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Clinical Medicine II > Pulm: Bronchitis & Pneumonia > Flashcards

Pulm: Bronchitis & Pneumonia Flashcards

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1
Q

What is the defining feature of chronic bronchitis?

A

Cough for at least 3 months in 2 consecutive years

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2
Q

Acute bronchitis is defined by the presence of…

A

cough > 5 days

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3
Q

What is the MC etiology of acute bronchitis?

A

Viral

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4
Q

What bacterial vector can cause bronchitis?

A

Bordatella pertussis

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5
Q

The presence of purulent sputum (is/isn’t) predictive of bacterial infx…

A

Is not

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6
Q

A patient presents with:

Wheezing
Bronchospasm (reduced FEV1)
Rhonchi cleared with coughing

What should you suspect?

A

Acute bronchitis

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7
Q

Is the presence of crackles/rales typical in acute bronchitis?

A

no

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8
Q

A patient presents with:

cough > 5 days
Wheezing
Bronchospasm
Rhonchi

How is a dx often made?

A

clinical for bronchitis

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9
Q

What diagnostic modality can be considered in acute bronchitis with the following abnormal findings?

Fever
tachypnea
Tachycardia
evidence of consolidation

cough lasting > 3 weeks

A

CXR

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10
Q

What condition are you assessing for when you get a CXR on a patient with acute bronchitis?

A

pneumonia

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11
Q

How should acute bronchitis be treated?

A

symptomatic relief

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12
Q

What is the only indication for abx in acute bronchitis?

A

pertussis

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13
Q

What phase of pertussis?

URI Sxs
Fever

1-2 week duration

A

Catarrhal

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14
Q

What phase of pertussis?

Persistent, paroxysmal cough
Inspiratory “whooping”
post-tussive emesis

2-6 week duration

A

paroxysmal

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15
Q

What phase of pertussis?

cough resolving

lasts weeks to months

A

convalescent

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16
Q

A patient presents with:

Persistent, paroxysmal cough that leads to vomiting.

What do you suspect and what diagnostic is gold standard for diagnosis?

A

Pertussis, bacterial culture of NP secretions

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17
Q

When should culture of NP secretions be used for pertussis dx?

A

weeks 0-2

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18
Q

When should PCR be used to dx pertussis?

A

weeks 0-4

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19
Q

When can serology be considered to dx pertussis?

A

weeks 2-8

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20
Q

What treatment of pertussis decreases transmission rate, but has little effect on symptom resolution?

A

abx

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21
Q

What are 1st and 2nd line abx to treat pertussis?

A

1st line: Macrolides

2nd: TMP-SMZ

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22
Q

Prevention is key to controlling pertussis. What vaccine is now given as a booster to adolescents?

A

Tdap

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23
Q

Who should receive abx prophylaxis for pertussis?

A

close contacts

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24
Q

Is pertussis reportable?

