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FNP2- test 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

PE of asthama?

labs?

A

Allergic: Eosinophilic inflammation - in blood work

Expiratory wheeze or rhonchi

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2
Q

Hx questions to ask pt with suspected asthma?

A 
How frequent cough, wheezing, difficulty breathing
Nighttime awakening 
Medication response
Activity response 
Exacerbations required oral steroids
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3
Q

Med must know for tx asthma in pts 6 and older?

A

NO SABA alone (death in 6 and older), only under age of 5

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4
Q

Asthma differentials?

A 
Allergic rhinitis/sinusitis
Respiratory infection
GERD
Medication induced cough (ACE Inhibitors) 
COPD
Heart Failure
Vocal cord dysfunction
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5
Q

GINA Asthma Guidelines

  • mild
  • moderate
  • severe
A

Mild:- well controlled with PRN alone or with low ICS (6 or older) -> STEP 1/2
Hard to diagnose under 5
Moderate- well controlled with low dose ICS.
-> LABA (STEP 3) SABA prn

Severe: high dose ICS/ LABA, -> remains uncontrolled (Step 4), saba prn
No ICS for kids under 6 y.o ,9

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6
Q

What age is treated as an adult for asthma

A

Over 6 years

<5 cant do spirometry

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7
Q

Pedi Asthma Differentials

A

VIral URI
Allergic rhinitis
Foreign body

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8
Q

How to treat pedi asthma? 1-11 years old

A
  • Montelukast chewable
  • Neb ICD until able to use inhaler

1-11 y/o
Neb with albuterol
Oral steroid burst : 60 mg/day
Liquid prednisone : 1-2mg/kg/day QAM for 3-10 days
Orapred 15mg/ml (has sorbitol- can make diarrhea worse)

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9
Q

For Rescue only
Not to be used alone, except for < 5 years of age.
Albuterol
Levalbuterol
Used in Combination therapy (long-acting, LABAs)
Salmeterol (Serevent)
Formoterol (Foradil)

A

Beta 2 Agonists

For Rescue only (short-acting, SABAs).

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10
Q

Acute infection of lower RR tract in infants and young children (common in infant hospitalization)
Agent: RSV, Rhino, adeno, corona

A

Bronchiolitis (self limiting, most mild)

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11
Q

Dehydration , feeding, lethargy → impending RR failure

Decrease UO

A

Bronchiolitis

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12
Q

How to manage/ tx bronchiolitis?

A

Improves itself, most mild and managed at home

Supportive- antipyretics, hydration, bulb syringe

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13
Q

TOXIC appearance
Otitis media, nasal congestion, tons secretions, tachypnea, increase WOB, wheezing, rhonchi, delayed cap refill, displaced spleen and liver d/t lung expansion

A

bronchiolitis

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14
Q

Inflammation of the trachea and bronchi/ lower tract by definition , caused by viruses or lung irritation
Risk Factors:
Occupational - exposure to irritants
Smoking

A

Bronchitis- URI

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15
Q

Cough-may or may not have sputum lasting longer than 7 days
Retrosternal pain- behind the sternum—> “chest cold”
Nasal discharge
Sore throat
Low grade fever
Reduction in FEV1

A

Bronchitis

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16
Q

What to consider in adult with hacking cough lasting > 2 weeks?

A

consider B. Pertussis

over Bronchitis

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17
Q

Cough and sputum on most days for 3 months of year, two consecutive years

A

Chronic Bronchitis

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18
Q

How to Tx/ manage Bronchitis?

