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568 > Unit 2 > Flashcards

Unit 2 Flashcards

1
Q

T or F: Clinicians should NOT perform testing or initiate abx in pt with bronchitis unless PNA is suspected

A

True

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2
Q

T or F: Pt should be tested with symptoms of group A strep pharyngitis by rapid antigen detest and/or culture for GAS

A

True

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3
Q

T or F: Clinicians should treat ever pt with abx is they have suspected strep pharyngitis

A

False

They should only treat those who have CONFIRMED sterp pharyngitis with abx

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4
Q

Examples of acute respiratory tract infections

A

Uncomplicated bronchitis
pharyngitis
rhinosinusitis
common cold

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5
Q

T or F: abx have the highest number of medication related adverse reactions

A

True

1 in 5 ER for adverse drug reactions

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6
Q

Symptomatic tx for adults with ARTI

A

decongestants
analgestics
antipyretics
cough suppressants

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7
Q

Symptoms of croup

A

barking cough
inspiratory stridor
retractions

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8
Q

What is croup

A

Rapid onset of narrowing of subglottic airway secondary to inflammation associated with VIRAL RTI

Usually between ages 6mo-3y

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9
Q

Tx for croup

A

corticoseroids (Dexamethasone)
nebulized racemic epi

OTC meds = NO relief

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10
Q

Immunizations to help with croup

A

Diptheria

Rubella

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11
Q

Pertussis coughing fits can last for up to ___ weeks

A

10

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12
Q

Best way to prevent pertussis

A

IMMUNIZE with DTaP and Tdap

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13
Q

Pertussis pathogens

A

B. pertussis

gram-negative requires isolation

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14
Q

Pertussis- how does it work?

A

Bacteria attach to the cilia of respiratory epithelial cells> produce toxins that paralyze the cilia> cause inflammation of respiratory tract > interferes with clearing of pulmonary secretions

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15
Q

Pertussis incubation period

A

symptoms usually develop within 5-10 days

infections through the 3rd week after onset of paroxysms or until 5 days after start of effective antimicrobial tx

Cough persists for 1-6 weeks

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16
Q

Pertussis older than 1 treated within ___ weeks and <1y and pregnant women treated within __ weeks of cough onset

A

3 weeks

6 weeks

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17
Q

Pertussis treatment

A

Macrolides:
Azithro*
Clarithro
Erythro

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18
Q

Pertussis in infants

A 
APNEA
coryza
exhaustion
no "whoop"
low-grade fever
paroxysms
minimal cough
posttussive vomiting
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19
Q

Dx pertussis

A

NP swab or aspirate and culture

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20
Q

influenza spread by ____

A

DROPLET

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21
Q

Incubation period for influenza

A

1-4 days

can infect 1 day before sx and 5-7 days after

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22
Q

s/sx flu

A 
fever
myalgia
HA
malaise
nonproductive cough
sore throat
rhinitis

CHILD: otitis, N/V

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23
Q

T or F: Rapid antigen tests have a sensitivity of 99% and specificities or 25-30%

A

FALSE

Sensitivity 50-70%
Specificities 90-95%

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24
Q

Tx for flu

A

Antivirals: 5 DAYS
Zanamivir
Oseltamivir

can reduce duration by 1 days wihen administered within 48 hr of onset

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25
Q

T or F: Antivirals are recommended for all persons with suspected or confirmed flu requiring hospitalization or who have progressed, severe, or complicated

A

True

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26
Q

Who gets tx for flu

A 
Child <2
Adult >65
COPD, cardio disease, renal,hepatic, hematologiccal, metabolic disorsers, neuro disorders, developmental delay, muscular dystrophy
immunocompromised
pregnant or postpartum
<19 who are on ASA long-term
Indians/Alaska natives
morbidly obese
nursing home resident
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27
Q

Zanamivir (Relenza)

A

inhaled
for uncomplicated acute illness
For child >7 and older

*NOT recommended for underlying airway disease (asthma, COPD)

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28
Q

Oseltamivir (Tamiflu)

A

PO
uncomplicated acute illness
For child >2 weeks and older and chemopropylaxiz >1 and older

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29
Q

Marboxil (Xofluza)

A

uncomplicated flu within 2 days of illness
>12 y and older and at least 40kg

NOT for pregnant or breastfeeding

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30
Q

Peramivir (Rapivab)

A

IV
acute uncomplicated flu within 2 days
>2y

NOT recommended for chemphylaxis a

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31
Q

T or F: FluMist (LAIV) is not recommended to give now

A

FALSE

it is recommending LAIV as a suitable option in age appropriate pt

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32
Q

Vaccine forms that contain eggs

A

Trivalent
Quadrivalent

Approved for 65 y and older

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33
Q

Only vaccine that does not contain eggs

A

RIV (Recombinant hemagglutinin flu)

Must be 18

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34
Q

Live attenuated influenza vaccine (LAIV4)

A

2-49 y/o who are not pregnant

healthcare personnel
person in close contact with high-rsk groups

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35
Q

precaution for influenza IIV and LAIV

A

mod-sever acute illness with or without fever

HX guillain-barre within 6 weeks following dose of flu vaccine

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36
Q

LAIV contraindications

A 
<2
18 and younger receiving ASA therapy
prengany
asthma
>50 y
underlying medical contiion( immuno, renal, pulmonary, neuro, hepatic, CV disease. 
close contact with immuno pt 
CSF leak or cochlear implant
allergic reaction
2-4y with asthma
use of antiviral within 48 hr
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37
Q

