1. The patient’s condition is most likely caused by
A. Rhinovirus
B. Staphylococcus aureus
C. Streptococcus pneumoniae
D. Environmental irritants such as secondhand smoke or chemical exposure
Most cases (> 90%) of acute bronchitis are caused by some form of viral infection (i.e. Rhinovirus, Coronavirus, Influenza A or B, Parainfluenzae). While B. and C., which are both types of bacteria, could potentially cause bronchitis, it is much less likely to be a bacterial infection ( < 10% of cases) and these are much more likely to cause pneumonia. (p. 1187). D. Environmental exposures are more likely to cause pneumoconiosis or hypersensitivity pneumonitis. The symptom presentation for a patient with pneumoconiosis or pneumonitis would look entirely different than this patient’s presentation (worsening respiratory symptoms, such as dyspnea and it is more likely to be chronic. The patient also does not have any known risk factors of such exposures.
2. A nurse practitioner suspects that a patient has acute viral bronchitis. In addition to conducting a thorough physical assessment, which of the following should the provider order?
A. Airborne droplet precautions isolation status
B. Pulmonary function tests
C. Chest X-ray
D. Antibiotic therapy
Chest x-rays are important in differentiating between pneumonia and bronchitis. In bronchitis, there will be no infiltrates shown on x-ray, while in pneumonia there will be. (Understanding Pathophysiology, p 695). B is incorrect. Pulmonary function tests are not indicated in acute bronchitis. These are indicated in chronic diseases such as asthma and COPD. A is not correct. TB infections are spread through airborne droplets. D would be indicated in treating bacterial bronchitis rather than viral bronchitis. Viral bronchitis treatment includes rest, aspirin, humidity, and a cough suppressant.
3. Signs and symptoms of acute bronchitis include which of the following?
A. Hypersecretion of mucus and chronic productive cough for at least 3 months of the year for at least 2 consecutive years
B. Malaise, fever, and white fluffy infiltrates found on x-ray
C. Fever, chills, and coughing fits that are worsened by breathing dusty air
D. Night sweats, anorexia, and hemoptysis
Fever, chills, paroxysmal cough, malaise, and chest radiographs showing no infiltrates are all clinical manifestations of acute bronchitis. Coughs are aggravated by cold, dry, dusty air. A is the definition of chronic bronchitis (Understanding Pathophysiology, p 693). B shows clinical manifestations of pneumonia. Consolidation of lung tissue is found on xray as a result of inflammatory mediators damaging bronchial mucus membranes, causing the terminal bronchioles to fill with infectious debris and exudate. This finding is key to distinguishing between pneumonia and bronchitis. D shows signs and symptoms found in tuberculosis infections. (Understanding Pathophysiology, p 697).
4. Acute Bronchitis can be characterized by all of the following EXCEPT:
A. Fever and malaise
B. Crackles on auscultation with white infiltrates shown on x-ray
C. Episodes of generalized chest pain after coughing fits
D. Dry cough that is worsened by breathing in cold, dry air
Crackles on auscultation with white infiltrates shown on x-ray are typical of pneumonia, one of our differential diagnoses. A, C, and D are all symptoms that can be seen with acute bronchitis.
5. What causes the hallmark cough of acute bronchitis?
A. Fungal invasion of bronchi
B. Edema of the upper airways
C. Copious amounts of sputum production from hypersecretion of mucus
D. Virus triggers the inflammatory response and irritates the bronchi
Acute bronchitis is a viral infection, not fungal. Edema of the upper airways would indicate an upper respiratory infection, acute bronchitis affects the lower airways. Hypersecretion and copious amounts of sputum cause cough in chronic bronchitis, while acute bronchitis usually presents with a dry, non-productive cough.