Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AANP Class - Leik, Sarah Michell, MedMastery, & Other > Respiratory / Pulmonary > Flashcards

Respiratory / Pulmonary Flashcards

1
Q

Pneumonia
s/s

A
  • cough, fever, fatigue, pleuritic chest pain
  • increased tactile fremitus (felt)
  • auscultate egophony which is increased resonance with eeeee that sounds like aaaaa indicating consolidation, decreased lung capacity, and pleural effusion
  • auscultate the lungs (crackles/rhonchi, decreased lung sounds over lower lobes with consolidation)
  • chest xray looking for areas of consolidation and infiltrates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PNA
diagnosis

A
  • chest xray looking for areas of consolidation and infiltrates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PNA prevention

A

flu vaccine (# complication is PNA)
pneumococcal vaccines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PNA prevention

When do I give PNA vaccines?

A

Healthy, immunocompetent persons 65 and older:
* a single dose of PPSV23
Persons with some chronic conditions asthma/copd, etc.:
* a single dose of PPSV23
Chronic kidney disease:
* both PCV13 and PPSV23
Sickle cell and asplenia (no spleen):
* both PCV13 and PPSV23
Immunocompromised:
* both PCV13 and PPSV23

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Viral PNA

A

RSV
dry hacky cough
fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Bacteria PNA

A

60-80% of PNA
- higher risk is asthma, COPD, cystic fibrosis

atypical PNA
Mycoplasma pneumoniae (walking PNA)
milder more persistent symtoms

typical PNA
Streptococcus PNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pneumonia
TX

  • 2 main choices (MAD Lung +)
A

MAD Lung

If patient is healthy and does not meet below criteria, treat with MAD
- Macrolides, such as azithromycin (Zithromax) - low resistance rates
- Amoxicillin (Amoxil)
- Doxycycline

If patient has co-morbidies OR taken any antibiotic in the last 90 days, treat with think
a) LUNG - levofloxacin/Levaquin (fluoroquinolones) - not cipro
OR
b) macrolide / azithromycin with amoxicillin

FOLLOW UP with chest x-ray at 8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Chronic obstructive pulmonary disease
COPD
Combination of 2 diseases

A

chronic bronchitis leads to cilia destruction
emphysema destroys alveoli = dyspnea + wheezing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

COPD risk factors

A

occupational hazards
pollution
smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

COPD
s/s

A

chronic cough
sputum production
dyspnea

  • percussion will be hyperresonate (hyper-expansion with increased thoracic gas)
  • feels like they have difficulty taking a good deep breath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

COPD
COPD ASSESSMENT TEST = CAT
assessment components
Treat > 10

A

not used for diagnosis, measures quality of life with COPD and tracks changes over time

0–5 that reflects response, zero indicates no effect on quality of life, whereas a 5 suggests a very significant effect

  1. how often you cough
  2. how much mucus is in your cough/chest
  3. how much tightness you feel in your chest
  4. how out of breath you feel after walking uphill or climbing stairs
  5. how much your condition limits your activities at home
  6. how comfortable or safe you feel leaving your home with COPD
  7. how well you’re able to sleep
  8. how much energy you have

0–9 Low
10–20 Medium* significant disruption
21–30 High
31–40 Very high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

COPD
Diagnosis

A

Spirometry
FEV1/FVC ratio
Score < 0.70 or 70% confirms diagnosis

Low FEV1/FVC ratio = obstructive airway disease
High FEV1/FVC ratio = reactive airway disease (asthma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

COPD
Group A = CAT < 10
tx

A

CAT < 10
0 or 1 exacerbation

Bronchodilators = drugs that open up airway
- TEROL
- SABA: albuterol (short)
- LABA: formoterol (long)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

COPD
Group B = CAT >10
tx

A

CAT >10
0 or 1 exacerbation too (like group A but more significant)

Long Acting Medications:
LAMA: - PIUM = tiotropium
LABA: -TEROL = sameterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

COPD
Group C = CAT < 10
tx

A

CAT < 10
although CAT is less than 10, there are multiple exacerbations and/or hospitalizations

First Line
LAMA: -PIUM = start here!
Can also add: LABA/LAMA combo (remember LABA is -TEROL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

