Diagnosis and Management of Lower Respiratory Disorders Flashcards by W W

Q

Acute inflammation of the upper airways presenting with persistent cough and sputum production; mucous membranes become edematous and hyperemic

A

Acute Bronchitis

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Q

__________

Systemic disease caused by M. tuberculosis

A

Tuberculosis

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Q

Atypical Pneumonia: Management
1. Healthy patients (< 60 years of age with no comorbidities - no recent antibiotic use): a.
A macrolide, such as _______ (Zithromax), clarithromycin (Biaxin), erythromycin, fluoroquinolones, or doxycycline

A

azithromycin

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Q

Typical Pneumonia: Management

Patients with other health problems (e.g., COPD, diabetes, heart failure, or cancer or > 60 years of age, no recent antibiotic use):
a. Fluoroquinolone, such as _________ (Levaquin), gemifloxacin (Factive), or moxifloxacin (Avelox), or beta-lactam plus a macrolide

A

levofloxacin

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Q

Typical Pneumonia: Management
1. Healthy patients (< 60 years of age with no comorbidities - no recent antibiotic use): a.
A macrolide, such as _________ (Zithromax), clarithromycin (Biaxin), erythromycin, or doxycycline

A

azithromycin

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Q

Laboratory/Diagnostics Pneumonia
1. ______ WBCs (maybe low in immunocompromised
or elderly)
2. Infiltrates by CXR
3. GS and culture if indicated
4. CXR and consider blood cultures as needed

A

Elevated

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Q

Atypical Pneumonias: Pathogens
Caused by atypical pathogens such as
C_______ pneumoniae

A

Chlamydophila

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Q

Atypical Pneumonias: Pathogens
Caused by atypical pathogens such as
M________ pneumoniae

A

Mycoplasma

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Q

Atypical Pneumonias: Pathogens
Caused by atypical pathogens such as
L_______ pneumophila,

A

Legionella

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Q

Atypical Pneumonia: Signs/Symptoms

Cough
Headache
______ _________
Excessive sweating
Fever
Soreness in the chest

A

Sore throat

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Q

Typical Pneumonia: Signs/Symptoms
Fever/shaking chills
Purulent sputum
Lung \_\_\_\_\_\_\_\_ on physical exam 
Malaise
Increased fremitus

A

consolidation

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Q

_________ pneumoniae is the most common etiological agent of community-acquired pneumonia (CAP) in adults.

A

Streptococcus

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Q

________
Inflammation of the lower respiratory tract as microorganisms gain access by aspiration, inhalation, or hematogenous dissemination; accounts for 10% of admissions to medical services

A

Pneumonia

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Q

Out-Patient Management: (Chronic Bronchitis/Emphysema) .*

5. Inhaled tiotropium bromide (______) promotes bronchodilation

A

Spiriva

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Q

Out-Patient Management: (Chronic Bronchitis/Emphysema) .*

Inhaled ipratropium bromide (______) or
sympathomimetics: Mainstay of therapy

A

Atrovent

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Q

Out-Patient Management: (Chronic Bronchitis/Emphysema) .*

3. _____ drainage may clear excess secretions

A

Postural

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Q

Out-Patient Management: (Chronic Bronchitis/Emphysema) .*

2. Avoidance of irritants or ______

A

allergens

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Q

Out-Patient Management: (Chronic Bronchitis/Emphysema) .*

________ of smoking

A

Discontinuation

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Q

Patients usually have features of both (Chronic Bronchitis/Emphysema) .
Laboratory/Diagnostics
3. TLC, FRC, and RV maybe ______

A

increased

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Q

Patients usually have features of both (Chronic Bronchitis/Emphysema) .
Laboratory/Diagnostics
2. FEV1 and all other measurements of expiratory airflow _______

A

reduced

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Q

Patients usually have features of both (Chronic Bronchitis/Emphysema) .
Laboratory/Diagnostics
1. Low, ______ diaphragm by CXR

A

flattened

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Q

Emphysema

8. Total lung capacity ______

A

increased

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Q

Emphysema

7. Hematocrit _____

A

normal

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Q

Emphysema

6. Percussion _______

A

hyper resonant

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Emphysema | 5. The Chest A-P diameter ________

increased

Emphysema | 4. Body habitus (_____, wasted)

thin

Emphysema | 3. ___ sputum (clear)

