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CDM2 - Final > Respiratory Cases > Flashcards

Respiratory Cases Flashcards

1
Q

classifications of asthma

A

intermittent: sx 2/week or less, 2/mo or less nocturnal awakenings
mild: sx > 2/week, 3-4/mo nocturnal awakenings
moderate: daily sx, >1/mo nocturnal awakenings
severe: sx throughout the day, nocturnal sx every night

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2
Q

order of workup for asthma (after you’ve done thorough h&p of course)

A
  1. PFTs
  2. If PFTs are normal -> methacholine challenge or ASA challenge
  3. CXR -> r.o PNA/COPD/ca
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3
Q

stepwise approach to asthma tx

A
  1. exercise induced: PRN SABA
  2. PRN low ICS
  3. PRN low ICS + LABA
  4. daily low ICS + LABA
  5. daily med ICS + LABA
  6. daily high ICS + LABA

all steps get PRN SABA

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4
Q

if asthma is well controlled, PRN SABA should not be used more than

A

1/week

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5
Q

what class of drug is Symbicort
what condition is it commonly used for

A

ICS/LABA combo
asthma

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6
Q

when are peak flow meters used

A

daily at home

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7
Q

when are PFTs done

A

for initial dx and when indicated for another reason

no formal guidelines

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8
Q

when are systemic steroids used for asthma

A

only for acute exacerbation

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9
Q

PE findings of COPD (2)

A

expiratory wheezing
prolonged expiratory phase of respiration

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10
Q

CXR findings of COPD (2)

A

increased AP diameter
flattened diaphragm

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11
Q

what diagnostic tools are used to assess/stage COPD

A

subjective: mMRC/CAT
objective: PFTs

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12
Q

when are sputum cultures recommended for acute exacerbations of bronchitis (5)

A

complicated attack
failed abx
suspect atypical
immunocompromised
homeless or group living
IVDU

not first line soc!

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13
Q

what 3 organisms mc cause acute exacerbations of bronchitis

A

h.flu
strep pneumo
m.cat

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14
Q

what is the timeline for tamiflu administration

A

w.in 48 hr of sx onset

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15
Q

what is the most effective rescue med for COPD

A

SAMA/SABA combo -> Combivent

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16
Q

when are abx recommended for acute exacerbation of bronchitis in COPD pt

A

moderate to severe exacerbation -> 2 out of 3:
-increased dyspnea
-increased sputum volume/viscosity
-increased sputum purulence

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17
Q

when would you use azithromycin for acute bronchitis flare in COPD pt

A

uncomplicated flare
no rf
age > 65 yo
FEV1 > 50% predicted

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18
Q

top 3 abx recommended for uncomplicated acute bronchitis attack

A
  1. azithromycin
  2. clarithromycin
  3. cefuroxime
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19
Q

duration of abx for uncomplicated acute bronchitis attack

A

5-7 days

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20
Q

how do you define a complicated acute bronchitis attack

A

1 or more rf:
age > 65 yo
FEV1 < 50% predicted
2 or more exacerbations/year
cardiac dz

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21
Q

what 3 abx are used for complicated acute bronchitis attack

A
  1. moxifloxacin
  2. levofloxacin
  3. augmentin
22
Q

in a nutshell summary of outpatient (uncomplicated) abx for acute bronchitis attack

A

most: macrolide OR 2nd/3rd gen cephalo
high risk w.o pseudo risk: augmenting OR fluoroquinolone
high risk w. pseudo risk: fluoroquinolone

23
Q

in a nutshell summary of inpatient (complicated) abx for acute bronchitis attack

A

pseudo risk: fluoroquinolone or 3rd gen cephalo
no pseudo risk: IV cefepime, ceftazidime, zosyn

24
Q

what class of drug is a Spiriva

A

LAMA

25
Q

what 2 drugs are commonly used for COPD

A

Combivent (SABA/SAMA) -> rescue
Spiriva (LAMA) -> daily

26
Q

how often should FEV1 be monitored in COPD pt

A

annually

27
Q

tx to consider for COPD pt who presents w. sx of acute bronchitis attack, but has poorly managed pharm for COPD, and is non toxic AF

A

delay abx prescribing
increased COPD tx x 3-4 days
if no improvement -> rx abx

28
Q

are systemic steroids recommended for COPD

A

not really ever… unless super super sick

29
Q

CENTOR criteria

A
30
Q

do you need to flu swab an otherwise healthy pt who presents > 48 hr after sx onset

A

probs not -> won’t give tamiflu outside this window, so why swab?

31
Q

what meds might you prescribe for viral URI (2)

A

OTC APAP PRN

32
Q

f.u for viral URI in peds if RSV (+)

A

1-2 days

33
Q

f.u for viral URI in peds if RSV (-)

A

1 week

34
Q

indications for emergent care in kiddo w. viral URI

A

difficulty breathing
AMS
toxic AF
poor feeding/hydration
no improvement
maxillary tooth pain
high fever

35
Q

virus mc responsible for viral URI

A

rhinovirus

also: flu, adenovirus, enterovirus, rev

36
Q

what lung sound is associated w. PNA

A

crackles

37
Q

who gets a ddimer

A

low risk for PE

38
Q

what PE could you do to assess for DVT

A

leg exam
if positive -> US deep veins

39
Q

why might you do a CT in PNA pt.

A

r.o PE and PNA

40
Q

what pathogens are mc associated w. HAP (6)

A

pseudomonas
acinetobacter
s.aureus
h.flu
klebsiella
e.coli

41
Q

definition of HAP

A

develops > 48 hr after admission

42
Q

2 major rf for HAP (besides hospital admit)

A

ventilation
aspiration

43
Q

you should base abx tx for HAP on (3)

A

risk for MRSA
risk for pseudomonas
local antibiogram

44
Q

denver health antibiogram guidelines for HAP tx

A

cefepime 2 g IV q 8 hr

indications for addition of IV vanco:
VAP
hx MRSA infxn
IV abx in past 90 days

indications for addition of IV vanco + amikacin:
severely ill w. septic shock

mod-severe pcn allergy: levofloxacin

45
Q

clinical stability criteria for HAP (5)

A

afebrile x at least 24 hr
no unexplained tachy
WBC nl or improving
O2 needs improving or at baseline
tolerating PO

46
Q

step down po abx choice for clinically stable HAP patients

A

levofloxacin

47
Q

what tool is used to assess PNA disposition (2)

A

CURB 65
SIRS

48
Q

sepsis/SIRS criteria

A

temp: < 36 OR > 38
HR: > 90 bpm
tachypnea: > 20 OR PaCO2 < 32
WBC: < 4,000 OR > 12,000

49
Q

q hr sepsis bundle (5)

A
  1. measure lactate
  2. obtain cultures
  3. abx
  4. rapid admin of crystalloid
  5. vasopressor
50
Q

t/f: all pt’s who meet SIRS criteria should be considered septic

A

f!

CDM2 - Final (9 decks)

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