Exam 2 FNP Theory 1 Flashcards
1
Q
WWhat is the difference between obstructive and restrictive lung disease?
A
Obstructive has shortness of breath because they can’t exhale all the air from their lungs. Restrictive cannot fully fill their lungs with air.
2
Q
Normal Respiratory rate for 0-1 year old
A
24-38
3
Q
Normal Respiratory rate for 1-3 year old
A
22-30
4
Q
Normal Respiratory rate for 4-6 year old
A
20-24
5
Q
Normal Respiratory rate for 7-9 year old
A
18-24
6
Q
Normal Respiratory rate for 10-14 years old
A
16-22
7
Q
Normal Respiratory rate for 15-18
A
14-20
8
Q
What is a common cause of morbidity and mortality in children under age of 2?
A
Foreign Body Aspiration
9
Q
What is the most fatal cause of aspiration?
A
Hot Dogs
10
Q
What is the cause of a rapid onset of hoarseness and the development of a chronic croupy cough and aphonia (loss of the ability to speak)?
A
Laryngeal foreign body aspiration
11
Q
What are the symptoms of a tracheal foreign body aspiration?
A
Brassy Cough
Hoarseness
Dyspnea
Cyanosis
Homophonic wheeze
12
Q
What diagnostic studies would you do for a foreign body aspiration?
A
X-ray (but some foreign bodies will not show up)
CT-scan if x-ray is inconclusion
Refer to pulmonology for bronchoscopy
13
Q
When is upper respiratory infections most contagious?
A
The first 3 days
14
Q
When should you decide not to do a throat swab?
A
if there are any nasal symptoms
15
Q
What is the peak incidence of croup?
A
2 years
16
Q
What are the ages that croup usually affects?
A
Between 6 months and 5 years
17
Q
When does croup usually happen?
A
Late fall, early winter
18
Q
What sex does croup usually affect more?
A
Males
19
Q
What’s the most common viral type of croup?
A
Laryngetracheitis
20
Q
What croup is caused by allergies and that occurs at night affecting the well child?
A
Acute spasmodic croup
21
Q
What croup is caused by a bacterial superinfection?
A
Laryngeotracheobronchitis and larygotrachobronchopneumonia
22
Q
What are the symptoms of croup?
A
Barking cough
gradual onset of rhinorhea, fever, sore throat
hoarseness
inspiratory stridor
symptoms typically worsen at night
23
Q
What diagnostics would you do if you suspect croup?
A
Nothing, it is usually based on clinical symptoms?
24
Q
If someone has croup and has an x-ray done, what would you find?
A
steeple sign evidence by laryngeal narrowing of subglottic space in the AP view
25
What is management of croup?
Antipyretics, pushing fluids, cool mist humidifier
26
What is the mainstay of pharmacological management for croup?
0.6 mg/kg dexamethasone im or orally or 2 mg budesonide nebulized
27
How long does croup usually last?
3-7 days
28
What are indications for hospitalization for croup?
Severe croup
Respiratory rate 70-90
Hypoxemia (RA>90)
Change in level of consciousness
Dehydration
29
What are the signs and symptoms of epiglottis?
Severe sore throat
Fever
Irritability
Muffled Voice (Hot Potato Voice)
Dyspnea
Drooling
Toxic Appearing
Tripod Position
30
If epiglottis is suspected, DO NOT
elicit a gag reflex.
31
X-ray for someone who has epiglottis will have
a thumb print sign
32
If you suspect someone has epiglottis what should you do?
Send them straight to the emergency room; may need a tracheostomy.
33
What is the peak age for epiglottis?
1-6 years
34
What is the peak incidence of bronchiolitis?
2-6 months
35
What is the most common cause of bronchiolitis?
RSV
36
What are risk factors for hospitalization for RSV?
Prematurity
Low Birth Weight
Less than 12 weeks of age
Bronchopulmonary disease
Defects of the airway
Congenital heart disease
Neurologic Disease
37
When does RSV bronchiolitis usually occur?
October through May
38
What organisms are involved with broncholitis?
RSV
Parainfluenza
Rhinovirus
Adenovirus
Influenza
Mycoplasma
39
What are the signs and symptoms of broncholitis?
Rhinorhea
Nasal Congestion
Low grade fever for 2 to 3 days
Poor appetite
Hoarse cough progressing to wet, deep cough
40
What are the physical examination signs for bronchiolitis?
Nasal congestion with thick purulent discharge
Tachypnea (40-80 breaths per minute)
Nasal flaring, head bopping, grunting
Fine or coarse crackles throughout breaths cycle
Hypoxemia
41
What diagnostic testing is needed for bronchiolitis?
