526 Respiratory Flashcards
What is the length of time that differentiates acute from chronic cough
8 weeks
what findings would rule out need for CXR
HR <100
Resp rate <24
Oral temp <38
no focal consolidation, egophony or fremitus
how long would a patient have a cough for before you would suspect bronchitis
7 days
how long would a patient have a cough for before you would start investigating other causes besides bronchitis
3 weeks
what might you suspect in an adult with a paroxysmal cough lasting more than 2 weeks
infection with B. pertussis
does smoking affect the decision to prescribe abx in bronchitis
no, abx are of little use in bronchitis and smoking hx does not change that
what is first line treatment for pertussis? what is second line?
first line is macrolides (“mycins”), second line is septra
in what patients would you not give azithromycin to?
any history or heart conduction abnormalities
what is the most common pathogen in acute bronchitis
influenza
when is a CXR indicated for cough
infectious suspicion, cough lasting longer than 3 weeks not responsive to empiric treatment
what is the difference ebtween central and obstructive breathing sleep disorders
central = brain stem dysfunction
(resp movements not occuring)
obstructive = problem with actual airway (resp movements occuring but not effective)
what are the predictors of OSA
obesity, thick neck, receding jaw, large tongue, large tonsils
what is the definitive diagnostic test for OSA
polysomnography
what questionnaire can help determine risk for OSA
STOPBANG
what causes increased egophony and increased tactile fremitus
consolidation
what are 3 common bacterial pathogens that cause pneumonia
strep, influenzae, staph
what is the difference between bronchopneumonia, atypical or interstitial pneumonia, and lobar pneumonia
broncho is throughout the lungs
atypical is in the interstitial
lobar is consolidation of an entire lobe
what are the symptoms of pneumnia
dyspnea
CP
productive cough
systemic symptoms
how is pneumonia diagnosed
CXR with patchy areas or consolidated depending on type of pneumonia
what physical findings are in a pneumonia
dullness to percussion
tactile ffremitus
late inspiratory crackls
broncheal breath sounds
bronchophony and egophony
what pathogen is responsible for the majority of typical CAP
step pneumonia
will a CXR always show pneumonia
CXR is variable and may be normal in the early course of the disease
what prodrome is seen in atypical pneumonia
sore throat and headache
what gram negative and gram positive bacterias most commonly cause pneumonia
gram negative = H influenzae
gram positive = S. pneumoniae
atypical pneumonia is described as ….
pneumonia caused by nonbacterial organisms
A physical exam shows fine rales, no signs of consolidation, and maculopapular eruptions on the skin. What is most likely
atypical pneumonia
how would a CXR differ in typical vs atyipcal pneumonia
typical - lobar consolidations, cavitation or large pleural effusion
atypical = bilateral diffuse infiltrate
what is first like treatment for pneumonia in a previously healthy person with no abx use in the last 3 months? what is second line?
1st line is macrolides “mycins”
2nd line is Doxycycline
how would treatment for a pneumonia differ for a person who has comorbidities
macrolide “mycins” PLUS fluroquinolone “floxacins” or beta lactam (cefotaxime, ceftriaxone, ampicillin)
is hemoptysis a common symptom of pneumonia
no, although it can happen, it is not common and may suggest necrosis, lung abscess or another underlying lung disease
