Unit 5-respiratory Flashcards
What is number one cause of URI? How long can it last on hard surfaces?
Rhinovirus. Lasts up to 3 hours
What are other causes of URI?
coronavirus, RSV, adenoinfluenza
What is incubation period for rhinovirus?
1-10 days
What is most common cause of rhino sinusitis?
S. Pneumoniae and H. Inffluenzae.
Differentiate between acute and chronic sinusitis?
Acute aries after prolonged cold et last less than 3 wks. Chronic is defined as symptoms lasting 3-8 weeks or greater than 3 months.
What is differential diagnoses for patients suspected to have sinusitis who present w/ light sensitivity, neck pain, HA, fever?
meningitis or brain abcess
When should abx therapy be given to patients with sinusitis?
Fever >102, pain or tenderness in ears sinus or face, purulent sputum, sore throat and symptoms that persist with NO improvement for over 10 days
How long is abx tx for sinusitis?
At least 14 days, or 7 days beyond resolution of symptoms
What is first line tx for sinusitis? Second line?
Amoxicillin and Augmentin. For allergic, Bactrim.
Macrolides,
What meds are used to treat acute attacks of asthma and are pen?
Beta agonists such as albuterol.
What is diagnostic criteria for asthma?
expiratory wheezing, h/o cough worse at night, reversible airflow restriction, increased symptoms w/ exercise, viral infection etc.
What is most effective therapy for treating asthma long term? How long does it take for them to achieve max effect?
Inhaled corticosteroids such as beclomethasone, fluticasone, triamcinolone
2weeks.
What is first line treatment for asthma in children?
How long does it take for them to be effective/max effect?
Mast cell stabilizers-cromolyn
1-2 wks and a bit longer for max effect
How long doe LABAs like Serevent last?
12 hours-do NOT act rapidly
What is normal starting dose for prednisone for treatment of acute asthma exacerbation?
30-60mg daily, then tapered if >14 days.
How is chronic bronchitis defined?
cough and sputum for 3 months for 3 consecutive years.
What is first line tx for COPD? Second Line?
SABA is first line. Second line for patients with persistent symptoms is combo therapy-SABA and anticholinergic.
When in COPD are systemic corticosteroids used?
only in severe flair ups.
When do you use abx to treat acute bronchitis?
If symptoms persist for >10-14 days. (4-6 if tob or pulm disease)
What are antibiotic choices for acute bronchitis?
ampicillin, amoxicillin, macrolides
What are common signs of chronic bronchitis exacerbation
mild-severe cough, increase in frequency and severity of cough, loss of appetite, chills, hemoptysis.
What is appropriate choice for non complicated chronic bronchitis?
Complicated chronic bronchitis?
How are the two differentiated?
ampicillin
2nd or 3rd gen cephalosporon, amox-clav, fluroquinolones
Simple-FEV1>50%, Complicated <50%
What is the most common organism in Community Acquired pneumonia? What are others?
Most common strep pneumonia. Others are H Influenzae, S. aureus.
What appears on cxr if pneumonia is present?
infiltrates
What vaccine is helpful against strep pneumonia?
Pneumococcal vaccine 23-valent
What abx are resistant to s. pneumonia and are therefor not good choices?
aminopenicillins and cephalosporins
What is first choice to tx pneumonia as outpatient?
macrolide or doxycycline. Fluroquinolone if pt has had above therapy in the last 10-14 days.
What is treatment of choice in MRSA pneumonia?
vanco, bactrim
What is first choice for aspiration pneumonia?
Augmentin
How is failure defined in treating pneumonia?
Symptoms >3-5 days, Leukocytosis >3 days, Fever >2-4 days-NO IMPROVEMENT IN 3 DAYS on abx
What is good choice to treat mild CAP?
5 days of azithromycin
What is first choice for pneumonia in presence of comorbidities such as heart lung liver or renal disease, DM, ETOH, malignancy, recent abx
2nd gen cephalosporin or Beta lactamase inhibitor
When evaluating for asthma, what % increase in PEF or FEV1 from baseline is considered diagnostic (after beta adrenergic agonist is administered).
and improvement of 12% or more from baseline.
What is recommended dose of inhaled steroids for treating asthma?
2-4 inhalations 2-4x daily.–LOWEST effective dose.
What is recommended dose of mast cell stabilizers (cromolyn)?
2-4 inhalations 3-4x daily
What precautions should be taken when taking Accolate (a leukotriene modifier)
Admin w/ meals reduces bioavailability
In what patients should caution be used when giving beta adrenergic agonists for asthma?
ischemic heart disease, hypertension, cardiac arrhythmia, seizure, hyperthyroid
If amoxicillin (or other first line abx for sinusitis) does not improved symptoms after ________days, change abx.
eight days
What symptoms indicate a sinus infection is most likely bacterial rather than viral?
symptoms persiste for over 10 days, symptoms are unusually severe, facial tenderness, transient periorbital swelling, daytime cough, fever over 102.2
What is normal dose and high dose amoxicillin?
45mg/kg 90 mg/kg
what criteria indicate need for initiation of therapy for asthma in neonates to children age 4?
Four or more episodes of wheezing in the past year that lasted more than one day and that affected sleep AND those who have risk factors for developing persistent asthma
what is considered first line asthma therapy in children? Why?
mast cell stabilizers-cromolyn
the do not affect linear growth as corticosteroids do
what adverse affect can occur in women using inhaled corticosteroids?
decreased bone mineral content
What genetic deficiency can cause emphysema?
deficiency of protein alpha1-antitrypsin
what are presenting symptoms of emphysema?
dyspnea w/ light exertion, scant thick sputum, slight cough w/ little sputum production
If albuterol (saba) is paired with ipratropium (anticholinergic), what order should they be used?
ipratropium first, then SABA two ours later
what normally precedes the symptoms of acute bronchitis?
s/s of URI (coryza, malaise, chills, back and muscle pain, headache) **Fever rare and is more commonly seen with adenovirus, influenza and M. pneumoniae
what is the hallmark sign of acute bronchitis?
cough that is initially dry and nonproductive that becomes productive.
What are indications for hospitalization in pneumonia?
severe VS w/ HR >140, SBP 30, temp>101, altered mental status