Diagnostics usually made from clinical signs
X-ray not needed usually; if needed to rule out other differential; could see hyperinflation and a flattened diaphragm
Respiratory PCR could be ordered to determine virus
42
What is the management for bronchiolitis?
Supportive therapy (hydration, antipyretics, management of nasal congestion)
43
When is the peak illness for bronchiolitis?
3-4 days
44
What is the criteria for hospitalization for bronchiolitis?
Age
Tachypnea/Hypoxemia
Dehydration
45
What is anticipatory guidance for bronchiolitis?
Avoid secondhand smoke
Encourage breastfeeding for first 6 months
Reinfection is common
May have prolonged wheezing after infection
Cough and other signs may resolve after 1 to 2 weeks
46
What is the prevention for bronchiolitis?
Palivizumab Synagis) (limited to 24 months or younger), must be given every month during RSV season, this is limited to children that are at risk of getting severe RSV
1 dose of maternal RSV (Abrysvo) vaccine between 32 through 36 months of pregnancy
1 dose of nirsevimab for all infants age 8 months or younger born during their first RSV season
1 dose of nirsevimab for infants age 8-19 months of age who are at an increased risk and entering their second RSV season
47
What are clinical manifestations of bronchitis?
Dry, hacking cough typically last 3 to 4 days
Mild URI symptoms including rhinitis and pharyngitis
48
What are physical examination findings for bronchitis?
Initially clear, mucopurulent nasal drainage
Auscultation may be normal initially
Over the next week, may have coarse crackles
During this time, temperature becomes elevated
49
What are bronchitis diagnostics?
Bronchitis is usually a clinical diagnosis because 95% of cases are viral.
If bacterial bronchitis, a CBC can be ordered and an elevated neutrophil is suspect of bacterial etiology
50
What is the treatment for bronchitis?
Rest
Hydration
Avoid environmental irritants
Humidification of air
Antipyretics/Analgesics
Do not recommend cough suppressants
Follow-up in 2 weeks
51
How long does bronchitis last?
Usually self-limiting lasting about 2 weeks
52
How long can you be contagious with influenza?
Viral shedding 5-7 days prior to symptoms and can remain infectious for 10 days after
53
When is peak flu season?
December to March
54
Which influenza is the most serious?
Influenza A
55
What are influenza manifestations?
Abrupt onset of fever with rigors and chills
Pharyngitis
Cough
Diffuse myalgias
Fatigue
Headache
Conjunctivitis
Can have GI symptoms
56
When do symptoms usually resolve with influenza?
3-7 days
57
What are physical examination signs for influenza?
High fever
Tachycardia
Tachypnea
Nonproductive cough
58
What diagnostics do you need for influenza?
If symptom onset is less than 72 hours, then you can get a rapid PCR.
59
What is the treatment for influenza?
Encourage fluids
Antipyretics
Antiviral therapy for high risk children
Proper follow-up-->return if symptoms get worse
60
Who should get oseltamivir?
Younger than 2 years of age
Neurologic, blood, lung, endocrine, heart, kidney, liver disorders
Obese
Weakened immune system
Non-hispanic black persons, hispanci/latin person, and American Indian and Alaskan natives
61
What prevention can you talk to your patients about influenza?
Influenza vaccine greater than 6 months; children ages 6mo-8 years require 2 doses 1 month apart
62
What is the incubation phase for pertusis?
5-10 days
63
When are people contagious with pertusis?
From symptoms onset to 3 weeks later; most contagious from symptoms onset to 2 weeks after cough
64
What is the peak season for pertussis?
June-October
65
How is pertussis transmitted?
Airborne droplet
66
What is the catarrhal stage for pertussis?
upper respiratory symptoms; rhinorrhea, sneezing, mild cough, low-grade fever
67
What is the paroxysmal stage for pertussis?
Whooping cough
Color change, bulging eyes, tearing, tongue protrusion,
Post-tussive vomiting is common
68
What is the convalescent stage of pertussis?
The cough gradually decreases but can last for months
69
What are physical findings of pertussis?
Paroxysmal cough associated with cyanosis, lacrimation, post-tussive vomiting, exhaustion
Subconjunctival hemorrhages
Petechiae of head and neck
Breath sounds are normal
70
What is the gold standard for diagnostics for pertussis?
A culture but difficult to obtain because you need to swab the posterior nasopharynx for 15 to 30 seconds
71
What are the other diagnostics for pertussis?
PCR
CBC with show leukocytosis
72
What is the treatment for pertussis?
