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Clinical Year Exams > MYE SPE (Cough) condensed > Flashcards

MYE SPE (Cough) condensed Flashcards

1
Q

Acute vs. Chronic Bronchitis (hint: think time)?

A
  • Acute = 5+ days (usually 1-3 weeks)

- Chronic = 3+ months of year for 2 consecutive years

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2
Q

What is the MC etiology of Acute Bronchitis? Give an example of two pathogens

A

VIRAL

  • Influenza
  • Parainfluenza
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3
Q

What does the presence of purulent sputum indicate with Bronchitis?

A

NOTHING

- Purulent sputum does NOT mean bacterial infection

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4
Q

How do you dx Bronchitis?

A

Clinical

- CXR is NOT necessary (non-specific findings)

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5
Q

What is the recommended tx for Bronchitis (4)?

A

Symptomatic relief…

  • NSAIDs, ASA, Acetaminophen
  • ICS
  • Antitussives
  • Beta-2 Agonists
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6
Q

WHEN would abx be indicated in tx of Bronchitis?

A

Pertussis = BACTERIAL

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7
Q

What is the pathogen associated with Pertussis? What three sxs (triad) are associated with this condition?

A

Bordetella pertussis

  • Coughing spells (paroxysms of cough)
  • Inspiratory whoop
  • Posttussive emesis
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8
Q

What are the three phases of Pertussis (describe each), and how long does each last?

A
  1. Catarrhal = URI sxs, fever for 1-2 weeks
  2. Paroxysmal = triad of sxs (cough paroxysms, inspiratory whoop, posttussive emesis) for 2-6 weeks
  3. Convalescent = cough gradually improves for weeks/months
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9
Q

What dx test is the GOLD standard for Pertussis?

A

Culture (bacterial)

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10
Q

What is the recommended tx for Pertussis? What is an alternative option?

WHAT is the purpose of initiating tx?

A

Macrolides = Azithromycin
- Bactrim

Abx decrease transmission (do NOT resolve sxs)

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11
Q

Which are four examples of pathogens/conditions that cause cough and are reportable to the State Health Department?

A
  • Pertussis
  • COVID-19
  • Influenza
  • TB
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12
Q

What populations are at increased risk for VIRAL Bronchitis aka Influenza (7)?

A
  • Children <2
  • Adults 65+
  • Comorbidities
  • IC
  • Pregnant
  • Morbidly obese
  • Nursing home resident
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13
Q

What four symptoms are often seen with Influenza? What is the typical onset, and when is it most contagious?

A

ABRUPT onset of…

  • Fever
  • Myalgias
  • Malaise
  • HA

First 2 days

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14
Q

If outpatient, when is testing recommended for Influenza (3)? If inpatient, when is it recommended?

What additional test is also often ordered as the GOLD standard?

A

OP: NOT recommended unless high risk = 65+, children <5 years or IC

IP: ANY patient with sxs upon admission or during admission

GOLD standard = viral culture (3-10 days for results)

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15
Q

What is the MC complication of Influenza?

A

PNA

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16
Q

What is the recommended treatment for Influenza if severe or high-risk, and what is the window for giving it? How does this affect prognosis (2)?

A

Tamiflu (Oseltamivir) within 48 hours of sxs onset

- Reduces complications and shortens course by 1-2 days

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17
Q

What is the MC transmission of CAP?

A

Aspiration of oropharynx

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18
Q

What is the MC TYPICAL pathogen associated with CAP?

A

Streptococcus pneumoniae

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19
Q

What is the MC ATYPICAL pathogen associated with CAP?

A

Mycoplasma pneumoniae

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20
Q

What is the MC etiology of CAP (and what pathogen)? What is the 2nd MC etiology (and what pathogen)?

A
  • MC = BACTERIAL: Streptococcus pneumoniae

- 2nd MC = VIRAL: Influenza

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21
Q

What three sxs are seen with TYPICAL CAP?

A
  • Acute onset
  • Fever
  • Cough
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22
Q

What three sxs may be seen with ATYPICAL CAP?

A
  • Subacute onset
  • NON-productive cough
  • Viral prodrome
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23
Q

What three PE findings are indicative of CAP (Typical or Atypical)?

