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Acute & Chronic II > Test 3 > Flashcards

Test 3 Flashcards

1
Q

If a cough in acute bronchitis lasts more than 14 days, then consider

A

pertussis

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2
Q

Usual duration of cough with acute bronchitis

A

1-3 weeks

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3
Q

s/s of acute bronchitis

A

cough with or without sputum, low grade fever, wheezes/rhonchi

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4
Q

Diagnostic for acute bronchitis

A

usually based on history and exam

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5
Q

This does not necessarily indicate a bacterial cause in acute bronchitis

A

purulent sputum

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6
Q

treatment for acute bronchitis

A

antitussive therapy for nighttime cough, NSAIDs, ipratropium inhaler

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7
Q

3 changes in asthma

A

bronchoconstriction, hyperresponsiveness, and inflammation

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8
Q

Restrictive disease is when

A

alveoli cannot be filled

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9
Q

obstructive disease is when

A

air cannot get out

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10
Q

factors that can exacerbate asthma

A

GERD, atopy

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11
Q

Exercise induced asthma is when symptoms begin

A

5-10 min after completing exercise and resolve in 1-4 horus

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12
Q

severe rhinorrhea, sneezing, N/V, and airway obstruction that occurs in those 20-30s.

A

aspirin-induced asthma

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13
Q

hallmark symptoms of asthma

A

wheezing, dyspnea, cough, and sputum production

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14
Q

Diagnosis for asthma is with

A

peak flow meters and spirometry

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15
Q

Between asthma attacks, sputum is usually ___; during an asthma attack, the sputum may be ____ even with an absence of infection

A

clear; yellow or green

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16
Q

Asthma is diagnosed with a FEV1 of ___ and a ____ FEV1/FVC ratio that improves with bronchodilator therapy.

A

less than 80%; reduced

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17
Q

In intermittent asthma, the symptoms occur ____; nighttime awakenings occur _____; SABA use is _______; and FEV1 is _____.

A

less than 2 days/week;
less than twice a month;
less than 2 days a week;
normal.

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18
Q

In mild persistent asthma, the symptoms occur ____; nighttime awakenings occur _____; SABA use is _______; and FEV1 is _____.

A

more than 2 days a week;
3-4 times a month;
more than 2 days a week but not daily;
Greater than 80%

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19
Q

In moderate persistent asthma, the symptoms occur ____; nighttime awakenings occur _____; SABA use is _______; and FEV1 is _____.

A

Daily;
More than once a week but not nightly;
Daily;
60-80%

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20
Q

In severe persistent asthma, the symptoms occur ____; nighttime awakenings occur _____; SABA use is _______; and FEV1 is _____.

A

throughout the day;
every night;
several times a day;
less than 60%

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21
Q

Normal FEV1/FVC is

A

70-80%

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22
Q

FVC is forced expiratory volume and can help indicate

A

restrictive disease if less than 80%

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23
Q

FEV1 is max volume expired in 1 second and can help indicate

A

obstructive disease if less than 70%

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24
Q

Step 1 of asthma approach

A

SABA PRN

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25
Q

Step 2 of asthma approach

A

low dose ICS + SABA PRN

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26
Q

Step 3 of asthma approach

A

low dose ICS + LABA + SABA PRN

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27
Q

Step 4 of asthma approach

A

medium dose ICS + LABA + SABA PRN

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28
Q

Step 5 of asthma approach

A

high dose ICS + LABA + SABA PRN

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29
Q

Step 6 of asthma approach

A

High dose ICS + LABA + oral steroid

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30
Q

SABA can be used up to ____ treatments at ____ minute intervals

A

3; 20

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31
Q

Use of SABA more than _____ days a week indicate inadequate control

A

2

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32
Q

common LABA

A

salmetrol and formoterol

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33
Q

Combined LABA + ICS drugs

A

fluticasone/salmeterol (Advair);

bedesonide/formoterol (Symbicort)

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34
Q

LABAs are usually only indicated for those older than

A

12

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35
Q

Can be used as alternatives to those with asthma who do not tolerate SABAs.

