respiratory ?s Flashcards
Which of the following is the most common pathogen implicated in acute bronchitis?
S. pneumoniae
H. influenzae
M. pneumoniae
Respiratory virus
Respiratory virus
You anticipate finding which of the following on physical examination in a 25-year-old man with an acute asthma flare with a reduced FEV1?
Intercostal retraction
Inspiratory crackles
Increased tactile fremitus
Hyperresonance
Hyperresonance
asthma is an air trapping disease
You see Michelle, a 38-year-old woman with moderate persistent asthma who is using medium-dose inhaled fluticasone daily and albuterol via MDI as needed. In a typical month, she uses albuterol 2 puffs “about 2 times, when I feel my chest getting a little tight, and it works right away.” In an average month, she has no episodes of nocturnal awakening with cough or wheeze, typically has excellent activity tolerance.
Which of the following is the most important additional clinical parameter to obtain today in evaluating Michelle’s baseline asthma control?
SaO2
Peak expiratory flow
Auscultation of breath sounds
Resting respiratory rate
Peak expiratory flow
You see Michelle, a 38-year-old woman with moderate persistent asthma who is using medium-dose inhaled fluticasone daily and albuterol via MDI as needed. In a typical month, she uses albuterol 2 puffs “about 2 times, when I feel my chest getting a little tight, and it works right away.” In an average month, she has no episodes of nocturnal awakening with cough or wheeze, typically has excellent activity tolerance.
Michelle returns for an urgent care visit three weeks later with a 2-day history of URI symptoms. She has a dry cough and reports, “The albuterol is not working as well as usual. I was up all night coughing. When I cough, a little bit of white phlegm sometimes comes up.” She denies fever, nausea, or vomiting. Which of the following is the most important clinical parameter in assessing Michelle’s asthma flare?
SaO2=97%
Peak expiratory flow=55% of personal best
Presence of bilateral expiratory wheezes
Patient report of reduced response to beta2-agonist use
Peak expiratory flow=55% of personal best
You see Michelle, a 38-year-old woman with moderate persistent asthma who is using medium-dose inhaled fluticasone daily and albuterol via MDI as needed. In a typical month, she uses albuterol 2 puffs “about 2 times, when I feel my chest getting a little tight, and it works right away.” In an average month, she has no episodes of nocturnal awakening with cough or wheeze, typically has excellent activity tolerance.
Michelle’s physical examination is consistent with an asthma flare triggered by viral RTI. Her medication regimen should be adjusted to include which of the following? (Yes or no).
An oral systemic bronchodilator titrated to therapeutic level
A short course of an oral corticosteroid
An oral macrolide antimicrobial
A single dose of injectable
NO An oral systemic bronchodilator titrated to therapeutic level
YES A short course of an oral corticosteroid
NO An oral macrolide antimicrobial
NO A single dose of injectable
Which of the following is consistent with the diagnosis of all stages of chronic obstructive pulmonary disease?
FEV1:FVC ratio <0.70 post-bronchodilator
Dyspnea on exertion
Hypoxemia
Orthopnea
FEV1:FVC ratio <0.70 post-bronchodilator
A 78-year-old man with COPD, who uses an inhaled LAMA daily on a set schedule and SABA via MDI as needed for symptom relief, presents with a COPD exacerbation. Which of the following describes the role of imaging in the evaluation of COPD exacerbation?
A chest x-ray is a routine part of the evaluation of a person with COPD exacerbation
In COPD exacerbation, chest x-ray should not be obtained due to radiation risk
A chest x-ray should be ordered in COPD exacerbation in the patient with fever and/or low SaO2 to help rule out concomitant pneumonia
A thoracic CT is the preferred imaging study to order in a COPD exacerbation
A chest x-ray should be ordered in COPD exacerbation in the patient with fever and/or low SaO2 to help rule out concomitant pneumonia
Ms. Matthews is a 78-year-old woman with severe COPD, who is currently using a LABA/LAMA DPI and who presents for an acute care visit. Her current medications include an ACEI, thiazide diuretic, statin, and a calcium channel blocker. She reports increasing dyspnea and worsening cough with small amounts of yellow-green sputum for the past 24 hours. She states, “I hardly slept at all last night. I kept waking up coughing.” She denies nausea, vomiting, or fever. Physical examination reveals bilateral expiratory wheezes and rhonchi with hyperresonance to percussion without increased tactile fremitus or dullness to percussion. SaO2=98%, T=97.6°F (36.4°C), BP=136/84 mm Hg, P=92, regular, RR=20. When considering pharmacologic therapy to treat Ms. Matthews, the NP prescribes which of the following? Choose all that apply.
A single dose of an injectable, sustained-release corticosteroid
Oral clarithromycin
Opioid-containing cough suppressant
A short-course of an oral corticosteroid
NO A single dose of an injectable, sustained-release corticosteroid
NO Oral clarithromycin
NO Opioid-containing cough suppressant
YES A short-course of an oral corticosteroid
Teresa, a 38-year-old woman with no chronic health problems, presents with a chief complaint of “A cold I cannot shake for the past three weeks.” She also reports an intermittent frontal headache and has taken acetaminophen with relief, as well as general malaise and a dry cough that is particularly problematic at night. She denies nausea, vomiting, chills, fever, or dyspnea. She underwent a bilateral tubal ligation approximately 10 years ago, and is allergic to penicillin with a hive-form reaction. Examination reveals the following: SaO2=97%, BP=114/70 mm Hg, T=98°F (36.7°C), HR=88, RR=20, bilateral coarse late inspiratory crackles without wheeze. She is in no acute distress. Chest x-ray demonstrates bilateral interstitial infiltrates.
