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Respiratory Flashcards

1
Q

s/s of pulmonary emboli

A

dyspnea, coughing up pink-frothy sputum, tachycardia

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2
Q

s/s of impending respiratory failure in asthmatic patient

A

tachypnea, cyanosis, “quiet” lung sounds without breath sounds

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3
Q

trx for impending respiratory failure in asthmatic patient

A

adrenaline injection STAT, call 911, apply oxygen, albuterol neb

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4
Q

vesicular breath sounds are common in

A

lower lobes

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5
Q

normal egophony

A

“eee”; abnormal is “bahh”

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6
Q

normal tactile fremitus

A

when patient says “ninety nine”, strong vibrations felt on upper lobes, softer on lower lobes

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7
Q

normal percussion to lungs

A

resonance

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8
Q

abnormal percussion to lungs

A

hyperresonance in COPD; dull in pneumonia

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9
Q

COPD is characterized as

A

loss of elastic recoil and alveolar damage

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10
Q

chronic bronchitis is characterized as

A

cough with mucus production for more than 3 months for at least 2 consecutive years

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11
Q

risk factors for COPD

A

smoking, increased age, occupational exposure, alpha1 typsin genetic deficiency

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12
Q

physical exam in those with COPD

A

barrel chest, prolonged expiration, hyperresonance on percussion, decreased tactile fremitus

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13
Q

contraindications for anticholinergic inhalers

A

BPH, glaucoma, bladder neck obstruction

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14
Q

treatment for mild COPD (Class I)

A

short acting anticholinergic or SABA PRN

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15
Q

treatment for moderate COPD (Class II)

A

Long acting anticholinergic or LABA + SABA PRN

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16
Q

treatment for severe COPD (Class III)

A

ICS + LABA or LA anticholinergic + SABA PRN

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17
Q

treatment for very severe COPD (Class IV)

A

ICS + LABA + LA anticholinergic + SABA PRN

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18
Q

long acting beta agonists (LABA) examples

A

salmetrol, formoterol

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19
Q

short acting beta agonists (SABA) examples

A

albuterol (Proair, ventolin), levoalbuterol (Xopenex)

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20
Q

acute cough is for

A

less than 3 weeks

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21
Q

subacute cough is for

A

3-8 weeks

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22
Q

chronic cough is for

A

more than 8 weeks

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23
Q

common causes of cough

A

asthma, GERD, infection

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24
Q

Most common cause of acute bronchitis

A

virus

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25
Q

common cause of community acquired pneumonia

A

Streptococcus pneumoniae

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26
Q

common cause of atypical pneumonia

A

Mycoplasma pneumonia, chlamydophila pneumonia

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27
Q

Suspect DRSP in these people

A

age greater than 65, abtx therapy in the past 3 months, alcoholics, those with co-morbids, immunosuppression, exposure to children

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28
Q

suspect atypical pneumonia in these people

A

healthy adults

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29
Q

s/s of pneumonia

A

cough, purulent sputum, fever, chills, SOB

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30
Q

trx for healthy individuals with atypical pneumonia

A

macrolide or doxycycline

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31
Q

trx for those with DRSP

A

respiratory quinolone

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32
Q

trx for those with DRSP who are allergic to quinolones

A

beta lactam + macrolide or doxycycline

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33
Q

consider referral to hospital in these people with pneumonia

A 
CRB65:
Confusion
RR greater than 30
BP less than 90/60
Age greater than 65
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34
Q

Pneumonia vaccine recommendations

A

PPSV23 for adults 19-64 who are at increased risk (asthma, COPD, heart surgery);
PCV13 and PPSV23 1 year later in ALL adults older than 65, and in those 19-64 with asplenia, immunocompromised

35
Q

symptoms of COPD

A

chronic and progressive dyspnea, cough, and sputum production

36
Q

Diagnosis of COPD

A

spirometry shows FEV1/FVC less than 70%

37
Q

characteristics of COPD stage I

A

FEV1/FVC less than 70%;

FEV1 is greater than 80%

38
Q

characteristics of COPD Stage II

A

FEV1/FVC less than 70%;

FEV1 is between 50-80%

39
Q

characteristics of COPD stage III

A

FEV1/FVC less than 70%;

FEV1 is between 30-50%

40
Q

characteristics of COPD stage IV

A

FEV1/FVC less than 70%;

FEV1 is less than 30%

41
Q

short acting bronchodilators have a greater risk of this kind of arrhythmia

A

afib and aflutter

42
Q

types of bronchodilators

A

beta 2 agonists and anticholinergics

43
Q

SE of inhaled anticholinergics

A

“Oh this drug, it makes me pink. Sometimes, I can’t think or even blink. I can’t see, I can’t pee, I can’t spit, I can’t shit”.