Mild

Emphysema 2. The onset of symptoms after age ___

50

Emphysema 1. Progressive, constant ______

dyspnea

Chronic Bronchitis 8. Hematocrit _______

increased

Chronic Bronchitis 7. _______ on CXR

Hyperinflation

Chronic Bronchitis 6. Percussion _____

normal

Chronic Bronchitis 5. Chest A-P diameter _______

normal

Chronic Bronchitis 4. Body habitus (_____, obese)

stocky

Chronic Bronchitis 3. _____ sputum production (purulent)

Copious

Chronic Bronchitis 2. The onset of symptoms after age _____

35

Chronic Bronchitis Intermittent mild to moderate _____

dyspnea

Abnormal, permanent enlargement of the alveoli

Emphysema

Characterized by excessive secretion of bronchial mucus and is manifested by productive cough for three months in at least two consecutive years

Chronic bronchitis

Management Asthma: 6. Antileukotrienes useful in the maintenance of chronic asthma [e.g., montelukast (_____)]

Singulair

Management Asthma: 5. Inhaled anticholinergics [e.g., ____ ______ (Atrovent)] may be added if necessary

ipratropium bromide

Management Asthma: 4. If symptoms persist, increase inhaled corticosteroids or add long-acting B2 adrenergic agonists [e.g., Salmeterol (_____)]; other options: ________ or antimediators

Serevent | theophylline

Management Asthma: 2. Daily maintenance with inhaled corticosteroids (e.g., Budesonide (Pulmicort), Triamcinolone (Azmacort, etc.)] a. Side effects include candidal infection of the oropharynx, dry mouth, and _____ _____

sore throat

Management Asthma: 2. Daily maintenance with inhaled corticosteroids (e.g., Budesonide (______), Triamcinolone (_______, etc.)] a. Side effects include candidal infection of the oropharynx, dry mouth, and sore throat

Pulmicort | Azmacort

Management Asthma: | Short-acting B2 adrenergic agonist [e.g., Albuterol (_______)] for symptom relief or before exercise

Proventil

Laboratory/Diagnostics Asthma: | 5. The chest x-ray is ________ unless to rule out other conditions; may show hyperinflation

unnecessary

Laboratory/Diagnostics Asthma: | 5. The chest x-ray is ________ unless to rule out other conditions; may show hyperinflation

unnecessary

Laboratory/Diagnostics Asthma: | 4. Initially, respiratory _____ expected as the primary acid/base imbalance

alkalosis

Laboratory/Diagnostics Asthma: | 3. Will generally see improvement in FVC or FEV 1 of 15% or FEF 25 to 75 of __% after an inhaled bronchodilator

25%

Laboratory/Diagnostics Asthma: 2. PFTs reveal abnormalities typical of obstructive dysfunction b. Hospitalization is recommended if peak flow is < ___ liters/minute initially or does not improve to > 50% predicted after one hour of treatment.

60

Laboratory/Diagnostics Asthma: 2. PFTs reveal abnormalities typical of obstructive dysfunction a. Hospitalization is recommended if the initial FEVI is < ____% predicted or does not increase to at least 40% predicted after one hour of vigorous therapy.

30

Laboratory/Diagnostics Asthma: | Slight WBC elevation with _________

eosinophilia

Signs/Symptoms of Asthma: *** Ominous signs include fatigue, absent breath sounds, _______ chest/abdominal movement, inability to maintain recumbency, cyanosis, and others ***

paradoxical

Signs/Symptoms of Asthma: 7. Pulsus paradoxus > ___ mm Hg 8. Hyperresonance 9. Cough 10. Chest tightness

12

Signs/Symptoms of Asthma: | 6. Pulse > ____ bpm

110

Signs/Symptoms of Asthma: | 5. Respiratory rate > ____ bpm

28

Causes Asthma: 1. Dust mites 2. Pets (cat, dog) 3. Cockroaches 4. Indoor molds 5. _________ 6. Cigarette smoke

Exercise

_________ Increased responsiveness of the trachea and bronchi to stimuli, manifested by narrowing of the airways; hypertrophy of smooth muscle, mucosal edema and hyperemia, thickening of the epithelial basement membrane, hypertrophy of mucus glands, acute inflammation, and plugging of airways by thick, viscid mucus

