Exam 1 Material Flashcards
(354 cards)
1
Q
What is differential diagnosis?
A
A process where a provider differentiates between two or more conditions that could be behind a person’s symptoms.
2
Q
What is the goal of differential diagnosis?
A
To rule out each condition until one clear diagnosis emerges.
3
Q
What does the chief complaint lead to in the differential diagnosis process?
A
Hypothesis (possible diagnosis).
4
Q
What does the history of present illness (HPI) contribute to?
A
It may add other hypotheses.
5
Q
What does the review of systems (ROS) elicit?
A
Symptoms, circumstances, contributing factors that either support or eliminate possibilities.
6
Q
What does a physical exam provide in the differential diagnosis process?
A
Objective data to support or rule out diagnoses.
7
Q
Why is it important to cast a wide net at the beginning of differential diagnosis?
A
Thinking of multiple possibilities helps avoid missing something by jumping to a quick conclusion.
8
Q
How many diagnoses should Maryville University AGACNP students list for each problem/symptom?
A
A minimum of three diagnoses.
9
Q
What are the components of the differential diagnosis process?
A
- Chief Complaint
- History of Present Illness (HPI)
- Review of Systems (ROS)
- History
- Physical Exam (PE)
- Diagnostics and Results
- Diagnosis
- Plan
10
Q
What is an example of a chief complaint?
A
Cough.
11
Q
Fill in the blank: The goal of differential diagnosis is to _______ life threatening or time critical conditions.
A
rule out
12
Q
What are examples of cardiac conditions in differential diagnosis of chest pain?
A
- Unstable angina
- Heart attack
13
Q
What are examples of pulmonary conditions in differential diagnosis of chest pain?
A
- Pulmonary embolism
- Pulmonary hypertension
- Pneumonia
14
Q
What are examples of gastrointestinal conditions in differential diagnosis of chest pain?
A
- Gastroesophageal reflux disease
- Barrett’s esophagus
- Peptic ulcers
15
Q
What are examples of musculoskeletal conditions in differential diagnosis of chest pain?
A
- Fractured ribs
- Other trauma to the chest wall or sternum
16
Q
What are miscellaneous causes of chest pain?
A
- Anxiety
- Panic attacks
- Lymphoma
17
Q
What are possible diagnoses for altered mental status?
A
- Stroke
- Cerebral hypoxia
- Cerebral hemorrhage
- Seizure
- Trauma
- TBI
- Tumor
- Vasculitis
- Encephalitis
18
Q
What are possible diagnoses for dyspnea based on acute onset?
A
- Acute airway obstruction
- Pneumonia
- Acute respiratory distress syndrome
- Pneumothorax
- Acute myocardial infarction
19
Q
What are possible chronic causes of dyspnea?
A
- COPD
- Congestive heart failure
- Valvular heart disease
- Anemia
- Renal failure
20
Q
What are examples of symptoms that could be reported by patients?
A
- Shortness of breath
- Chest pain
- Fever
- Abdominal pain
- Vomiting
- Change in mental status
21
Q
What is the format for listing differential diagnoses in a note?
A
List the symptom/problem followed by at least three reasonable diagnoses.
22
Q
Fill in the blank: Differential diagnosis for hyperkalemia could include _______.
A
Kidney disease (AKI or CKD)
23
Q
What are potential causes of hypotension?
A
- Severe infection (Sepsis)
- Blood loss
- Dehydration
- Medication induced
24
Q
What is the definition of healthcare safety?
A
Protection of patients from harm during healthcare delivery.
25
What does Quality Improvement (QI) aim to achieve?
Enhancement of healthcare services to improve patient outcomes.
26
What is the goal of readmission reduction?
To decrease the number of patients readmitted to hospitals after discharge.
27
What does systems theory in healthcare safety imply?
Many accidents are due to small failures aligning; addressing one can prevent harm.
28
True or False: Errors will never happen in healthcare.
False
29
List factors that increase the likelihood of errors in healthcare.
* Fatigue
* Stress
* Interruptions
* Complexity
* Transitions
30
What percentage of inpatients experience adverse drug events (ADE)?
6-10%
31
What was the rate of adverse events found in the Harvard Medical Practice Study?
3.7%
32
What percentage of adverse events were considered preventable in the study?
58%
33
Name three common types of adverse events.
* Adverse drug events
* Wound infections
* Diagnostic errors
34
What are some prevention strategies for reducing errors?
* Checklists
* CPOE with clinical decision support
* Barcoding medication administration
* Readback verbal orders
* Standardized abbreviations
35
What are the three main components of Quality Theory?
