HYHO URI/Pneumonia Flashcards
(68 cards)
1
Q
Common symtoms seen in URI/pneumonia?
A
- Cough with or wo sputum
- Fatigue/malaise
- Fever and dyspnea
- Rigors, pleuritic chest pain,
- Anorexia
- Preceding viral illness
2
Q
How do typical vs atypical pneumonias present differently?
A
Typical => inflammatory response with cough
Atypical => less inflammation and less severe.
3
Q
PE findings for URI?
A
- Increased work to breathe
- Retractions
- Adventitious breath sounds (crackles, rhonchi, wheezing)
- Hypoxemia
4
Q
+ special tests that indicate URI
A
- Tactile fremitis
- Egophany/Bronchophany
- Dullness to percussion
5
Q
DDx for NON-infectious causes of cough
A
- UACS (upper airway cough s=yndrome)
- Asthma/ COPD
- GERD
6
Q
What is the most common cause of a chronic cough in healthy, non-smokers with a NL CXR?
A
UACS (allergic rhinitis and bacterial sinusitus(
7
Q
What is the most sensitive and specific test used to diagnose GERD diseaes?
Is it required to diagnose GERD
A
24-hour esophageal pH monitoring; not required to dx GERD
8
Q
What is the 1st line of treatment for GERD?
A
4-weeks on a PPI = diagnostic and therapeutic
9
Q
After 4 weeks on a PPI, if GERD does NOT improve, what do we do?
A
Endoscopy
10
Q
DDx for infectious cough and congestion
A
- 1. Common cold/URI/viral
- 2. Pharyngitis
- 3. Sinusits
- 4. Bronchitis
- 5. Influenza
- 6. Pneumonia
11
Q
Acute Bronchitis
- What is it?
- Commonly presents in
- Most commonly occurs in
- Most common etiology
A
- inflammation of the tracheobronchial tree that causes [increased mucus production and airway hyperresponsiveness] d/t a URI (often, viral)
- Healthy adult as a cough that lasts 1-3 weeks
- Winter (Nov-Feb)
- Viral
12
Q
Bacterial causes of acute bronchitis
A
- Mycoplasma
- Chlamydia pneumonia
- Bordatella pertussis
13
Q
What is the initial phase and protracted phase of acute bronchitis
A
intial phase = cough and systemic systems occur due to infection/inflammation; no fever or low grade
protracted: bronchial hyperresponsivenss causes the coughing, without pulmonary disease
14
Q
MC presentation of acute bronchitis
A
productive, purulent sputum
15
Q
in acute bronchitis, is the color of the sputum diagnostic of of the presence of a BACTERIAL infection
A
no
16
Q
testing and treatment of acute bronchitis
A
- testing: no viral culture, serology or sputum analysis is needed
-
treatment: self-limited; lasts for less than 2 weeks but the cough can last for 2> months.
- ABX ONLLLLLY for at-risk patients or when clinical suspician is high for CAP (even though NL CXR or if you think it is caused by bacteria
- Bronchodilators
17
Q
prevent acute bronchitis
A
- wash hands, avoid tobacco/lung irritants, cough into elbow
- avoid ABX for tx bc often viral
18
Q
Rhinosinusitis
- what is it
- acute/subacute/chronic
- how long does it last
- MCC in adults and children
A
- inflammation of nasal mucosa + 1 or more paranasal sinusesdue to obstruction of NL draining
- acute (<4 weeks) subacute (4-12) chronic (>12)
- viral = improves after 7-10 days; if it does not improve after 7 days in adults or 10 days in kids => think bacterial
- MCC
- adults = s. pneumonia & H. influenza
- children = H. influze and moracella catarrhallas
19
Q
Sx/Diagnosis of rhinosinutisis
A
- Purulent nasal discharge
- Maxillary dental/facial pain
- Unilaterally maxillary sinus is tender
Sx improve, then worsen.
20
Q
First line therapy for rhinosinutis
A
Directed at infection:
Amoxicillin + trimethoprim-sulfamethazole (10-14 days)
21
Q
Pharyngitis
- What is it
- MCC cause
- Clinical course
- Dx requires us to do what
A
- Inflammtion of pharynx and tonxils = severe throat pain
- Viral
- In adults = benign and self-limited
- RO other causes of severe throat pain
22
Q
Pharyngitis
- MCC in who
- Common causes in teens/young adults
- adults
- pediatrics?
