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AANP Leik and Fitzgerald > Resp > Flashcards

Resp Flashcards

1
Q

UTPTF:

what patients should undergo lung cancer screening?

A

Adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years:
Screen for lung cancer with low-dose computed tomography (CT) every year.
Stop screening once a person has not smoked for 15 years

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2
Q

Percussion

in which conditions would you find tympany/hyperresonance?
dullness?

A

Tympany or hyperresonance: with COPD, emphysema

Dull: with lobar consolidation, pleural effusion, solid organ

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3
Q

What is normal FEV1/FVC ratio?

A

• FEV1/FVC ratio: proportion of vital capacity that a person can exhale in 1 second

○ Normal - 75% and higher

Post-bronchodilator FEV1/FVC < 0.7 is cutoff for COPD

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4
Q

What are examples of conditions that can cause obstructive dysfunction?

A

asthma
COPD
bronchiectasis

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5
Q

What are examples of conditions that can cause restrictive dysfunction?

A

pulmonary fibrosis
pleural disease
diaphragm obstruction

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6
Q

What is the role of PCV13 and PPV 23 vaccines in COPD?

A
  • PCV 13 (Prevnar): prevent bacteremia and invasive pneumococcal disease
  • PPV 23 (Pneumovax): prevent CAP
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7
Q

what is the definition of chronic bronchitis?

A

chronic productive cough for 3+ months for 2 or more consecutive years

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8
Q

Physical exam findings for COPD

Percussions:
Tactile fremitus:
Egophony:
CXR:

A

Percussion: hyperresonance
Tactile fremitus and egophony: decreased
CXR: flattened diaphragms with hyperinflation, sometimes bullae

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9
Q

what is the role of phosphodiesterase-4 inhibitors in COPD?

A

Roflumilast (Daliresp)

once daily medication, reduces risk of COPD exacerbation if severe COPD, NOT bronchodilator.

Side effects: diarrhea, nausea, anorexia, abdo pain, sleep disturbance, headache. AVOID if moderate-severe liver disease

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10
Q

What are the conditions where home O2 would be considered for COPD?

A

-chronic hypoxemia (PaO2 < 55 mmHg) or PaO2 < 88%

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11
Q

situations to avoid use of SABA (eg albuterol)?

situations to avoid use of SAMA (eg ipratropium)?

A

SABA: caution in CV disorder (CAD, arrhythmia, angina), hyperthyroidism

SAMA: avoid if narrow angle glaucoma, BPH (risk of urinary retention)

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12
Q

Community acquired pneumonia:

  • most common bacterial pathogen? (gram pos or neg?)
  • most common pathogen in COPD and smokers?
  • most common pathogen in cystic fibrosis?
A

S.Pneumoniae (gram positive) most common in CAP
H.Influenza (gram negative): more common in smokers, COPD
Atypical: mycoplasma pneumoniae
Cystic fibrosis: Pseudomonas aeruginosa (gram negative)

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13
Q

Findings in community acquired pneumonia:

  • auscultation:
  • percussion:
  • tactile fremitus:
  • egophony:
  • pectoriloquy:
A

Auscultation: rhonchi, crackles, wheezing
Percussion: dullness over affected lobe
Tactile fremitus and egophony: increased
Pectoriloquy: whispered words sound louder

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14
Q

Examples of organisms responsible for atypical pneumonia

A

Mycoplasma pneumoniae: non-pulmonary complications (eg hemolytic anemia, meningo-encephalitis)
Chlamydophila pneumoniae: school-age kids, develops into bronchitis or mild pneumonia
Legionella pneumoniae: air conditioned spaces, causes Legionnaires’ disease with fatality rate 10%. Risk factor: smoking, COPD, immunocompromised, comorbidities
Chlamydia psittaci: zoonotic from pet birds and poultry

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15
Q

if Legionella is suspected, what diagnostic tests should be done?

A

urinary antigen test for Legionella pneumoniae

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16
Q

how is legionella spread?

A

inhalation of contaminated water or soil

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17
Q

what is the median duration of cough in acute bronchitis?

A

18 days

Range 1-3 weeks)

18
Q

Bordetella pertussis is a gram _____ bacteria

A

negative

19
Q

what level of precaution is needed for pertussis? (airborne vs droplet vs contact)

A

droplet

20
Q

Postexposure prophylaxis of close contacts to pertussis should occur within _____(time frame) of onset of cough in index case?

A

3 weeks

21
Q

which lymph nodes are involved in URTI?

A

small shotty nodes in submandibular and anterior cervical chain

22
Q

which lymph nodes are involved in pulmonary TB?

A

anterior or posterior cervical and supraclavicular nodes

23
Q

which TB medication causes saliva, sweat, urine, feces and tears to become orange/red in colour?

A

rifampin

24
Q

which TB medication causes optic neuropathy (change in visual acuity, red green colour blindness)?

A

ethambutol

25
Q

which TB medication can cause asymptomatic hyperuricemia and non-gouty polyarthralgia?

A

pyrazinamide?

26
Q

which TB medication can cause peripheral neuritis and neuropathy?

A

isoniazid

*give with 25-50 mg B6 daily

27
Q

Mantoux result of 5 mm or larger is positive in:

A
  • HIV positive
  • recent contact with TB case
  • immunocompromised
  • CXR sign of previous untreated TB
28
Q

(US specific:)

Mantoux result of 15 mm or larger is positive in:

A

people with no risk factors for TB

29
Q

what is the gold standard test for diagnosis of TB?

A

mycobacterial culture with AFB x 3 samples

30
Q

timeframe for when TST will become positive after infection

A

2-8 weeks after infection

31
Q

booster phenomenon for TB testing:

-two step TB test: when is second test done?

A

1-3 weeks after

32
Q

what is the role of phosphodiesterase 4 inhibitors (eg roflumilast aka Daliresp) in severe COPD?

side effects?

A

reduces risk of COPD exacerbation
*not a bronchodilator

side effects:

  • unintended weight loss
  • change in mood/thinking/behaviour
33
Q

CDC.gov

Contacts to confirmed TB: should be retested in ______ (time frame) after exposure

A

do TST, if initial test neg then retest 8-10 weeks after end of exposure

if child <5 years or immunosuppressed AND has neg initial TST –> do CXR
if CXR normal –> start treatment, second test in 8-10 weeks

34
Q

CDC.gov

How should contact tracing be done for positive TB case?

A

3 months from first symptom onset/first presumed symptom

initial interview with index case within 1 business day of diagnosis

35
Q

CDC.gov

What size/measurement of TST is considered positive for contacts of confirmed TB case?

A

5 mm or more

36
Q

which bacteria in CAP produces beta-lactamase?

which antibiotics are effective against this?

A
  • macrolides
  • fluoroquinolones
  • cephalosporins

*addition of clavulanate inactivates beta-lactamase

37
Q

CAP

what is the risk of using macrolides?

Clarithro and erythro especially?

A

Risk: QT prolongation

Clarithro and erythro are potent CYP4503A4 inhibitors

38
Q

CAP

what is the risk of using clarithro/erythro with CCB?

A

increased risk for profound hypotension

39
Q

CAP

what is the risk of using clarithro with select statins (lova, simva, atrovastatin)?

A

increased risk of myositis and rhabdomyolysis

40
Q

Acute bronchitis

Predominantly bacterial or viral?
Top 3 bacterial organisms?

A

Bordetella pertussis
Mycoplasma pneumoniae
Chlamydia pneumoniae

41
Q

what class of antibiotics is first line for treatment of pertussis?

A

macrolides

AANP Leik and Fitzgerald (14 decks)

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