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Diagnosis and Mangement 1 > respiratory > Flashcards

respiratory Flashcards

1
Q

common cold is also known as:

A

URI, acute respiratory tract infection(ARTI)

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2
Q

URI is characterized by:

A

mild coryzal symptoms(acute inflammation of the mucous membrane of the nasal cavities), rhinorrhea, nasal obstruction and sneezing

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3
Q

25% to 80% of URI are caused by:

A

rhinovirus

other viral agents include coronavirus, RSV, adenovirus, influenza viruses and parainfluenza viruses

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4
Q

rhinoviral infections usually affect UR tract, but may also cause :

A

otitis media; sinusitis

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5
Q

purulent nasal discharge after 14 days signals:

A

bacterial sinusitis

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6
Q

goals for successful asthma management:

A
  • achieve and maintain control of symptoms
  • maintain normal activity levels, including exercise
  • maintain pulmonary function as close to normal as possible
  • prevent asthma exacerbations
  • avoid adverse effects from asthma medications
  • prevent asthma mortality
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7
Q

AAT deficiency :

A

a condition in which the body doesn’t make enough of a protein that protects the lungs and liver from damage. the condition can lead to emphysema and liver dx.

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8
Q

the common cold is usually associated with _______, ___________

A

rhinovirus, parainfluenza

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9
Q

beta-1 receptors are primarily in the _____ and stimulation causes ______ and ______

A

heart; tachycardia and increased contractility

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10
Q

beta-2 receptors are primarily in the ___ and _____. stimulation causes _______, _______, _______ in muscle and liver

A

Lungs and skeletal muscle

vasodilation; bronchodilation, increased glycogenolysis

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11
Q

beta agonists open up_____

A

bronchii

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12
Q

commonly used selective short acting beta agonist (SABA)

A

albuterol

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13
Q

long acting selective beta agonists, last up to 15h

A

salmeterol, formoterol

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14
Q

_________ corticosteroids are the mainstay of long term control of asthma

A

inhaled;

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15
Q

when prescribing a inhaled corticosteroid, note both the ____ and ____ dose

A

low and high

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16
Q

quick relief asthma medications:

A

SABA’s; anticholinergics; systemic corticosteroids

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17
Q

inhaled corticosteroids, mast cell inhibitors, long acting beta agonists, theoyphylline, leukotriene modulators are all____ term control medications for asthma

A

long

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18
Q

a patients asthma is persistent if: they experience symptoms more than ____ days per week; are awakened in night with symptoms ____ /week; ____ of ADL’s; use thier SABA more than ___ /week

A

2; 1-3; limitation; 2

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19
Q

step 1 (intermittent asthma) therapy:

A

SABA PRN

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20
Q

step 2 asthma therapy:

A

preferred: Low dose ICS
alternative: cromolyn, LTRA; nedocromil or theophylline

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21
Q

step 3 asthma therapy:

A

preferred: low dose ICS + LABA or medium dose ICS
alternative: Low dose ICS+ either LTRA or theophylline

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22
Q

__________ _________ _________, called LTRAs for short, are a class of oral medication that is non-steroidal.

A

Leukotriene receptor antagonists

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23
Q

LTRAs work by:

A

blocking a chemical reaction that can lead to inflammation in the airways. Their unique mechanism of action results in a combination of both bronchodilator and anti-inflammatory effects.

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24
Q

step 4 asthma therapy:

if step 4 or higher required then ________

A

preferred; medium dose ICS + LABA

alternative: med dose ICS + either LTRA or theophylline

consult with asthma specialist

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25
Q

step 5 asthma therapy:

A

high dose ICS + LABA

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26
Q

step 6 asthma therapy:

A

high dose ICS + LABA + oral corticosteroid

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27
Q

any pt with fever of unknown origin, failure to thrive, significant weight loss, or unexplained lymphadenopathy should be evaluated for ______

A

tuberculosis

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28
Q

community acquired pneumonia should be suspected if the pt’s history includes:

A

high fever, dyspnea, tachycardia, evidence of consolidation on exam, presence of symptoms for 2 weeks or more.