Macrolide antibiotics
Azithromycin
Clarithromycin
Erythromycin
Can use Bactrim in infants older than 2 months if they can't take a macrolide antibiotic, aren't responding to a macrolide or the culture sensitivity is resistant to macrolide
Need to treat everyone in the household and close contacts regardless of age, status, and symptoms
73
Do you have to report pertussis to the state health department?
Yes
74
What is the most common peak attack for pneumonia in children 2-3 years of age?
Viral
75
What is the most common peak attack for pneumonia in children over age 5?
Bacterial
76
What is the single largest cause of death worldwide?
Pneumonia
77
What are common pathogens for bacterial pneumonia?
Streptococcus pneumoniae
Mycoplasma Pneumonia
Streptococcus pyegines
Staphylococcus aureus
78
What are common pathogens for viral pneumonia?
Adenovirus
RSV
Parainfluenza I, II, III
Influenzas A and B
Rhinovirus
Human metapnumovirus
79
What are clinical manifestations of viral pneumonia?
Progresses more slowly than bacterial
Difficulty feeding, restlessness, fussiness
Nasal congestion
Hoarseness, wheezing, rapid/shallow respirations
Temperature variable
80
What are the clinical manifestations of bacterial pneumonia?
Abrupt onset of fever of 104
Mild cough, diarrhea, vomiting
Restlessness
Nasal flaring,
Abdominal distention
Cough may be absent
Circumoral cyanosis
81
What are physical examination findings for viral pneumonia?
Nontoxic appearing
Cough
Tachypnea
Diffuse bilateral wheezing
Decreased breath sounds
Retractions
Cyanosis
82
What are physical examination findings for bacterial pneumonia?
Fever
Tachypnea
Tachycardia
Fever
Diminished breath sounds
Dullness to percussion
Increased tactile fremitus over area of consolidation
May have palpable liver and spleen
Cyanosis
83
What type of pneumonia is usually a bacterial pneumonia?
Lobar pneumonia
84
What type of pneumonia is usually a viral pneumonia?
Interstitial pneumonia
85
What diagnostics are there for viral pneumonia?
Viral antigen in the respiratory tract
CXR will show bilateral diffuse infiltrates
WBC will be normal or less than 20,000
86
What diagnostics are there for bacterial pneumonia?
WBC count will be 15,000-40,000
CXR recommended for children with hypoxemia or respiratory distress
O2 Saturation
87
What bacterial pneumonia can present with GI symptoms?
Right lower lobe
88
What is pneumonia treatment for a viral pneumonia?
Supportive care
89
What is the treatment for bacterial pneumonia?
Children 6 months and younger are hospitalized
Acetaminophen for fever/pain
Amoxicillin for 7-10 days
90
What are indications for hospitalization for pneumonia?
Less than 6 months
Underlying medical problems (cardiopulmonary disease, genetic disease, immunocompromised)
Fever greater than 101.3
Cyanosis
Altered mental status
Dehydration
Extended capillary refill
Hypoxemia
91
What is the recommended follow-up for pneumonia?
Follow-up within 48 hours
If condition is worsened may require hospitalization.
CXR not recommended
Respond to treatment in 2-3 days
Another follow-up visit in 10-14 days
92
What is the pneumonia vaccine schedule?
2, 4, 6, 12-15
93
What is the cause of the COVID-19 pandemic?
SARS-COV-2
94
What is the transmission of the common cold coranovirus?
Direct contact with large aerosolized droplets
95
What is the transmission of the SARS coronavirus?
Close range contact
Respiratory particles
Airborne route
96
What are clinical manifestations of coronaviruses?
Most children are asymptomatic
Fever (1st symptom in neonates)
Cough (3rd symptom in neonates)
Shortness of breath
Myalgias
Rhinorrhea
Headache
Sore throat
Nausea/Vomiting
Abdominal pain
Diarrhea
Lost of smell or taste (Food aversion 2nd symptom in neonates)
97
What is the diagnostics for coronavirus?
Sars Covid-19 PCR
Have known exposure in the last 14 days
Requires clearance to return to school
98
What conditions place children at risk for severe COVID-19?
Medical complexity
Genetic, neurologic, and metabolic conditions
Congenital heart disease/cardiovascular disease
Obesity (BMI greater than 95th percentile)
Diabetes
Chronic pulmonary disease
Sickle cell disease
Immunosuppression
99
What is multisystem inflammatory syndrome in children?
Similar to Kawasaki disease (persistent fever, hypotension, GI symptoms, rash, and myocarditis)
100
What is the treatment for coronavirus?
Supportive care
Severe may need supplemental oxygen
101
When should you treat with antivirals for coronavirus?
