Respiratory 2 Flashcards by Meg Dolohanty

what is the average incubation period for URIs?

1-5 days

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how long does viral shedding occur w/ URI

3 weeks

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what eye condition is often seen with URIs?

Conjunctivitis

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is it common for a URI to become pneumonia

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does mucus color or lymph nodes matter for URI bacterial or viral diagnosis

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how do you treat pharyngitis?

Amoxicillin, PCN, Erythromycin, Clindamycin (if positive rapid strep)

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how much of laryngitis is viral?

90%

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how much is otitis media is viral?

48%

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what bacteria cause otitis media?

strepto pneumo
Moraxella
H. influenze

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what are some symptomatic relief meds for URIs

Pseudoephedrine
Phenylephrine
Ipratropium  bromide: effective but expensive
NaCl  Nasal drops
Afrin, Neosynephrine 
Antihistamines

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what are 2 very powerful vasoconstrictors that can lead to necrosis in the nose

afrin, neosynephrine

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contraindications for symptomatic relief meds?

HTN
hx of arrhythmia
BPH
urinary retention 
glaucoma

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what are some expectorants?

Guaifenesin

SSKi (potassium iodine)

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what are some cough suppressants

dextromethorphan (OTC meds)
codeine
hydrocodone
tessalon perles (benzonatate)- anesthetic

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where is bronchitis found

south of the larynx

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for kids 2-5 years old what are the most common causes of bronchitis

RSV

adenovirus

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when should you give abx to a 2-5 year old?

culture + for heavy growth strep, H. flu, associated sinusitius or not improving in a week

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are abx needed in adolescents and adults with acute bronchitis?

No, usually self limited

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common causes of adolescents with bronchitis

viral
mycoplasma
chlamydia
pertussis

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what can a persistent cough of >14 days be?

pertussis

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how do you tx pertussis

erythromycin
azithromycin
bactrim

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what is the tx for COPD exacerbations?

antibiotic and steroid

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what is the typical pneumonia?

lobar

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In HIV or non-HIV what is the number one cause of pneumonia?

stret. pneumo

Rigors (chills), fever, purulent sputum and “lobar infiltrates”

Typical pneumonia

what etiology of pneumonia is a lobar consolidating infiltrate

strept pneumo | legionella

what is the etiology of lobar enlargement for penumo?

klbsiella

who do you see anaerobe pneumonia with?

poor teeth | foul smelling

bronchopneumonia can have what etiologies

mycoplasm strep pneumo h. flu

if you see a cavitation on x-ray waht should you suspect

anaerobic bacteria, TB

what 4 organisms cause atypical pneumonias?

mycoplasm chlamydia legionella viral- influenza

what do you do for atypical pneumonias?

serologic studies: convalescent titers

outpatient tx of pneumonia of someone who is previously healthy no use of macrolide <3 months

macrolide or doxycycline

pneumonia tx | patient with comorbidities or used macrolides <3 month ago or in a high macrolide resistant area

respiratory flurorquinolone or | macrolide + beta-lactam

For inpatient, non-ICU tx for pneumonia

Resp Fluoroquinolones or anti pneumoccocal beta-lactam + Macrolide

ICU pneumo tx | 3 options

1. Anti pneumococcal Beta-lactam and azithromycin 2. Anti pneumococcal Beta-lactam and resp fluoroquinolo. 3. (PCN allergies) resp fluoroquinolone +Aztreonam

if someone has CAP with CA-MRSA what should you add?

Vanco | Linezolid

Buboes in groin, exposure to animals

Bubonic plagues

Begins as flu-like illness, respiratory symptoms, hemoconcentration and thrombocytopenia, typical blood smear

Hantavirus

if a person has bilateral, fever, and hypoxemia what should you get?

blood and sputum gram stains and cultures

what empiric therapy do you start on someone with bilatreal infiltrates, fever, hypoxemia

ceph de jour plus macrolides/ doxy or flouroquinolones

Severe hypoxemia V/Q mismatching PaO2/FiO2 ratio <150) bilateral diffuse infiltrates on CXR

ARDS

Is ARDS caused by a heart problem?

what are some causes ARDS?

sepsis pneumonia severe trauma

in the developing world what is there a high correlation with TB?

HIV/ AIDS

what lobe of the lung usually has TB?

RUL

where can TB go?

anywhere | lymph nodes

if someone has no risk of TB exposure what is considered positive?

>15 mm

what populations is a positive TB test >5 mm

HIV infection contact to active TB case abnormal CXR immunosupression

what populations do you use >10 mm as positive TB test?

``` Recent immigrants IV drug users children high risk medical residents of jails/ hospitals/ nursing homes ```

what test is an alternative to tuberculin skin test?

whote blood interferon (IFN)-gamma assay

if a patient is an alcoholic and you can't treat TB b/c INH would ruin the liver would you do the test?

if there is a positive TST test what should you get?

sputum for AFB smear and culture x 3 mornings

what med should you also give with INH?

B6 (pyridoxine)

if a pregnant lady has any risk factors for TB what do you do?

give INH

what should a patient report while on INH

any abdominal pain

if a person has active TB how long should they be in isolation?

minimum of 2 weeks

how long should you treat for TB?

6 months