Respiratory Flashcards
excess tracheobronchial mucus production resulting in a productive cough that occurs for at least 3 months a year for 2 or more consecutive years
chronic bronchitis
abnormal dilatation of terminal airspaces w/ destruction of the alveolar septa
emphysema
airway condition that is reversible and there is no associated w/ smoking
asthma
what is associated w/ the panacinar form of emphysema
alpha 1 antitrypsin deficiency
what type of emphysema is smoking associated w/
centrilobular
What type COPD has marked V/Q mismatch?
chronic bronchitis
late findings of COPD- chronic bronchitis
weight gain
lethargy
cyanosis
how does emphysema typically present
minimal cough/ scant amounts of thin sputum
dyspnea w/ exertion
weight loss (caynosis is rate)
lungs sounds w/ chronic bronchitis
coarse rhonchi and wheezes
lung sounds w/ emphysema
hyperresonant
decreased breath sounds
increased A-P chest diamester
lowered diaphragms
the volume of air that can be exhaled going from maximal inhalation to maximal exhalation
Forced vital capacity (FVC)
the volume of air exhaled in 1 second, starting a maximal inhalation
forced expiratory volume in 1 second (FEV1)
what is a normal FEV1/FVC
0.75-0.80
what is stage I of COPD?
FEV/FVC 80% predicted
what stage of COPD is FEV1 30%
Stage III- Severe
what stage of COPD is FEV1 50%
Stage II-Moderate
what vaccines do people with COPD need?
yearly influenza vaccines
pneumococcal vaccine
first line med for COPD
tiotropium bromide
COPD patients with PAO2<90% can benefit from what?
continuous supplemental oxygen
How is TB spread?
respiratory route- droplets formed by coughing , usually requries several months of close contact
Risk factors for TB
older age
low socioeconomic status
recent immigration from 3rd world country
HIV positive
symptoms of TB
fever, chills, night sweats anorexia fatigue cough hemoptysis (advanced dz)
pulmonary findings w/ tb
dullness w/ decreased fremitus or distanct hollow breath sounds
M. tuberculosis stains positive in a what stain?
acid-fast
what is considered a positive TB skin test in someone form a low-risk group
> 15 mm
what is considered a positive TB test in a moderate risk individual (recent immigration, IV drug user)
> 10 mm
what is considered a positive TB test in an HIV-infected individual or patients w/ organ transplants receiving >15 mg of prednisone a day
> 5 mm
first line drugs for TB
isoniazid (INH) fiampin pyrazinamide ethambutol streptomycin
chemoprpolyaxis fo recent skin test onverters
daily INH
what is the vaccine for TB that is not recommended for routine use in the US
BCG vaccine (live attenuated strain of Mycobacterium bovis)
what is a whole blood test for the diagnosis of latent TB?
QuantiFERON-TB Gold
after how many weeks of treatment are TB patients usually noninfectious
2 weeks
TB med that produced red-orange discoloration of body fluids
rifampin
TB med that can cause red-green color blindness
ethambutol
Diagnosis of cystic fibrosis
elevated sweat chloride >60 on 2 occcasions
what organ systems does CF mainly affect
lungs
pancreas
Pulmonary manifestations of CF
persistent, productive cough
hyperinflation of the lung fields
PFTs consistent w/ obstructive airway dz
clubbing seen in moderate disease states
what causes most cases of acute bronchitits?
viruses
what suggests acute bronchitis
presitence of cough for mroe than 5 days , and cough generally persists up to 2-3 weeks
Is fever common in acute bronchitits?
No, it suggests either influenza or pneumonia
Indications for chest x-ray w/ acute cough
pulse >100/ min
respiratory rate >24
temp >38
how should acute bronchitits be treated?
symptomatic treatment- NSAIDs
what differs pneumonia from bronchitits?
pneumonia patients more liekly to have high fever, experience dyspnea and shills, ahve chest pains
If symptoms of a URI persist for more than a week what abx can be started for 10-14 days?
amoxicillin or TMP/SMX
ABX to give for outpatient CAP <60
erythromycin
Azithromycin
Doxycycline (less expensive)
For patients >60 what are good abx choices for pneumonia
Fluoroquinolone (ex- levofloxacin)
2nd gen cephalosporin