One or more medical conditions that place them at risk
Lack of vaccination against COVID-19
Expected inadequate response to vaccine
Medical related technological depended not related to COVID-19
Having obesity
102
What is the antiviral needed for COVID-19?
Must be given withing 5 to 7 days of symptom onset
Greater than 12 years of age and greater than 40 kg-->Nirmetravelir-ritonavir
Greater than 28 days and greater than 3 kg-->Remdesivir
103
What is the genetic component of cystic fibrosis?
Both parents have to have the gene
104
What are clinical manifestations for neonates with cystic fibrosis?
Meconium ileus
Prolonged jandice
105
What are clinical manifestations for infants with cystic fibrosis?
Failure to thrive
Chronic cough
Recurrent pneumonia
106
What are clinical manifestations for children/adolescents with cystic fibrosis?
Severe dehydration
Unexplained bronchiectasis
Rectal prolapse
Chronic sinusitis
Unexplained pancreatitis or cirrhosis
Recurrent pneumonia
Wheezing
Exercise intolerance
hemoptysis
107
What is diagnostic testing for cystic fibrosis?
Sweat test
Order if newborn screening is negative but you suspect cystic fibrosis
Greater than 60 mmol/L
30-59 in infants less than 6 months
40-59 in children older than 6 months
less than 30; unlikely CF
Referral to CF clinic if positive
108
What is the management of cystic fibrosis?
High frequency chest wall oscillation twice daily
High-dose ibuprofen
Oral azithromycin 3 times a week-->screen for atypical bacteria before starting
Bronchodilators
Hypotonic nasal solution
High calorie, high protein, high fat diet
Supplementation of A, D, E, K
Starting at age 10; oral glucose test done annually
If diabetes is diagnosed, insulin is the treatment
109
What is pectus excavatum?
Funnel Chest
Autosomal dominant trait
Associated with Marfan Syndrome and Ehrlers-Danlos Syndrome
If severe, can affect pulmonary and cardiac systems
110
What is pectus carinatum?
Pigeon Chest
Most common in males
111
What is the management for pectus deformity?
Severe deformity, refer to pulmonologist or cardiologist
Surgical intervention best at the start of puberty
If genetic etiology, refer to geneticist
112
What is the definition of apnea?
Cessation of airflow greater than 20 seconds, accompanied by bradycardia
113
What is the definition of brief resolved unexplained event?
Cyanosis or pallor
Absent, decreased, or irregular breathing
Marked change in tone
Altered level of responsiveness
114
What puts someone at risk for a BRUE?
Less than 2 months of age
History of prematurity (less than 32 weeks)
Previous BRUE
Event duration greater than 60 seconds
CPR required
Concerning history of physical findings
115
What are some diagnostics you would do for a BRUE?
Respiratory panel
Electrolytes
Blood glucose
CBC
EKG
Echo
EEG
Blood gases
116
What is the management of a BRUE in someone who is low risk?
Monitor in office for 1-4 hours with pulse oximetry
117
What is the management of a BRUE in someone who is high risk?
Send to emergency room
118
What are risk factors for asthma?
Family history of eczema
Preadolescent boys
History of mother smoking prenatally
Respiratory viral illness
119
What are common triggers for asthma?
Inhalant allergens
Irritants (smoke exposure)
Viral illness
Weather
Exercise
Emotions/stress
Occupational exposure
Medication sensitivities (NSAIDs, aspirin)
Sulfite sensitivities (Processed food, beer, wine)
120
What are clinical manifestations in asthma?
Recurrent wheezing
Dry, persistent, nocturnal cough
Recurrent chest tightness or shortness of breath
Sputum production
Exercise induced cough
Atopic profile
Eczema
Seasonal symptoms
Rhinitis
Conjunctivitis
121
What are physical findings for asthma?
Allergic shiners
Allergic salute
Conjunctivitis
Boggy, pale, nasal mucosa
Grunting
Eczema
Bilateral wheezing, end-expiratory wheezing on forced expiration
Hyperresonance on percussion
Increased anterior-posterior diameter
Retractions
Dry cough
122
What are the diagnostics for asthma?
Detailed history
Spirometry greater than 7 years
Peak flow is a monitoring tool
CXR for new asthmatics
Allergy testing
GERD testing
123
What is intermittent asthma?
Symptoms less than 2 times per week and nighttime symptoms less than 2 times per month.
Asymptomatic and peak flow is normal between excaberations
124
What is mild persistent asthma?
Symptoms more than 2 times per week but less than daily
Nighttime symptoms 2 times per month
Exacerbations may affect activity
125
What is moderate persistent asthma?
Daily symptoms, daily use of SABA
Nighttime symptoms 1 time per week
Exacerbations affect daily activity
126
What is severe persistent asthma?
