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Flashcards in Adult - Respiratory Deck (32):
1

What is the most likely cause of acute bronchitis?

virus

rhinovirus, coronavirus, adenovirus

2

What are the signs and symptoms of acute bronchitis?

productive cough
~ headache
~ wheezing
~ fever

3

What is the significance of fever in acute bronchitis?

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

4

What are the lung sounds of acute bronchitis?

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

5

What is the normal percussion tone of the chest?

resonant

6

What is the percussion tone of acute bronchitis?

resonant

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

7

How is the diagnosis of acute bronchitis made?

usually by clinical picture

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

8

What is the non pharm management of acute bronchitis?

supportive treatment
increased fluids
humidification

9

What is the pharm management of acute bronchitis?

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

10

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

macrolide (-mycin)

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

11

What does hyper-resonance indicate?

air trapping

12

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

younger is more clear cut

hence, more CXR in older adult to be sure

13

What type of mucus is associated with asthma?

thick, viscid mucous which leads to plugging of airways

14

What is pulsus paradoxus?

Drop in systolic BP during inspiration

15

What are some ominous signs of asthma? (5)

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

16

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

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

17

Which two conditions make up COPD?

chronic bronchitis
emphysema

18

characterized by excessive secretion of bronchial mucus and productive cough

chronic bronchitis

time frame?
at least 3 months in two consecutive years

19

abnormal, permanent enlargement of the alveoli

emphysema

20

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

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

21

What is the typical picture of a patient with emphysema?

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

22

Can people have features of both chronic bronchitis and emphysema?

yes

23

What is the CXR finding of a patient with COPD?

low, flattened diaphragm

due to air trapping

24

Which PFT values are reduced in COPD?

F or Flow values - FEV1 FVC etc

25

Which PFT values may be increased in COPD?

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

26

What is the mainstay of COPD management?

inhaled anticholinergics - ipratroprium bromide (Atrovent)

27

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

S. pneumoniae

28

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

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

29

What are signs and symptoms of ATYPICAL pneumonia?

ENT and URI symptoms + lung symptoms

EXCESSIVE SWEATING
fever
headache
sore throat
~ soreness in chest
adventitious breath sounds

30

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

Legionella pneumophila

Mycoplasma pneumoniae

31

What are the CXR findings in community acquired pneumonia?

infiltrates

32

How are patients categorized into groups for management of CAP?

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