* Structure
* Process
* Outcomes
36
What does the CQI Tool 'Plan-Do-Check-Act' focus on?
Ongoing quality improvement through small, incremental steps.
37
What are factors impacting healthcare quality?
* Stress
* Production pressure
* System design
* Research
38
Fill in the blank: Patients receive only about half of _______ care in the U.S.
[recommended]
39
What is the role of feedback in improving quality and performance?
Best given in a short time frame rather than delayed.
40
What is the Chronic Care Model?
A combined approach needed for managing chronic diseases, emphasizing team-based care.
41
What is the goal of data reporting in healthcare?
To help patients make educated choices in healthcare selection.
42
What is the purpose of Pay-For-Performance programs?
To use incentives and consequences to improve healthcare outcomes.
43
What factors contribute to readmission risk among Medicare beneficiaries?
* Chronic conditions
* Prior admissions
* Social factors
44
What is a common error risk during hospital discharge?
Handoff errors and medication errors.
45
List tools used for readmission risk reduction.
* Screening tools (e.g., LACE index, 8Ps)
* Improve communication
* Written instructions
46
What is the role of discharge planning?
To develop an individualized plan that meets patient needs.
47
What are some essential components of discharge tools?
* Medication reconciliation
* Discharge summary
* Written patient instructions
48
True or False: Many readmissions are avoidable.
True
49
What are some screening tools for assessing readmission risk?
* LACE index
* HOSPITAL score
* 8Ps
50
What strategies can be employed to reduce readmissions?
* Phone follow-up
* Home visits
* Telemonitoring
* Multi-faceted interventions
51
Name some resources for improving transitions of care.
* National Transitions of Care Coalition
* Institute for Healthcare Improvement
* Project BOOST
* Project RED
52
What are refractive errors?
Common disorder, reduced visual acuity
53
What disorders are related to the lids and lacrimal apparatus?
Disorders include conjunctival and scleral disorders
54
What is conjunctivitis?
Infection, dry eyes, allergies
55
What are common conditions affecting the cornea?
Ulcers, abrasions, trauma, keratitis
56
What does uveitis/iritis refer to?
Inflammation of the uvea
57
What are key retinal disorders?
Retinal detachment, macular degeneration, DM & HTN retinopathy
58
What is papilledema?
Swelling of the optic nerve head
59
What are the two types of visual changes noted in the subjective history?
Acute vs. chronic
60
What co-morbidities are important in ocular assessments?
HTN, DM, neurological conditions
61
What medications can have ocular effects?
Examples include respiratory bronchodilators, thiazides, anticholinergic drugs, SSRIs, SNRIs, topiramate
62
What is assessed during a physical exam of the eye?
Secretions, lid & lacrimal glands, conjunctiva, cornea, pupil size and shape
63
What is the significance of the HPI in eye assessments?
It helps determine acute vs. chronic conditions and associated factors
64
What are the key findings in acute conjunctivitis?
Copious discharge, intact visual acuity, pain is not severe, cornea clear, pupils normal
65
What is the primary treatment for viral conjunctivitis?
Supportive care
66
What characterizes bacterial conjunctivitis?
Purulent discharge, often self-limited, can last 10-14 days
67
What are the findings of a corneal ulcer?
Watery purulent discharge, blurred vision, moderate to severe pain, pupils normal, photophobia
68
What is the common cause of corneal ulcers?
Infection, but non-infectious causes should also be considered
69
What is the presentation of ocular trauma involving a foreign body?
‘Something in my eye’ with possible visualization of the foreign body
70
What symptoms indicate ocular trauma from a corneal abrasion?
Pain, photophobia, history of trauma, no evidence of foreign body
71
What are the findings in diabetic retinopathy?
Retinal vessels abnormalities, edema, exudate
72
What are the acute changes in hypertensive retinopathy?
Cotton wool spots, hemorrhage, edema, exudate
73
What is the mnemonic for eye inflammation?
IRITIS
74
What does 'I' stand for in the IRITIS mnemonic?
Increased pressure: acute closed angle glaucoma
75
What is the definition of hearing loss?
Acute vs. chronic, sensorineural vs. conductive
76
What is external otitis?
Bacterial or fungal infection external to the tympanic membrane
77
What are the common treatments for acute otitis externa?
Reduce moisture, local anti-microbial treatment
78
What is malignant external otitis?
Persistent otitis leading to osteomyelitis of the skull base
79
What are common symptoms of acute otitis media?
Fluid accumulation, otalgia, erythema, decreased TM mobility
80
What is the treatment for acute otitis media?