Risk factor for COVID

A

> 65

poorly controlled medical conditions

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38
Q

Transmission for COVID

A

direct person-to-person
Respiratory droplets

lives on contaminated surfaces

less likely to happen 7-10 days illness

mucous membranes in the mouth, eyes, or nose

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39
Q

Clinical manifestation for COVID- child, adult

A

more infectious in early stages

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40
Q

out-pt management for COVID-child, adult

A

telehealth

monitor for deterioration

symptomatic and supportive care

usually quarantine for 15 days

Adequate vitamin D intake

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41
Q

Amylase (AML)

A

enzyme that digest starch and glucose
produced by pancreas, salivary glands, and lung tumors

Increase: pancreatitis, CRF, follow up for perforated peptic ulcer

Decrease: usually insignificant
chronic pancreatitis
pancreatic CA, liver disease
toxemia of prego

In pancreatitis, will rise in 2hr, peak at 12-48hr, return innn 3-4days

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42
Q

Albumin

A

Bloods main protein, produced by liver, responsible for oncotic pressure

Increase: dehydration

Decrease: malnutrion, liver disorder, chronic disease, burns, nephrotic syndrome, CRF, Hodkins

USes: evaluating edema, liver disease, suspected malnutrition

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43
Q

Total protein

A

50% albummin

Increase: multiple myeloma

Decrease: prego, cytotoxic drugs, dietary deficiency

USE: suspected hepatic disease, suspected protein deficiency

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44
Q

ALT and AST

A

Primary located in hepatocytes, leaked when liver is injured ALT(L for liver), AST (S for skeleton or cardiac)

Increase: Both=liver injury, AST= muscle or cardiac injury

Decrease: advanced cirrhosis or hepatitis

Use: dx and monitor liver disease, screen test of pt on meds

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45
Q

Alkaline phosphatase (ALP)

A

found in all body tissue, produced by liver and bones, unknown function

Increase: obstructed bile ducts, new bone formation in child and pagets disease

Use: detect biliary obstruction, supplement from other liver study

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46
Q

Prostate-specific antigen (PSA)

A

produced by normal, hyperplastic, and CA

Increase: BPH, CA, following massage, biopsy

Decrease: insignificant

Use: detect disease, stage PA CA

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47
Q

TSH or Thyrotropin

A

secreted by anterior pituitary and responsible for increasing T3 and T4 by thyroid gland

Increase: hypothyroidism, thyroiditis, inadequate hormone therapy

Decrease: hyperthyroidism
excess levothyroxine
pituitary failure
hypothalamic failure

use: dx thyroid

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48
Q

Elevated TSH indicates

A

primary hypothyroidism

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49
Q

BUN 8-26

A

Product of protein metabolism, formed by the liver from ammonia and excreted in urine

Increase: renal insufficiency, increased protein intake, decrease water intake, decrease urine flow, blood in GI tract, inhibition of anabolism, hyperthyroidism, increased protein catabolism

Decrease: nephrosis, liver failure or hepatitis, late prego, overhydration

USE: eval renal, aid in hydration

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50
Q

Creatinine

A

end product of creatine metabolism
A better measure of renal damage

Bad sensitivity

Increase: a falling GFR, renal impairment, increase muscle mass

Use: screen for renal injury (HTM or DM)

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51
Q

Serum Calcium

A

Controlled by parathyroid hornome, calcitonin, and adrenal steroids
Ca regulates neuromuscular activity, skeletal development, blood coag

Increase:Hyperparathyroid, parathyroid tumor, pagets, metastatic CA, prolonged immobility, renal disease, diuretics, overuse of antacids, excess ingestion, adrenal insufficiency

Decrease: hypoparathyroid, malabsorption, cushings

Use: neuromuscular, skeletal, and endocrine disorders, aid in arrhythmias, blood clotting problem, acid-base imbalanace, muscle crampy or tetany

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52
Q

Chloride

A

extracellular anoin, present in blood and stomach, abdosrbed from intestines and excreted by kidney

Increase: nephritis, eclampsia, anemia, cardiac disease, dehydration from diarrrhea

Decrease: fever, DM, PNA, GI loss, CHF, thiazide diuretic

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53
Q

Potassium

A

intracellular cation

Increase: renal disorder, meds, abnormal intake, burns or crush injury, MI, DKA, , causes hemolyzed specimen

Decrease: renal disorder, meds, excess licorice ingestion

Use: monitor renal, diuretic, arrhythmias, c/o weakness

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54
Q

Sodium

A

extracellular cation, affects H2O distribution, maintains osmotic pressure, promotes neuromuscular functions

Increase: excess ingestion, inadequate water, aldosteronism

Decrease: HF, cirrhosis, nephrotic syndrome, D/V, CRI, diuretic

Use: elav HF, liver disease, CRF, acid-base

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55
Q

Bilirubin

A

Degrade RBC,

Increase in unconjugated or indirect: hepatic damage or severe overload in hemolytic disease or SCC
Conjugated or direct: blocked pathway from liver to biliary tree

