Flashcards in Pulmonary Infectious Diseases Deck (59):
What are common respiratory complaints?
A. Sputum production
4. Difficulty breathing
5. Chest Pain
What are common questions to ask in the HPI in a pulmonary pt?
1. Onset of sx’s
2. Sputum production
4. Shortness of breath
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
What should be observed on a physical exam of a pulmonary pt?
1. Acute distress
2. Cyanosis: central vs. peripheral
What should be palpated on a physical exam of a pulmonary pt?
1. Chest wall tenderness
2. Tactile fremitus
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
What may be the auscultation results for a pulmonary pt?
Clear, rhonchi, wheezing, rales
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)
What is the primary etiology of acute bronchitis?
1. Primarily viral
A. Rhinovirus (common cold sxs, most common in fall and winter months)
-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
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
What other etiologies or concomitant diseases can cause acute bronchitis?
allergic or irritant
Often occurs after or with a URI
What are the primary etiologies of acute bronchitis in COPD pts?
1. Hemophilus influenzae
2. Strep pneumonia
3. Moraxella catarrhalis
What are the symptoms of acute bronchitis?
A. Non-prod or productive
4. +/- fever
8. Irritant exposure
9. GI sx’s w/adenovirus
What are the signs of acute bronchitis?
3. No abn auscultatory findings
What are the dx studies for acute bronchitis?
1. Usually none unless attempting to rule out pneumonia
What acute bronchitis etiology can lead to otitis media and croup in children under 2 years old?
What are the supportive care treatments for healthy adults with acute bronchitis?
2. Acetaminophen/Ibuprofen prn fevers, myalgias
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)
A. Ipratropium (Atrovent) for wheezing
3. Antitussives or Expectorants
A. Guaifenesin (Mucinex), dextromethorphan (Robitussin DM), codeine
What are the abx treatments for COPD/asthma pts with acute bronchitis?
A. Azithromycin (Z-pak), clarithromycin (Biaxin), erythromycin
B. Effective against mycoplasma, chlamydia, pertussis
A. Effective against chlamydia
3. Trimethoprim Sulfa (Bactrim)
A. Effective against gram negatives, including Hemophilus
What infectious agent does doxycycline treat?
What infectious agents do macrolides treat?
mycoplasma, chlamydia, pertussis
What infectious agents does trimethoprim sulfa (bactrim) treat?
gram negatives, including Hemophilus
What should acute bronchitis pts be educated about?
1. Droplet precautions
4. Return if increasing sx’s
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
How are the influenza viruses identified?
Identified by surface proteins on virus
(H and N)
Hemagglutinin & Neuraminidase
Which influenza A subtype is correlated with the seasonal flu?
Which influenza A subtype is correlated with the swine flu?
Which influenza A subtype is correlated with the avian flu?
How is influenza spread?
1. Susceptible individual exposed to infected droplets
A. Mostly airborne
B. Some person to person
C. Some fomite to person
What months comprise the flu season?
Who is at a higher risk for the flu?
1. School children & family
2. Housebound /institutionalized
How long is the incubation period of the flu virus?
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
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
8. N/V/D esp. in children
9. +/- acute encephalopathy
10. Fever: ~5 days
16. dry cough
17. Lungs may be clear or have rhonchi
What may be the cough progression in influenza?
1. Minimal to start
2. Gets worse, nonproductive
3. Pleuritic chest pain
What are the signs of acute encephalopathy in influenza?
altered mental status, ataxia, seizures, coma
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
When is a CXR indicated in influenza?
Elderly and patients at high risk of complications
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
When are ABGs indicated in influenza pts?
When is LP indicated in influenza pts?
if meningitis/encephalitis suspected
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
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
How soon after the flu vaccine is administered does it become effective?
What flu strains does Trivalent Inactivated Influenza Vaccine (TIV) contain?
2 influenza A (H3N2, H1N1) & 1 Influenza B
What flu strains does Quadrivalent Inactivated Influenza Vaccine (QIV)
2 influenza A (H3N2, H1N1) & 2 Influenza B
What is the trade name for Live Attenuated Influenza Vaccine (LAIV)?
How old must a pt be to receive the Standard Seasonal Flu Vaccine (T) and Quadrivalent Influenza Vaccine (Q?
> 6 months
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
Who can receive Intradermal Influenza Vaccination?
Who can receive Fluzone High-Dose Seasonal Influenza Vaccine (T/Q)?
> 65 yr
Who can receive Live Attenuated Influenza Vaccine [LAIV] (T/Q) Nasal Spray?
Healthy 2-49 yr (Q preferred 2-8 yr)
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
Why are neuraminidase inhibitors used to treat influenza?
Influenza viruses contain the enzyme neuraminidase which is essential to the life cycle of the virus
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
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
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
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
When are CXR indicated in influenza pts?
1. if sx’s worsen
A. Influenza pneumonia
B. Secondary bacterial pneumonia