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PCMIII Exam 2 > HYHO SPE2 Upper Resp and PNA > Flashcards

HYHO SPE2 Upper Resp and PNA Flashcards

1
Q

Receptors that initiate coughing are located where?

A

Larynx, trachea, major bronchi

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2
Q

Signals sent by cough receptors travel by means of what nerves? To where?

A

Vagus N., Phrenic N.

Cough center in Medulla

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3
Q

Classic cough pattern

A

Deep inspiration => attempted expiration against closed glottis that suddenly opens => forceful exhalation of air, secretions, and foreign debris from tracheobronchial tree

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4
Q

Where is the coughing sound generated?

A

Larynx

(resonates in nasal cavity and lungs)

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5
Q

Most common clinical features of an upper respiratory infection/PNA

A

Cough (79-91% with or without sputum)

Fatigue/malaise (90%)

Fever/dyspnea (75%)

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6
Q

Positive predictive value of an upper respiratory complaint <60% with what combination?

A

Fever, tachycardia, rales, hypoxia (<95%)

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7
Q

What is the most common cause of chronic cough in healthy nonsmokers with normal CXR?

A

Upper Airway Cough Syndrome (UACS)

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8
Q

2nd most common cause of chronic cough

A

Asthma/COPD

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9
Q

3rd most common cause of chronic cough

A

GERD (after UACS and asthma/COPD)

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10
Q

Most sensitive and specific test for GERD

A

24-hr esophageal pH monitoring

(NOT required to make GERD dx)

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11
Q

First line treatment for GERD

A

PPI x4 weeks

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12
Q

Most common presentation of acute bronchitis

A

Productive (purulent) sputum production

Cough in healthy adult 1-3 weeks duration

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13
Q

Is the color of sputum diagnostic of a bacterial infection?

A

No, just indicative of epithelial cells and WBCs

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14
Q

When does the protracted phase of acute bronchitis occur?

A

After initial phase

Evidence of reactive airway disease, persistent cough 2-4 weeks

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15
Q

Are antibiotics recommended for URI?

A

NO

Only for at-risk pts (underlying heart/lung/kidney dz or immunosuppressed or in pts with a high suspicion for CAP

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16
Q

What medication can significantly reduce cough in pts with bronchial hyperreactivity?

A

Bronchodilators

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17
Q

How is sinusitis categorized chronologically?

A

Acute: <4 weeks

Subacute: 4-12 wks

Chronic: >12 weeks

Recurrent acute: 4+ episodes/year with interim resolution of sx

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18
Q

Most common organisms involved in acute bacterial sinusitis in adults

A

S. Pneumoniae

H. Influenza

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19
Q

Most common organisms involved in acute bacterial sinusitis in children

A

H. Influenza

Moraxella catarrhalis

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20
Q

Pt presents with purulent nasal discharge, maxillary dental/facial pain and tenderness. Pt states sx have gotten worse after initially improving a week ago. What do they most likely have?

A

Rhinosinusitis

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21
Q

First line therapy for sinusitis

A

Amoxicililin and TMP-SMX for 10-14 days directed at cause of infection

  • 2nd line: cephalosporins, fluoroquiniolones*
  • Oral/nasal decongestants for sx relief*
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22
Q

Most common etiology of pharyngitis

A

Viral

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23
Q

What population does pharyngitis more frequently occur in?

A

Pediatric population (4-7 yo)

30% caused by GAS

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24
Q

What bacterial microbes are the most common causese of pharyngitis in teens/young adults?

