1Acute bronchitis occurs mostly in the _____
winter
2Bronchitis leads to:
inflammation
narrowing of airway passages
increased mucous production
3Bronchitis is an infection of ___ ____
respiratory epithelium
4What is the hallmark presentation of acute bronchitis?
cough that lasts longer than 5 days
5A patient with acute bronchitis may or may not have ?
fever
dyspnea
fatigue or malaise
chest discomfort
6A patient with acute bronchitis will typically have
sore throat
nasal congestion
7What lung sounds will you hear with acute bronchitis?
wheezing, rhonchi and rales
8When would you treat a patient with chronic bronchitis as an outpatient?
unremarkable or mildly elevated vital signs
no comorbitities
unremarkable or minimally abnormally PE
normal cxr
9When would you treat a patient with chronic bronchitis as an inpatient?
fever
tachypnea
tachycardia
hypoxia
CXR findings
hx of asthma, copd, recent atbx failure
10If a patient has comorbities, over 65, smoke or immunocompromised what would you give them to treat their acute bronchitis and why?
atbx to decrease risk of atypical pneumonia
11What mechanical factors are critically important in host defense?
cilia, nasal turbinates, gag reflex, cough, normal flora
12How is pneumonia incolculated?
inhalation of infected aerosols
aspiration of oropharyngeal secretions or gastric contents
hematogenous spread from an infected pleural or mediastinal space
13What are the methods of defense against pneumonia?
hair and turbinates
branching architecture
mucociliary clearance
gag reflex
normal flora
14Risk factors for pneumonia
advanced age
obesity
dimentia
seizures
CHF
COPD or asthma
cigarette smoking
alcoholism
immunosupression
15What is a caveat of community acquired pneumonia?
patient no hospitalized or residing in long term care facility for more than 14 days before onset of symptoms
16What is the MCC of CAP?
S. pneumoniae
17Which patient is more likely to be infected by staph aureus causing CAP?
people with comorbid ilnesses
18Acute bronchitis occurs mostly in the _____
winter
19S/S of CAP?
fever
cough
dyspnea
sweats
chills
rigors
chest discomfort
pleurisy
fatigue
malaise
h/a
20What is a poor prognostic sign for CAP?
hypothermia
21Patients with cavitary opacities should have ?
sputum fungal and mycobacterial cultures
22What is a precursor released in response to bacterial toxins?
procalcitonin
23When do you admit for CAP?
Curb 65 that is 2-5
24When do you admit to the ICU for CAP?
1 major criteria
3 or more minor criteria
25What are the major criteria for ICU admission for CAP?
septic shock with need for vasopressor support
respiratory failure requiring mechanical ventilation
26What are the minor criteria for ICU admission for CAP?
resp rate greater than 30
hypoxemia
hypothermia
hypotension requiring aggressive fluid resuscitation
confusion
WBC less than 4000
BUN greater than or equal to 20
metabolic acidosis
increased lactate level
27What is the treatment for CAP in a health patient with no recent atbx use?
macrolide or doxy
28Who are patients at risk for drug resistance?
greater than 65
antibiotic use in last 90 days
comorbid illness
immunosuppresion
exposure to child in daycare
29What should be the treatment of patients who are at risk for drug resistance or hospitalized CAP patients ?
Macrolide plus beta lactam
respiratory fluoroquinolone
30First line treatment for ICU patients with CAP?
ceftriaxone with either azithromycin or respiratory floroquinolone
31What are some complications of bacterial CAP?
respiratory failure
sepsis
shock
multi-organ failure
disseminate intravascular coagulation
exacerbation of comorbid illness
lung abscess
complicated pleural effusion or empyema
32Non infectious complications of CAP?
MI and new major arrhythmias (A-fib)
worsening of heart failure
33What are the common CAP viral pathogens
Influenza (A,B, H1N1)
RSV
Adenovirus
Parainfluenza
34Prevention strategies for CAP?
smoking cessation
pneumococcal vaccine
seasonal influenza vaccine
35What is done in the hospital for management of pnuemonia
blood cultures
oxygen stats
admin of atbx within 6 hours of presenation to ED
ascertainment of influenza and pneumococcal vaccination status
counseling for smoking cessation
36Common pathogens causing PNA in hospitalized patients?
oral flora, S, aureus (MRSA), legionella
37Clinical manifestations of mycoplasma pneumonia?
nonproductive cough, h/a, malaise, chills and fevers
38What is used to treat mycoplasma pneumoniae?
macrolides
tetracycline
respiratory fluoroquinolones
39Legionella causing atypical CAP manifests as?
nonspecific symptoms- fever, malaise, fatigue, h/a, anorexia
then cough that is usually mild and nonproductive
40How is legionella causing CAP treated?
macrolides- azithromycin or clarithromycin
41What is the most clinically usedful means for diagnosisng chlamydia pneumoniae?
serology
42What is the treatment for chlamydia pneumoniae?
erythromycin or tetracycline
43Most common organisms responsible for HAP?
S. aureus
P. aeruginosa
Klebsiella
E. Coli
44What might VAP patients be infected with?
acinetobacter species
45S/S of nosocomial pneumonia?
2 or more of the following
fever
cough
leukocytosis
purulent sputum
46Lab finding for nonsocomial pneumonia?
blood cultures x 2 (not accurate)
CBC, CMP
arterial blood gas or pulse ox (severity)
thoracentesis
47What are patients with neutropenia predisoposed to?
S aureus, aspergillus, candida
48S/S of pneumocystis jiroveci PNA
fever
cough
dyspnea
cyanosis and tachypnea (severe cases)
49Treatment for P. Jiroveci PNA
bactrim
dapsone and trimethoprim
50Prevention of P. jiroveci PNA with prophylaxis (bactrim) for
patients with HIV with a CD4 count less than 200, weightloss or oral candidiasis s
hematological malignancy
transplant patients
51Which mycobacterium is common in AIDs?
kansaii
52Common pathogens causing PNA in young kids?
strep pneumo
mycoplasma
chlamydia pneumonia
MRSA
53Common pathogens causing PNA in elderly and debilitated
strep pneumo
influenza
MRSA
54Common pathogens causing PNA in hospitalized patients?
oral flora, S, aureus (MRSA), legionella