Respiratory Flashcards
A medication that has a side effect of “a cough”
ACE-I
Two respiratory pathogens that are known to cause “Atypical Pneumonia” are:
- Mycoplasma Pneumonia
* Streptococcus Pneumonia
What does a “peak flow meter” measure
- EXPIRATORY flow (peak expiratory flow) - The air that flows out the patient’s lungs.
Chest X-ray of an asthma patient will show
- HyperInflation
The “GOLD STANDARD” to diagnose COPD and Asthma
- Spirometry/Pulmonary Function Test (FEV1 and FVC)
- A dry cough for the 1st 5 days, then…
- Progressing to a productive, rough cough.
- Sputum maybe clear, white, yellow, or green or bloody.
- Is usually preceded by a viral infection
- Acute Bronchitis
The most common forms of COPD include:
- Chronic Bronchitis, and…
* Emphysema
- An FEV1/FVC ratio of 80%
The above mentioned is indicative of:
Mild COPD
Treatment for Mild COPD includes
- Reduction of risk factors (smoking cessation)
- Flu and Pneumonia vaccines
- Short-Acting anticholinergics (Ipratroprium/Atrovent) PRN or
- Short-Acting beta-agonists (Albuterol/Proventil) PRN
The cornerstone pharmacological therapy for ASTHMA is:
- Inhaled corticosteroids (ICS)
- CHRONIC, recurrent cough, wheeze, shortness of breath and/or chest tightness
- Symptoms occurs or are “worse at night”, or with exercise, viral infections, or irritants (smoking)
- An increase in FEV1 greater than 12% from baseline, post short-acting beta2-agonist
- **The above is a diagnosis of: ***
- Asthma
Populations that are at increased risk for Tuberculosis and would have a PPD or Mantoux result “Greater than or equal to 10mm” ( >10mm)
- Foreign born people/ Recent Immigrants
- Prisoners
- Nursing home residents
- Indigents/Homeless
- Minorities
- Healthcare providers/Migrant Farmers
- People with blood disorders or prolonged steroid therapy use
- OVERCROWDED POPULATIONS
The goal of COPD is to:
- Reduce the disease progression
- Reduce symptoms and exacerbations
- Improve exercise tolerance and quality of life.
Common sign on a chest Xray of a patient with Croup:
- Steeple Sign (Soft tissues of the neck and chest show subglottic narrowing)
Coughing with excessive mucus production for at least 3 or more months for 2 consecutive years or more.
- Chronic Bronchitis
Permanent alveolar damage and loss of elastic recoil, which result in chronic “hyperinflation” of the lungs
- Emphysema
Rust colored sputum is often seen with
- Steptococcus Pneumonia
The “GOLD STANDARD” for diagnosing Community Acquired Pneumonia is:
- Chest Xray
In a healthy person, with a onset of severe cough of 2 weeks (14 days), you should suspect:
- Pertussis
Difference between “Bacterial” pneumonia and “Atypical” pneumonia is:
- Bacterial PNA (S. Pneumoniae) = Acute Onset, “high fever and chills”, and lobar infiltrates on C-Xray
- Atypical PNA (M. Pneumonia = Gradual Onset, “low-grade fever”, interstitial or patchy (diffuse) infiltrates on C-Xray.
The cornerstone treatment for COPD includes:
- Inhaled Anticholinergics (Atrovent), and/or ..
* Long-Acting Beta Agonists (Salmeterol)
All asthma patients need a _____ PRN
- Short-Acting Beta2 agonist (Albuterol)
Peak Expiratory Flow Rate (PEFR or PEF) is based on: (mnemonic HAG)
- Height
- Age
- Gender
Risk factors of Pulmonary Embolisms include:
- Atrial Fibrillation (A-Fib)
- Pregnancy
- Estrogen therapy
- Surgery
- Long bone fractures
- Prolonged Inactivity
- With tactile fremitus, an abnormal finding would be considered, when _____
- Vibrations are felt stronger during palpation, in the lower lobes than the upper lobes, when the patients says “99” or “1,2,3”
Reduction in airflow rates is considered as
- Obstructive dysfunction (Asthma, COPD, bronchiectasis)
1st line treatment for community acquired pneumonia in patient with no co-morbidities
- *** MACROLIDES ****
- Clarythromycin B.I.D x 10 days
- Azythromycin Daily x 5 days
- Erythromycin Q.I.D x 10 days
2nd line treatment for CAP
- Tetracyclines (Doxycycline 100mg B.I.D x 10 days)
Anticholingergic medications should be avoided in patients with:
- Narrow-angled Glaucoma
- BPH
- Bladder neck obstruction
During percussion of the lung fields, “Tympany” or “Hyperresonance” is associated with * _______, and “Dull-tone” is associated with * _____.
