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respiratory/pulmonary Flashcards

1
Q

pulmonary disorder s/s

A

cough, SOB, pain in chestt

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2
Q

differentiate dx for cough

A

pneumonia
bronchitis.
postnasal drip
heart failure

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3
Q

SOB link to respiratory issue s/s

A

clubbing
barrel chest
cyanosis
pursed-lip breath
hemoptysis

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4
Q

chronic bronchitis treatment

A

its s a viral treatment with fluid and rest
also advise the pt that the cough can lass as long as 21 days

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5
Q

heart failure chest x ray result

A

when an x-ray show bilateral congestion most likely is heart failure

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6
Q

most common pathogen in CAP

A

strep pneu

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7
Q

patient with a penicillin allergy with ATB for CAP

A

doxycycline 100mg daily
clarithromycin 500mg bid
azithromycin 500mg 1st day then 250mg daily

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8
Q

doxycycline produce GI symptoms

A

stop doxycycline and give a macrobile azithromycin or clarithromycin

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9
Q

levofloxacin contraindication (quinolones)

A

impaired bone formation contraindicated in age<18
prolonged QT torsade de pointe
dehydration
history of the biceps Tendon
pregnancy

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10
Q

bupropion

A

increase risk of seizure

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11
Q

primary
secondary
Tertiary

A

prevention
screening
treatment

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12
Q

pneumonia

A

infection and inflammation of the alveoli

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13
Q

Dx of pneumonia

A

a chest x-ray will show infiltrates, consolidation or opacity

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14
Q

ATS/IDA guideline for CAP treatment without comorbidities

A

1-Amoxicillin 1g (1000mg) 3 times a day: Best evidence
2-Doxycycline 100mg twice daily-conditional recommendation- low quality evidence
3-Macrolide (azithromycin, clarithromycin SR or ER)-conditional recommendation- mod quality evidence

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15
Q

CAP in pt with comorbidities can be managed with combination therapy or monotherapy guidelines do not specify preference

A

-chronic disease of major organ system(heart, lung, liver, kidney) or malignancy
-alcoholism
-Asplenia (The absence of a spleen)

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16
Q

ATS/IDA guideline for CAP treatment with comorbidities

A

-combination therapy
Amoxicillin/clavulanate or Cefpodoxime or cefuroxime
PLUS
Macrolide or Doxycycline
-Monotherapy
Respiratory fluoroquinolone (levofloxacin,moxifloxacincin, gemifloxacin)

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17
Q

pt with CAP test positive for influenza should be still treated with ATB

A

YES
guideline recommended treated for bacteria
viral/bacterial pneumonia often occurs

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18
Q

How long should should the pt with CAP BE TREATED

A

usually 5-10days
At least 5 days plus clinical improvement
-normalization of vitals and adequate dietary intake
follow up imaging is no longer recommended in patients with expected clinical improvement

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19
Q

pneumonia prevention

A

vaccination
pneumonia
influenza one dose annually
Sars-Cov2-primary series plus booster

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20
Q

what is the implication of increased tactile fremitus and dullness to percussion in a person with pneumonia?

A

Increased intensity of tactile fremitus generally occurs as a result of increased density within the lung tissue. This commonly occurs as a result of lung consolidation, which refers to the replacement of the air within healthy lung tissue with another substance; either inflammatory exudate, blood, pus, or cells.

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21
Q

COPD which guidelines should you know

A

2022 global initiative for chronic obstructive lung disease (GOLD) guidelines

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22
Q

when to suspect COPD

A

history/physical finding
-chronic tobacco use or noxious lung exposure from pollution, indoor stove, occupational
-genetic factors, family hystory or childhood predispositions
symptoms
presence of chronic productive cough with frequent lower respiratory tract infection

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23
Q

COPD -WHEN TO SUSPECT

A

Physical exam often normal may have barrel chest, wheezing. pursed lip breathing. decrease breath sounds

24
Q

COPD DX

A

spirometry is required for Dx
post-bronchodilator FEV1/ FVC ration <0.7
in other words, the pt can forcefully expel less than 70% of the air in their lungs even after using a bronchodilator