A

anticholinergics

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36
Q

short acting anticholinergic

A

ipratropium (Atrovent) 2-3 puffs every 6 hours

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37
Q

combined anticholinergic and beta 2 agonist

A

ipratropium/albuterol (Combivent)

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38
Q

For acute asthma exacerbations, you can tell the patient to continue SABA use to

A

every 3-4 hours for next 24-48 hours

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39
Q

used for prophylaxis for mild to moderate asthma

A

cromolyn

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40
Q

why theophylline has limited use

A

narrow therapeutic range, side effects same as caffeine

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41
Q

education for use of inhalers

A

slowly inhale, hold breath for 4-10 seconds, breath out through pursed lips. wait 1 min in between puffs.

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42
Q

This score in asthma control test means asthma is not well controlled

A

less than 19

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43
Q

f/u when stepping up or down in asthma therapy

A

in 4-6 weeks

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44
Q

improvement in occupational asthma after cessation of exposure is typically

A

gradual and reaches a plateau 2 years after

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45
Q

difference b/t cardiac and noncardiac chest pain characteristics

A

cardiac chest pain is pressure, noncardiac chest pain is stabbing and sharp

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46
Q

Chest pain that localizes to a small area of the chest suggests

A

pleural or chest wall involvement.

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47
Q

noncardiac chest pain has onset that is

A

abrupt

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48
Q

for those less than 40, this can r/o cardiac disease for chest pain

A

ECG

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49
Q

for those older than 40, this can be done r/o cardiac disease for chest pain

A

stress test, cardiac enzymes, heart cath

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50
Q

Musculoskeletal chest pain characteristics

A

persistent; aggravated by movement or breathing; can be reproduced by touch.

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51
Q

Pleuritic or pneumothorax chest pain characteristics

A

stabbing or shooting pain that is aggravated by breathing, coughing, sneezing

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52
Q

seen in young tall, thin men ages 30-40 who smoke and have no history of lung disease.

A

primary spontaneous pneumothorax

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53
Q

those with GERD related chest pain can be given

A

trial of twice daily high dose PPI for 1-2 months

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54
Q

acute cough lasts

A

less than 3 weeks

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55
Q

subacute cough lasts

A

3-8 weeks

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56
Q

chronic cough lasts

A

more than 8 weeks

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57
Q

most coughs are caused by

A

viral URI

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58
Q

common causes of subacute cough

A

asthma or sinusitis

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59
Q

postinfectious cough usually lasts

A

longer than 8 weeks after viral infection and resolves on its own

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60
Q

common causes of chronic cough

A

asthma, GERD

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61
Q

ACEI cough resolves in

A

1-4 weeks after cessation

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62
Q

characteristics of psychogenic cough

A

barking cough that doesn’t occur at night

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63
Q

First step in treating chronic cough

A

anithistamines, nasal steroids, Atrovent x 2 weeks

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64
Q

Second step in treating chronic cough

A

spirometry to check for asthma

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65
Q

Third step in treating chronic cough

A

Trial of high-dose PPI to treat for GERD

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66
Q

Fourth step in treating chronic cough

A

Chest xray

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67
Q

characterized as a dry, nocturnal cough and associated with a drop in morning peak flows

A

cough-variant asthma

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68
Q

methacholine test

A

bronchoconstrictor, incrementally given. Positive if there’s a 20% drop in FEV1.

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69
Q

COPD is categorized as

A

chronic bronchitis and emphysema

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70
Q

chronic bronchitis is characterized by a persistent cough for

A

3 consecutive months for 2 consecutive years.

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71
Q

destruction of the alveolar walls leading to expiratory airway collapse

A

emphysema

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72
Q

risk factors for COPD

A

smoking, recurrent respiratory infections, recurrent sinus infections, nasal polyps

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73
Q

COPD can cause this complication

A

cor pulmonale (right ventricular hypertrophy)

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74
Q

S/S of COPD

A

dyspnea on exertion, increase AP diameter of chest, prolonged expirations

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75
Q

With inspiration in those with COPD, there is a _____movement of the rib cage and _____ movement of the abd wall.