A

Mycoplasma pneumoniae

Chlamydia pneumoniae

Arcanobacterium

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25
GAS infection causing pharyngitis is extremely difficult to distinguish clinically from what infectious microbe?
EBV - Infectious mononucleosis
26
Findings of GAS pharyngitis
Abrupt onset sore throat and fever Tonsillar/Palatal petechiae Tender cervical adenopathy **Absence of cough**
27
Dx of GAS can be made by what 2 tests? Which one is the gold standard?
Rapid antigen testing (rapid Strep) Throat culture (**gold standard**)
28
What is the CENTOR criteria used for?
Guideline for dx GAS without performing rapid Strep or throat culture
29
What points are given in the CENTOR criteria?
1. **Absence of cough** 2. Enlarged/tender cervical adenopathy, 3. **Fever 100.4 F or higher** 4. **T**onsillar swelling/exudate 5. Pt b/w **3 and 14 yo** 6. Deduct a point if pt is **\>45 yo** ## Footnote **0-1 points: recommend no further testing and no abx** **2-3 points: Rapid strep/throat culture, tx with abx if positive** **4+ points: Consider empiric treatment**
30
Abx of choice for GAS pharyngitis
Penicillin (10 day course of penicillin V or IM pen G benzathine) ## Footnote *Cephalosporin or macrolide if pt allergic to penicillins*
31
Leading cause of morbidity/Mortality worldwide
Community Acquired Pneumonia (CAP)
32
Acute infection of pulmonary parenchyma outside of healthcare setting is the definition of \_\_\_\_\_\_
Community-acquired PNA
33
What is the difference between hospital-acquired and ventilator-associated PNA?
HAP =\> PNA acquired \>48 hours after hospital admission VAP =\> acquired \>48 hours after endotracheal intubation
34
Most common cause of sepsis 2nd most common cause of hospitalizations
Pneumonia
35
Risk factors for PNA (review)
Extremes of age Immunosuppression/compromise Chronic disease/comorbidities (COPD, chronic lung dz, chronic heart dz, stroke, DM, malnutrition) Preceding viral upper respiratory infection (influenza) Smoking, alcohol (\>80g/d) and opiate overuse Lifestyle factors (crowded living conditions, low income settings, toxin exposure) Altered consciousness (alcoholism, stroke, seizure, drug use) Impaired airway protection
36
Most common bacterial cause of pneumonia?
S. pneumoniae ## Footnote **62% of cases has no identified causal organism**
37
Most severe causes of community acquired PNA
S. Pneumoniae Legionella
38
When would a CT be considered for a pt suspected of pneumonia?
If pt is immunocompromised and cannot mount a typical inflammatory response and have a negative CXR
39
What lab tests might you get for a pt suspected of PNA?
CBC - leukocytosis with left shift or leukopenia ESR CRP Procalcitonin
40
Classic lab abnormalities in S. pneumoniae-inflicted PNA
Elevated LFTs Hyponatremia Leukocytosis
41
Pt with bacterial pneumonia complains of currant jelly hemoptysis. Which microbe is this?
Klebsiella ## Footnote *Classically in alcoholics and aspiration*
42
Is pseudomonas a community-acquired PNA?
No ## Footnote *Occurs in immunosuppressed, CF, elderly, recently hospitalized, abx use, severe COPD*
43
Most common atypical agent of pneumonia in the elderly?
Legionella
44
Common sx of Legionella PNA
GI sx Hyponatremia Various pulmonary sx
45
How is Legionella dx?
UA for Legionella ag
46
What microbe may mimic Legionella but **without GI sx?**
Chalmydophila
47
Which microbe causes "walking pneumonia"?
Mycoplasma * Rash, arthralgia, Lacks GI sx* * Cycles every 4-8 years*
48
Tx of CAP with uncomplicated outpt treatment
Macrolide (azithromycin or clarithromycin) or Tetracyclie (doxycycline)
49
Tx of CAP in pts with significant comorbidities/failed firstline tx
Macrolide + penicillin/lactamase or Fluoroquinolone (levofloxacin or moxifloxacin)
50
What is the CURB-65 score?
Measures if pt should be admitted for pneumonia **C**onfusion **U**remia \>7 **R**espiratory rate \>30 **B**lood pressure \<90 systolic or \<60 diastolic Age \>**65**
51
What score on the Pneumonia Severity Index indicates that pt should be admitted?
4-5 - ICU inpt ## Footnote *1-3 are outpatient candidates*
52
Pt dx with pneumonia has a PSI score 1-2 and a CURB-65 of 0, what kind of care should they receive?
Ambulatory care
53
Pt with a PSI score \>3, CURB-65 \>1 with a \<92% O2 sat, should you admit this pt?
Yes
54
3 primary pillars for preventing CAP
1. Smoking cessation 2. Influenza vaccination for all pts 3. Pneumococcal vaccination for at-risk pts
55
3 main goals of initial manipulative treatment in PNA
1. Reduce parenchymal lung congestion 2. Reduced sympathetic hyper-reactivity to the parenchyma of the lung 3. Increased mechanical thoracic cage and diaphragmatic motion
56
Effective manipulative tx of pneumonia aims to optimize what 4 things?
1. Thoracic cage motion 2. Improve diaphragmatic motion 3. Enhance lymphatic drainage (open thoracic inlet first) 4. Stabilize autonomic influences
57
Increased parasympathetic tone in PNA causes _____ secretions and bronchiole \_\_\_\_\_
Thinned secretions Bronchiole constriction *OA, AA, C2*
58
Increased sympathetic tone causes ______ secretions and bronchiole \_\_\_\_\_\_
Thickened secretions Bronciole dilation *T2-T7*
59
Chapmans point for Bronchi
Anterior: IC space b/w 2nd/3rd ribs at sternocostal jxn Posterior: T2 midway b/w SP and tip of TP
60
Chapman's point for Upper Lung
Anterior: IC space b/w 3rd and 4th ribs at SC jxn Posterior: Space b/w TP of T3 and T4, midway bw SP and tip of TP
61
Chapman's point for Lower Lung
Anterior: IC space b/w 4th and 5th ribs at SC jxn Posterior: Space b/w TPs of T4 and T5, midway b/w SP and tip of TP
62
CXR with infiltrate What findings might be concerning for TB?
Reticulonodular pattern Upper lobe infiltrate "chronic pneumonia" or other TB risk factors - hx
63
CXR with infiltrate What differential dx might you evaluate for in a pt with cavitary lesions and empyema?
TB S. Pneumoniae - injection drug use Aspiration PNA - Altered mental status HCAP/HAP/VAP - recent hospitalization

PCMIII Exam 2 (13 decks)

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