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X Clin Med II Exam 2 > Bronchitis and Pneumonia > Flashcards

Bronchitis and Pneumonia Flashcards

(61 cards)

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1
Q

How to classify acute bronchitis

A

Cough > 5 days (typically 1-3 wks)

Usually lower respiratory

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2
Q

How to classify chronic bronchitis

A

Cough and sputum production on most days of the month

At least 3 mos of the year in 2 consecutive yrs

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3
Q

Pathophysiology of acute bronchitis

A

Self-limited inflammation of the bronchi due to upper airway infection-often associated with viral URI

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4
Q

Etiology of acute bronchitis

A

Viral (90%)- influenza, parainfluenza, coronavirus, rhinovirus, RSV, human metapneumovirus
Bacterial uncommon- M pneumonia, C pneumoniae, B pertussis

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5
Q

What is the only bacterial pathogen that should be treated with abx for acute bronchitis?

A

Bordetella pertussis

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6
Q

Presentation of acute bronchitis

A 
Cough (maybe sputum production)-purulent sputum not predictive of bacterial infection
Usually afebrile (unless influenza)
Chest wall tenderness
Wheezing
Mild dyspnea
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7
Q

What is seen on a physical exam in acute bronchitis?

A

Wheezing
Bronchospasm (reduced FEV1)
Rhonchi (clears with coughing)
Negative for crackles and signs of consolidation

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8
Q

Different types of crackles

A

Fine (hair between fingers)

Coarse (velcro)

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9
Q

When is pneumonia unlikely?

A 
When all findings are absent:
Fever (>38 C)
Tachypnea (>24 breaths/min)
Tachycardia (>100 breaths/min)
Evidence of consolidation on chest exam
Consider chest radiograph for pts with any of these findings or cough longer than 3 wks
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10
Q

Tx for acute bronchitis

A

Hydration and rest
Symptomatic relief (NSAIDs, intranasal ipratropium, antitussives, B2 agonists, lozenges etc)
Smoking cessation

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11
Q

Is a CXR necessary for acute bronchitis?

A

No, not necessary in most cases (r/o pneumonia)

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12
Q

What is pertussis?

A

“whooping cough” caused by bordetella pertussis

Prolonged progressive cough

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13
Q

Stages of pertussis

A

Catarrhal (1-2 wks of URI sxs/fever)
Paroxysmal (2-6 wks of persistent paroxysmal cough, whooping, emesis)
Convalescent (wks to mos of cough gradually resolving)

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14
Q

Gold standard for diagnosis of pertussis

A

Bacterial culture from nasopharyngeal secretions

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15
Q

When is serology used?

A

For diagnosis in later phases

2-8 wks from cough onset

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16
Q

Tx of pertussis

A

Empiric therapy used while obtaining diagnostic test for confirmation
Abx decreases transmission but has little effect on symptom resolution

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17
Q

What is the CDC recommended antibiotic regiment of pertussis in adults?

A

Azithromycin (500 mg PO followed by 250 mg for 4 days)
Clarithromycin (500 mg PO BID for 7 days)
Erythromycin (500 mg PO QID for 14 days)
Alternative Bactrim PO BID for 14 days

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18
Q

Treatment of pertussis in peds

A

Most kids <6 mos need admission

Otherwise sx control and abx

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19
Q

Who receives abx prophylaxis for pertussis?

A

Close contacts (it must be reported to state health dept)

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20
Q

High risk populations of influenza

A 
Kids <2
Adults >65
Underlying chronic disease
Immunosuppressed
Pregnant (up to 2 wks postpartum)
Morbidly obese
Resident of nursing home/chronic care facility
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21
Q

Presentation of influenza

A

Abrupt onset of fever, HA, myalgia and malaise (nonproductive cough, sore throat, nasal discharge less common)

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22
Q

Diagnostic tests for influenza

A

Rapid influenza diagnostic tests (10-30 min)- low sensitivity and high specificity
RTPCR (2-6 hrs)- most sensitive and specific
Viral culture (48-72 hrs)-confirmatory

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23
Q

Tx of influenza

A

Generally get better in 2-5 days (may be 1 wk more)

Antiviral therapy within 24-48 hrs of sx onset-Oseltamavir and Zanamivir- reduce sxs by 1-3 days