A

decreased; increased

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76
Q

Diagnosis of COPD

A

spirometry with FEV1/FVC

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77
Q

Stage I COPD

A

FEV1 > 80%

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78
Q

Stage II COPD

A

FEV1 50-80% with SOB on exertion

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79
Q

Stage III COPD

A

FEV1 30-50% with increased SOB and repeated exacerbations

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80
Q

Stage IV COPD

A

FEV1 less than 30% with impaired quality of life

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81
Q

Those with COPD may show this on labs

A

polycythemia d/t hypoxemia

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82
Q

standard Medicare criteria for home O2 is

A

PA02 less than 55 mg and o2 sat less than 88%

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83
Q

All patients with COPD should be prescribed with a

A

short acting bronchodilator as needed.

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84
Q

Those with Stage II-III COPD should have a

A

long acting bronchodilator (anticholinergic is preferred) + short acting bronchodilator

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85
Q

Those with Stage III-IV COPD should have a

A

long acting bronchodilator + ICS + short acting bronchodilator

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86
Q

Recommended first line therapy for COPD

A

ipratropium (atrovent) as needed + tiotropium (Spiriva) 1 inhalation daily

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87
Q

beclomethasone (QVAR)

A

inhaled corticosteroids

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88
Q

budesomide (Pulmicort)

A

inhaled corticosteroids

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89
Q

fluticasone propionate (Flovent)

A

inhaled corticosteroids

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90
Q

education about ICS

A

must be used regularly, rinse mouth after use

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91
Q

Inhaled bronchodilators relieve _____, and corticosteroids reduce ________.

A

bronchospasm; inflammation

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92
Q

if ICS is used in COPD, then recheck FEV1 in

A

3-4 weeks to see if the FEV1 improves

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93
Q

those with COPD should be educated about

A

pulmonary rehab, weight loss, smoking cessation

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94
Q

paradoxical breathing seen in severe dyspnea

A

chest wall rises and abd moves inward

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95
Q

Diagnostics for dyspnea

A

Chest xray, spirometry, V/Q scan to r/o PE, ECG/Echo, H&H to r/o anemia

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96
Q

most common causes of hemoptysis

A

bronchitis, lung cancer, PNA, TB

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97
Q

diagnostics for hemoptysis

A

sputum culture, CBC, coags, chest xray

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98
Q

hemoptysis from the GI tract is usually

A

coffee-ground, acidic

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99
Q

Urgent evaluation is needed if hemoptysis is more than

A

50 mL of blood loss in the past 24 hours

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100
Q

The most common causes of acute dyspnea

A

asthma, bronchitis, pneumothorax, PNA, PE

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101
Q

Repetitive upper airway narrowing or closure, which occurs during sleep

A

sleep apnea

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102
Q

diagnosis for sleep apnea

A

polysomnography (PSG)

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103
Q

s/s of sleep apnea

A

snoring, nocturnal gasping/choking, nocturia

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104
Q

There is evidence that untreated OSA is a cause

A

systolic hypertension.

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105
Q

most common signs of nicotine withdrawal

A

dysphoria and difficulty thinking

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106
Q

during precontemplation change of smoking cessation

A

advise patient to quit but do not pursue smoking cessation

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107
Q

when the patient shows awareness of smoking problem

A

contemplation

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108
Q

when the patient says they have to do something about their smoking

A

determination stage

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109
Q

important to provide intervention steps for smoking cessation during this stage

A

determination stage

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110
Q

when the patient actually stops smoking

A

action phase; make sure a f/u appt is set

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111
Q

Nicotine replacement therapy should be cautiously used in those with

A

cardiovascular disease

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112
Q

these types of nicotine replacements should be used for 8 weeks and gradually tapered

A

gum, patches, and nasal spray

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113
Q

buproprion for smoking cessation should NOT be prescribed in those with

A

eating or seizure disorders

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114
Q

most common side effect os buproprion

A

insomnia

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115
Q

dosing for buproprion

A

start with 150 mg daily x 3 days, then increase to bid;

start 1-2 weeks before quit date

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116
Q

Chantix can be started

A

1 week before quit date

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117
Q

common side effect of Chantix

A

nausea, high risk of hostile behavior

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118
Q

characterized by upper respiratory symptoms followed by lower respiratory infection with inflammation

A

bronchiolitis

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119
Q

bronchiolitis occurs in

A

children less than 2

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120
Q

most common cause of bronchiolitis

A

RSV

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121
Q

risk factors for bronchiolitis

A

prematurity, congenital heart disease

122
Q

s/s of bronchiolitis

A

starts off with upper URI symptoms (runny nose) for 1-3 days, then fever & cough occur.

