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AGNP review > Reapiratory > Flashcards

Reapiratory Flashcards

1
Q

Lung Cancer Screening

A

Annual low-dose CT (LDCT) in adults 50-80 w/ 20 pack year hx who currently smoke or who have quit within 15 years

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2
Q

Signs of Respiratory Failure

A

Tachypnea, lack of wheezing, accessory muscle use, diaphoresis, exhaustion

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3
Q

Causes of Tachypnea

A

Pain, fever, physical exertion, PE, hyperthyroidism

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4
Q

Egophony

A

Presence of consolidation in the lungs

Will hear “bah” sounds instead of “eee”

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5
Q

Whispered Pectoriloquy

A

Instruct pt to whisper “99”

Consolidation if words are clearly heard on the lower lobes

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6
Q

Normal lung percussion sound

A

Resonance

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7
Q

Gold standard test for Asthma and COPD

A

PFT (pre- and post-bronchodilator)

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8
Q

FEV1/FVC

A

Proportion of person’s VC that the person is able to expire in 1 second

Most important for detecting airflow obstruction

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9
Q

Restrictive lung diseases

A

Pulmonary fibrosis
Pleural disease
Diaphragm obstruction

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10
Q

Obstructive lung disease

A

Asthma
COPD (chronic bronchitis, emphysema)
Bronchiectasis

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11
Q

Asthma lung findings

A

Wheezing with prolonged expiration

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12
Q

Medication triggers for asthma

A

ASA or NSAIDs
BB
ACEI
Certain eye drops

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13
Q

Goal frequency of SABA use

A

< 2 days a week

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14
Q

Tx for Exercise-Induced Bronchoconstriction (asthma)

A

Pre-medicate 5-20 min before exercise w/ 2 puffs of SABA

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15
Q

Emergency Management of Asthma exacerbation

A

Albuterol 0.5% solution by nebulizer every 20-30 minutes up to 3 doses

Albuterol w/spacer, 4-8 puffs every 20 minutes for 8 doses

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16
Q

Glucocorticoids for Asthma exacerbations

A

Pred 40-60 for 5-7 days

If it is also taking inhaled glucocorticoids, no need to taper PO dose lasting 3 weeks or less

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17
Q

Peek Expiratory Flow (PEF)

A

Based on height, age, sex (HAS)

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18
Q

Chronic Bronchitis

A

Coughing w/excessive mucous for 3 or more months for a minimum of 2 or more consecutive years

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19
Q

“Blue bloater” vs “pink puffer”

A

Blue = chronic bronchitis (chronic hypoxia)

Pink = emphysema (adequate O2 saturation)

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20
Q

COPD Diagnosis

A

Post-bronch FEV1/FVC < 0.7

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21
Q

Digital clubbing

A

Not typical in COPD

22
Q

PNA initial testing

A

CBC w Diff
BUN/Cr
CXR

23
Q

PNA Tx

A

5-7 days of tx

W/o CM Doxy or Macrolide or Amoxicillin

W/ CM Fluoroquinolone or Doxy or macrolide + beta-lactam (Augmentin or Cefuroxime)

24
Q

PNA s/sx

A

Tachypnea, crackles or rales, consolidation (dullness on percussion, increased tactile fremitus, cough does not completely clear abnormal lung sounds), pleural friction rub (caused by pleurisy - pt reports sharp localized pain with deep breath/movement/cough)

25
Q

CURB-65

A

PNA assessment

0-1 treat as OP
2 short hospital stay or monitor closely

26
Q

CURB-65 Assessment Questions

A

Confusion of new onset
Blood urea nitrogen > 19
RR 30 BPM or more
BP < 90 systolic or < 60 diastolic
Age 65

27
Q

Acute Bronchitis Symptoms

A

Cough with or w/o sputum
Absence of fever or tachypnea
Lasting > 5 days
Absence of asthma, COPD, or other airway disease

28
Q

Acute Bronchitis Tx

A

Bronchodilator via MDI such as SAMA (ipatroprium bromide) or SABA (albuterol)

Pred 40 mg x 3-5 days

29
Q

Asthma Dx

A

Airflow obstruction that is at least partially reversible

Increase in FEV1 12% and > 200 ml from baseline post beta2agonist

Spirometry is preferred test to diagnose

Peak flow meter primarily used for monitoring

30
Q

SABA example

A

Albuterol

31
Q

SAMA

A

Ipratropium bromide

32
Q

What step is a daily inhaler added

A

Step 3

Following almost daily symptoms with nighttime awakening greater then 1 or more times a month

33
Q

LAMA example

A

Triotropium bromide (Spiriva)

34
Q

LABA example

A

Budesonide-formoterol (symbicort)

35
Q

LABA example

A

Budesonide-formoterol (symbicort)

36
Q

Asthma control questions

A
  1. Daytime asthma symptoms more than 2/week?
  2. Any nighttime awakening?
  3. Reliever therapy for symptoms more than 2/week?
  4. Any activity limitation
37
Q

Scoring asthma control

A

1-2 positive responses = partly controlled
3-4 positive responses = uncontrolled

38
Q

Asthma assessment

A

Measure FEV1 at diagnoses, after 3-6 months of controller therapy, then periodically

39
Q

Asthma and pregnancy

A

Treat as you would any non-pregnant pt

40
Q

Air trapping is seen

A

Acute Asthma flares
COPD

41
Q

Tactile fremitus

A

Decreases w/ decreased tissue density

Palpitations vibration from when the pt is speaking

42
Q

Asthma wheeze

A

Initially expiratory, then inspiratory

43
Q

COPD Interventions

A

Smoking cessation
Advice on physical activity and Pulm rehab
Influenza, pneumococcal, RSV, COVID vaccine

44
Q

COPD definition

A

Spirometry

FEV1: FVC < 0.70 post bronchodilation

45
Q

GOLD Classification

A

Severity of COPD

1 mild FEV1 80 % or more
2 mod FEV1 50-80%
3 severe FEV1 30-50%
4 very severe FEV1 less than 30%

46
Q

GOLD Classification

A

Severity of COPD

1 mild FEV1 80 % or more
2 mod FEV1 50-80%
3 severe FEV1 30-50%
4 very severe FEV1 less than 30%

47
Q

Asthma diagnoses

A

Spirometry not required like with COPD

48
Q

COPD First line tx

A

LABA or LAMA

W/ very occasional breathlessness SABA or SAMA

49
Q

COPD Second Line Tx

A

LAMA + LABA

50
Q

COPD w/hospitalization and greater than 2 exacerbations

A

LABA + LAMA

Add ICS if blood eosinophils are great or equal to 300

51
Q

COPD exacerbation w/ antibiotics

A

5 day course

52
Q

Pertussis TX

A

First line Macrolides x5-7 days
Second line Bactrim x 14 days

AGNP review (16 decks)

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