Pulm 2

Question 1

PNA can be what type of infection
3

Answer 1

bacterial
viral
fungal

Question 2

PNA - clinical pres
4

Answer 2

1. cough +/- sputum
2. fever
3. SOB
4. pleuritic CP

Question 3

PNA - PE findings of vitals
4

Answer 3

1. febrile
2. tachycardia
3. hypoxia
4. tachypnea

Question 4

PNA - PE findings for lung exam
4

Answer 4

1. rales/crackles
2. diminished lung sounds
3. wheezing
4. rhonchi

Question 5

PNA - consider ambulatory what

Answer 5

pulse oximetry

Question 6

PNA - img/testing
2

Answer 6

1. cxr if VS abnormal - infiltrate may not be visible in early illness
2. consider rapid influenza and/or COVID test

Question 7

PNA - some DD
5

Answer 7

1. asthma
2. COPD
3. infectious diseases - COVID, pertussis, TB etc.
4. acute bronchitis
5. PE

Question 8

PNA - most care can be managed where

Answer 8

OP

Question 9

PNA - abx if not comorbid conditions
3

Answer 9

1. amoxicillin 1 G PO q8h x 5 days
2. doxy 100 mg PO BID x 5 days
3. azithromycin 500 mg PO once, then 250 mg PO once for 4 days

Question 10

PNA - abx if comorbid conditions present
5

Answer 10

5 days
1. amoxicllin/clavulanic 875 PO BID
2. cefpodoxime 200 mg PO BID
3. cefuroxime 500 mg PO BID

any of above +
1. azithromycin 500 mg PO once, then 250 PO daily for 4 days OR
2. doxy 100 mg PO BID for 5 days

Question 11

PNA - peds abx rx
2

Answer 11

1. amoxicillin 45 mg/kg PO BID for 10 days
2. azithromycin 10 mg/kg PO once, then 5 mg/kg PO once daily x 4 days; presumed atypical

Question 12

PNA - when to refer to ER
4

Answer 12

1. respiratory distress
2. hypotension
3. hypoxia < 90%
4. failed OP tx

Question 13

asthma

Answer 13

chronic inflammatory condition of the lower airways w/ recurring and variable symptoms, expiratory airflow obstruction, bronchial hyperresponsiveness w/ underlying inflammation

Question 14

chronic inflammatory condition of the lower airways w/ recurring and variable symptoms, expiratory airflow obstruction, bronchial hyperresponsiveness w/ underlying inflammation

Answer 14

asthma

Question 15

asthma - symptoms often occur following what

Answer 15

exposure to a trigger - allergens, URI, exercise

Question 16

asthma - hx taking may include

Answer 16

family history of asthma, allergies, or eczema

Question 17

asthma - clinical pres
4

Answer 17

1. SOB
2. wheezing
3. cough +/- wheezing
4. chest tightness

Question 18

asthma - tripod position

Answer 18

seated, leaning forward w/ hands on knees to assist breathing - sign of respiratory distress

Question 19

asthma - PE findings can include
6

Answer 19

1. tachypnea
2. tachycardia
3. expiratory wheeze (most common)
4. inspiratory wheeze
5. diminished lung sounds
6. intercostal muscle contraction

Question 20

asthma - img/testing

Answer 20

1. consider peak flow testing pre and post tx
2. img not rec as most cxr will be normal
3. consider cxr if dx unclear

Question 21

asthma - DD can include
5

Answer 21

1. COPD
2. URI
3. PE
4. bronchiectasis
5. CHF

Question 22

asthma - tx overview
3

Answer 22

1. bronchodilator
2. consider steroid
3. oxygen if hypoxic

Question 23

asthma - bronchodilator options
2

Answer 23

SABA i.e. albuterol 2-4 puffs w/ MDI w/ spacer
NEB 2.5 mg

Question 24

asthma - steroid options
2

Answer 24

1. prednisone 40-60 mg PO x 5 days
2. dexamethasone 12 mg PO once (p0.6 mg/kg)

Question 25

asthma - d/c instructions
2

Answer 25

1. discuss proper use of albuterol, including use of a spacer
2. refer for PCP f/u

Question 26

how long does a cough typically last following an URI

Answer 26

average 18 days

Question 27

how is asthma dx

Answer 27

asthma is difficult to dx as it is a variable condition that can come and go - a series of test may be needed, the most common is a spirometry test

Question 28

asthma - when to refer to ER
4

Answer 28

1. worsening sx despite bronchodilators
2. hypoxia w/ O2 <90%
3. RR > 30 bpm
4. status asthmaticus