Continual symptoms, frequent exacerbations
Nighttime symptoms
Limited physical activity
127
What are non-pharmacological treatments for asthma?
Develop asthma action plan
Use peak flow monitoring
Avoid asthma triggers
128
What is the treatment for intermittent asthma?
Short acting beta agonist (Albuterol inhaler) as needed
129
What is the treatment for mild persistent asthma?
Short acting beta agonist (Albuterol)
Low dose inhaled corticosteroid (Budesonide, Fluctisone)
130
What is the treatment for moderate persistent asthma?
Medium dose inhaled corticosteroid or
Medium dose inhaled corticosteroid +LABA (formoterol or salmeterol) or Montelukast
131
What is the treatment for severe persistent asthma?
High dose inhaled corticosteroid or High dose inhaled corticosteroid + LABA or Montelukast or oral systemic glucocorticosteroid
132
When do you refer for asthma?
When you reach step 3, step 4 or higher especially
133
How is adult asthma different than children asthma?
Has high-pitched wheezes that do not clear with a cough
134
What is the spirometry results for intermittent asthma?
FEV1/FEV is greater than 80% and normal
135
What is the spirometry results for mild persistent asthma?
FEV1/FEV is greater than 80% and normalw
136
What is the spirometry results for moderate persistent asthma?
FEV1/FEV is below normal FEV1 is 60-80%
137
What is the spirometry results for severe persistent asthma?
FEV1/FEV is below normal FEV1 is below 60%
138
Does theolyphine need monthly labs?
Yes
139
What are the symptoms of asthma exacberations?
Worsening shortness of breath
Cough
Wheezing
Chest tightness
Can only speak short sentences
140
When do you sent acute exacerbations for asthma to the ER?
When peak flow is less than 50%
141
How do you treat an asthma exacberations?
SABA 2 to 8 puffs every 20 minutes for four times
Continue SABA every 3-4 hours for the next 24-48 hours
Add an oral glucocorticosteroid (prednisone 40-60 mg daily for 3-7 days)
142
When there are deterioting asthma symptoms, what should you do?
Continue inhaled SABAs
Use oxymask to keep saturation above 90%
Transfer to ED
Administer IV methyl prednisone (60-125 mg)
143
When should you refer for asthma?
Life threating exacberation
Any patient less than 4 that needs an ICS and LABA
Has been in the hospital greater than 2 times and on oral glucocorticosteroids greater than 2 times
Poor control or unresponsive to treatment
There is a question about asthma diagnosis
Unknown, severe allergy triggers
144
What are causative factors of COPD?
Smoking
Familial or hereditary factors
Allergy predisposition
145
What is chronic bronchitis?
Obstruction of small airway and productive cough greater than 3 months over 2 years
Skin has a blue tinge from hypoxemia
Peripheral edema secondary to heart failure
Chronic cough with large amounts of sputum
146
What is emphysema?
Loss of lung elasticity
Patient appears more cachectic
Pink skin color due to more normal oxygenation
Shortness of breath; tripod position
147
What are the most common symptoms of COPD?
Chronic cough
Chronic sputum production, excessive amounts usually white
Persistent dyspnea
May have wheezing and chest tightness
FEV1/FEV less than 70% and not reversed with a bronchodilator
148
What are the diagnostics of COPD?
Obtain baseline pulse ox
Pulmonary function testing
Office spirometry
CBC may show increased HCT
149
What can improve survival rates of COPD?
Nicotine patches
Chantix
Bupropion
150
What lifestyle changes can help COPD symptoms?
Wear a mask when working with environmental irritants
Avoid temperature extremes
Increase humidification
Bronchial hygiene with pursed lip breathing
Increased fluids
Refer to pulmonology rehab
Encourage annual pneumonia and influenza
Encourage exercise
151
What is classified as mild COPD?
No exacerbation within the last year
No hospitalization within the last year
CAT score less than 10
FEV1 greater than 80%
152
What is classified as moderate COPD?
Less than 1 exacerbation within the last year
NO COPD hospitalization within the last year
CAT score greater than 10
FEV1 50-80%
153
What is classified as severe COPD?
Greater than 2 exacerbations within the last year and/or 1 hospitalization within the last year
CAT score less than 10
FEV1 30-50%
154
What is very severe COPD?
Greater than 2 exacerbations within the last year and/or 1 hospitalization within the last year
CAT score greater than 10
FEV1 less than 30%
155
What is the treatment for mild COPD?
SABA as needed
Oxygen at night
156
What is the treatment for moderate COPD?
Either start with a LAMA or LABA.
Or both
SABA as needed
May need oxygen with activity
157
What is the treatment for severe COPD?
