Adult - Respiratory

Question 1

What is the most likely cause of acute bronchitis?

Answer 1

virus

rhinovirus, coronavirus, adenovirus

Question 2

What are the signs and symptoms of acute bronchitis?

Answer 2

productive cough
~ headache
~ wheezing
~ fever

Question 3

What is the significance of fever in acute bronchitis?

Answer 3

provides and important clue as to cause =
none or low grade –> viral
more pronounced –> bacterial

Question 4

What are the lung sounds of acute bronchitis?

Answer 4

clear
OR
if rhonchi –> clear after pt directed to cough

Question 5

What is the normal percussion tone of the chest?

Answer 5

resonant

Question 6

What is the percussion tone of acute bronchitis?

Answer 6

resonant

therefore, no evidence of consolidation which would be seen in pneumonia

Question 7

How is the diagnosis of acute bronchitis made?

Answer 7

usually by clinical picture

if concern about pneumonia, as in older adult –> CXR

Question 8

What is the non pharm management of acute bronchitis?

Answer 8

supportive treatment
increased fluids
humidification

Question 9

What is the pharm management of acute bronchitis?

Answer 9

as needed:
~ analgesics
~ cough suppressants (judiciously)
~ SABA
~ antibiotics

Question 10

If an antibiotic is warranted in acute bronchitis (significant fever, for example) which is a good choice?

Answer 10

macrolide (-mycin)

second line?
o doxycycline
o trimethoprim-sulfamethoxazole (Bactrim)

Question 11

What does hyper-resonance indicate?

Answer 11

air trapping

Question 12

Is the diagnosis of acute bronchitis vs pneumonia easier in the younger adult or older?

Answer 12

younger is more clear cut

hence, more CXR in older adult to be sure

Question 13

What type of mucus is associated with asthma?

Answer 13

thick, viscid mucous which leads to plugging of airways

Question 14

What is pulsus paradoxus?

Answer 14

Drop in systolic BP during inspiration

Question 15

What are some ominous signs of asthma? (5)

Answer 15

fatigue
absent breath sounds
cyanosis - late sign in the adult
inability to maintain recumbency
paradoxical chest/abdomen movement

Question 16

How are PFTs / peak flows used to determine need for hospitalization in the adult?

Answer 16

if FEV1 is < 30% of predicted or dose not increase to at least 40% after 1 hour of vigorous therapy

OR

if peak flow is < 60 L/min initially or does not improve to > 50% of predicted after 1 hour of treatment

Question 17

Which two conditions make up COPD?

Answer 17

chronic bronchitis

emphysema

Question 18

characterized by excessive secretion of bronchial mucus and productive cough

Answer 18

chronic bronchitis

time frame?
at least 3 months in two consecutive years

Question 19

abnormal, permanent enlargement of the alveoli

Answer 19

emphysema

Question 20

What is the typical picture of a patient with chronic bronchitis?

Answer 20

stocky or obese
normal chest A-P diameter
younger (onset after age 35)
copious, purulent sputum
intermittent dyspnea

Question 21

What is the typical picture of a patient with emphysema?

Answer 21

emaciated
increased chest A-P diameter
older (onset after age 50)
thin, spit-like sputum
progressive, constant dyspnea

Question 22

Can people have features of both chronic bronchitis and emphysema?

Answer 22

yes

Question 23

What is the CXR finding of a patient with COPD?

Answer 23

low, flattened diaphragm

due to air trapping

Question 24

Which PFT values are reduced in COPD?

Answer 24

F or Flow values - FEV1 FVC etc

Question 25

Which PFT values may be increased in COPD?

Answer 25

C / capacity or V / volume values - TLC, FRC, RV

Question 26

What is the mainstay of COPD management?

Answer 26

inhaled anticholinergics - ipratroprium bromide (Atrovent)

Question 27

What is the most common causative organism in typical community acquired pneumonia in adults?

Answer 27

S. pneumoniae

Question 28

What are signs and symptoms of TYPICAL pneumonia? (5)

Answer 28

``` LUNG CONSOLIDATION (big diff from bronchitis) fever/shaking chills purulent sputum malaise increased fremitus ```

Question 29

What are signs and symptoms of ATYPICAL pneumonia?

Answer 29

ENT and URI symptoms + lung symptoms ``` EXCESSIVE SWEATING fever headache sore throat ~ soreness in chest adventitious breath sounds ```

Question 30

What are the most common causative organisms in atypical community acquired pneumonia in adults?

Answer 30

Legionella pneumophila Mycoplasma pneumoniae

Question 31

What are the CXR findings in community acquired pneumonia?

Answer 31

infiltrates

Question 32

How are patients categorized into groups for management of CAP?

Answer 32

those < 60 years with no comorbidities --> macrolide (azithromycin, clarirthromycin, erythromycin) those =/> 60 years or with other health problems --> fluoroquinolones (levofloxicin, gemifloxicin, moxifloxicin) don't over treat the younger, don't undertreat the older