Pulm 1 Flashcards
What is the most common chronic disease in children?
Asthma
A 4 yo child is brought in because her mother is concerned about her cough that is consistently worse at night, wheezing, and recurring chest tightness. The child gets symptoms every day and she has awoken 3 nights this month from dyspnea. What is the most likely cause of this child’s disease? What stage disease is this?
The child has moderate asthma
It is caused by an inflammatory response of the airway to an allergen (allergen –> inflammation –> airway hyperresponse –> symptoms)
An 8 yo is brought in for his asthma. He is using his inhaler ~3 times/week, and when you perform spirometry you find that his FEV1/FVC is 79%. What stage asthma does he have? What step treatment is he on? What is he taking for his asthma? Should you change his daily asthma medications?
He has mild asthma
He is on Step 2 treatment and is most likely taking a SABA PRN and a low-dose ICS. Since he is using his inhaler > 2 times/week and his spirometry is 75-80% it is not well controlled and he should step up at least 1 step (to step 3)
A 13 yo comes in because he’s been having trouble with his asthma recently. He’s been using his inhaler 4 times/week, has woken up one night in the past couple weeks, and his asthma is slightly hindering his normal activity. He is currently on a SABA, low-dose ICS, and LABA. What do you recommend?
The pt is currently on step 3 treatment, but since his asthma is not well controlled he should step up at least 1 step (to step 4)
Step 4 treatment is a medium-dose ICS and LABA and he should come in for a F/U appointment in 2-6 weeks
A 29 yo female pt comes in because she wants to become pregnant, but she wanted to check with you to see if her pregnancy would affect her asthma. She is currently on a SABA, a low-dose ICS and a LABA. What do you tell her? Should you adjust her medications?
Her pregnancy might make her asthma better (33% chance), worse (33%), or remain the same (33%)
LABA’s should be avoided during pregnancy, so either change her LABA to Prednisone or, since the pt is a Stage 2, change her low-dose ICS to a medium-dose ICS
A 6 yo boy is brought in by his mother because he has been coughing, wheezing, and has had difficulty breathing 1 day this week and 1 day last week. It hasn’t interfered with his normal routine, but his mother is worried about the wheezing. His mother is worried it might be caused by his eczema. What do you tell her? What is the boy’s diagnosis? Are you going to treat it?
He has asthma. It isn’t caused by his eczema, but eczema is a risk factor for developing asthma
Based on his symptoms and lack of interference with normal activity he has intermittent asthma
Start him on Step 1, a SABA (inhaler) PRN
A 3 yo is brought in by his mother with wheezing, coughing, and dyspnea 3 times this week. His mother tells you that 3 months ago she brought him to the ER because he couldn’t breathe but he was ok after being treated with an oral corticosteroid. You strongly suspect that he has asthma. How will you diagnose it? What asthma classification do you suspect? What treatment do you recommend?
Since the pt is only 3 yo you can’t do spirometry (the ideal for diagnosing asthma)
Instead diagnose based on his symptoms, activity limitation, and quality of life factors
Labs (IgE and RAST) can also be run
Based on his severity components he has mild asthma
He should be started on Step 2 treatment: a SABA PRN and a low-dose ICS
A 7 yo pt is brought in with concomitant nasal polyps and severe, persistent chest tightness, dyspnea, and wheezing. What disease might he have? How would you diagnose it?
Intrinsic asthma
Hard to diagnose, but do skin tests (neg.), IgE (normal), and a bronchial biopsy or sputum sample (identical to atopic asthma)
A 6 yo comes in for his annual check up. When you ask about his asthma, his mother tells you that he has symptoms 0-1 times/week and uses his SABA ~1 time/week but it does not interfere with his normal daily routine. How is his asthma control? What do you recommend this pt do?
His asthma is well controlled
He should maintain his current asthma medications and should follow-up in 3 months, at which time he can step down if he has remained stable
A 32 yo pt comes in complaining of midline chest pain. For the past few days he has had a cold, but today he woke up with night sweats and a fever and he has been coughing all day. On physical examine you notice rhonchi that clear with coughing and wheezing. What is the most likely diagnosis? How are you going to treat this pt?
Acute bronchitis
Treat with antipyretics, ipratropium (Atrovent), or a SABA
A 68 yo pt comes in because he feels terrible today. He’s had a cold for the past couple days, but today he’s been coughing violently all day and about half of the time he coughs up blood. He has also had 2 bouts of vomiting within the past 6 hours. On PE you notice cyanosis around his lips and you hear rhonchi that don’t clear with coughing and wheezing. What is the most likely cause of this pt’s disease? What treatment do you recommend?
Acute bronchitis
Most likely caused by a viral infection, either influenza, parainfluenza, coronavirus, adenovirus, rhinovirus, or RSV
Other causes are: bacterial - m. neumonia, chlamydophila pneumonia, or bordtella pertussis; smoking; or pollution/toxins/occupational exposure
Since the pt is > 64 yo and has severe pulmonary signs, recommend hospitalization, IV fluids, and O2 therapy
A 52 yo pt comes in because she has been coughing all day, has had a little bit of difficulty breathing, and feels feverish. Last week she had a cold. The pt has a 10 pack year history of tobacco use. What is the most likely diagnosis? What treatment options do you recommend? What complications are you worried about in this pt?
Acute bronchitis
Recommend she stop smoking! Talk to the pt and offer as much support as possible (recommend small lifestyle changes, smoking cessation programs, etc.)
Since acute bronchitis is self-limiting it will most likely resolve in 5-21 days
Recommend antipyretics, ipratropium (Atrovent), or a SABA
You are worried the pt will later on develop chronic bronchitis or COPD if she doesn’t stop smoking
A pt comes in and you suspect a bacterial infection is causing her acute bronchitis. What should you do next?
Culture! Don’t give Abx unless you know it’s bacterial
