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Clinical Medicine II > Pulm: Bronchitis & Pneumonia > Flashcards

Pulm: Bronchitis & Pneumonia Flashcards

1
Q

What is the defining feature of chronic bronchitis?

A

Cough for at least 3 months in 2 consecutive years

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2
Q

Acute bronchitis is defined by the presence of…

A

cough > 5 days

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3
Q

What is the MC etiology of acute bronchitis?

A

Viral

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4
Q

What bacterial vector can cause bronchitis?

A

Bordatella pertussis

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5
Q

The presence of purulent sputum (is/isn’t) predictive of bacterial infx…

A

Is not

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6
Q

A patient presents with:

Wheezing
Bronchospasm (reduced FEV1)
Rhonchi cleared with coughing

What should you suspect?

A

Acute bronchitis

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7
Q

Is the presence of crackles/rales typical in acute bronchitis?

A

no

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8
Q

A patient presents with:

cough > 5 days
Wheezing
Bronchospasm
Rhonchi

How is a dx often made?

A

clinical for bronchitis

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9
Q

What diagnostic modality can be considered in acute bronchitis with the following abnormal findings?

Fever
tachypnea
Tachycardia
evidence of consolidation

cough lasting > 3 weeks

A

CXR

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10
Q

What condition are you assessing for when you get a CXR on a patient with acute bronchitis?

A

pneumonia

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11
Q

How should acute bronchitis be treated?

A

symptomatic relief

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12
Q

What is the only indication for abx in acute bronchitis?

A

pertussis

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13
Q

What phase of pertussis?

URI Sxs
Fever

1-2 week duration

A

Catarrhal

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14
Q

What phase of pertussis?

Persistent, paroxysmal cough
Inspiratory “whooping”
post-tussive emesis

2-6 week duration

A

paroxysmal

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15
Q

What phase of pertussis?

cough resolving

lasts weeks to months

A

convalescent

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16
Q

A patient presents with:

Persistent, paroxysmal cough that leads to vomiting.

What do you suspect and what diagnostic is gold standard for diagnosis?

A

Pertussis, bacterial culture of NP secretions

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17
Q

When should culture of NP secretions be used for pertussis dx?

A

weeks 0-2

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18
Q

When should PCR be used to dx pertussis?

A

weeks 0-4

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19
Q

When can serology be considered to dx pertussis?

A

weeks 2-8

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20
Q

What treatment of pertussis decreases transmission rate, but has little effect on symptom resolution?

A

abx

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21
Q

What are 1st and 2nd line abx to treat pertussis?

A

1st line: Macrolides

2nd: TMP-SMZ

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22
Q

Prevention is key to controlling pertussis. What vaccine is now given as a booster to adolescents?

A

Tdap

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23
Q

Who should receive abx prophylaxis for pertussis?

A

close contacts

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24
Q

Is pertussis reportable?

A

yes

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25
Q

Who is at risk for influenza progressing to pneumonia?

A

high-risk populations

extremes of ages
immunocompromised
pregnant
obese
crowded living
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26
Q

A patient presents with abrupt onset of:

Fever
HA
Myalgia
Malaise

Few findings on PE

What should you consider?

A

influenza

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27
Q

Which influenza diagnostic has the following features?

Low-moderate sensitivity
High specificity

10-30 minutes for results

A

RIDTs

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28
Q

The sensitivity of RIDTs is similar to clinical diagnosis. This means what for peak flu season?

A

negative RIDTs do not reliably exclude influenza, make clinical dx

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29
Q

Which influenza diagnostic has the following features?

most sensitive and specific

results in 2-6 hours

A

RT-PCR

30
Q

Which influenza diagnostic hast he following features?

Confirmatory use by public health

not used for initial clinical mgmt

A

Viral culture

31
Q

Treatment of flu is often symptomatic, but antivirals can be used. What drugs can help, and when must they be administered?

A

oseltamivir/zanamivir w/in 48 hours of onset

32
Q

What is the most common complication of influenza?

A

pneumonia

33
Q

What is the most common route of transmission for CAP?

A

aspiration from oropharynx

34
Q

What is the most common bacterial cause of typical and atypical CAP?

A

typical: Strep. pneumo
atypical: mycoplasma

35
Q

What etiology of CAP is unusual in immunocompetent hosts?

A

fungal

36
Q

A patient presents with acute onset of the following sxs… is this CAP or Flu?

Fever
Cough
Sputum production

A

CAP

37
Q

What are the pertinent negatives that distinguish CAP from flu?

A

myalgia, malaise, HA

38
Q

What are 4 signs of consolidation that would be indicative of pneumonia on chest exam?

A

dullness to percussion
increased tactile fremitus
bronchophony
egophony

39
Q

What two diagnostic modalities can help dx CAP?

