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Gen Med Unit 6 > Pulmonary Infectious Diseases > Flashcards

Pulmonary Infectious Diseases Flashcards

1
Q

What are common respiratory complaints?

A 
1. Cough
A. Sputum production
2. Dyspnea
3. Wheezing
4. Difficulty breathing
5. Chest Pain
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2
Q

What are common questions to ask in the HPI in a pulmonary pt?

A
  1. Onset of sx’s
  2. Sputum production
  3. Hemoptysis
  4. Shortness of breath
  5. Wheezing
  6. Chest pain
    A. Radiation of pain
  7. Constitutional sx’s:
    A. Elderly may not have fever, look for confusion
  8. Social Hx
  9. Exposure to illness
  10. Prior episodes
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3
Q

What should be observed on a physical exam of a pulmonary pt?

A
  1. Acute distress

2. Cyanosis: central vs. peripheral

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4
Q

What should be palpated on a physical exam of a pulmonary pt?

A
  1. Chest wall tenderness

2. Tactile fremitus

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5
Q

What should be percussed on a physical exam of a pulmonary pt? What are the results?

A
  1. Lung fields
    Resonant, hyper-resonant, dull
  2. Diaphragmatic excursion
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6
Q

What may be the auscultation results for a pulmonary pt?

A

Clear, rhonchi, wheezing, rales

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7
Q

What are the dx studies for a pulmonary pt?

A
  1. Medical Imaging
    A. CXR (PA and lateral, first study done), CT (as needed)
  2. CBC w/ diff: viral vs. bacterial etiology
  3. Sputum culture: hard to collect, give a nebulizer treatment first to open up bronchi
  4. Blood culture
  5. Arterial blood gas (ABG’s)
  6. Pulmonary function tests (PFT’s)
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8
Q

What is the primary etiology of acute bronchitis?

A
  1. Primarily viral
    A. Rhinovirus (common cold sxs, most common in fall and winter months)
    B. adenovirus:
    -conjunctivitis, GI symptoms like diarrhea
    C. influenza: chills, fever, muscle/joint aches. May have N/V in children
    D. parainfluenza: 4 types, URI and LRI infections, high risk for croup in children. Looks like a mild cold
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9
Q

What are the bacterial etiologies -

A

A. Mycoplasma pneumonia: “walking pneumonia”, young adults
B. Bordetella pertussis: not very common due to vaccines
C. Chlamydia pneumoniae
D. Streptococcus pneumoniae
E. Hemophilus influenzae: not very common due to vaccines

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10
Q

What other etiologies or concomitant diseases can cause acute bronchitis?

A

allergic or irritant

Often occurs after or with a URI

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11
Q

What are the primary etiologies of acute bronchitis in COPD pts?

A
  1. Hemophilus influenzae
  2. Strep pneumonia
  3. Moraxella catarrhalis
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12
Q

What are the symptoms of acute bronchitis?

A 
1. Cough
A. Non-prod or productive
2. Dyspnea
3. ST
4. +/- fever
5. Myalgias
6. CP
7. Malaise
8. Irritant exposure
9. GI sx’s w/adenovirus
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13
Q

What are the signs of acute bronchitis?

A
  1. Rhonchi
  2. Wheezing
  3. No abn auscultatory findings
  4. Myringitis
  5. Conjunctivitis
  6. Adenopathy
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14
Q

What are the dx studies for acute bronchitis?

A
  1. Usually none unless attempting to rule out pneumonia

A. CXR

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15
Q

What acute bronchitis etiology can lead to otitis media and croup in children under 2 years old?

A

Adenovirus

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16
Q

What are the supportive care treatments for healthy adults with acute bronchitis?

A
  1. Hydration
  2. Acetaminophen/Ibuprofen prn fevers, myalgias
  3. Prednisone
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17
Q

What are the treatments for wheezing in healthy adults with acute bronchitis?

