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Boards > Lower Respiratory Tract > Flashcards

Lower Respiratory Tract Flashcards

1
Q

Possible pathogens of community acquired pneumonia

A

s. pneumoniae
h. influence
m. pneumoniae
c. pneumoniae
legionella

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2
Q

What put someone at risk for drug resistant s. pneumoniae

A 
recent antimicrobial use in last 3 months
>65
day care exposure
alcohol use
medical comorbidities
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3
Q

s. pneumoniae desriptions

A

gram pos diplococci

most common cause or fatal CAP

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4
Q

Antimicrobial for drug resistant s. pneumoniae

A

High dose Amox 3-4 g/day
Resp fluroquinolones: moxi, levo, gemifloxacin
telithromycin

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5
Q

Risk with fluroquinolones

A

tendon rupture

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6
Q

Antimicrobial for non resistant s. pneumo

A

macrolide: azithro, clarithro, erythro
Amox 1.5-2.5 g/d
cephalosporins
tetracyclines: doxy

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7
Q

Risk with macrolide use

A

QT prolongation and increased risk of CV death

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8
Q

H. influenzae description

A

gram neg bacillus

common with tobacco related lung disease

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9
Q

What is h. influenzae resistant to?

A

beta-lactamase

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10
Q

Antimicrobial for h. influenzae

A 
those stable in the presence of beta-lactamase
cephalosporins
amoxicillin-clavulanate
macrolids: "mycins"
respiratory fluoroquinolones
testracyclines: doxy
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11
Q

M.pneumoniae and c.pneumoniae description

A

not revealed by gram stain
cough transmitted
from close proximity

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12
Q

Antimicrobials not effective with m. and c. pneumoniae

A

beta lactams (cephalosporins and pcn

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13
Q

Antimicrobials effective with m. and c. pneumoniae

A

macrolides “mycins”
fluoroquinolones : not clarithromycin
tetracyclines

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14
Q

Legionella sp description

A

not revealed by gram stain
contracted by inhaling mist or aspirating liquid from a water source
NOT person to person

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15
Q

candidate for out pt thearpy for CAP

A

previously healthy
no antimicrobials in last 3 months
younger

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16
Q

what is the likely pathogen in the healthy with CAP

A

s. pneumoniae with low DRSP
atypicals: m. and c. pneumoniea
influenza A&B
RSV
adenovirus
parainfluenza

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17
Q

outpt tx for the healthy with CAP

A

macrolide: azithro, clarithro, erythro

doxy

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18
Q

Comorbidities that could be present with CAP

A 
COPD
DM
renal failure
heart failure
asplenia
alcoholism
immunosuppressing meds
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19
Q

likely pathogens in those with comorbidities and CAP

A

s. pneumoniae with high DRSP risk
h. influenzae
m. and c. pneumoniae
legionella
respiratory viruses

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20
Q

outpt tx for those with comorbidities and CAP

A 
fluoroquinolones: moxi, gemi, levo
macrolide plus beta lactam
azithro/clarithro + HD amox claculanate
certriaxone
cefpodoxime
cefuroxime
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21
Q

Recommended dose of levoflaxacin

A

750mg x 5 days

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22
Q

High dose Amox facts

A

does not cover DRSP or atypicals so you must add another with

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23
Q

Cephalosporin facts

A

does not cover DRSP or atypicals so you must add another with

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24
Q

Doxy facts

A

covers atypicals but DRSP by itself

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25
Q

Normal range for WBC

A

6,000-10,000

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26
Q

Components of a WBC

A 
neutrophil
lymphocyte
monocyte
Eosinophil
basophil
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27
Q

point of action with neutrophil

A

bacteria

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28
Q

point of action with lymphocyte

A

virus

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29
Q

point of action with monocyte

A

debris

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30
Q

point of action for eosinophil

A

allergens
parasites
wheezes

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31
Q

point of action for basophils

A

anaphylaxis

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32
Q

Right shift =

A

viral

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33
Q

Left shift =

A

bacterial

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34
Q

WBC response to viral infection

A

normal TWBC
Normal bands and segs
elevated lymphs

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35
Q

WBC response to bacterial infection

A 
elevated TWBC (leukocytosis)
elevated neutrophils
elevated bands (>4%)
normal lymphs (25-45%)
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36
Q

substrate defined

A

a med or substance that is metabolized by the isoenzyme utilizing this enzyme in order to be modified so it can reach drug site