Oral antibiotics, surgical drainage if unresponsive
81
What does 'O' stand for in the OTITIS mnemonic?
Other referred pain
82
What does the mnemonic 'THROAT PAIN' stand for?
T: Thyroiditis
H: Herpangina, Hodgkins lymphoma
R: Retropharyngeal abscess
O: Oral ulcers: syphilis, herpes, aphthous ulcers
A: Angioneurotic edema
P: Peritonsillar abscess
A: Angina, Vincent and Ludwig angina
I: Infection: BACTERIAL – strep, GC, H flu, mycoplasma, diphtheria; VIRAL – mono, herpes, influenza, HIV/AIDS; FUNGAL – candida; OTHER – syphilis, chlamydia, toxic shock
N: Neoplasm
## Footnote
Source: Platt, Allan, PA-C. A differential diagnosis mnemonics handbook.
83
What age groups should be considered for lymphoma when assessing neck masses?
Age < 30 or > 70
## Footnote
Higher cancer risk is associated with age > 40.
84
What are the key signs to assess for airway compromise?
Stridor, respiratory effort
## Footnote
Assess your ABC’s quickly for warning signs.
85
What is the Centor criteria used for?
To aid in the diagnostic approach for Group A Beta Hemolytic Strep (GABHS)
## Footnote
It involves assessing fever, cough absence, lymphadenopathy, and tonsillar exudate.
86
What constitutes a positive Centor score for GABHS?
Score of 4: likely GABHS, treat empirically
## Footnote
0-1: unlikely to be strep; 2-3: rapid antigen test or throat culture recommended.
87
What are common risk factors for candidiasis in the oral/throat region?
Chronic immunosuppression, acute immunosuppression, DM, poor oral hygiene, dentures, anemia
## Footnote
Serious possibilities include cancer and new HIV diagnosis.
88
What symptoms suggest acute bacterial rhinosinusitis?
Purulent yellow/green nasal discharge, facial pain/pressure, fever, malaise, headache
## Footnote
Symptoms should persist for > 10 days.
89
What is the primary treatment for allergic rhinitis?
Intranasal corticosteroids, antihistamines, allergen avoidance
## Footnote
Immunotherapy may also be an option.
90
What is the treatment for Group A Beta Hemolytic Strep when confirmed?
PCN or cefuroxime, erythromycin if PCN allergic
## Footnote
Supportive care includes analgesia, anti-pyretic, anti-inflammatory.
91
What is the common presentation of squamous cell carcinoma of the larynx?
Change in voice quality, throat/ear pain, hemoptysis, dysphagia, weight loss
## Footnote
Risk factors include male gender, age 50-70, tobacco use.
92
What is the common cause of epiglottitis?
Rapid worsening sore throat, odynophagia
## Footnote
DM is a noted risk factor.
93
What are signs of deep neck infections like Ludwig angina?
Edema, erythema of the neck/chin/mouth, airway compromise potential
## Footnote
Dental causes are common.
94
What is the first-line treatment for peritonsillar abscess?
IV or oral antibiotics if able to swallow
## Footnote
Examples include Amoxicillin-sulbactam or clindamycin.
95
What is the management approach for uncontrolled epistaxis?
Direct pressure, vasoconstrictors, packing, possibly cautery
## Footnote
Urgent intervention may be necessary.
96
What is the recommended treatment for vocal cord paralysis?
Protect airway in severe cases, evaluate for cranial nerve deficits
## Footnote
Causes may include nerve damage, lesions, or tumors.
97
What are the primary risk factors for epistaxis?
Trauma, anti-coagulation, mucous membrane drying
## Footnote
Treatment may include direct pressure and packing.
98
What is the significance of a 'thumb sign' on x-ray?
Indicates epiglottitis
## Footnote
It is a classic radiological finding.
99
What does HPI stand for in pulmonary assessment?
History of Present Illness
## Footnote
HPI is crucial for understanding the patient's current health status and changes related to pulmonary disease.
100
What should be considered when assessing the reason for seeking care?
Worsening illness vs. routine follow-up
## Footnote
Understanding the reason helps determine the urgency and type of care needed.
101
What does the acronym OLD CARTS stand for in pulmonary assessments?
* Onset
* Location
* Duration
* Character
* Aggravating/relieving factors
* Radiation
* Temporal factors
* Severity
## Footnote
This acronym helps in detailing symptoms during assessments.
102
What components are included in the past medical history relevant to pulmonary assessment?
* Existing lung disease
* Comorbid diseases
* Atopy
* Cardiac history
* Upper airway issues
* Malignancy history
## Footnote
A comprehensive past medical history is vital for evaluating current pulmonary conditions.
