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Adult Health > COPD/Pneumonia/Asthma > Flashcards

COPD/Pneumonia/Asthma Flashcards

1
Q

PNE- Organism- Streptococcus Pneumonia

A

Most common, rust colored sputum

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2
Q

PNE- Organism- H. Influenzae

A

2nd Most common in smokers and COPD

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3
Q

PNE- Organism- Staph Aureus

A

Rarely in younger adults, mostly older adults, usually after influenza

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4
Q

PNE- Organism- Mycoplasma Pneumonia

A

Walking Pneumonia- usually in younger adults

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5
Q

Signs and symptoms of Pneumonia

A

Sudden, rust color sputum, myalgia, prouctive cough, crackles, egophony, dense shadows on CXR, putrid sputum, Fever >100

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6
Q

How often is a causative organism found in PNE?

A

Rarely

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7
Q

What two things are needed to diagnose pneumonia?

A
  1. CXR

2. Clinical findings

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8
Q

Evaluation of sputum sample for PNE?

A

> 25% of epithelial cells suggests contamination; correct specimen should show polymorphonuclear leukocytes

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9
Q

Differential Diagnosis for PNE?

A

Bacterial Bronchitis, lung cancer, exposure to moldy hay

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10
Q

When does PNE need O2?

A

PaO2 < 55 or O2 <90%

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11
Q

What does CURB 65 measure?

A 
C-confusion
Bun >19 
RR >30 
BP 65
>65 y.o.
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12
Q

CURB 65 recommendations?

A

1- home treatment

3- severe, hospital treatment

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13
Q

Treatment for uncomplicated PNE? with no recent use or comorbidities

A

Macrolid or doxycycline

  1. Azyithromycin 500 mg QD x 3 days
  2. Doxycycline 100 mg BID x 7 days
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14
Q

Treatment for PNE with recent ABX in last three months? or Comorbidities

A
  1. Levofloxacin 750 mg x 7 days;

2. Azithromycin 500 + amoxicillin 750 mg 93-4 g/day)

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15
Q

PNE Treatment with MRSA?

A

Linezolid

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16
Q

When do you do a follow CXR on patients with PNE?

A

If they smoke. If it has not cleared, reevaluate ABX and possible cancer

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17
Q

Classic chronic bronchitis

A

Blue bloaters

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18
Q

Classic emphysema?

A

Pink puffers

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19
Q

Physical Assessment for COPD?

A

barrel chest, prominent palpable heart, wheezes, clubbing of nails

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20
Q

Differential dx of COPD?

A

Bronchitis vs emphysema and if it’s reversible

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21
Q

What is the FEV1/FVC in COPD?

A
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22
Q

GOLD stages of COPD with FEV1 ?

A

All have FEV/FVC 80%- Mild
2- 50-79%- Moderate
3- 30-49%- Severe
4- <30%- Very Severe

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23
Q

Diagnostics in COPD?

A

ABG, PFTs, not usually CXR; A1 antitrypsin in patients less than 45 y.o.

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24
Q

When do you start patients on oxygen for COPD?

A

PaO2 <55 or Saturation < 88%

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25
Q

Lines of Therapy in COPD? There are 4

A
  1. short SABA
  2. Anticholinergic Bronchodilators
  3. Long acting BA
  4. Steroids
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26
Q

How often do you check theophylline levels? and Correct levels?

A

Every 6-12 months.

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27
Q

What is a short acting B2 Agonist?

A

Albuterol

28
Q

What is a long acting B2 Agonist? x2

A

Formeterol, salmeterol

29
Q

What is an anticholinergic bronchodilator?x2

A

Ipratropium, tiotropium

30
Q

Examples of inhaled steroids? x3

A

Beclomethasone, budesonide, fluticasone

31
Q

Types of Triggers for Asthma? x3

A

Allergens/environment, infections, psychological

32
Q

T/F- all patients with asthma wheeze

A

False

33
Q

What is asthma characterized?

A

Reversible inflammatory obstructive airway disease

34
Q

Diagnosis of asthma?

A

PFTs, reversibility of >15 % after beta agonist

35
Q

What will CBC show in asthma?

A

Elevated ESR and eosinophils

36
Q

Differential diagnosis of asthma?