Cough ____

A

What is the cause? Sx treatment- 80% improvement without

Cough: dextromethorphan/ benzonotate
Severe cough (bedtime: codine or hyd
Antipyretics
Cough suppressant is controversial- you want to be able to get the sputum out, not suppress it
Bronchodilator - doesn’t help w cough (unless has asthma)

NO ANTIBIOTIC- not likely bacterial - if it is, macrolides (first line)
Stop smoking

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19
Q

Illness of larynx, trachea and bronchi → stridor and barking, Inflammation of UR tract

Risk Factors:
18m-2 y.o
History of past infection - can cause recurrent spasmodic

Worse at night (runs course 3-5 days) 
Clinical Manifestations:
Rhinorrhea 
Barking cough
Fever
Accessory muscle use
A

Croup

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20
Q

WestleyCroup scoring system

A

*Less than 3 - mild
3-6 -moderate
>6 - severe

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21
Q

PE:
Dyspnea
Tachypnea
Retractions
Stridor - (stridor at rest- foreign body)
Wheezing and rales may be heard if there is additional lower airway involvement.

A

Croup

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22
Q

Croup Differentials?

How to manage?

A

Differentials:

  • FB aspiration (if stridor on rest)
  • Epiglottitis (if drooling)
Management:
Racemic epi (Causes vasoconstriction diminishing edema) 
Corticosteroids 
Humidifier in mild cases
Antipyretic 
Oral hydration
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23
Q

the maximum rate that person can exhale in a short, maximal expiratory effort after a full inspiration

A

Peak Flow

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24
Q

Most common cause of Bronchiolitis

A

RSV

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25
Q

Well-controlled with as-needed reliever medication alone or with low-intensity controller treatment such as low-dose inhaled corticosteroids (ICSs), leukotriene receptor antagonists, or
chromones

A

Mild asthma

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26
Q

Well-controlled with low-dose ICS/long-acting beta2-agonists

LABA

A

Moderate Asthma

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27
Q

Requires high-dose ICS/LABA to prevent it from becoming
uncontrolled, or asthma that remains uncontrolled despite this
treatment

A

Severe asthma

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28
Q

GINA no longer recommends ______ for first-line use in asthma except in children
aged under 5 years (where evidence is lacking) and where a trial of ICS should be
used in those not responding to as-needed

A

SABAs

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29
Q

for as-needed relief of symptoms, GINA’s preferred choice of reliever is _____ for adults and adolescents over the age of 12 and _____ taken as needed together with a ____ in children aged 6–11 years

A

ICSs in combination with formoterol for adults and adolescents over the age of 12

ICS taken as needed together with a SABA in children aged 6–11 years

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30
Q

long-acting bronchodilator with rapid action

A

ICS-formoterol

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31
Q

For Rescue only (short-acting, SABAs).

• Not to be used alone, except for < 5 years of age.

A

Beta2 Agonists
• Albuterol
• Levalbuterol

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32
Q

Used in Combination asthma therapy (long-acting, LABAs)

A

Beta2 Agonists
• Salmeterol (Serevent)
• Formoterol (Foradil)

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33
Q

Exercised Induced Asthma tx

A
  • Warm up
  • Scarf over mouth in cold
  • SABA 2 puffs 5 mins before exercise
  • LABA
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34
Q

Acute Exacerbation Management for > 12 years

A 
• Oral steroid burst 3-10 days
• Prednisone up to 60mg AM
• Methylprednisolone 40-60mg AM
• Medrol dosepak 4mg tablets (84mg total
divided over 6 days = inadequate dosing)
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35
Q

Acute Exacerbation Management for ages 6-11

A

• Chewable Montelukast (Singulair)
• Nebulizer for ICS until able to use inhaler
• Budesonide 0.25mg/2mL to 1mg/day; may
divide into BID

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36
Q

asthma exacerbation Ages 1-11

A 
• Nebulizer with albuterol or albuterol syrup
or inhaler
• Oral steroid burst: maximum 60mg/day
• Liquid prednisolone: 1-2mg/kg/day QAM x
3-10 days
• Pediapred 5mg/5mL (contains sorbitol)
• Orapred 15mg/5mL (contains sorbitol)
• Prelone 15mg/5mL (contains 5% alcohol)
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37
Q

Bacteria infection of RR tract that this cause by strains of gram + c, humans are only reservoir

