Chapter 20_2 flashcards

Question 1

Acute Rhinitis: Definition & Common Causes

Answer 1

Inflammation and irritation of nasal mucous membranes. Usually viral (rhinovirus, adenovirus, coronavirus, parainfluenza, RSV). Can also be allergic. [Text, source: 42, 44]

Question 2

Acute Rhinitis: Viral vs. Allergic Presentation

Answer 2

Viral: Nasal mucosa/turbinates red; yellow/green discharge; high lymphocytes. [Text, source: 43] Allergic: Nasal mucosa/turbinates gray/pale; clear discharge; high eosinophils; “allergic salute” (crease on nose). [Text, source: 43, 44]

Question 3

Acute Rhinitis: Treatment

Answer 3

Symptomatic: Antihistamines, analgesics, antipyretics (acetaminophen). Corticosteroid nasal spray often for allergic rhinitis. [Text]

Question 4

Acute Pharyngitis: Definition & Common Causes

Answer 4

Inflammation of the pharynx. Usually viral. Bacterial cause: Group A beta-hemolytic streptococcus (GABHS / Streptococcus pyogenes) - “Strep throat”. [Text, source: 45]

Question 5

Acute Pharyngitis: Assessment Findings

Answer 5

Red, swollen pharyngeal membranes and tonsils. Lymphoid follicles may be covered with white exudate. Cervical lymphadenopathy (especially with EBV). Fever, malaise, sore throat; typically no cough. [Text, source: 47, 48]

Question 6

Acute Pharyngitis: Diagnosis & Treatment

Answer 6

Diagnosis: Rapid screening test for streptococcal antigens, bacterial throat cultures. Heterophile antibody test to rule out EBV if lymphadenopathy present. Treatment: Antibiotics (penicillin, erythromycin) if GABHS. Symptomatic relief for viral (saltwater gargle, antipyretics). [Text, source: 45, 52]

Question 7

Group A Beta-Hemolytic Streptococcus (GABHS): Potential Sequelae

Answer 7

Can cause: Pharyngitis, bacteremia, pneumonia, meningitis, necrotizing fasciitis, rheumatic fever, rheumatic heart disease, scarlet fever, toxic shock syndrome, glomerulonephritis. [Text, source: 46]

Question 8

Acute Sinusitis: Definition & Duration

Answer 8

Infection/inflammation of facial sinuses. Acute: viral (5-7 days) often due to URI/allergy; bacterial (up to 4 weeks). Chronic: >12 weeks. [Text, source: 49]

Question 9

Acute Sinusitis: Symptoms & Diagnosis

Answer 9

Symptoms: Headache, facial pain/pressure over sinuses (worse bending forward), nasal obstruction, fatigue, purulent nasal discharge, fever. Diagnosis: Transillumination of sinuses, X-rays. [Text, source: 49]

Question 10

Acute Sinusitis: Treatment

Answer 10

Antimicrobial agents (if bacterial), decongestants, saline sprays, heated mist, mucolytic agents. [Text, source: 49]

Question 11

Acute Tonsillitis: Common Causes & Symptoms

Answer 11

Inflammation of tonsils/pharynx. Causes: GABHS, EBV, adenovirus, herpes simplex, CMV. Symptoms: Sore throat, fever, dysphagia. Cervical lymphadenopathy (esp. EBV). [Text, source: 50, 51]

Question 12

Acute Tonsillitis: Complication - Quinsy

Answer 12

Severe tonsil swelling with abscess formation, can cause significant swallowing difficulty. [Text, source: 51]

Question 13

Acute Tonsillitis: Diagnosis & Treatment

Answer 13

Diagnosis: Throat culture for GABHS. Heterophile antibody test for EBV. Treatment: Antibiotics if bacterial. Tonsillectomy for recurrent/severe cases. [Text, source: 51, 52]

Question 14

Epiglottitis: Definition & Danger

Answer 14

Infection/inflammation of epiglottis (flap covering trachea). Inflammation may obstruct trachea - MEDICAL EMERGENCY. [Text, source: 53, Alert]

Question 15

Epiglottitis: Causes & Diagnosis

Answer 15

Bacterial (S. pneumoniae, H. influenzae, S. aureus) or viral (parainfluenza, VZV, HSV-1). Diagnosis: X-ray (shows “steeple sign” - swelling of pharyngeal tissue), laryngoscopic exam. [Text, source: 53, 54]

Question 16

Epiglottitis: Treatment

Answer 16

Immediate hospitalization. Humidified oxygen, IV fluids. Antibiotics. Laryngoscope and tracheostomy equipment must be available at bedside. [Text, source: 53, 54, Alert]

Question 17

Laryngitis & Tracheitis: Definitions & Common Cause

Answer 17

Laryngitis: Inflammation of larynx (voice loss/hoarseness, high-pitched cough). Tracheitis: Inflammation of trachea (raspy cough/stridor). Usually viral. [Text, source: 55]

