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Review > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Acute bronchitis organisms

A

most likely viral
adenovirus
coronavirus
RSV

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2
Q

Acute bronchitis treatment

A

symptomatic

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3
Q

Pertussis organism

A

Bortadella pertussis (G-)

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4
Q

Pertussis stages

A

catarrhal
paroxysmal
convalescent

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5
Q

Most infectious stage of pertussis

A

catarrhal

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6
Q

Pertussis labs

A

nasopharyngeal swab

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7
Q

Pertussis treatment

A

1st line: Macrolides
-Azithromycin
Tdap booster
Prophylaxis for close contacts

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8
Q

CAP organisms

A
  • Streptococcus pneumoniae

- Haemophilus influenza

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9
Q

Gold standard for CAP diagnosis

A

CXR

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10
Q

CAP lab results

A
  • leukocytosis

- bandemia

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11
Q

CAP treatment for low risk patients

A
  • amoxicillin
  • doxycycline
  • macrolide
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12
Q

CAP treatment for high risk patients, used abx within last 3 months

A

-Augmentin or cefpodoxime or cefuroxime AND
Macrolide or doxycycline
-Levaquin

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13
Q

CAP high risk patients

A
  • > 65
  • immunocompromised
  • multiple comorbidities
  • recent antibiotic use
  • day care attendance, LTC facilities
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14
Q

PPSV23 only

A 
increased risk patients
-asthma
COPD
smoking
CVD
DM
liver disease
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15
Q

pneumococcal schedule for very high risk patients

A

PCV13 now
PPSV23 in 8 weeks
PPSV23 in 5 years (booster)

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16
Q

pneumoccoccal for >65 and healthy

A

PPSV23 only

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17
Q

> 65 and immunocompromised for pneumococcal

A

PCV13 now

PPSV23 in 1 year

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18
Q

Pneumococcal dosing for <2 years old

A

2 months
4 months
6 months
12-15 months

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19
Q

Children >2 who have not been pneumococcal vaccinated

A

1 dose PCV13

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20
Q

Atypical PNA organisms

A
  • mycoplasma pneumoniae
  • chlamydia pneumoniae
  • Legionella pneumoniae
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21
Q

Atypical PNA treatment

A

-macrolide
azithromycin
clarithryomycin
erythromycin

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22
Q

Phlegm color in bacterial PNA

A

rust colored

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23
Q

COPD components

A
  • emphysema
  • chronic bronchitis
  • possible asthma
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24
Q

COPD with emphysema presentation

A
  • barrel chest
  • increased AP diameter
  • accessory muscle use
  • pursed lip breathing
  • weight loss
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25
Q

COPD with chronic bronchitis presentation

A
  • chronic cough
  • sputum production
  • coarse crackles
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26
Q

Inhaled anticholinergic mechanism

A

prevent bronchoconstriction

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27
Q

Beta agonist mechanism

A

produce bronchodilation

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28
Q

What to add to first line treatment for CODP

A
  • SAMA, LABA

- SABA

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29
Q

Examples of SAMA

A

-ipratropium (Atrovent)

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30
Q

Examples of LAMA

A

-tiotropium (Spiriva)

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31
Q

Example of LABA

A
  • salmeterol
  • indacaterol
  • olodaterol
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32
Q

SAMA SABA combo

A

Ipratropium/albuterol (Combivent)

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33
Q

alpha-1-trypsin deficiency

A
  • rare
  • severe lung damage at early ages
  • early onset COPD
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34
Q

When to avoid SAMA/LAMA

A

narrow-angle glaucoma
BPH
bladder neck obstruction

35
Q

General treatment of COPD

A
  • smoking cessation
  • annual flu
  • pulmonary rehab therapy
  • treat lung infections aggressively
36
Q

Consider which organism with PNA in COPD

A

Haemophilus influenzae

need gram - coverage antibiotics

37
Q

Lung cancer screening recommendations

A
  • annual low-dose CT for current smokers 55-80 with 30 pack-year history
  • patients who have quit smoking within the last 15 years
38
Q

What level of prevention is lung cancer screening

39
Q

Inhaled ICS examples

A
  • Fluticasone (Flovent)
  • Triamcinolone (Azmacort)
  • Beclamethasone (Qvar)
  • Budesonide (Pulmicort)
40
Q

Teaching needed for inhaled ICS

A
  • oral thrush, wash out mouth after use

- HPA axis suppression

41
Q

LABA patient education

A

-warm of increased risk of asthma deaths

42
Q

Leukotriene inhibitor examples

A
  • Montelukast (Singulair)

- Zileuton (Zyflo)

43
Q

Montelukast monitoring

A

-nueropsychological effects

44
Q

Zileuton monotiroing

45
Q

Mast cell stabilizer examples

A
  • Cromolyn

- Nedocromil

46
Q

Methylxanthine examples

A

-Theophylline

47
Q

Immunomodulators

A

Omalizumab (anti-IgE)

