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Diagnosis and Management of Lower Respiratory Disorders Flashcards

1
Q

Acute inflammation of the upper airways presenting with persistent cough and sputum production; mucous membranes become edematous and hyperemic

A

Acute Bronchitis

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2
Q

__________

Systemic disease caused by M. tuberculosis

A

Tuberculosis

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3
Q

Atypical Pneumonia: Management
1. Healthy patients (< 60 years of age with no comorbidities - no recent antibiotic use): a.
A macrolide, such as _______ (Zithromax), clarithromycin (Biaxin), erythromycin, fluoroquinolones, or doxycycline

A

azithromycin

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4
Q

Typical Pneumonia: Management

  1. Patients with other health problems (e.g., COPD, diabetes, heart failure, or cancer or > 60 years of age, no recent antibiotic use):
    a. Fluoroquinolone, such as _________ (Levaquin), gemifloxacin (Factive), or moxifloxacin (Avelox), or beta-lactam plus a macrolide
A

levofloxacin

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5
Q

Typical Pneumonia: Management
1. Healthy patients (< 60 years of age with no comorbidities - no recent antibiotic use): a.
A macrolide, such as _________ (Zithromax), clarithromycin (Biaxin), erythromycin, or doxycycline

A

azithromycin

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6
Q

Laboratory/Diagnostics Pneumonia
1. ______ WBCs (maybe low in immunocompromised
or elderly)
2. Infiltrates by CXR
3. GS and culture if indicated
4. CXR and consider blood cultures as needed

A

Elevated

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7
Q

Atypical Pneumonias: Pathogens
Caused by atypical pathogens such as
C_______ pneumoniae

A

Chlamydophila

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8
Q

Atypical Pneumonias: Pathogens
Caused by atypical pathogens such as
M________ pneumoniae

A

Mycoplasma

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9
Q

Atypical Pneumonias: Pathogens
Caused by atypical pathogens such as
L_______ pneumophila,

A

Legionella

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10
Q

Atypical Pneumonia: Signs/Symptoms

  1. Cough
  2. Headache
  3. ______ _________
  4. Excessive sweating
  5. Fever
  6. Soreness in the chest
A

Sore throat

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11
Q 
Typical Pneumonia: Signs/Symptoms
Fever/shaking chills
Purulent sputum
Lung \_\_\_\_\_\_\_\_ on physical exam 
Malaise
Increased fremitus
A

consolidation

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12
Q

_________ pneumoniae is the most common etiological agent of community-acquired pneumonia (CAP) in adults.

A

Streptococcus

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13
Q

________
Inflammation of the lower respiratory tract as microorganisms gain access by aspiration, inhalation, or hematogenous dissemination; accounts for 10% of admissions to medical services

A

Pneumonia

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14
Q

Out-Patient Management: (Chronic Bronchitis/Emphysema) .*

5. Inhaled tiotropium bromide (______) promotes bronchodilation

A

Spiriva

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15
Q

Out-Patient Management: (Chronic Bronchitis/Emphysema) .*

  1. Inhaled ipratropium bromide (______) or
    sympathomimetics: Mainstay of therapy
A

Atrovent

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16
Q

Out-Patient Management: (Chronic Bronchitis/Emphysema) .*

3. _____ drainage may clear excess secretions

A

Postural

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17
Q

Out-Patient Management: (Chronic Bronchitis/Emphysema) .*

2. Avoidance of irritants or ______

A

allergens

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18
Q

Out-Patient Management: (Chronic Bronchitis/Emphysema) .*

________ of smoking

A

Discontinuation

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19
Q

Patients usually have features of both (Chronic Bronchitis/Emphysema) .
Laboratory/Diagnostics
3. TLC, FRC, and RV maybe ______

A

increased

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20
Q

Patients usually have features of both (Chronic Bronchitis/Emphysema) .
Laboratory/Diagnostics
2. FEV1 and all other measurements of expiratory airflow _______

