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Primary Care 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Streptococcus pneumoniae

A

inhabits the oropharynx, gram positive coccus in pairs of diplococci. aquired in the community. frequently follows a URI. Polysaccharide capsule responsible for most cases of nonresolving pneumonia syndromes. causes lobar pneumonia.

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2
Q

physical findings supporting asthma

A

nasal polyps, pale nasal lining indicating allergi rhinitis and allergic asthma, atopic dermatitis with lichenified plaques

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3
Q

consolidation with a blocked airway

A

percusson dull, fremitius decreased, breath sounds decreased, voice transmission decreased, crackles absent

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4
Q

greater prevalence of asthma within menstrual cycle

A

periovulatory days 12-18, perimenstruall days 26-4

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5
Q

pulmonary function testing

A

tests airflow limitation

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6
Q

moderate asthma

A

dyspnea - while at REST, prefers sitting. talks in PHRASES. usually agitated. common accessory muscles. loud wheeze through out exhalation. pulse 100-120. pulsus 10-25.

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7
Q

mast cells causes

A

smooth muscle hypertrophy

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8
Q

peak expiratory flow

A

measured during a brief forceful exhalation. take large breathe in, put peak flow in mouth then blow hard and fast three times and take the highest measurement. if peak improved by 20 percent 20 minutes after bronchodilator then dx asthma

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9
Q

severe asthma

A

dyspnea at rest, SITS UPRIGHT. talks in words, agitated, loud through out inhalation and exhalation wheeze, pulse > 120, paradoxus >25.

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10
Q

Staph aureus pneumonia

A

gram positive in clusters can occur secondary to the flu, within the oropharynx of a hospitalized patient or a complication of staph in the blood stream.

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11
Q

eosinophils causes

A

mucus hypersecretion, airflow limitation

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12
Q

Exercise induced asthma

A

exercise and 5-15 minutes after have asthma s/s resolve over 30-60 minutes

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13
Q

consolidation or atelectasis with a patent airway

A

percussion dull, fremitius increased, breath sounds bronchial, voice transmission bronchophony, whispered pectoriloquy, egophony, crackles present

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14
Q

chlamyodphila

A

tetracyclin, macrolide

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15
Q

aspiration pneumonia

A

anaerobic organisms affecting those with impared consciousness or difficultly swallowing, poor dentition - gradual onset, sputum with foul odor suggesting anaerobic infecion necrosis and abscess formation may follow. occurs in dependent areas of the lung. lower lobe in upright pts or superior lower lobe in supine patients – can have pleural effusion or empyema

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16
Q

H influenzae pneumonia

A

gram negative coccobacillary in the nasopharynx and in lower airways of patients with COPD. COPD is a predisposing factor

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17
Q

outpatient w history of cardiopulmonary disease

A

same as without cardiopulm PLUS anaerobes, aerobes gram neg bacilli – treat quinolones or beta lactam plus macrolide

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18
Q

bronchodilator response

A

2 puffs of bronchodilator and repeat spirometry 15 minutes later, increased FEV of 12 percent and FVC at least 200 is a bronchodilator response

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19
Q

pathological process common to all pneumonia

A

infection and inflammation of the distal pulmonary parenchyma

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20
Q

inflamm cascade of asthma

A

epithelial cells, mast cells, cd4, eosinophils

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21
Q

Extrinsic asthma

A

external - early in life, allergic, allergens, food, pollen, dust, occupational, aspergillosis. type 1 hypersensitivity

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22
Q

spirometry

A

maximal inhalation followed by a rapid and forceful complete exhalation into the spirometer will measure forced expiratory volume FEV1 and forced vital capacity FVC. need this baseline in all asthma pts.

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23
Q

Intrinsic asthma

A

viral infection, medication, cold, exercise, no hx of allergic reaction, develops later in life

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24
Q

hae influenzae pneumonia

A

2nd or 3rd cephalosporins (cef), bactrim

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25
Q

site of disease for copd and asthma

A

copd - peripheral airways and lung parenchyma leading to squamous metaplasia, small airway fibrosis and parencymal destruction… small bronchodilator response, poor response to steroids.

asthma - proximal airways leading to basement membrane and bronchoconstriction… large bronchodilator response. good response to steroids.

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26
Q

obstructive airflow pattern on spirometry level

A

FEV1/FVC

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27
Q

clinical features of copd

A

midlife, slowly progressive, long history of tobacco smoking, dyspnea during exercise, irreversible airflow limitation

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28
Q

pneumonia and contributing factors

A

infection and inflammation of the distal pulmonary parenchyma. contributing factors are viral upper resp tract infection, alcohol abuse, cigarette smoking, heart failure, copd

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29
Q

pleural effusion

A

dull percussion, decreased fremitus, voice and breath sounds, absent crackles

30
Q

pneumonia results in this process

A

ventilation perfusion mismatch and hypoxemia

31
Q

most common cause of bacterial pneumonia

A

step pneumoniae

32
Q

persistent severe asthma

A

symptoms through out the day needing meds, awakening 7times a week, extreme limitations in activity, FEV 5%

33
Q

Worse time for s/s

A

night and early morning

34
Q

Klebsiella pneumoniae

A

gram negative rod found in the GI tract, found with underlying alcoholism. leads to lobar pneumonia (same as step pneumonia –> lobar)

35
Q

copd inflammatory mediators

A

cd8, macrophages, neutrophils

36
Q

outpatient no cardiopulmonary disease

A

common organisms: s pneumo, m pneumo, c pneumo, resp virus, h influenzae – therapy: macrolide azithromycin or clarithromycin or doxy

37
Q

Triggers

A

allergen, cold, exercise, viral infection, cold air

38
Q

bacterial pneumonia characterized by an outpouring of

A

PMNs polymorphocnuclear leukocytes to fight the infection

39
Q

neutrophils cause

A

subbasement membrane fibrosis, airway hyperresponsiveness

40
Q

What is asthma?

