Pulmonary Infectious Diseases Flashcards Preview

Gen Med Unit 6 > Pulmonary Infectious Diseases > Flashcards

Flashcards in Pulmonary Infectious Diseases Deck (59):
1

What are common respiratory complaints?

1. Cough
A. Sputum production
2. Dyspnea
3. Wheezing
4. Difficulty breathing
5. Chest Pain

2

What are common questions to ask in the HPI in a pulmonary pt?

1. Onset of sx’s
2. Sputum production
3. Hemoptysis
4. Shortness of breath
5. Wheezing
6. Chest pain
A. Radiation of pain
7. Constitutional sx’s:
A. Elderly may not have fever, look for confusion
8. Social Hx
9. Exposure to illness
10. Prior episodes

3

What should be observed on a physical exam of a pulmonary pt?

1. Acute distress
2. Cyanosis: central vs. peripheral

4

What should be palpated on a physical exam of a pulmonary pt?

1. Chest wall tenderness
2. Tactile fremitus

5

What should be percussed on a physical exam of a pulmonary pt? What are the results?

1. Lung fields
Resonant, hyper-resonant, dull
2. Diaphragmatic excursion

6

What may be the auscultation results for a pulmonary pt?

Clear, rhonchi, wheezing, rales

7

What are the dx studies for a pulmonary pt?

1. Medical Imaging
A. CXR (PA and lateral, first study done), CT (as needed)
2. CBC w/ diff: viral vs. bacterial etiology
3. Sputum culture: hard to collect, give a nebulizer treatment first to open up bronchi
4. Blood culture
5. Arterial blood gas (ABG’s)
6. Pulmonary function tests (PFT’s)

8

What is the primary etiology of acute bronchitis?

1. Primarily viral
A. Rhinovirus (common cold sxs, most common in fall and winter months)
B. adenovirus:
-conjunctivitis, GI symptoms like diarrhea
C. influenza: chills, fever, muscle/joint aches. May have N/V in children
D. parainfluenza: 4 types, URI and LRI infections, high risk for croup in children. Looks like a mild cold

9

What are the bacterial etiologies -

A. Mycoplasma pneumonia: "walking pneumonia", young adults
B. Bordetella pertussis: not very common due to vaccines
C. Chlamydia pneumoniae
D. Streptococcus pneumoniae
E. Hemophilus influenzae: not very common due to vaccines

10

What other etiologies or concomitant diseases can cause acute bronchitis?

allergic or irritant
Often occurs after or with a URI

11

What are the primary etiologies of acute bronchitis in COPD pts?

1. Hemophilus influenzae
2. Strep pneumonia
3. Moraxella catarrhalis

12

What are the symptoms of acute bronchitis?

1. Cough
A. Non-prod or productive
2. Dyspnea
3. ST
4. +/- fever
5. Myalgias
6. CP
7. Malaise
8. Irritant exposure
9. GI sx’s w/adenovirus

13

What are the signs of acute bronchitis?

1. Rhonchi
2. Wheezing
3. No abn auscultatory findings
4. Myringitis
5. Conjunctivitis
6. Adenopathy

14

What are the dx studies for acute bronchitis?

1. Usually none unless attempting to rule out pneumonia
A. CXR

15

What acute bronchitis etiology can lead to otitis media and croup in children under 2 years old?

Adenovirus

16

What are the supportive care treatments for healthy adults with acute bronchitis?

1. Hydration
2. Acetaminophen/Ibuprofen prn fevers, myalgias
3. Prednisone

17

What are the treatments for wheezing in healthy adults with acute bronchitis?

1. Beta 2 agonist
A. Albuterol (Proventil/Ventolin/ProAir) for wheezing
B. Levalbuterol tartrate (Xopenex)
2. Anticholinergic
A. Ipratropium (Atrovent) for wheezing
3. Antitussives or Expectorants
A. Guaifenesin (Mucinex), dextromethorphan (Robitussin DM), codeine

18

What are the abx treatments for COPD/asthma pts with acute bronchitis?

1. Macrolides
A. Azithromycin (Z-pak), clarithromycin (Biaxin), erythromycin
B. Effective against mycoplasma, chlamydia, pertussis
2. Doxycycline
A. Effective against chlamydia
3. Trimethoprim Sulfa (Bactrim)
A. Effective against gram negatives, including Hemophilus

19

What infectious agent does doxycycline treat?

Chlamydia

20

What infectious agents do macrolides treat?

mycoplasma, chlamydia, pertussis

21

What infectious agents does trimethoprim sulfa (bactrim) treat?

gram negatives, including Hemophilus

22

What should acute bronchitis pts be educated about?

1. Droplet precautions
2. Hydration
3. Hand-washing
4. Return if increasing sx’s

23

What are the etiologies of influenza?

1. Influenza A
A. Generally more pathogenic
2. Influenza B
A. Generally less pathogenic
3. Influenza C
A. Mild illness in humans

24

How are the influenza viruses identified?

Identified by surface proteins on virus
(H and N)
Hemagglutinin & Neuraminidase

25

Which influenza A subtype is correlated with the seasonal flu?

H3N2

26

Which influenza A subtype is correlated with the swine flu?

H1N1

27

Which influenza A subtype is correlated with the avian flu?

H5N1

28

How is influenza spread?

1. Susceptible individual exposed to infected droplets
A. Mostly airborne
B. Some person to person
C. Some fomite to person

29

What months comprise the flu season?

