respiratory Tract Infections
What are the 3 most common infections involving the lower respiratory tract?
1. Bronchitis
2. Bronchiolitis
3. Pneumonia
Acute Bronchitis is caused most commonly by _______ and almost always is self-limiting
Respiratory Viruses
What does therapy for Acute Bronchitis target?
•Therapy targets associated symptoms:
- lethargy, malaise
- fever (ibuprofen or acetaminophen)
- fluids for rehydration
In therapy for acute bronchitis:
_•Routine use of ______ should be avoided_
antibiotics
T/F: In treatment of acute bronchitis, medication to suppress cough is always indicated
FALSE
•Medication to suppress cough is RARELY indicated
(consider if cough is affecting sleep)
Which lower respiratory tract pathogens account for the majority of acute bronchitis cases?
Influenza virus
Adenovirus
Which 2 common cold viruses cause acute bronchitis?
Rhinovirus and coronavirus
Acute bronchitis- Which pathogens are seen in children?
- Similar pathogens to adults:
- Common cold viruses (rhinovirus and coronavirus)
- LRT pathogens (influenza virus and adenovirus)
- Parainfluenza virus
Primary bacterial etiology for acute bronchitis appears to be common or rare?
Rare
(secondary bacterial infections may be involved)
______________ appears to be a frequent cause of acute bacterial bronchitis_
Mycoplasma pneumoniae
(“Walking Pneumonia”)
The following microorganisms are causative agents of what condition?
- Chlamydophila pneumoniae
- B. pertussis (agent responsible for whooping cough)
- S. pneumoniae, Streptococcus species, Staphylococcus species, and Haemophilus species, Moraxella catarrhalis, Mycobacterium tuberculosis
Acute Bronchitis
If acute bronchitis is found to be from the following organisms, what does this likely represent?
- S. pneumoniae
- Streptococcus species
- Staphylococcus species
- Haemophilus species
- Moraxella catarrhalis
- Mycobacterium tuberculosis
probably represent contamination by normal flora of the upper respiratory tract rather than true pathogens
What is the most common cause of acute bronchiolitis?
Respiratory Synctial Virus (RSV)
What patient population does acute bronchiolitis mostly affect?
- Mostly affects infants during their first year of life
- Usually self-limiting viral illness in a healthy infant
What is the treatment approach for a generally healthy baby with acute bronchiolitis?
- Can be followed as outpatient
- Treat fever
- Oral Fluids
- Observe closely for evidence of respiratory deterioration
What is the treatment approach for children severely affected by acute bronchiolitis?
- oxygen therapy
- IV fluids
- In a subset of patients:
- aerosolized bronchodilators
- Consider tx w/ ribavirin
What does the American Academy of Pediatrics recommended regarding the routine use of ribavirin in children severely affected by acute bronchiolitis?
The do not recommend routine use of ribavirin
Acute Bronchiolitis treatment approach:
Which patients might benefit from tx w/ ribavirin?
Patients with:
- Bronchopulmonary dysplasia
- Congenital heart disease
- Prematurity
- Immunodeficiency
In children w/ underlying pulmonary or cardiovascular disease, prophylaxis against what might be warranted?
- Prophylaxis against RSV (RSV immune globulin or Palivizumab)
- Administer monthly during the RSV season (late fall, winter, early spring)
Acute Bronchiolitis treatment approach:
- In prophylaxis against RSV for children w/ underlying pulmonary/cardiovascular disease, what tx is preferred?
- Why is this tx preferred?
Palivizumab (a monoclonal antibody for RSV)
Preferred (over Ribavirin) due to:
- ease of administration
- lack of administration-related adverse effects
- noninterference with select immunizations
The following is used for prophylactic tx for RSV in order to try to prevent what?
-
RSV Immune Globulin
- Preformed antibody (AB) or immunoglobulin (Ig)
- RSV Ig is used by the immune system to identify and neutralize foreign bacteria and viruses
Acute Bronchiolitis caused by RSV
What are the ADEs of Palivizumab (a monoclonal antibody), used as prophylaxis against RSV (a casuative agent of acute bronchiolitis)
Flu-like sxs:
- Fever
- Rash
- Antibody formation
- Anaphylaxis (very rare)
- Thrombocytopenia
“FAART”
Chronic Bronchitis is caused by what interacting factors?
•inhalation of noxious agents (cigarettes, exposure to occupational dusts, fumes and environmental pollution)
•host factors (genetic factors and bacterial infections)
The following is the hallmarch of which disease?
- chronic cough
- excessive sputum production
- expectoration with persistent presence of microorganisms in the patient’s sputum
Chronic Bronchitis
What is the treatment for acute exacerbations of chronic bronchitis
- attempts to mobilize and enhance sputum expectoration (chest physiotherapy, humidifier)
- oxygen if needed
- aerosolized bronchodilators (albuterol)
- Antibiotics (Can use Anthonisen criteria to determine if abx therapy is indicated)
A patient with an acute exacerbation of chronic bronchitis will most likely benefit from antibiotic therapy what sxs are present? (According to Anthonisen criteria)
If 2 or 3 of the following are present:
- Increase in SOB
- Increase in sputum volume
- Production of purulent sputum
What is the 1st and 2nd most common bacterial pathogens isolated from sputum of patients with acute exacerbations of chronic bronchitis?
