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Clin Med B 2 > Lower Respiratory infections part 1 > Flashcards

Lower Respiratory infections part 1 Flashcards

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1
Q

what are HPI and ROS findings that should be assessed for in Lower respiratory tract infections
(general, EENT, cardio, abdominal, respiratory, skin)

A

differentiated ones are:
wt loss/gain
chest pain/pressure
productive v non
NVD
hemoptysis
dyspepsia
rash

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2
Q

what should be assessed on the PE of lower respiratory tract infections

A
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3
Q

what are the causes of acute bronchitis

A
  • bacterial or viral respiratory tract infection
  • heavy smoking
  • allergy
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4
Q

what is considered chronic bronchitis

A

cough for over three months over a two year period

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5
Q

how long does ACUTE bronchitis typically last

A

at least 5 days and up to 3 weeks

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6
Q

what is the most common cause of bronchitis in unhealthy immunocompromised people

A

bacteria

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7
Q

what is the MCC of bronchitis in healthy adults

A

viruses

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8
Q

what is the pathophysiology of bronchitis

A
  1. infection in conducting airway
  2. inflammation of airway
  3. exudate production
  4. bronchospasm
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9
Q

what are the two sequential phases of bronchitis

A
  1. direct inoculation of tracheobronchial epithelium (responsible for first 1-5 days)
  2. hypersensitivity of airway receptors. (responsible for 1-3 weeks) causing sloughed epithelium and increased mucous production
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10
Q

what is the difference in appearance of normal bronchi vs bronchitis

A
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11
Q

what are viral causes of acute bronchitis

A

influenza A/B
Adenovirus
Parainfluenza
RSV
Rhinovirus/Picornavirus
Coronavirus
HMNV

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12
Q

What is the MC virus that causes bronchitis

A

influenza A and B
(said in class)

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13
Q

what are bacterial causes of acute bronchitis

A

s. pneumo
H. flu
M. Cat

remember this is MC in immunocompromiised people

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14
Q

what are atypical causes of acute bronchitis

A

B pertussis (1-12%)
C pneumonia (0-6%)
M pneumonia (0-6%)
B bronchiseptica

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15
Q

who are atypical bronchitis MC in

A

mostly in non-vaccinated or immunocomped people

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16
Q

what should be included in the HPI of acute bronchitis

A
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17
Q

what are symptoms of acute bronchitis

A

cough
substernal pain
wheezing
fever
fatigue
malaise
chest tightness
SOB
dyspnea/PND/cyanosis

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18
Q

What is included on the PE for acute bronchitis

A
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19
Q

what are the general PE findings in acute bronchitis

A
  • cough w/wo bronchospasm
  • wheezing (worse in smokers and asthma)
  • rhonchi (clears with cough)
  • fever (rare, low grade)
  • chest wall tenderness
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20
Q

what illness is associated with diffuse wheezing with increased respiratory effort

A

pneumonia or asthma exacerbation

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21
Q

what illness is associated with stridor

A

Croup
foreign body.