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56
Q

Neutrophils are what % of total WBC and the role

A

50-70%

First line of defence against bacteria and inflammation

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57
Q

Lymphocytes are what % of total WBC and the role

A

25-35%

Increase in chronic or viral infection or in leukemia

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58
Q

Monocytes are what % of total WBC and the role

A

2-6%

Secondline of defense
stronger and longer lived than neutrophils
respond to viral infections & chronic bacterial infections and inflammation

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59
Q

Eosinophils are what % of total WBC and the role

A

0-3%

Elevated in allergies, parasites infection, and drug reactions

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60
Q

Basophils are what % of total WBC and the role

A

1-3%

similar to neutrophils
play a role in preventing blood clotting
elevtated in allergic reactions and hypothyroidism

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61
Q

Immature granulocytes (bands) are what % of total WBC and the role

A

0-5%

immature or early stage neutrophils
Elevated when body first launching response to bacterial or viral infection and are a sign of acute infection

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62
Q

Shift to the left

A

increase in bands
Means acute infection
Elevated in leukemia and pernicious anermia

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63
Q

Shift to the right

A

Increase in mature neutrophils

Seen in disease f liver

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64
Q

Children 2 weeks to 12yr have inverse neutro:lymph relationship

A

Neutro: 29-47%
Lymph: 38-63%

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65
Q

palpate for respiratory exam

A
  1. trachea at suprasternal notch
  2. posterior chest wall (fremitus/transmission of vibration)
  3. Anterior chest wall (assess cardiac impulse)
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66
Q

Pulmonary function test measures what 3 things

A

Airflow rates

Lung volumes

Ability of lung to transfer gas across alveoli-cap membrane

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67
Q

What indicates to the FNP that the pt needs PFT

A

type/extent of lung dysfunction

dx of causes of dyspnea and cough

detect early lung dysfunction

follow-up response to therapy

pre-op assessment

disability eval

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68
Q

T or F: A pt with acute severe asthma should have PFT done

A

FALSE

Contraindicated in acute severe asthma, resp. disress, angina, pneumothorax, hemoptysis, active TB

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69
Q

T or F: To measure PFT, you compare the pt values to values derived from a large study

A

TRUE

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70
Q

What is Kussmals resp

A

RAPID, LARGE-VOLUME breathing = intense stimulation of resp center r/t METABOLIC ACIDOSIS

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71
Q

What is Cheyne-stokes

A

RHYTHMIC, wax/waning of rate and TV

Regular periods of apnea

Seen in LV failure, neuro dx, sleep at high altitude

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72
Q

Digital clubbing is a sign of what?

A 
lung abscess
empyema
bronchiectasis
CF
idiopathic pulm fibrosis
AV malformation
late presentation
concomitant lung cx
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73
Q

What is cyanosis

A

blue-bluish gray discoloration of skin & mm due to increase amount of UNSATURATED HgB in capillary blood

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74
Q

T or F: cyanosis if a reliable indicator of hypoxemia

A

FALSE

Need to get PaO2 or Hgb measurement

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75
Q

increased CVP indicates

A 
measure pulmonary HTN
Impaired ventricular function
Pericardial effusion or restriction
Valvular hear dx
COPD
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76
Q

BLE edema indicates

A

Pulmonary HTN with chronic lung disease= RV failure

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77
Q

Expansion of the chest but collapse of abd on inspiration indicates what

A

weakness of diaphragm

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78
Q

Causes of asymmetric chest expansion

A

Unilateral vlm loss
unilateral airway obstruction
Asymmetry pulmonary/pleural fibrosis
Splinting from chest pain

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79
Q

Dull percussion indicates?

A

Lung consolidation,

Pleural effusion

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80
Q

Hyperresonant percussion Indicates?

A

emphysema

pneumothorax

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81
Q

Bronchial lung sounds heard over periphery of lung

A

Imply consolidation

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82
Q

Globally diminished lung sounds indicates?

A

Predicitive of significant airflow obstruction

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83
Q

Wheezing indicates?

A

high-pitched, muscial, distinct whistle sounds

BRONCHOSPASM, MUSCOSAL EDEMA, EXCESSIVE SECRETIONS due to narrow airway

  • powerful indicator of obstructive lung disease
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84
Q

Rhonchi indicates

A

lower-pitched, snorous, gurgling quality- larger airways=excessive secretions and abnormal airway collapse
CLEARS AFTER COUGH

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85
Q

Fine crackles indicates

A

soft, high-pitches, crisp

with interstitial dx or early pulmonary edema

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86
Q

Fine-late inspiratory crackles indicates?

A

pulmonary fibrosis

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87
Q

Coarse crackles indicates?

A

louder, lower-pitches,

PNA, obstructive lung dx, late pulm edema,

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88
Q

Early coarse crackles indicates what?

A

PNA or HF

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89
Q

Normal lung sounds hear over suprasternal notch are ?

A

tracheal or bronchial (louder, higher-pitched, hollow quality, louder on expiration

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90
Q

T or F: spirometry is good for measuring lung vml to assess presence or severity of obstructive/ restrictive pulmonary dysfunction

A

TRUE

expressed in FEV and FVC

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91
Q

FEV is?

A

Forced expiratory vlm.

Measure how much air a person can exhale during a forced breath

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92
Q

FEV1?

