3- LRI

Question 1

What is the MCC of acute bronchitis

Answer 1

Lower respiratory viruses (self limited)
Adenovirus, influenza virus
(Kids: also Parainfluenza)

Question 2

IF bacterial, what are MCC of acute bronchitis

Answer 2

Mycoplasma Pneumoniae

Normal flora contamination with: S. Pneumoniae, Staph, Haemophilus

Question 3

When would suspect a bacterial etiology in acute bronchitis

Answer 3

previously healthy pt. with persistent fever
respiratory Sx for 4-6 days
Immunocompromised/predisposed

Question 4

How do you treat acute viral bronchitis

Answer 4

Symptomatic for fever, malaise, lethargy; IBO, Acetaminophen, fluids
-Avoid abx, rarely use cough suppressants

Question 5

How do you treat Acute bacterial bronchitis

Answer 5

Abx therapy aimed towards likely pathogen (S. pneuma and M. pneumoniae)- AZITHROMYCIN (macrolide)
-Fluoroquinolone as alternate

Question 6

What is the single most common reason patients seek medical attention

Answer 6

respiratory tract infections (major cause of morbidity from acute illness)

Question 7

What are the most common LRI

Answer 7

Bronchitis
Bronchiolitis
Pneumonia

Question 8

What is bronchitis

Answer 8

inflammation of the walls of bronchi/bronchioles causing narrowing
affects large elements

Question 9

What is bronchiectasis

Answer 9

widening of the bronchi with excess mucus causing narrowing

affects small elements

Question 10

How is bronchitis classified

Answer 10

Acute: all ages
Chronic: usually adults

Question 11

What are symptoms of bronchiolitis (infancy)

Answer 11

cough, coryza, vomiting, diarrhea, noisy breathing, labored breathing (grunting, flaring, retractions)

Question 12

What are Acute bronchiolitis findings

Answer 12

Tachy, RR 40-80 (retractions), wheezing, INSP rales, mild conjunctivitis
Normal WBC
ABN ABG’s (hypoxemia- rarely hypercarbia)

Question 13

What is the MCC of acute bronchiolitis

Answer 13

RSV (self limiting)

Question 14

How do you treat healthy acute bronchiolitis babies

Answer 14

treat fever, oral fluids, observe for labored breathing

Question 15

How do you treat severe babies

Answer 15

oxygen therapy, IV fluids

+/- bronchodilators and Ribavarin

Question 16

Who would you give Ribacvarin to

Answer 16

acute bronchiolitis patients with bronchopulmonary dysplasia
congenital HD
premature
immunodeficient

Question 17

What is prophylaxis for RSV

Answer 17

Pavilizumab (preferred) or RSV immunoglobulin

-Should be given to those with underlying heart/pulm disease monthly during peak season (late fall-early spring)

Question 18

What are S/E of palivizumab

Answer 18

fever
rash
antibody formation
anaphylaxis
thrombocytopenia

Question 19

What causes chronic bronchitis

Answer 19

inhalation of noxious agents + env. factors + bac/viral info

Question 20

What is the definition of chronic bronchitis

Answer 20

chronic cough, excess sputum, and organisms in expectoration for >3 months for 2 years

Question 21

How do you treat an acute chronic bronchitis exacerbation

Answer 21

Chest physiotherapy/ humidified air (mobilize and increase expectoration)
Bronchodilators (albuterol)
+/- Oxygen therapy and Abx

Question 22

What are common pathogens in chronic bronchitis

Answer 22

H. Influenza
M. Catarrhalis
S. Pneumoniae

Question 23

If needed, what abx are preferred in chronic bronchitis

Answer 23

Doxycycline
Ampicillin
Amoxicillin
Augmentin 
Levo/Moxifloxacin

Question 24

What will you find on chronic bronchitis PE

Answer 24

inspiratory rales/rhonchi, exp. wheezing
Hyper resonance, decreased BS
obesity, clubbing, barrel chest

Question 25

What will chronic bronchitis labs show

Answer 25

Erythrocytosis | decreased vital capacity, prolonged exp. flow

Question 26

What are PNA PE findings

Answer 26

Dullness to percussion, increased tactile remits, decreased BS, crackles, retractions tachycardia, tachypnea

Question 27

What will PNA lab findings show

Answer 27

Leukocytosis

Question 28

PNA symptoms are

Answer 28

Abrupt onset fever, chills, dyspnea, pleuritic CP, productive cough (rust sputum)

Question 29

RF for CAP

Answer 29

``` 65+ y/o DM cardio/pulm/renal/liver disease smoking, alcohol (asplenia) ```

Question 30

RF for HAP

Answer 30

``` 60+ y/o aspiration, COPD, ARDS, coma antacids, ppi, H2 antagonist head trauma, ICP NG tube/enteral ntr reintubation/tracheostomy IV abx w/in 90 days (MDR risk) ```

Question 31

RF for VAP

Answer 31

all HAP RF + | MDR risk w/ septic shock, acute renal replacement therapy, 5+ days of hospitalization

Question 32

What is the MCC of PNA in adults

Answer 32

Strep Pneumo

Question 33

What is the MCC of PNA in kids

Answer 33

RSV, parainfluenza, adenovirus (if bacterial, S. Pneumo) (older children, M. pneumoniae)

Question 34

What is "adjunct therapy" for PNA in adults

Answer 34

humidified O2 for hypoxemia bronchodilators if w/ bronchospasm rehydration fluids chest physiotherapy

Question 35

What is Grade 1A PNA prevention

Answer 35

Pneumo vaccine and flu vaccine | Flu meds as prophylaxis or w/in 48 hours of Sx onset

Question 36

What is Grade 1B PNA prevention

Answer 36

Macrolide (azithromycin) if in close contact with pertussis | Use SINGLE dose aerosol meds