URI/Pneumonia HYHO Flashcards
What are the most common causes of chronic cough in order of decreasing frequency?
- upper airway cough syndrome (in healthy nonsmokers)
- asthma/copd
- GERD
- postnasal drip
- medication side effects
- CHF
- malignancy
- smoking
- pollution
What is the most sensitive and specific test for diagnosis of reflux disease?
24 hour esophageal ph monitoring
What is the first line of treatment for GERD?
4 week trial of PPI which is diagnostic and therapeutic
What are 6 DDx of infectious causes of cough?
- common cold/URI
- pharyngitis
- sinusitis
- Bronchitis
- Influenza
- Pneumonia
What is the most common presenting symptom of acute bronchitis?
sputum production
What presentation is NOT diagnostic of a bacterial infection in acute bronchitis?
the color of the sputum
What is the treatment for acute bronchitis?
nothing - its self-limited. antibiotics do not provide clinical benefit.
When do you prescribe antibiotics for cough?
- patients with underlying heart/lung/kidney disease
- high suspicion for CAP
- high suspicion for b pertussis, mycoplasma or chlamydia
How do you diagnose and treat rhinosinusitis?
Presence of purulent nasal discharge, maxillary dental or facial pain, unilateral maxillary sinus tenderness, and worsening symptoms after initial improvement.
Amoxicillin and trimethoprim-sulfamethoxazole
What is the modified centor criteria?
- A point is given for each of the following criteria:
- Absence of cough; enlarged/tender anterior cervical adenopathy; fever of 100.4 F or higher; and tonsillar
swelling/exudates. - One additional point is added if patient is between 3 and 14 years of age and one point is deducted if patient is age 45 years or greater.
- 0-1 points; recommend no further testing and no antibiotic indicated.
- 2-3 points; perform rapid strep or throat culture and treat with antibiotic if positive.
- 4 or more; consider empiric antibiotic treatment.
Treatment for GAS pharyngitis?
penicillin
What are the DDx for pneumonia?
Noninfectious illnesses that mimic CAP or co-occur and present with pulmonary infiltrate and cough:
- CHF with pulmonary edema.
- Pulmonary embolism.
- Pulmonary hemorrhage.
- Atelectasis.
- Aspiration or chemical pneumonitis.
- Drug reactions.
- Lung cancer.
- Collagen vascular diseases.
- Vasculitis.
- Acute exacerbations of bronchiectasis.
- Interstitial lung diseases (eg, sarcoidosis, asbestosis, hypersensitivity pneumonitis, cryptogenic organizing pneumonia)
Which bug is associated with alcoholics, aspiration and currant jelly hemoptysis?
klebsiella
is pseudomonas a CAP?
no
Which bug that causes atypical pneumonia presents with GI symptoms and hyponatremia?
legionella
Which two bugs cause healthcare/hospital acquired pneumonia? (also caused by recent abx use)
pseudomonas and MRSA
Which bug mimics legionella but lacks the GI symptoms?
chlamydophilia
What other symptoms is legionella associated with?
sinusitis, pancreatitis, myocarditis, pyelonephritis
What is the CAP uncomplicated outpatient treatment?
macrolide (azithro or clarithromycin) or tetracycline (doxycycline)
What is the CAP outpatient treatment in pts with significant comorbidities/failed first line?
macrolide + penicillin/lactamase or fluoroquinolone
What is curb-65?
measures confusion, uremia >7, respiratory rate >30, BP<90/60, age> 65
what are the three primary pillars for the prevention of CAP?
smoking cessation
influenza vaccine for all patients
pneumococcal vaccination for at risk patients
What is the first step in lymphatic drainage?
open thoracic inlet first (thoracic MFR)
How does treating OA, AA, C2 help sx of pneumonia?
it increases parasympathetic tone, so it thins secretions and constricts the bronchioles
