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
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How often is a causative organism found in PNE?
Rarely
7
What two things are needed to diagnose pneumonia?
1. CXR
2. Clinical findings
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Evaluation of sputum sample for PNE?
>25% of epithelial cells suggests contamination; correct specimen should show polymorphonuclear leukocytes
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Differential Diagnosis for PNE?
Bacterial Bronchitis, lung cancer, exposure to moldy hay
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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.
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CURB 65 recommendations?
1- home treatment
3- severe, hospital treatment
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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
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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
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When do you do a follow CXR on patients with PNE?
If they smoke. If it has not cleared, reevaluate ABX and possible cancer
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Classic chronic bronchitis
Blue bloaters
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Classic emphysema?
Pink puffers
19
Physical Assessment for COPD?
barrel chest, prominent palpable heart, wheezes, clubbing of nails
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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
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Diagnostics in COPD?
ABG, PFTs, not usually CXR; A1 antitrypsin in patients less than 45 y.o.
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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
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What is a long acting B2 Agonist? x2
Formeterol, salmeterol
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What is an anticholinergic bronchodilator?x2
Ipratropium, tiotropium
30
Examples of inhaled steroids? x3
Beclomethasone, budesonide, fluticasone
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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
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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
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When to refer asthma to pulmonologist?
When it's the first asthma diagnosis, or after step 3
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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
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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
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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
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What medication should all patients with COPD get?
Short acting beta 2 agonist
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What is an FDA warning for long acting beta agonist in asthma?
Increased risk of death in certain groups if given without inhaled steroid
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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