Asthma

``` Management Acute Bronchitis: 1. Supportive treatment 2. Humidifiers 3. Increase fluid intake 4. Cough suppressants used judiciously 5. Analgesics for chest soreness or fever 6. B2 adrenergic agonists [Albuterol (Proventil)] for wheezing 7. Antibiotics indicated only for bacterial infections a. __________ b. Doxycycline c. Trimethoprim-sulfamethoxazole ```

Macrolides

Laboratory/Diagnostic Findings Acute Bronchitis: 1. Usually, none indicated 2. If the diagnosis is unclear: a. ________ culture and sensitivity b. CXR

Sputum

Physical Exam Findings Acute Bronchitis: 1. No evidence of lung consolidation a. Clear to auscultation b. Resonance to percussion c. Upper airway rhonchi clear with coughing 2. ______ or low-grade temperature (viral) 3. More pronounced temperature (bacterial)

Afebrile

Signs/Symptoms of Acute Bronchitis 1. Productive cough 2. _________ 3. Wheezing

Headache

Causes/Incidence of Acute Bronchitis: | 4. Most common in patients < ____ years old

50

Causes/Incidence of Acute Bronchitis: | 3. Increased incidence in _____

smokers

Causes/Incidence of Acute Bronchitis: 2. Bacterial: Mycoplasma pneumoniae, Streptococcus pneumonia, _____, Moraxella catarrhalis

H. flu

Causes/Incidence of Acute Bronchitis: | Viral: Rhinovirus, ______, adenovirus

coronavirus

Systemic disease caused by M. tuberculosis

Tuberculosis

1. The most common clinical presentation is pulmonary disease

Tuberculosis

Tuberculosis | 2. Other sites of involvement include lymphatics, genitourinary, ______, meninges, peritoneum, and the heart

bone

Tuberculosis 3. Patients at increased risk include those in crowded living conditions; the institutionalized; ____-positive persons; and those afflicted with diabetes, chronic renal insufficiency, malignancy, malnutrition, and other forms of immunosuppression.

HIV

``` Tuberculosis Signs/Symptoms 1. Majority of patients are asymptomatic 2. ____, anorexia 3. Dry cough progressing to productive and sometimes blood-tinged 4. Weight loss, low-grade fever 5. Night sweats ```

Fatigue

Laboratory / Diagnostics: Tuberculosis 1. Definitive diagnosis by culture of M. _____ X 3 2. AFB smears are presumptive evidence of active TB 3. Small homogeneous infiltrate in upper lobes by CXR 4. PPD shows exposure: Not diagnostic for active disease; repeat CXRin six months

tuberculosis

Laboratory / Diagnostics: Tuberculosis | 2. ___ smears are presumptive evidence of active TB

AFB

Laboratory / Diagnostics: Tuberculosis | 3. Small homogeneous infiltrate in _____ lobes by CXR

upper

Laboratory / Diagnostics: Tuberculosis | 4. ______ shows exposure: Not diagnostic for active disease; repeat CXRin six months

PPD

Management: Tuberculosis | 1. The local health department should ____ notified of all cases of TB.

be

Management: Tuberculosis 2. Hospitalization is not required but should be considered if the patient is non-compliant or is likely to expose susceptible individuals ( _______ pressure room).

negative

Medication Regimen: Tuberculosis | 1. _____ 300 mg, rifampin 600 mg, pyrazinamide 1.5 to 2.0 gm, and ethambutol 15 mg/ kg initially

Isoniazid

Medication Regimen: Tuberculosis | 2. If the isolate proves to be fully susceptible to INH and RIF, then the fourth drug may be _____.

dropped

Medication Regimen: Tuberculosis | 3. Continue the first three drags daily for ___ months, then four more months of INH and RIF daily.

two

Medication Regimen: Tuberculosis | 4. Persons with HIV should be treated for ____ months.

nine

Medication Regimen: Tuberculosis | 5. A variety of DOT options are also available at ________ times weekly dosing,

twice/three

Monitoring Therapy: Tuberculosis 1. Patients with pulmonary TB should have _____ sputum smears and cultures for the first six weeks after initiation of therapy, then monthly until negative, cultures documented.

weekly

Monitoring Therapy: Tuberculosis | 2. Continued symptoms or positive cultures after ____ months should raise the suspicion of drug resistance. "

three

Baseline Evaluation: Tuberculosis | 1. Liver function studies, CBC, and serum _____ should be obtained at baseline.

creatinine

Baseline Evaluation: Tuberculosis | 2. Patients taking ethambutol should be tested for visual acuity and ______ color perception.

red-green

Chemoprophylaxis Those with a positive skin test should receive six months of INH: 1. A positive test is ____ mm for HW infected persons, contacts of a known case, or persons with a chest film typical for TB.

5

Chemoprophylaxis Those with a positive skin test should receive six months of INH: 2. A positive test is ___ mm for immigrants from high prevalence areas, or those in high-risk groups, or health care workers.

10

Chemoprophylaxis Those with a positive skin test should receive six months of INH: 3. A positive test is ____ mm for all others not in high prevalence groups.