123
Q

course of bronchiolitis

A

self-limited and resolves in 28 days

124
Q

treatment for nonsevere bronchiolitis

A

bulb suction, fluids

125
Q

NOT recommended for nonsevere bronchiolitis

A

bronchodilators, glucocorticoid

126
Q

Cystic Fibrosis is a

A

autosomal recessive

127
Q

usual presenting symptoms in cystic fibrosis

A

pulmonary infections, pancreatic insufficiency, elevated sweat chloride levels.

128
Q

cystic fibrosis is caused by a mutation in the

A

CFTR protein

129
Q

complications of CF in adulthood

A

spontaneous pneumothorax and hemoptysis

130
Q

diagnosis of cystic fibrosis

A

newborn screening (IRT and DNA assay), if positive then diagnosis is confirmed with sweat chloride testing > 6 mmol/L

131
Q

atbx recommended for those with CF

A

azithromycin

132
Q

Many patients with CF show improvement with

A

bronchodilators

133
Q

foreign body aspiration occurs in those

A

less than 3

134
Q

commonly aspirated products

A

peanuts, nuts, seeds, popcorn, pieces of toys

135
Q

Most aspirated foreign bodies are located in the

A

bronchi

136
Q

S/S of bronchial foreign body aspiration

A

coughing/wheezing, hemoptysis, dyspnea, fever, decreased breath sounds

137
Q

problem with choking episode is

A

it is usually self-limited followed by an asymptomatic period

138
Q

complication of foreign body aspiration

A

pneumonia

139
Q

why chest xray is not always diagnostic in foreign body aspiration

A

most objects are radiolucent and are not detected on xray

140
Q

best diagnostic tool for foreign body aspiration

A

bronchoscopy

141
Q

Hard and/or round foods should not be offered to children younger than

A

four years old

142
Q

cause of croup

A

parainfluenza virus type 1

143
Q

age group for croup

A

3 months to 3 years old

144
Q

anatomic sign of croup seen on chest xray

A

steeple sign of the trachea

145
Q

s/s of croup

A

initially starts with congestion;

progresses to fever, hoarsness, barking cough, stridor

146
Q

diagnosis for croup

A

usually based on history and PE

147
Q

trx for mild croup

A

humidity mist, fluids, antipyretics, dexamethasone

148
Q

trx for moderate to severe croup

A

referral to ER

149
Q

most common type of lung cancer

A

non-small cell lung cancer

150
Q

most effective screening tool for lung cancer

A

low-dose helical CT

151
Q

most common symptom of lung cancer

A

cough, hemoptysis

152
Q

staging of non-small cell lung cancer

A

size of tumor, regional lymph node involvement, degree of metastasis

153
Q

problem with lung cancer

A

already advanced to later stages by time of diagnosis.

154
Q

total volume in the pleural space is

A

20 mL

155
Q

Most common causes of pleural effusion

A

CHF, pneumonia, cancer

156
Q

s/s of pleural effusion

A

pleuritic sharp, unilateral chest pain, nonproductive cough, dyspnea

157
Q

physical findings in pleural effusion

A

dullness to percussion, absent tactile fremitus, egophony (E to A change), pleural friction rub

158
Q

why chest xrays aren’t always diagnostic for pleural effusion

A

can only detect effusion greater than 500 mL

159
Q

best diagnostic tool for pleural effusion

A

Chest US or CT

160
Q

inflammation of the pleura

A

pleurisy

161
Q

sharp or stabbing that is exacerbated by coughing, deep breathing, sneezing.

A

pleuritic chest pain

162
Q

drugs associated with pleurisy

A

nitrofurantoin, methotrexate, amiodarone, beta blockers

163
Q

may be described as a “stitch on the side”

A

pleurisy

164
Q

physical exam with pleurisy

A

pt will lie on affected side, tenderness on palpation, pleural friction rub

165
Q

pleural friction rub in pleurisy is only heard when

A

patient take a deep breath

166
Q

treatment for pleurisy

A

thoracentesis, NSAIDs

167
Q

typical pneumonia is caused by

A

streptococcus pneumonia

168
Q

atypical pneumonia is caused by

A

influenza virus, mycoplasma pneumonia

169
Q

more likely to acquire atypical pneumnoia

A

young adults

170
Q

community acquired pneumonia is caused by

A

Streptococcus pneumoniae (gram +) and H. influenza (gram negative)

