Bronchitis & Pneumonia Flashcards
(91 cards)
1
Q
Bronchitis
A
cough >5 days
typically 1-3 weeks long
2
Q
Chronic bronchitis
A
cough and sputum production most days of the month
***at least 3 months of the year in 2 consecutive . years
3
Q
Pathophys behind acute bronchitis
A
self-limited inflammation of bronchi due to upper airway infection
associated w/ viral URI
4
Q
Etiology of acute bronchitis
A
VIRAL! (90%)
Bacterial (mycoplasma, chlmaydia, bordetella pertussis)
5
Q
Which bacterial infection responds to abx tx
A
bordatella pertussis
6
Q
Sx of acute bronchitis
A
cough (+/- sputum) afebrile (unless influenza) chest wall tenderness wheezing mild dyspnea
7
Q
PE for acute bronchitis
A
wheezing
bronchospasm (reduced FEV1)
rhonchi (clears w/ coughing)
(-) crackles and signs of consolidation (that is pneumo)
8
Q
Dx for acute bronchitis
A
Clinical!
WBC: normal or elevated
CXR: normal/nonspecific
9
Q
Crackles
A
pneumonia
10
Q
Rhonchi
A
acute bronchitis
11
Q
Pneumonia is unlikely if all of the following signs are absent
A
fever (>100.4)
tachynea (>24 breaths/min)
tachycardia (>100 bpm)
evidence of consolidation (crackles, egophony, fremitus)
12
Q
Tx for acute bronchitis
A
reassurance
hydration& rest
Sx relief
13
Q
Sx relief for acute bronchitis
A
NSAID, ASA, acetaminophen intranasal ipratropium antitussive (dextromethorphan) B2 agonists (albuterol inhaler, SVN) OTC (lozenges, tea, mucolytics) smoking cessation*
14
Q
Abx for bronchitis
A
ONLY PERTUSSIS
15
Q
CXR for bronchitis
A
not necessary
only used to r/o pneumonia
16
Q
Whooping cough
A
pertussis
17
Q
Phases of pertussis
A
- Catarrhal: URI sx, fever (1-2 weeks)
- Paroxysmal: persistent paroxysmal cough, inspiratory “whooping”; POST TUSSIVE EMESIS (2-6 wks)
- Convalescent: cough gradually resolves (weeks - months)
18
Q
Prodrom w/ pertussis
A
rhinorrhea, mild cough, sneezing
19
Q
Dx of pertussis
A
nasopharyngeal secretions – BACTERIAL CULTURE = GOLD STANDAARD
PCR (faster)
Serology (more useful in later phases: 2-8 wks from cough onset)
20
Q
Tx of pertussis goals
A
decreases transmission! little effect on sx resolution
21
Q
Tx for pertussis
A
supportive
Macrolide
22
Q
dosage for pertussis
A
Azithro 500 mg PO, followed by 250 mg for 4 days
Clarithro 500 mg PO BID x 7 days
Erythro 500 mg PO QID x 14 days
23
Q
Alternative tx for pertussis
A
Bactrim PO BID x 14 days
24
Q
Pertussis tx in peds
A
< 6 mo most need admission/isolation
Sx control
Macrolides
25
Abx prophylaxis for pertussis
given to close contacts
vaccination (+Tdap booster)
26
Influenza involes
upper and lower RT
| usually self-limited
27
High risk for influenza
```
children <2 YO
adults >65 YO
chronic disease
immunosuppressed
pregnant (up to 2 wks postpartum)
morbidly obese
nursing homes/chronic care facilities
```
28
Presentation of influenza
```
fevere
h/a
myalgia
malaise
nonproductive cough
sore throat
nasal d/c
```
29
PE for influenza
hot, flushed
febrile
mild cervical LAD
30
Dx for influenza
RIDT (10-30 min) - more sensitivity
RT-PCR (2-6 hrs) - most sensitive and specific
Viral culture (48-72 hrs) - confirmatory; not used for clinical management
31
Negative RIDT
during periods of peak influenza activity, negative test does not exclude influenza (make dx clinically)
32
Tx for influenza
usually improves 2-5 days
antiviral 24-48 hrs of sx onset (Neuraminidase inhibitors: oseltamivir, zanamivir)
33
Antiviral therapy
reduces sx duration by 1-3 days
34
Most common complication of influenza
Pneumonia
35
acute infection of pulmonary parenchyma
pneumonia
36
What is pneumonia?