A

Diphtheria

38
Q

Thick grey pseudomembrane. In nasopharyngeal, pharynx, trachea that bleeds when removed
Blood nasal discharge
Sore throat
Neck swelling with cervical Aden it is (bull neck)
Cutaneous lesions (non-healing ulcers with dirty grey membranes

A

Diphtheria

39
Q

Diagnostics for Diphtheria

A

Culture from nose, throat or lesions

40
Q

Diphtheria Differentials

A

Acute step pharyngitis
Mono
Nasal foreign body/ purulent rhino- nasal diphtheria, epiglottis, laryngeal diphtheria, viral croup

41
Q

how to manage / tx diphtheria

A

Children: hospital for tracheostomy
Anti-serum - scratch test prior d/.t allergies + Abx
Erythromycin oral for 14 dats, PCN G 14 days IM or IV,
Supportive care
Droplet precautions until 2 - cultures
Immunization after recovery

42
Q

Sudden swelling of the epiglottis, which worsens rapidly (w/i hours) → death
Airway obstruction, mucous plugging

A

Epiglottitis

43
Q 
Tripod
Retractions, cyanosis (late sign)
Abrupt onset of fever, irritability
***Muffled voice***
Severe sore throat , dysphagia
***Drooling***
 Increased respiratory distress. 
cough and the hoarseness are generally absent… considered late symptoms
A

Epiglottitis

44
Q
  • Inspiratory stridor
  • Drooling, muffled voice and high fever
  • Respiratory obstruction
  • Tripod position- Hyperflexion of the neck
A

Epiglottitis

  • Do not examine the throat as it can cause spasms and worsen obstruction *
45
Q

Diagnostics for Epiglottitis

A

History and observation- ICU and airway mgmt
CBC- increase WBC (left shift)
Blood cultures
Lateral neck radiograph before examining the patient. If positive it will show the “thumb sign”.
Following intubation, epiglottis culture is performed

46
Q

management for Epiglottitis

A

Goal is to establish the airway and start appropriate antibiotics

Droplet isolation first 24 hours, upright until airway secure

47
Q

Antibiotics to tx Epiglottitis

A

Antibiotic- Gram +. H fl (B) cephalosporins (cefotaxime or ceftriaxone), Amp/sub

Cephalosporin allergies: Amp/Sub, Levofloxacin
7-10days

Very transmissible. Susceptible children should take prophylaxis with Rifampin

48
Q

Swallowed- where is it?

coughing, wheezing

A

Larynx

49
Q

Swallowed- where is it?

Brassy cough, dyspnea, cyanosis

A

Trachea

50
Q

Swallowed- where is it?

R lung aspiration

A

Bronchiole

51
Q

Respiratory illness with PROLONGED coughing; children>adults, highly contagious
Risk Factors:
*unvaccinated infants

A

Pertussis

52
Q

Adults- cough worse at night, gagging and vomiting, WHOOPING COUGH,
DEADLY TO NEWBORNS- Tdap for pregnant moms
1-2 weeks symptoms

A

Pertussis

53
Q

phase of pertussis ?
low grade fever, rhinorrhea, mild cough, excessive lacrimation, and conjunctivitis (Highly spreadable ) 1-2 weeks of UR sx

A

Catarrhal phase of pertussis

54
Q

phase of pertussis?

Increased mucous, paroxysmal cough, cyanosis vomiting, exhaustion (whoop)
Adults: 2-3 weeks cough * hallmark symptoms*

A

Paroxysmal

55
Q

phase of pertussis?
Decease in cough, less persistent, slow recovery. Symptoms wane.
1-2 weeks or months

A

Convalescent

56
Q

what sx is not seen in pertussis and thus if present means you should look for another reason

A

Fever

57
Q

Diagnostics for pertussis

A

PCR Swab

Nasopharyngeal secretion culture (gold standard but can take too long)
Toxin IgG
CBC- 18k WBC, lymphocyte count (lymphocytosis in infants and children who are in the paroxysmal phase)

