Lower Respiratory

Question 1

Exam findings of pneumonia

Answer 1

tachypnea
crackles/rales
consolidation (bacterial pna usually)
dullness to percussion
increased tactile fremitus
pleuritic friction rub (late finding)

Question 2

CAP dx evaluation

Answer 2

CBC w/diff
BUN/Cr
Chest x-ray

Question 3

CAP therapy without comorbidities (-H.influenzae, atypical legionella spp)

Answer 3

5 days min
AABCDE
doxycycline
or macrolide
or amoxicillin

Question 4

CAP therapy with COPD, DM, renal/HF, AUD

Answer 4

PO levofloxacin or moxi-

or PO doxy + amox-clav

Question 5

CURB-65

Answer 5

Confusion new onset
UREA (BUN) >19
Respiratory rate ≥30
Blood pressure <90/<60
≥65 years old

Question 6

Acute bronchitis

Answer 6

lower airway inflammation
presenting with 5 day cough +/- sputum
absence of fever & tachypnea 
lasting >5 days following URI
absence of asthma, COPD, and others

Question 7

Viral acute bronchitis tx

Answer 7

most resolve
for protracted, problematic cough
- SAMA ipratropium bromide (atrovent)
- or SABA albuterol
- or prednisone 40 mg po for 3-5 days

Question 8

Bacterial acute bronchitis tx and cause

Answer 8

M & C pneumoniae (atypical)
occurs in 5%
- consider macrolide or doxy if indicated

Question 9

asthma dx

Answer 9

airway inflammation first bronchospasm follows
increased FEV1 ≥12% and >200 ml from baseline s/p SABA; measure again 3-6 months of controller therapy
spirometry is needed
peak flow meter for monitoring

Question 10

asthma sx

Answer 10

wheeze, SOB, chest tightness, and/or cough d/t obstruction and hyperresponsiveness
may worsen at night or w/ exercise, viral infections, smoke

Question 11

assessment Q’s for asthma

Answer 11

daytime asthma sx >2x/week?
night awakening d/t asthma?
SABA use >2x/week?
activity limitation d/t asthma?

0 = well controlled
1-2 = partially controlled
3-4 = uncontrolled

Question 12

COPD dx

Answer 12

spirometry required
FEV1:FVC <0.70 post-bronchodilator
FEV1 = determines class
CAT or CCQ questionnaire
alpha-1 antitrypsin deficiency (AATD) screening in age <45 yr, european, family hx of early onset COPD, panniculitis