A
  1. Beta 2 agonist
    A. Albuterol (Proventil/Ventolin/ProAir) for wheezing
    B. Levalbuterol tartrate (Xopenex)
  2. Anticholinergic
    A. Ipratropium (Atrovent) for wheezing
  3. Antitussives or Expectorants
    A. Guaifenesin (Mucinex), dextromethorphan (Robitussin DM), codeine
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18
Q

What are the abx treatments for COPD/asthma pts with acute bronchitis?

A
  1. Macrolides
    A. Azithromycin (Z-pak), clarithromycin (Biaxin), erythromycin
    B. Effective against mycoplasma, chlamydia, pertussis
  2. Doxycycline
    A. Effective against chlamydia
  3. Trimethoprim Sulfa (Bactrim)
    A. Effective against gram negatives, including Hemophilus
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19
Q

What infectious agent does doxycycline treat?

A

Chlamydia

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20
Q

What infectious agents do macrolides treat?

A

mycoplasma, chlamydia, pertussis

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21
Q

What infectious agents does trimethoprim sulfa (bactrim) treat?

A

gram negatives, including Hemophilus

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22
Q

What should acute bronchitis pts be educated about?

A
  1. Droplet precautions
  2. Hydration
  3. Hand-washing
  4. Return if increasing sx’s
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23
Q

What are the etiologies of influenza?

A 
1. Influenza A
A. Generally more pathogenic
2. Influenza B
A. Generally less pathogenic
 3. Influenza C
 A. Mild illness in humans
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24
Q

How are the influenza viruses identified?

A

Identified by surface proteins on virus
(H and N)
Hemagglutinin & Neuraminidase

25
Q

Which influenza A subtype is correlated with the seasonal flu?

26
Q

Which influenza A subtype is correlated with the swine flu?

27
Q

Which influenza A subtype is correlated with the avian flu?

28
Q

How is influenza spread?

A
  1. Susceptible individual exposed to infected droplets
    A. Mostly airborne
    B. Some person to person
    C. Some fomite to person
29
Q

What months comprise the flu season?

30
Q

Who is at a higher risk for the flu?

A
  1. School children & family

2. Housebound /institutionalized

31
Q

How long is the incubation period of the flu virus?

32
Q

How long is the influenza ‘viral shedding’ or contagious period?

A

Viral shedding 0-24h prior to illness and continues for 5-10d, may be longer in children

33
Q

What are the sxs of influenza?

A
  1. Abrupt onset: sxs for 2-3 days
  2. Fever 100-104, chills
  3. Sore throat ~severe, lasting 3-5d
  4. Myalgias mild/severe
  5. Headache-frontal/retro-orbital ~ severe
    A. May have photophobia, burning pain w/ocular movements
  6. Weakness/fatigue-may require bed rest. May last days to weeks
  7. Cough
  8. N/V/D esp. in children
  9. +/- acute encephalopathy
  10. Fever: ~5 days
  11. tachycardia
  12. hypoxia
  13. Pharyngitis
  14. conjunctivitis
  15. dehydration
  16. dry cough
  17. Lungs may be clear or have rhonchi
34
Q

What may be the cough progression in influenza?

A
  1. Minimal to start
  2. Gets worse, nonproductive
  3. Pleuritic chest pain
  4. Dyspnea
35
Q

What are the signs of acute encephalopathy in influenza?

A

altered mental status, ataxia, seizures, coma

36
Q

What are the dx studies in influenza?

A 
1. Usually clinical
A. if CBC done, leukopenia, lymphopenia
B. Viral culture: Sensitive but 3-5d processing time
C. In office testing: 
 -Nasopharyngeal swab or wash 
- 70-80% sensitive
37
Q

When is a CXR indicated in influenza?

A

Elderly and patients at high risk of complications

38
Q

What is the purpose of a CXR in influenza? What are the results?

A
  1. To exclude pneumonia
    A. Early: normal or minimal bilateral symmetrical interstitial infiltrates
    B. Later: symmetrical patchy infiltrates, +/- superimposed bacterial infection
39
Q

When are ABGs indicated in influenza pts?

