Flashcards in COPD/Pneumonia/Asthma Deck (67):
PNE- Organism- Streptococcus Pneumonia
Most common, rust colored sputum
PNE- Organism- H. Influenzae
2nd Most common in smokers and COPD
PNE- Organism- Staph Aureus
Rarely in younger adults, mostly older adults, usually after influenza
PNE- Organism- Mycoplasma Pneumonia
Walking Pneumonia- usually in younger adults
Signs and symptoms of Pneumonia
Sudden, rust color sputum, myalgia, prouctive cough, crackles, egophony, dense shadows on CXR, putrid sputum, Fever >100
How often is a causative organism found in PNE?
What two things are needed to diagnose pneumonia?
2. Clinical findings
Evaluation of sputum sample for PNE?
>25% of epithelial cells suggests contamination; correct specimen should show polymorphonuclear leukocytes
Differential Diagnosis for PNE?
Bacterial Bronchitis, lung cancer, exposure to moldy hay
When does PNE need O2?
PaO2 < 55 or O2 <90%
What does CURB 65 measure?
CURB 65 recommendations?
1- home treatment
3- severe, hospital treatment
Treatment for uncomplicated PNE? with no recent use or comorbidities
Macrolid or doxycycline
1. Azyithromycin 500 mg QD x 3 days
2. Doxycycline 100 mg BID x 7 days
Treatment for PNE with recent ABX in last three months? or Comorbidities
1. Levofloxacin 750 mg x 7 days;
2. Azithromycin 500 + amoxicillin 750 mg 93-4 g/day)
PNE Treatment with MRSA?
When do you do a follow CXR on patients with PNE?
If they smoke. If it has not cleared, reevaluate ABX and possible cancer
Classic chronic bronchitis
Physical Assessment for COPD?
barrel chest, prominent palpable heart, wheezes, clubbing of nails
Differential dx of COPD?
Bronchitis vs emphysema and if it's reversible
What is the FEV1/FVC in COPD?
GOLD stages of COPD with FEV1 ?
All have FEV/FVC 80%- Mild
2- 50-79%- Moderate
3- 30-49%- Severe
4- <30%- Very Severe
Diagnostics in COPD?
ABG, PFTs, not usually CXR; A1 antitrypsin in patients less than 45 y.o.
When do you start patients on oxygen for COPD?
PaO2 <55 or Saturation < 88%
Lines of Therapy in COPD? There are 4
1. short SABA
2. Anticholinergic Bronchodilators
3. Long acting BA
How often do you check theophylline levels? and Correct levels?
Every 6-12 months.
What is a short acting B2 Agonist?
What is a long acting B2 Agonist? x2
What is an anticholinergic bronchodilator?x2
Examples of inhaled steroids? x3
Beclomethasone, budesonide, fluticasone
Types of Triggers for Asthma? x3
Allergens/environment, infections, psychological
T/F- all patients with asthma wheeze
What is asthma characterized?
Reversible inflammatory obstructive airway disease
Diagnosis of asthma?
PFTs, reversibility of >15 % after beta agonist
What will CBC show in asthma?
Elevated ESR and eosinophils
Differential diagnosis of asthma?
COPD, viral infection, CHF, coughs, Drugs such as BB, ASA, NSAID, ACE
When to refer asthma to pulmonologist?
When it's the first asthma diagnosis, or after step 3
What are the drugs of choice for asthma?
6 steps of asthma treatment?
1- SABA PRN
2- low dose steroid
3. Low steroid + LABA
4. Med Steroid + LABA
5. High Steroid + LABA, ? omalizumab?
6- High ICS +STeroid+oral steroid + omalizumab
Other medications for asthma?
Cromolyn, theophilline, and omalizumab
When should you consider omalizumab in patients with asthma?
At step 5
What does lung cancer rate in the number of cancer deaths?
Highest cause of cancer
Who should be screened for lung cancer?
High risk patients:
>55, >30 pack year within last 15 years
How long does a cough with chronic bronchitis last?
3 weeks, but can last up to 4-6 weeks
How long does the common cold last?
In acute bronchitis, what percentage of infections are viral?
What are the three main infectious organisms for acute bronchitis?
1. Bordetella Pertussis
2. Chlamydophila pneumonia
3. Mycoplasma pneumoniae
What three things are not recommended for acute bronchitis, and which medication is?
Not recommended: abx, expectorants, and inhaler
Recommended as Needed: Albuterol, sometimes oral steroids if severe
What are the two different types of pneumonia vaccinations and what do they cover?
1. Pneumovax- 23 serotypes
2. PCV or Prevnar- 13 serotypes- 50 years and older
What is a consequence of using macrolids such as clarithromycin or erythromycin? (x2)
1. Should not be used with Calcium channel blockers for hypotension
2. Should not be used with statin for increased risk of rhabdo
Why are atypical pathogens not susecptible to beta-lactams?
Because they do not have a cell wall
What antibiotics cause an increase in the QT interval?
What do patients with pneumonia usually present with?
1. Cough (90%)
2. Dyspnea (66%)
3. Sputum production (66%)
4. Pleuritic chest pain (50%)
What is the most common pathogen in pneumonia in patients with COPD?
What antibiotic do you use for patients with latent tuberculosis (no CXR findings)?
Isonizid for 6-9 months
When is an induration on PPD that is greater than 5 cm positive?
2. Recent contact with person with TB
3. CXR consistent with prior TB
4. Organ transplants
5. Immunosuprressed (prednisone, immunomodulators)
When is an induration on PPD that is greater than or equal to 10 cm positive?
1. Recent Immigrant (<5 years)
2. Injection drug user
3. Residents and employees of high-risk congregate settings
4. Mycobactteriology laboratory personal
5. Persons with clinical conditions that place that at high risk
6. Children less than 4
7. Infants, children, and adolescents exposed to adults in high-risk categories
When is an induration on PPD that is greater than or equal to 15 cm positive?
No known risk factors for TB
When do you give oral steroid in COPD exacerbation?
If FEV is less than 60% of predicted.
How long must patients wear oxygen with COPD per day?
What should all patients with COPD be referred to?
What medication should all patients with COPD get?
Short acting beta 2 agonist
What is an FDA warning for long acting beta agonist in asthma?
Increased risk of death in certain groups if given without inhaled steroid
What are side effects of inhaled steroids?
Candidiasis, sore throat, and hoarseness
How long does the dose of oral steroids need to be before you taper them?
When do symptoms of asthma commonly occur?
At night, exercise