A
  • Decreased breath sounds
  • Crackles/rales
  • Signs of consolidation (dullness to percussion, tactile fremitus, bronchophony, egophony)
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24
Q

What are four signs of consolidation, and what condition are these associated with?

A

CAP

  • Dullness to percussion
  • Tactile fremitus = put medial side of hand on pt back and have them say “99” with increased vibration
  • Bronchophony = spoken words louder/clearer
  • Egophony = spoken “e” heard as “a”
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25
Q

What is the GOLD standard finding on CXR for CAP? What other two findings may be seen?

A

Infiltrates

- Also, consolidation and/or cavitation

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26
Q

What are three complications of PNA?

A
  • Bacteremia (in blood)
  • Sepsis (bacteremia/other infection triggers systemic infection)
  • Abscess
27
Q

What is CURB-65 and what condition is it associated with? What is it used to determine?

A

If 2+ present = admit for PNA (3+ = ICU)

  • Confusion
  • Urea of 7+
  • RR of 30+
  • BP <90/60
  • 65+ years old
28
Q

What is the recommended OUTPATIENT tx for bacterial PNA if uncomplicated (1, 1) vs complicated (2, 1)?

A
  • OP uncomplicated = Azithro OR Doxy

- OP complicated = Augmentin + Azithro OR Levofloxacin

29
Q

What is the recommended OUTPATIENT tx for bacterial PNA if uncomplicated (2)?

A
  • Azithromycin

- Doxy

30
Q

What is the recommended OUTPATIENT tx for bacterial PNA if complicated (2 or 1)?

A
  • Augmentin + Azithro

- Levofloxacin

31
Q

What is the recommended INPATIENT tx for bacterial PNA (2, 2)?

A
  • Augmentin + Azithro

- Augmentin + Levofloxacin

32
Q

What is the minimum length of abx OP tx for PNA?

A

5 days

33
Q

What is the dx criteria for HAP/VAP PNA (__ AND 2/3)

A

New/progressive lung infiltration on imaging PLUS 2+…

  • Fever
  • Purulent sputum
  • Leukocytosis
34
Q

What etiology of PNA is most associated with HIV, and what is the pathogen?

A

FUNGAL

- Pneumocystis jirovecii

35
Q

What two sxs are associated with PCP (Pneumocystis jirovecii) PNA?

What finding is seen on CXR?

A
  • Fever
  • NON-productive cough

Ground glass opacities seen on CXR

36
Q

What is the preferred tx for PCP (Pneumocystis jirovecii) PNA?

A

Bactrim

37
Q

What is the MC finding seen on CXR for Aspiration PNA?

A

RLL infiltrate

38
Q

What is the MC etiology and pathogen associated with Common Cold/URI?

A

VIRAL

- Rhinovirus

39
Q

What four sxs are often seen with Common Cold/URI? When is it most contagious?

A
  • NON-productive cough
  • Clear/watery rhinorrhea
  • Nasal congestion
  • Sore throat (dry/scratchy)

First 2-3 days

40
Q

What are two possible complications of Common Cold/URI?

A
  • Acute rhinosinusitis

- AOM

41
Q

What is the typical course of Common Cold/URI, and what is the treatment (2)?

A

SELF-LIMITING (1-2 weeks)

  • NSAIDs/Acetaminophen
  • Antihistamines (Sudafed)
42
Q

Compare mild intermittent, mild persistent, moderate persistent and severe persistent Asthma (3 components each)?

A
  • Mild intermittent = <2 days/week, night awake <2 x/month, FEV1 80%+
  • Mild persistent = 2+ days/week, night awake 3-4 x/month, FEV1 80%+
  • Moderate persistent = daily, weekly, FEV1 60-80%
  • Severe persistent = throughout day, awake nightly, FEV1 <60%
43
Q

What three sxs are associated with Asthma?

A
  • SOB
  • Wheezing
  • Cough (worse at night)
44
Q

What two findings may be seen on sputum culture with Asthma?

A
  • Curschmann’s spirals

- Charcot-Leyden crystals

45
Q

What are the six steps of Asthma treatment, and how do they relate to the Asthma classifications (1, 1 or 1, 1 or 2, 2 or 2, 2, 3)?