CXR- interstitial edema, atelectasis, perihilar infiltrates

58
Q

pertussis Differentials

A

RSV, adenovirus, influenza, gastro-esophageal reflux, CF, aspiration pneumonia, asthma, FB aspiration

59
Q

Treatment for pertussus

A

(hospital if severe)
Antibiotics( Macrolide-1st line- azithromycin ) TMP-SMX is alternative

Bactrim is alternative to macrolide if > 2 months old
Must give early in disease process for it to be effective

Erythromycin in < 1 month olds can cause pyloric stenosis

60
Q

preferred for pertussis prophylaxis for babies < 1 month

A

Azithromycin

61
Q

Increased amount of fluid in pleural space- IS IT WORSE WITH INSPIRATION?

A

Pleurisy(symptom)/Pleural Effusion

62
Q

Inflammation in the pleural space: causes pain as layers rub together form swelling- viral most common; not a dx, but a symptom of numerous localized and systemic disease processes
Risk Factors:
Trauma
Systemic disease- SLE, sarcoidosis

A

Pleurisy ( symptom)/Pleural Effusion

63
Q

Pain over affected chest area, usually lower portion of test
Painful with deep inhalation- sharp/ stabbing pain
coughing / sneezing- worse, toughing
R/O MI !!!!!!
They may lay on affected side to decrease lung expansion

A

Pleurisy

64
Q

Guarded near area, palpation is tender, friction rub with auscultation
Fevers, chills, productive cough (PNA), joint pain/ rash (inflammatory issues or connective tissues disorder)
Tenderness to palpation - directly over site of inflammation
Percussion- dull if there is consolidation or pleural effusion

A

Pleurisy/ Pleural Effusion

65
Q

diagnostics for Pleurisy/ Pleural Effusion

differentials?

A

tics
No dx but can help r/o
CXR
CBC- high leuk with shift to left; leukoPENIA= viral or SLE, CT or thora is severe , Thoracentesis

66
Q

managing Pleurisy/ Pleural Effusion

A 
Most are viral- sx mgmt 
Steroids- SLE helps with inflammation 
NSAIDS- pain 
Treat underlying - refer 
Severe- Refer
67
Q

(most common in outpatient and inpatient ) - 8th leading cause of death , 1st among infection related death

A

CAP (community-acquired pneumonia)

68
Q

what is the typical pathogen for pneumonia in 4m- 18 years

A

S pna (typical)

69
Q 
Sudden onset 
Chills common 
Cough 
Purulent sputum 
pleuritic pain 
focal crackles 
wheezes are rare 
air space-filling on CXR infiltrate 
commonly from S Pneumoniae
A

Typical Pneumonia

70
Q 
Slower onset (days) 
chills are rare 
prominent cough 
dry sputum 
musculoskeletal pain 
diffuse crackles 
occasional wheeze 
diffuse & interstitial CXR infiltrate
commonly from M. pneumoniae
A

Atypical Pneumonia

71
Q

Those at risk of Drug-resistant pneumococci

A

over 65, children in daycare, beta-lactam therapy in last 90 days, ETOH disorder, immunosuppression

72
Q

Gold standard for pneumonia dx

A

CXR

73
Q

What to give pt … No Abx in 3 months and outpatient CAP:

Non-ICU:
ICU:

A

Macrolide (p 509) or doxycycline

Non-ICU:L Fluroquinolone or B lactam
ICU: B lactam + azithromycin a fluoroquinolone

74
Q

How to tx MRSA pt with CAP (community acquired pneumonia)?

A

amoxicillin/ doxycycline, or azithromycin

75
Q

What to watch out for Macrolides (-mycin drugs) / fluoroquinolones (-floxacin drugs)?