A

CBC showing left-shift leukocytosis

CXR showing infiltrate, consolidation, cavitation

40
Q

This PNA test has the following features:

  • uses expectorated sputum prior to initiation of tx
  • cannot be definitive proof of causative agent
  • Generally not recommended outpatient
A

sputum culture

41
Q

The following are complications of what disorder?

bacteremia
sepsis
abscess
empyema
respiratory failure
A

pneumonia

42
Q

The CURB-65 score refers to what 5 atypical features?

A 
Confusion
Urea (> 7)
RR 30+
BP (hypotension)
65 yo +
43
Q

What CURB-65 score warrants admission to hospital?

A

2

44
Q

What CURB-65 scores warrant ICU admission?

A

3-5

45
Q

CRB-65 recommends admission to hospital with a score of ______ and eliminates the need to asses what?

A

1

don’t assess BUN

46
Q

The PSI and CURB-65 scores should be applied as a(n) _______ rather than a ________ for decision making

A

adjunct to

replacement

47
Q

What is the best predictor of a good outcome for CAP?

A

right site of care (inpatient/outpatient)

48
Q

How long should the course of abx be for CAP?

A

at least 5 days

49
Q

What is the mean time to return to work after initiating Abx with CAP?

A

6 days

50
Q

When is follow-up CXR needed in CAP?

A

7-12 weeks post-treatment if 40+ or smokers

51
Q

What two courses of abx can be used to treat outpatient, uncomplicated CAP?

A

Azithromycin 500mg PO day 1, then 250mg PO QD days 2-5

Doxycycline 100mg PO BID x 7-10 days

52
Q

Complicated pneumonia is characterized by:

Recent abx
COPD
Liver/renal dz
heart disease
alcoholism
asplenia
immunosuppression

What treatment can be used outpatient for complicated CAP?

A

Augmentin 500 mg PO BID + macrolide (beta-lactam + macrolide)

or

levofloxacin 750mg PO QD x 5 days

53
Q

CAP inpatient treatment requires a minimum 5 day course of abx and resolution of what?

A 
afebrile 48-72 hours
no supp. O2
HR < 100
RR < 24
SBP 90+
54
Q

What is a major lifestyle factor that can help prevent and treat CAP?

A

smoking cessation

55
Q

In the ICU what abx are used to treat PNA?

A

beta lactam + azithro OR fluoroquinolone

56
Q

What can be used in the ICU for PNA with PCN allergy?

A

fluoroquinolone + Aztreonam

57
Q

The following populations should be considered for what intervention?

65+

19-64 with increased risk due to: 
cardiopulm disease
sickle cell
tobb
splenectomy
liver disease
A

Pneumococcal vaccine

58
Q

How do you treat HAP/VAP?

A

broad spectrum abx

59
Q

A patient presents with:

New onset/progressive infiltrate on CXR

Fever
Purulent sputum
Leukocytosis

A

HAP/VAP

60
Q

HAP/VAP Dx depends on presence of infiltrates and how many other criteria? (fever, purulent sputum, leukocytosis)

A

2

61
Q

What diagnostic test is indicated to test for HAP/VAP?

A

Sputum gram stain and cx

62
Q

What is the best way to treat HAP/VAP?

A

prevention

63
Q

The following are ways to prevent what?

avoid antacids
decontamination of OP
selective gut decontamination
probiotics
positioning
subglottic drainage
A

VAP

64
Q

A patient presents with non-resolving pneumonia. You must consider what other dx?

A 
atypical (viral, fungal) infx
aspiration PNA
CHF
cancer
fibrosis
65
Q

What diagnostics are indicated in evaluating non-resolving PNA?

A

Chest CT
bronchoscopy
throacoscopy
open lung biopsy

66
Q

A patient with concurrent AIDS presents with:

Fever
Nonproductive cough
dyspnea
extra-pulmonary lesions

What is this presentation concerning for?

A

PJP/PCP

67
Q

A patient presents with the following lab findings:

high LDH

Low CD4

CXR showing reticular, ground glass opacity

Sputum

A

PJP/PCP

68
Q

What is the treatment of choice for pneumocystitis jirovecii?

A

Bactrim

69
Q

Who should receive bactrim as prophylaxis for PJP?

A

HIV + and

hx of PJP
CD4 < 200
OP thrush

70
Q

The following are risk factors for what?

Post-op state
neuro compromise
anatomic defect

A

aspiration pneumonia

71
Q

A CXR with aspiration pneumonia most commonly shows infiltrate in what location?

A

RLL

72
Q

Aspiration pneumonia can be treated with what four abx regimens?

A
  1. piperacillin/tazobactam
  2. ampicillin/sulbactam
  3. clindamycin
  4. moxifloxacin

Clinical Medicine II (31 decks)

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