Add the LAMA or LABA
Could add ICS
SABA as needed
158
What is the treatment for very severe COPD?
LABA+LAMA
SABA as needed
Continue oxygen
Consider macrolide (especially if a smoker)
159
What are signs of COPD exaberations?
Worsening dyspnea
Increased sputum production
Sputum purenlence
160
What are indications for hospitalization for COPC?
Sudden, severe worsening of dyspnea at rest
Changes or worsening of peripheral edema
Failure to respond to treatments
History of comorbidities under poor control
Lack of home support
161
What are pharmacotherapy for COPD exacerbations?
Initiate O2 therapy.
Increase the frequency of SABA and may add SAMA.
Add oral glucocorticosteroid for 5 days (prednisone 40 mg).
162
When should you prescribe an antibiotic for COPD?
When there are 3/3 of the cardinal symptoms, or 2/3 of the cardinal symptoms with one being purulent sputum.
163
What is a complication of COPD?
Cor Pulmonale
164
What are signs of Cor Pulmonale?
Peripheral edema, elevation of neck veins, and a congested liver
165
How do you diagnose Cor Pulmonale?
Significant COPD with elevated hematocrit and hypoxemia
EKG
166
How do you treat Cor Pulmonale?
Treat airflow obstruction
Restrict salt intake to 2 grams/day
24-hour diuretic
Add supplemental oxygen to reach oxygen saturation between 90-95%
Monitor hemoglobin/hematocrit every 4 to 8 weeks
167
What is the most frequent reason for acute care visits?
Cough
168
What are the most common reason for a chronic cough?
Post Nasal Drip
GERD
Asthma
169
What are some diagnostics to consider for a cough?
Chest X-ray
Office Spirometry
Speech pathology consult
H. Pylori Test
CBC
TB skin testing
Sinus CT
170
What are treatments for acute cought?
Lozenges
Intranasal Ipratropium
Albuterol
Antihistamines
Hypertonic nasal spray
Increased humidification
Antitussives
171
What are the treatments for a subacute cough?
Intranasal Ipratropium
Inhaled corticosteroids
Antihistamines
Dextromethasone/Guaifenesin
Codeine
172
What are treatments for a chronic cough?
Stop smoking
Increase humidification
Antitussives
Intranasal Ipratropium
Refer to pulmonology
173
What are clinical manifestations for bronchiatasis?
Sputum Production
Hemoptysis
Infections
Tenacious Cough
174
What is the diagnostics for bronchiastasis?
High Resolution CT
175
What is the management for bronchiastasis?
Massive bleeding: refer to ER
Infection: Treat with macrolide abx
Quit Smoking
Pulmonary Rehabilition
176
What are clinical manifestations for acute bronchitis?
Cough, with or without sputum production that lasts 1-6 weeks
Cough may produce burning substernal pain
Low grade fever, rales, rhonchi may be present
177
What are the diagnostics for acute bronchitis?
It is a clinical diagnosis.
CBC; Leukocytosis may indicate bacterial infection
Elevated CRP may be indicative of pneumonia
178
What is the treatment of acute bronchitis?
Supportive care
Antitussive therapy
Dextromethorphan (10-20 mg every 4 hours)
Benzonatate (100 to 200 mg 3/times a day as needed for cough)
Codeine (30 mg every 4 to 6 hours)
179
What are indications for referral for acute bronchitis?
Patients with progressive dyspnea
O2 saturation is less than 90%
Signs of sepsis
180
What are the four most common serious causes of dyspnea?
Heart Failure
Pneumonia
Obstructive Lung Disease
Pulmonary Embolism
181
What are risk factors for Obstructive Sleep Apnea?
BMI (Greater than 30)
Waist circumference greater than hip circumference
Neck Circumference (Greater than 16 in women and greater than 17 in males)
Traumatic craniofacial injuries
Male gender
Age greater than 40
Smoking history
Postmenopausal women
Comorbidities (DM, HF, COPD, CVA, hypothyroidism)
Substance abuse
182
What are signs and symptoms of obstructive sleep apnea?
Snoring and apnea periods
Daytime sleepiness
Poor concentration
Does not feel rested upon awakening
183
What are physical findings for obstructive sleep apnea?
Obesity
Crowded oropharyngeal airway
Large neck circumference
Mallampti score (3 and 4 are high risk)
184
What are diagnostics for obstructive sleep apnea?
STOP-bang questionnaire
Gold standard is in-laboratory polysomnography
185
What is the criteria for diagnosis obstructive sleep apnea?
Mild OSA is 5-14 events per hour
Moderate OSA is 15 to 29 events per hour
Severe OSA is greater than 30 per hour
186
What is the treatment for obstructive sleep apnea?
