LRTI

Question 1

What are some examples of LRTI

Answer 1

acute bronchitis
acute exacerbation of chronic bronchitis
pneumonia
- CAP
- HAP
Influenza
SARS
Anthrax

Question 2

What is acute bronchitis

Answer 2

inflammatory syndrome of the tracheobronchial tree

Question 3

What is acute bronchitis caused by

Answer 3

Viral pathogens mainly
M. pneum
C. Pneum
Bordatella pertussis

Question 4

What is the clinical presentation of acute bronchitis

Answer 4

cough
sputum
smokers have prolonged cough

Question 5

What is txt for acute bronchitis

Answer 5

no antibiotics
symptomatic support
-rest
- clear fluids
- NSAIDS
- Antitussive
- bronchodilators

DON’T USE cold medications

Question 6

What is AECB

Answer 6

acute infection exacerbation in patients with existing chronic bronchitis

Question 7

What is AECB caused by

Answer 7

Viral 20-50%
C, M, S pneum
H flu
M Cat

Question 8

What are AECB symptoms

Answer 8

DOE
sputum purulence
sputum volume

Question 9

What is txt for mild/moderate AECB

Answer 9

stop smoking
antichol bronchodilator
oral prednisone
usually no abx
- Amoxicillin
- Coxycycline

Question 10

What is txt for severe AECB

Answer 10

stop smoking
antichol bronchodilator
oral prednisone
abx
- amox/clav
- macrolides
- cepharlosporins
- flouriquinilones

Question 11

what is CAP

Answer 11

most common infectious cause of death US

mortality increases if hospitalized

Question 12

What is CAP MOA

Answer 12

inhalation of particles
seeding via bloodstream from extra-pulmonary infection
aspiration

Question 13

What is CAP caused by

Answer 13

atypical
S pneumon
Viral
infections with co-morbidities

Question 14

What are some symp for CAP due to strep. pneum

Answer 14

Rust colored Sputum
Rapid onset fever
High WBC
CXR - lobar consolidation

Question 15

What are some symp for CAP due to Mycoplasma pneumoniae

Answer 15

slow course
non-productive cough
WBC normal or slightly high

Question 16

What are some symp for CAP due to Legionella pneumoniae

Answer 16

Pleuritic chest pain
hemoptysis
increased LFT
Hyponatremia

Question 17

How diagnosis CAP

Answer 17

CXR
sputum stain
sputum culture
BP
RR
signs dehydration
mental status
pulse oximetry
CBC
serum electrolytes
LFT
BUN/Cr
glucose

Question 18

What do you use to determine hospitalization when dealing with CAP

Answer 18

CURB-65

Question 19

What is CURB-65

Answer 19

Confusion
Uremia > 19
RR > 30
BP < 90/60
age > 65

Question 20

What is the txt choice for CAP in Outpatient that was previously healthy with no abx in last 3 months

Answer 20

Macrolide

Question 21

What is the txt choice for CAP in Outpatient with presence of co-morbidity or high resistance

Answer 21

Respiratory fluoroquinolone
OR
Macrolide + amino-penicillin option

Question 22

What is the txt choice for CAP in Inpatient in non-ICU

Answer 22

IV route
Respiratory fluoroquinolone
OR
Macrolide + cephalosporin

Question 23

What is the txt choice for CAP in Inpatient in ICU

Answer 23

IV route
Cephalosporin + azithromycin
OR
Respiratory fluoroquinolone

Question 24

when to switch from IV to oral therapy with CAP

Answer 24

Hemodynamically stable
improving clinically
able to ingest medications
normally functioning gastrointestinal tract

Question 25

What are the current guidelines for CAP duration of therapy

Answer 25

Minimum of 5 days afebrile 48-72 hrs 1 or less CAP-associated signs of clinical instability

Question 26

What is the 2nd most common nosocomial infection in US

Answer 26

HAP

Question 27

What are mortality rates for HAP

Answer 27

30-50%

Question 28

What is on the pathogen list for CAP

Answer 28

``` Pseudomonas aeruginosa E. Coli Klebsiella pneumoniae Acinetobacter species Staphylococcus aureus (MRSA) ```

Question 29

What are Clinical Stability Criteria

Answer 29

``` Temp LE 100 HR LE 100 RR LE 24 Systolic GE 90 PaO2 GE 90 PO2 GE 60 Oral Intake Mental Status ```