Respiratory 2 Flashcards
what is the average incubation period for URIs?
1-5 days
how long does viral shedding occur w/ URI
3 weeks
what eye condition is often seen with URIs?
Conjunctivitis
is it common for a URI to become pneumonia
no
does mucus color or lymph nodes matter for URI bacterial or viral diagnosis
No
how do you treat pharyngitis?
Amoxicillin, PCN, Erythromycin, Clindamycin (if positive rapid strep)
how much of laryngitis is viral?
90%
how much is otitis media is viral?
48%
what bacteria cause otitis media?
strepto pneumo
Moraxella
H. influenze
what are some symptomatic relief meds for URIs
Pseudoephedrine Phenylephrine Ipratropium bromide: effective but expensive NaCl Nasal drops Afrin, Neosynephrine Antihistamines
what are 2 very powerful vasoconstrictors that can lead to necrosis in the nose
afrin, neosynephrine
contraindications for symptomatic relief meds?
HTN hx of arrhythmia BPH urinary retention glaucoma
what are some expectorants?
Guaifenesin
SSKi (potassium iodine)
what are some cough suppressants
dextromethorphan (OTC meds)
codeine
hydrocodone
tessalon perles (benzonatate)- anesthetic
where is bronchitis found
south of the larynx
for kids 2-5 years old what are the most common causes of bronchitis
RSV
adenovirus
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
are abx needed in adolescents and adults with acute bronchitis?
No, usually self limited
common causes of adolescents with bronchitis
viral
mycoplasma
chlamydia
pertussis
what can a persistent cough of >14 days be?
pertussis
how do you tx pertussis
erythromycin
azithromycin
bactrim
what is the tx for COPD exacerbations?
antibiotic and steroid
what is the typical pneumonia?
lobar
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
- Anti pneumococcal Beta-lactam and azithromycin
- Anti pneumococcal Beta-lactam and resp fluoroquinolo.
- (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?
No
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?
No
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