171
Q

pneumonia in those with COPD, alcoholics, and diabetics is mostly caused by

A

Moraxella catarrhalis

172
Q

outpatient trx of pneumonia

A

macrolide

173
Q

outpatient trx of pneumonia in those with heart/lung disease, liver disease, or DM

A

fluoroquinolone + macrolide

174
Q

not recommended for diagnosis of PNA in the outpatient setting

A

sputum culture; usually diagnosed through chest xray

175
Q

s/s of pneumonia in elderly

A

lethargy, decreased appetitie, AMS

176
Q

secondary pneumothorax is caused by

A

COPD, SLE, sarcoidosis, asthma

177
Q

tension pneumothorax is caused by

A

mechanical ventilation or CPR

178
Q

pneumothorax results when there is a loss of

A

negative pressure in the pleural space

179
Q

s/s of pneumothorax

A

sudden sharp pain, dyspnea, cough

180
Q

tension pneumothorax is a

A

medical emergency

181
Q

diagnosis of pneumothorax

A

chest xray, ultrasound

182
Q

treatment for asymptomatic pneumothorax

A

none, resolution in 7-14 days

183
Q

treatment for primary pneumothorax

A

needle aspiration

184
Q

treatment for secondary pneumothorax

A

chest tube

185
Q

primary pneumothorax is

A

recurrent, refer to pulmonologist

186
Q

pulmonary arterial hypertension results in

A

high pulmonary vascular resistance and right ventricular hypertrophy (cor pulmonale)

187
Q

PAH is a PA pressure greater than

A

25 mmHg

188
Q

common causes of PAH

A

hypoxia

189
Q

s/s of PAH

A

asymptomatic until it becomes severe;

angina, cough, hemoptysis

190
Q

usual time of onset of symptoms for PAH

A

insidious onset of 2 years

191
Q

signs of right ventricular failure (JVD, hepatomegaly, ascites) is often seen with

A

PAH

192
Q

diagnostic for PAH

A

doppler Echo, ECG

193
Q

treatment for PAH

A

CCB, tadalafil;
oxygen;
CPAP

194
Q

Multisystem, inflammatory, granulomatous disease of unknown origin that commonly affects young and middle-aged adults age 20-45

A

sarcoidosis

195
Q

Presentation of sarcoidosis

A

asymptomatic with abnormal chest xray;

dry cough, dypsnea, chest pain, fever

196
Q

other involvements with sarcoidosis

A

ocular and skin lesions

197
Q

complication of sarcoidosis

A

pulmonary fibrosis

198
Q

treatment for asymptomatic sarcoidosis

A

none; NSAIDs, steroids

199
Q

treatment with stage III-IV sarcoidosis

A

immunosuppression, steroids

200
Q

f/u with sarcoidosis

A

recurrence is common

201
Q

sudden infant death syndrome occurs mostly in those less than

A

1 years of age

202
Q

risk factors for SIDS

A

maternal smoking, low birth weight, preterm labor, prone sleeping, soft bedding, bed-sharing, overheating

203
Q

protective measures for SIDS

A

pacifier, room-sharing, breastfeeding, fan use

204
Q

multidrug resistance is growing for TB in these drugs

A

rifampin and isoniazid

205
Q

TB infection occurs when the inhaled particles reach the

A

alveoli

206
Q

Most cases of TB are

A

asymptomatic and identified through positive skin test

207
Q

s/s of TB

A

fatigue, weight loss, night sweats, cough, hemoptysis, low grade fever

208
Q

A person with TB will react positively to the skin test ____ after infection.

A

2-8 weeks

209
Q

PPD skin test

A

induration is measured in 48-72 hours. Should be recorded by mm of induration

210
Q

factors that cause false negative PPD result

A

age > 45, simultaneous live vaccination, infection

211
Q

factors that can cause a false positive resolve

A

BCG vaccine

212
Q

two step testing for TB

A

if negative, give second test 1-3 weeks later

213
Q

Positive if induration in greater than 5 mm in those with

A

HIV, close contacts with TB

214
Q

Positive if induration in greater than 10 mm in those with

A

immigrants, high risk facilities (prison, LTC, hospital, homeless), chronic disease (DM, renal failure, children less than 4)

215
Q

Positive if induration in greater than 15 mm in those with

A

no known risk factor for TB

216
Q

Must be done with every TB case

A

reported to local health department.

