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Clinical Medicine 2 > Exam 2: Bronchitis > Flashcards

Exam 2: Bronchitis Flashcards

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1
Q

What constitutes acute bronchitis?

A

A cough lasting more than 5 days

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2
Q

What constitutes chronic bronchitis?

A

Cough and sputum production on most days of the most, at least 3 months out of the year in 2 consecutive years

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3
Q

What is the most common etiology of bronchitis? Examples?

A

Viral

Influenza A and B, parainfluenza, coronavirus, rhinovirus, HSV

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4
Q

What is the only bacterial cause of bronchitis in which you should treat with antibiotics?

A

Bordetella pertussis

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5
Q

Does presence of purulent sputum production indicate bacterial infection?

A

No

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6
Q

Patient presents with cough, wheezing, mild dyspnea,and is afebrile. On physical exam, there is wheezing, bronchospasm with reduced FEV1, and rhonchi. What are you suspicious of?

A

Acute bronchitis

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7
Q

What should you not hear on lung auscultation in a patient with acute bronchitis?

A

Crackles or signs of consolidation

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8
Q

When should you order a CXR for a patient with acute bronchitis?

A
  • Fever
  • tachypnea
  • tachycardia
  • evidence of consolidation of auscultation
  • cough lasting more than 3 weeks
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9
Q

What medications can toy use for symptomatic relief in bronchitis?

A
  • NSAIDs, aspirin, Tylenol
  • Intranasal ipratropium
  • Antitussives (avoid codeine)
  • B2 agonist
  • OTC products such as cough drops, tea, honey, expectorants
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10
Q

Whooping cough is also known as?

A

Pertussis

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11
Q

What is the etiology of pertussis?

A

Bordetella pertussis

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12
Q

What is the clinical presentation of pertussis?

A

Coughing fits followed by the classic whooping sound, prolonged progressive cough

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13
Q

What are the 3 phases of pertussis?

A

1) catarrhal
2) paroxysmal
3) Convalescent

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14
Q

What are the symptoms of the catarrhal phase of pertussis and how long does it last?

A

URI symptoms, fever

Lasts 1-2 weeks

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15
Q

What are the symptoms of the paroxysmal phase of pertussis and how long does it last?

A

Persistent paroxysmal cough, inspiratory whooping, post-tussive emesis

Lasts 2-6 weeks

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16
Q

What are the symptoms of the convalescent phase of pertussis and how long does it last?

A

Cough gradually resolves

Lasts weeks to months

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17
Q

What is the gold standard of diagnosis of pertussis?

A

Bacterial culture

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18
Q

When you suspect pertussis, how should you treat it?

A

Empiric therapy may be initiated while obtaining a diagnostic test for confirmation.
-Abx treatment decreases transmission, but has little effect on symptom resolution

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19
Q

What are the two methods for diagnosing pertussis?

A

Nasopharyngeal secretions (bacterial culture and PCR)

Serology

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20
Q

What antibiotics are recommended for pertussis treatment?

A

Macrolides

  • Azithromycin 500mg PO followed by 250mg for 4 days
  • Clarithromycin 500mg PO BID for 7 days
  • Erythromycin 500mg PO QID for 14 days
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21
Q

What is the alternative antibiotics to macrolides to treat pertussis?

A

Bactrim DS PO BID for 14 days

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22
Q

What is the best way to prevent pertussis?

A

Vaccinations and Abx prophylaxis

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23
Q

What are the high risks populations for influenza?

A

Children <2, adults >65, underlying chronic disease, immunosuppressed, pregnant, obese, and residents of nursing homes

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24
Q

Patient presents with abrupt onset of fever, HA, myalgia, and malaise. Febrile on exam with mild cervical lymphadenopathy. What are you suspicious of?