A

reduced

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21
Q

Patients usually have features of both (Chronic Bronchitis/Emphysema) .
Laboratory/Diagnostics
1. Low, ______ diaphragm by CXR

A

flattened

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22
Q

Emphysema

8. Total lung capacity ______

A

increased

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23
Q

Emphysema

7. Hematocrit _____

A

normal

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24
Q

Emphysema

6. Percussion _______

A

hyper resonant

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25
Q

Emphysema

5. The Chest A-P diameter ________

A

increased

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26
Q

Emphysema

4. Body habitus (_____, wasted)

A

thin

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27
Q

Emphysema

3. ___ sputum (clear)

A

Mild

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28
Q

Emphysema

  1. The onset of symptoms after age ___
A

50

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29
Q

Emphysema

  1. Progressive, constant ______
A

dyspnea

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30
Q

Chronic Bronchitis

  1. Hematocrit _______
A

increased

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31
Q

Chronic Bronchitis

  1. _______ on CXR
A

Hyperinflation

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32
Q

Chronic Bronchitis

  1. Percussion _____
A

normal

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33
Q

Chronic Bronchitis

  1. Chest A-P diameter _______
A

normal

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34
Q

Chronic Bronchitis

  1. Body habitus (_____, obese)
A

stocky

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35
Q

Chronic Bronchitis

  1. _____ sputum production (purulent)
A

Copious

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36
Q

Chronic Bronchitis

  1. The onset of symptoms after age _____
A

35

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37
Q

Chronic Bronchitis

Intermittent mild to moderate _____

A

dyspnea

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38
Q

Abnormal, permanent enlargement of the alveoli

A

Emphysema

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39
Q

Characterized by excessive secretion of bronchial mucus and is manifested by productive cough for three months in at least two consecutive years

A

Chronic bronchitis

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40
Q

Management Asthma:
6. Antileukotrienes useful in the maintenance of chronic
asthma [e.g., montelukast (_____)]

A

Singulair

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41
Q

Management Asthma:
5. Inhaled anticholinergics [e.g., ____ ______
(Atrovent)] may be added if necessary

A

ipratropium bromide

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42
Q

Management Asthma:
4. If symptoms persist, increase inhaled corticosteroids or add long-acting B2 adrenergic agonists [e.g.,
Salmeterol
(_____)]; other options: ________ or antimediators

A

Serevent

theophylline

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43
Q

Management Asthma:
2. Daily maintenance with inhaled corticosteroids (e.g., Budesonide (Pulmicort), Triamcinolone (Azmacort, etc.)]
a. Side effects include candidal infection of the
oropharynx, dry mouth, and _____ _____

A

sore throat

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44
Q

Management Asthma:
2. Daily maintenance with inhaled corticosteroids (e.g., Budesonide (______), Triamcinolone (_______, etc.)]
a. Side effects include candidal infection of the
oropharynx, dry mouth, and sore throat

A

Pulmicort

Azmacort

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45
Q

Management Asthma:

Short-acting B2 adrenergic agonist [e.g., Albuterol (_______)] for symptom relief or before exercise

A

Proventil

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46
Q

Laboratory/Diagnostics Asthma:

5. The chest x-ray is ________ unless to rule out other conditions; may show hyperinflation

A

unnecessary

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47
Q

Laboratory/Diagnostics Asthma:

5. The chest x-ray is ________ unless to rule out other conditions; may show hyperinflation

A

unnecessary

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48
Q

Laboratory/Diagnostics Asthma:

4. Initially, respiratory _____ expected as the primary acid/base imbalance

A

alkalosis

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49
Q

Laboratory/Diagnostics Asthma:

3. Will generally see improvement in FVC or FEV 1 of 15% or FEF 25 to 75 of __% after an inhaled bronchodilator

A

25%

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50
Q

Laboratory/Diagnostics Asthma:
2. PFTs reveal abnormalities typical of obstructive dysfunction
b. Hospitalization is recommended if peak flow is < ___
liters/minute initially or does not improve to > 50%
predicted after one hour of treatment.