217
Q

preventative therapy for those with latent TB

A

INH for 9 months

218
Q

complication of INH

A

hepatitis

219
Q

cause of Type 1 Diabetes

A

autoimmune destruction of beta cells in the pancreas resulting in insulinopenia

220
Q

Type II diabetes causes

A

insulin resistance

221
Q

s/s of type 2 diabetes

A

polyuria, polyphagia, polydipsia, blurred vision, fatigue

222
Q

ADA criteria for diagnosis of diabetes

A

A1C > 6.5%;
FPG > 126 mg/dL;
2-hour OGTT with 75 g > 200 mg/dL;
random plasma glucose > 200 mg/dL

223
Q

benefits of exercise in diabetes

A

increases glucose uptake in skeletal muscles and improves insulin sensitivity

224
Q

Step 1 of DM management

A

lifestyle modifications, begin metformin

225
Q

Step 2 of DM management

A

add either basal insulin (most effective) or sulfonyurea (least expensive)

226
Q

Step 3 of DM management

A

if Hgb persists > 7%, increase insulin

227
Q

goal of type 2 DM management is to keep

A

A1C

228
Q

Early morning hyperglycemia is controlled by _____

A

basal insulin

229
Q

post-meal glucose spikes are controlled by _____

A

prandial insulin.

230
Q

onset of rapid acting insulin (Novolog, Humalog)

A

10-20 min

231
Q

peak of rapid acting insulin (Novolog, Humalog)

A

1-3 hours

232
Q

duration of rapid acting insulin (Novolog, Humalog)

A

3-5 hours

233
Q

onset of short acting insulin (Regular & Humalin R)

A

30-60 min

234
Q

peak of of short acting insulin (Regular & Humalin R)

A

2-4 hours

235
Q

duration of short acting insulin (Regular & Humalin R)

A

5-8 hours

236
Q

onset of intermediate acting insulin (NPH)

A

1-2 hours

237
Q

peak of of intermediate acting insulin (NPH)

A

2-12 hours

238
Q

duration of intermediate acting insulin (NPH)

A

24 hours

239
Q

onset of long acting insulin (Levemir, Lantus)

A

90 min

240
Q

duration of long acting insulin (Levemir, Lantus)

A

24 hours

241
Q

Long acting insulin is

A

peakless

242
Q

MOA of metformin

A

suppresses hepatic glucose production

243
Q

Goal is to keep premeal insulin between

A

80-130 mg/dL

244
Q

Pramlintide (Symlin)

A

SQ pen given before meals along with insulin

245
Q

MOA of sulfonyurea

A

stimulate insulin secretion

246
Q

education with sulfonyureas

A

take with meals

247
Q

medication that can cause hypoglycemia

A

sulfonyureas

248
Q

act in the small intestine, delaying the digestion of polysaccharides which leads to lower postprandial glucose levels.

A

alpha glucosidase inhibitors

249
Q

with alpha glucosidase inhibitors, the med must be taken wtih

A

the first bite of a meal that contains carbs

250
Q

f/u care for Diabetes

A

A1c every 3 months;
lipid panel annually;
urine microalbumin annually

251
Q

thiazolidinediones (Actos) is contraindicated in

A

those with CHF as they cause edema

252
Q

release insulin and decrease glucagon levels by slowing the inactivation of incretin hormones.