A

Influenza

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25
What is important to remember about rapid influenza diagnostic tests?
During periods of peak influenza activity, negative rapid antigen tests do no reliably exclude influenza
26
What are the 3 methods of diagnosing influenza and how long does each take?
- Rapid influenza diagnostic test (10-30 minutes) - PT-PCR (2-6 hours) - VIral culture (48-72 hours)
27
When does antiviral therapy need to be initiated for influenza in order for it to be effective? What is the effect?
If started within 48 hours of symptom onset, will reduce symptom duration by 1-3 days
28
What drugs are used to treat influenza?
Neuraminidase inhibitors (Oseltamivir and Zanamivir)
29
What is the most common complication of influenza?
PNA
30
What is it called when you have an acute infection of pulmonary parenchyma with inflammation and consolidation of lung tissue from an infectious agent?
Pneumonia
31
What is the most common etiology of typical CAP?
S. Pnuemoniae
32
What are the 4 routes of transmission for CAP?
- Aspiration from the oropharynx (most common) - inhalation of contaminated droplets - hematogenous spread - Extension from infected pleural or mediastinal space
33
What is the most common cause of atypical CAP?
Mycoplasma pneumoniae
34
Fungal CAP is unusual in what populations?
Immunocompetent hosts
35
What is the typical clinical presentation of CAP?
Abrupt onset of fever, cough, sputum production, dyspnea, night sweats, and pleuritic chest pain
36
What will be seen on CXR in a patient with CAP?
Infiltrate on plain chest radiograph with possible lobar consolidation, interstitial infiltrates, and cavitation
37
What will be seen on CBC in a patient with CAP?
Leukocytosis (15-30) with a left shift
38
What are the possible complications of PNA?
Bacteremia, sepsis, abscess, empyema, and respiratory failure
39
What is CURB-65 used for and what are the components?
Used to evaluate severity of PNA ``` Confusion Urea >7, BUN >20 Respiratory rate >30 Blood pressure (SBP <90 or DBP <60) 65-age >65 years old ```
40
At what CURB-65 score would you admit to the hospital? Admit to ICU?
Hospital: 2 ICU: 3
41
How long should antibiotics be given for CAP?
At least 5 days
42
What is uncomplicated CAP?
Previously healthy patient with no antibiotic use within the last 3 months
43
What antibiotics should you give for uncomplicated CAP?
- Macrolide (azithromycin 500mg on day one, followed by 4 days of 250mg per day) - Or doxycycline 100mg BID for 7-10 days
44
What is complicated CAP?
Patient with recent antibiotic use, COPD, renal or liver disease, CA, DM, chronic heart disease, alcoholism, asplenia, or immunosuppresion
45
What antibiotics should be given for complicated CAP?
- Combination of Beta lactam and a macrolide (Augmentin 500mg BID and azithromycin) - Or respiratory fluoroquinolone (Levofloxacin 750mg daily for 5 days)
46
What are the complications for CAP when you should consider pseudomonas risk?
Alcoholism, cystic fibrosis, neutropenia fever, CA, recent intubation, organ failure, and shock
47
What are the complications of CAP when you should consider MRSA?
ESRD, IVDA, prior Abx use, and flu
48
When is inpatient treatment indicated for CAP?
-Minimum of 5 days of antibiotics and afebrile for 48-72 hours, supplemental O2 not needed, Heart rate less than 100, RR less than 24, and SBP greater than 90
49
What is HAP?
48 hours or more after admission and did not appear to be incubating at the time of admission
50
What patients are at highest risk for HAP?
ICU patients and Pseudomonas Aeruginosa has worst prognosis
51
What is VAP?
A type of HAP that develops more than 48-72 hours after ET intubation
52
How is HAP or VAP diagnosed?
-New or progressive infiltrate on lung imaging and at least two of the following: fever, purulent sputum, or leukocytosis
53
What tests are indicated with HAP and VAP?
Sputum gram stain and culture
54
What PNA is associated with HIV?
Pneumocystis Jirovecii PNA
55
What are the clinical findings with Pneumocystis Jirovecii PNA?
- High LDH - low CD4 - CXR with reticular ground glass opacities - Sputum
56
What is the treatment for Pneumocystis Jirovecii PNA?
Bactrim
57
What is the aspiration PNA?
Displacement of gastric contents into the lung causing injury and infection
58
What is the etiology of aspiration PNA?
Gram negative and anaerobic pathogens
59
What are the risk factors for aspiration PNA?
- Post op state - neurologic compromise - Anatomical defect
60
What is the gold standard for diagnosis of CAP?
CXR
61
What antibiotics are given for aspiration PNA?
Piperacillin/ tazobactam, or Ampillcin/sulbactam OR Clindamycin OR moxifloxacin
62
What is the leading cause of opportunistic infection in HIV patients?
Pneumocystis Jirovecii PNA

Clinical Medicine 2 (22 decks)

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