Lower Respiratory Tract Disorders Flashcards
Community acquired pneumonia
lung / bronchi infection, caused by pathogens acquired while residing in community NOT in acute care
causative agents–> #1 S. PNEUMONIAE,
M. PNEUMONIAE, C PNEUMONIAE = ATYPICAL
What are symptoms associated with S. pneumoniae CAP?
COMPS conjunctivitis otitis media meningitis pneumonia sinusitis
Gram-positive diplococci
What treatmens can be used for a previously healthy patient with S. pneumoniae CAP?
treatments also apply to H. influenzae, M. pneumoniae, adenovirus
Oral doxycycline 100 mg bid or
oral Azythromycin / erythromycin
can remember: ABCDE = azithro, biaxin (clarithro), doxycycline, erythromycin
What treatments can be used for patients with CAP who have co-morbidities such as COPD, diabetes, renal or heart failure?
Respiratory floriquinolone PO
or
Doxycycline, azithromycin, clarithromycin PLUS beta lactam such as amoxicillin, amoxicillin clauv, PO or ceftriaxone IM
Name and describe physical exam findings common in Pneumonia ?
Tachypnea - increased rate 2/2 impaired gas exchange
Crackles or rales - occurs from sudden opening of distal fluid filled airways
Consolidation - MOST OFTEN 2/2 pna but may be blood, DULLNESS TO PERCUSSION, INCREASED TACTILE FREMITUS NOT ALTERED BY COUGH
Pleuritic friction rub - 2/2 pleural inflammation, sharp/localized pain that is WORSE with deep breath, movement or cough
What is the CURB-65 criteria associated with pneumonia?
calculated for mortality risk / appropriate treatment
C = CONFUSION, NEW ONSET
U= BUN >19
R= RESPIRATORY RATE OF 30 OR MORE
B= BLOOD PRESSURE <90 SYSTOLIC, <60 DIASTOLIC
AGE 65 OR OLDER
0-1 = outpatient treatment 2= consider short hospital stay, oral or parenteral antbx 3-5= hospitalization, consider icu need? parenteral antbx
Acute bronchitis
lower airway inflammation, presents with cough with/without sputum production, lasting >5 days, usually follows URI
PE: resonance to percussion = normal, ronchi will clear w/ cough, clear auscultation
Tx- humidifier, increase fluids, analgesics if fever
Bacterial tx = macrolides, doxy or bactrim
What are you most likely to find on a chest xray of someone with TB?
An infiltrate in the right upper lobe
When is hospitalization recommended in asthma patient?
FEV1 less than 30% predicted
Peak flow is less than 60 liters/ minute
What are omnious signs of asthma ?
fatigue absent breath sounds paradoxical chest / abdominal movement inability to maintain recumbency cyanosis
Is asthma a restrictive or obstructive disease?
obstructive
INFLAMMATORY DISEASE CAUSING DIFFICULTY BREATHING
STEP 1 TREATMENT OF ASTHMA
Short acting beta2 agonist SABA = albuterol or levalbuterol
PRN
relaxes bronchial muscles
STEP 2 TREATMENT OF ASTHMA
low dose inhaled corticosteroid ICS = budenoside PULMICORT, fluticasone FLOVENT, triamcinolone AZMACORT
STEP 3 TREATMENT OF ASTHMA
Low dose ICS + long active beta2 agonist LABA salmeterol or perforomist combination preparations = FLUTICASONE + SALMETEROL = ADVAIR FORMOTEROL + BUDESONIDE = SYMBICORT
NAME SOME INHALED CORTICOSTEROIDS
FLOVENT
PULMICORT
MOMETASONE
PREFERRED CONTROLLER TREATMENT FOR PERSISTENT ASTHMA
CONSISTENT DAILY USE
NAME ICS / LONG ACTING BETA AGONISTS COMBOS FOR ASTHMA
BUDESONIDE + FORMOTEROL = SYMBICORT
FLUTICASONE + SALMETEROL = ADVAIR
MOMETASONE + FORMOTEROL = DULERA
IF controlled with ICS alone, no need to use the above
What is a leukotriene modifier used for asthma?
MONTELUKAST OR SINGULAIR
added benefit of allergic rhinitis support
more often used in conjunction with ICS
Name asthma relieving medications
SABAs = albuterol, levalbuterol or xopenex
BETA AGONISTS ACTIVATE BETAS IN AIRWAYS = DILATION AND RELAXATION OF AIRWAYS
What treatment is used in mild to moderate COPD exacerbation in outpatient setting?
Gram +/- coverage = doxycycline and TMP-SMX/ bactrim
(+ = s.pneumoniae, - = h.influenzae, moraxella, h. parainfluenzae)
Cephalosporin
Amoxicillin
What treatments are used in MORE SEVERE cases of outpatient COPD exacerbation ?
Beta lactam = Amoxicillin-clavulanate, Cephalosporin
Macrolide = azithromycin, calrithromycin
Respiratory fluoroquinolone = REALLY SICK, moxifloxacin, levofloxacin HIGH RISK OF TENDON RUPTURE ESPECIALLY IF ON PREDNISONE TOO
What is FVC?
volume of gas forcefully expelled from lungs after maximal inspiration
What is FEV1?
volume of gas expelled in FIRST SECOND of FVC maneuver
How do you characterize obstructive lung disease?
Reduced AIRFLOW RATES = FEV1, FVC, PEFR
lung volumes within NORMAL RANGE OR LARGER
How do you characterize restrictive lung disease ?
TLC, FRC, RV
reduced volumes and expiratory flow rates ^
What is TLC?
volume of gas in lungs after maximal inspiration
What is FRC?
Functional residual capacity
What is RV?
Residual volume
volume of gas remaining in lungs following maximal expiration
PNEUMONIA PEARLs in ELDERLY
classic signs of disease may be absent anorexia / poor appetite decreased ADLs Tachypnea fever confusion / MS changes Earliest sign in elderly = tachypnea then SOB Aspiration pneumonia usually RML
Pertussis
whooping cough
bordetella pertussis
early symptoms = runny nose, low grade fever, occasional cough
late = cough followed by WHOOP, vomiting during cough, exhaustion after
TX- azithromycin, clarithromycin, erythromycin
NO COUGH MEDS
tdap in 3rd trimester pregnancy women ***