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29
Q

diagnostics usually aren’t needed in cases of acute bronchitis because _______ and _______ in the absence of ______, _______, ________ and _______ are strongly suggestive of acute bronchitis and minimize the likelihood of pneumonia

A

cough and normal vital signs

tachycardia, rales, tachypnea and egophony

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30
Q

the most common symptom associated with acute bronchitis:

A

cough with or without sputum production beginning early in the course of the URI

the sputum may be clear at the onset of the infection and become mucoid.

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31
Q

uncommon causes of acute cough should be suspected in those with:

A

heart disease (CHF), hay fever/allergic rhinnitis and those with environmental risk factors such as farm workers

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32
Q

An acute cough lasts:
A subacute/ persistent cough lasts:
Chronic cough is more than:

A

less than 3 weeks
3-8 weeks
more than 8 weeks

33
Q

_______ ______ is suspected when cough is accompanied by unexplained weight loss and fevers with night sweats, particularly in persons with significant tobacco or occupational exposures.

A

Bronchogenic carcinoma

34
Q

_____________ is suspected when acute cough is accompanied by vital sign abnormalities

A

Pneumonia

35
Q

_________ are the most common cause of acute bronchitis and include:
most common:
less common:

A

Viruses

most: influenza A and B, parainfluenza virus,
less: respiratory synctial virus ( RSV), coronavirus and adenovirus

36
Q

if a cough lasts __ weeks or longer, a chest xray is indicated in the absence of other known causes

A

3

37
Q

Pts with progressive dyspnea, oxygen saturation less than 90%, and S/S of sepsis require:

A

hospitalization for IV therapy, enhanced pulmonary therapy, IV abx

38
Q

______ is a chronic inflammatory disorder of the airways characterized by increased responsiveness of the tracheobronchial tree to various stimuli, resulting in episodic reversible narrowing and inflammation of the airways.

A

asthma

39
Q

Th1 - type and Th2- type cytokine responses are different immune responses the influence the development of:

A

asthma

40
Q

A genetic and strongly predisposing factor in the development of asthma is ________

A

atopy - the genetic tendency for development of immunoglobulin E (IgE) -mediated hypersensitivity reactions in response to environmental antigens and allergens.

41
Q

episodic wheezing associated with dyspnea, cough and sputum production are clinical hallmarks of _____

A

asthma

42
Q

what should always be considered in the differential diagnosis of a cough?

A

asthma; cough can be the principal or only manifestation of asthma, especially in young children. if the cough is treated symptomatically, it can easily result in delayed or missed diagnosis of asthma.

43
Q

Fever is uncommon in _______ and ________ but common in _________ and _______

A

cold, bronchitis

flu, pneumonia

44
Q

most common pathogen associated with pneumonia:

A

Strep Pneumoniae

45
Q

other typical pneumonia pathogens:

A

H. Influenza, M catarrhalis

hospital acquired: S. pneumoniae, resp viruses, P aeruginosa

46
Q

rales heard in lobe affected, increase tactile fremitus over affected lobe and positive egophony is likely :

A

community acquired pneumonia

47
Q

diagnostics for pneumonia:

A

chest xray; CBC; CMP( BUN/Creat; liver enzymes; phosphate level - looking for elevations which would indicate hypoperfusion and injury); lactic acid( elevation equates to tissue hyoxia), procalcitonin ( evelation differentiates infectious systemic inflammatory responses syndrome for noninfectious SIRS); sputum for C/S

48
Q

silhouette sign on an xray:

A

ABNORMALITY - the elimination/loss of the silhouette of lung/ soft tissue caused by a mass or fluid

49
Q

in previously healthy outpatients with community acquired pneumonia with no abx use in the past three months prescribe:

A

a macrolide or doxycycline

doxycycline has been found to be as effective as levaquin

50
Q

macrolides include:

A

azithromycin ( zithromax), clarithromycin

51
Q

Flouroquinolones include:

A

Levaquin, cipro, Avelox

52
Q

sharp pain with deep breathing accompanied by SOB is likely:

A

Pleurisy

53
Q

Peurisy is most commonly caused by:

A

viral infections

54
Q

tx for pleurisy includes:

A

acetaminophen; narcotic based antitussive; NSAIDS;Rest: ley on affected side; treat the underlying side ( abx if not already in use); incentive spirometer;

55
Q

what is a “left shift” in a wbc?