A

Hypoxic pts

40
Q

When is LP indicated in influenza pts?

A

if meningitis/encephalitis suspected

41
Q

What complications result from influenza?

A
  1. Risk for secondary bacterial pneumonia
    A. Staph Aureus (MSSA/MRSA)
    -Severe and difficult to treat
    -Can be severely acute with death occurring w/in 24h
    Strep B. Pneumoniae/H. influenza (HIB)
    -2-3wks after initial sx’s
    -Manage as community acquired pneumonia
42
Q

What are the high risk groups for influenza?

A
  1. Children < 4yo
  2. Adults > 65yo
  3. Chronic medical problems
  4. Pregnancy 2nd-3rd trimester
  5. Limited respiratory function due to cognitive or neuromuscular disorders
43
Q

How soon after the flu vaccine is administered does it become effective?

44
Q

What flu strains does Trivalent Inactivated Influenza Vaccine (TIV) contain?

A

2 influenza A (H3N2, H1N1) & 1 Influenza B

45
Q

What flu strains does Quadrivalent Inactivated Influenza Vaccine (QIV)
contain?

A

2 influenza A (H3N2, H1N1) & 2 Influenza B

46
Q

What is the trade name for Live Attenuated Influenza Vaccine (LAIV)?

47
Q

How old must a pt be to receive the Standard Seasonal Flu Vaccine (T) and Quadrivalent Influenza Vaccine (Q?

A

> 6 months

48
Q

Who is Flublok Seasonal Influenza Vaccine recommended for? What is unique about this vaccine?

A

It contains recombivant Q/T

For ppl over 18 with egg allergies

49
Q

Who can receive Intradermal Influenza Vaccination?

50
Q

Who can receive Fluzone High-Dose Seasonal Influenza Vaccine (T/Q)?

51
Q

Who can receive Live Attenuated Influenza Vaccine [LAIV] (T/Q) Nasal Spray?

A

Healthy 2-49 yr (Q preferred 2-8 yr)

52
Q

What are the contraindications for influenza vaccines?

A
  1. Severe egg allergy
  2. h/o severe reaction to prior flu vaccine
  3. < 6mo old
  4. Hx of Guillain Barre Syndrome (GBS) w/in 6 weeks post flu vaccine
  5. pts who are already sick when coming in for vaccine
53
Q

Why are neuraminidase inhibitors used to treat influenza?

A

Influenza viruses contain the enzyme neuraminidase which is essential to the life cycle of the virus

54
Q

What are 2 ex of Neuraminidase inhibitors? What is their dosing?

A
  1. Zanamivir (Relenza) inhaled bid x 5 d
  2. Oseltamivir (Tamiflu) po bid x 5 d
    - some H1N1 resistance
55
Q

What are the indications for hospitalization of influenza pts?

A
  1. Influenza w/exacerbation of chronic illness
  2. Influenza pneumonia
  3. Severely ill/unable to care for self
56
Q

Who should be immunized against the flu virus?

A
  1. 6 mo old -18 yo (<8yo 2 doses if first flu vaccine)
    healthy 2 – 8 yr (LAIV)
  2. All ≥ 50 yo
  3. 19-49 yo chronic illness/long term care facility
  4. Pregnant or will be during flu season
  5. People who request it
  6. Healthcare workers
  7. Family/close contact with high risk individual
57
Q

What do flu pts need to be educated about?

A
  1. Importance of vaccination
  2. Droplet precautions
  3. Indications for post exposure prophylaxis
    QD med x 10 d
  4. Return if no improvement
58
Q

When are CXR indicated in influenza pts?

A
  1. if sx’s worsen
    A. Influenza pneumonia
    B. Secondary bacterial pneumonia
59
Q

What flu vaccine can pregnant women not receive?

A

Live attenuated vaccine

Gen Med Unit 6 (14 decks)

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