Respiratory Flashcards
Atrovent and Spiriva are considered what types of medication
Anti-cholinergics
What type of asthma medication should be avoided in patients with hypertension, Angela, or hyper thyroidism
SABA
-buterols
What type of asthma medication should be avoided and narrow angle glaucoma, BPH, what bladder neck obstruction
Anti-cholinergics
Dyspnea, chronic cough, and chronic sputum production our key indicators of what respiratory condition
COPD
What testing is required for a diagnosis of COPD
Spirometery
What is the FEV1/FVC ratio for a COPD diagnosis?
Greater than .70
What characteristics do we use for COPD staging
HAG
Height
Age
Gender
At what age does COPD usually occur
Greater than age 40. Almost never see COPD before age 40.
What is first line treatment for COPD
Beta agonist such as albuterol or lev
albuterol
What type of respiratory drug causes tachycardia
Short acting beta agonists
What is an example of a long acting beta agonist
Salmeterol
What is the second line treatment for COPD
Inhaled anti-cholinergics
The suffix tropium is an example of which respiratory medication
Inhaled anticholinergic
What type of respiratory medication causes constipation, and increased intraocular pressure
Inhaled anticholinergics
Which respiratory medication causes memory impairment, confusion, hallucinations, dry mouth, blurred vision, urinary retention, constipation, tachycardia, and acute angle glaucoma
Anticholinergic medications
In COPD what is the only known treatment to prolong life
Supplemental oxygen therapy
Long term use of oral corticosteroids greater than 24 weeks, increases the risk of
Pneumonia
When you are treating a patient with COPD, pick an antibiotic that has coverage against
H. Influenzae
What test is the gold standard for diagnosing community acquired pneumonia
Chest x-ray
How long do you wait to repeat a chest x-ray after community acquired pneumonia treatment
Six weeks
What type of antibiotic treats percussis
A macrolide
What type of pneumonia produces rust colored sputum and is the most common cause of death from pneumonia
Strep pneumonia
What type of pneumonia is considered walking pneumonia
Mycoplasma pneumonia
Patients eight greater than 65 years old, with co-morbidities, recent three months antibiotic exposure, alcoholics, immuno suppressed, exposure to child in daycare are all at risk for
Drug resistant strep pneumonia
Abrupt onset with fever, chills, cough, pain in side or chest, rust colored sputum are all symptoms of
Strep pneumonia
How do you treat an atypical pathogen pneumonia
Macrolide or doxycycline
Young, otherwise healthy, non-smokers, community outbreak are at risk populations for what respiratory condition
Atypical pneumonia
Low-grade fever, cough, chills, headache, malaise, rash, joint aches, arrhythmias are all symptoms of what respiratory condition
Atypical pneumonia
How do you treat a patient for community acquired pneumonia and that has no signs of DRSP
Macrolide or Doxycycline
If DRSP is suspected, how do you treat
Respiratory quinolone such as moxifloxacin, gemifloxacin, or levofloxacin.
Or, beta lactate (pcn or ceph) plus macrolide or doxycycline
Patients that are Aged 19-64 with an increased risk of pneumococcal disease should receive (asthma, COPD, CV)
Pneumococcal vaccine PPSV 23
All adults greater than or equal to the age of 65 years old, or aged 19 to 64 with a asplenia, immunocompromising conditions, CSF leaks, cochlear implants, plus additional PPSV23 should receive which immunization
Pneumococcal vaccine PCV13 then PPSV23 in 1 year
What age and comorbidities are considered a vulnerable population for immunization
Age 65 years and older, age 19 to 64 with a comorbidity such as renal disease, rheumatoid arthritis, heart disease, asthma, COPD
What is curb-65
C is for confusion, U is for blood urea nitrogen and greater than 19.6, R is for respirations greater than 30 breaths per minute, B is for systolic blood pressure less than 90, diastolic blood pressure less than 60, age equal or greater than 65.
When do you repeat the pneumococcal vaccine for a high-risk patients
5 to 7 years as it boosts antibodies
How do you treat bronchitis
Symptomatically
What are laboratory tests for pertussis
Nasopharyngeal swab and polymerase chain reaction.
