COPD/Pneumonia/Asthma Flashcards Preview

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Flashcards in COPD/Pneumonia/Asthma Deck (67):
1

PNE- Organism- Streptococcus Pneumonia

Most common, rust colored sputum

2

PNE- Organism- H. Influenzae

2nd Most common in smokers and COPD

3

PNE- Organism- Staph Aureus

Rarely in younger adults, mostly older adults, usually after influenza

4

PNE- Organism- Mycoplasma Pneumonia

Walking Pneumonia- usually in younger adults

5

Signs and symptoms of Pneumonia

Sudden, rust color sputum, myalgia, prouctive cough, crackles, egophony, dense shadows on CXR, putrid sputum, Fever >100

6

How often is a causative organism found in PNE?

Rarely

7

What two things are needed to diagnose pneumonia?

1. CXR
2. Clinical findings

8

Evaluation of sputum sample for PNE?

>25% of epithelial cells suggests contamination; correct specimen should show polymorphonuclear leukocytes

9

Differential Diagnosis for PNE?

Bacterial Bronchitis, lung cancer, exposure to moldy hay

10

When does PNE need O2?

PaO2 < 55 or O2 <90%

11

What does CURB 65 measure?

C-confusion
Bun >19
RR >30
BP 65
>65 y.o.

12

CURB 65 recommendations?

1- home treatment
3- severe, hospital treatment

13

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

14

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)

15

PNE Treatment with MRSA?

Linezolid

16

When do you do a follow CXR on patients with PNE?

If they smoke. If it has not cleared, reevaluate ABX and possible cancer

17

Classic chronic bronchitis

Blue bloaters

18

Classic emphysema?

Pink puffers

19

Physical Assessment for COPD?

barrel chest, prominent palpable heart, wheezes, clubbing of nails

20

Differential dx of COPD?

Bronchitis vs emphysema and if it's reversible

21

What is the FEV1/FVC in COPD?

22

GOLD stages of COPD with FEV1 ?

All have FEV/FVC 80%- Mild
2- 50-79%- Moderate
3- 30-49%- Severe
4- <30%- Very Severe

23

Diagnostics in COPD?

ABG, PFTs, not usually CXR; A1 antitrypsin in patients less than 45 y.o.

24

When do you start patients on oxygen for COPD?

PaO2 <55 or Saturation < 88%

25

Lines of Therapy in COPD? There are 4

1. short SABA
2. Anticholinergic Bronchodilators
3. Long acting BA
4. Steroids

26

How often do you check theophylline levels? and Correct levels?

Every 6-12 months.

27

What is a short acting B2 Agonist?

Albuterol

28

What is a long acting B2 Agonist? x2

Formeterol, salmeterol

29

What is an anticholinergic bronchodilator?x2

Ipratropium, tiotropium

30

Examples of inhaled steroids? x3

Beclomethasone, budesonide, fluticasone

31

Types of Triggers for Asthma? x3

Allergens/environment, infections, psychological

32

T/F- all patients with asthma wheeze

False

33

What is asthma characterized?

Reversible inflammatory obstructive airway disease

34

Diagnosis of asthma?

PFTs, reversibility of >15 % after beta agonist

35

What will CBC show in asthma?

Elevated ESR and eosinophils

36

Differential diagnosis of asthma?

COPD, viral infection, CHF, coughs, Drugs such as BB, ASA, NSAID, ACE

37

When to refer asthma to pulmonologist?

When it's the first asthma diagnosis, or after step 3

38

What are the drugs of choice for asthma?

Inhaled corticosteroids

39

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

40

Other medications for asthma?

Cromolyn, theophilline, and omalizumab

41

When should you consider omalizumab in patients with asthma?

At step 5

42

What does lung cancer rate in the number of cancer deaths?

Highest cause of cancer

43

Who should be screened for lung cancer?

High risk patients:
>55, >30 pack year within last 15 years

44

How long does a cough with chronic bronchitis last?

3 weeks, but can last up to 4-6 weeks

45

How long does the common cold last?

7-10 days

46

In acute bronchitis, what percentage of infections are viral?

90%

47

What are the three main infectious organisms for acute bronchitis?

1. Bordetella Pertussis
2. Chlamydophila pneumonia
3. Mycoplasma pneumoniae

48

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

49

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

50

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

51

Why are atypical pathogens not susecptible to beta-lactams?

Because they do not have a cell wall

52

What antibiotics cause an increase in the QT interval?

Macrolid antibiotics

53

What do patients with pneumonia usually present with?

1. Cough (90%)
2. Dyspnea (66%)
3. Sputum production (66%)
4. Pleuritic chest pain (50%)

54

What is the most common pathogen in pneumonia in patients with COPD?

H. influenzae

55

What antibiotic do you use for patients with latent tuberculosis (no CXR findings)?

Isonizid for 6-9 months

56

When is an induration on PPD that is greater than 5 cm positive?

1. HIV
2. Recent contact with person with TB
3. CXR consistent with prior TB
4. Organ transplants
5. Immunosuprressed (prednisone, immunomodulators)

57

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

58

When is an induration on PPD that is greater than or equal to 15 cm positive?

No known risk factors for TB

59

When do you give oral steroid in COPD exacerbation?

If FEV is less than 60% of predicted.

60

How long must patients wear oxygen with COPD per day?

15 hours

61

What should all patients with COPD be referred to?

Pulmonary rehabilitation

62

What medication should all patients with COPD get?

Short acting beta 2 agonist

63

What is an FDA warning for long acting beta agonist in asthma?

Increased risk of death in certain groups if given without inhaled steroid

64

What are side effects of inhaled steroids?

Candidiasis, sore throat, and hoarseness

65

How long does the dose of oral steroids need to be before you taper them?

7 days.

66

When do symptoms of asthma commonly occur?

At night, exercise

67

What medication do most patients with COPD need and why?

Anticholinergics because the bronchioles are largely regulated by cholinergic receptors.