A
  • Step 1 = Mild Intermittent: SABA PRN
  • Step 2 = Mild Persistent: low-dose ICS daily OR LTRA (Montelukast)
  • Step 3 = Moderate Persistent: medium-dose ICS daily OR low-dose ICS + LABA; consider referral
  • Step 4 = Severe Persistent: medium-dose ICS + LABA OR medium-dose ICS + LTRA; REFER
  • Step 5 = been referred: high-dose ICS + LABA
  • Step 6 = been referred: high-dose ICS + LABA + oral steroids
46
Q

What six sxs are associated with GERD?

A
  • Heartburn (30-60 min postprandial)
  • Regurgitation
  • CHRONIC COUGH
  • Wheezing
  • Hoarseness
  • Dental enamel loss
47
Q

What is the recommended dx test for GERD?

A

Upper endoscopy

48
Q

What is the recommended tx for GERD (2)?

A
  1. Lifestyle modifications

2. H2 Blockers (Ranitidine) vs. PPIs (Omeprazole)

49
Q

What four symptoms are seen with LEFT-sided CHF?

A

LEFT:

  • DOE
  • PND
  • Orthopnea
  • Fatigue
50
Q

What four symptoms are seen with RIGHT-sided CHF?

A

RIGHT:

  • JVD
  • Hepatic congestion
  • Ascites
  • Edema
51
Q

What condition can present with pulsus alternans?

A

LEFT-sided CHF

52
Q

What is the recommended treatment for ACUTE exacerbation of CHF (5)?

A

LMNOP

  • Lasix
  • Morphine
  • Nitrates
  • O2
  • Position (sit up)
53
Q

What four drugs/groups of meds can be used to treat CHF?

What other patient education should be provided to CHF patients (4)?

A
  • Loop diuretics
  • ACE-I
  • BBs
  • Entresto (Sacubitril/Valsartan)

Can consider…

  • Aldosterone Antagonists
  • Hydralazine/Nitrates

Education: weight loss, low sodium, lower fluids, daily weight monitoring

54
Q

What two condition are you at increased risk for with Asbestosis?

A
  • Bronchogenic Carcinoma

- Malignant Mesothelioma

55
Q

How can you differentiate a nodule from a mass with Solitary Pulmonary Nodules (SPNs)? What is there increased chance of with a mass?

What are the MC type of SPN?

A
  • Nodule = <3 cm
  • Mass = 3+ cm; greater change of CA

MC = infectious granulomas (TB, Cocci, abscess)

56
Q

What three findings are indicative of a BENIGN Solitary Pulmonary Nodule (SPN)?

A
  • SLOW growth
  • Round/smooth
  • Calcifications
57
Q

What three findings are indicative of a MALIGNANT Solitary Pulmonary Nodule (SPN)?

A
  • RAPID growth
  • Irregular/speculated
  • Cavitation with thick walls
58
Q

What is the greatest RF associated with Bronchogenic Carcinoma?

A

SMOKING

59
Q

What are the two types of Bronchogenic Carcinoma, and what are the subtypes of each (1, 3)?

A

SCLC
- Oat Cell

NSCLC

  • Adenocarcinoma
  • SCC (Squamous Cell)
  • LCC (Large Cell)
60
Q

Which two subtypes of Bronchogenic Carcinoma present most often with cough?

A
  • SCLC (Oat Cell CA)

- Squamous Cell CA (type of NSCLC)

61
Q

What are three major RF associated with COPD, and which is most common?

A
  • SMOKING = MC
  • Secondhand smoke
  • Alpha-1 Antitrypsin Deficiency
62
Q

What three sxs are often seen with COPD?

A
  • Excess sputum production
  • Cough
  • DOE
63
Q

What value are the four grades of COPD based on (GOLD), and what are the four grades?

A

Based on FEV1…

  • GOLD 1 = FEV1 of 80%+
  • GOLD 2 = FEV1 of 50-70%
  • GOLD 3 = FEV1 of 30-49%
  • GOLD 4 = FEV1 of <30%
64
Q

What are the four categories of treatment of COPD (1, 2 or 2, 2, 2 or 3)

A
  • Category A = SABA
  • Category B = SABA + LABA, SABA + LAMA
  • Category C = SABA + LAMA
  • Category D = SABA + LAMA, SABA+ LABA + LAMA

Clinical Year Exams (3 decks)

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