Bronchitis and Influenza Basics for the Physician Assistant Exam
The Physician Assistant Exam (PANCE) will expect you to have a firm grasp on infectious processes like bronchitis and influenza. These are fairly common conditions and affect many people every year.
The most common etiologies of bronchitis are viral, including the adenovirus (also a common viral cause of pharyngitis), respiratory syncytial virus (or RSV), and rhinovirus (the cause of the common cold).
Acute bronchitis can also have bacterial causes. These causes are basically what you read about earlier in “Knocking out pneumonias.” All the causes of the typical CAP can be causes of acute bronchitis.
Whereas chronic bronchitis is characterized by a chronic cough, acute bronchitis is characterized by an acute airway inflammation. Catchy, huh, how “chronic” matches “chronic” and “acute” matches “acute?” Anyway, imaging studies such as chest radiographs are nondiagnostic for acute bronchitis. The diagnosis is made on clinical presentation with shortness of breath and wheezing, along with a negative chest radiograph.
Antibiotics are prescribed for people whose symptoms don’t resolve, for people with underlying lung disease, for geriatric patients, or for people whose immune status is in question.
Influenza (the flu) is an infectious disease caused by viruses of the family Orthomyxoviridae. The virus causes outbreaks during late fall and winter. The most common viral types are influenza A and B, with A being more common than B.
Both virus types produce similar symptoms, which can begin 24 to 48 hours after infection. They include cough, fever, rigors, arthralgias, and myalgias. Sometimes you can isolate the virus from the nose or pharynx — that is, a nasal swab can be done.
Several medications have been used in treating influenza:
Oseltamavir (Tamiflu) can treat both influenza A and B, but it’s effective in lessening the duration and intensity of symptoms only if it’s given in the first 24 to 48 hours. Zanamivir (Ralenza) is a newer medication that works in a manner similar to oseltamavir.
Amantadine, the same medication prescribed for Parkinson’s disease, is used to treat influenza A, but it isn’t effective against influenza B. Again, for this medication to have any effect, it has to be given early. Another medication that sounds like amantadine, rimatadine (Flumadine), works in a similar manner.
Vaccines can effectively prevent influenza virus infection. They’re typically administered widely — look for a flu clinic near you. The flu vaccine is reformulated every year and manufactured 6 months before flu season starts so it’s ready when people need it.
A common test question asks about the association between children with viral infections (primarily influenza), the use of salicylates, and the development of Reye’s syndrome, a deadly medical condition that can affect the liver and brain. Bottom line: Don’t give salicylate derivatives of any kind to children under the age of 19.
For which of the following people would you most strongly recommend the flu vaccine?
(A) A woman under the age of 65 with no documented health problems
(B) A nurse working the day shift in a hospital
(C) A researcher working in a lab
(D) A 25-year-old librarian
(E) A 55-year-old person diagnosed with acute bronchitis that has resolved
The correct answer is Choice (B). Any person over the age of 65, healthcare professional, or person with a compromised immune system (or suffering from a chronic medical condition) should get the vaccine. Choice (A) is wrong because she isn’t over the age of 65. Choice (C) is in the lab; contact with people is minimized, so vaccination is less important. The same concerns Choice (D).