- Tympany = COPD
* Dull-tone = Bacterial PNA with lobar consolidation, Pleural effusion.
Reduction of lung volume due to decreased lung compliance
- Restrictive Dysfunction (Pulmonary fibrosis, pleural disease, diaphragm obstruction)
This testing is used on immunocompromised patients testing for TB and Candida
- Anergy testing (PPD is placed in one arm and Candidas is placed in the other arm)
If a PPD test is greater than 10mm induration, what should be ordered?
- Chest X-ray
Medications that do NOT affect the inflammatory changes seen in Asthma patients include:
- Bronchodilators - bronchodilators open up air passages, but do not have anti-inflammatory components to reduce inflammatory changes seen in Asthma patients.
- HIV (+)
- Recent contact with infectious TB cases
- CXR with fibrotic changes consistent with previous TB disease.
- Any child who had close contact or has TB symptoms (before age 5)
- Immunocompromised patients
- *** The above mentioned will show a PPD or mantoux result of:
- Greater than or equal 5 mm (>5mm)
1st line treatment for SEVERE asthmatic exacerbation or respiratory distress is:
- Adrenaline Injection (Epinepherine)
Treatment plan for Acute Bronchitis includes:
- Fluids and Rest (1st Choice)
- Anti-tussives (Benzonatate/Tessalon)
- Muculytics/Expectorants (Guaifenesin)
- Albuterol Inhalers for wheezing
- ** NO ANTIBIOTICS***
- Severe sore throat
- High Fever
- Fine sand paper rash
- ** The above mentioned are characteristics of ***
- Scarlet Fever (A group “A” streptococcal infection)
Streptococcus Pneumoniae is the bacterium most responsible for the highest mortality in patients with _____
- Community Acquired Pneumonia
- A viral infection caused by RSV that is commonly seen during the winter/spring months in infants and young children.
- Signs and Symptoms include: Fever, Inspiratory and/or Expiratory wheezing, with clear drainage
- *** The above mentioned is indicative of **
- Bronchiolitis
This asthma classification includes:
- Normal FEV between exacerbations
- Symptoms are less than 2 days a week
- Use of Short acting beta-agonist (S.A.B.A) is less than 2 days a week.
- Intermittent Asthma
Mild Persistent asthma includes:
- FEV greater than 80%
- Symptoms are greater than/equal to 2 days a week, but not daily.
- Night time awakenings are 1 - 2 a month
- Used of S.A.B.A is greater than/equal to 2 days a week, but not daily.
- Minor limitation in normal activity
This classification of asthma includes:
- Symptoms throughout the day
- Nighttime awakenings > 1 time a week
- S.A.B.A usage is several times a day
- Extremely limited in normal activity
- FEV
- Severe Persistent
Abnormal forms of lymphocytes will occasionally show in which viral infections
- Epstein Barr Virus
A pathogenic bacteria found in older children and adults with cystic fibrosis
- Pseudomonas Aeruginosa
Medications that do NOT treat inflammation in Asthma patients include
- Theophylline - this medication controls inflammation, but does not reduce inflammation.
Auscultation of normal breath sounds would include:
- Vesicular breath sounds in the lower lobes, and…
* Bronchial breath sounds in the upper lobes
Pulsus Paradoxus is usually associated with:
- Severe Airway Obstruction (i.e status asthmaticus, severe COPD exacerbation)
Treatment for Intermittent Asthma (mild intermittent asthma) includes:
- Albuterol (Ventolin) M.D.I prn
Treatment for Severe Persistent Asthma includes:
- High-dose ICS, plus…
- Long-acting beta2 - agonists, plus…
- Oral steroids daily
- Albuterol M.D.I prn
- Risk Factors for “Drug Resistant Streptococcus Pneumonia” include:
- Antimicrobial therapy within the last 3 months
- Alcoholism, liver, or renal disease
- Co-Morbidities
- Immunosuppression
- Exposure to children in daycare
The only treatment known to prolong life in COPD patients is:
Supplemental Oxygen
The treatment for TB exposure in HIV (-) patients include:
- INH 300mg/day for 9 months
- How does the anticholinergic drug “Ipratropium (Atrovent)”,used in COPD patients, work?
- It decreases parasympathetic tone/reduces cholinergic tone, which thereby produces bronchodilation