Question 18

Croup (Laryngotracheobronchitis)

Answer 18

Children’s disease involving inflammation of larynx, trachea, and bronchi. Characterized by a “barking cough”. [Text, source: 55]

Question 19

Acute Bronchitis: Definition & Pathophysiology

Answer 19

Inflammation of bronchi and bronchioles, usually viral or bacterial, or from toxic inhalation. Diminished bronchial mucociliary function; edematous mucous membrane; air passages obstructed by mucus. [Text, source: 58]

Question 20

Acute Bronchitis: Common Etiologies (Viruses & Bacteria)

Answer 20

Viruses: Influenza A/B, parainfluenza, RSV, coronavirus. Bacteria: Mycoplasma spp., Chlamydia pneumoniae, S. pneumoniae, Moraxella catarrhalis, H. influenzae, Bordetella pertussis. [Text, source: 59]

Question 21

Pertussis (Whooping Cough) & Vaccine

Answer 21

Bronchitis cause by Bordetella pertussis. Vaccine preventable (DTaP/Tdap). Recent resurgence in U.S. [Text, source: 60]

Question 22

Acute Bronchitis: Clinical Presentation

Answer 22

Starts like common cold -> sore throat, nasal discharge, muscle aches, fever. Persistent cough (10-20 days) becomes prominent. Sputum (clear, yellow, green, or blood-tinged - color not indicative of bacterial vs viral). Rhonchi and wheezes. [Text, source: 61, 62]

Question 23

Acute Bronchitis: Diagnosis & Treatment

Answer 23

Diagnosis: Symptomatology, sputum culture (to rule out pneumonia or identify bacteria). Treatment: Broad-spectrum antibiotics (if bacterial), expectorants, mucolytics, bronchodilator. Cough suppressants at night. [Text, source: 63]

Question 24

Pneumonia: Definition & Pathophysiology

Answer 24

Inflammation of lung tissue where alveolar air spaces fill with purulent, inflammatory cells, and fibrin. Pathogens (inhaled droplets) adhere to respiratory epithelium -> inflammation -> vasodilation, neutrophils enter alveoli -> exudative edema accumulates, hindering gas exchange. [Text, source: 64, 68]

Question 25

Crackles (Rales) in Pneumonia

Answer 25

Sound produced by alveoli opening and closing against purulent exudate. Pathognomonic for pneumonia. [Text, source: 68]

Question 26

Community-Acquired Pneumonia (CAP): Most Common Cause

Answer 26

*Streptococcus pneumoniae* (pneumococcus). Others: *H. influenzae*, *Legionella*, *Staphylococcus*. Pneumococcal vaccine recommended. [Text, source: 65]

Question 27

Hospital-Associated Pneumonia (HAP) / Ventilator-Associated Pneumonia (VAP)

Answer 27

HAP: Lung infection contracted after 48 hours of hospital admission. VAP: HAP in intubated/mechanically ventilated patients. Common cause for both: *Staphylococcus aureus* (especially MRSA). Others: *Enterococcus* (VRE), *Pseudomonas*. [Text, source: 65, 66]

Question 28

Aspiration Pneumonia: Common Cause

Answer 28

Caused by anaerobic bacteria swallowed from the oropharynx. Risk factors: impaired gag/cough reflex, decreased LOC, chronic gingivitis/periodontitis. [Text, source: 65]

Question 29

Legionnaire's Disease (Pneumonia)

Answer 29

Caused by *Legionella pneumophila*. Transmitted via contaminated water systems (e.g., air conditioning). Affects clusters in hotels, dorms, cruise ships. [Text, source: 66]

Question 30

Mycoplasma Pneumonia ("Walking Pneumonia")

Answer 30

Caused by *Mycoplasma pneumoniae* (small bacteria, no cell wall). Patient may not appear very ill but has persistent cough, headache, earache. Common in <40 yrs. [Text, source: 66]

Question 31

Pneumocystis Pneumonia (PCP)

Answer 31

Caused by *Pneumocystis jirovecii* (opportunistic fungus). Most common opportunistic infection in HIV/AIDS patients. [Text, source: 67]

Question 32

Pneumonia: Clinical Presentation

Answer 32

Sudden onset cough (productive/nonproductive), fever, chills, pleuritic chest pain, dyspnea, hemoptysis, tachypnea, accessory muscle use. Dullness to percussion, increased fremitus. Egophony, bronchophony, whispered pectoriloquy. Elderly may lack fever. [Text, source: 69]

Question 33

Pneumonia: Diagnosis & Treatment

Answer 33

Diagnosis: Chest x-ray (most important), sputum culture, CBC (WBC elevation), pulse oximetry, ABGs. Urine antigen tests for *S. pneumoniae*, *Legionella*. Treatment: Antibiotics (if bacterial), oxygen, Fowler's position, analgesia, antipyretics, bronchodilators. Pneumococcal vaccine for prevention. [Text, source: 70]