A

yes

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25
Who is at risk for influenza progressing to pneumonia?
high-risk populations ``` extremes of ages immunocompromised pregnant obese crowded living ```
26
A patient presents with abrupt onset of: Fever HA Myalgia Malaise Few findings on PE What should you consider?
influenza
27
Which influenza diagnostic has the following features? Low-moderate sensitivity High specificity 10-30 minutes for results
RIDTs
28
The sensitivity of RIDTs is similar to clinical diagnosis. This means what for peak flu season?
negative RIDTs do not reliably exclude influenza, make clinical dx
29
Which influenza diagnostic has the following features? most sensitive and specific results in 2-6 hours
RT-PCR
30
Which influenza diagnostic hast he following features? Confirmatory use by public health not used for initial clinical mgmt
Viral culture
31
Treatment of flu is often symptomatic, but antivirals can be used. What drugs can help, and when must they be administered?
oseltamivir/zanamivir w/in 48 hours of onset
32
What is the most common complication of influenza?
pneumonia
33
What is the most common route of transmission for CAP?
aspiration from oropharynx
34
What is the most common bacterial cause of typical and atypical CAP?
typical: Strep. pneumo atypical: mycoplasma
35
What etiology of CAP is unusual in immunocompetent hosts?
fungal
36
A patient presents with acute onset of the following sxs... is this CAP or Flu? Fever Cough Sputum production
CAP
37
What are the pertinent negatives that distinguish CAP from flu?
myalgia, malaise, HA
38
What are 4 signs of consolidation that would be indicative of pneumonia on chest exam?
dullness to percussion increased tactile fremitus bronchophony egophony
39
What two diagnostic modalities can help dx CAP?
CBC showing left-shift leukocytosis CXR showing infiltrate, consolidation, cavitation
40
This PNA test has the following features: - uses expectorated sputum prior to initiation of tx - cannot be definitive proof of causative agent - Generally not recommended outpatient
sputum culture
41
The following are complications of what disorder? ``` bacteremia sepsis abscess empyema respiratory failure ```
pneumonia
42
The CURB-65 score refers to what 5 atypical features?
``` Confusion Urea (> 7) RR 30+ BP (hypotension) 65 yo + ```
43
What CURB-65 score warrants admission to hospital?
2
44
What CURB-65 scores warrant ICU admission?
3-5
45
CRB-65 recommends admission to hospital with a score of ______ and eliminates the need to asses what?
1 don't assess BUN
46
The PSI and CURB-65 scores should be applied as a(n) _______ rather than a ________ for decision making
adjunct to replacement
47
What is the best predictor of a good outcome for CAP?
right site of care (inpatient/outpatient)
48
How long should the course of abx be for CAP?
at least 5 days
49
What is the mean time to return to work after initiating Abx with CAP?
6 days
50
When is follow-up CXR needed in CAP?
7-12 weeks post-treatment if 40+ or smokers
51
What two courses of abx can be used to treat outpatient, uncomplicated CAP?
Azithromycin 500mg PO day 1, then 250mg PO QD days 2-5 Doxycycline 100mg PO BID x 7-10 days
52
Complicated pneumonia is characterized by: ``` Recent abx COPD Liver/renal dz heart disease alcoholism asplenia immunosuppression ``` What treatment can be used outpatient for complicated CAP?
Augmentin 500 mg PO BID + macrolide (beta-lactam + macrolide) or levofloxacin 750mg PO QD x 5 days
53
CAP inpatient treatment requires a minimum 5 day course of abx and resolution of what?
``` afebrile 48-72 hours no supp. O2 HR < 100 RR < 24 SBP 90+ ```
54
What is a major lifestyle factor that can help prevent and treat CAP?
smoking cessation
55
In the ICU what abx are used to treat PNA?
beta lactam + azithro OR fluoroquinolone
56
What can be used in the ICU for PNA with PCN allergy?
fluoroquinolone + Aztreonam
57
The following populations should be considered for what intervention? 65+ ``` 19-64 with increased risk due to: cardiopulm disease sickle cell tobb splenectomy liver disease ```
Pneumococcal vaccine
58
How do you treat HAP/VAP?
broad spectrum abx
59
A patient presents with: New onset/progressive infiltrate on CXR Fever Purulent sputum Leukocytosis
HAP/VAP
60
HAP/VAP Dx depends on presence of infiltrates and how many other criteria? (fever, purulent sputum, leukocytosis)
2
61
What diagnostic test is indicated to test for HAP/VAP?
Sputum gram stain and cx
62
What is the best way to treat HAP/VAP?
prevention
63
The following are ways to prevent what? ``` avoid antacids decontamination of OP selective gut decontamination probiotics positioning subglottic drainage ```
VAP
64
A patient presents with non-resolving pneumonia. You must consider what other dx?
``` atypical (viral, fungal) infx aspiration PNA CHF cancer fibrosis ```
65
What diagnostics are indicated in evaluating non-resolving PNA?
Chest CT bronchoscopy throacoscopy open lung biopsy
66
A patient with concurrent AIDS presents with: Fever Nonproductive cough dyspnea extra-pulmonary lesions What is this presentation concerning for?
PJP/PCP
67
A patient presents with the following lab findings: high LDH Low CD4 CXR showing reticular, ground glass opacity Sputum
PJP/PCP
68
What is the treatment of choice for pneumocystitis jirovecii?
Bactrim
69
Who should receive bactrim as prophylaxis for PJP?
HIV + and hx of PJP CD4 < 200 OP thrush
70
The following are risk factors for what? Post-op state neuro compromise anatomic defect
aspiration pneumonia
71
A CXR with aspiration pneumonia most commonly shows infiltrate in what location?
RLL
72
Aspiration pneumonia can be treated with what four abx regimens?
1. piperacillin/tazobactam 2. ampicillin/sulbactam 3. clindamycin 4. moxifloxacin

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