A

AE: QT prolong
Fluro: tendonitis, rupture, peripheral neuropathy, AAA
Macrolide: rate >25% resistance then it NOT a good option - combo therapy
Comorbidities

76
Q

Drug that can cause fetal demise (new)
Bacterial protein synthesis inhibitor (strep pneumoniae, MSSA, H influenzae, legionella, mycoplasma, and chlamydia pneumoniae)
QT prolongation* and can affect CYP drugs

A

Lefamulin

used to tx pneumonia

77
Q

Fluoroquinolone- also works with gram negative pathogens

Risk of AAA, Tendonitis/ rupture

A

Delfoxacin

used to tx pneumonia

78
Q

Caused by a virus. Causes common cold symptoms. More severe in infants and old adults. The infection starts at the nasopharynx and progresses towards the lower respiratory tract. It causes edema and necrosis of the epithelial cells which results in airway obstruction/trapping.

Risk Factors:
November-April
Prematurity, smoke exposure

A

RSV

79
Q

Clinical Manifestations: Rinorrhea, otitis media with or without effusion, dehydration, conjunctivitis, respiratory distress (tahcy), barrel chest and displaced liver and spleen (lungs displacement)

PE: Nasal secretion, cough, fever and lower respiratory infection symptoms. More severe infection presents with apnea, severe cough with possible cyanotic episodes, and poor oral intake. (sx may last up to 3 weeks)

A

RSV

80
Q

Dx for RSV

A

Viral testing not recommended (takes 5 days) unless severe case or patient is immunosuppressed. Rapid nasopharyngeal specimens can be used as diagnostic if indicated. Blood cultures not indicated as concurrent bacterial infection with RSV is not common

81
Q

How to manage RSV?

what is not recommended?

A

Supportive, hydration, Pulse ox, CPAP in severe cases

NOT recommended: bronchodilators, antibiotics steroids, nebs (also for bronchiolitis)
Ribavirin (antiviral) not recommended unless immunocompromised with severe RSV

82
Q

Infection of the trachea causing airway inflammation and obstruction- life-threatening

caused by epithelial damage from viral infection and/or mechanical trauma in the trachea at the level of the cricoid cartilage = damaged tissue that’s more susceptible to bacterial superinfections.

A

Tracheitis

83
Q

mucosal damage is characterized by subglottic edema, purulent secretions, and a pseudomembrane
= airway obstruction or even toxic shock syndrome

hyperpyrexia, a brassy cough, noisy respirations, lethargy, dyspnea, rapid progression of airway occlusion, and the presence of upper airway infection or croup

A

Tracheitis

84
Q

Toxic appearance, anxiety, agitation, lethargy, pallor, cyanosis, severe stridor, sx of pneumonia

A

Tracheitis

85
Q

The gold standard for microbiologic diagnosis of Tracheitis?

A

Tracheal bacterial cultures

86
Q

How to manage trachitis?

A

Airway! -> Emergency Transport

Antibiotic therapy is based on gram stain and culture results

87
Q

how do foreign bodies in various locations of the respiratory tract present?
- larynx, trachea, bronchioles

started suddenly, was gagging or choking,

A

Larynx= unilateral wheeze

Trachea= brassy cough, echoing wheeze, cyanosis

Bronchioles= (usually on the right side)

88
Q

Reduced in obstructive lung disease

A

FEV1

89
Q

abnormality in ___ often indicates restrictive lung condition

A

FVC

90
Q

represents the % of lung capacity one is able to exhale in 1 sec, if low/ abnormal = obstruction

what is abnormal for adults/ kids?

A

FV1/FVC Ratio

Adults = Gold critiera <70% is abnormal 
Kids= <85%
91
Q

For Rescue only (short-acting, SABAs).
Not to be used alone, except for < 5 years of age.
Albuterol
Levalbuterol

Used in Combination therapy (long-acting, LABAs)
Salmeterol (Serevent)
Formoterol (Foradil)

A

Beta 2 Agonists

92
Q

scratching sound/ loud creek- at the end of inspiration, stops when hold breath

A

Friction rub

FNP2- test 1 (7 decks)

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