Question 34

Pneumonia Severity Index (PSI)

Answer 34

Clinical tool to assess need for inpatient care and mortality risk for pneumonia patients, based on patient characteristics and clinical findings. [Text, source: 71, 72, 73]

Question 35

Lung Abscess: Definition & Risk Factors

Answer 35

Localized area of purulent inflammation in lung resulting in tissue necrosis and central liquefaction. Risk factors: Bacterial pneumonia, aspiration (esp. anaerobic bacteria from oral cavity), IV drug use, immunosuppression (HIV), malignancy. [Text, source: 75]

Question 36

Lung Abscess: Symptoms, Diagnosis, Treatment

Answer 36

Symptoms: Copious foul-smelling sputum (key sign), productive cough, chills, fever, chest pain. Diagnosis: CT scan, sputum culture (after rupture). Treatment: IV antibiotics, surgical drainage or lobectomy, bronchoscopy for drainage, chest tube if pleural space involved. [Text, source: 76]

Question 37

Tuberculosis (TB): Causative Organism & Transmission

Answer 37

*Mycobacterium tuberculosis*. Spread by inhalation of airborne droplets from an infected person's cough or sneeze. [Text, source: 77]

Question 38

Active TB Disease vs. Latent TB Infection (LTBI)

Answer 38

Active TB: Symptoms present, bacteria actively multiplying, can infect others, can be fatal if untreated. [Text, source: 77, 78] LTBI: Infected with TB but disease is dormant (bacteria walled off in tubercle/Ghon's focus), no clinical symptoms, noninfectious, but can reactivate to active TB. Both require treatment. [Text, source: 78, 80, 81, 82]

Question 39

TB: Risk Factors for Active Disease

Answer 39

Immunosuppression (HIV/AIDS - 20-40x higher risk; cancer chemotherapy, biologic agents for autoimmune disease, steroids), crowded living conditions, travel to endemic areas, diabetes, smoking (for relapse). [Text, source: 79, 80]

Question 40

TB: Pathophysiology (Tubercle, Ghon's Focus, Ranke Complex, Caseous Necrosis)

Answer 40

Inhaled M. tuberculosis -> settles in lungs (apex common). WBCs wall off infection forming a granuloma called a tubercle (Ghon's focus). Calcified Ghon's focus = Ranke complex. Immune response damages lung tissue -> caseous necrosis (cheese-like appearance). Bacteria remain dormant in tubercle. [Text, source: 80, 81, 82, 83]

Question 41

TB: Extrapulmonary Sites

Answer 41

Cervical lymph node (Scrofula), Vertebrae (Pott’s disease), Adrenal gland (Addison’s disease), Meninges. [Text, source: 84]

Question 42

TB: Symptoms (Active Disease)

Answer 42

Chronic cough (often purulent sputum), hemoptysis, weight loss, anorexia, low-grade fever, night sweats, chest pain. Immunosuppressed/elderly may lack classic symptoms. [Text, source: 85]

Question 43

TB Diagnosis: Mantoux Tuberculin Skin Test (PPD)

Answer 43

Screening test; injects PPD intradermally. Positive = induration (elevated, hardened area) at 48-72 hrs (reaction size for positivity varies by risk factors, >15mm positive for all). Indicates prior exposure/sensitization, not active disease. Requires follow-up chest X-ray. [Text, source: 86, 87]

Question 44

TB Diagnosis: Effect of BCG Vaccine on Mantoux Test

Answer 44

Bacillus Calmette-Guérin (BCG) TB vaccine (used in some countries) causes positive Mantoux test. Does not mean active TB. [Text, source: 89]

Question 45

TB Diagnosis: Interferon Gamma Release Assay (IGRA)

Answer 45

Blood test to diagnose TB exposure. Positive test requires further testing (chest X-ray) to determine latent vs. active. IGRA result NOT affected by BCG vaccine. [Text, source: 90]

Question 46

TB Diagnosis: Sputum Cultures & NAAT

Answer 46

Sputum smear for acid-fast bacilli (AFB) and culture of *M. tuberculosis* (most reliable for active TB, determines antibiotic sensitivity). Nucleic Acid Amplification Test (NAAT) on sputum for rapid M. tuberculosis detection (e.g., Xpert MTB/RIF also detects rifampicin resistance). [Text, source: 88, 91]

Question 47

TB Treatment: Medications & Duration

Answer 47

Antimicrobial combination therapy: Isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin. Long duration (6-12 months). Respiratory isolation until non-contagious. Patient education critical for adherence to prevent MDR-TB (multi-drug resistant TB). [Text, source: 92]