Lifestyle changes
Refer to pulmonology/sleep specialist for co-management
Positive airway pressure is the gold standard
187
If you have a patient that is complaining about the positive airway pressure device, what should you do?
Mask Fit
Humidification
Pressure adjustments
188
What type of breathing usually happens with nonhypercapnic central sleep apnea?
Cheyenes-Stokes
189
What is considered massive hemotypsis?
200 mL of blood in 24 hours
190
What are the most common causes of hemotypsis?
Acute/chronic bronchitis
Lung Cancer
Pneumonia
Tuberculosis
191
What may be a sign of lung cancer?
Abrupt hemoptysis in smokers proceeded by a chronic with little to no sputum production
192
What diagnosis would you make if someone presented with hemoptysis, acute onset of fever, sputum production, and pleuritic pain.
Pneumonia
193
What are diagnostics for hemoptysis?
Chest X-ray
CT (40 years or older and smoking at least 30 pack a year)
Bronchoscopy (hemoptysis greater than 1 week)
CBC
Coagulation studies
Sputum cytology
194
What is the management of hemoptysis?
Emergency referral if massive hemoptysis
Referral to pulmonology if persistent hemoptysis
Monitor every 3 years if negative findings on diagnostics
195
What are signs and symptoms of active tuberculosis?
Fatigue
Unintentional weight loss
Anorexia
Low grade fever
Night sweats lasting longer than 1 to 3 weeks
Productive cough (usually dry and progress to purulent)
196
What are signs and symptoms of latent tuberculosis?
Does not have any clinical findings
197
What are the risk factors for exposure of tuberculosis?
Extended travel in high incidence countries
Illicit drug use
Immigration in the last 5 years from high incidence countries
Medically underserved or homeless persons
Resident or employee in institutional or health care facilities
198
What are risk factors from latent TB to active TB?
Age younger than 5 years
Body weight less than 90% of ideal weight
Diabetes mellites
Drug and alcohol abuse
History of untreated active TB
Immunosuppressive disease
Immunosuppressive therapy
Recent contact with someone who has active TB
199
What is the screening for TB?
Mantoux test
200
If the induration is 5 mm or greater, what individuals is this positive for
HIV
Recent contact
Nodular or fibrotic changes on x ray
Organ transplant
201
If the induration is 10 mm or greater, what individuals is this positive for
Recent arrivals from high incidence countries
IV drug users
Resident/employee of high-risk congregate setting
Mycrobacterology lab personel
Comorbid individuals
Children less than 4
Infants, children exposed to high risk individuals
202
If the induration is 15 mm or greater, what individuals is this positive for
Persons with no known risk factors for TB
203
What are the diagnostics for TB?
Chest X-ray
QuantiFERON Gold is the test of choice for someone who has had a TB vaccine
Sputum culture for acid-fast bacilli
204
What is the treatment of TB?
Referral to health department (within 24 hours)
Referral to infectious disease
205
How is community acquired pneumonia classified?
Occurs in community and is greater than 48 of hospitilization
206
What is the most common organism that causes bacterial pneumonia?
Streptococcus pneumonia
H. influenza
207
What types of organisms can cause viral pneumonia?
Parainfluenza
Influenza
208
What types of organisms can cause atypical pneumonia?
Mycoplasma pneumonia
Legionella
Chlamydophila pneumonia
209
How can you get fungal pneumonia?
Soil or bird droppings
210
What are signs and symptoms of pneumonia?
Tachypnea
Tachycardia
Fever
Exertional dyspnea
Anorexia
Decreased breath sounds
Egophony on auscultation
Dullness to percussion
211
What are the diagnostics for pneumonia?
Pulse oximetry
CBC (Leukocytosis with a left shfit, leukopenia, hgb/hct may be lower)
CMP to evaluate kidney function
CRP if greater than 40 is suspect of bacterial
Test for influenza
Chest X-ray (Bacterial is consolidated; viral/atypical is interstitial)
212
When should you refer to the hospital for pneumonia?
Confusion
Elevated BUN
Respiratory rate greater than 30
Systolic blood pressure less than 90
Age greater than 65
213
What is the treatment for pneumonia?
If they are not allergic to penicillian and no comorbidities, amoxicillin plus a macrolide.
If they have comorbidities, Augmentin plus a macrolide.
Alternative would be doxycycline.
NSAID/Tylenol
Bentonites
Consider stopping PPI for 1 month after the illness
Consider oxygen therapy if pulse ox drops to 88%
Humidification
214
What is the follow-up for pneumonia?
