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AANP FNP: Adult > Lower Respiratory > Flashcards

Lower Respiratory Flashcards

1
Q

Signs and symptoms of acute bronchitis

A 
Persistent cough
Increased mucous production
Wheezing
Lungs clear, resonant to percussion, upper airway clears with coughing
High fever indicates bacterial infection
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2
Q

Strep pneumoniae is the most common pathogen in the following conditions:

A 
Bronchitis
Sinusitis
Otitis Media
Meningitis
Community Acquired Pneumonia
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3
Q

Management of acute bronchitis

A

Supportive care

If suspect bacterial (high fever) treat with macrolides (azithromycin, clarithromycin), doxycycline, or Bactrim

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4
Q

Is asthma obstructive or restrictive disease?

A

Obstructive

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5
Q

Pathophysiology of asthma

A
  1. Increased responsiveness trachea and bronchi- narrowing airways
  2. Hypertrophy of smooth muscle
  3. Hypertrophy of mucous glands, plugging of airway by thick mucous
  4. Thickening of epithelial basement membrane (remodeling)
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6
Q

Unique feature of asthma

A

pulsus paradoxus (>12 mm Hg)

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7
Q

Ominous signs of asthma (reasons to call 911 on your asthmatic in the clinic)

A 
Fatigue
Absent breath sounds
Paradoxical chest/abdominal movement
Unable to remain laying down
Cyanosis
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8
Q

What FEV1 score would lead to recommendation of hospitalization for asthmatic patient?

A

FEV1

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9
Q

What peak flow score would make you recommend hospitalization for asthmatic patient?

A

Peak flow 50 percent predicted after one hour of treatment

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10
Q

What would x-ray of asthma exacerbation show?

A

Hyperinflation

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11
Q

Management of asthma in adults

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LABA
    - inhaled anticholinergic (ipratroprium) for significant secretions
    - antileukotrienes (Singulair) may be useful for chronic asthma related to allergies
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12
Q

Are chronic bronchitis and emphysema obstructive or restrictive?

A

Obstructive

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13
Q

Chronic bronchitis presentation

A

Copious purulent sputum production

Stocky, obese, > 35 years old

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14
Q

Presentation of emphysema

A

abnormal, permanent enlargement of alveoli
mild clear sputum
thin, wasted body, > 50 years old
Chest A-P diameter increased

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15
Q

Typical signs/symptoms of typical versus atypical pneumonia

A

Typical- fever, chills, purulent sputum, lung consolidation, malaise
Atypical- URI/ENT symptoms along with lung consolidation

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16
Q

Atypical pneumonia pathogens

A

Mycoplasma pneumoniae

Legionella pneumoniae

17
Q

Management of community acquired pneumonia

A

Healthy patients: macrolide (azithromycin, clarithromycin) or doxycycline
Patient with comorbidities: Fluoroquinolone (Levaquin, moxifloxacin)

18
Q

Signs and symptoms of tuberculosis

A

Most patients are asymptomatic
Fatigue, low grade fever
Night sweats
Anorexia, weight loss

19
Q

Screening tests for tuberculosis

A

AFB smear

PPD skin test (shows exposure)

20
Q

Definitive diagnosis of tuberculosis

A

Small homogenous infiltrate in upper lobes by Chest x-ray

Culture for M. tuberculosis

21
Q

Differential diagnosis for night sweats

A
  • TB
  • menopause
  • AIDS
  • lymphoma
  • endocarditis
22
Q

Management of tuberculosis

A

Notify health dept
Consider hospitalization for noncompliant patient or someone who is likely to expose susceptible individuals
Medications
Weekly sputum smears and cultures for 6 weeks, then monthly

23
Q

Medications for tuberculosis

A

INH, rifampin, pyrazinamide, and ethambutol for 2 months
Then 4 more months of INH and rifampin
Weekly LFTs while on INH
Patients on ethambutol should be tested for visual acuity and red-green color perception

24
Q

TB skin test results

A

> 5 mm is positive for: HIV, contacts of known TB, or person with chest x-ray typical for TB
10 mm is positive for: immigrants, health care workers
15 mm is positive for all others

25
Q

How does a pleural effusion look on chest x-ray?

A

“Blunting” or “shadowing” of the costophrenic angle

26
Q

Types of pleural effusions

A

transudates- clear
exudates- cream colored
empyema- pus
hemorrhagic- blood

27
Q

Organisms that cause acute bronchitis

A

Viral: Rhinovirus, Coronavirus, Adenovirus
Bacterial: Strep pneumoniae, H. flu, M. catarrhalis, Mycoplasma pneumoniae

AANP FNP: Adult (14 decks)

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