- H. influenzae (45%)
- M. Catarrhalis (30%)
What are the preferred drugs used to tx acute exacerbation of chronic bronchitis?
- Ampicillin
- Amoxicillin
- Amoxicillin/clavulanate
- Levofloxacin
- Ciprofloxacin ??
- Moxifloxacin
- Doxycycline
- Minocycline
- Tetracycline
- TMP- SMX
The following is the clinical presentation of what illness?
•Signs and symptoms
- Abrupt onset of fever, chills, dyspnea, and productive cough
- Rust-colored sputum or hemoptysis
- Pleuritic chest pain
Pneumonia
Which illness has the following clinical presentation?
Physical examination
- Tachypnea and tachycardia
- Dullness to percussion
- Increased tactile fremitus, whisper pectoriloquy, and egophony
- retractions and grunting
- Diminished breath sounds over affected area
- Inspiratory crackles during lung expansion
CXR showing dense lobar or segmental infiltrate
Pneumonia
The following laboratory tests are seen in which illness?
- Leukocytosis with predominance of polymorphonuclear cells
- Low oxygen saturation on arterial blood gas or pulse oximetry
Pneumonia
What is the most prominent pathogen causing CAP in otherwise healthy adults?
S. pneumoniae
What are other common pathogens that cause CAP? (other than S. pneumo which is the most common)
- M. pneumoniae
- Legionella species
- C. pneumonia
- H. influenzae
- variety of viruses including influenza
What is the adjunct tx for CAP?
- humidified oxygen for hypoxemia
- bronchodilators (albuterol) when bronchospasm is present
- rehydration fluids
- chest physiotherapy for marked accumulation of retained respiratory secretions
What is the empirical therapy for CAP in a previously healthy individual on an outpatient basis?
- Tx: Macrolide/azalide or Tetracycline (Doxy)
What is the empiric therapy for CAP in a pt w/ comorbidities (DM, heart/lung/liver/renal dz and alcoholism) on an outpatient basis if the pathogen is viral?
Oseltamivir or zanamivir if <48 hrs from onset of sxs
What is the empiric therapy for CAP in a pt w/ comorbidities (DM, heart/lung/liver/renal dz and alcoholism) on an outpatient basis if the pathogen is MDR S. pneumo?
Flouroquinolone
OR
B-lactam + macrolide
What is the empiric therapy for CAP in an elderly patient in regions with >25% rade of macrolide-resistant S. pneumo on an outpatient basis?
- Piperacillin/tazobactam or cephalosporin or carbapenem
- Fluoroquinolone or B-lactam + macrolide/tetracycline
Which 2 pathogens usually cause CAP in an elderly patient in regions with >25% rade of macrolide-resistant S. pneumo?
- S. pneumoniae
- Gram negative bacilli
Which pathogens usually cause inpatient, non-ICU CAP? (5)
- S. pneumo
- H. influenzae
- M. pneumoiae
- C. Pneumonia
- Legionella
What is the empiric tx for CAP, inpatient non-ICU?
(usual pathogens= s. pneumo, H. flu, Legionella, etc)
Fluoroquinolone
OR
B-lactam + macrolide/tetracycline
What is the empiric tx for CAP for a pt who is in the ICU (usual pathogens= S. pneumo, S. aureus, Legionella, gram neg bacilli, H. flu)
B-lactam + macrolide/fluoroquinolone
What is the empiric tx for CAP for a pt who is in the ICU if P. aeruginosa is suspected
Piperacillin-tazobactam
or
meropenem
or
cefepime + fluoroquinoloned/aminoglycoside/azithromycin
or
β-lactam + AMG + azithromycin/respiratory fluoroquinolone
What is the empiric tx for CAP for a pt who is in the ICU if MRSA is suspected
Piperacillin-tazobactam or meropenem or cefepime + fluoroquinoloned/aminoglycoside/azithromycin or β-lactam + AMG + azithromycin/respiratory fluoroquinolone
All of the above (tx for P.aeruginosa) + Vancomycin or linezolid
Most pediatric pneumonias are caused by what?
viruses (RSV, parainfluenza and adenovirus)
Pneumonia in pediatrics:
____________ is an important pathogen in older children
M. pneumoniae
Beyond the neonatal period, _______is the major bacterial pathogen in childhood pneumonia?
•S. pneumoniae (followed by Group A strep, S. aureus and H. flu)
Guidelines for preventing healthcare-associated pneumonia:
Unless contraindicated, administer a ______ to any person who has had close contact with persons having pertussis
macrolide
(Grade 1B recommendation)
Guidelines for preventing healthcare-associated pneumonia:
Unless contraindicated, provide prophylactic treatment to all patients without influenza illness in the involved unit with ______, ____, ______ for a minimum of 2 weeks or until approximately 1 week after the end of the outbreak
amantadine, rimantadine, or oseltamivir
(Grade 1A recommendation)
Guidelines for preventing healthcare-associated pneumonia:
- Unless contraindicated, patients with influenza should receive ______, _______, _______, or _______ within 48 hours of the onset of symptoms
amantadine, rimantadine, oseltamivir, or zanamivir
(grade 1A recommendation)
Tx for HAP and VAP
(she said we didn’t need to memorize this chart but this is also the only information she gave us regarding HAP/VAP tx so idk)