LABA/LAMA combination drugs

A

Tiotropium/olodaterol = Respimat = Once daily
Aclidinium/formoterol = Genuair = Twice daily
Umeclidinium/vilanterol = Ellipta = Once daily
Glycopyrronium/indacaterol = Breezhaler = Once daily
or Neohaler = Twice daily
Glycopyrronium/formoterol fumarate = Aerosphere = Twice daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

COPD
Group D = CAT > 10
tx

A

CAT > 10
multiple exacerbations and/or 1+ hospitalizations

First Line
LABA/LAMA combo
- remember LABA is -TEROL & LAMA is - PIUM

If symptoms are persistent may add ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Long Acting Beta Antagonists
LABA examples

A

salmeterol
formoterol
arformoterol
indacaterol
vilanterol
olodaterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Long-acting muscarinic antagonists
LAMA

A

tiotropium
aclidinium
umeclidinium
glycopyrrolate (also called glycopyrronium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Inhaled Corticosteroids
ICS examples

A

Beclomethasone Dipropionate
Budesonide
Ciclesonide
Fluticasone Furoate
Fluticasone Propionate
Mometasone
Mometasone Furoate HFA 100 or 200 mcg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

COPD exasterbation s/s

A

increased difficulty breathing
increased sputum amount
increased sputum purulence (pus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

COPD exasterbation mild tx

A

SABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

COPD exasterbation moderate tx

A

SABA + antibiotics/steriods

Antibiotics
- macrolide
- tetracycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

COPD exasterbation severe tx

A

send to hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

COPD treatment order

A

Groups A to D
A: bronchodilators SABA or LABA
B: long acting medications LABA or LAMA
C: LAMA
D: LABA/LAMA combo likely with ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Asthma
Diagnostic

A

forced expiratory volume FEV1 = amount of air forced out of lungs in one second

HAG = Height, Age, Gender
- this helps us with expected values
* in children we take into account their weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Asthma
FEV1 Range

A

Step 1 & 2: Intermittent to Mild Persistent > 80%
Step 3: Moderate 60% to 80%
Step 4-5: Severe (refer) < 60%

follow-up annually if not more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Asthma rescue inhaler

A

ICS/LABA combination
- aka Budesonide/formoterol combination (Symbicort)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Asthma
Symptom exacerbation number
Step 1 Tx

A

Symptoms < 2x per month

Treatment:
1. ICS-LABA PRN
low dose inhaled corticosteroid (ICS) and formoterol
- aka Budesonide/formoterol combination (Symbicort)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Asthma
Symptom exacerbation number
Step 2 Tx

A

Symptoms < 2x per month, but not daily
L-ICS daily

Treatment:
1. ICS-LABA PRN
low dose inhaled corticosteroid (ICS) and formoterol
- aka Budesonide/formoterol combination (Symbicort)

OR

  1. ICS-LABA
    Budesonide/formoterol combination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Asthma
Symptom exacerbation number or…
Step 3 Tx

A

Symptoms on most days or waking up 1x/week

Treatment:
ICS-LABA
Budesonide/formoterol combination (Symbicort)

L-ICS with LTRA
Leukotriene receptor antagonist = montelukast = Singulair
- great add on treat, but not an add on treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Asthma
Symptom exacerbation number
Step 4 Tx

A

Refer to pulmonology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Long Acting Beta Antagonists
LABA examples

A

salmeterol
formoterol
arformoterol
indacaterol
vilanterol
olodaterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

COPD treatment order

A

Groups A to D
A: bronchodilators SABA or LABA
B: long acting medications LABA or LAMA
C: LAMA
D: LABA/LAMA combo likely with ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Long-acting muscarinic antagonists
LAMA

A

tiotropium
aclidinium
umeclidinium
glycopyrrolate (also called glycopyrronium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Long Acting Beta Antagonists
LABA examples

A

salmeterol
formoterol
arformoterol
indacaterol
vilanterol
olodaterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

COPD treatment order

A

Groups A to D
A: bronchodilators SABA or LABA
B: long acting medications LABA or LAMA
C: LAMA
D: LABA/LAMA combo likely with ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Asthma main s/s

A

cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q
A
39
Q

How do we determine success of asthma treatment?

A

Patients monitor symptoms daily and record s/s and reduction of symptoms shows what adjustments need to be made, but it’s not based on rescue inhaler from before

40
Q

What medication do we not prescribe by itself?
Black Box Warning

A

Long-acting β-agonists (salmeterol and formoterol) received “black box” warnings because of severe with some associated death

41
Q

What medication is now the cornerstone of asthma treatment?