A

Chronic inflammatory disorder of the airways. Bronchial hyperresponse and inflammation leading to airway obstruction Recurrent, reversible

41
Q

staph pneumonia

A

oxacillin, nafcillin, cefazolin, vancomycin

42
Q

lobar pneumonia

A

process not limited to segmental boundaries but tending to spread through out an entire lobe of the lung from alveolus to alvelous through interalveolar pres of Kohn. Step pneumoniae and lobar pneumoniae

43
Q

emphysema and pneumothorax

A

hyperressonant on percussion, decreased fremitus, decreased breath sounds, decreased voice, absent crackles

44
Q

Allergens commonly causing asthma

A

furry animals, dust mites, cockroaches, mold, pollen

45
Q

work induced asthma

A

10 percent of new asthma cases, workplace related exposure confirmed with airflow variable before and after workshift. support with igE specific antibodies in the blood

46
Q

anaerobes

A

pcn, clindamycin

47
Q

intermittent asthma

A

80, exacc needing corticosteroids 0-1 yearly

48
Q

Pseudomonas aeroginosa

A

found in environmental sources within the hospital environment seen in patients who are debilitated, hospitalized and often previously treated with abx

49
Q

persistent moderate asthma

A

daily symptoms needing meds, nighttime awakening > 1 week, some limitation with activity, fEV 60-80, FEV/FVC reduced 5%

50
Q

What are the main s/s of asthma?

A

Wheezing, SOB, Cough

51
Q

resp arrest

A

dyspnea while at rest, sits upright, talks in words, DROWSY CONFUSED. paradoxical abdominal accessory muscles. wheeze absent. bradycardia. no paradoxus.

52
Q

Mycoplasmal pneumonia

A

slower, insidious onset with a *nonproductive cough,

53
Q

copd inflamm cascade

A

macrophage, epithelial cells, cd8, neutrophils

54
Q

most common causes of chronic cough

A

The most common etiologies of chronic cough are upper airway cough syndrome (due to postnasal drip), asthma, and gastroesophageal reflux. Cough may also be a complication of drug therapy, particularly with angiotensin converting enzyme (ACE) inhibitors.

Other less common causes of chronic cough include a number of disorders affecting the airways (nonasthmatic eosinophilic bronchitis, chronic bronchitis, bronchiectasis, neoplasm, foreign body) or the pulmonary parenchyma (interstitial lung disease, lung abscess)

55
Q

s pneumoia abx

A

PCN, macrolide (mycins)

56
Q

mild asthma

A

dyspnea - while WALKING, can lie down. talks in SENTENCES. alert may be agitated. Usually no accessory muscles. moderate wheeze only on expiratory.pulse

57
Q

interstitial pneumonia

A

exuberant inflammatory process but not highly destructive. inflammatory process is within the interstitial walls rather than the alveolar spaces. classically, viral pneumonia begins like this. also, pneumococcal pneumonia behaves this way – healing process restores normal architecture… when organisms are more destructive, tissue necrosis and cavity formation will occur in the parenhyma – cavitary.

58
Q

legionella

A

macrolides, quinalones

59
Q

spirometry determines what

A

if obstruction is present - reduced FEV1/FVC ratio, assess the reversibility, determine severity of airflow limitation

60
Q

allergic asthma eosinophil

A

> 1,500

61
Q

clinical features in patients with pneumonia

A

fever with or without chills, cough w or without sputum, dyspnea, pleuritic chest pain, crackles, dullness, bronchial breath sounds and egophony with consolidation, polymorphic

62
Q

most frequent cause of pneumonia in young healthy adults

A

mycoplasma - the smallest known free living organism

63
Q

persistent mild asthma

A

> 2 days a week symptoms needing meds, not daily. awakening 3-4 a month, minor limits with daily activity, fEV > 80 normal, exacc > 2 times yearly.

64
Q

bronchopneumonia

A

distal airway inflammation is prominent along with alveolar disease and spread of infection and inflammatory process occurs through airways not alveoli – patchy in distribution. staphylocci and a variety of gram neg bacilli may produce this

65
Q

mycoplasma

A

macrolides (mycins), quinolones

66
Q

gram negative rods

A

3rd or 4th cephalosporins, extended pcn with beta lactamase inhibitor

67
Q

airway inflammation in asthma

A

air is trapped in alveolis, central and peropheral airways are involved, dysregulation of cells - epithelial, eosinophils, lymphocytes, mast cells, alveolar macrophages, neutrophils, – cells regulate airway inflammation and initiate airway remodeling and permanent airway structure

68
Q

normal lung

A

percussion resonant, fremitus normal, breath sounds vesicular at bases, voice transmission normal, no crackles

69
Q

staph or gram negative pneumonia appearance with pt

A

very ill with complex underlying health problems

70
Q

bronchoprovocative testing

A

provocative metacholine, mannitol, exercise or hyperventilation of cold, dry air. positive test is a 20 percent decrease in FEV of methacholine 8mg or less

71
Q

Aspirin and asthma

A

cough, wheeze or chest tightness 30-120 minutes after aspirin or cyclooxygenase inhibitor

72
Q

pneumococcal pneumonia

A

abrupt onset with sudden development of shaking chills and high fever - cough may be productive of yellow green or blood tinged. before this pneumonia they often have an URI.

Primary Care 2 (13 decks)

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