A

amnt of air exhaled during 1st forced breath

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93
Q

FVC?

A

forced vital capacity

total amnt of air exhaled during entire FEV test

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94
Q

Obstructive dysfunction

A

decreased FEV1/FVC ratio

reduced airflow rates seen in asthma, COPD, bronchiectasis, bronchiolitis, upper airway obstruction, CF

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95
Q

Decreased FEV1/ FVC ratio seen in what disease

A

asthma
COPD
bronchiectasis, bronchiolitis, upper airway obstruction, CF

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96
Q

T or F: If obstruction is evident (decrease FEV1/FVC) you need to repear spirometry 50 minutes after inhaled bronchodilator to help assess if dx is reversible

A

FALSE

Do it 10-20minutes after bronchodilator

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97
Q 
Restrictive dysfunction (Decreased FVC)
Chest Wall
A

ankylosing spondylitis
kyphosys
obesity
scholiosis

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98
Q 
Restrictive dysfunction (Decreased FVC)
DRUGS
A

amio

methotrexate

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99
Q 
Restrictive dysfunction (Decreased FVC)
Interstitial lung dx
A 
asbestosis
PNA
idiopathic pulm fibrosis
Sarcoidosis
Large PE
pleural thickening
prior lung resection
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100
Q 
Restrictive dysfunction (Decreased FVC)
NEuromuscular Dx
A

GBS
amyotrophic lateral sclerosis
MD
MG

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101
Q

Those at risk for CAP

A

older
etoh/tobacco
asthma/copd/immuno

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102
Q

PNA signs

A 
fever (low in eldery)
dyspnea
tachypnea
mental status change
bronchial breath sounds
inspiratory crackles
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103
Q

CAP pathogens

A

S pneumo
M pneumo
C pneumo

104
Q

Viruses that can cause CAP

A

influenza
RSV
adenovirus
parainfluenza

105
Q

3 rapid PCR test to identify CAP organism

A

sputum gram stain
urinary antigen test
rapid antigen test

106
Q

T or F: obtain a flu swab before starting suspected CAP

A

TRUE

to r/o flu for abx

107
Q

CXR with CAP

A

pulmonary opactiy

Can take 6 weeks to clear

108
Q

Pt present with significant pleural fluid collect. What do you do?

A

REFER

probably need thoracentesis

109
Q

CXR with cavitary opacities. What do you do?

A

REFERE and ISOLATE d/t TB

110
Q

Previously health patients with no recent (within 90 days) use of abx – what is the recommended outpatient abx
choice?

A

MACROLIDES or Azithromycin, Doxy

DONOT USE FLUROS in ambulatory pt without comorbidities or recent abx use- risk tendon rupture

111
Q

Patient w/ risk of drug resistance (abx <90 days, >65yr old, comorbid illness, immunosuppression, exposed to
child in daycare) – what is recommended abx choice?

A

Resp fluoroquinolone or a macrolide + b-lactam OR

cefpodoxime

112
Q

What is the typical abx treatment duration for adults?

A

minimum of 5 days of therapy and

continue abx until pt is afebrile for 48-72hr

113
Q

Vaccines to prevent CAP

A

influenza

pneumococcal

114
Q

2 clinical prediction rules to guide admission or traige of CAP

A

CURB-65

PSI

115
Q

CURB-65

A 
Confusion
Urea: BUN >7
Resp: >30
BP: S <90, D <60
Age: >65

0=outpt tx
1-2= admit to hospital
3-4=URGENT REFERRAL,ICU

116
Q

PSI score

A

PNA severity index

age, gender, nursing home status, comorbid conditions, physical exam, labs

117
Q

T or F: Hospital -acquired PNA occurs after 25 hr

A

FALSE

Has to be more than 48 hr after admission

S aureus
P aerugi
Enterobacter
K pneumo
E coli
118
Q

Ventilator-associated occurs when

A

More than 48hr after ET intubation and mechanical ventilation

Acinetobacter species
S maltophilia

119
Q

symptoms of vap

A

fever, leukocytosis, purulent sputum + new or progressive parenchymal
opacity on chest x-ray

120
Q

What are the 3 factors used to distinguish nosocomial pneumonia (HAP/VAP) from CAP?

A

Different
infectious causes, different abx susceptibility patterns (higher incidence of drug resistance), poorer
underlying health status of pt (increased risk for more severe infections)

121
Q

When should FNP initiated treatment for nosocomial pneumonia

A

ASAP

NEED blood cultures, WBC, chem panel, ABG

122
Q

What is the initial treatment of HAP/VAP? What is the treatment duration?

A

Individualized based on
pathogen, severity of illness, response to therapy, comorbid conditions (VAP study suggested 8 days was as
effective as 15 days – except in cases caused by P. aeruginosa)

123
Q

Single drug therapy for HAP/VAP

A

Zosyn**
Cefepime
Levofloxacin
Meropenem / Imipenem

124
Q

2 combo drug therapy for HAp/VAP

A 
CHOOSE ONE 
Zosyn**
Cefepime / Ceftazidime
Levofloxacin/ Ciprofloxacin
Meropenem / Imipenem
Aztreonam

+ ONE OF THESE
Vancomycin
Linezolid

125
Q

2 combo drug therapy for HAP + risk factors for pseudomonas and other gram - bacilli

A 
CHOOSE ONE 
Zosyn**
Cefepime /
Ceftazidime
Meropenem /
Imipenem
Aztreonam
\+ ONE OF THESE
Levofloxacin/
Ciprofloxacin
Gentamycin /
Tobramycin
Aztreonam
126
Q

Cough with foul-smelling sputum=

A

anaerobc either abscess or PNA

127
Q

The film is noted to have a thick-walled solitary

cavity surrounded by consolidation and air-fluid level present. What do you suspect?

