Term
| What are the 3 kinds of bronchitis? |
|
Definition
| Acute, Chronic, and bronchiolitis |
|
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Term
T/F
Bronchitis is generally considered a viral etiology. |
|
Definition
|
|
Term
T/F
Pneumonia is generally considered a bacterial infection. |
|
Definition
|
|
Term
| Name 3 Lower resp. tract infections other than bronchitis and pneumonia. |
|
Definition
|
|
Term
| What is the clinical presentation of acute bronchitis? |
|
Definition
| cough, sore throat, malaise, headache, coryza, and fever less than 39 (102.2) |
|
|
Term
| What might the physical findings be in a patient with acute bronchitis? |
|
Definition
| ronchi and coarse, moist bilateral rales; CXR is normal with no infiltrates and no exudates |
|
|
Term
| When should a diagnosis of acute bronchitis be made? |
|
Definition
| When there is no clinical or radiological evidence of pneumonia and acute asthma or an exacerbation of COPD has been ruled out |
|
|
Term
| How long does acute bronchitis last? |
|
Definition
|
|
Term
T/F
There is no role for inhaled bronchodilator therapy in acute bronchitis. |
|
Definition
|
|
Term
| How do you diagnose whooping cough? |
|
Definition
| nature of the cough and immunization record |
|
|
Term
| What is the treatment for whooping cough? |
|
Definition
| Erythromycin (EES) 30-50 mg/kg/day as 3 divided doses x 10 days |
|
|
Term
| How soon should treatment be started with whooping cough? |
|
Definition
| macrolide should be started within the first 2 weeks |
|
|
Term
| How long should a patient with whooping cough be isolated? |
|
Definition
| first 5 days of treatment |
|
|
Term
| Name 3 primary bacterial agents that can cause acute bronchitis in rare cases. |
|
Definition
| Mycoplasma pneumoniae, Chlamydia pneumoniae, Bordetella pertussis |
|
|
Term
| Name 3 causes of secondary bacterial infection in acute bronchitis. |
|
Definition
| Streptococcus ssp., Staphylococcus spp., Hemophilis spp. |
|
|
Term
T/F
Dyspnea, cyanosis, and severe airway obstruction are typical of bronchitis. |
|
Definition
|
|
Term
| When are cultures used to diagnose acute bronchitis? |
|
Definition
| they are only used for diagnosis in prolonged or severe cases because bacterial etiology is more likely at that point |
|
|
Term
| What is the treatment for acute bronchitis? |
|
Definition
| symptomatic and supportive care - fluids and bed rest, antipyretics, vaporizer to lessen respiratory secretions (especially in infants < 1 year) |
|
|
Term
| Where is acetominophen metabolized? |
|
Definition
|
|
Term
| Where is ibuprofen metabolized? |
|
Definition
|
|
Term
| What effects does acetominophen have? |
|
Definition
antipyretic and analgesic
NO anti-inflammatory effects |
|
|
Term
| What is the maximum dosage of acetominophen for an adult? |
|
Definition
short term 4g/day
long term 3g/day |
|
|
Term
| How do you dose ibuprofen and acetominophen together? |
|
Definition
| Take 1 every 3 hours, alternating. |
|
|
Term
| Why is aspirin not often recommended? |
|
Definition
|
|
Term
|
Definition
| a rare, potentially fatal childhood disease |
|
|
Term
| Why is aspirin not used in children? |
|
Definition
| studies have found a link between the use of aspirin during a viral illness and Reye's syndrome |
|
|
Term
| What characterizes Reye's syndrome? |
|
Definition
| severe increase of intracranial pressure and an abnormal accumulation of fat in the liver; first symptom is uncontrollable vomiting and nausea; swelling in the brain may cause seizures and the child may stop breathing |
|
|
Term
| How do you treat Reye's syndrome? |
|
Definition
| drugs to control the swelling in the brain and IV fluids to restore normal blood chemistry; ventilator to aid in breathing |
|
|
Term
| What % of cases of Reye's syndrome used to be fatal? |
|
Definition
|
|
Term
| Name 3 cough suppressants used to treat acute bronchitis. |
|
Definition
| dextromethorphan, codeine, and hydrocodone |
|
|
Term
| How does dextromethophan work? |
|
Definition
| Penetrates the CNS to act on the brainstem to inhibit the cough center; inhibits glutamenergic synaptic transmission of inputs from sensory receptors in the airway as a result of facilitation of serotonergic mechanism |
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|
Term
T/F
Expectorants are recommended for acute bronchitis. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What do expectorants do to ease symptoms? |
|
Definition
| promote drainage of mucus from the lungs by thinning the mucus and lubricating the irritated respiratory tract |