Flushing, confusion, glaucoma, urinary retention, dry mouth, constipation.

44
Q

Inhaled steroids are started in COPD when

A

stage III or IV

45
Q

trx for exacerbations of COPD

A

prednisone 40 mg daily x 5 days

46
Q

Most effective intervention for preventing exacerbations and progression of COPD

A

stop smoking

47
Q

health promotion for COPD

A

annual flu, pneumonia vaccine, exercise

48
Q

Goal of asthma management

A

prevent exacerbations

49
Q

triad s/s of asthma

A

wheezing, cough, SOB; symptoms worse at night

50
Q

risk factors of asthma

A

young age, family hx, atopic disease

51
Q

intermittent asthma

A

symptoms less than twice a week

52
Q

mild persistent asthma

A

symptoms more than twice a week but not daily

53
Q

moderate persistent asthma

A

symptoms daily

54
Q

severe persistent asthma

A

throughout the day

55
Q

trx for intermittent asthma

A

SABA

56
Q

trx for mild persistent asthma

A

low dose ICS + SABA

57
Q

trx for moderate persistent asthma

A

medium dose ICS + LABA + SABA

58
Q

Education for asthma patient

A

RTC if SABA is used more than twice a week, patient needs step up therapy.

59
Q

LABA can be used alone in

A

COPD

60
Q

med combination with highest risk of death in asthma patient

A

LABA and SABA; all patients with asthma need a form of ICS

61
Q

physical exam of those with pneumonia

A

crackles, dull percussion, increased tactile fremitus

62
Q

trx for acute bronchitis

A

symptomatic

63
Q

trx for pertussis

A

macrolides

64
Q

s/s of common cold

A

fever, sore throat, runny nose, nasal congestion; self-limited for 4-10 days

65
Q

Prior BCG vaccine

A

not a contraindication for PPD testing if more than 5 years

66
Q

trx for TB

A

at least two drugs (rifampin and INH) to prevent resistance

67
Q

ethambutal for TB can cause

A

optic neuritis

68
Q

PPD is positive if less than or equal to 5 mm in people with

A

hx of HIV, recent contact with infected TB person, children with symptoms, immunocompromised

69
Q

PPD is positive if less than or equal to 10 mm in people with

A

immigrants, drug users, healthcare workers, homeless, jail, nursing home

70
Q

two step testing for TB

A

do first PPD, if negative, then repeat in 1-3 weeks, if still negative, then patient is truly negative

71
Q

theophylline

A

can be used for asthma as a bronchodilator; however it has a narrow level and has many drug interactions

72
Q

Leukotriene inhibitors

A

montelukast, zileuton

73
Q

mast cell stabilizer

A

cromolyn sodium

74
Q

Zileuton requires

A

monitoring LFTs

75
Q

peak expiratory flow is measured by

A

HAG: height, age, gender

76
Q

croup is mostly caused by

A

parainfluenza type 1

77
Q

croup is common in those

A

less than 3

78
Q

s/s of croup

A

stridor, barking cough, fever

79
Q

Primary spontaneous pneumothorax occurs mostly in

A

tall, thin men who smoke

80
Q

complication of COPD

A

right ventricular hypertrophy (cor pulmonale)

81
Q

cautiously give nicotine in those with

A

coronary artery disease, nicotine is a potent vasoconstrictor

82
Q

black box warning with Chantix

A

increase in hostility, agitation, suicide; increase risk of heart attacks

83
Q

common causes of pleuritic chest pain

A

viral, bacterial infections; TB

84
Q

trx for pleuritic chest pain

A

indomethacin

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