A

Lung abscess

128
Q

The film is noted to have multiple areas of

cavitation within an area of consolidation What do you suspect?

A

Necrotizing PNA

129
Q

the presence of purulent pleural fluid accompanying either lung abscess or necrotizing pneumonia – this would
indicate what complication?

A

Empyema

ultrasound should be ordered to locate fluid, reveal pleural loculations

130
Q

Tx for empyema

A

1st line: Clindamycin IV q8hr (witch to PO with improvement) OR amoxicillin-clavulanate (Augmentin) q12hrs
• Alternative: amoxicillin or PCN G + metronidazole

131
Q

How long tx for

  1. anaerobic PNA
  2. Lung abscess
  3. Empyema
A

Anaerobic pneumonia: continued until chest x-ray improves (process could take a month or more)
• Lung abscess: until chest x-ray resolution of abscess cavity is demonstrated
• Empyema treatment: REFER! must have tube thoracostomy

132
Q

Pleuritis key sx

A

localized pain, sharp,
fleeting – worse with coughing, sneezing,
deep breaths or movement; diaphragmatic
involvement = referred ipsilateral shoulder
pain

133
Q

Tx pleuritis

A

treat underlying dx
• Pain: analgesics / NSAIDs (indomethacin, 2-
3x/day)
• Control cough: codeine or other opioid:

134
Q

Pleural Effusion sx

A

chest pain + pleuritis, trauma, or infection; dyspnea (large effusions à dullness to percussion and decreased/absent
breath sounds over effusion); CXR shows pleural effusion; diagnostic findings on thoracentesis

135
Q

bronchial breath sounds, egophony just above effusion indicate

A

compressive atelectasis

136
Q

5 processes that cause pleural effusions

A
  1. increased hydrostatic pressure/decreased oncotic pressure= transudates
  2. abnormal cap permeability=exudates
  3. Decreased lymphatic clearance from pleural space=exudates
  4. Infection of pleural space=empyema
  5. Bleeding into pleural space= hemothorax
137
Q

90% of transudates in pleural effusions are caused by HF or CA

A

HF

CA= exudative

138
Q

Pulmonary infiltrates

A

hx of HIV, WBC <1000, current or recent
chemo, taking more than 5/mg day of prednisone presents
with pulmonary infiltrates; XRAY NOT HELPFUL to dx!
MUST HAVE SPUTUM CX!

139
Q

T or F: Xray are helping in dx of pulmonary infiltrates in immunocompromised pt

A

FALSE

Must get sputum cx

140
Q

Infectious and noninfectious causes of pulmonary infiltrates

A

Infectious causes: bacterial, mycobacterial, fungal,
protozoal, helminthic, viral pathogens

Noninfectious causes: pulmonary edema, alveolar
hemorrhage, med reaction, pulmonary thromboembolic
dx, malignancy, radiation pneumonia

141
Q

Causes of neutropenia PNA

A

s aureus
aspergillus
gram- bacilli
candid

142
Q

Fulmiant PNA or occuring 2-4 weeks after organ transplant- bacterial or viral

A

Bacterial

143
Q

Insidious PNA causes

A

viral
fungal
protozoal
mycobacterial infection

144
Q

Organism in pulm infiltrates occuring several months after organ transplant

A

viral (P jirovecii- cytomegalovirus)

fungi (aspergillus)

145
Q

The FNP knows that she must order what diagnostic testing to

definitively dx cause of pneumonia?

A

Sputum cx

146
Q

T or F: 40-80% exudative pleural effusions are malignant

A

TRUE

common breast and lung CA,

147
Q

What is parapneumonic pleural effusions>

A

exudate that accompanies bacterial pneumonias

148
Q

pleural effusion with purulent drainage is most likelt

A

empyema

149
Q

Pleural exudate

A

ratio of pleural fluid protein to serum protein
ratio of pleural fluid LD to serum protein
Pleural fluid LD greater than 2/3 upper limit of normal serum LD

150
Q

Pleural Fluid H

A

<7.30= drain the fluid

151
Q

T or F: Diagnostic thoracentesis can be done when there is a new pleural effusion and no reason

A

FALSE

They MUST be done

152
Q

Transudative pleural effusion:

A

pleural disease absent

direct treatment at underlying condition

153
Q

What is an empyema

A

gross infection indicated by gram stain or culture. ALWAYS drain by thora

154
Q

Spontaneous pneumo

A

acute onset of UNILTARAL chest pain, dyspnea;
UNILATERAL chest expansion, decreased tactile fremitus, hyperresonance,
diminished breath sounds

small pneumothorax (mild tachycardia); large pneumothorax (diminished breath
sounds, decreased tactile fremitus, decreased movement of chest)
155
Q

