Sinusitis and Bronchitis

Question 1

Clinical presentation of acute bacterial rhinosinusitis

Answer 1

Onset with persistent signs or sx, lasting from greater than or equal to 10 days without any evidence of clinical improvement
Onset with severe signs or sx of high fever and purulent nasal drainage or facial pain lasting for at least 3-4 consecutive days at the beginning of the illness
Onset with worsening signs or symptoms characterized by new-onset fever, headache, or increase in nasal discharge

Question 2

S/Sx (examples) of acute bacterial rhinosinusitis

Answer 2

Purulent anterior nasal d/c
Nasal congestion
Facial congestion
HA

Question 3

Desired outcome for rhinosinusitis

Answer 3

Reduce s/sx
Limit abx tx
Eradicate infection
Minimize duration of illness
Prevent complications
Prevent progression

Question 4

What is the first line tx for acute bacterial rhinosinusitis?

Answer 4

Augmentin

Question 5

Nonpharmacologic therapy for nonbacterial rhinosinusitis

Answer 5

Nasal decongestant sprays
-Phenylephrine and oxymetazoline
Oral decongestants

Question 6

Nonpharmacologic therapy for acute bacterial rhinosinusitis

Answer 6

Decongestants and antihistamines are not recommended
Intranasal saline irrigation
Intranasal corticosteroids

Question 7

When is high-dose augmentin preferred in acute bacterial rhinosinusitis?

Answer 7

Geographic regions with high rates of invasive pcn-nonsusceptible S. pneumoniae
Severe infection
Attendance at daycare
<2 yrs or <65 yrs
Recent hospitalization
Abx use within the last mo
Immunocompromised persons

Question 8

Pcn allergy (children) tx for acute bacterial rhinosinusitis

Answer 8

Levofloxacin

Clindamycin + cefixime or cefpodoxime

Question 9

Pcn allergy (adults) tx for acute bacterial rhinosinusitis

Answer 9

Doxycycline
Levofloxacin
Moxifloxacin

Question 10

Adverse effects of Levofloxacin

Answer 10

Tendon rupture

Cartilage growth hindrance

Question 11

Side effects of doxycycline in children

Answer 11

Bone growth abnormalities

Tooth discoloration

Question 12

What are FDA guidelines regarding acute sinusitis, acute bronchitis, and URI tx?

Answer 12

No FQs

If you tried everything and it still doesn’t work, go to FQs

Question 13

Duration of therapy for acute bacterial rhinosinusitis

Answer 13

10-14 days courses (uncomplicated rhinosinusitis, children)
5-7 days (adults)
Reevaluate and initiate alternative antibiotics if symptoms persist or worsen after 48 to 72 hours of appropriate antibiotic therapy

Question 14

What is the hallmark symptom of acute bronchitis?

Answer 14

Cough

Question 15

Goals of acute bronchitis therapy

Answer 15

Provide comfort

Treat dehydration and respiratory compromise

Question 16

Approach to acute bronchitis tx

Answer 16

Symptomatic and supportive

Question 17

Pharmacologic therapy for acute bronchitis

Answer 17

Mild analgesic-antipyretic therapy
-ASA
-Acetaminophen
--No longer preferred by pediatricians
-Ibuprofen
--Use as antipyretic has increased
No sufficient evidence for beta 2 agonist or corticosteroid
Dextromethorphan may assist with persistent cough
Routine use of abx is discouraged

Question 18

When should you use ibuprofen with caution?

Answer 18

Children < 6 mos
Elderly
Poor renal fxn

Question 19

Chronic bronchitis

Answer 19

Most often a component of COPD

Presence of a chronic cough productive of sputum lasting > 3 consecutive months/year for 2 consecutive years

Question 20

Contributing factors to chronic bronchitis

Answer 20

Cigarette smoking
Occupational exposure
Environmental pollution
Host factors

Question 21

S/sx of chronic bronchitis

Answer 21

Excessive sputum expectoration
Cough
Cyanosis

Question 22

Physical exam of chronic bronchitis

Answer 22

Chest auscultation
Hyperresonance on percussion
Nl vesicular breathing sounds ar diminished

Question 23

Chest radiograph of chronic bronchitis

Answer 23

Barrel chest

Depressed diaphragm with limited mobility

Question 24

Lab tests for chronic bronchitis

Answer 24

Erythrocytosis (increased hematocrit)

Question 25

Pulmonary function tests for chronic bronchitis

Answer 25

Decreased vital capacity | Prolonged expiratory flow

Question 26

Gold 1 criteria for COPD

Answer 26

Mild | FEV greater than or equal to 80% predicted

Question 27

Gold 2 criteria for COPD

Answer 27

Moderate | FEV1 50-80% predicted

Question 28

Gold 3 criteria for COPD

Answer 28

Severe | FEV1 30-50 predicted

Question 29

Gold 4 criteria for COPD

Answer 29

Very severe | FEV1 <30% predicted

Question 30

Common bacterial pathogens in chronic bronchitis

Answer 30

``` H. influenzae M. catarrhalis S. pneumoniae E. coli Enterobacter Klebsiella P. aeruginosa ```

Question 31

Goals of tx therapy for chronic bronchitis

Answer 31

Reduce severity of chronic sx and ameliorate acute exacerbations Achieve prolonged exacerbation-free intervals

Question 32

General approach to chronic bronchitis tx

Answer 32

Reduce exposures Pulmonary rehabilitation Postural drainage techniques

Question 33

Pharmacologic therapy for chronic bronchitis

Answer 33

``` Vaccinations Inhalers -SABA -LABA -LAMA -ICS -Phosphodiesterase inhibitors Antimicrobials -Based on hx and response ```

Question 34

Anthonisen criteria (chronic bronchitis)

Answer 34

Increase in shortness of breath Increase in sputum volume Production of purulent sputum

Question 35

Factors in selecting abx for chronic bronchitis

Answer 35

Infection-free period Effective against responsible pathogen Least risk of drug interactions Promotes compliance

Question 36

Long-term usage of abx in chronic bronchitis

Answer 36

Macrolides have been associated with a significant reduction in acute exacerbations