A

60

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51
Q

Laboratory/Diagnostics Asthma:
2. PFTs reveal abnormalities typical of obstructive dysfunction
a. Hospitalization is recommended if the initial FEVI is <
____% predicted or does not increase to at least 40%
predicted after one hour of vigorous therapy.

52
Q

Laboratory/Diagnostics Asthma:

Slight WBC elevation with _________

A

eosinophilia

53
Q

Signs/Symptoms of Asthma:
** Ominous signs include fatigue, absent breath sounds, _______ chest/abdominal movement, inability to maintain recumbency, cyanosis, and others **

A

paradoxical

54
Q

Signs/Symptoms of Asthma:

  1. Pulsus paradoxus > ___ mm Hg
  2. Hyperresonance
  3. Cough
  4. Chest tightness
55
Q

Signs/Symptoms of Asthma:

6. Pulse > ____ bpm

56
Q

Signs/Symptoms of Asthma:

5. Respiratory rate > ____ bpm

57
Q

Causes Asthma:

  1. Dust mites
  2. Pets (cat, dog)
  3. Cockroaches
  4. Indoor molds
  5. _________
  6. Cigarette smoke
58
Q

_________
Increased responsiveness of the trachea and bronchi to stimuli, manifested by narrowing of the airways; hypertrophy of smooth muscle, mucosal edema and hyperemia, thickening of the epithelial basement membrane, hypertrophy of mucus glands, acute inflammation, and plugging of airways by thick, viscid mucus

59
Q 
Management Acute Bronchitis:
1. Supportive treatment
2. Humidifiers
3. Increase fluid intake
4. Cough suppressants used judiciously
5. Analgesics for chest soreness or fever
6. B2 adrenergic agonists [Albuterol (Proventil)] for 
     wheezing 
7. Antibiotics indicated only for bacterial infections 
    a. \_\_\_\_\_\_\_\_\_\_
    b. Doxycycline
    c. Trimethoprim-sulfamethoxazole
A

Macrolides

60
Q

Laboratory/Diagnostic Findings Acute Bronchitis:

  1. Usually, none indicated
  2. If the diagnosis is unclear:
    a. ________ culture and sensitivity
    b. CXR
61
Q

Physical Exam Findings Acute Bronchitis:

  1. No evidence of lung consolidation
    a. Clear to auscultation
    b. Resonance to percussion
    c. Upper airway rhonchi clear with coughing
  2. ______ or low-grade temperature (viral)
  3. More pronounced temperature (bacterial)
62
Q

Signs/Symptoms of Acute Bronchitis

  1. Productive cough
  2. _________
  3. Wheezing
63
Q

Causes/Incidence of Acute Bronchitis:

4. Most common in patients < ____ years old

64
Q

Causes/Incidence of Acute Bronchitis:

3. Increased incidence in _____

65
Q

Causes/Incidence of Acute Bronchitis:
2. Bacterial: Mycoplasma pneumoniae, Streptococcus
pneumonia, _____, Moraxella catarrhalis

66
Q

Causes/Incidence of Acute Bronchitis:

Viral: Rhinovirus, ______, adenovirus

A

coronavirus

67
Q

Systemic disease caused by M. tuberculosis

A

Tuberculosis

68
Q
  1. The most common clinical presentation is pulmonary disease
A

Tuberculosis

69
Q

Tuberculosis

2. Other sites of involvement include lymphatics, genitourinary, ______, meninges, peritoneum, and the heart

70
Q

Tuberculosis
3. Patients at increased risk include those in crowded living conditions; the institutionalized; ____-positive persons; and those afflicted with diabetes, chronic renal insufficiency, malignancy, malnutrition, and other forms of immunosuppression.