Tension pneumo

A

mediastinal shift, cyanosis, hypotension EMERGENCY REFER

156
Q

ABG finding on spontansoue pneumo

A

hypoxemia and respiratory alkalosis

157
Q

Risk for tension pneumo

A

smoking
high altitudes
flying inunpressurized plane
scuba

158
Q

Hyperventilation syndrome

A 
Increase in alveolar ventilation à
hypercapnia (pregnancy, hypoxemia,
obstructive/infiltrative lung disease,
sepsis, hepatic dysfunction, fever,
pain)
159
Q

Central neurogenic

A

monotonous,
sustained pattern of rapid and deep
breathing (comatose patients with brainstem
injury)

160
Q

Functional (acute) hyperventilation

A

hyperpnea, paresthesia, carpopedal spasm,
tetany, anxiety; tx: breath through pursed
lips/nose with one nostril pinched,
rebreathing expired gas from paper bag over
face (decrease respiratory alkalemia);
anxiolytic drugs

161
Q

Functional (chronic) hyperventilation

A

fatigue, dyspnea, anxiety, palpitations,
dizziness à symptoms re-produced during
voluntary hyperventilation

162
Q

Tx for PE

A

heparin then followed by 6 months of PO warfarin

163
Q

ABSOLUTE CONTRAINDICATIONS TO THROMBOLYTIC THERAPY:

A

active internal

bleeding and stroke within past 2 months

164
Q

MAJOR CONTRAINDICATIONS TO THROMBOLYTIC THERAPY:

A

uncontrolled HTN,

surgery/trauma within past 6 weeks

165
Q

Patient w/recurrent thromboembolisms despite blood thinners wants to know what can be done help decrease incidence of
DVT breaking off into lungs?

A

Placement of an inferior vena cava filter

166
Q

In patient who are very ill or cannot be given thrombolytic therapy, what should you do?

A

embolectomy

167
Q

RSV

A 
low-grade fever,
tachypnea, wheezing, apnea;
increased mucus secretion;
hyperinflated lungs, decreased gas
exchange, increased WOB;
children à major cause of
morbidity / mortality @ extreme
ages (<5yr, >65yr)

leading cause of hospitalizations in children

168
Q

Risk factors for RSV

A

prematurity (severe disease);
early RSV bronchiolitis in kids + family hx
of asthma = persistent airway reactivity in
life

169
Q

Influenza

A

presence of fever (>38.2C) and
cough during flu season = influenza in ages >4 years old

Unvaccinated adults: abrupt onset of fever, chills, HA, malaise,
myalgias, runny/stuffy nose, sore throat, hoarseness, cough,
substernal soreness

Kids w/Type B: GI complaints

Elderly: lassitude, confusion, without fever or respiratory
symptoms

170
Q

Incubation period for influenza

A

1-4 days

Fever last 1-7 days

171
Q

What do you expect with influenza that has persistent fever >4 days with nonproductive cough, w/productive cough and WBC >10,000?

A

Suspect secondary bacterial infection

172
Q

Avian Influenza

A 
occurs from exposure to
infected poultry or birds as hosts; does not
easily transmit between humans; illness
ranges from mild disease to rapid
progressive
173
Q

Risk factor for avian flu

A

direct or indirect exposure to
infected live or dead poultry or contaminated
environments (live bird markets); slaughtering or
handling carcasses of infected poultry

174
Q

Symptoms of avian influenza

A

hx of exposure to dead/ill birds or live
poultry markers in prior 10 days, recent travel to
Southeast Asia/Egypt, contact with known case =
HOW YOU DISTIGUISH FROM REGULAR
INFLUENZA!

175
Q

Adenovirus

A 
56 stereotypes,
divided into 7 subgroups A-G;
occurs throughout the year; usually
self-limited and occur most
commonly in infants, young kids,
military recruits

Incubation period 4-9 days

176
Q

S/sx of adenovirus

A 
Common cold: rhinitis, pharyngitis,
mild malaise without fever Conjunctivitis Pharyngitis (fever lasts 2-12 days +
malaise, myalgia)
Lower respiratory infection cough,
rales, pneumonia (types 1,2,3,4,7 –
acute resp dx, atypical pneumonia)
Type 14: severe/fatal pneumonia in
chronic lung dx
177
Q

tx RSV

A

supportive

hydration
humidified air
vent support as needed

Prevent with PNA vaccine

178
Q

____ syndrome is a complication in children with Type B flu

A

Reye

179
Q

Tx avian flu

A

severe illness and confirmed cases with
mild disease = ASAP TREATMENT!

