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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
Q

GAS infection causing pharyngitis is extremely difficult to distinguish clinically from what infectious microbe?

A

EBV - Infectious mononucleosis

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26
Q

Findings of GAS pharyngitis

A

Abrupt onset sore throat and fever

Tonsillar/Palatal petechiae

Tender cervical adenopathy

Absence of cough

27
Q

Dx of GAS can be made by what 2 tests? Which one is the gold standard?

A

Rapid antigen testing (rapid Strep)

Throat culture (gold standard)

28
Q

What is the CENTOR criteria used for?

A

Guideline for dx GAS without performing rapid Strep or throat culture

29
Q

What points are given in the CENTOR criteria?

A
  1. Absence of cough
  2. Enlarged/tender cervical adenopathy,
  3. Fever 100.4 F or higher
  4. Tonsillar swelling/exudate
  5. Pt b/w 3 and 14 yo
  6. Deduct a point if pt is >45 yo

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
Q

Abx of choice for GAS pharyngitis

A

Penicillin (10 day course of penicillin V or IM pen G benzathine)

Cephalosporin or macrolide if pt allergic to penicillins

31
Q

Leading cause of morbidity/Mortality worldwide

A

Community Acquired Pneumonia (CAP)

32
Q

Acute infection of pulmonary parenchyma outside of healthcare setting is the definition of ______

A

Community-acquired PNA

33
Q

What is the difference between hospital-acquired and ventilator-associated PNA?

A

HAP => PNA acquired >48 hours after hospital admission

VAP => acquired >48 hours after endotracheal intubation

34
Q

Most common cause of sepsis

2nd most common cause of hospitalizations

A

Pneumonia

35
Q

Risk factors for PNA (review)

A

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
Q

Most common bacterial cause of pneumonia?

A

S. pneumoniae

62% of cases has no identified causal organism

37
Q

Most severe causes of community acquired PNA

A

S. Pneumoniae

Legionella

38
Q

When would a CT be considered for a pt suspected of pneumonia?

A

If pt is immunocompromised and cannot mount a typical inflammatory response and have a negative CXR

39
Q

What lab tests might you get for a pt suspected of PNA?

A

CBC - leukocytosis with left shift or leukopenia

ESR

CRP

Procalcitonin

40
Q

Classic lab abnormalities in S. pneumoniae-inflicted PNA

A

Elevated LFTs

Hyponatremia

Leukocytosis

41
Q

Pt with bacterial pneumonia complains of currant jelly hemoptysis. Which microbe is this?

A

Klebsiella

Classically in alcoholics and aspiration

42
Q

Is pseudomonas a community-acquired PNA?

A

No

Occurs in immunosuppressed, CF, elderly, recently hospitalized, abx use, severe COPD

43
Q

Most common atypical agent of pneumonia in the elderly?

A

Legionella

44
Q

Common sx of Legionella PNA

A

GI sx

Hyponatremia

Various pulmonary sx

45
Q

How is Legionella dx?

A

UA for Legionella ag

46
Q

What microbe may mimic Legionella but without GI sx?

A

Chalmydophila

47
Q

Which microbe causes “walking pneumonia”?

A

Mycoplasma

  • Rash, arthralgia, Lacks GI sx*
  • Cycles every 4-8 years*
48
Q

Tx of CAP with uncomplicated outpt treatment

A

Macrolide (azithromycin or clarithromycin)

or

Tetracyclie (doxycycline)

49
Q

Tx of CAP in pts with significant comorbidities/failed firstline tx

A

Macrolide + penicillin/lactamase

or

Fluoroquinolone (levofloxacin or moxifloxacin)

50
Q

What is the CURB-65 score?

A

Measures if pt should be admitted for pneumonia

Confusion

Uremia >7

Respiratory rate >30

Blood pressure <90 systolic or <60 diastolic

Age >65

51
Q

What score on the Pneumonia Severity Index indicates that pt should be admitted?

A

4-5 - ICU inpt

1-3 are outpatient candidates

52
Q

Pt dx with pneumonia has a PSI score 1-2 and a CURB-65 of 0, what kind of care should they receive?

A

Ambulatory care

53
Q

Pt with a PSI score >3, CURB-65 >1 with a <92% O2 sat, should you admit this pt?

A

Yes

54
Q

3 primary pillars for preventing CAP

A
  1. Smoking cessation
  2. Influenza vaccination for all pts
  3. Pneumococcal vaccination for at-risk pts
55
Q

3 main goals of initial manipulative treatment in PNA

A
  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
Q

Effective manipulative tx of pneumonia aims to optimize what 4 things?

A
  1. Thoracic cage motion
  2. Improve diaphragmatic motion
  3. Enhance lymphatic drainage (open thoracic inlet first)
  4. Stabilize autonomic influences
57
Q

Increased parasympathetic tone in PNA causes _____ secretions and bronchiole _____

A

Thinned secretions

Bronchiole constriction

OA, AA, C2

58
Q

Increased sympathetic tone causes ______ secretions and bronchiole ______

A

Thickened secretions

Bronciole dilation

T2-T7

59
Q

Chapmans point for Bronchi

A

Anterior: IC space b/w 2nd/3rd ribs at sternocostal jxn

Posterior: T2 midway b/w SP and tip of TP

60
Q

Chapman’s point for Upper Lung

A

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
Q

Chapman’s point for Lower Lung

A

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
Q

CXR with infiltrate

What findings might be concerning for TB?

A

Reticulonodular pattern

Upper lobe infiltrate

“chronic pneumonia” or other TB risk factors - hx

63
Q

CXR with infiltrate

What differential dx might you evaluate for in a pt with cavitary lesions and empyema?

A

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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