Nov-March

30

Who is at a higher risk for the flu?

1. School children & family
2. Housebound /institutionalized

31

How long is the incubation period of the flu virus?

1-4 days

32

How long is the influenza 'viral shedding' or contagious period?

Viral shedding 0-24h prior to illness and continues for 5-10d, may be longer in children

33

What are the sxs of influenza?

1. Abrupt onset: sxs for 2-3 days
2. Fever 100-104, chills
3. Sore throat ~severe, lasting 3-5d
4. Myalgias mild/severe
5. Headache-frontal/retro-orbital ~ severe
A. May have photophobia, burning pain w/ocular movements
6. Weakness/fatigue-may require bed rest. May last days to weeks
7. Cough
8. N/V/D esp. in children
9. +/- acute encephalopathy
10. Fever: ~5 days
11. tachycardia
12. hypoxia
13. Pharyngitis
14. conjunctivitis
15. dehydration
16. dry cough
17. Lungs may be clear or have rhonchi

34

What may be the cough progression in influenza?

1. Minimal to start
2. Gets worse, nonproductive
3. Pleuritic chest pain
4. Dyspnea

35

What are the signs of acute encephalopathy in influenza?

altered mental status, ataxia, seizures, coma

36

What are the dx studies in influenza?

1. Usually clinical
A. if CBC done, leukopenia, lymphopenia
B. Viral culture: Sensitive but 3-5d processing time
C. In office testing:
-Nasopharyngeal swab or wash
- 70-80% sensitive

37

When is a CXR indicated in influenza?

Elderly and patients at high risk of complications

38

What is the purpose of a CXR in influenza? What are the results?

1. To exclude pneumonia
A. Early: normal or minimal bilateral symmetrical interstitial infiltrates
B. Later: symmetrical patchy infiltrates, +/- superimposed bacterial infection

39

When are ABGs indicated in influenza pts?

Hypoxic pts

40

When is LP indicated in influenza pts?

if meningitis/encephalitis suspected

41

What complications result from influenza?

1. Risk for secondary bacterial pneumonia
A. Staph Aureus (MSSA/MRSA)
-Severe and difficult to treat
-Can be severely acute with death occurring w/in 24h
Strep B. Pneumoniae/H. influenza (HIB)
-2-3wks after initial sx’s
-Manage as community acquired pneumonia

42

What are the high risk groups for influenza?

1. Children < 4yo
2. Adults > 65yo
3. Chronic medical problems
4.Pregnancy 2nd-3rd trimester
5. Limited respiratory function due to cognitive or neuromuscular disorders

43

How soon after the flu vaccine is administered does it become effective?

2 weeks

44

What flu strains does Trivalent Inactivated Influenza Vaccine (TIV) contain?

2 influenza A (H3N2, H1N1) & 1 Influenza B

45

What flu strains does Quadrivalent Inactivated Influenza Vaccine (QIV)
contain?

2 influenza A (H3N2, H1N1) & 2 Influenza B

46

What is the trade name for Live Attenuated Influenza Vaccine (LAIV)?

Flumist

47

How old must a pt be to receive the Standard Seasonal Flu Vaccine (T) and Quadrivalent Influenza Vaccine (Q?

> 6 months

48

Who is Flublok Seasonal Influenza Vaccine recommended for? What is unique about this vaccine?

It contains recombivant Q/T

For ppl over 18 with egg allergies

49

Who can receive Intradermal Influenza Vaccination?

18-64 yr

50

Who can receive Fluzone High-Dose Seasonal Influenza Vaccine (T/Q)?

> 65 yr

51

Who can receive Live Attenuated Influenza Vaccine [LAIV] (T/Q) Nasal Spray?

Healthy 2-49 yr (Q preferred 2-8 yr)

52

What are the contraindications for influenza vaccines?

1. Severe egg allergy
2. h/o severe reaction to prior flu vaccine
3. < 6mo old
4. Hx of Guillain Barre Syndrome (GBS) w/in 6 weeks post flu vaccine
5. pts who are already sick when coming in for vaccine

53

Why are neuraminidase inhibitors used to treat influenza?

Influenza viruses contain the enzyme neuraminidase which is essential to the life cycle of the virus

54

What are 2 ex of Neuraminidase inhibitors? What is their dosing?

1. Zanamivir (Relenza) inhaled bid x 5 d
2. Oseltamivir (Tamiflu) po bid x 5 d
- some H1N1 resistance

55

What are the indications for hospitalization of influenza pts?

1. Influenza w/exacerbation of chronic illness
2. Influenza pneumonia
3. Severely ill/unable to care for self

56

Who should be immunized against the flu virus?

1. 6 mo old -18 yo (<8yo 2 doses if first flu vaccine)
healthy 2 – 8 yr (LAIV)
2. All ≥ 50 yo
3. 19-49 yo chronic illness/long term care facility
4. Pregnant or will be during flu season
5. People who request it
6. Healthcare workers
7. Family/close contact with high risk individual

57

What do flu pts need to be educated about?

1. Importance of vaccination
2. Droplet precautions
3. Indications for post exposure prophylaxis
QD med x 10 d
4. Return if no improvement

58

When are CXR indicated in influenza pts?

1. if sx’s worsen
A. Influenza pneumonia
B. Secondary bacterial pneumonia

59

What flu vaccine can pregnant women not receive?

Live attenuated vaccine