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Flashcards in Respiratory infections Deck (40):
1

acute bronchitis common presentation

cough lasting more than 5 days (1-3 weeks), associated with sputum production, rarely fever, chest pain, wheezing, rhonchi that clears with coughing

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Acute bronchitis causative agents

influenza A/B, parainfluenza, coronavirus, rhinovirus, RSV, human metapneumovirus, mycoplasma pneumoniae, chlamydophilia, pertussis

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Acute bronchitis diagnosis

Clinical! CXR for elderly, bad vitals, fever, signs of consolidation, sputum culture, procalcitonin

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Procalcitonin above what indicates antibiotics should be used

above .5 mcg/L

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Differential diagnosis of acute bronchitis

chronic bronchitis, pneumonia, post-nasal drip, GERD, asthma

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acute bronchitis treatment

mainly symptomatic, NSAIDs, aspirin, acetaminophen, aspirin, cough suppressants are controversial, antibiotics have no benefit

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Most common cause of bronchiolitis in infants under 1 year

RSV

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Symptoms of bronchiolitis

rhinorrhea, pharyngitis, cough, wheezing, rhonchi, CXR normal, fever and WBS inconsistant

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Diagnosis of bronchiolitis

antigen defection assay

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Treatment of bronchiolitis

supportive, O2, acetaminophen, fluids, inhaled albuterol or epi only if effective, no steroids, antibiotics or ribavirin

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Pertussis

highly contagious, acute respratory illness

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Pertussis symptoms

URI, whooping cough, coughing to point of vomiting, dyspnea, seizures 20-25%, maybe apnea

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Treatment of pertussis

supportive, hydration, pulmonary toilet, oxygen, erythromycin, clarithromycin, azithromycin, TMP-SMX for 14 days

14

Croup

viral illness causing edema of upper airways, narrowed airways

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Croup etiology

parainfluenza viruses, adenovirus, RSV, mycoplasma pneumoniae

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Croup symptoms

URI, barky cough, hoarseness, tachypnea, mild stridor worse at night

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Croup diagnosis

X ray shows subglottic narrowing "steeple sign"

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Croup treatment

cool, moist air used, Dexamethasone .6 mg/kg IM reduces hospital stays, neb epi for immediate relief, beta agonist bronchodilators not effective

19

Epiglittitis

rare since influenza vaccine, visualize cherry red epiglottis

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Epiglottitis diagnosis

X ray thumb print sign

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Epiglottitis treatment

ceftriaxone, cefotaxime, cefuroxime

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Tuberculosis caused by

M. Tuberculosis, M. bovis, M. caprae, M. africanum, a few others

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TB risk factors of infection

Comorbidities, HIV infection, silicosis, renal failure, diabetes, IV drug use, gastrectomy, jejunoileal bypass, smoking, malnutrition, underweight

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TB clinical manifestations

primary pulmonary, reactivation, endobronchial, lower lung field, tuberculoma

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Primary pulmonary TB clinical manifestations

Fever, pleuritic or retrosternal chest pain, pleural effusion, enlarged bronchial lymph nodes, fatigue, cough, arthralgias, pharyngitis

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Primary Pulmonary TB CXR

usually normal, Hilar adenopathy, pleural effusion, pulmonary infiltrates

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Reactivation TB clinical manifestations

usually 2-3 years after initial infection, insiduous onset, cough, wt loss, fatigue, fever w/ night sweats, chest pain and dypnea, hemoptysis

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Reactivation TB CXR

apical posterior segments of upper lobes are affected most commonly, superior segments of lower lobes, anterior segments of upper lobes

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TB diagnosis

clinical, TST or interferon gamma release essay (IGRE), radiography, isolation of M. tuberculosis from secretions or tissues

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Isolation of M tuberculosis, diagnosis

sputum, bronchoscopy, body fluids, tissue biopsy, serology

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TB microbiology

staining for detection of acid fast bacilli, molecular test, nucleic acid amplification, Xpert MTB/RIF essay

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TB diagnosis gold standard

culture, highly sensitive and specific, isolates a specific mycobacterial species, determines presence of drug resistance

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PPD

purified protein deriviative test used to test for presence of sensitization to certain antigenic component of M. tuberculosis

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TB reporting

any persons confirmed or suspected of having TB must be reported to a state or local public health authority within 24 hours

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TB treatment

Directly observed therapy and use of multiple chemotherapeutic agents are key to successful therapy, includes initial and continued phase

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Initial phase TB treatment

Isoniazid, Rifampin, Pyrazinamide, Ethambutol

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Isoniazid

bactericidal, easily tolerated in a single oral daily dose, inexpensive, potentially hepatotoxic, peripheral neuropathy is a risk in certain pt pop (diabetics, renal failure)

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Rifampin

bactericidal, well tolerated as single daily oral dose, less hepatotoxic when compared to INH, induces hepatic microsomal enzymes and may decrease the effectiveness of several drugs

39

Pyrazinamide

bactericidal at an acidic pH. administered as single oral dose, GI side effects are common, hepatotoxic, may cause hyperuricemia due to decreased renal excretion of uric acid may lead to gout

40

Ethambutol

bacteriostatic, single daily oral dose, well tolerated, optic neuritis is an uncommon but serious complication