|
|
Term
| What is the dosing for guafenesin (Mucinex)? |
|
Definition
|
|
Term
| How might you avoid prescribing an antibiotic for acute bronchitis without making the patient uncomfortable? |
|
Definition
| dx of chest cold instead of acute bronchitis |
|
|
Term
T/F
When a medication has dextromethorphan added it says DM. |
|
Definition
|
|
Term
| What is benzonatate (Tessalon)? |
|
Definition
|
|
Term
| How do you dose benzonatate? |
|
Definition
100 mg perles bid-tid
Walmart $4 prescription |
|
|
Term
| Why is antiviral therapy not typically used for acute bronchitis? |
|
Definition
| because of the inability of clinical trials to prove the efficacy of these meds for acute bronchitis |
|
|
Term
| What criteria are used to diagnose chronic bronchitis? |
|
Definition
| cough and sputum expectoration occurring on most days for at least 3 months of the year and for at least 2 consecutive years without the presence of other pulmonary or cardiac causes |
|
|
Term
| What is usually in the history of chronic bronchitis? |
|
Definition
| history of smoke or chemical exposure - respiratory irritants |
|
|
Term
| How many COPD patients are there in the US? |
|
Definition
|
|
Term
| What 2 diseases make up COPD? |
|
Definition
| chronic bronchitis and emphysema |
|
|
Term
| What are the 3 subgroup classifications of chronic bronchitis? |
|
Definition
1. simple chronic bronchitis with no evidence of COPD on pulm. function testing
2. chronic bronchitis with COPD FEV1 > 50%
3. chronic bronchitis with COPD FEV1 < 50% |
|
|
Term
T/F
If you have chronic bronchitis, you have COPD. |
|
Definition
|
|
Term
| How do we treat chronic bronchitis? |
|
Definition
depends on classification 1, 2, or 3
symptomatic and supportive care, maybe antibiotics |
|
|
Term
| What 3 things can help us classify chronic bronchitis? |
|
Definition
obesity - based on BMI
clubbing of the digits
CXR - barrel chest, depressed diaphragm |
|
|
Term
| What might the clinical presentation be for a patient with chronic bronchitis? |
|
Definition
cough - rhonchi, rales, wheezing
decreased breath sounds
mild fever (< 39 or 102.2)
sore throat, malaise, headache |
|
|
Term
| What are the 2 main treatment goals for chronic bronchitis? |
|
Definition
1. reduce the severity of chronic symptoms
2. decrease the number of acute exacerbations |
|
|
Term
| How can we reduce the severity of chronic bronchitis? |
|
Definition
stop smoking
avoidance of bronchial irritants
pulmonary therapy program (exercise, breathing techniques, postural draining techniques) |
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|
Term
|
Definition
|
|
Term
| How do you dose bronchodilators? |
|
Definition
| 2 puffs prn up to QID - if more than 1 is used, still QID TOTAL |
|
|
Term
| How do you treat acute exacerbations of chronic bronchitis? |
|
Definition
| bronchodilators or use an updraft machine |
|
|
Term
| How do you dose duoneb (albuterol + ipratripium) updraft solution? |
|
Definition
|
|
Term
| What medications are used with an updraft machine? |
|
Definition
| albuterol inhalation solution, ipratropium bromide, duoneb (both together), levabuterol |
|
|
Term
T/F
Abuterol is a short acting beta agonist. |
|
Definition
|
|
Term
T/F
While using beta agonists, it is important to avoid concomitant beta-blocker therapy. |
|
Definition
|
|
Term
| Why does albuterol have little effect on adrenergic receptors of the heart? |
|
Definition
| It is a selective better blocker, blocking beta2 receptors which relaxes the airway smooth muscle but not blocking beta1 receptors of the heart |
|
|
Term
| What is a leading indicator of mortaity in asthma patients and indicates further evaluation in COPD patients? |
|
Definition
| the use of more than one inhaler per month of albuterol |
|
|
Term
| How does ipratropium bromide act as a bronchodilator? |
|
Definition
| it blocks the action of Ach at parasympathetic sites in bronchial smooth muscle |
|
|
Term
| What is the DOC bronchodilator for COPD patients? How is it dosed? |
|
Definition
albuterol + ipratropium bromide
2 puffs prn QID |
|
|
Term
| What is antibiotic therapy for acute exacerbations of chronic bronchitis based on? |
|
Definition
| subgroup classification and severity of symptoms |
|
|
Term
| What is the antibiotic therapy for simple chronic bronchitis with mild symptoms? |
|
Definition
| no antibiotics, just symptomatic and supportive care |
|
|
Term
| What is the antibiotic therapy for simple chronic bronchitis with intense symptoms? Give dosage |
