Pulmonary 1

Question 1

bronchitis

Answer 1

inflammation of large airways characterized by cough w/ or w/o sputum

Question 2

inflammation of large airways characterized by cough w/ or w/o sputum

Answer 2

bronchitis

Question 3

acute bronchitis - duration of a/sx, follows
2

Answer 3

symptoms 5 days - 3 weeks; typically preceded by URIs

Question 4

chronic bronchitis - duration, predecessor to

Answer 4

sx present most days 3 months or more in a year, and it has been 2 or more consecutive years
predecessor to COPD

Question 5

bronchitis clinical pres
3

Answer 5

1. cough
2. URI sx
3. fever

Question 6

bronchitis - cough may present for how long

Answer 6

weeks, mean duration 18 days

Question 7

bronchitis - cough may have what

Answer 7

+/- sputum production

Question 8

bronchitis - fever can accompany what
2

Answer 8

wheezing
dyspnea

Question 9

bronchitis - PE findings
2

Answer 9

may be present
1. wheezing
2. rhonchi

Question 10

rales vs rhonchi mnemonic

Answer 10

rales/crackles in the tails (aveoli)
rhonchi/wheezing in the bronchi (bronchial tree)

Question 11

bronchitis - img/testing

Answer 11

consider cxr t r/o pneumonia

Question 12

bronchitis - DD
5

Answer 12

1. PNA
2. pertussis
3. COPD exacerbation
4. asthma exacerbation
5. irritants - smoke, inhalation, chemicals, allergic irritants

Question 13

bronchitis - what tx’s not indicated
3

Answer 13

1. abx not indicated for acute bronchitis
2. steroids not indicated for acute bronchitis
3. bronchodilators not indicated for acute bronchitis

Question 14

bronchitis - when to give abx, steroids, bronchodilators

Answer 14

abx - COPD or chronic bronchitis exacerbations
steroids - suspected asthma or COPD or chronic bronchitis exacerbation
bronchodilators - consider for reactive airway disease

Question 15

bronchitis - non pharm antitussives
4

Answer 15

1. smoking cessation
2. how water/tea
3. honey
4. avoiding irritants

Question 16

bronchitis - pharm antitussives have limited efficacy data but options include
3

Answer 16

1. benzonatate/Tessalon pearls (100-200mg TID x 1 week; max 600 mg/day)
2. guaifenesin/Mucinex
3. dextromethorphan/Robitussin

Question 17

bronchitis - when to refer to PCP

Answer 17

PCP f/u in 3-5 days if worsening symptoms

Question 18

bronchitis - when to send to ER
2

Answer 18

1. respiratory distress
2. hypoxia

Question 19

COPD

Answer 19

chronic inflammatory disease that caues obstruction of airflow

Question 20

chronic inflammatory disease that caues obstruction of airflow

Answer 20

COPD

Question 21

COPD two types

Answer 21

emphysema
chronic bronchitis

Question 22

COPD clinical pres
6

Answer 22

1. dyspnea
2. chest tightness
3. wheezing
4. cough productive of sputum
5. hypoxia
6. +/- fever

Question 23

COPD - usually has hx of
2

Answer 23

smoking
home oxygen use

Question 24

acute exacerbations of COPD often associated w/

Answer 24

URI

Question 25

COPD - PE findings 9

Answer 25

1. inspiratory/expiratory wheezing 2. rhonchi 3. decreased breath sounds 4. tachypnea 5. accessory muscle use 6. pursed lips 7. increase AP chest diameter 8. cyanosis 9. cachexia

Question 26

COPD - img/testing 2

Answer 26

1. consider cxr if concerned for PNA or HF 2. consider EKG

Question 27

COPD - DD 7

Answer 27

1. asthma 2. PNA 3. PE 4. pneumothorax 5. CHF 6. ACS 7. arrhythmia

Question 28

COPD - most can be managed where

Answer 28

OP

Question 29

COPD - tx 3

Answer 29

1. short acting bronchodilators 2. possible abx 3. possible prednisone PO 5-7 days

Question 30

COPD - bronchodilator rx options (adults)

Answer 30

i.e. albuterol inhaler 2-4 puffs (q4-6 hours, max 12 puffs/day) albuterol NEB 2.5 mg (max 10mg/day) other SABA is levalbuterol

Question 31

COPD - pediatrics bronchodilator info 2

Answer 31

2-4 years old NEB 0.63-2.5 mg NED q4-6h prn 5 years + NED 1.25-5 mg q4-8h prn

Question 32

COPD - steroid PO

Answer 32

consider prednisone 40-60 mg PO for 5-7 days

Question 33

COPD - abx if 3 cardinal sx present

Answer 33

1. increased dyspnea 2. increased sputum volume 3. increased purulence OR increase sputum purulence + 1 other cardinal sx

Question 34

COPD abx choices 3

Answer 34

1. azithromycin 500 mg PO once daily x 3 days 2. doxy 100 mg PO BID 5-7 days 3. cefuroxime 500 mg PO BID 5-7 days

Question 35

COPD - when to refer to ER 3

Answer 35

1. hypoxia <92% on RA or home oxygen 2. little to no improvement after tx 3. impaired mental status or somnolence