URI/Pneumonia HYHO Flashcards

1
Q

What are the most common causes of chronic cough in order of decreasing frequency?

A
  1. upper airway cough syndrome (in healthy nonsmokers)
  2. asthma/copd
  3. GERD
  4. postnasal drip
  5. medication side effects
  6. CHF
  7. malignancy
  8. smoking
  9. pollution
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2
Q

What is the most sensitive and specific test for diagnosis of reflux disease?

A

24 hour esophageal ph monitoring

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3
Q

What is the first line of treatment for GERD?

A

4 week trial of PPI which is diagnostic and therapeutic

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4
Q

What are 6 DDx of infectious causes of cough?

A
  1. common cold/URI
  2. pharyngitis
  3. sinusitis
  4. Bronchitis
  5. Influenza
  6. Pneumonia
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5
Q

What is the most common presenting symptom of acute bronchitis?

A

sputum production

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6
Q

What presentation is NOT diagnostic of a bacterial infection in acute bronchitis?

A

the color of the sputum

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7
Q

What is the treatment for acute bronchitis?

A

nothing - its self-limited. antibiotics do not provide clinical benefit.

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8
Q

When do you prescribe antibiotics for cough?

A
  • patients with underlying heart/lung/kidney disease
  • high suspicion for CAP
  • high suspicion for b pertussis, mycoplasma or chlamydia
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9
Q

How do you diagnose and treat rhinosinusitis?

A

Presence of purulent nasal discharge, maxillary dental or facial pain, unilateral maxillary sinus tenderness, and worsening symptoms after initial improvement.

Amoxicillin and trimethoprim-sulfamethoxazole

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10
Q

What is the modified centor criteria?

A
  • 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.
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11
Q

Treatment for GAS pharyngitis?

A

penicillin

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12
Q

What are the DDx for pneumonia?

A

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)
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13
Q

Which bug is associated with alcoholics, aspiration and currant jelly hemoptysis?

A

klebsiella

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14
Q

is pseudomonas a CAP?

A

no

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15
Q

Which bug that causes atypical pneumonia presents with GI symptoms and hyponatremia?

A

legionella

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16
Q

Which two bugs cause healthcare/hospital acquired pneumonia? (also caused by recent abx use)

A

pseudomonas and MRSA

17
Q

Which bug mimics legionella but lacks the GI symptoms?

A

chlamydophilia

18
Q

What other symptoms is legionella associated with?

A

sinusitis, pancreatitis, myocarditis, pyelonephritis

19
Q

What is the CAP uncomplicated outpatient treatment?

A

macrolide (azithro or clarithromycin) or tetracycline (doxycycline)

20
Q

What is the CAP outpatient treatment in pts with significant comorbidities/failed first line?

A

macrolide + penicillin/lactamase or fluoroquinolone

21
Q

What is curb-65?

A

measures confusion, uremia >7, respiratory rate >30, BP<90/60, age> 65

22
Q

what are the three primary pillars for the prevention of CAP?

A

smoking cessation
influenza vaccine for all patients
pneumococcal vaccination for at risk patients

23
Q

What is the first step in lymphatic drainage?

A

open thoracic inlet first (thoracic MFR)

24
Q

How does treating OA, AA, C2 help sx of pneumonia?

A

it increases parasympathetic tone, so it thins secretions and constricts the bronchioles

25
How does treating T2-T7 help sx of pneumonia?
in increases sympathetic tone so it thickens secretions and dilates bronchioles
26
What is the motor innervation to the diaphragm?
C3-C5: phrenic n.
27
Chapmans point for bronchi
intercostal space between 2nd and 3rd ribs at sternocostal junction. T2 midway between SP and tip of TP
28
Chapmans point for upper lung
intercostal space between 3rd and 4th ribs at the sternocostal junction. Space between the TPs of T3 and T4, midway between SP and tip of TP
29
chapmans points for lower lung
intercostal space between 4th and 5th ribs at the sternocostal junction. space between the TPs of T4 and T5, midway between the SP and tip of TP