Acute BronchitisDefinition Inflammation of the airways (trachea, bronchi, bronchioles) characterized by cough | Etiology >90% viral (rhinovirus, coronavirus, RSV) | CXR will be ____ in acute bronchitis Negative | Treatment for acute bacterial bronchitis Second-generation cephalosporin (ie Ceftin) | When are antibiotics indicated in acute bronchitis Elderly, underlying cardiopulmonary disease, cough >7-10 days, immunocompromised state |
Acute epiglottitisDefinition A severe, life-threatening infection of the epiglottis* | Most common ages 2-7 yo | What has decreased the incidence in children Wide-spread administration of H. flu vaccine | Clinical findings Patients sit upright with necks extended, higher fever, reap. distress, drooling | Lateral neck radiograph finding Thumbprint sign | Treatment Secure airway + broadspectrum 2nd or 3rd generation cephalosporin (cefotaxime or ceftriaxone) x 7-10 days |
Buzzwords: Drooling, sniffing position, tripod, toxic, thumbprint sign | | CroupDefinition Viral laryngotracheo-bronchitis, affects kids 6mo-5yo | Most common cause Parainfluenza virus types 1 & 2 | Clinical findings Harsh, barking, seal-like cough | PA neck film radiograph Steeple sign | Treatment Mild croup doesn't need treatment |
Buzzwords: pediatric with barking cough, steeple sign, inspiratory stridor TuberculosisOrganism Mycoplasma tuberculosis-acquired by inhaling organisms within aerosol droplets expelled from coughing | Inactive TB most commonly found in Apices of lungs | Most common symptom Cough | Histologic hallmark Bx showing caveating granulomas | Tx for LTBI INH x 9 months | Tx for active TB INH/RIF/PZA/EMB x 2 months then INH/RIF x 4 months | Indurations greater than ___ should be treated aggresively 5mm |
Buzzwords: Apical infiltrates, fever, chills, dry cough Acute bronchiolitisDefinition Inflammation of the bronchioles (<2mm diameter), primarily in kids/infants | Most common organism RSV | Treatment Hospitalization + ribavirin + supportive measures |
| | PneumoniaDefinition Inflammation in the alveoli of the lung caused by microorganisms | Most common cause of CAP Strep pneumo. | Clinical Features cough, sputum, SOB, pleuritic chest pain, sweats, rigors | Treatment-uncomplicated/outpatient Doxycycline, erythromycin, macrolides (azithromycin), fluoroquinolones | Treatment-inpatient (want to cover Legionella) Ceftriaxone/cefotaxime + azithromycin/or fluoroquinolone | Most common cause of atypical CAP Mycoplasma pneumo. | Treatment-atypical CAP erythromycin (Mycoplasma pneumo.) or tetracycline (Chlamydia) | Who is at highest risk for HAP? ICU patients on mechanical ventilation | Organism in ICU with worst prognosis Pseudomonas auroginosa | Most common opportunistic infection in patients with HIV Pneumocystis jiroveci | Treatment-HIV-related pneumonia Bactrim (trimethroprim/sulfa.) | When is prophylaxis recommended for HIV-pneumonia CD4<200 | Clinical Scenario: >35yo with PNA. Rusty colored or yellow-green sputum. Acute onset F/C Strep. pneumonia | Clinical Scenario: <35 yo, college students. Fever, cough, +/- sputum, chills, muscle aches, Bullous myringitis Mycoplasma pneumonia | Clinical Scenario: PNA w/ Smokers, COPD H. influenza | Clinical Scenario: PNA w/ DM, immunocompromised, EtOH. Currant color sputum. Klebsiella | Clinical Scenario: PNA w/ Water, late summer, construction site. Diarrhea. Toxic looking Legionella | Clinical Scenario: PNA from Nursing homes, chronic care facility. Purulent sputum Staphylococcus aureus | Clinical Scenario: PNA & HIV+, AIDS, Immunocompromised. Sx out of proportion to exam. Diffuse interstitial & alveolar infiltrates Pneumocystis jerovecii; TMP-SMX = Drug of choice | Clinical Scenario: PNA & decreased mental status, poor dental hygiene, dentures, foul smelling sputum, bronchiectasis. Patchy infiltrates in dependant lung zones Aspiration pneumonia |
Buzzwords: Fever, cough, sputum. Crackles, decreased breath sounds, dullness to percussion, +egophony, pectoriloquy. CXR – infiltrates or consolidation |
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