Respiratory Flashcards

Question

Atypical Pneumonia

Answer 1

Seasonal outbreaks (summer/fall). Highly contagious. Also known as walking pneumonia. M. pneumoniae: Nonpulmonary complications may occur (e.g., hemolytic anemia, meningo-encephalitis, urcticaria). Gold standard for diagnosis is polymerase chain reaction (PCR) of sputum or oropharyngeal swab Chlamydophila pneumoniae: More common in school-age children; Legionella pneumoniae: Causes a severe type of pneumonia called Legionnaires’ disease. S&S: several weeks of fatigue, accompanied by coughing that is mostly nonproductive. Gradual onset of symptoms. History of a cold before onset of bronchitis. Tx: Azithromycin (Z-Pack) × 5 days Levofloxacin (Levaquin) 750 mg PO × 5 to 7 days

Answer 2

Usually self-limited, may last 1-3 weeks Cause: viral and sometimes bacterial S&S: Cough that is keeping him awake at night. wheezing and rhonchi (clears with coughing). May report history of a cold before onset of bronchitis symptoms. Tx: Symptom management Dextromethorphan, tessalon perles Guaifenesin Albuterol for wheezing

Answer 3

Whooping cough Caused by Bordetella pertussis bacteria (gram negative) Coughing at least 14 days’ w/: paroxysmal coughing OR inspiratory whooping (or posttussive vomiting) without apparent cause. Apnea is more common in infants. First stage: Catarrhal stage (lasts 1–2 weeks). If treated at this stage, can shorten disease course (if treated within 3 weeks of onset). Second stage: Paroxysmal coughing (lasts 2–4 weeks). Treatment has little influence on disease but is useful to prevent disease spread. Third stage: Convalescent stage (lasts 1–2 weeks). Treatment goal is to eradicate carriage state/disease spread. Antibiotic will not shorten illness at this stage. Dx: nasal swab, PCR or ELISA Tx: First-line: Macrolides - Azithromycin (Z-Pack), Erythromycin, Clarithromycin Macrolides given to infants <1 month of age: Monitor for infantile hyperpyloric stenosis (IHPS) Treat close contacts within 3 weeks exposure

Answer 4

Self-limiting infection (range of 4–10 days). Most contagious from days 2 to 3 Nasal turbinates: Swollen with clear mucus Treat symptoms;

Answer 5

Caused by Mycobacterium tuberculosis Most common site of infection is the lungs Reportable disease S&S: Fever, anorexia, fatigue and night sweats w/ cough Later sign: blood-stained sputum Very late sign: Weight loss If active TB - test for HIV Dx: Mantoux test Quantiferon gold Sputum C&S gold standard, NAAT, AFB CTX Tx: Never treat with fewer than 3 drugs: isoniazid (INH), rifampin (RIF), ethambutol (ETH), pyrazinamide (PZA) Treatment duration is 6-9 months MDR TB - refer to a specialist

Answer 6

Latent TB - granulomas found, not infectious Miliary TB - aka disseminated TB disease. Infects multiple organs Multidrug-resistant TB - resistant to at least two of the best drugs Reactivated TB infection - Latent TB becomes reactivated BCG vaccine - can cause false positives on skin tests

Answer 7

Isoniazid (INH): Give with pyridoxine (vitamin B6) to decrease risk of peripheral neuritis, neuropathy, hepatitis, seizures. Ethambutol (ETH): Optic neuritis, rash. Avoid if patient has eye problems. Eye exam at baseline. Pyrazinamide (PZA): Hepatitis, hyperuricemia, arthralgias, rash Rifampin (RIF): Hepatitis; thrombocytopenia; orange-colored tears, saliva, and urine; drug interactions

Answer 8

Once-weekly isoniazid plus rifapentine × 3 months Daily rifampin × 4 months (preferred for HIV-negative adults/children) Daily isoniazid plus rifampin × 3 months preventive treatment for LTBI is encouraged for those <35 years of age. After 35 years of age, much higher risk of liver damage from INH chemoprophylaxis.

Answer 9

Inject 0.1 mL of 5TU-PPD subdermally. Looking for induration, not redness Positive if: ≥5 mm: HIV-infected persons Recent contact with infectious TB cases CXR with fibrotic changes consistent with previous TB disease (cavitations on the upper lobes) Immunocompromised ≥10 mm: Recent immigrants (past 5 years) from high-prevalence countries (Latin America, Asia [except Japan], Africa, India, Pacific islands) Child <4 years of age or children/adolescents exposed to high-risk adult Injection drug user, healthcare worker, homeless Employees or residents from high-risk congregate settings (jails, nursing homes) ≥15 mm: Persons with no known risk factors for TB

Answer 10

Chronic Airway inflammation S&S: SOB, wheezing, chest tightness. Cough that wakes from sleep. Respiratory symptoms can have an internal or external trigger (URI, dust, smoke, exercise, stress). Exacerbations can be life threatening Tx: Assess asthma control Every patient needs PRN SABA - rescue inhaler (albuterol or levalbuterol) NExt add low-dose ICS Next use LABA + ICS (Fluticasone with salmeterol (Advair), budesonide with formoterol (Symbicort)) May need short course of steroids for exacerbation

Answer 11

Stepwise: Step 1 Symptoms less than two times a month Low-dose ICS with formoterol PRN (alternative is SABA with low-dose ICS) Step 2 Symptoms two times a month or more, but less than daily Low-dose ICS daily or low-dose ICS with formoterol PRN Step 3 Symptoms most days, or waking with asthma once a week or more Low-dose ICS–LABA daily or medium-dose ICS or low-dose ICS + leukotriene receptor antagonist (LTRA) Step 4 Symptoms most days, or waking with asthma once a week or more (low lung function) Medium-dose ICS–LABA daily; refer for expert advice Step 5 Symptoms most days, or waking with asthma once a week or more (low lung function) Refer for phenotypic assessment; add anti-IgE

Answer 12

Premedicate 5 to 20 minutes before exercise with two puffs of a SABA (albuterol [Ventolin], levalbuterol [Xopenex], pirbuterol [Maxair]). Effect will last up to 4 hours.

Answer 13

Give nebulizer treatment: Albuterol 0.5% solution by nebulizer every 20 to 30 minutes up to three doses. If unable to use inhaled bronchodilators, give epinephrine 1:1,000 solution intramuscularly (IM). After nebulizer treatment(s): Listen for breath sounds. If inspiratory and expiratory wheezing is present, this is a good sign (signals opening up of airways). If there is a lack of breath sounds or wheezing after a nebulizer treatment, this is a bad sign (patient is not responding). Call 911. Discharge: For moderate-to-severe exacerbations, Medrol Dose Pack or prednisone tabs 40 mg/day × 4 days (no weaning necessary if 4 days or less and not steroid dependent). Continue medications and increase dose (or add another controller drug).

Answer 14

Blow hard three times, highest one is recorded Need height, age, gender; use HAG mnemonic