PULMONARY DISORDERS TEST 3

Question 1

TUBERCULOSIS

Answer 1

infectious diseases caused by mycobacterium tuberculosis
primary tuberculosis -gain access to aveoli of the lungs TB go dormant (rest) –>detect by TB skin test & treat otherwise host become immunocompromise then lungs disease will develop (once TB positive it alway positive)
secondary tuberculosis - usually pulmonary
site of pulmonary infection: APEX of the lung

Question 2

Pulmonary tuberculosis –> aka secondary tuberculosis

clinical manifestation

Answer 2

fatigue, anorexia, wt. loss, night sweats, low grade diurnal (evening) fever, cough, chest pain r/t cough, hemoptysis, irregular menses.

Question 3

Pulmonary tuberculosis (secondary TB) 
examination

Answer 3

rales in upper posterior area, may evidence of pleural effusion lymphadenopathy.

Question 4

TB diagnostic testing

Answer 4

• -> The Mantoux Test
  * *read in 48-72 hours
  * *Two step testing (>45 y.o only)
  * *anergy :if pt is immunocompomised
• -> QTF-G Blood test
  * *results in 24 hours
• –CXR : if positive to exclude pulmonary disease; if negative - then prophylaxis with ISONIAZID

Question 5

TB prophylaxis with INH

Answer 5

criteria
Positive TB skin test, other tests negative
No liver contraindication
Regardless of hx BCG vaccination (usually given to toddler in 3rd world)
side effects
Hepatitis - need baseline and monthly LFTs
Drugs that increase risk (tylenol for example)

Question 6

TB prophylaxis –> peripheral neuropathy

Answer 6

• -> Use B6 (pyridoxine) to decrease risk if pt has DM, uremia, alcoholism, malnutrition, during pregnancy, or if pt. has a seizure disorder requiring Dilantin
• give to people who take INH**
• -> if x-ray shows active TB refer Mandatory reporting in all 50 states–must reported to local health department.

Question 7

Influenza

Answer 7

acute infection of respiratory tract–Influenza virus type A or B

• *highly contagious: self-limiting
• *spread by droplet–virus shed 24 hours before symptoms occur

Question 8

S/sx of influenza

Answer 8

fever (peak at 12 hours after onset), chills, H/A , malaise, loss of appetite, dry cough nasal congestion w/ clear drainage, sore throat –COUGH is most prominent
cervical lymph node enlargement

Question 9

Dx testing for influenza

Answer 9

rapid test or cell culture for virus : takes 2-7 days

Question 10

Rx for influenza

Answer 10

rest fluids, antipyretic/analgesic
Antiviral meds: zanamivir (Relenza) and Oseltamivir (Tamilflu)
–> if used as Rx: should be started in first 48 hours; reduces severity and duration of symptoms (1 day)
–> may be used prophylactically for persons at high risk
**influenza vaccine best prevention **
including pregnancy women
six mos and older who not allergic to eggs
nasal spray cannot given to children under 1

Question 11

Asthma

Answer 11

chronic inflammatory disorder of the airways
6th most common reason for visit –most common respiratory disorder of all age groups
triggered by many factors, including allergens, infections, exercise, changes in weather, irritants, allergy to ASA

Question 12

s/sx asthma

Answer 12

episodic wheezing associated with dyspnea, cough, breathlessness, anxiety, sputum production

most common symptom: COUGH
between attacks : no symptoms

exercise induced: begins 5-10 minutes after exercise (breathing air rapidly )

*dx by signs and symptoms
& spirometry

Question 13

allergens cause asthma

Answer 13

cat dander
dust mites
cockroach
tree and grass pollen

others: viral illness, occupational exposure, socioeconomic deprivation, anxiety, depression, stress

Question 14

acute severe asthma

Answer 14

d/t poor response to therapy

self medication beta 2 adrenergic agonist inhaler they may use weeks before seek medical help

Question 15

Physical exam of asthma

Answer 15

wheezing-forced expiration both inspiratory and expiratory as it worsens, use of accessory muscles increases. HYPERINFLATION
Severe attack- labored breathing –> ER

Question 16

Asthma Dx tests

Answer 16

**spirometry
–> most useful= peak expiratory flow rate (PEFR) , FEVI, MMEFR, and FVC
mild asthma= decreased PEFR, FEVI, MMEFR
bronchospasm= decreased FEVI, MMEFR and FEVI/FVC ration

-> dx. hallmark : decrease obstruction after bronchodilator.

Question 17

Asthma control

Answer 17

avoid environmental trigger
antiinflammatory medication
pt education

Question 18

acute bronchitis etiology

Answer 18

transient inflammation of the trachea and major bronchi
begins with URI (cold ) cough that causes burning pain in chest, nose & throat symptoms that subside but cough persists, along with wheezes, rhonchi, course rales

Question 19

clinical dx of acute bronchitis

Answer 19

s/x low grade temp cough

no dx testing

Question 20

acute bronchitis causes

Answer 20

viral illness, occupational exposure
socioeconomic deprivation
anxiety depression , stress

refer if not responding to tx or if symptoms linger for longer than 2 weeks
education- s/e of medication; cough may persist 10-14 days

Question 21

pneumonia defined

Answer 21

bacterial and atypical or “walking pneumonia”
bacterial - most common organism for CAP =streptococcus pneumoniae
leading cause of death from infectious disease and 7th most common cause of death in US from all causes

Question 22

different organism of pneumonia

Answer 22

• • Gram positive bacteria : streptococcus pneumoniae
• • Gram negative bacteria: Haemophilus influenza
• *Atypical pneumonia : Mycoplasma pneumoniae

bacterial pneumonia–> shaky chills productive coughs with bloody rust color sputum
tight chest pain …
consolidation –> egophony

Question 23

Atypical pneumonia

Answer 23

teenager
living in dormatory
fever dry cough
much less ill than bacterial pneumonia 
no lungs consolidation 
macular papular rash on skin or bullous on tympanic membrane (painful) 
fine rales 
CXR patchy palbulor 
wbc lightly elevate or not at all

Question 24

Group 1 outpatients pneumonia TX

Answer 24

**MACROLIDES are first line or Doxycycline

if comorbidities or high risk for resistance –> MOXIFLOXACIN, gemifloxacin, levofloxacin, or
macrolide + augmentin

Question 25

patient education : pneumonia

Answer 25

rest increase fluids antipyretics/analgesic
avoid cough suppressant (so they can expectorate !!)
directions for antibiotic use and side effects
follow up : 24 hours even though abt take up to 48 hr to work

Question 26

smoking cessation

Answer 26

most preventable cause of premature death in U.S
1 in 5 deaths is related to smoking
35 million smokers try to quit each year
7% of them succeed
A few minutes of counseling is an effective way to help people stop smoking

Question 27

6 phases of change

Answer 27

(1) precontemplation
(2) contemplation - I know I should quit, but ..
(3) determination - I want to quit (self efficacy)
(4) action- set date , specific plan –follow up with provider within 2 week
(5) maintenance- deal with urge
(6) relapse - what did you learn this time?

Question 28

4 “A” for health care providers

Answer 28

Ask
Advise
Assist
Arrange (follow up)

Question 29

General concerns about Quiting (smoke)

Answer 29

Women : weight gain
Men : professional athlete image
Adolescent : point out effect on appearance
Adults: more concern about health

Question 30

pharmacologic intervention for smoking

Answer 30

nicotine replacement
bupropion (Wellbutrin, Zyban)
Varenicline (Chantix)- cause nightmare
Nic Vax -facilitates nicotine antibody development that prevents nicotine getting to the brain
“cold turkey” –> best way & withdraw symptoms does last long