A

A “left shift” is a phrase used to note that there are a high number of young, immature white blood cells present. Most commonly, this means that there is an infection or inflammation present and the bone marrow is producing more WBCs and releasing them into the blood before they are fully mature.

56
Q

intrinsic restrictive lung disorders:

A

sarcoidosis, pneumoconiosis, TB, interstitial pneumonia

57
Q

extrinsic restrictive lung disorders ( chest wall):

A

scoliosis, kyphosis, obesity, pleurisy, rib fx

58
Q

what is spirometry used for:

A

definitively get a diagnosis for restrictive or obstructive disease

59
Q

top risk for developing COPD:

A

smoking; second hand smoke; occupational dust/chemicals

60
Q

the MBMRCS is a scale for :

A

COPD - risk for exacerbation leading to a hospital admission based on activity eg; pt category A is low risk with less symptoms

61
Q

evaluating a COPD pt requires multiple steps of data collection including:

A

degree of airflow limitation, questionnaire such as CAT or MBMRCS to gauge activity level

62
Q

less common than viral, bacterial causes of acute bronchitis include:

A

bordetella pertussis, mycobacterium tuberculosis, cornybacterium diphtheriae, mcoplasma pneumoniae.

63
Q

B. pertussis should be considered in adults with______ ______

A

persistent coughs

64
Q

the most common symptom of acute bronchitis initially is ________ which becomes_______

A

a dry, hacking, raspy cough which becomes a loose, productive cough

other symptoms: sore throat, rhinorrhea or nasal congestion, rhonchi during respiration, low grade fever, malaise, retrosternal pain during deep breathing and coughing, decreased/lack of appetite.

65
Q

pharmaceutical therapy for acute bronchitis includes ______ for fever/pain, ______ for cough, _______ for wheezes, rhonchi or pt with hx of asthma

A

acetaminophen, expectorants, albuterol

66
Q

if acute bronchitis symptoms persist longer than 8-14 days:

A

abx ( long term persistence indicates bacterial infection)

augmentin 500 mg by mouth every 8 hrs; doxycycline 100mg by mouth every 12h

sputum culture prior to abx therapy to isolate causative pathogen

67
Q

acute asthma attack is characterized by:

A

airway obstruction, symptoms of breathlessness, anxiety, and often accompanied by wheezing and sometimes coughing.

68
Q

during a sever asthma flare, you would expect to find during physical exam of the chest:

A

hyperresonance on thoracic percussion

69
Q

what is most likely to show up on a chest xray of a person during a acute severe asthma attack:

A

hyperinflation

70
Q

_____ ______ should be considered if lateral wheezes are heard upon chest auscultation

A

foreign bodies

71
Q

A _______ chest xray usually excludes malignant disease, bronchiectasis, persistent pneumonia, sarcoidosis and TB

A

normal

72
Q

hemoptysis sputum indicates:

A

bronchogenic cancer, pulmonary embolus, TB

73
Q

yellow green purulent sputum indicates:

A

bronchitis

74
Q

pink frothy sputum suggests:

A

pulmonary edema

75
Q

fetid purulent sputum indicates:

A

anaerobic infections

76
Q

rust colored sputum indicates:

A

pneumococcal pneumonia

77
Q

foam, serous, mucopurulent layers of sputum suggests:

A

bronchiectasis

78
Q

In adults of all ages and children over 1 year, _______, ________ and_______ are the three most common causes of chronic cough

A

upper airway cough syndrome (postnasal drip), asthma, GERD

Diagnosis and Mangement 1 (5 decks)

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