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NR602 - Primary Care of the Childbearing > Week 3 - Respiratory conditions > Flashcards

Week 3 - Respiratory conditions Flashcards

1
Q

Allergic rhinitis

A
  • AR is a disorder that results in nasal mucosal inflammation due to Th2 cell. Eventually histamines are activated causing sneezing, vasodilation which leads to obstruction of nasal passages, nasal secretion and sensory nerve hyperresponsiveness
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2
Q

Two phases of allergic rhinitis

A
  1. Immediate 15-30 min after exposure due to mast cell release
  2. 6-12 hours afterwards due to t cells, basophils and eosinophils infiltrating the nasal mucosa
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3
Q

Clinical diagnosis for allergic rhinitis

A

Based on the presence of rhinorrhea, nasal pruritus and congestion, and sneezing.

Symptoms are seasonal or perennial depending on the allergen

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4
Q

Allergic rhinitis - intermittent vs persistent

A

Intermittent, 4 weeks or less

Persistent, longer than 4 weeks

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5
Q

Physical exam findings for allergic rhinitis

A
  • Reduced nasal passage patency or bilateral obstruction due to congestion/inflammation
  • Mouth breathing, snoring, nasal speech
  • Pale, purple, edematous nasal mucous membranes (boggy)
  • Clear secretions
  • Itching or rubbing nose (allergic salute)
  • Nasal stuffiness, postnasal drip, sneezing, congestion, cough
  • Allergic shiners
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6
Q

Treatment of allergic rhinitis

A
  • Oral or nasal H1 antihistamines or oral/nasal decongestants, inhaled nasal corticosteroids
  • Allergy immunotherapy
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7
Q

Streptococcal pharyngitis symptoms

A
  • abrupt onset
  • lack of nasal symptoms
  • pharyngitis
  • cervical tender lymph nodes
  • arthralgia
  • myalgia
  • headache
  • moderate/high fever
  • nausea & vomiting,
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8
Q

Diagnostic test for streptococcal pharyngitis

A

Rapid strep test

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9
Q

Streptococcal pharyngitis treatment

A

Penicillin V potassium –
250mg 2x or 3x a day for 10 days,

children over 27kgs 500mg BID or 2xday for 10 days

MORE COMMON
* amoxicillin suspension more palatable 50mg/kg/day (max 1000mg) or 25mg/kg/day BID for 10 days

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10
Q

Cause of scarlet fever pharyngitis

A

Caused by erythrogenic toxin (bacteria) common in kids who have had strep throat

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11
Q

S/S of scarlet fever pharyngitis

A
  • sore throat
  • vomiting
  • headache
  • chills
  • malaise
  • tonsils are erythematous, edematous and exudative
  • pharynx covered with gray/white exudate
  • plaate and uvula are erythematous and redended
  • tongue coated aond red (strawberry tongue)
  • scarlatina rash begins on neck and sprads to trunk
  • resolves in 5-7 days
  • finely papular
  • feels like sandpaper
  • spread is contact and droplet
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12
Q

Treatment for scarlet fever pharyngitis

A

penicillin or amoxicillin as strep throat

Penicillin V potassium –
250mg 2x or 3x a day for 10 days,

children over 27kgs 500mg BID or 2xday for 10 days

MORE COMMON
* amoxicillin suspension more palatable 50mg/kg/day (max 1000mg) or 25mg/kg/day BID for 10 days

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13
Q

Mastoiditis

A
  • Infection of the mastoid cells that may occur with or follow AOM
  • Lining of the mastoid air cells become inflamed with progressive swelling and obstruction caused by drainage from the mastoid
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14
Q

S/S of Mastoiditis

A
  • Recurrent AOM
  • Fever
  • Otalgia
  • Persistent OM unresponsive to ABX
  • Postauricular swelling
  • Discharge from EAC
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15
Q

Mastoiditis managment

A
  • Urgent referral to ENT
  • Hospitalization
  • IV abx
  • Possibly surgical intervention with myringotomy, tube placement and mastoidectomy
  • CT (preferred – shows inflammation and coalescence of mastoid air cells)
  • Xray – coalescence of mastoid air cells
  • IV antibiotic therapy – cefotaxime or ceftriaxone until culture results obtained
  • Myringotomy for culture and drainage
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16
Q

Peritonsillar abscess

A
  • Usually caused by streptococcus
  • Area of puss filled tissue at the back of the mouth next to one of the tonsils. Painful and can caus swelling that pushes the tonsil toward the uvula.
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17
Q

Treatment for peritonsillar abscess

A

Treat with penicillin or augmentin

18
Q

Upper respiratory infection cause

A

Usually viral

19
Q

S/S URI

A
  • Low onset fever
  • Rhinnorhea (key finding)
  • Sore throat – dysphagia
  • Mild cough
  • Poor sleep
20
Q

URI treatment

A
  • Saline nose spray
  • Increase fluids
  • Humidifier
  • Treat pain/ fever
21
Q

