Respiratory infections

Question 1

acute bronchitis common presentation

Answer 1

cough lasting more than 5 days (1-3 weeks), associated with sputum production, rarely fever, chest pain, wheezing, rhonchi that clears with coughing

Question 2

Acute bronchitis causative agents

Answer 2

influenza A/B, parainfluenza, coronavirus, rhinovirus, RSV, human metapneumovirus, mycoplasma pneumoniae, chlamydophilia, pertussis

Question 3

Acute bronchitis diagnosis

Answer 3

Clinical! CXR for elderly, bad vitals, fever, signs of consolidation, sputum culture, procalcitonin

Question 4

Procalcitonin above what indicates antibiotics should be used

Answer 4

above .5 mcg/L

Question 5

Differential diagnosis of acute bronchitis

Answer 5

chronic bronchitis, pneumonia, post-nasal drip, GERD, asthma

Question 6

acute bronchitis treatment

Answer 6

mainly symptomatic, NSAIDs, aspirin, acetaminophen, aspirin, cough suppressants are controversial, antibiotics have no benefit

Question 7

Most common cause of bronchiolitis in infants under 1 year

Answer 7

RSV

Question 8

Symptoms of bronchiolitis

Answer 8

rhinorrhea, pharyngitis, cough, wheezing, rhonchi, CXR normal, fever and WBS inconsistant

Question 9

Diagnosis of bronchiolitis

Answer 9

antigen defection assay

Question 10

Treatment of bronchiolitis

Answer 10

supportive, O2, acetaminophen, fluids, inhaled albuterol or epi only if effective, no steroids, antibiotics or ribavirin

Question 11

Pertussis

Answer 11

highly contagious, acute respratory illness

Question 12

Pertussis symptoms

Answer 12

URI, whooping cough, coughing to point of vomiting, dyspnea, seizures 20-25%, maybe apnea

Question 13

Treatment of pertussis

Answer 13

supportive, hydration, pulmonary toilet, oxygen, erythromycin, clarithromycin, azithromycin, TMP-SMX for 14 days

Question 14

Croup

Answer 14

viral illness causing edema of upper airways, narrowed airways

Question 15

Croup etiology

Answer 15

parainfluenza viruses, adenovirus, RSV, mycoplasma pneumoniae

Question 16

Croup symptoms

Answer 16

URI, barky cough, hoarseness, tachypnea, mild stridor worse at night

Question 17

Croup diagnosis

Answer 17

X ray shows subglottic narrowing “steeple sign”

Question 18

Croup treatment

Answer 18

cool, moist air used, Dexamethasone .6 mg/kg IM reduces hospital stays, neb epi for immediate relief, beta agonist bronchodilators not effective

Question 19

Epiglittitis

Answer 19

rare since influenza vaccine, visualize cherry red epiglottis

Question 20

Epiglottitis diagnosis

Answer 20

X ray thumb print sign

Question 21

Epiglottitis treatment

Answer 21

ceftriaxone, cefotaxime, cefuroxime

Question 22

Tuberculosis caused by

Answer 22

M. Tuberculosis, M. bovis, M. caprae, M. africanum, a few others

Question 23

TB risk factors of infection

Answer 23

Comorbidities, HIV infection, silicosis, renal failure, diabetes, IV drug use, gastrectomy, jejunoileal bypass, smoking, malnutrition, underweight

Question 24

TB clinical manifestations

Answer 24

primary pulmonary, reactivation, endobronchial, lower lung field, tuberculoma

Question 25

Primary pulmonary TB clinical manifestations

Answer 25

Fever, pleuritic or retrosternal chest pain, pleural effusion, enlarged bronchial lymph nodes, fatigue, cough, arthralgias, pharyngitis

Question 26

Primary Pulmonary TB CXR

Answer 26

usually normal, Hilar adenopathy, pleural effusion, pulmonary infiltrates

Question 27

Reactivation TB clinical manifestations

Answer 27

usually 2-3 years after initial infection, insiduous onset, cough, wt loss, fatigue, fever w/ night sweats, chest pain and dypnea, hemoptysis

Question 28

Reactivation TB CXR

Answer 28

apical posterior segments of upper lobes are affected most commonly, superior segments of lower lobes, anterior segments of upper lobes

Question 29

TB diagnosis

Answer 29

clinical, TST or interferon gamma release essay (IGRE), radiography, isolation of M. tuberculosis from secretions or tissues

Question 30

Isolation of M tuberculosis, diagnosis

Answer 30

sputum, bronchoscopy, body fluids, tissue biopsy, serology

Question 31

TB microbiology

Answer 31

staining for detection of acid fast bacilli, molecular test, nucleic acid amplification, Xpert MTB/RIF essay

Question 32

TB diagnosis gold standard

Answer 32

culture, highly sensitive and specific, isolates a specific mycobacterial species, determines presence of drug resistance

Question 33

PPD

Answer 33

purified protein deriviative test used to test for presence of sensitization to certain antigenic component of M. tuberculosis

Question 34

TB reporting

Answer 34

any persons confirmed or suspected of having TB must be reported to a state or local public health authority within 24 hours

Question 35

TB treatment

Answer 35

Directly observed therapy and use of multiple chemotherapeutic agents are key to successful therapy, includes initial and continued phase

Question 36

Initial phase TB treatment

Answer 36

Isoniazid, Rifampin, Pyrazinamide, Ethambutol

Question 37

Isoniazid

Answer 37

bactericidal, easily tolerated in a single oral daily dose, inexpensive, potentially hepatotoxic, peripheral neuropathy is a risk in certain pt pop (diabetics, renal failure)

Question 38

Rifampin

Answer 38

bactericidal, well tolerated as single daily oral dose, less hepatotoxic when compared to INH, induces hepatic microsomal enzymes and may decrease the effectiveness of several drugs

Question 39

Pyrazinamide

Answer 39

bactericidal at an acidic pH. administered as single oral dose, GI side effects are common, hepatotoxic, may cause hyperuricemia due to decreased renal excretion of uric acid may lead to gout

Question 40

Ethambutol

Answer 40

bacteriostatic, single daily oral dose, well tolerated, optic neuritis is an uncommon but serious complication