|
Definition
symptomatic and supportive care and antibiotics
azithromycin, 3 pack 500 mg po QD x 3 days
doxycycline
trimethoprim/sulfamethoxazole 800/160 mg po bid x 10 days |
|
|
Term
| How does trimethoprim/sulfamethoxazole work? |
|
Definition
| prevents bacterial proteins and nucleic acids from being synthesized |
|
|
Term
| What is the antibiotic therapy for chronic bronchitis with COPD and mild symptoms? |
|
Definition
| azithromycin, doxycycline, co-trimaxazole (bactrim DS) |
|
|
Term
| What is the antibiotic therapy for chronic bronchitis with COPD and severe symptoms? |
|
Definition
levofloxacin, 750 mg QD x 7 days
clarithromycin 500 mg ii tabs QD x 7 days |
|
|
Term
| What is the antibiotic therapy for chronic bronchitis with severe COPD and mild symptoms? |
|
Definition
levofloxacin
amoxicillin-clavulanate 1000/62.5 mg 2 tabs po q12h x 10 days |
|
|
Term
| What is the antibiotic therapy for chronic bronchitis with severe COPD and severe symptoms? |
|
Definition
consider hospitalization for IV abx as for pneumonia - run cultures
ceftriaxone 1 g IM with levofloxacin or Augmentin and follow up in 24 h. |
|
|
Term
| What % of patients will have resolution of their cough after smoking cessation? |
|
Definition
|
|
Term
| Is long-term antibiotic prophylaxis indicated for chronic bronchitis? |
|
Definition
|
|
Term
|
Definition
| acute viral infection of the lower respiratory tract affecting infants |
|
|
Term
| What age is the peak incidence of bronchioloitis? |
|
Definition
|
|
Term
T/F
Bronchiolitis is unusual after age 2. |
|
Definition
|
|
Term
| What time of year do most cases of bronchiolitis occur? |
|
Definition
| winter and continues into spring |
|
|
Term
T/F
Viral bronchiolitis can be life threatening. |
|
Definition
|
|
Term
| How many deaths occur from bronchiolitis n the US each year? |
|
Definition
|
|
Term
| What 3 viruses account for most cases of bronchiolitis? |
|
Definition
|
|
Term
| What % of cases of bronchiolitis are caused by RSV? |
|
Definition
|
|
Term
| What % of bronchiolitis cases are caused by human metapneumovirus? |
|
Definition
|
|
Term
| What % of bronchiolitis cases are caused by parainfluenza viruses? |
|
Definition
7-10%
(includes adenoviruses, influenza, rhinovirus, enterovirus, and herpes simplex) |
|
|
Term
| What % of children between 6-12 months have antibodies to hMPV? |
|
Definition
|
|
Term
| At what age do 100% of patients show evidence of past infection with hMPV? |
|
Definition
|
|
Term
| What is the clinical presentation of bronchiolitis? |
|
Definition
prodrome - irritability, restlessness, mild fever (lasts 2-7 days)
dehydration - cough prevents fluid intake; emesis, diarrhea, fever
tachypnea (40- 80 RR)
labored breathing, retractions of the chest wall, nasal flaring, and grunting |
|
|
Term
T/F
Cyanosis is unusual in bronchiolitis. |
|
Definition
|
|
Term
T/F
Hypoxemia is uncommon with bronchiolitis. |
|
Definition
|
|
Term
| When is hypercarbia seen in bronchiolitis? |
|
Definition
| Only in the most severe cases |
|
|
Term
| When are bronchodilators used in the treatment of bronchiolitis and why? |
|
Definition
| only for bronchospasm with clear therapeutic benefit because they may be detrimental to patients |
|
|
Term
T/F
Corticosteroids/leukotriene modifiers are not currently recommended in the treatment of bronchiolitis. |
|
Definition
| True - but they are used in 60% of patients |
|
|
Term
T/F
Antibiotics should not be used for bronchiolitis. |
|
Definition
| True - unless coexistant bacterial infection is known to exist. |
|
|
Term
| What is the most important measure in preventing RSV infection? |
|
Definition
| hand washing - alcohol based rubs are preferred |
|
|
Term
T/F
Breast-feeding reduces the risk of infection with RSV. |
|
Definition
|
|
Term
| What treatment regimen helps reduce rate of hospital admission in bronchiolitis patients? |
|
Definition
epinephrine nebulizer treatment
dexamethasone shot then oral treatment for 5 days |
|
|
Term
|
Definition
| a monoclonal antibody to RSV that has been shown to reduce the risk of severe infection in high risk patients - premies, infants with chronic lung disease, and infants with congenital heart defects |
|
|
Term
| How is palivizumab given? |
|
Definition
| injection once a month for several months (max 3-5 doses) |
|
|
Term
| What % of palvizumab is not human? |
|
Definition
|
|
Term
T/F
There have been resistant RSV strains isolated from clinical samples. |
|
Definition
|
|
Term
| What is the most common cause of death from infection in the US? |