25
COPD TREATMENT
-Beta-agonists produce bronchodilation by stimulating beta receptors in the heart and lungs End in -TEROL -Inhaled antimuscarinics prevent bronchoconstriction by blocking the action of acetylcholine at muscarinic receptors End in TROPIUM -COMBO AGENTS SAMA+SABA LAMA+LABA LABA+ICS LABA+LAMA+ICS
26
SABA SHORT ACTING BETA ANTAGONIST
Albuterol levalbuterol onset <5mn duration 4-6 hours 8hours
27
LABA long-acting BETA ANTAGONIST
Salmeterol onset 10-20mn duration 12-24hrs
28
SAMA SGORT ACTING MUSCARIN ANTAGONIST
Ipratropium (Atrovent) duration 6hours
29
LAMA
Tiotropium (Spiriva) duration 24hours nb. work well with long-acting beta-agonists
30
prescribing strategy for stable COPD
-SAMA PRN OR SABA prn -LABA AND LAMA PLUS RESCUE MED -ICS+( LABA or LAMA) -ICS + (LABA and/or LAMA)
31
COPD EXECERBATION KEY SYMPTOMS and management
increase dyspnea -Mild SABA Albuterol -Moderate SABA +ATB (5-7days) and/or oral corticosteroid -severe ED or hospitalization severe SOB, mental status change, low BP
32
considered differentia dx
pneumonia-CXR -pulmonary embolism-D-dimer, chest CT,PE protocol -Afib /flutter-ECG pleural effusion-CXR
33
COPD comorbidities
-cardiovascular disease (HF, CAD, tachyarrhythmias, afib, -metabolism syndrome -osteoporosis -depression/anxiety -lung cancer
34
SUPRACLAVICULAR LYMPH NODES is associated with high rates of malignancy
Right -lungs -mediastinum -Esophagus left -Abdominal Malignancy stomach gallbladder, liver, pancreas, ovaries, prostate
35
lung cancer screening guidelines USPSTF RECOMMENDATION
adult aged 50-80 years who have >20 pack-year smoking history AND currently smoke OR quit within the past 15 years screen Annually with low-dose CT
36
ASTHMA S/S
Wheeze, SOB, chest tightness, and cough varies in intensity over time s/ occurs or worsens at night with exercise viral infection, exposure to allergens, or irritants, hard laughing or crying, stress, personal family history of asthma, atopic disease, eczema
37
Asthma dx criteria
presence of asthma feature (history) reversible airway obstruction spirometry demonstrates airways are at least partially reversible after SABA > 12% improvement from baseline or Fev>200ml or after 4 weeks on ICS nothing else could be causing symptoms
38
NB pick flow is use for monitoring not for dx
using symbercort as rescue is not FDA approve.NEVER answer Symbercort as rescue on exam
39
nb when asthma pt out of control
the drug to add is steroid to the SABA like Budesonide
40
when rescue steroid don't work
increase to moderate dose
41
Long acting bronchedilator
never use alone in asthma can cause sudden death always combine with steroid
42
why is Timolol contraindicated in pt with asthma
is a beta blocker that can xce bronchoconstriction in pt with asthma
43
SABA
Albuterol levabulterol
44
inhaled steroid suffix one
flucasone monetasome budesonide
45
Asthma treat
1-interminittent SABA rescue prn no symptoms most day< 2 weeks -persistent daily low dose ICS plud SABA prn or PRN low-dose ICS/SABA comb (symbicort)
46
risk factors for asthma related death
-history of intubation /ventilation or hospitalization for asthma in a last year - not currently using ICS poor adherence to ICS SABA overuse (1 canister/month) psychiatric disease, psychosocial problems -lack of an asthma action plan
46
risk factors for asthma related death
-history of intubation /ventilation or hospitalization for asthma in a last year - not currently using ICS poor adherence to ICS SABA overuse (1 canister/month) psychiatric disease, psychosocial problems -lack of an asthma action plan
47
Asthma severity Mild intermittent
-symptoms < ou egale 2 days /weeks or < ou egale 2 nights /month exacerbation is brief
48
mild persistent
symptoms > 2 times/week but not daily or 3-4 times/month at nighttime
49
moderate persistent
daily symptoms or >1 night/week, but not nightly
50
severe persistent
symptoms throughout the day often 7 night /week
51
most common pathogen implication in pneumonia
0-4years viral >5 bacterial: atypical pathogen (mycoplasma and Chlamydophila
52
rust-colored sputum is associated with strep pneumonia but scant watery sputum is associate with atypical pathogen
53
patient with penicillin allergy can take
tetracyclines -doxycycline quinolones-ciprofloxacin Macrolides -clarithromycin, azithromycin, aminoglycosides(gentamicin glycopeptides(vancomycin
54
ATB to avoid with penicillin allergy
cephalosporin beta-lactam ATB cefazolin cephalexin cefuroxime,cefoxitin ceftriaxone ceftazi

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