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37
Q

example of a substrate

A

CPY450 substrates: sildenafil, atorvastatin

simvastatin, venlafaxine, alprazolam

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38
Q

inhibitor defined

A

blocks the activity of the isoenzyme limiting the substrate section
increasing level of substrate

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39
Q

example of inhibitor

A

CPY450 inhibitors: erythro, claithro, telithromycin

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40
Q

If a substrate and inhibitor are given together

A

can increase the substrate

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41
Q

inducer defined

A

accelerates the activity of the isoenzyme so that substrate is pushed out the exit pathway
reducing substrate levels

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42
Q

example of inducer

A

St. Johns wort
oral contraception
cyclosporine
can cause tx failure of substrate

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43
Q

likely causative organism in CAP

A

s. pneumoniae and respiratory viruses

44
Q

If someone is pregnant and has atypical pneumonia tx with

A

azithro or erythro

45
Q

If low risk and has atypical pneumonae and PCN allergic

A

try doxy x 7 days

46
Q

If someone is a smoker and has multiple comorbidities and atypical pneumonae tx with

A

5 day levofloxacin

47
Q

physical exam findings with pneumonia

A

consolidation and pleural inflammation/pleurisy

48
Q

detecting consolidation on physical exam

A

dullness to percussion: dense tissue sounds dull

increased tactile fremitus: increased with increased density

49
Q

detecting pleural inflammation on physical exam

A

pt report of sharp, local pain worse with a deep breath or cough
sounds like stepping into fresh snow when there is a friction rub

50
Q

When to do a rpt chest x-ray following pneumonia

A

6-8 weeks

51
Q

What is the most common pathogen of bronchitis

A

respiratory infections

52
Q

other causes of bronchitis

A

m. pneumoniae
c. pneumoniae
b. pertussis

53
Q

Tx of bronchitis from virus

A

anticholinergic bronchodilator: ipratropium bromide
inhaled beta agonist: albuterol
corticosteroid

54
Q

Tx of bronchits from other organisms

A

macrolide or tetracycline

55
Q

Asthma defined

A

chronic disorder characterized by variable and recurring symptoms, airway obstruction, bronchial hyperresponsiveness and inflammation

56
Q

make the dx of asthma when

A

recurrent cough, wheeze, SOB
symptoms worse at night or with exercise or irritants
increase in FEV1 >12% after giving beta agonist

57
Q

what test is needed to officially make dx of asthma

A

spirometry

peak flow used for monitoring, not dx

58
Q

3 goals of asthma therapy

A

reduce impairment
reduce risk
optimize health and function

59
Q

Assessment of asthma

A

classify the severity
identify precipitating factors
identify pts at risk for exacerbations or death
assess knowledge and skills

60
Q

visit frequency in a person with asthma

A

3-6 months if well controlled
2-6 weeks if not well controlled
2 weeks if very poorly controlled

61
Q

inhaled corticosteroids

A 
mometasone
fluticasone
budesonide
beclomethasone
ciclesonide
62
Q

inhaled corticosteroids and long acting beta agonists

A

budesonide + formoterol
fluticasone + salmeterol
mometasone + formoterol

63
Q

Tx with ICS/LABA cautions

A

should not be used in those who do not respond to inhaled corticosteroids alone

64
Q

Leukotriene modifiers with asthma

A

montelukast (Singulair)

help with allergic rhinitis

65
Q

Is an inhaled corticosteroid systemically absorbed?

A

no, most goes to the lungs

66
Q

reliever meds in asthma

A

SABA with onset 1 min and lasting 4 hours

systemic corticosteroids with onset in 6 hours

67
Q

what would suggest a need for better control in asthma

A

use of SABA >2 days/week for anything other than exercise

68
Q

anticholinergics in ashtma tx

A

used for the prevention NOT tx of bronchospasm

“bromide”

69
Q

theophylline in asthma tx

A

increases cyclic AMP

narrow therapeutic index

70
Q

intermittent asthma classification

A

< 2 days/week
not waking up more than 2 times/hs/month
using SABA 80% predicted
FEV/FVC normal