|
Definition
|
|
Term
| How many pneumonia cases are there annually in the US? |
|
Definition
|
|
Term
| What are the 3 ways in which microorganisms access the lungs? |
|
Definition
1. inhaled aerosolized particles
2. through the blood stream from an extrapulmonary site of infection in sepsis
3. aspiration of oropharyngeal contents |
|
|
Term
T/F
Lung infection with viruses predisposes the lungs to infection. |
|
Definition
|
|
Term
| What is the clinical presentation of pneumonia? |
|
Definition
abrupt onset of fever, chills, dyspnea
productive cough - rust-colored sputum or hemoptysis
pleuritic chest pain
tachypnea
tachycardia
PE: inspiratory crackles, diminished breath sounds over the area of infection, dullness to percussion, increased tactile fremitus |
|
|
Term
| What will show on the CXR of a patient with pneumonia? |
|
Definition
| dense infiltrate in 1 lobe or segment of the lung |
|
|
Term
| What will show on the lab studies of a patient with pneumonia? |
|
Definition
Hypoxemia
CBC - leukocytosis with left shift
blood cultures usually negative
sputum cultures may show the pathogen |
|
|
Term
| What is the most common cause of CAP? |
|
Definition
| Streptococcus pneumoniaee |
|
|
Term
| Why is urinary antigen detection for the C polysaccharide from the pneumococcal cell wall used to determine if someone has Strep. pneumoniae? |
|
Definition
| because it remains positive for weeks after initial symptoms and can be used after abx are begun |
|
|
Term
| How do you determine if someone has severe CAP? |
|
Definition
| One major criteria or 2 minor criteria |
|
|
Term
| What are the major criteria for determining severe CAP? |
|
Definition
serum p < 7.3
systolic pressure < 90 mm Hg |
|
|
Term
| What are the minor criteria for determining severe CAP? |
|
Definition
respirations > 30
BUN > 30
altered mental status
age > 80 years
multi-lobular/bilateral infiltrates on CXR
Pa02 < 54 mm Hg |
|
|
Term
| What are 3 parts of supportive therapy upon hospitalization? |
|
Definition
1. respiratory function - O2, ventilation
2. Circulatory collapse - rehydration, nutritional support
3. Control of fever |
|
|
Term
| What is the outpatient abx therapy for adults with CAP? |
|
Definition
levofloxacin 750 mg QD x 10 days
gemifloxacin 320 mg po QD x 7 days
clarithromycin 500 mg ii tabs QD x 10 days |
|
|
Term
| What is the outpatient abx therapy for pediatrics with CAP? |
|
Definition
clarithromycin
amoxicillin/clavulanate
ceftriaxone |
|
|
Term
| What is empyema and how is it treated? |
|
Definition
| pus in the pleural space and it should be drained with an image guided catheter |
|
|
Term
| When should you follow up with pneumonia patients? |
|
Definition
|
|
Term
| What are the 2 pneumonia vaccines and when are they used? |
|
Definition
Pneumovax 23 - used in those with weakened immune systems and those over 65
Prevnar - covers 80% of pneumococcal infections in peds population
Also, yearly flu vaccine helps prevent pneumonia cases caused by flu |
|
|
Term
| What are 3 atypical pathogens that may cause pneumonia? |
|
Definition
| Mycoplasma penumoniae, Chlamydia pneumoniae, and Legionella pneumoniae |
|
|
Term
| How is Legionella pneumoniae spread? |
|
Definition
spray from stagnant water
no person to person spread
has 14% mortality rate |
|
|
Term
| What is the clinical presentation of atypical pneumoniae? |
|
Definition
| headache, sore throat, cough, low grade fever, and scant infiltrates on a CXR (diffuse alveolar pattern) |
|
|
Term
| How do you treat atypical pneumonia? |
|
Definition
levofloxacin
clarithromycin 500 mg ii tabs QD x 10 days
doxycycline |
|
|
Term
| How should nursing home acquired pneumonia be treated outpatient? |
|
Definition
levofloxacin or moxifloxicin
OR
amoxicillin/clavulanate or cefuroxime or cefpodoxime AND azithromycin |
|
|
Term
| How should nursing home acquired pneumonia be treated inpatient? |
|
Definition
3 medications IV
1. antipseudomonal - cephalosporin (cefepime), cabapenem (imipemem/cilastatin), B-lactam (piperacillin-tazobactam)
2. antipsudomonal - fluoroquinolone (levofloxacin), aminoglycoside (tobramycin)
3. Anti-MRSA - vancomycin or linezolid |
|
|
Term
|
Definition
severe acute respiratory syndrome
caused by a coronavirus |
|
|
Term
|
Definition
| acute respiratory distress syndrome |
|
|
Term
| What is the prophylactic treatment for SARS? |
|
Definition
| hand washing with povidone-iodine products and isodine gargle |
|
|
Term
T/F
No pharmacological treatment has proven effective against ARDS. |
|
Definition
|
|