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22
Q

what illness is associated with sustained heave across the left sternal border

A

right ventricular hypertrophy due to chronic bronchitis

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23
Q

what illness is associated with clubbing or cyanosis

A

CF
COPD
chronci bronchitis

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24
Q

what illness is associated with bullous myringitis

A

mycoplasma pneumonia

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25
what illness is associated with conjunctivitis adenopathy and rhinorrhea
adenovirus
26
what findings are more suggestive of upper respiratory infection rather than lower respiratory infection
nasal congestion rhinorrhea erythematous throat injected sclera lymphadenopathy
27
what are emergent diagnoses (this card is not done)
28
How do you diagnose acute bronchitis
mostly clinically, can use a chest xray
29
what are possible lab studies that could be done to diagnose acute bronchitis
* NP swab/viral panel * CBC with diff (WBC normal to low) * procalcitonin (to distinguish bacterial v non) * blood culture (if bacterial suspected) * sputum cytology * bronchoscopy
30
what is the treatment for acute bronchitis
reassurance and education with symptomatic treatment
31
what are the antitussive medications.
dextromethorphan codeine benzonatate
32
What are the Central acting antitussives
dextromethorphan
33
what is the peripheral acting antitussive
benzonatate
34
what is the expectorant medication
guaifenesin
35
when would you NOT want to give cough suppressants
when the cough is productive. this could lead to pneumonia. we want them to cough it up. (said in class)
36
what does colored sputum in acute bronchitis indicate
NOTHING hehe
37
what is the focus when you have a patient with acute bronchitis
RULE OUT PNEUMONIA
38
which is acute bronchitis
the left shows left lower lobular pneumonia. the right is acute bronchitis, which usually presents with a clear CXR
39
Is acute bronchitis contagious?
no???
40
what are the types of influenza
ABC
41
what type of virus is influenza
encapsulated, single-stranded RNA viruses
42
what is the part of the influenza virus that makes it virulent
the surface proteins hemagglutinin and neuraminidase
43
what is the function of hemagglutinin
binds to respiratory epithelial cells, allowing cellular infections
44
what is the function of neuraminidase
cleaves the bond that holds newly replicated virions to the cell surface, permitting the infection to spread
45
which subtype is identified by the variants of hemagglutinin and neuraminidase
influenza A
46
which influenza is the most pathogenic
influenza A
47
how does influenza spread
human to human via aerosols
48
describe the incubation and transmission timeline of influenza
* transmission may occur as early as 1 day prior to symptoms. * incubation period ranges 1-4 days * viral shedding lasts 5-10 days * most virulent in first 3 days of symptoms
49
when is flu season?
* northern hemisphere - early fall through late spring * tropical areas - year round
50
what are general symptoms of influenza
general - fever, HA, fatigue EENT - sore throat, rhinorrhea, nasal congestion Lungs - coughing, dyspnea GI - NVD MSK - myalgia, joint pain, body aches
51
what should be done on a PE when influenza is suspected
52
how do you diagnose influenza
rapid influenza swab or NP swab criterion standard: * reverse transcription PCR * viral culture NP * viral culture throat
53
what other diagnostic studies may be ordered for influenza
CXR - r/o pneumonia CBC - shows leukopenia and lymphocytopenia
54
How do you treat influenza
* supportive care * NSAIDS/acetominophin for fever and myalgias * antiviral drugs, neuraminidase inhibitors or polymerase acidic endonuclease inhibitors (must be started w/i 48 hrs of sympotms)
55
when would you hospitalize a patient with the flu
if hypoxic or if considered a high risk group such as infants, elderly and immunocompromised
56
what are the antivirals used for the flu
* Oseltamivir (Tamiflu) * Zanamivir (Relenza) * Rapivab (Peramivir) (IV only) (FDA approved in 2014) * Baloxavir marboxil (Xofluza) indicated for high-risk
57
what are the neuraminidase inhibitors
oseltamivir zanamivir
58
how effective is the influenza vaccination
50-70% effective against influenza A and B. 10-14 days after vaccination
59
which flu vaccine is live
the FluMist which is inhaled. do NOT give to pregnant or immunocompromised.
60
what is the bacterial agent that causes whooping cough
bordetella pertussis
61
what type of bacteria is bordetella pertussis
gram negative, aerobic, encapsulated, pleomorphic coccobacilli
62
how is bordetella pertussis spread
aerosolized droplets, attaches to respiratory epithelium and then travels to bronchi and bronchioles
63
what are the differences between toxins A and B that are formed by pertussis
* B attaches to the cell surface * A enters the cell and inactivates the regulation of cAMP leading to increased mucus and decreased phagocytic action.
64
what are the stages of pertussis
the whole disease lasts 6 weeks stage 1 - catarrhal stage stage 2 - paroxysmal stage stage 3 - convalescence stage
65
what occurs during the catarrhal stage of pertussis
* lasts 1-2 weeks * nasal Congestion * Rhinorrhea * Sneezing * Low grade fever * Tearing * Conjunctival Erythema
66
what occurs during the paroxysmal stage
* lasts 1 - 10 weeks * Paroxysms of intense coughing with “whoop” * Posttussive vomiting and turning red with coughing
67
what occurs during the convalescent stage
* 2 - 3 weeks * Chronic cough lasting for weeks
68
what is the typical PE for pertussis
69
How does the PE differ for pertussis in infants <3 mo
70
what is the diagnostic techniques for pertussis
* clinical - suspicion high in children with cough for more than 2 weeks. * CXR likely normal (not needed) * CBC - leukocytosis and lymphocytosis * PCR in NP secretions * GOLD STANDARD - bacterial culture of NP secretions to confirm BP infection
71
what is the window of diagnosis for bordetella pertussis
72
what are management goals of treating bordetella pertussis
* limit paroxysms * decrease contagiousness * decrease severity of cough * decrease associated s/s * maximize rest, nutrition, recovery
73
what is the medication used to treat pertussis
macrolides reduce severity of sympotms if started early.
74
who should be treated empirically for bordetella pertussis and how
all close contacts of infected individuals should be treated empirically! with macrolides
75
what is the dosage for pertussis treatment
76
what is the vaccination used for pertussis

Clin Med B 2 (44 decks)

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