A
  • low dose inhaled corticosteroid (ICS) and formoterol
  • aka Budesonide/formoterol combination (Symbicort)
  • this is also our exacerbation treatment
42
Q

What if the patient does not have full blown COPD but has symtoms?

A

presribe bronchodilator (SABA or LABA)

42
Q
A
42
Q
A
42
Q
A
42
Q
A
42
Q
A
43
Q

COPD patient loses weight unintentional

A

Lung cancer is highest risk when pt has COPD (both genders)

  • high calorie, high protein, small meals if breathing is too much caloric output
44
Q

CURB - 65

A

Confusion
Urea (blood urea nitrogen)
Respiratory rate > 20 or >30 depending on guidelines
BP < 90/60
65 age

1 point each, great than 2 points = admission

45
Q

Tuberculosis - TB
- appearance on chest xray

A

consolidation in upper lobes

46
Q

Tuberculosis - TB
Diagnosis

A
  • Confirmation of the TB diagnosis
    ◦ Acid-fast bacilli (AFB) smear, plus
    ◦ Three sputum cultures positive for mycobacterium tuberculosis
47
Q

Tuberculosis - TB
Mantoux

A

2 step test with 48-72 hours after the test
- 15 mm + for general public
- 10 mm + for individuals in high-risk settings or recent immigrants from high-risk countries
- 5 mm+ for HIV-positive (CD4 count > 200) or immunocompromised patients taking tumor necrosis factor (TNF) inhibitors (4x)

  • note TNF Inhibitors are used to treat certain autoimmune diseases, Rheumatoid arthritis, Ankylosing spondylitis, Psoriatic arthritis
48
Q

Differentiate mononucleosis from streptococcal pharyngitis (strep)?

A
  1. splenomegaly for mono
  2. palatal petechiae for strep
49
Q

Streptococcal pharyngitis (strep)
Tx

A

penicillins

50
Q

Complication of untreated strep throat

A

Scarlett fever / Scarlatina (strawberry tongue), Rheumatic fever, Glomerulonephritis

Rheumatic fever is a condition that can inflame or make the heart, joints, brain, and skin swell

Glomerulonephritis is inflammation and damage to the filtering part of the kidneys (glomerulus)

51
Q

Mononucleosis
Tx

A

Symptom treatment

52
Q

When can mono pt play sports?

A

Spleen ultrasound still enlarged

53
Q

What if the patient has strep and mono?
Tx

A

macrolide
cephalosporin
penicillin VK

*not other penicillin to avoid morbilliform rash

54
Q

Complication of strep throat…

A

Peritonsillar abscess which is a deviated uvula that are very painful and lead to sepsis

55
Q

Bronchitis
tx

A
  • 95% are viral, do not treat with antibiotics unless it is pertussis (whooping cough)

*dTap or Tdap prevents pertussis

56
Q

Sinusitis
tx

A

Amoxicillin
Augmentin (amoxicillin/clavulanate)

57
Q

Sinusitis
s/s

A

upper respiratory s/s
facial pressure
toothache

58
Q

Allergic Rhinitis
tx

A

first line: avoid triggers
1. internasal corticosteroids - flonase
2. antihistamines
- diphenhydramine (Benadryl)

*avoid antihistamines in older population

59
Q

Allergic Reaction labs

A

IgE

59
Q
A
59
Q
A
59
Q
A
59
Q
A
59
Q
A
60
Q

Anticholinergic Side Effects

A

dry mouth
difficulty peeing - urinary retention
sedating
blurred vision
constipation
tachycardia
confusion
impaired memory

61
Q

Corticosteroids
classic triad of atopy

A

asthma
allergy
atopic dermatitis

62
Q
A
62
Q
A
62
Q
A
62
Q
A
63
Q
A
64
Q
A
64
Q
A
64
Q
A
64
Q
A
64
Q
A
65
Q
A
65
Q
A
65
Q
A
65
Q
A
65
Q
A
66
Q
A
66
Q
A
66
Q
A
66
Q
A
67
Q
A
68
Q
A
68
Q
A
68
Q
A
68
Q
A
68
Q
A
69
Q
A
69
Q
A
69
Q
A
70
Q
A
70
Q
A

AANP Class - Leik, Sarah Michell, MedMastery, & Other (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions