Pulm

Question 1

Pt presents with cough d/t inflmmation of the bronchioles, bronchi and trachea. What could the pt have?

Answer 1

Upper RSI - Acute bronchitis

Question 2

Most common organisms for bacteria infection for acute bronchitis

Answer 2

Streptococcus pneumoniae (CAP) 
Haemophilus influenzae

Question 3

how to distinguish bronchitis from pneumonia?

Answer 3

Think PNA if…

more productive cough
Fever >100.4
infiltrates on x-ray

Question 4

Decision criteria for Chest XRAY

Answer 4

** only if you suspect PNA

tachypnea
hypoxia
fever
abnormal lung exam

Question 5

what is referred to as the 100 day cough?

Answer 5

Pertussis

Question 6

Non pham management for bronchitis

Answer 6

increase fluids
humidifier
rest
smoking cessation

honey in children <1 yr

Question 7

Dextromethoprhan / Guiafenesin is what kind of medication

Answer 7

Cough suppressant / Expectorant combo

Contraindicated in pts with parkinsons or on SSRIs

avoid in pts who have difficulty clearing secretions

Question 8

Codeine/guaifenesin

Answer 8

Do not take MAO inhibitor, Parkinsions, SSRI

Scheduled V medication

AVOID narcotic cough suppressants in pts with COPD//Asthma

Question 9

What is a cough suppressive medication

Answer 9

Dextromethorphan

Question 10

what is medication class that this secretions?

Answer 10

Expectorants

Ex: Guaifenesin

Question 11

What the MOA for antitussive medications and example

Answer 11

MOA- Topical anesthetic effect on the respiratory stretch receptors

Ex: Benzonatate (Tessalon Pearls)

Question 12

SE of Benzonatate

Answer 12

Do not break/chew - produces local anesthesia and reduce gag refulx

dizziniess, drowsiness, visual changes

begins 15-20mins, lasts 3-8 hrs

Avoid use in pts sensitive to or taking agents with PABA d/t possible CNS effects

Question 13

Caution/ contraindications to Guaifenesin

Answer 13

Contra: Parkinsons & SSRI usage
Caution if nephrolithiasis
not for children < 6

Question 14

Name short acting bronchodilators

Answer 14

Albuterol

Levalbuterol

Question 15

Would you give ABX for bronchitis?

Answer 15

No, since MOST bronchitis is viral.

If everything has been tried and pt has refractory fever or secondary infection try amoxicillin

Question 16

What is an acute infection of the lung in a patient who acquired infection in the community involving the parenchyma, alveolar spaces, and intersitital tissue

Answer 16

Community acquired pneumonia

Question 17

What is the most common agent that causes CAP?

Answer 17

Streptococcus Pneumoniae (Pneumococcal PNA)

Question 18

Assessment findings for CAP?

Answer 18

productive cough 
Fever 
Dyspnea
Pleuritic CP 
Diminished Breath sounds
Consolidation on percussion - dullness 
Egophony E to A changes 
Bronchophony: Voice sounds are louder and clearer than normal

Question 18

Assessment findings for CAP?

Answer 18

productive cough 
Fever 
Dyspnea
Pleuritic CP 
Diminished Breath sounds
Consolidation on percussion - dullness 
Egophony E to A changes 
Bronchophony: Voice sounds are louder and clearer than normal

Question 19

What is required to make a diagnosis of PNA?

Answer 19

Chest Xray!!!

other tests: EKG to r/o Cardiac, Flu swab, possible ABG, CBC (increased WBC), Procalcitonin

Question 20

Hallmark sing of bacterial PNA?

Answer 20

Causative agent: Pneumococcal pneumonia

Rust colored sputum!
preceded by a URI

Question 21

Causative pathogen for primary atypical pneumonia?

Answer 21

Mycoplasma Pneumonia

Question 22

Features of Mycoplasma pneumonia

Answer 22

systemic symptoms predominant over lung s/s

typically in pts <35yrs

Sore Throat
dry cough
Maculopapular rash!!!

may take 6 weeks w/treatment to eradicate

Question 23

Viral PNA (not covid) s/s

Answer 23

Headache
fever
myalgia

Question 24

who is most at risk of Klebsiella Pneumoniae PNA

Answer 24

ETOH, Immunocompromised pts

Question 25

What symptoms occur specific to Klebsiella Pneumoniae PNA?

Answer 25

Bacteria causes tissue necrosis of parenchyma

Currant jelly sputum (coughing up necrosed lung tissue)

HIGH mortality rate. 25-50%

Question 26

What is the number one cause of epiglottitis in children & adults?

Answer 26

Haemophilus Influenzae

Question 27

Whos most at risk of getting Haemophilus Influenzae?

Answer 27

Younger pts if not vaccinated (Hib vacc)

Question 28

What type of PNA has Coryza as a prodrome

Answer 28

Coryza (stuffy nose)

Haemophilus Influenzae PNA

Question 29

what patient population is Legionella Pneumophila PNA most prevelent in?

Answer 29

Middle aged men
Smokers
ETOH
immunosuppresed

Question 30

S/S Legionella Pneumophila PNA

Answer 30

Prodrome resembles Flu 
fever 
headache 
NEUROLOGICAL manifestations 
Relative bradycardia

Question 31

Chlamydial PNA s/s

Answer 31

Cough
fever
sputum production

**Not seriously Ill

*** babies of moms w/chlamydia

Question 32

PNA Tx: Outpatient, health, No recent ABX

Answer 32

Amoxicillin (PCN) - x5 days

Or

Macrolide (Azithromycin 5 days /Clarithromycin 7-14days)

Or

Doxycycline (7-10 days)

Question 33

What are the two most common bacterial causes of CAP

Answer 33

1st: Mycoplasma Pneumoniae ( most common walking pneumonia)
2: Streptococcus pneumoniae (most common worldwide)

Question 34

PNA tx: Outpatient, healthy, RECENT abx

Answer 34

Respiratory fluoroquinolone (Levofloxacin) 10-14 days

or

Macrolide (azithromycin) x 5days + high dose amoxicillin (x 10days)

or

Macrolide + high dose amoxicillin/clavulanate

Question 35

PNA tx: Outpatient WITH Comorbidities, NO recent Abx

Answer 35

Combo therapy

Amoxicillin/Clavulanate

Cephalosporin + macrolide or doxycycline

OR

Respiratory Fluroquinolone monotherapy (Levaquin)

Question 36

PNA tx: outpatient, comorbidities, recent ABX

Answer 36

RSP fluoroquinolone (levaquin)

Macrodie + beta-lactam (high dose amoxicillin/clavulanate or cefpodoxime, or cefprozil or cefuroxime)