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24
Q

Most common complication of influenza

A

Pneumonia

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25
What is pneumonia?
Acute infection of pulmonary parenchyma | Inflammation and consolidation of lung tissue from infectious agent
26
Classifications of pneumonia
Source based: community acquired, hospital acquried and ventilator associated Symptom based: typical and atypical
27
Epidemiology of CAP
Men>women African Americans>Caucasians Incidence highest at extremes of ages (<4 and >60)
28
How is CAP transmitted?
Aspiration from the oropharynx is most common Inhalation of contaminated drops Hematogenous spread Extension from infected pleural or mediastinal space
29
Pathophysiology of CAP
Proliferation of microbial pathogens at the alveolar level when the capacity of macrophages to kill is exceeded
30
Etiology of CAP
Typical is bacterial (mostly streptococcus pneum) | Atypical is bacterial (mostly mycoplasma pneumoniae), viral or fungal (unusual in immunocompetent host)
31
Risk factors of CAP
General: asthma, immunosuppression, advanced age, alcoholism, institutionalization Pneumococcal (dementia, seizure disorder, heart failure, cerebrovascular disease, alcoholism, tobacco, COPD, HIV)
32
Clinical presentation of CAP
Acute onset fever and cough (typical) | Can also be sputum, hemoptysis, dyspnea, night sweats, pleuritic chest pain, chest pain, chills, rigor
33
Atypical presentation of CAP
Subacute onset of viral prodrome, nonproductive cough, low grade fever, HA, myalgia, malaise, confusion, weakness, delirium etc
34
What is seen on the physical exam in CAP?
Fever, tachypnea, hypoxia, tachycardia, diaphoresis, decreased breath sounds, crackles, signs of consolidation
35
Gold standard for diagnosis of CAP
Infiltrate on plain chest radiograph (lobar consolidation, interstitial infiltrates, cavitation) Others like leukocytosis with left shift
36
Complications of CAP
Bacteremia, sepsis, abscess, empyema, respiratory failure
37
What is CURB-65?
Way to predict pt mortality and recommendation for tx Confusion Urea>7 mmol/L, BUN>20 mg/dL Respiratory rate>30 breaths/min Blood pressure (SBP<90 or DBP<60) 65-age >65 Give 1 pt for everything (admit at 2 and 3+ assess for ICU)
38
What is the best predictor of a good outcome for CAP?
Right site of care
39
Duration of abx for outpatient care of CAP
At least 5 days
40
What pt reassurance is necessary for outpatient tx?
Median resolution time is 3 days for fever, 14 days for cough and fatigue Many will have sxs for amonth Return to work about 6 days
41
When do you need a follow up CXR?
Not routinely | 7-12 wks post tx in pts > 40 yo or smokers
42
Outpatient tx for uncomplicated CAP (typical and atypical)
Azithromycin 500 mg day 1, 4 days of 250 mg Doxycycline (100 mg BID for 7-10 days) Uncomplicated means previously healthy, no abx use within past 3 mos
43
What is complicated CAP?
Pts with recent abx use, COPD, liver or renal disease, cancer, DM, chronic heart disease, alcoholism, asplenia or immunosuppression
44
Outpatient tx for complicated CAP
Combo of beta-lactam (Augmentin 500 mg BID) plus macrolide (azithromycin) OR Respiratory fluoroquinolone (levofloxacin 750 mg daily for 5 days)
45
Inpatient tx for CAP
Minimum of 5 days of abx and afebrile for 48-72 hrs, supplemental 02, HR <100, RR<24, SBP>90 In order to discharge
46
Who needs a pneumococcal vaccine?
Pts >65 Pts 19-64 at increased risk for pneumococcal infection and/or serious complications of infection (cardiopulm disease, sickle cell, tobacco use, splenectomy, liver disease)
47
What is hospital acquired pneumonia?
48 hrs or more after admission and did not appear to be incubating at time of admission
48
Who is at the highest risk for HAP?
ICU (psuedomonas) | Mechanical ventilation
49
What is ventilator associated pneumonia?
A type of HAP that develops more than 48-72 hrs after endotracheal intubation
50
Diagnosis of HAP and VAP
New and progressive infiltrate on lung imaging AND at least 2 of the following (fever, purulent sputum, leukocytosis) Indicated to do sputum gram stain and culture
51
Best tx strategy of VAP
``` Prevention! Avoidance of acid-blocking meds Decontamination of oropharynx Probiotics Positioning Subglottic drainage ```
52
What should be considered with non-resolving pneumonias?
``` Atypical infection (viral/fungal) Aspiration CHF Cancer Fibrosis *further eval ```
53
What is pneumocystic jirovecii pneumonia?
PCP Was considered protozoan and now fungi Associated with HIV (low CD4) Leading diagnosis of AIDS defining condition
54
Sxs of PCP
Fever, nonproductive cough, progressive dyspnea, extra-pulmonary lesions
55
What is seen on the tests in PCP
High LDH, low Cd4, CXR, sputum
56
Tx for PCP
Bactrim is preferred
57
When do you consider prophylaxis for PCP?
Risk factors in pts with HIV (history of previous PCP, CD4<200, oropharyngeal thrush) Bactrim is preferred
58
What is aspiration pneumonia?
Displacement of gastric contents to lung causing injury and infection by gram-negative and anaerobic pathogens
59
Risk factors for aspiration pneumonia
Post-opertion, neurologic compromise, anatomical defect or aberrancy
60
What is commonly seen on a CXR in aspiration pneumonia?
RLL infiltrate
61
Abx for aspiration pneumonia
Piperacillin or ampicillin or clindamycin or moxifloxacin

X Clin Med II Exam 2 (6 decks)

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