Lower Respiratory Disorders Flashcards
What are the primary pathologies strep pneumoniae is implicated in?
Sinusitis, CAP, AOM, Bronchitis, Meningitis
If you have a bacterial infection causing bronchitis, what do you give?
Macrolide, Doxycycline, or Bactrim.
When would you hospitalize someone for asthma?
If initial FEV1 50% predicted after 1 hour.
After taking an inhaled bronchodilator/B2 agonist, how much of an improvement would you expect to see in FEV1?
15%
What is the primary purpose of B2 adrenergic agonists? What are examples?
short-acting, quick relief for symptoms or before exercise.
Ex= albuterol
What is the primary purpose of inhaled corticosteroids? Any particular considerations?
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).
What is the progression/management of asthma?
SABA–> ICS–> increase ICS or add LABA–> add anticholinergics (ipratropium bromide) if secretions–> stabilizing/maintenance med such as leukotriene receptor antagonist.
What is an example of a long-acting B2 agonist?
salmeterol (serevent)
What is an example of a antileukotriene?
montelukast (singulair
What airway diseases are obstructive in nature?
asthma, chronic bronchitis, and emphysema (= COPD)
What differentiates chronic bronchitis from emphysema?
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
What would you expect to see on a Chest XRay on someone with COPD?
flattened diaphargm
What is the management of COPD?
- Stop smoking
- Avoidance of irritants or allergies
- Postural drainage to clear excess secretions
- Inhaled ipratropium bromide
What are typical signs/symptoms of CAP?
fever/shaking chills, purulent sputum, lung consolidation, malaise, increased fremitus
What are atypical sign/symptoms of CAP?
cough, HA, sore throat, excessive sweating, soreness in the chest
What are atypical PNU pathogens?
Legionella pneumophilia, Mycoplasma pneumoniae, and Chlamydophilia pneumoniae
What is the management of CAP in patients
A macrolide (Azithromycin, Clarithromycin, Erythromcycin) or Doxycycline. *Monitor for QT prolongation with Azith
What is the treatment for CAP in those with comorbid illness or who are >60?
Fluoroquinolone (Levofloxacin, Gemifloxacin, or Moxifloxacin).
*Monitor for achilles tendon rupture as reported by heel pain.
What are the differential diagnoses in night sweats?
TB. Lymphoma. Menopause. AIDS/HIV. Endocarditis.
What are the diagnostics for TB?
Culture of M. tuberculosis (AFB) x 3 and a small homogenous infiltrate in upper lobes by CXR
What is your next step if your patient has a + PPD?
A Chest XRay
What is your next step if you patient has a + PPD and a - Chest XRay?
Start on INH prophylaxis
What do you do if your patient has a + PPD, + Chest XRay, and + Culture?
Start on 4-drug TB regimen with Isoniazid, Rifampin, Pyrazinamide, and ethambutol (RIPE) x 6-9 months.
If the TB isolate proves to be fully susceptible to INH and Rif, what do you do?
Drop the ethambutol. Continue RIP daily x 2 months and then just IF daily x 4 months.
What special considerations should be taken with patients taking ethambutol?
Visual acuity and red-green color perception testing
What is considered to be a positive PPD test in those with HIV or have known contacts with TB?
5mm
What is considered a positive PPD test for someone with no risk factors?
15mm
What is considered a positive PPD test for healthcare workers or for immigrants from high prevalence countries?
10mm
Which PFTs test lung volume?
TLC (volume of gas in lungs after inspiration), FRC (functional residual capacity), RV (volume of gas remaining in lungs after maximal expiration)
What does FVC represent?
volume of gas forcefully expelled from the lungs after maximal inspiration
What PFTs would you expect to find in obstructive diseases?
(can’t get air out) reduced airflow rates, therefore volumes will be WNL
What PFTs would you expect to find in restricitive disease (PNU)?
reduced volumes (can’t get air in), normal expiratory flow rates.
What do F values represent?
Airflow rates
How is intermittent asthma treated? What are some characteristics of intermittent asthma?
nighttime awakenings 0-2/month. use of SABA
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?
Mild Persistent.
*Treated with Low-dose ICS.
What are the four classifications of asthma?
Intermittent. Mild Persistent. Moderate Persistent. Severe Persistent.
When would you consider adding a short course of oral steroids into the regimen for asthma management?
If asthma moderate-severe persistent.
When would you consult with an asthma specialist for a child 0-4 yrs old? 5-12? > 12yrs?
0-4yrs: at step 3, possibly step 2
5-12yrs: step 4, possibly step 3
>12yrs: step 4, possibly step 3
What is a normal ESR range, encompassing men and women of any age?
15-30
