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PCM III Test 2 > URI/Pneumonia HYHO > Flashcards

URI/Pneumonia HYHO Flashcards

1
Q

What are the most common causes of chronic cough in order of decreasing frequency?

A
  1. upper airway cough syndrome (in healthy nonsmokers)
  2. asthma/copd
  3. GERD
  4. postnasal drip
  5. medication side effects
  6. CHF
  7. malignancy
  8. smoking
  9. pollution
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2
Q

What is the most sensitive and specific test for diagnosis of reflux disease?

A

24 hour esophageal ph monitoring

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3
Q

What is the first line of treatment for GERD?

A

4 week trial of PPI which is diagnostic and therapeutic

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4
Q

What are 6 DDx of infectious causes of cough?

A
  1. common cold/URI
  2. pharyngitis
  3. sinusitis
  4. Bronchitis
  5. Influenza
  6. Pneumonia
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5
Q

What is the most common presenting symptom of acute bronchitis?

A

sputum production

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6
Q

What presentation is NOT diagnostic of a bacterial infection in acute bronchitis?

A

the color of the sputum

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7
Q

What is the treatment for acute bronchitis?

A

nothing - its self-limited. antibiotics do not provide clinical benefit.

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8
Q

When do you prescribe antibiotics for cough?

A
  • patients with underlying heart/lung/kidney disease
  • high suspicion for CAP
  • high suspicion for b pertussis, mycoplasma or chlamydia
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9
Q

How do you diagnose and treat rhinosinusitis?

A

Presence of purulent nasal discharge, maxillary dental or facial pain, unilateral maxillary sinus tenderness, and worsening symptoms after initial improvement.

Amoxicillin and trimethoprim-sulfamethoxazole

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10
Q

What is the modified centor criteria?

A
  • A point is given for each of the following criteria:
  • Absence of cough; enlarged/tender anterior cervical adenopathy; fever of 100.4 F or higher; and tonsillar
    swelling/exudates.
  • One additional point is added if patient is between 3 and 14 years of age and one point is deducted if patient is age 45 years or greater.
  • 0-1 points; recommend no further testing and no antibiotic indicated.
  • 2-3 points; perform rapid strep or throat culture and treat with antibiotic if positive.
  • 4 or more; consider empiric antibiotic treatment.
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11
Q

Treatment for GAS pharyngitis?

A

penicillin

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12
Q

What are the DDx for pneumonia?

A

Noninfectious illnesses that mimic CAP or co-occur and present with pulmonary infiltrate and cough:

  • CHF with pulmonary edema.
  • Pulmonary embolism.
  • Pulmonary hemorrhage.
  • Atelectasis.
  • Aspiration or chemical pneumonitis.
  • Drug reactions.
  • Lung cancer.
  • Collagen vascular diseases.
  • Vasculitis.
  • Acute exacerbations of bronchiectasis.
  • Interstitial lung diseases (eg, sarcoidosis, asbestosis, hypersensitivity pneumonitis, cryptogenic organizing pneumonia)
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13
Q

Which bug is associated with alcoholics, aspiration and currant jelly hemoptysis?

A

klebsiella

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14
Q

is pseudomonas a CAP?

A

no

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15
Q

Which bug that causes atypical pneumonia presents with GI symptoms and hyponatremia?

A

legionella

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16
Q

Which two bugs cause healthcare/hospital acquired pneumonia? (also caused by recent abx use)

A

pseudomonas and MRSA

17
Q

Which bug mimics legionella but lacks the GI symptoms?

A

chlamydophilia

18
Q

What other symptoms is legionella associated with?

A

sinusitis, pancreatitis, myocarditis, pyelonephritis

19
Q

What is the CAP uncomplicated outpatient treatment?

A

macrolide (azithro or clarithromycin) or tetracycline (doxycycline)

20
Q

What is the CAP outpatient treatment in pts with significant comorbidities/failed first line?

A

macrolide + penicillin/lactamase or fluoroquinolone

21
Q

What is curb-65?

A

measures confusion, uremia >7, respiratory rate >30, BP<90/60, age> 65

22
Q

what are the three primary pillars for the prevention of CAP?

A

smoking cessation
influenza vaccine for all patients
pneumococcal vaccination for at risk patients

23
Q

What is the first step in lymphatic drainage?

A

open thoracic inlet first (thoracic MFR)

24
Q

How does treating OA, AA, C2 help sx of pneumonia?

A

it increases parasympathetic tone, so it thins secretions and constricts the bronchioles

25
Q

How does treating T2-T7 help sx of pneumonia?

A

in increases sympathetic tone so it thickens secretions and dilates bronchioles

26
Q

What is the motor innervation to the diaphragm?

A

C3-C5: phrenic n.

27
Q

Chapmans point for bronchi

A

intercostal space between 2nd and 3rd ribs at sternocostal junction. T2 midway between SP and tip of TP

28
Q

Chapmans point for upper lung

A

intercostal space between 3rd and 4th ribs at the sternocostal junction. Space between the TPs of T3 and T4, midway between SP and tip of TP

29
Q

chapmans points for lower lung

A

intercostal space between 4th and 5th ribs at the sternocostal junction. space between the TPs of T4 and T5, midway between the SP and tip of TP

PCM III Test 2 (6 decks)

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