Respiratory Illnessess 2

Question 1

patients most likely to get severe resp. tract infections? (5)

Answer 1

infants <6 mo. frail elderly. immunocompromised. chronic organ dysfunction. smokers/alcoholics

Question 2

laboratory ID of strep pneumoniae

Answer 2

optochin (quinine) susceptible. catalase negative but grows better with catalase. produces pneumolysin = alpha hemolysin so it breaks down Hb = green pigment

Question 3

why is pneumococcus so virulent?

Answer 3

polysaccharide capsule = prevents phagocytosis, activates complement. pneumolysin is cytotoxic = inflammation = pt becomes sick.

Question 4

treating strep pnemoniae: most strains susceptible to? if resistant? exception

Answer 4

penicillin. for resistant: higher dose of penicillin will still work - except meningitis with a resistant strain so use cephalosporin+ vancomcyin

Question 5

what are the pathogens in acute otitis media + sinusitis?

Answer 5

viruses. strep pneumoniae, h. inflenzae + moraxella catarrhalis > GAS, staph aureus

Question 6

otitis media + sinusitis: when to use antibiotics

Answer 6

reserved for those with lousy immune systems (infants <6 mo, immunocompromised), sever symptoms or failure to improve in 48 hours despite analgesics

Question 7

otitis media + sinusitis: what antibiotic would you use

Answer 7

amoxillin, or amoxillin clavulanate if amoxillin on its own didn’t work

Question 8

croup: aka? what?

Answer 8

laryngotracheitis = inflammation of larynx and trachea

Question 9

croup: what type of infection? usually in who?

Answer 9

viral infection. usually in children 6 - 36 months of age

Question 10

croup: main sign? worrying if?

Answer 10

barky cough + stridor (sound like a seal when they breathe). esp. worried if they have stridor at rest

Question 11

croup: treatment

Answer 11

mild: moist air. severe: single dose of dexamethasone (corticosteroid) orally.

Question 12

acute bronchitis: what? results in what?

Answer 12

inflammation of the bronchi. prolonged productive aka wet/moist cough that typically drags on for >10 days following a regular cold

Question 13

acute bronchitis and antibiotics

Answer 13

most recover w/o. only people with chronic long problems like COPD need antibiotics

Question 14

bronchioloitis: what? bacterial or viral? occurs in who?

Answer 14

inflammation of the bronchioles. viral infection that primarily occurs in children <2 yo.

Question 15

bronchiolitis: cardinal feature? usually lasts how long?

Answer 15

wheezing, usually on expiration not inspiration. 3 - 7 days

Question 16

pneumonia: usually have which symptoms? then do what to confirm diagnosis?

Answer 16

cough, fever, tachypnea. chest X ray (or ultrasound of the chest)

Question 17

Pneumonia: most caused by?

Answer 17

viruses or bacteria (hard to know which is which). can also be due to fungi, parasites

Question 18

clues that point to bacterial pneumonia

Answer 18

acute onset. high fever and chills. crackles + crepitations (vs. wheezing). large pleural effusion. empyema. lung abscess. higher WBC and C reactive protein.

Question 19

lobar vs broncho vs. interstitial pneumonia: bacterial or viral?

Answer 19

lobar pneumonia on CXR = bacterial. interstitial = viral. bronchopnemonia can be both