respiratory SM

Question 1

What is the predominant symptom in asthma?

Answer 1

cough

especially at night

Question 2

How do you know treatment is successful in asthma?

Answer 2

peak flow readings at home

do NOT determine success of tx based on rescue inhaler use

Question 3

What medication should NEVER be given alone for asthma?

Answer 3

LABA - formoterol, salmeterol, olodaterol)

Question 4

What three things impact peak flow?

Answer 4

HAG!
height
age
gender

Question 5

What is the cornerstone of treatment for asthma with 2019 GINA guidelines?

Answer 5

ICS

fluticasone, betamethasone, budesonide, momentasone

Question 6

What is the new step-up medications for 2019 GINA? (int, mild, moderate, severe)

Answer 6

INT: ICS-LABA prn

mild: Low-ICS daily
mod: ICS-LABA daily OR add on ICS with singulair
severe: referral

Question 7

What is the go to ICS-LABA combination for treatment of asthma?

Answer 7

budesonide-formoterol

Question 8

How is COPD diagnosed?

Answer 8

Spirometry

FEV1/FVC ration <0.70

Question 9

What are expected findings of COPD?

Answer 9

barrel chest
hyperresonance on percussion
clubbing of fingers
 chronic cough
(bronchitis, emphysema - give them bronchodilator IF they do not have COPD yet)

Question 10

What is treatment group A COPD?

Answer 10

Bronchodilators

(SABA, LABA) albuterol

Question 11

What is treatment group B COPD?

Answer 11

LABA or LAMA

formoterol

Question 12

What is treatment group C COPD?

Answer 12

LAMA

Tiotropium

Question 13

What is treatment group D COPD?

Answer 13

LAMA
LAMA-ICS
LAMA-LABA-ICS

Question 14

What are the expected findings of pneumonia?

Answer 14

increased respiratory rate
cough
fever
rhochi 
wheezes
increased tactile fremitus

Question 15

What is seen on XRAY of pneumonia?

Answer 15

consolidation and infiltrates

Question 16

What antibiotics are used to treat pneumonia in a HEALTHY patient?

Answer 16

MAD
Macrolides
Amoxicillin
Doxycycline

Question 17

What antibiotices are used to treat pneumonia for patients with comorbidites or have taken an antibiotic in the last 90 days?

Answer 17

Fluoroquinolones - Levofloxacin/Levaquin

Combo - Augmentin & macrolide

Question 18

What is CURB-65? What score indicates outpatient therapy vs inpatient?

Answer 18

Confusion
blood Urea nitrogen >19
Respiratory >30
Blood pressure systolic <90 diastolic <60
Age >65

outpatient: 0-1, maybe 2
>/3 = admit

Question 19

How do you differentiate strep throat vs mono?

Answer 19

strep - palatal petechiae

mono - splenomegaly (no abx)

Question 20

A patient with mono one month ago completed ultrasound of spleen, it is normal. The mono-spot is positive today. May they play sports?

Answer 20

yes

pt’s can return to sports after ultrasound, usually wait 4 weeks

Question 21

What is the treatment of streptococcal pharyngitis?

Answer 21

tx pcn VK, amoxicillin, cephalosporin or a macrolide

VK pcn will not cause rash if pt has both mono/strep

Question 22

What rash results from an untreated strep throat? Why should strep throat be treated?

Answer 22

Scarletina (scarlet fever rash) - sandpaper with sore throat

Rheumatic fever
Glomerulonephritis

Question 23

A patient with a nagging cough that they cannot get rid of, you should suspect

Answer 23

acute bronchitis - this is 95% viral, no antibiotics

Question 24

When should acute bronchitis be treated with antibiotics? What antibiotic? Why? What vaccine helps prevent this?

Answer 24

Pertussis infection
Azithromycin - decrease spread of infection
Tdap or Dtap