71
Q

mild persistent asthma classification

A 
> 2days/week but not daily
waking up at hs 3-4x/month
needing SABA >2x/week but not daily
minor activity limitation
FEV >80%
FEV/FVC normal
72
Q

mod persistent asthma classification

A 
daily symptoms
waking up at hs > 1x week
daily use of SABA
some activity limitation
FEV >60 but <80
FEV/FVC reduced by 5%
73
Q

severe persistent asthma classification

A 
multiple times in a day
HS waking every night
need for SABA multiple times daily
extreme activity limitation
FEV 5%
74
Q

level of asthma severity is determined by

A

impairment and risk

impairment by asking previous 2-4 weeks and spirometry

75
Q

what approach is used in managing asthma

A

stepwise approach

steps 1-6

76
Q

approach to intermittent asthma

A

step 1 : SABA prn

77
Q

approach to mild persistent asthma

A

step 2: low dose ICS

could do cromolyn, LRTA

78
Q

approach to mod persistent asthma

A

step 3: low dose ICS plus a LABA or a medium dose ICS

79
Q

approach to sev persistent asthma

A

step 4: med dose ICS plus LABA

refer to specialist for anything step 4 and above

80
Q

step 5 in asthma approach

A

high dose ICS plus LABA

81
Q

step 6 in asthma approach

A

high dose ICS plus LABA plus corticosteroids

82
Q

those eligible for step down in asthma tx plan

A

asthma well controlled for 3 months

83
Q

you would anticipate this finding on an acute asthmatic or COPD flare

A

hyperresonance

trouble getting air out

84
Q

other findings with air trapping

A

decreased tactile fremitus
wheeze (expir first then inspir)
low diaphragms
increased AP diameter

85
Q

COPD described

A

preventable and tx disease
its pulmonary components is characterized by airflow limitation that is not fully reversible
the airflow limitation is progressive

86
Q

consider a dx of COPD if

A

progressive dyspnea
chronic cough
sputum production
hx of exposure to risk factors suchs as smoke, pollution

87
Q

How is degree of limitation assessed in COPD

A

spirometry
FEV/FVC < 70% post bronchodilator confirms limitation
classification is then based on FEV1 alone

88
Q

Mild airway limitation in COPD

A

FEV1>80%

89
Q

mod airway limitation in COPD

A

FEV1< 80%

90
Q

severe airway limitation in COPD

A

FEV1<50%

91
Q

very severe airway limitation in COPD

A

FEV1<30%

92
Q

Med management for low risk COPD with less symptoms

A

anticholinergic: ipratropium PRN
SABA prn
LABA

93
Q

med management for low risk COPD with more symptoms

A

LA anticholinergic: tiotropium
LABA: salmeterol
or a combo of the 2

94
Q

med management for high risk COPD with less symptoms

A

ICS: fluticasone, budesodine
plus
LABA or LA anticholinergic

95
Q

med management for high risk COPD with more symptoms

A

ICS plus LABA or anticholinergic

96
Q

goal of long term ashtma therapy in COPD

A

ensure adequate oxygen delivery by increasing PaO2 at rest to 60mm Hg and producing sat of 90% or >

97
Q

COPD exacerbation defined

A

an event in the natural course of the disease characterized by a change in the pts baseline dyspnea, cough and or sputum

98
Q

Tx of COPD exacerbation

A

bronchodilators suchs as SABA or LABA
If FEV < 50% add systemic steroid
add inhaled coritocosteroid
stop smoking

99
Q

Antimicrobial therapy in COPD if

A

increased dyspnea
increased sputum volume
increased sputum purulence

100
Q

For mild to mod COPD exacerbation what abx

A

Amox
Doxy
Cephalosporin
Bactrim

101
Q

For severe COPD exacerbation what abx

A 
Amox-claulanate
Cephalosporin
Azithro
Clarithro
Fluroquinolone
may need x-ray if fever of low SaO2
102
Q

What is consistend with the dx of all stages of COPD

A

FEV1/FVC ration < 0.70

103
Q

Classic presentation of pneumothorax

A 
sudden onset
pleuritic chest pain
difficulty breathing
diminished breath sounds
decreased tactile fremitus and hyperresonance
104
Q

inhaled anthrax clinical presentation

A

low grade fever, non productive cough

on x-ray see widened mediastinum due to hemorrhage into bone

105
Q

cutaneous anthrax clinical presentation

A

pustular skin lesion that eventually forms ulcer and eschar

106
Q

injection site care following vaccinia “smallpox” vaccine

A

keep covered

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