A

DPP4 inhibitors (Januvia)

253
Q

hypoglycemia is blood sugar less than

A

70 mg/dL

254
Q

hyperglycemia is blood sugar greater than

A

180 mg/dL

255
Q

education on sick days with diabetics

A

check blood sugar every 4 hours;
drink 8 oz of sodium rich fluid every hour;
continue meds even if not eating

256
Q

provides the earliest indication of renal damage from diabetes

A

microalbumin

257
Q

Once microalbuminuria is confirmed in those with diabetes, then

A

start an ACEI or ARB

258
Q

types of neuropathy with diabetes

A

peripheral, gastroparesis, neurogenic bladder, sexual dysfunction, orthostatic hypotension

259
Q

All pregnant women are screened for GM at

A

24- 28 weeks

260
Q

Diagnosis for GM is made if OGTT with 75 g is

A

fasting > 92;
1-hour > 180;
2-hour > 153

261
Q

If lifestyle modifications fail, then this can be added for diabetes prevention

A

metformin

262
Q

Meds that can be used during pregnancy

A

insulin, glyburide, metformin

263
Q

complications of GM

A

macrosomnia, hypoglycemia, PIH, polyhdramnios, preterm labor

264
Q

These types of insulin have a reduced risk of hypoglycemia

A

rapid acting and long acting insulin

265
Q

these can mask the signs of hypoglycemia

A

alcohol and beta blockers

266
Q

trx for mild to moderate hypoglycemia

A

15-20 g of carb/sugar

267
Q

DKA is characterized as

A

hyperglycemia, ketonuria, and anion gap metabolic acidosis

268
Q

s/s of DKA

A

abdominal pain, N/V, Kussmaul respirations, fruity odor

269
Q

Labs in DKA

A

glucose less than 800 mg/dL;
high potassium;
elevated anion gap

270
Q

a rapid urine dipstick that can determine serum ketone levels to explain the high anion gap in DKA

A

Nitroprusside

271
Q

treatment for DKA

A

Isotonic fluids, correct K+ first, IV insulin

272
Q

SQ insulin in DKA can be started when anion gap is

A

less than 12

273
Q

HHNK is seen in

A

type 2 diabetics and elderly

274
Q

DKA is seen in

A

type 1 diabetics and young

275
Q

S/S of HHNK

A

gradual signs of polyuria and polydipsia, altered mental status

276
Q

labs in HHNK

A 
glucose > 1000 mg/dL;
high osmolality;
hyponatremia;
NO ketones in urine;
pH > 7.30
277
Q

most common cause of HHNK and DKA

A

stopping insulin and dehydration

278
Q

metabolic syndrome is characterized as

A

abdominal obesity, hyperglycemia, high triglycerides, low HDL, HTN, inflammatory state

279
Q

labs values in metabolic syndrome

A

triglyceride > 150;
HDL 130/85;
fasting glucose > 100

280
Q

risk factors for metabolic syndrome

A

family hx, obesity, abd fat, physical inactivity

281
Q

Metabolic syndrome places the patient in a ____ state.

A

prothrombic

282
Q

Diagnostic of metabolic syndrome

A

microalbuminuria;

fasting insulin > 10

283
Q

acanthosis nigricans is seen in

A

metabolic syndrome

284
Q

treatment for metabolic syndrome

A

antihypertensives, statins, ASA therapy, metformin

285
Q

hemoptysis from the respiratory tract is

A

bright red/pink, frothy, alkaline pH

286
Q

primary diagnostic tool for TB

A

sputum specimen

287
Q

compared to albuterol, levalbuterol has ___ with a lower dose

A

greater bronchodilation

288
Q

caution with prescribing this antibiotic with theophylline

A

macrolide

289
Q

name a 3rd of 4th generation fluoroquinolone

A

levaquin

290
Q

a short acting bronchodilator is effective for

A

4 hours

291
Q

hyperresonnance on percussion is seen in those with

A

asthma

292
Q

what pathogen is found in an acute exacerbation of chronic bronchitis

A

H. influenza

293
Q

in cystic fibrosis, which vitamins are not well absorbed

A

fat soluble: A, D, E, K

294
Q

GI problem in those with cystic fibrosis

A

meconium ileus

295
Q

a problem seen after mechanical ventilation in a neonate

A

bronchopulmonary dysplasia (BPD)

296
Q

symptoms of BPD resolve by

A

age 3

297
Q

abtx for a 78 year old with community acquire PNA and COPD

A

amoxicillin and macrolide

298
Q

a risk factor for pneumonia death

A

renal insufficiency

299
Q

is someone with latent TB contagious?

A

No

300
Q

s/s of somogyi effect

A

excessive hunger, weight gain, hyperglycemia

301
Q

action to trx somogyi effect

A

decrease evening insulin, check blood sugar at 2 am

Acute & Chronic II (4 decks)

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