48
Q

Mild intermittent asthma

A
  • FEV1/PEF >80%
  • symptoms <2x/week
  • SABA PRN
49
Q

Mild persistent asthma

A
  • FEV1/PEF >80%
  • Symptoms >2x/week
  • SABA PRN + low dose ICS
  • alt: Cromolyn, montelukast, theophylline, nedocromil
50
Q

Moderate persistent asthma

A
  • FEV1 or PEF 60-80%
  • daily symptoms
  • SABA PRN + low dose ICS with salmeterol (Advair) or medium-dose ICS
  • alt: low dose ICS plus Singulair, theophylline, or zileuton
51
Q

Severe persistent asthma

A
  • FEV1/PEF <60%
  • symptoms most of the day
  • high dose ICS +LABA plus daily oral steroid
  • SABA
52
Q

Exercise induced asthma

A
  • premedicate 10-15 minutes before activity

- effect lasts up to 4 hours

53
Q

Asthma exacerbation treatment

A
  • albuterol neb treatment
  • may repeat every 20 minutes up to 3 doses
  • if unable to use give epi IM
54
Q

Peak expiratory flow rate

A

measures effectiveness of treatment, worsening symptoms, and exacerbations
-blow hard three times onto spirometer, highest value is recorded as best

55
Q

Mnemonic for PEF

A

HAG

  • height
  • age
  • gender
56
Q

Spirometer green zone

A
  • 80-100% expected

- maintain or reduce medications

57
Q

Spirometer yellow zone

A
  • 50-80%

- maintain or increase if having exacerbation

58
Q

Spirometer red zone

A

<50%

  • call 911 if after treatment
  • if in respiratory distress, give IM epi and call 911
59
Q

Chronic use of high-dose inhaled steroids

A
  • osteoporosis
  • mild growth retardation
  • glaucoma
  • cataracts
  • immune suppression
  • HPA suppression
60
Q

What to do if you suspect allergic asthma

A
  • check serum IgG allergy panels

- refer to allergist

61
Q

Menopausal women on me to high dose ICS long term

A

-consider calcium and vitamin D supplement

62
Q

TB organism

A

-mycobacterium tuberculosis

63
Q

most contagious TB

A

pulmonary
pleural
larygneal

64
Q

Is latent TB infectious

65
Q

Miliary TB

A
  • infects multiple organ systems
  • younger children <5
  • elderly
  • milia seed pattern on xray
66
Q

First line drugs for TB

A

-isoniazid and rifampicin

67
Q

Direct observed treatment for TB

A
  • for non–compliant patients

- nurse needs to physically see them take their medication

68
Q

What to do with positive PPD

A
  • assess for s/sx

- order CXR

69
Q

Latent TB treatment

A
  • HIV (-): INH for 9 months
  • HIV (+): INH for 12 months
  • monitor LFTS
70
Q

Who to treat latent TB

A
  • recommended for <35yo

- less risk of liver damage

71
Q

Positive TB test <5 mm

A
  • HIV (+)
  • recent contact
  • CXR with fibrotic changes with previous TB
  • any child (<5) with close TB contact
  • IC
72
Q

Positive TB for >10

A
  • recent immigrant (within last 5 years)
  • child <4 or adolescent exposed
  • IVDU
  • Health care worker
  • homeless
  • employee in high risk setting
73
Q

Positive TB >15

A

anyone with no known risk for TB

74
Q

Preferred test for BCG vaccination

A
  • IGRA

- available within 24 hours

75
Q

Purpose of 2 step TB test

A
  • booster phenomenon
  • person will have false negative to first test if not tested for many years
  • repeat in 1-3 weeks, will be positive if patient has TB
76
Q

How many drugs should TB be treated with

A

at least 2 or 3

77
Q

Category A (GOLD 1-2) treatment

A

-SABA PRN
OR
-SABA/SAMA

78
Q

Category B (GOLD 1-2) treatment

A
  • LABA or LAMA

- SABA PRN

79
Q

Category C (GOLD 3-4) treatment

A
  • LAMA

- if poor control use LABA and LAMA

80
Q

Category D (GOLD 3-4) treatment

A
  • high risk

- refer to pulmonologist

81
Q

Most common cause of COPD exacerbations

A

bacterial or viral cause

82
Q

COPD exacerbation antimicrobial treatment options

A
  • Concern for Haemophilus influenzae infection
  • Bactrim DS, doxycyline, or Ceftin
  • severe: Augmentin or respiratory quinolones
  • Medrol dose pack
83
Q

1 cause of CAP in cystic fibrosis patients

A

Psudomonas aeruginosa

84
Q

COPD lung changes

A
  • reduction in FEV1
  • increase RV
  • increase TLC

Review (24 decks)

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