A

COPD, viral infection, CHF, coughs, Drugs such as BB, ASA, NSAID, ACE

37
Q

When to refer asthma to pulmonologist?

A

When it’s the first asthma diagnosis, or after step 3

38
Q

What are the drugs of choice for asthma?

A

Inhaled corticosteroids

39
Q

6 steps of asthma treatment?

A 
1- SABA PRN 
2- low dose steroid
3. Low steroid + LABA
4. Med Steroid + LABA
5. High Steroid + LABA, ? omalizumab?
6- High ICS +STeroid+oral steroid + omalizumab
40
Q

Other medications for asthma?

A

Cromolyn, theophilline, and omalizumab

41
Q

When should you consider omalizumab in patients with asthma?

A

At step 5

42
Q

What does lung cancer rate in the number of cancer deaths?

A

Highest cause of cancer

43
Q

Who should be screened for lung cancer?

A

High risk patients:

>55, >30 pack year within last 15 years

44
Q

How long does a cough with chronic bronchitis last?

A

3 weeks, but can last up to 4-6 weeks

45
Q

How long does the common cold last?

A

7-10 days

46
Q

In acute bronchitis, what percentage of infections are viral?

A

90%

47
Q

What are the three main infectious organisms for acute bronchitis?

A
  1. Bordetella Pertussis
  2. Chlamydophila pneumonia
  3. Mycoplasma pneumoniae
48
Q

What three things are not recommended for acute bronchitis, and which medication is?

A

Not recommended: abx, expectorants, and inhaler

Recommended as Needed: Albuterol, sometimes oral steroids if severe

49
Q

What are the two different types of pneumonia vaccinations and what do they cover?

A
  1. Pneumovax- 23 serotypes

2. PCV or Prevnar- 13 serotypes- 50 years and older

50
Q

What is a consequence of using macrolids such as clarithromycin or erythromycin? (x2)

A
  1. Should not be used with Calcium channel blockers for hypotension
  2. Should not be used with statin for increased risk of rhabdo
51
Q

Why are atypical pathogens not susecptible to beta-lactams?

A

Because they do not have a cell wall

52
Q

What antibiotics cause an increase in the QT interval?

A

Macrolid antibiotics

53
Q

What do patients with pneumonia usually present with?

A
  1. Cough (90%)
  2. Dyspnea (66%)
  3. Sputum production (66%)
  4. Pleuritic chest pain (50%)
54
Q

What is the most common pathogen in pneumonia in patients with COPD?

A

H. influenzae

55
Q

What antibiotic do you use for patients with latent tuberculosis (no CXR findings)?

A

Isonizid for 6-9 months

56
Q

When is an induration on PPD that is greater than 5 cm positive?

A
  1. HIV
  2. Recent contact with person with TB
  3. CXR consistent with prior TB
  4. Organ transplants
  5. Immunosuprressed (prednisone, immunomodulators)
57
Q

When is an induration on PPD that is greater than or equal to 10 cm positive?

A
  1. Recent Immigrant (<5 years)
  2. Injection drug user
  3. Residents and employees of high-risk congregate settings
  4. Mycobactteriology laboratory personal
  5. Persons with clinical conditions that place that at high risk
  6. Children less than 4
  7. Infants, children, and adolescents exposed to adults in high-risk categories
58
Q

When is an induration on PPD that is greater than or equal to 15 cm positive?

A

No known risk factors for TB

59
Q

When do you give oral steroid in COPD exacerbation?

A

If FEV is less than 60% of predicted.

60
Q

How long must patients wear oxygen with COPD per day?

A

15 hours

61
Q

What should all patients with COPD be referred to?

A

Pulmonary rehabilitation

62
Q

What medication should all patients with COPD get?

A

Short acting beta 2 agonist

63
Q

What is an FDA warning for long acting beta agonist in asthma?

A

Increased risk of death in certain groups if given without inhaled steroid

64
Q

What are side effects of inhaled steroids?

A

Candidiasis, sore throat, and hoarseness

65
Q

How long does the dose of oral steroids need to be before you taper them?

A

7 days.

66
Q

When do symptoms of asthma commonly occur?

A

At night, exercise

67
Q

What medication do most patients with COPD need and why?

A

Anticholinergics because the bronchioles are largely regulated by cholinergic receptors.

Adult Health (21 decks)

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