A
- Pediatric pts (4-7 YO)
- MCC in adolescents and young teens
- Myoplasma
- Chlamydia pneumonia
- Arcanobacterium
-
MCC in adults (15%) and pediatric (30%) patients
- GroupASTrep
23
Q
Diagnosis and findings of Pharyngitis
A
- Abrupt onset of sore throat and fever
- Petachiae on palate/tonsil
- Tender cervical adenopathy
- NOOOOO cough
- If GAS = sandpaper liek rash)
24
Q
How to diagnose GAS
A
1. throat culture = gold standard
- Rapid strep antigen test.
25
How can we diagnosde **GAS** without a throat culture or rapid antigen test
CENTOR criteria
* give a pt for:
* **fever of 100.4 or higher**
* **no cough,**
* **enlarged/tender cervical adenopathy,**
* **swollen/exudative tonsils**
* one extra point of
* pt is 3-14 YO
* deduct one pt if
* pt is \>45YO
* **0-1 = no more testing; no ABC**
* **2-3= perform rapid strep or throat culture and treat with ABX if +**
* **4+ = give empiric ABX treatment**
26
Tx of **GAS pharyngitis**
1. **Penicillin**
1. **if allergic =\> cephalosporin and macrolides.**
27
what is the leading cause of **mortality** & **morbidity** in the world; what kind of symptoms does it cause?
**pneumonia**: sx range from (**mild** fever/productive cough =\> **severe** respiratory distress and sepsis)
28
What is **CAP** (community aquired pneumonia) vs **nocosomial** infection?
* acute infection of the lung parenchyma that occurs OUTSIDE of the healthcare setting (nursing home, dialysis center, recently hospitalized)
* Nocosomial = occurs in health care setting (hospital acquired pneumonia (HAP) or ventillatory-associated pneumonia VAP)
*
29
What is **hospital aquired pneumonia**
pneumonia acquired **\>48 hours after hospital admission.**
30
what is **VAP** (ventillator acquired pneumonia)
acquired **\>48 hours after endotracheal intubation.**
31
**RF** to pneumonia
* 1. elderly
* 2. known COPD
* 3. HF or kidney failure
* 4. DM
32
what are sx and signs of pneumonia
* sx = dyspnea, high fever, rigors, pleuritic CP, AMS
* signs = abnormal VS = high fever, HR \> 100 bpm; RR \> 24 ;hypotension and hypoxia
33
if pt presents with **acute cough \< 3 weeks a**nd has sx, signs or RF to pneumonia, what do we do?
**Obtain PA and lateral CXR**
34
MC bacterial of of pneumonia
s. pneumonia
35
most severe cases of community acquired pneumonia are due to:
**1. S. pneumo**
**2. Legionalla**
36
what do you see on diagnostic testing with **CAP**
**1. Leukocytosis with a left shift or leukopenia**
**2. Elevated inflammatory markers:** ESR/CRP/procalcitonin
**3. Infilatrate on CXR** if often required to dx; if immunocomponrised and cant produce a immune repsonse =\> CT.
37
DDX for **noninfectious** illnesses that can mimic CAP or co-occur and cause a **[pulmonary infiltrate and cough]**
* **1. CHF with pulmonary edema**
* **2. PE**
* **3. Pulmonary hemorrhage**
* **4. Atelectasis**
38
**Strep. pneumonia**
* classically targets
* classic lab findings
* responds to what abx
* elderly, young and immunocompromised
* high LFTs, hyponatremia, leukocytosis
* **Penicillin, macrolides, fluoroquinolones**
39
what cause of bacterial pneumonia can cause [**empyema** and **EXTENSIVE infiltrate on CXR]**
**s. aureus**
40
pneumonia caused by **MRSA** is MC in what settings
1. healthcare related pneumonoia and recent hospitailiation
2. recent ABX use (esp. fluroquinoogones) within the past 3 months
3. Immunosupression
41
pneumonia due to community-acquired methicillin resistant stap. aerus (CA-MRSA) most commonly occurs in whom?
1. Younger, heathier people with ho skin/ST infection, contact sports, IV/IM drugs, crowded living conditions or MSM
42
what cause of bacterial pneumonia is often **very severe,** causing necrotizing and cavitary pneumonias, empyema, hemoptysis, septic shock and respiratory failure
**CA-MRSA**
43
what cause of pneumonia is MC in **alcoholics** or **aspiration**, causing a **currant jelly hemoptysis**
**klebsiella**
44
What cause of pneurmonia causes [severe disease, mult infiltrates and systemic illness[ in ill patients, elderly, CF, hospitalized, ABX use and severe COPD
pseudomonas
45
**pseudomonas** is NOT a ____ and common for it to be what?
**NOT a CAP**
ABX resistance = **treat with \>1 ABX**
46
what type of pneumonia occurs in [elderly, **sickle cells, splenectomy, i**mmunocompromsied]
haemophailus influnza
47
what type of pneuimonia occurs in **children** due to **hepB vaccine**
**haemophilus influenza**
48
atypical pneumonas
**1. legionella**
**2. Clamydophilia**
**3. Mycoplasma**
49
What atypical pneumonia is the most common atypical agent in the **elderly** and what unique symptoms does it cause?