1st line: neuraminidase inhibitor oseltamivir
for 5 days administered
within 48hr of onset of illness; hospitalized
patients receive 10 days

180
Q

Adenovirus dx

A

Chest CT scan à
multifocal consolidation or “ground glass”
opacity without airway inflammation

181
Q

What is an early sign in pneumococcal PNA

A

bronchial breath sounds

182
Q

Risk factors for pneumococcal PNA

A

alcoholism, asthma, HIV+, sickle cell, splenectomy, hematologic disorders

183
Q

Pneumococcal PNA tx

A

empiric abx pending isolation and identification of causative agent (amoxicillin PO – uncomplicated cases; cephalosporins; PCN allergy = “mycins” à monitor all patients for clinical response (less cough, within 2-3
days due to pneumococci becoming increasingly resistant to PCN and 2nd line agents)

184
Q

Complications of pneumococcal PNA

A

parapneumonic effusion
empyema
pneumococcal pericarditis>tamponade=emergency

185
Q

Bordetella pertussis

A

effects infants under 2 yrs. old; adolescents /
adults are reservoirs for infection; transmitted by DROPLETS;
symptoms last 6 weeks in 3 consecutive stages

incubation period 7-17 days

186
Q

Stages of pertussis

A

Stage 1 (Catarrhal): insidious onset – lacrimation, sneezing, coryza,
anorexia, malaise, hacking night cough that becomes diurnal
Stage 2 (Paroxysmal): bursts of rapid, consecutive coughs followed by
deep, high-pitched inspiration (whoop)
Stage 3 (Convalescent): begins 4 weeks after onset with decrease in
frequency and severity of paroxysms of cough

187
Q

H. influenza can causes

A 
sinusitis
otitis
bronchitis
epiglottis
PNA 
cellulitis
arthritis
meningitis
endocarditis

Sinusitis, otitis, respiratory tract infection: Amoxicillin PO
Beta-lactamase strains: Augmentin PO

More seriously ill- ceftriaxone IV

188
Q

Legionnaires disease

A

immunocompromised,
smokers, chronic lung disease; high fever,
grossly purulent sputum, pleuritic chest
pain, toxic appearance; CXR: focal patchy
infiltrates or consolidation; gram-stain of
sputum – polymorphonuclear leukocytes
and shows no organisms

189
Q

Tx for pertussis

A

antibiotics (erythromycin, azithromycin, clarithromycin, or Bactrim)

190
Q

What disease has a cherry-red swollen epiglottis

A

Epiglottitis

Tx with ceftriaxone IV

191
Q

Legionnaires spread by

A

contaminated water source

192
Q

legionnaires tx

A

azithromycin PO, clarithromycin, or a
fluoroquinolone for 10-14 days (21-days for
immunocompromised patient)
NO ERYTHROMYCIN!

193
Q

T or F: Can tx legionnaires with erythromycin

A

FALSE

194
Q

ACute bronchodilators

A

short-acting B-agonists/ anticholinergics

195
Q

Anti-inflammatory meds

A

inhaled corticosteroids, cromones

196
Q

Nebulized abx beneficial in?

A

CF

197
Q

T or F: spacers must be used in <4mo

A

TRUE

198
Q

nebulized mucolytics

A

used in CF and other conidtions with impaired secretion control

199
Q

tactile fremitus is a sign of

A

change with consolidation or air in the pleural space

rapid shallow breathing

200
Q

Wheezing or prolonged expiratory compared to inspiratory time sign of

A

intrathoracic airway obstruction

201
Q

Tachypnea with an equal inspiratory and expiratory time sign of

A

decreased lung compliance

202
Q

unilateral crackles sign of

A

PNA

203
Q

signs of cor pulmonale

A

loud pulmonic component of the 2nd hear sound , , hepatomegaly, elevated neck veins

204
Q

the FOUNDATION for

investigating pediatric thorax

A

CXR

frontal (posteroir-anterior) and lateral view

eval chest wall abnormalities, heart size and shape, mediastinum, diaphragm, and lung parenchyma

205
Q

When pleural fluid is suspected, what should the FNP

order?

A

Lateral decubitus radiographs (helps in determining the

extent and mobility of the fluid)

206
Q

When a foreign body is suspected, what should the FNP

order?

A

Forced expiratory radiographs (shows focal air trapping

and shift of mediastinum to the contralateral side)

207
Q

When an FNP wants to differentiate croup from epiglottitis,

what should the FNP order?

A

Lateral neck radiographs (useful
in assessing the size of adenoids and tonsils, and seeing the
“thumbprint sign” associated with epiglottitis)

208
Q

To detect swallowing dysfunction in patients with suspected
aspiration, tracheoesophageal fistula, vascular rings and
slings, and achalasia – what should the FNP order?

A 
Fluoroscopic studies (upper GI series, videofluoroscopic
swallowing studies)
209
Q

To detect paralysis of the diaphragm, what should the FNP

order?

A

Fluoroscopy or ultrasound (demonstrates paradoxic

movement of the involved hemidiaphragm)

210
Q

To evaluate for congenital lung lesions, pleural disease,
mediastinum, pulmonary masses/nodules, what should the
FNP order?

A 
Chest CT (effusions, recurrent pneumothorax;
lymphadenopathy)
211
Q

To evaluate for ILD or bronchiectasis (while decreasing
radiation exposure compared to a standard CT), what
should the FNP order?

A

high-resolution CT

212
Q

When assessing vascular or bronchial anatomical

abnormalities, what should the FNP order?

A

MRI

213
Q

When assessing regional ventilation and perfusion – detect
vascular malformations and pulmonary emboli, what
should the FNP order?

A

ventilation-perfusion scan

214
Q

When assessing the pulmonary vascular bed more precisely,

what should the FNP order?

