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Lower Respiratory Disorders > Lower Respiratory Disorders > Flashcards

Lower Respiratory Disorders Flashcards

1
Q

What are the primary pathologies strep pneumoniae is implicated in?

A

Sinusitis, CAP, AOM, Bronchitis, Meningitis

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2
Q

If you have a bacterial infection causing bronchitis, what do you give?

A

Macrolide, Doxycycline, or Bactrim.

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3
Q

When would you hospitalize someone for asthma?

A

If initial FEV1 50% predicted after 1 hour.

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4
Q

After taking an inhaled bronchodilator/B2 agonist, how much of an improvement would you expect to see in FEV1?

A

15%

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5
Q

What is the primary purpose of B2 adrenergic agonists? What are examples?

A

short-acting, quick relief for symptoms or before exercise.

Ex= albuterol

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6
Q

What is the primary purpose of inhaled corticosteroids? Any particular considerations?

A

For control/maintenance. Side effects include oral thrush/candida so patients need to be instructed to rinse their mouth out; and sore throat.
Ex. Budesonide (Pulmicort) and Triamcinolone (Azmacort).

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7
Q

What is the progression/management of asthma?

A

SABA–> ICS–> increase ICS or add LABA–> add anticholinergics (ipratropium bromide) if secretions–> stabilizing/maintenance med such as leukotriene receptor antagonist.

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8
Q

What is an example of a long-acting B2 agonist?

A

salmeterol (serevent)

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9
Q

What is an example of a antileukotriene?

A

montelukast (singulair

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10
Q

What airway diseases are obstructive in nature?

A

asthma, chronic bronchitis, and emphysema (= COPD)

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11
Q

What differentiates chronic bronchitis from emphysema?

A

Chronic bronchitis: >35, copious purulent sputum production; stocky, obese; normal chest AP diameter; Hct increased.
Emphysema: >50, mild clear sputum, chest AP diameter increased; thin, wasted; hyperresonance; progressive, constant dyspnea

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12
Q

What would you expect to see on a Chest XRay on someone with COPD?

A

flattened diaphargm

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13
Q

What is the management of COPD?

A
  1. Stop smoking
  2. Avoidance of irritants or allergies
  3. Postural drainage to clear excess secretions
  4. Inhaled ipratropium bromide
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14
Q

What are typical signs/symptoms of CAP?

A

fever/shaking chills, purulent sputum, lung consolidation, malaise, increased fremitus

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15
Q

What are atypical sign/symptoms of CAP?

A

cough, HA, sore throat, excessive sweating, soreness in the chest

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16
Q

What are atypical PNU pathogens?

A

Legionella pneumophilia, Mycoplasma pneumoniae, and Chlamydophilia pneumoniae

17
Q

What is the management of CAP in patients

A 
A macrolide (Azithromycin, Clarithromycin, Erythromcycin) or Doxycycline.
*Monitor for QT prolongation with Azith
18
Q

What is the treatment for CAP in those with comorbid illness or who are >60?

A

Fluoroquinolone (Levofloxacin, Gemifloxacin, or Moxifloxacin).
*Monitor for achilles tendon rupture as reported by heel pain.

19
Q

What are the differential diagnoses in night sweats?

A

TB. Lymphoma. Menopause. AIDS/HIV. Endocarditis.

20
Q

What are the diagnostics for TB?

A

Culture of M. tuberculosis (AFB) x 3 and a small homogenous infiltrate in upper lobes by CXR

21
Q

What is your next step if your patient has a + PPD?

A

A Chest XRay

22
Q

What is your next step if you patient has a + PPD and a - Chest XRay?

A

Start on INH prophylaxis

23
Q

What do you do if your patient has a + PPD, + Chest XRay, and + Culture?

A

Start on 4-drug TB regimen with Isoniazid, Rifampin, Pyrazinamide, and ethambutol (RIPE) x 6-9 months.

24
Q

If the TB isolate proves to be fully susceptible to INH and Rif, what do you do?

A

Drop the ethambutol. Continue RIP daily x 2 months and then just IF daily x 4 months.

25
Q

What special considerations should be taken with patients taking ethambutol?

A

Visual acuity and red-green color perception testing

26
Q

What is considered to be a positive PPD test in those with HIV or have known contacts with TB?

A

5mm

27
Q

What is considered a positive PPD test for someone with no risk factors?

A

15mm

28
Q

What is considered a positive PPD test for healthcare workers or for immigrants from high prevalence countries?

A

10mm

29
Q

Which PFTs test lung volume?

A

TLC (volume of gas in lungs after inspiration), FRC (functional residual capacity), RV (volume of gas remaining in lungs after maximal expiration)

30
Q

What does FVC represent?

A

volume of gas forcefully expelled from the lungs after maximal inspiration

31
Q

What PFTs would you expect to find in obstructive diseases?

A

(can’t get air out) reduced airflow rates, therefore volumes will be WNL

32
Q

What PFTs would you expect to find in restricitive disease (PNU)?

A

reduced volumes (can’t get air in), normal expiratory flow rates.

33
Q

What do F values represent?

A

Airflow rates

34
Q

How is intermittent asthma treated? What are some characteristics of intermittent asthma?

A

nighttime awakenings 0-2/month. use of SABA

35
Q

You have a patient who reports asthma symptoms at least two days/week, with nighttime awakenings 2 times/month. He reports some limitation in his activities. His PFTs are normal. Where would you classify his asthma as of today?

A

Mild Persistent.

*Treated with Low-dose ICS.

36
Q

What are the four classifications of asthma?

A

Intermittent. Mild Persistent. Moderate Persistent. Severe Persistent.

37
Q

When would you consider adding a short course of oral steroids into the regimen for asthma management?

A

If asthma moderate-severe persistent.

38
Q

When would you consult with an asthma specialist for a child 0-4 yrs old? 5-12? > 12yrs?

A

0-4yrs: at step 3, possibly step 2
5-12yrs: step 4, possibly step 3
>12yrs: step 4, possibly step 3

39
Q

What is a normal ESR range, encompassing men and women of any age?

A

15-30

Lower Respiratory Disorders (2 decks)

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