71
Q 
Tuberculosis
Signs/Symptoms
1. Majority of patients are asymptomatic
2. \_\_\_\_, anorexia
3. Dry cough progressing to productive and sometimes 
    blood-tinged
4. Weight loss, low-grade fever
5. Night sweats
72
Q

Laboratory / Diagnostics: Tuberculosis

  1. Definitive diagnosis by culture of M. _____ X 3
  2. AFB smears are presumptive evidence of active TB
  3. Small homogeneous infiltrate in upper lobes by CXR
  4. PPD shows exposure: Not diagnostic for active disease; repeat CXRin six months
A

tuberculosis

73
Q

Laboratory / Diagnostics: Tuberculosis

2. ___ smears are presumptive evidence of active TB

74
Q

Laboratory / Diagnostics: Tuberculosis

3. Small homogeneous infiltrate in _____ lobes by CXR

75
Q

Laboratory / Diagnostics: Tuberculosis

4. ______ shows exposure: Not diagnostic for active disease; repeat CXRin six months

76
Q

Management: Tuberculosis

1. The local health department should ____ notified of all cases of TB.

77
Q

Management: Tuberculosis
2. Hospitalization is not required but should be considered if the patient is non-compliant or is likely to expose susceptible individuals ( _______ pressure room).

78
Q

Medication Regimen: Tuberculosis

1. _____ 300 mg, rifampin 600 mg, pyrazinamide 1.5 to 2.0 gm, and ethambutol 15 mg/ kg initially

79
Q

Medication Regimen: Tuberculosis

2. If the isolate proves to be fully susceptible to INH and RIF, then the fourth drug may be _____.

80
Q

Medication Regimen: Tuberculosis

3. Continue the first three drags daily for ___ months, then four more months of INH and RIF daily.

81
Q

Medication Regimen: Tuberculosis

4. Persons with HIV should be treated for ____ months.

82
Q

Medication Regimen: Tuberculosis

5. A variety of DOT options are also available at ________ times weekly dosing,

A

twice/three

83
Q

Monitoring Therapy: Tuberculosis
1. Patients with pulmonary TB should have _____ sputum smears and cultures for the first six weeks after initiation of therapy, then monthly until negative, cultures documented.

84
Q

Monitoring Therapy: Tuberculosis

2. Continued symptoms or positive cultures after ____ months should raise the suspicion of drug resistance. “

85
Q

Baseline Evaluation: Tuberculosis

1. Liver function studies, CBC, and serum _____ should be obtained at baseline.

A

creatinine

86
Q

Baseline Evaluation: Tuberculosis

2. Patients taking ethambutol should be tested for visual acuity and ______ color perception.

87
Q

Chemoprophylaxis
Those with a positive skin test should receive six months of INH:

  1. A positive test is ____ mm for HW infected persons, contacts of a known case, or persons with a chest film typical for TB.
88
Q

Chemoprophylaxis
Those with a positive skin test should receive six months of INH:

  1. A positive test is ___ mm for immigrants from high prevalence areas, or those in high-risk groups, or health care workers.
89
Q

Chemoprophylaxis
Those with a positive skin test should receive six months of INH:

  1. A positive test is ____ mm for all others not in high prevalence groups.
90
Q

Pulmonary Function Tests

The volume of gas forcefully expelled from the lungs after maximal inspiration FEV1

91
Q

Pulmonary Function Tests

The volume of gas expelled in the first second of the FVC maneuver

92
Q

Pulmonary Function Tests

Maximal mid-expiratory airflow rate

93
Q

Pulmonary Function Tests

Maximal airflow rate achieved in FVC maneuver

94
Q

Pulmonary Function Tests

The volume of gas in the lungs after maximal inspiration

95
Q

Pulmonary Function Tests

Functional residual capacity

96
Q

Pulmonary Function Tests

The volume of gas remaining in the lungs after maximal expiration

97
Q

______ diseases characterized by reduced airflow rates; lung volumes within the normal range or larger

A

Obstructive

98
Q

_______ diseases characterized by reduced volumes and expiratory flow rates

A

Restrictive

99
Q

Types of Pleural Effusions

  1. ___________
  2. Exudates
  3. Empyema
  4. Hemorrhagic
A

Transudates

100
Q

Gerontology Considerations
Pulmonary
1. Physiologic changes
a. Lungs become _____

101
Q

Gerontology Considerations
Pulmonary
1. Physiologic changes
b. Respiratory muscle strength and endurance _____

102
Q

Gerontology Considerations
Pulmonary
1. Physiologic changes
c. The chest wall becomes more _____

103
Q

Gerontology Considerations
Pulmonary
d. Total lung capacity remains constant, but:
____ ____ (the volume of air that can be forcibly
exhaled) decreases because of residual volume
increases (the amount of au” remaining in the lungs
after maximum expiration).

