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NP > Adult - Respiratory > Flashcards

Adult - Respiratory Flashcards

1
Q

What is the most likely cause of acute bronchitis?

A

virus

rhinovirus, coronavirus, adenovirus

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2
Q

What are the signs and symptoms of acute bronchitis?

A

productive cough
~ headache
~ wheezing
~ fever

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3
Q

What is the significance of fever in acute bronchitis?

A

provides and important clue as to cause =
none or low grade –> viral
more pronounced –> bacterial

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4
Q

What are the lung sounds of acute bronchitis?

A

clear
OR
if rhonchi –> clear after pt directed to cough

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5
Q

What is the normal percussion tone of the chest?

A

resonant

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6
Q

What is the percussion tone of acute bronchitis?

A

resonant

therefore, no evidence of consolidation which would be seen in pneumonia

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7
Q

How is the diagnosis of acute bronchitis made?

A

usually by clinical picture

if concern about pneumonia, as in older adult –> CXR

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8
Q

What is the non pharm management of acute bronchitis?

A

supportive treatment
increased fluids
humidification

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9
Q

What is the pharm management of acute bronchitis?

A 
as needed:
~ analgesics
~ cough suppressants (judiciously)
~ SABA
~ antibiotics
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10
Q

If an antibiotic is warranted in acute bronchitis (significant fever, for example) which is a good choice?

A

macrolide (-mycin)

second line?
o doxycycline
o trimethoprim-sulfamethoxazole (Bactrim)

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11
Q

What does hyper-resonance indicate?

A

air trapping

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12
Q

Is the diagnosis of acute bronchitis vs pneumonia easier in the younger adult or older?

A

younger is more clear cut

hence, more CXR in older adult to be sure

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13
Q

What type of mucus is associated with asthma?

A

thick, viscid mucous which leads to plugging of airways

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14
Q

What is pulsus paradoxus?

A

Drop in systolic BP during inspiration

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15
Q

What are some ominous signs of asthma? (5)

A 
fatigue
absent breath sounds
cyanosis - late sign in the adult
inability to maintain recumbency
paradoxical chest/abdomen movement
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16
Q

How are PFTs / peak flows used to determine need for hospitalization in the adult?

A

if FEV1 is < 30% of predicted or dose not increase to at least 40% after 1 hour of vigorous therapy

OR

if peak flow is < 60 L/min initially or does not improve to > 50% of predicted after 1 hour of treatment

17
Q

Which two conditions make up COPD?

A

chronic bronchitis

emphysema

18
Q

characterized by excessive secretion of bronchial mucus and productive cough

A

chronic bronchitis

time frame?
at least 3 months in two consecutive years

19
Q

abnormal, permanent enlargement of the alveoli

A

emphysema

20
Q

What is the typical picture of a patient with chronic bronchitis?

A 
stocky or obese
normal chest A-P diameter
younger (onset after age 35)
copious, purulent sputum
intermittent dyspnea
21
Q

What is the typical picture of a patient with emphysema?

A 
emaciated
increased chest A-P diameter
older (onset after age 50)
thin, spit-like sputum
progressive, constant dyspnea
22
Q

Can people have features of both chronic bronchitis and emphysema?

A

yes

23
Q

What is the CXR finding of a patient with COPD?

A

low, flattened diaphragm

due to air trapping

24
Q

Which PFT values are reduced in COPD?

A

F or Flow values - FEV1 FVC etc

25
Q

Which PFT values may be increased in COPD?

A

C / capacity or V / volume values - TLC, FRC, RV

26
Q

What is the mainstay of COPD management?

A

inhaled anticholinergics - ipratroprium bromide (Atrovent)

27
Q

What is the most common causative organism in typical community acquired pneumonia in adults?

A

S. pneumoniae

28
Q

What are signs and symptoms of TYPICAL pneumonia? (5)

A 
LUNG CONSOLIDATION  (big diff from bronchitis)
fever/shaking chills
purulent sputum
malaise 
increased fremitus
29
Q

What are signs and symptoms of ATYPICAL pneumonia?

A

ENT and URI symptoms + lung symptoms

EXCESSIVE SWEATING
fever
headache
sore throat 
~ soreness in chest
adventitious breath sounds
30
Q

What are the most common causative organisms in atypical community acquired pneumonia in adults?

A

Legionella pneumophila

Mycoplasma pneumoniae

31
Q

What are the CXR findings in community acquired pneumonia?

A

infiltrates

32
Q

How are patients categorized into groups for management of CAP?

A

those < 60 years with no comorbidities –> macrolide (azithromycin, clarirthromycin, erythromycin)

those =/> 60 years or with other health problems –> fluoroquinolones (levofloxicin, gemifloxicin, moxifloxicin)

don’t over treat the younger, don’t undertreat the older

NP (76 decks)

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