How is pertussis treated
Macrolides
What is the first line treatment for COPD
Albuterol or short acting beta agonist, then salmeterol LABA if poorly controlled
A patient with COPD and a smoker with pneumonia is most likely to have what type of pneumonia
H influenza pneumonia
Do you give TDap or TD to a patient aged 11 or older
TDap
What respiratory condition should be suspected in a patient that is healthy and afebrile and has been coughing for more than 2 to 3 weeks, and treated with an antibiotic that was not a macrolide and it’s getting worse
Pertussis, but be sure to rule out pneumonia first
Do use of topical nasal decongestants for more than 3 days can cause rebound nasal congestion called
Rhinitis medicamentosa (Afrin use)
A chest x-ray that shows cavitations and adenopathy and granulomas on the hila of the lungs is consistent with
TB
Is latent TB infectious
No
What drugs are first line treatment for TB
Isoniazid and rifampicin
Is TB a reportable disease
Yes
All TB patients should be tested for
HIV infection
What type of TB drug causes optic neuritis?
Ethambutal
Avoid if patient has abnormal vision i.e. blindness, retinal vein occlusion
If a TB skin test is greater than or equal to 5 mm it is consistent with
HIV-positive, recent contact with infectious TB cases, immunocompromised
A TB test that is greater than or equal to 10 mm is consistent with
Recent immigrants, child less than four years of age or children/adolescence exposed to high-risk adult, IV drug user, healthcare worker, homeless, employees or residence from high-risk congregate settings
A TB skin test results of greater than 15 mm is consistent with
Persons with no risk factors for TB
What blood test can be used in the place of the TB skin test
The interferon y release assay blood tests
If a PPD result is listed as 9.5, is it positive or negative
Negative
A PPD result under 10mm is
Negative
Asthma is a disease of
Inflammation
Cough, wheezing, shortness of breath, chest tightness, spirometry are all symptoms and tools to diagnose
Asthma
In COPD, spirometry is used to demonstrate
Presence of airway obstruction
In asthma, spirometry is used to demonstrate
Presence of airway constriction
Asthma symptoms that occur less than or equal to two days a week is considered
Intermittent asthma
Asthma symptoms that occur greater than two times a week but not daily is considered
Persistent asthma
All asthma patients need to have which medication prescribed
Short acting beta agonist such as albuterol
What medication do you start an asthma patient that has persistent asthma
Low-dose inhaled corticosteroid
After a low-dose inhaled cortico steroid is prescribed, how do you bump up treatment
Step up to a medium dose inhaled corticosteroid or add a long acting beta agonist
While gaining asthma control, when should a patient follow up
Every 2 to 6 weeks
While monitoring asthma control when should a patient follow up
Every 1 to 6 months
If the patient with asthma requires step down treatments how often should the patient follow up
Every three months
How often should spirometry be performed on asthma patients
Every 1 to 2 years
How do you treat exercise induced bronchoconstriction
Treat 10-15 mins before exercise, short acting beta agonist for most patients, with daily exercise consider inhaled corticosteroids
All asthma patients should have which immunizations
Pneumococcal immunization and influenza immunization annually
Should exercise be recommended for asthma patients
Yes
An alternate medication for a patient with persistent asthma is
Theophylline
What drug interaction does Theophylline have
Macrolides, quinolones, Cimetidine, anticonvulsants
What will minimize the risk of oral thrush while using inhaled corticosteroid’s
A spacer
It also helps to gargle or drink water after use
What type of medication increases the risk of asthma death
Long acting beta agonist
Which asthma medication requires serum concentration monitoring
Theophylline
What do you give a patient during an asthmatic exacerbation
Give a nebulizer treatment of albuterol. May repeat every 20 minutes for up to three doses. If Unable to use inhaled bronchodilators, give epinephrine IM
For A patient with an asthmatic exacerbation what should be prescribed at discharge
Medrol dose pack or prednisone tabs 40 mg per day times four days
What is peak expiratory flow rate based on
H-height
A-age
G-gender
What is the green zone of the spirometer mean
80 to 100% of expected volume
Maintain or reduce medications
What does the yellow zone of the spirometer mean
50-80% of expected volume
Maintenance therapy needs to be increased or patient is having an acute exacerbation
What does the red zone of the spirometer mean
Below 50% of expected
If after treatment patients peak expiratory flow rate is still below 50% expected, call 911. If in respiratory distress, give epinephrine injection. Call 911
Chronic use of which asthmatic drug causes osteoporosis, mild growth retardation and children, glaucoma, cataracts, immune suppression, hypothalmic-pituitary-adrenal suppression, and other effects
High dose inhaled steroids
What is the first line treatment for severe asthmatic exacerbation or respiratory distress
Adrenaline injection
If you suspect that the patient has allergic asthma, check
Immunoglobulin G allergy panels and one for two allergist for scratch testing and treatment
What supplements should be prescribed for menopausal women and other high-risk patients for osteoporosis Who are on medium to high dose inhaled steroids long term
Vitamin D 1500 mg tabs QD and calcium
What kind of testing should be done in males and females who are on chronic steroids
Bone density testing
What eye problems occur in patients that are on long term steroids
Cataracts and glaucoma. Annual eye exams should be given.
