526 Respiratory

Question 1

What is the length of time that differentiates acute from chronic cough

Answer 1

8 weeks

Question 2

what findings would rule out need for CXR

Answer 2

HR <100
Resp rate <24
Oral temp <38
no focal consolidation, egophony or fremitus

Question 3

how long would a patient have a cough for before you would suspect bronchitis

Answer 3

7 days

Question 4

how long would a patient have a cough for before you would start investigating other causes besides bronchitis

Answer 4

3 weeks

Question 5

what might you suspect in an adult with a paroxysmal cough lasting more than 2 weeks

Answer 5

infection with B. pertussis

Question 6

does smoking affect the decision to prescribe abx in bronchitis

Answer 6

no, abx are of little use in bronchitis and smoking hx does not change that

Question 7

what is first line treatment for pertussis? what is second line?

Answer 7

first line is macrolides (“mycins”), second line is septra

Question 8

in what patients would you not give azithromycin to?

Answer 8

any history or heart conduction abnormalities

Question 9

what is the most common pathogen in acute bronchitis

Answer 9

influenza

Question 10

when is a CXR indicated for cough

Answer 10

infectious suspicion, cough lasting longer than 3 weeks not responsive to empiric treatment

Question 11

what is the difference ebtween central and obstructive breathing sleep disorders

Answer 11

central = brain stem dysfunction
(resp movements not occuring)
obstructive = problem with actual airway (resp movements occuring but not effective)

Question 12

what are the predictors of OSA

Answer 12

obesity, thick neck, receding jaw, large tongue, large tonsils

Question 13

what is the definitive diagnostic test for OSA

Answer 13

polysomnography

Question 14

what questionnaire can help determine risk for OSA

Answer 14

STOPBANG

Question 15

what causes increased egophony and increased tactile fremitus

Answer 15

consolidation

Question 16

what are 3 common bacterial pathogens that cause pneumonia

Answer 16

strep, influenzae, staph

Question 17

what is the difference between bronchopneumonia, atypical or interstitial pneumonia, and lobar pneumonia

Answer 17

broncho is throughout the lungs
atypical is in the interstitial
lobar is consolidation of an entire lobe

Question 18

what are the symptoms of pneumnia

Answer 18

dyspnea
CP
productive cough
systemic symptoms

Question 19

how is pneumonia diagnosed

Answer 19

CXR with patchy areas or consolidated depending on type of pneumonia

Question 20

what physical findings are in a pneumonia

Answer 20

dullness to percussion
tactile ffremitus
late inspiratory crackls
broncheal breath sounds
bronchophony and egophony

Question 21

what pathogen is responsible for the majority of typical CAP

Answer 21

step pneumonia

Question 22

will a CXR always show pneumonia

Answer 22

CXR is variable and may be normal in the early course of the disease

Question 23

what prodrome is seen in atypical pneumonia

Answer 23

sore throat and headache

Question 24

what gram negative and gram positive bacterias most commonly cause pneumonia

Answer 24

gram negative = H influenzae
gram positive = S. pneumoniae

Question 25

atypical pneumonia is described as ….

Answer 25

pneumonia caused by nonbacterial organisms

Question 26

A physical exam shows fine rales, no signs of consolidation, and maculopapular eruptions on the skin. What is most likely

Answer 26

atypical pneumonia

Question 27

how would a CXR differ in typical vs atyipcal pneumonia

Answer 27

typical - lobar consolidations, cavitation or large pleural effusion
atypical = bilateral diffuse infiltrate

Question 28

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?

Answer 28

1st line is macrolides “mycins”
2nd line is Doxycycline

Question 29

how would treatment for a pneumonia differ for a person who has comorbidities

Answer 29

macrolide “mycins” PLUS fluroquinolone “floxacins” or beta lactam (cefotaxime, ceftriaxone, ampicillin)

Question 30

is hemoptysis a common symptom of pneumonia

Answer 30

no, although it can happen, it is not common and may suggest necrosis, lung abscess or another underlying lung disease