Respiratory Flashcards
Egophony
Increased resonance of voice sounds/patient says the vowel “E”, normal lung tissue will sound like “eee”, consolidated lungs will sound like “aaay”
Tactile fremitus
Vibration of chest wall when patient speaks” “99”/fremitus increases or decreases in abnormalities
Whispered pectoriloquy
Refers to increased loudness of whispering during lung auscultation
FEV1 percent of intermittent asthma
> 80%
FEV1 percent of mild persistent asthma
> 80%
FEV1 percent of moderate persistent asthma
60%-80%
FEV1 percent of severe asthma
< 60%
What are the four clinical classifications of asthma?
Intermittent, mild persistent, moderate persistent, and severe persistent
Peak expiratory flow volume is determined by what three things?
Height, age, and gender, think HAG
Pulsus paradoxus
Systolic pressure drops during inspiration/response to increased pressures
What two pulmonary disorders may cause pulsus paradoxus?
Asthma and emphysema, any condition that can affect internal body pressures
What are the three cardiac causes of pulsus paradoxus?
Tamponade, pericarditis, and cardiac effusion, any condition that affects internal body pressures
Consolidation of the lungs is not present in what kind of pneumonia?
Atypical pneumonia
What is the most common cause of atypical pneumonia?
Mycoplasma pneumoniae
What three populations are at highest risk for atypical pneumonia?
College students, school-aged children, and military recruits
Most common location of TB in the lungs
Upper lobes
What class of antibiotics in considered first line therapy for community-acquired pneumonia without comorbidity?
Macrolides such as azithromycin
Most common bacterial pathogen that causes acute bronchitis in smokers
H. Flu
Most common bacterial pathogen that causes acute bronchitis
Pertussis
Most common cause of acute bronchitis in general
Viral pathogens
Best antibiotic choice for pertussis infection
Macrolides or Bactrim if allergic
Best antibiotic choice for pregnant women when treating CAP
Amoxicillin
CAP follow up chest x-ray in adults
8-12 weeks
FEV1 % post bronchodilator to diagnose COPD
< 0.70 %
Two drug classes to treat COPD
Beta agonists and inhaled anticholinergics
Beta agonists
Short acting or long acting “LABA’s and SABAS” think drugs that end in “terol”
Beta agonist mechanism of action
Stimulate beta receptors in heart and lungs, bronchodilation
Inhaled anticholinergics mechanism of action
Blocks acetylcholine in the brain, which is responsible for smooth muscle contraction, prevents bronchoconstriction, think drugs that end in “tropium”
Sequence of treating asthma
SABA, low dose ICS, LABA, refer for severe asthma
Positive TB skin test reading of 5 mm or greater
Those with HIV, immunocompromised, recent contract with TB, < age 5 with close TB contact
Positive TB skin test reading of 10 mm or greater
Recent immigrants within 5 years from high prevalence countries, child younger than 4 exposed to TB, IV drug use, homeless, healthcare worker, employees of high risk areas like jails and nursing homes
Positive TB skin test reading of 15 mm or greater
The rest of the population with no known risk factors
Recommended age for pneumonia vaccine
Age 65 or older
Sequence of pneumonia vaccination
Start with PCV13, then PPSV23 one year later
Does PCV13 need to be given again?
No
What should be done if patient is given PCV13 before age 65?
Do not repeat PCV13, give PPSV23 if patient has not received it in last 5 years
First line treatment for mild COPD
SABA or short-acting anticholinergic, start with SABA, then move to short-acting anticholinergic
Sequence of COPD medication treatment
SABA, short-acting anticholinergic, LABA or LAMA, combo meds, ICS, refer
Optimal treatment for latent TB
Isoniazid