What type of breath sounds consist of a full inspiratory phase with a shortened and softer expiratory phase
Broncovesicular breath sounds
When performing a respiratory assessment on a four-year-old child further valuation is warranted in the presence of
Supraclavicular retractions
Dyspnea that occurs when the patient is lying down and improves when the patient sits or stands up
Orthopnea
In order to locate the rib you need to palpate
Between the spine and the lateral chest
What type of breath sounds are heard over the periphery of the lung fields
Vesicular
When potassium in the lungs if you were hear resonance, what kind of finding is this
Normal
When percussing the lungs if Dullness is found, what should be considered
A lung with fluid or solid tissue replacing air
A condition associated with a chronic cough that produces copious amounts of purulent sputum is most likely
Bronchiectasis
Respiratory effort in the neonate is initiated at birth as a result of
Chemical, thermal, and mechanical factors
The hilar region of the lungs describes
The area around the heart
Breath sounds heard on the chest over the hilar region are
Bronchovesicular
Which technique that determines whether the tissues in the chest are airfilled, fluid filled, or solid
Percussion
Where is the coastal angle located
Where right and left costal margin’s form an angle where they meet at the xiphoid process
Tachypnea in a child with a fever is related to
The child’s febrile state
When percussing the chest in a patient who has left-sided heart failure the sound emanated would be
Resonant
Breath sounds consisting of a full inspiratory and expiratory phase with the inspiratory face usually being louder and normally heard over the trachea and larynx are considered
Bronchial
Breath sounds auscultated over the periphery of the lung fields are quiet and wispy during the inspiratory phase followed by a short, almost silent expiratory phase. These breath sounds are considered
Vesicular
Where is the angle of Louis located
On the manubrium and body of the strernum
Pain from pleurisy may be referred to that
Epigastric area
The lower tip of the scapula is located
Around the seventh or eighth rib
Factors that aggravate costochondritis may include
Movement of the chest, trunk, and arms
On auscultation of the chest, if the patient says 99 and it is clearly heard, this is indicative of
Lung density in the area
Breath sounds that are normally audible over the hilar region of the chest is termed
Bronchovesicular
To locate the 12 rib, palpate
Between the spine and the lateral chest
Breath sounds heard over the periphery of the lung fields are
Vesicular
Which cardiovascular medication can worsen COPD
Propanolol or beta blockers
What type of respiratory medications can cause tachycardia
Albuterol or inhaled beta agonists
The chest circumference of a 12 month old is
Equal to head circumference
Which immunization has shifted the pathogenesis see if you were cases of streptococcus pneumoniae
Pneumococcal immunization
How do you treat bronchiolitis in a child
Symptomatic treatment
What diagnostic test is required for a definitive diagnosis of TB
Sputum specimen
Which asthma medication is linked to an increase in the risk of sudden death if used alone
Long acting bronchodilator
What respiratory disease can cause anxiety or depression
COPD
What antihypertensive medication should be avoided in patients with a history of emphysema
Beta blockers
What is the minimum size of induration considered positive for PPD
5mm
What are the three stages of pertussis
Catarrhal
Paroxysmal
Convalescent
An autosomal recessive disorder such as cystic fibrosis is expressed in the offspring when
Both parents carry the gene
What condition is associated with mucus Production greater than three months per year for at least two consecutive years
Chronic bronchitis
A call is received from a nursing home reporting that an 86-year-old resident has become weak, dizzy, and short of breath over the past several hours. The patient has tachycardia, crackles, a wet cough, generalized pallor, and circumoral cyanosis. What is the most likely diagnosis
CHF
Left sided
Is tuberculosis only in the lungs
No it can occur in the kidneys brain lymph nodes adrenals bone and more
A patient that is taking a long term antihistamine is in need of what supplement
Iron
When should influenza vaccine be given
Influenza vaccine should be given annually to all persons 65 years or older, and to persons six months or older who are in chronic care facilities or who suffer from chronic cardio pulmonary disorders, metabolic disorders, hemoglobin pathology, or immunosuppression
When is the pneumococcal vaccine recommend
Age 65 and over