Asthma symptoms

A
  • varying degree of airflow obstruction that presents as coughing, wheezing, chest tightness, breathlessness, and respiratory distress
  • persistent cough without significant wheezing
  • bronchospasm
  • long term airway remottling
  • airflow obstruction reversible w or w/o treatment
22
Q

Triggers for asthma

A
  • viral respiratory infections,
  • environmental allergens,
  • change in the weather,
  • stress,
  • emotional expression,
  • exercise
  • comorbid conditions such as sinusitis and gastroesophageal reflex
23
Q

Asthma biphasic reaction

A
  • Early asthmatic response – within 15-30 min of exposure, resolves 1 hour after removal
  • Late phase response – 6-26 hours after exposure, last hours to weeks, needs a corticosteroid for treatment (response to beta agonist is muted)
24
Q

Causes of allergen induced asthma

A
  • House dust mites, cockroaches, indoor molds
  • Saliva and dander of cats and dogs
  • Outdoor seasonal molds
  • Airborne pollens—trees, grasses, and weeds
  • Food allergy, including egg and tree nut
25
Q

Asthma PE findings

A
  • Wheezing
  • Coughing
  • Prolonged expiration
  • Diminished breath sounds
  • Altered levels of alertness, nasal flaring, retractions, accessory muscle use, nasal flaring, restlessness, apprehension, agitation, drowsiness to coma
  • Tachycardia/HTN, Hypotension
  • Cyanosis
  • Sinusitis, AR, AD
26
Q

Asthma diagnostics

A
  • O2 saturations
  • CBC if secondary infection or anemia suspected
  • Allergy evaluation
  • PFTs
  • Spirometry
  • FEV1
27
Q

Spirometry values for asthma obstruction

A

FEV1

  • > 75%: Normal
  • 60% to 75%: Mild obstruction
  • 50% to 59%: Moderate obstruction
  • <49%: Severe obstruction
28
Q

Intermittent asthma

A
  • symptoms 2 or less times per week
  • SABA 2 days a week
  • No interference with nomal activity
  • Night time symptoms 2 or less per month
  • FEV1 >80%
29
Q

Mild persistent asthma

A
  • Symptoms more than 2x week but less than daily
  • SABA more than 2 days a week but less than daily
  • Minor affect on activity
  • Nightime smptoms 3-4x per month
  • FEV1 >80%
30
Q

Moderate persistent asthma

A
  • Daily symptoms
  • Daily SABA
  • Exacerbations affect activity 2+ times per week – may last day
  • Night symptoms mmore than 1x week less than nightly
  • FEV1 >60% but <80% predicted
31
Q

Severe persistent asthma

A
  • Continual symptoms
  • SABA several times per day
  • Extremely limited physical activity
  • Frequent exacerbations
  • Night symptoms every night
  • FEV1 <60%
32
Q

Gold standard testing for asthma diagnosis

A

Pulmonary function testing

33
Q

Control measures for chronic asthma

A
  • Avoid allergens/ irritants
  • Use AC – close windows and doors, remain inside when allergens are high
  • Control environment to eliminate allergen
  • Allergen immunotherapy
  • Treat AR, GERD,
  • Use a written action plan
34
Q

Acute bronchitis history

A

Usually viral.

  • dry hacking unproductive cough
  • chest pain with coughing
  • family history of asthma, CF, atopy, smoke and allergen exposure
  • exposure to infection at daycare
  • nature of cough
35
Q

Acute bronchitis PE

A
  • Variable degrees of URI symptoms
  • Low-grade or no fever
  • Coarse breath sounds changing rhonchi and rales
36
Q

Acute bronchitis treatment

A
  • analgesia
  • hydration
  • antiviral therapy for those with underlying respiratory disease
  • trial of bronchodilators if asthma suspected
37
Q

Respiratory Syncytial Virus

A
  • common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious. Infants and older adults are more likely to develop severe RSV and need hospitalization
38
Q

RSV symptoms

A
  • Runny nose
  • Decrease in appetite
  • Coughing
  • Sneezing
  • Fever
  • Wheezing
  • Apnea
39
Q

RSV diagnosis

A

PCR swab

40
Q

RSV treatment

A
  • Manage pain and fever
  • Increase fluid intake
41
Q

Cystic fibrosis

A
  • multisystem genetic disorder manifested by chronic obstructive pulmonary disease (COPD), GI disturbances, and exocrine dysfunction; it is the most common autosomal-recessive disease
  • Chronic airway infection, mucus that is adherent and stringy, dysfunctional mucociliary transport, airway obstruction, chronic infections
42
Q

Cystic fibrosis diagnosis

A

Diagnosis is based on evidence of CFTR (gene on chromosome 7) dysfunction and signs and symptoms of the disease.

Newborns are screened.

NR602 - Primary Care of the Childbearing (18 decks)

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