Acute Respiratory

Question 1

Acute Bronchitis

Answer 1

acute and elf-limited inflammation of trachea / upper bronchial, viral

Cough for 7+ days, dyspnea occasionally, phlegm, low grade fever, most coughs non-productive

Treat with cough suppressants for rest, albuterol for smokers, symptom care

Symptoms for 2+ weeks = refer

Question 2

Chronic Bronchitis

Answer 2

Cough or sputum for most days of 3 month period

Question 3

Bronchitis Differentials

Answer 3

Asthma - cough at night, wheezes, triggered

CHF - shortness of breath when flat

Question 4

Chronic Cough Red Flags

Answer 4

Smoker with >20 pack year history
Smoker >45 years old with change to cough
Hemoptysis
Weight loss
Dyspnea at night
Pain / difficulty swallowing
Recurrent pneumonia
Anemia or fatigue
Significant sputum production

Question 5

Pneumonia (CAP v HAP)

Answer 5

Community acquired - not in facility or LTC for 14 days before symptoms. Strep, H. Influenza, M. Pneumonia

Hospital Acquired - 48 hours or after in facility. S. Pneumonia, Staph, Legionella, H. Influenza

Question 6

Atypical Pnuemonia

Answer 6

Not seen on gram stain. M. pnuemoniea, Chalymydia, Legionella, RSV

Question 7

Community Acquired Pneumonia Treatment

Answer 7

Usuallly S. Pneumoniae (Gram +)

Fever, chills, malaise, cough, dyspnea, consolidation

Doxycycline is first choice for treatment then Fluoroquinolone or Beta-Lactam + Macrolide

Question 8

Atypical Pneumonia Treatment

Answer 8

Less ill, dry hacking cough, less consolidation or rales

Doxycycline is treatment or amoxicillin in peds

Question 9

Pleural Effusions

Answer 9

abnormal amount of fluid in pleural space

caused by HF, Tb, PE, lung disease, lupus, viral infection, bacterial infection

Mild dyspnea, non productive cough, pleuritic chest pain, activity intolerance, pain often is sharp and unilateral with localization on deep respiratory

Mild cases the treatment is supportive, significant cases need referral

transudative pleural effusion is generally associated with a systemic condition rather than with a pleural disease

Question 10

Pleurisy

Answer 10

Inflammation of pleura
Symptom, not a diagnosis
localized chest pain with a shooting pain on inspiration
May have a friction rub

Can lead to an effusion

Question 11

ARDS

Answer 11

Fluid backs up in alveoli and surfactant breaks down causing alveoli collapse

Dyspnea is first sign, can lead to lung injury and DIC, pulmonary edema

Question 12

What is the criteria for hospitalization vs outpatient management for patients with pneumonia.

Answer 12

Decisions on whether to admit or treat in the community are based on patient symptoms, ability to care for self at home, and accessibility of heath care

CURB-65 Tool can be used
CURB-65 criteria, 1 point each:
1. Confusion
2. BUN >19 (if unable to get BUN: check urine and if dark or specific gravity is elevated; add 1 point)
3. Respiratory rate >30/min
4. SBP <90; DBP <60
5. Age ≥65
2+ = hospital or close observation at home
3+ = admit to hospital

Question 13

Consolidation signs

Answer 13

dullness on percussion
Increased tactile fremitus
Whispered pectoriloquy increased

Question 14

Vesicular v. Bronchial Breath Sounds

Answer 14

The bronchial breath sounds over the trachea / apex has a higher pitch, louder, inspiration and expiration are equal and there is a pause between inspiration and expiration.

The vesicular breathing is heard over the thorax, lower pitched and softer than bronchial breathing.

Question 15

Rhonchi

Answer 15

low pitched, loud, heard on inspiration

cleared with cough

Question 16

Vocal cord dysfunction

Answer 16

May mimic asthma signs

Question 17

Hyperresonance

Answer 17

If the percussion produces a drum-like sound known as hyperresonance, it could indicate excess air has filled the space around the lungs or in the lungs and is prohibiting them from expanding fully.

It also occurs in overinflation syndromes such as COPD, Asthma.