* **Legionella**
* **GI symptoms** and **hyponatremia**
50
**Legionella**
1. - how does it when occur differ from others?
2. -If suspected, do what?
3. -Associated with what?
4. CXR fingings\*\*
1. all year; others decrease in summer
2. get UA to detect antigen
3. -itis (sinusitis, pancreatitis, myocarditis, pyelonephritis)
4. **patchy infiltrate, hilar adenopathy, pleural effusion**
51
how does **chlamydophilia** differ from **legionella**
**similar CXR;** but **NO GI sx** and **milder** sx.
52
pneumonia that has ***sore throat*** and **HA**, occuring in **cycles** (every 4-8 years)
other key sx?
mycoplasma
bullous myringitis and NO GI sx
53
treatment of **CAP uncomplicated outpatient**
**macrolide** (azithromycin/clarithromycin) or **tetracyclin (doxycycline)**
54
treatment of CAP uncomplicated outpatient in pts with **significant comorbidities/failed 1st-line treatment**
**[macrolide + penicilin/lactamase**] OR [**fluoroquinolone - levofloxacin/moxifloxaxin)**
55
what should aid in disposition (how we handle pneumonia
**clinical decision tool (PSI/PORT score or Curb-65)** + clinical judments
56
what does **CURB-65** measure
* Confusion
* Uremia \> 7
* RR \> 30
* BP (systolic \<90 or diastolic \<60)
* \>65 YO
57
what pts with pneumonia get ambulatory care (outpatient)
healthy with NL vital signs (PSI of 1-2 or CURB of 0 or 1 if \>65)
58
**PSI/PORT** of
* 1-3
* 4-5
**1-3 = outpatient**
**4-5 = inpatient**
59
what pts get **admitted to hostpital** with pneumonia
**1. O2 sat \<92% on RA**
**2. PSI \>3**
**3. CURB-65 of \>2 if over 65**
60
what pts get admitted to **ICU** with pneumonia
1. **Respiratory failure** that needs **mechanical ventillation,** **sepsis**, **AMS**, **hypotension** that requires vasopressor
2. **Persistant high fever**
3. **RR \>30**
4. **WBC \>4000**
61
With ABX, most patients with pneumonia recover in \_\_\_\_\_\_; 50% will still have what sx after 30 days?
3-5 days with ABX
- CP, malaise, dyspnea, cough
62
3 pillars to **prevent CAP**
* **1. Stop smoking**
* **2. Influenza vaccines** for ALL pts
* **3. Pneumococcal vaccin**e for AT-RISK pts
63
**intial** manipulative treatment goal of **pneumonia**
1. decrease parenchymal lung congestion
2. decrease sympathetic hyper-reactivity of lung parenchyma
3. Increase motion of thoracic cage and diaphram
64
effective pneumonia treatment aims to optimize what 4 things?
1. **motion of thoracic cage**
2. **function of the diaphragm**
3. **increase lymphatic drainage (OPEN THORACIC INLET 1st)**
4. **stabilize autonomics**
65
**Pneumonia**
1. Sympathetics
2. Parasympathetics
3. Motor
1. sympathetics = T2-7; increase tone will thicken secretions & dilate bronchiole dilation
2. parasympathetics = OA, AA, C2 ; increase tone will thin secretions and constrict bronchioles
3. Motor = c3-5 = phrenic nerve to diaphram
1. irriation is due to decreased excurion and overuse
66
Chapmain Pts for lung
1. **Bronchi**
1. **Anterior**: 2-3rd ICS at sternocostal junction
2. **Posterior**: T2, between the SP and tip of SP
67
Chapmain Pts for lung
2, Upper lung
3. Lower lung
1. Upper lung =
1. Anteiror = 3/4th ICS at sternocostal junction
2. Posterior
1. Space in between TP of T3/4
2. between the SP and tip of TP
2. Lower lung
1. Anterior = 4/5 ICS at sternocostal junction
2. Posterior
1. space in between TP of T4/5
2. Between SP and tip of TP
68
CXR =
1. lower/middle lobe infiltrates
2. diffuse bilateral symmetric infiltrates
3. Upper lobe
1. CAP
2. CAP; if influenza season = consider influenza pneumonia
3. CAP or TB