A

Vital capacity

104
Q

Gerontology Considerations
Pulmonary
1. Physiologic changes
e. ______ AP diameter

105
Q

Gerontology Considerations
Pulmonary
1. Physiologic changes
f. __________ to percussion

A

Hyperresonance

106
Q

Gerontology Considerations
Pulmonary
1. Physiologic changes
g. Alveolar surface area decreases up to _____%, which
reduces maximal oxygen uptake (i.e., over time,
exercise capacity declines secondary to less “reserve”).

107
Q

Gerontology Considerations
Pulmonary
1. Physiologic changes
h. Alveoli ______ more easily

108
Q

Gerontology Considerations
Pulmonary
1. Physiologic changes
i. The number of cilia _______

A

diminishes

109
Q

Gerontology Considerations
Pulmonary
1. Physiologic changes
j. The number of mucus-producing cells _____

110
Q

Gerontology Considerations
Pulmonary
1. Physiologic changes
k. ______ cough reflex

111
Q

Gerontology Considerations
Pulmonary
1. Physiologic changes
l. _______ response to hypoxia and hypercapnia

112
Q

Possible findings/results: Gerontology Considerations

a. ______ pulmonary functional reserve

113
Q

Possible findings/results: Gerontology Considerations

b. D__

114
Q

Possible findings/results: Gerontology Considerations

c. Exercise ______

A

intolerance

115
Q

Possible findings/results: Gerontology Considerations

d. Decreased chest/lung ______

116
Q

Possible findings/results: Gerontology Considerations

e. Less effective _______

A

exhalation

117
Q

Possible findings/results: Gerontology Considerations

f. ______ mucus clearance

118
Q

Possible findings/results: Gerontology Considerations

g. ______ risk of atelectasis, infection, and bronchospasm

119
Q

Gerontology Considerations:
Pneumonia
1. PEARLS in the Elderly

a. At least ____% of all cases are among adults over 65 years of age.

120
Q

Gerontology Considerations:
Pneumonia
1. PEARLS in the Elderly

b. Those living in a long term care facility have a ___% risk of development over a period of two years.

121
Q

Gerontology Considerations:
Pneumonia
1. PEARLS in the Elderly

c. Most common pathogens: ________ pneumoniae, gram-negative bacilli (Haemophilus influenza, Moraxella catarrhalis, Klebsiella), and Staph aureus

A

Streptococcus

122
Q

d. Clinical findings: Gerontology Considerations:
Pneumonia
•a. Classic, expected signs may be absent.
•b. Weakness; decreased ADLs
•c. Anorexia/poor appetite
•d. Tachypnea and/or SOB
•e. ________
•f. Fever with cough productive of sputum
•g. Confusion or mental status changes

A

Tachycardia

123
Q

e. CXR findings: Gerontology Considerations:
Pneumonia
• 1. May have ______presentations based on the
offending pathogen •

124
Q

e. CXR findings: Gerontology Considerations:
Pneumonia
2. ______ pneumonia can present with either
bronchopneumonia, lobar pneumonia, or other
locations on the CXR.

125
Q

e. CXR findings: Gerontology Considerations:
Pneumonia
• 3. ______ pneumonia may present as bilateral
interstitial infiltrates.

126
Q

e. CXR findings: Gerontology Considerations:
Pneumonia
• 4. _______ pneumonia may be localized to the right
middle lobe or show diffuse involvement.

A

Aspiration

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