The results of her laboratory tests do not show alarm findings. In treating Teresa, you prescribe the following.
A 7-day course of oral doxycycline
A 10-day course of oral moxifloxacin
A single dose of IM ceftriaxone plus a 7 day course of oral cefpodoxime
A 7-day course of oral amoxicillin
A 7-day course of oral doxycycline
Mr. Spaulding is a 70-year-old man with a 50 pack-year cigarette smoking history, chronic obstructive pulmonary disease, and hypertension. He lives in an apartment with his 68-year-old wife and an adult son. Mr. Spaulding presents today with a 24-hour history of increasing dyspnea and productive cough with white-yellow sputum. He is alert, oriented, and answers questions with ease. Physical examination reveals the following: Breathing slightly labored at rest, BP=130/78 mm Hg, T=99.8°F (37.7°C), HR=96, RR=22, dullness to percussion over the left base with increased tactile fremitus and tubular breath sounds as well as crackles in the right base. Cardiac examination reveals no S3, no S4, no murmur, with nondistended neck veins.
Mr. Spaulding’s current medications include an inhaled corticosteroid, a long-acting beta2-agonist, an ACE inhibitor with a thiazide diuretic, a statin, and low-dose aspirin, as well as a short-acting beta2-agonist as needed. Laboratory testing reveals BUN and hematocrit=WNL. The preferred choice of antimicrobial therapy for Mr. Spaulding is a:
7-day course of oral clarithromycin
5-day course of oral levofloxacin
10-day course of oral amoxicillin-clavulanate
3-day course of injectable ceftriaxone
5-day course of oral levofloxacin
Mr. Spaulding is a 70-year-old man with a 50 pack-year cigarette smoking history, chronic obstructive pulmonary disease, and hypertension. He lives in an apartment with his 68-year-old wife and an adult son. Mr. Spaulding presents today with a 24-hour history of increasing dyspnea and productive cough with white-yellow sputum. He is alert, oriented, and answers questions with ease. Physical examination reveals the following: Breathing slightly labored at rest, BP=130/78 mm Hg, T=99.8°F (37.7°C), HR=96, RR=22, dullness to percussion over the left base with increased tactile fremitus and tubular breath sounds as well as crackles in the right base. Cardiac examination reveals no S3, no S4, no murmur, with nondistended neck veins.
Mr. Spaulding returns in 2 days. He states that he is feeling somewhat better, with less shortness of breath but with continued fatigue and production of small amounts of white-yellow sputum. He states he has taken his antimicrobial therapy as advised without difficulty. Physical examination reveals the following: Alert, BP=130/78 mm Hg, T=97.8°F (36.6°C), HR=88, RR=18, dullness to percussion over the left base with increased tactile fremitus and tubular breath sounds. Cardiac examination reveals no S3, no S4, no murmur, with nondistended neck veins. At this point, you consider the following two best options:
A repeat chest x-ray should be obtained today
His antimicrobial needs to be changed to an agent with wider spectrum of activity
Mr. Spaulding should be advised to complete his current course of therapy
Pneumococcal and seasonal influenza vaccines should be updated today as needed
Mr. Spaulding should be advised to complete his current course of therapy
Pneumococcal and seasonal influenza vaccines should be updated today as needed
Teresa, a 38-year-old woman with no chronic health problems, presents with a chief complaint of “A cold I cannot shake for the past three weeks.” She also reports an intermittent frontal headache and has taken acetaminophen with relief, as well as general malaise and a dry cough that is particularly problematic at night. She denies nausea, vomiting, chills, fever, or dyspnea. She underwent a bilateral tubal ligation approximately 10 years ago, and is allergic to penicillin with a hive-form reaction. Examination reveals the following: SaO2=97%, BP=114/70 mm Hg, T=98°F (36.7°C), HR=88, RR=20, bilateral coarse late inspiratory crackles without wheeze. She is in no acute distress. Chest x-ray demonstrates bilateral interstitial infiltrates.
Which of the following describes the recommended additional diagnostic testing for Teresa? Choose all that apply.
Blood urea nitrogen (BUN) and creatinine (Cr) CBC with WBC differential Blood culture Sputum gram stain and culture Procalcitonin
Blood urea nitrogen (BUN) and creatinine (Cr)
CBC with WBC differential
Mr. Spaulding is a 70-year-old man with a 50 pack-year cigarette smoking history, chronic obstructive pulmonary disease, and hypertension. He lives in an apartment with his 68-year-old wife and an adult son. Mr. Spaulding presents today with a 24-hour history of increasing dyspnea and productive cough with white-yellow sputum. He is alert, oriented, and answers questions with ease. Physical examination reveals the following: Breathing slightly labored at rest, BP=130/78 mm Hg, T=99.8°F (37.7°C), HR=96, RR=22, dullness to percussion over the left base with increased tactile fremitus and tubular breath sounds as well as crackles in the right base. Cardiac examination reveals no S3, no S4, no murmur, with nondistended neck veins.
His physical examination findings are suggestive of:
A left lower lobe consolidation
Diffuse hyperinflation
Heart failure
Atelectasis
A left lower lobe consolidation
