Infectious Disease | Acute Bronchitis

0:00Hi everyone, welcome back to the Med Bullets Step 2 and 3 podcast. In today's episode, we covered the topic of acute bronchitis found under the infectious disease section at MedBullets.com. Let's begin with a clinical snapshot. A 22-year-old man presents to his physician with a cough. He describes the cough as non-productive and lasting for a few days. He denies any subjective fever, acid reflux, and has not had his influenza vaccination. On exam, there are weasers and bronchi on pulmonary oscultation. The patient is reassured that his symptoms will self-resolve in one to three weeks, and that he can try T or over-the-counter medications, such as dextromethorifan, to improve his cough. Let's continue with an introduction to acute bronchitis. This is defined as inflammation of the lower respiratory tract. In terms of the ideology, viruses are a more common cause. Specific viruses may include influenza A and B, para-influenza, respiratory-sensitial

1:04virus, coronavirus, adenovirus, rhinovirus, and human metanumovirus. Moving on to the presentation, symptoms may include a cough that lasts at least five days. It can be productive or non-productive, and it may be accompanied by cold symptoms, such as a fever, sore throat, and nasal congestion and runny nose. On exam, one may note weasers and bronchi on pulmonary oscultation. When making the diagnosis, remember that this is based on history and physical exam, and imaging is not necessary. In terms of the differential, make sure to think about pneumonia, with a differentiating factor being that this will present with a cough with fever, tachypnea, or tachycardia, with signs of consolidation or rails. Also think about post-nasal drip syndrome, with differentiating factors being that patients will present with the sensation of post-nasal drainage. In terms of treatment, symptomatic treatment for a cough includes conservative options such as hot tea, lasanges, and smoking avoidance.

2:08Medical options may include dextramatorphine and guyphenicine, and lastly, with regards to prognosis, remember that this is typically self-limiting in last one to three weeks. Now that we've discussed the major points relating to acute bronchitis, let's walk through a question to apply what we've learned and get a sense of how the topic might be tested. For this question, consider the following clinical scenario. A 24-year-old man presents to the emergency department with a cough. He states that he just returned from a trip to Las Vegas. He otherwise feels well and has had no chest pain, decreased exercise tolerance, or fevers. His temperature is 98 degrees Fahrenheit, or 36.7 degrees Celsius. Blood pressure is 121 over 77. Pulse is 71 beats per minute, respirations are 11 breaths per minute, and oxygen saturation is 100% on room air. Physical exam demonstrates a well-appearing man with a cough.

3:08There is no lymphatonopathy, tonsillular exudates, or erythema of the oropharynx. Breath sounds are clear bilaterally with good air movement. The patient's ambulatory oxygen saturation is 99%, which of the following is the most appropriate treatment for this patient? And the answer choices are choice one, a moxicillin clavulane, choice two, azithromyocin, choice three, septary axon, and azithromyocin, choice four, rest, and hydration. Or choice five, vancomycin, and sephapeme. The best answer to this question is choice four, rest, and hydration. This young, healthy patient who is a febrile with stable vitals and a cough likely has acute bronchitis. Acute bronchitis should be treated with supportive therapy in young, healthy patients. Acute bronchitis is inflammation of the bronchi in larger airways.

4:09There are many causes, however the most common causes are viral infection, pollution, and smoking. Bacteria are an uncommon cause of bronchitis. For this reason, any patient who has stable vitals and a normal physical exam without focal lung findings should not be treated empirically with antibiotics. A chest radiograph may be performed to support the diagnosis and roll out a pneumonia. However, this is not mandatory in the workup. Supportive therapy with hot tea, lasanges, honey, and cough suppressants can be recommended for most patients. Let's also discuss whether their choices are incorrect. Choice one. A moxacillin clover lany is an appropriate outpatient regimen for a community acquired pneumonia as it covers the most common causes including Streptococcus pneumonia. Fever, focal breath sounds, and a consolidation on chest radiography would support this diagnosis. Choice two. A zithromyocin covers for atypical causes of pneumonia that may cause a classic walking

5:10pneumonia with hazy, bilateral interstitial infiltrates in an otherwise well-appearing patient. A common cause of atypical pneumonia is microplasma pneumonia. Choice three. Cephtriaxone in zithromyocin is appropriate inpatient management of a community acquired pneumonia, which would be appropriate in patients with a community acquired pneumonia in addition to hypoxia, organ system dysfunction, confusion, or immunosuppression. Note that the key organism to cover for is Streptococcus pneumonia. Choice five. Vencomycin and cephopem is appropriate management of hospital acquired pneumonia, which presents similarly to community acquired pneumonia, but in a patient who develops symptoms of pneumonia greater than 48 hours after hospital admission. Note that coverage must include all the organisms from a community acquired pneumonia in addition to pseudomonas aerogenosa and MRSA. Finally, a bullet summary. A cute bronchitis generally only requires supportive therapy in healthy patients who have stable

6:12vitals. That's all for this review about a cute bronchitis. We hope that was helpful. This is the Med Bullets Step Two and Three podcast, a daily audio review session for Med Bullets, the free learning and collaboration community for medical student education. As a reminder, you can follow along with these podcast episodes by reviewing the topics directly on medbullets.com. You can listen to these episodes on the Med Bullets website or phone app while reading through the topic. If the Med Bullets podcast has been valuable to you, we'd be thrilled if you consider leaving us a five-star rating and writing us a review on Apple Podcasts. We will help us spread the word and increase our discoverability tremendously. Thanks for tuning in. We'll see you all tomorrow, right here, on the Med Bullets Step Two and Three podcast.