A

pulm angio

215
Q

Obstructive sleep apnea CAN ONLY BE

DIAGNOSED by

A

polysomnogram

“sleep study”

216
Q

Children with apnea-hypopnea index >5 events per hour =

A

OSA

217
Q

PSG recommended for

A 
obesity
downs
craniofacial abnormalities
neuromuscular disorders
sickle cell disease
mucopolusaccharidoses

*discordance between tonsillar size on eam and severity of symptoms

218
Q

high risk age for upper foreign body aspiration

A

6mo-3yr

219
Q

lower foreign body aspiration sx

A

sudden onset coughing, wheezing, respiratory distress, *asymmetrical breath sounds or localized wheezing

220
Q

what sx should you NOT see with croup

A

fever

221
Q

T or F: A cxr is needed to dx croup?

A

FALSE

not needed, may show steeplet sign

222
Q

tx mild-mod croup

A

supportive therapy (oral hydration) cool mist (not effective)

1 dose dexamethasone

D/C <3hr is sx resolve

223
Q

tx mod-severe croup

A

humidified O2, nebulized epi

224
Q

bacterial tracheitis

A

severe form of laryngotracheobronchiis

severe upper airway obstruction and fever, viral coinfection, sniffing dog position/tripod

Sudden onest of high fever, dysphagia, drooling, muffled voice, inspiratory retractions, stridor

225
Q

disease progression in bacterial tracheitis

A

viral coup> doesnt improve> develop high fever, toxicity, and severe upper airway obstruction

226
Q

Typical lab finding in bacterial tracheitis

A

elevated WBC with left shift, tracheal secretions

227
Q

signs of CAP bacterial

A

fever>39, tachypnea, cough, crackles, decreased breath sounds over consolidation, abnormal CXR

may have other areas of infection (meningitis, OM, sinusitis, pericarditis, epiglottitis, abscess)

228
Q

Signs of CAP viral

A

URI prodrome (fever, coryza, cough, hoarseness), wheezing and rales, myalgia, malaise, H/A

causes: RSV, parainfluenza, influenza, A/B,

229
Q

What is the MOST common bacterial cause of CAP in children?

A

S. pneumo

230
Q

When patients should be hospitalized for CAP?

A

all infants <3mo for abx (IV or PO), any child with
apnea, hypoxemia, poor feeding, effusion of CXR, moderate or severe respiratory distress, or clinical
deterioration on treatment

231
Q

If patient is managed outpatient, what is the treatment? Follow-up?

A

F/U within 12hr-5days

232
Q

Tx for bacterial pna

A

amoxicillin

233
Q

tx for viral pna

A

if influsenza: tramiflu, relenza

234
Q

Key sx of empyema

A

<5, current bacterial PNA, respiratory distress and chest pain, fever, meniscus or layering fluid

S. pneumo

235
Q

What sounds is percussed on the affected side with empyema

A

dullness

236
Q

T or F: large parapneumonic effusions can cause tracheal deviation

A

TRUE

to the contralateral side

237
Q

Mycoplasma PNA sx

A

fever, <5, dry cough> sputum production, HA, malaise, RALES and CHEST PAIN, bronchpneumonic infiltrates in middle/lower lobes, pleural effusions

238
Q

mycoplasma PNA tx

A

azithromycin , cipro

239
Q

bronchiolitis sx

A

<2, begins as URI>tachypnea, rapid, shallow breathing, wheezing>irritability, poor feeding, vomiting>crackles, nasal flaring, retractions, hypoxia

meniscus or layering fluid

  • starts as URI: fever, rhinorrhea & cough
240
Q

common causes of bronchiolitis

A

RSV, parainfluenza, adenovirus,

241
Q

Bronchiolitis on xray

A

non-specific hyperinflation and increased interstitial markings

242
Q

which lobe is most commonly affected by aspiration PNA

A

right upper lobe in a supine pt

will see perihilar infiltrates with or without bilateral air trapping

243
Q

complications of aspiration PNA

A

empyema or lung abscess,

CHRONIC- bronchiectasis- need CT

244
Q

tx for aspiration PNA

A

clinda

245
Q

Key sx of empyema

A

<5, current bacterial PNA, respiratory distress and chest pain, fever, meniscus or layering fluid

S. pneumo

246
Q

What sounds is percussed on the affected side with empyema

A

dullness

247
Q

T or F: large parapneumonic effusions can cause tracheal deviation

A

TRUE

to the contralateral side

248
Q

Mycoplasma PNA sx

A

fever, <5, dry cough> sputum production, HA, malaise, RALES and CHEST PAIN, bronchpneumonic infiltrates in middle/lower lobes, pleural effusions

249
Q

mycoplasma PNA tx

A

azithromycin , cipro

250
Q

bronchiolitis sx

A

<2, begins as URI>tachypnea, rapid, shallow breathing, wheezing>irritability, poor feeding, vomiting>crackles, nasal flaring, retractions, hypoxia

meniscus or layering fluid

  • starts as URI: fever, rhinorrhea & cough
251
Q

common causes of bronchiolitis

A

RSV, parainfluenza, adenovirus,

252
Q

Bronchiolitis on xray

A

non-specific hyperinflation and increased interstitial markings

253
Q

which lobe is most commonly affected by aspiration PNA

A

right upper lobe in a supine pt

will see perihilar infiltrates with or without bilateral air trapping

254
Q

complications of aspiration PNA

A

empyema or lung abscess,

CHRONIC- bronchiectasis- need CT

255
Q

tx for aspiration PNA

A

clinda

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