15

Pulmonary Function Tests The volume of gas forcefully expelled from the lungs after maximal inspiration FEV1

FVC

Pulmonary Function Tests The volume of gas expelled in the first second of the FVC maneuver

FEV1

Pulmonary Function Tests Maximal mid-expiratory airflow rate

FEV 25-75

Pulmonary Function Tests Maximal airflow rate achieved in FVC maneuver

PEFR

Pulmonary Function Tests The volume of gas in the lungs after maximal inspiration

TLC

Pulmonary Function Tests Functional residual capacity

FRC

Pulmonary Function Tests The volume of gas remaining in the lungs after maximal expiration

RV

______ diseases characterized by reduced airflow rates; lung volumes within the normal range or larger

Obstructive

_______ diseases characterized by reduced volumes and expiratory flow rates

Restrictive

Types of Pleural Effusions 1. ___________ 2. Exudates 3. Empyema 4. Hemorrhagic

Transudates

Gerontology Considerations Pulmonary 1. Physiologic changes a. Lungs become _____

stiffer

Gerontology Considerations Pulmonary 1. Physiologic changes b. Respiratory muscle strength and endurance _____

diminish

Gerontology Considerations Pulmonary 1. Physiologic changes c. The chest wall becomes more _____

rigid

Gerontology Considerations Pulmonary d. Total lung capacity remains constant, but: ____ ____ (the volume of air that can be forcibly exhaled) decreases because of residual volume increases (the amount of au" remaining in the lungs after maximum expiration).

Vital capacity

Gerontology Considerations Pulmonary 1. Physiologic changes e. ______ AP diameter

Increased

Gerontology Considerations Pulmonary 1. Physiologic changes f. __________ to percussion

Hyperresonance

Gerontology Considerations Pulmonary 1. Physiologic changes g. Alveolar surface area decreases up to _____%, which reduces maximal oxygen uptake (i.e., over time, exercise capacity declines secondary to less "reserve").

20

Gerontology Considerations Pulmonary 1. Physiologic changes h. Alveoli ______ more easily

collapse

Gerontology Considerations Pulmonary 1. Physiologic changes i. The number of cilia _______

diminishes

Gerontology Considerations Pulmonary 1. Physiologic changes j. The number of mucus-producing cells _____

increases

Gerontology Considerations Pulmonary 1. Physiologic changes k. ______ cough reflex

Decreased

Gerontology Considerations Pulmonary 1. Physiologic changes l. _______ response to hypoxia and hypercapnia

Decreased

Possible findings/results: Gerontology Considerations a. ______ pulmonary functional reserve

Reduced

Possible findings/results: Gerontology Considerations b. D__

DOE

Possible findings/results: Gerontology Considerations c. Exercise ______

intolerance

Possible findings/results: Gerontology Considerations d. Decreased chest/lung ______

expansion

Possible findings/results: Gerontology Considerations e. Less effective _______

exhalation

Possible findings/results: Gerontology Considerations f. ______ mucus clearance

Decreased

Possible findings/results: Gerontology Considerations g. ______ risk of atelectasis, infection, and bronchospasm

Increased

Gerontology Considerations: Pneumonia 1. PEARLS in the Elderly a. At least ____% of all cases are among adults over 65 years of age.

50

Gerontology Considerations: Pneumonia 1. PEARLS in the Elderly b. Those living in a long term care facility have a ___% risk of development over a period of two years.

30

Gerontology Considerations: Pneumonia 1. PEARLS in the Elderly c. Most common pathogens: ________ pneumoniae, gram-negative bacilli (Haemophilus influenza, Moraxella catarrhalis, Klebsiella), and Staph aureus

Streptococcus

d. Clinical findings: Gerontology Considerations: Pneumonia a. Classic, expected signs may be absent. b. Weakness; decreased ADLs c. Anorexia/poor appetite d. Tachypnea and/or SOB e. ________ f. Fever with cough productive of sputum g. Confusion or mental status changes

Tachycardia

e. CXR findings: Gerontology Considerations: Pneumonia 1. May have ______presentations based on the offending pathogen

multiple

e. CXR findings: Gerontology Considerations: Pneumonia 2. ______ pneumonia can present with either bronchopneumonia, lobar pneumonia, or other locations on the CXR.

Bacterial

e. CXR findings: Gerontology Considerations: Pneumonia 3. ______ pneumonia may present as bilateral interstitial infiltrates.

Viral

e. CXR findings: Gerontology Considerations: Pneumonia 4. _______ pneumonia may be localized to the right middle lobe or show diffuse involvement.

Aspiration