Follow up in the office in 24 to 48 hours
If not improving, refer to emergency room
Encourage pneumonia vaccine dependent on age.
215
What are risk factors for lung cancer?
Smoking
Environmental exposure
Comorbidities
History of chest radiographs
Genetics
216
What are the signs and symptoms of lung cancer?
New onset of cough in smoker/former smoker
Hemoptysis
Dyspnea
Hoarseness
Superior vena cava syndrome (dilated neck veins, facial edema)
Chest pain
Pleural involvement
Weight loss
217
What are the diagnostics of lung cancer?
Chest X-Ray
If abnormal, CT
Then refer to pulmonology/oncology
Serum calcium level
PT/PTT
CBC
CMP
218
What are signs of cancer mets outside of lung cancer?
Liver (asymptomatic)
Bone (Elevate CA and alk phos level)
Adrenal
Brain
Supraclavicular lymph node enlargement
219
What is the primary treatment in early stages of lung cancer?
Lobectomy
220
What is the primary treatment in late stages of lung cancer?
Radiation/Chemotherapy
221
What is the treatment of small cell lung cacer?
Chemotherapy/Radiation
Pallitative
222
Who should get a low CT lung cancer screening?
Annual low dose screening in high risk individuals (50-77 years) with a greater than 20 smoke pack history and current smoker or has quit within 15 years
223
What are common causes of pleural effusions?
CHF
Pneumonia
Cancer
Viral Infections
224
What are signs and symptoms of pleural effusions?
Often asymptomatic
Can present with dyspnea, nonproductive cough, pleuritic chest pain, activity intolerance
225
What are diagnostics for pleural effusion?
Chest X-ray
CT Scan or PET scan if malignancy is suspected
If effusion is diagnosed, order thoracentesis
226
What is transduative pleural effusions look like?
Occurs due to increased hydrostatic pressure or low plasma oncotic pressure
Examples include CHF, liver cirrhosis, nephotic syndrome, pulmonary embolism
227
What is exudative pleural effusion look like?
Occurs due to inflammation and increased capillary permeability
Examples include pneumonia, cancer, TB, autoimmune, and viral infection
228
What is the management of a pleural effusion?
Management based on cause of effusion
May require a chest tube
Medications are driven to treat cause
229
What are the signs and symptoms of pulmonary hypertension?
Asymptomatic in early stages
In late stages, dyspnea, fatigue, chest discomfort, syncope, cough, edema, and decreased exercise intolerance.
230
What are physical exam findings for someone who has pulmonary hypertension?
Lung sounds are clear
Loud second heart sound
Murmur of tricuspid or pulmonic regurgitation
Loud S3 on inspiration
Decreased carotid pulse
Jugular vein distention
Increased liver size
Ascites
Edema
Atrial Flutter
231
What are the diagnostics for pulmonary hypertension?
EKG
Chest X-ray
ECHO or cardiac MRI
Right catherization for definitive diagnosis
232
What is the treatment for pulmonary hypertension?
Treatment is aimed at reducing physical symptoms
Referral to cardiology/pulmonology
Diuretics are the mainstay treatment
233
What poses the greatest risk for developing a pulmonary embolism?
DVT
234
What are signs and symptoms of a pulmonary embolism?
Non-specific and varies greatly between patients
Dyspnea
Tachypnea
Pleuritic chest pain
Hemoptysis
Orthopnea
Tachycardia
Jugular Vein Distension
Abnormal Lung Sounds
235
What are some risk factors for developing a pulmonary embolism?
Surgery
Trauma
Long-bone fracture
Travel
Period of immobility
Malignancy
Paralysis
Heart failure
Smoking
Pregnancy
Estrogen therapy
History of previous PE
236
What are the diagnostics for a pulmonary embolism?
Well's Criteria
Revised Geneva Score
Pulmonary Embolism Rule-Out Criteria
D-Dimer (It is only positive if caused by a thrombus; good to exclude a PE)
CT is the gold standard
237
What is the treatment for a pulmonary embolism?
Refer to emergency department
Initial anticoagulation is administered soon as possible. Low-molecular weight heparin 1 mg/kg twice a day
Long-term anticoagulation (up to 3 months) after discharge
238
What is the target INR treatment of PE?
2.0-3.0 with 2.5 being the target
239
What are the signs and symptoms of sarcodosis?
Dyspnea
Cough
Adventitious breath sounds
Chest pain
Lesions
Hypercalcemia
240
What are the diagnostics for sarcodosis?
Chest X-ray
CT
Tissue biopsy
241
What is the treatment of sarcodosis?
Corticosteroids is the first line treatment
Refer to pulmonology for biologic and cytotoxic agents