inflammation and consolidation of lung tissue from infectious agent; result of virulent organism, large inoculum and/or impaired host defense
37
Classification of pneumonia
typical vs. atypical
CAP, HAP, VAP
38
Highest incidence of pneumonia
<4 yo
>60 yo
M>F
African Americans > Caucasians
39
Transmission of CAP
ASPIRATION from oropharynx * (most common)
inhale droplets
hematogenous spread
extension from infected pleural or mediastinal space
40
Pathophys behind CAP
proliferation of bacteria in alveoli when macrophages ability is exceeded;
alveolar macrophages initiate an inflammatory response to increase the lower respiratory tract defenses
41
Most common cause of typical pneumo
Streptococcus pneumoniae
42
Most common cause of atypical pneumonia
Mycoplasma pneumonia
43
Causes of atypical pneumo
bacterial, viral, fungal
bacterial: mycoplasma, chlamydophila, legionella, C. psittaci
44
Viral etiology of pneumona
influenza
RSV
Parainfluenza
adeno
45
Fungal causes of pneumonia
histoplasmosis
blastomycosis
coccidiodomycosis
Cryptococcus
*unusual in immunocompetent host
46
Presentation of pneumonia
```
acute onset *
fever *
cough *
sputum production
hemoptysis
dyspnea
night sweats
pleuritic chest pian
chest pain, chills, rigors
```
47
PE for pneumonia
```
fever
tachypnea: RR>24
hypoxia
tachycardic
diaphoresis
decreased/bronchial breath sounds
crackles (rales)
Consolidation signs
```
48
Consolidation signs
dullness to percussion
increased tactile fremitus
bronchophony
egophony
49
(+) bronchophony
"99" is louder and clearer
50
(+) egophony
E heard as "A"
51
Dx of pneumonia
Leukocytosis w/ left shift (15k-30k)
| CXR: infiltrate (lobar consolidation, interstitial infiltrates, cavitation)
52
Gold standard for pneumonia
infiltrate on CXR
53
Dx for CAP
CT- not routinely recommended
Microbio testing (sputum, blood culture): very ill/risk factors for unusal organisms
Urine antigen test: legionella and s. pneumo
PCR tests: research studies
Procalcitonin and CRP: inflammatory markers - help distinguish between bacterial and viral
54
Testing for legionella or S. pneumo
Urine antigen test
55
Helps distinguish b/w bacterial and viral pneumo
procalcitonin and CRP
56
Complications of pneumo
```
bacteremia
sepsis
abscess
empyema
respiratory failure
```
57
Severity index and admission
Class I-II: probably not
Class III: observation unit
Class IV and V: admit to hospital
58
CURB-65 score for pneumonia
```
Confusion
urea > 7, BUN >20
RR >30
BP (sys <90 or DBP <60)
65 YO or more
```
59
CURB-65 and recommendation
0 &1: outpatient
2: admit
3-5 assess for ICU care
60
Outpatient uncomplicated pneumo tx
Macrolide: azithro 500 mg PO day 1, 250 mg PO x 4 days
OR
Doxycycline (100 mg BID x 7-10 days)
61
Tx for complicated pneumo
beta-lactam + macrolide:
Augmentin 500 mg BID + azithromycin
OR
Respiratory fluorquinolone (levofloxacin 750 mg daily x 5 days)
62
Education to pt on pneumo sx
```
abx at least 5 days
3 days for fever to resolve
14 days for cough and fatigue
1/3 have sx at 28 days
return to work in 6 days
```
63
F/u for pneumo
CXR not needed routinely
64
When to do f/u CXR in pneumonia
7-12 weeks post tx in pts >40 yo or smokers
65
Risk for pseudomonas
```
alcoholism
CF
neutropenic fever
recent intubation
cancer
organ failure
septic shock
```
66
MRSA risk
end stage renal disease
IV drug abuse
prior abx use
influenza
67
When to d/c inpatient
min 5 days abx and:
- afebrile 48-72 hrs
- supplemental O2 not needed
- HR <100 bpm
- RR <24
- SBP >90 mmHg
68
When to have pneumococcal vaccine
>65 yo
| 19-64 yo at increased risk (cardiopulm disease, SS, tobacco abuse, splenectomy, liver disease)
69
Uncomplicated outpt tx
macrolide or doxy
70
Complicated out patient or non-ICU
macrolide + beta-lactam
OR
resp. fluroquinolone
71
ICU
beta-lactam + azithro
OR
beta-lactam + fluoroquinolone
If PCN allergy: fluoroquinolone + aztreonam
72
What is HAP?
48 hrs or more after admission and did not appear to be incubating at time of admission
73
Risk for HAP
ICU (pseudomonas aeruginosa - worst prognosis)
| Mechanical ventilation
74
VAP
HAP that develops 48-72 hrs after endotracheal intubation
75
Tx for HAP or VAP
broad spectrum abx
76
Dx of HAP/VAP
new/progressive infiltrate on imaging AND 2 of the following:
- fever
- purulent sputum
- leukocytosis
Sputum gram stain + culture indicated
77
Best tx of VAP
```
avoid acid-blocking meds
decontamination of oropharynx
selective decontamination of gut
probiotics
positioning
subglottic drainage
```
78
Further eval for non-resolving pneumo
chest CT
fiberoptic bronchoscopy
thoracoscopy
open lung bx
79
Pneumocystis jirovecci aka
pneumocystis carinii; PCP; pneumocystis pneumonia
80
What is PCP
fungi
81
what is PCP associated w/
HIV (CD4 count low)
82
Sx of PCP
fever
cough- nonproductive
progressive dyspnea
extra-pulmonary lesions
83
Testing for PCP
high LDH
Low CD4
CXR
sputum
84
Tx for PCP
Bactrim
85
Alternative tx for PCP
TMP-dapsone
clindamycin-primaquine
pentamidine (best SE profile)
steroids
86
Prophylaxis for PCP in HIV
hx of previous PCP
CD4 <200
oropharyngeal thrush
87
Prolphyaxis tx
bactrim
| alt: dapsone, pentamidine
88
What is aspiration pneumonia?
displacement of gastric contents to the lung causing injury and infecftion; gram-negative and anaerobic pathogens
89
Risk factors for aspiration pneumo
```
post-op
neuro comprovis (CVA, parkinson's, ALS, sedation)
anatomical defect or aberrancy
```
90
CXR in aspiration pneumo
RLL infiltrate common
91
Aspiration pneumo tx
supportive
| abx: piperacillin/tazobactam OR ampicillin/subactam OR clinda OR moxifloxacin