103
What types of inhalation exposures should be reviewed in social history?
* Smoking
* Occupational exposures
* Hobby-related exposures
## Footnote
These factors can significantly impact lung health.
104
What is a common diagnostic test for assessing pulmonary function?
Pulmonary Function Testing (PFT)
## Footnote
PFTs help to assess the severity of lung function abnormalities.
105
What are the two primary types of pulmonary disorders categorized by the lungs?
* Alveolar disorders
* Interstitial disorders
## Footnote
These categories help in diagnosing specific conditions affecting lung function.
106
What are the common etiologies for acute dyspnea?
* Pulmonary embolism
* Pulmonary edema
* Obstructed airway
* Pneumothorax
* Pneumonia
* Asthma/COPD
## Footnote
These conditions often require immediate medical attention.
107
Fill in the blank: Pulse oximetry assesses _______ non-invasively.
oxygenation
## Footnote
It is a vital tool for monitoring patients' oxygen levels.
108
True or False: Hemoptysis can be a symptom of both infectious and inflammatory conditions.
True
## Footnote
It is important to assess the underlying causes of hemoptysis for appropriate management.
109
What should be considered in the differential diagnosis for cough?
* Pulmonary causes
* ENT issues
* GERD
* Malignancy
* Infection
## Footnote
A thorough differential is necessary to identify the cause of the cough.
110
What are the types of cough based on duration?
* Acute (< 3 weeks)
* Sub-acute (3-8 weeks)
* Chronic (> 8 weeks)
## Footnote
Duration helps in determining the underlying cause and treatment options.
111
What is the purpose of using a peak flow meter?
Objective assessment of airflow obstruction
## Footnote
It is commonly used for monitoring asthma and assessing acute exacerbations.
112
What factors should be assessed in dyspnea evaluation?
* Acute vs. chronic nature
* Exposures
* Positioning
* Level of exertion
* Frequency of symptoms
## Footnote
These factors help in understanding the severity and potential causes of dyspnea.
113
What does the acronym PPOPPA stand for in acute dyspnea assessment?
* Pulmonary Embolism
* Pulmonary Edema
* Obstructed airway
* Pneumothorax
* Pneumonia
* Asthma
## Footnote
This mnemonic aids in recalling critical conditions that can cause acute dyspnea.
114
What is the significance of the CURB-65 score?
It assesses pneumonia severity
## Footnote
This scoring tool helps in determining the need for hospitalization in pneumonia cases.
115
What testing is typically included in a full pulmonary function test?
* Spirometry
* Lung volumes
* DLCO
## Footnote
These tests provide comprehensive insights into lung function and capacity.
116
What are common symptoms associated with hemoptysis?
* Bright red blood
* Dark red blood
* Brown blood
## Footnote
The color of the blood can help determine the source of bleeding.
117
What are the potential non-pulmonary causes of dyspnea?
* Cardiac disease
* Anemia
* Anxiety
## Footnote
Identifying non-pulmonary causes is essential for comprehensive patient management.
118
What is a key factor in assessing the severity of a cough?
Frequency of symptoms
## Footnote
Understanding how often a patient coughs can indicate the severity of the underlying condition.
119
What is the general SpO2 level that indicates significant hypoxemia?
SpO2 < 94%
## Footnote
This threshold often necessitates further evaluation and possible intervention.
120
What is the role of bronchoscopy in pulmonary assessment?
Airway visualization and tissue sampling
## Footnote
It is often used when there are abnormalities detected on imaging.
121
What is the importance of reviewing medication history in pulmonary assessments?
Identifying potential pulmonary toxicity
## Footnote
Certain medications can have adverse effects on lung function.
122
What is the standard format for writing ABG results?
pH / PaCO2 / PaO2 / HCO3 / SaO2
123
What are the severity grades of hypoxemia based on PaO2 levels?
* ≥ 80 mmHg: None
* 60 – 79 mmHg: Mild
* 40 – 59 mmHg: Moderate
* < 40 mmHg: Severe
124
What is the cause of metabolic alkalosis?
* Acid deficit
* NG suction
* Prolonged vomiting
* Diuretics
* Base excess
* Massive transfusion
* Excess diuretics
* Excess antacids
125
What conditions can lead to metabolic acidosis?
* Lactic acidosis
* DKA
* Renal failure
* Severe diarrhea
126
What typically causes respiratory alkalosis?
* Alveolar hyperventilation
* Hyperventilation
* Anxiety
* Pain
* Fever
* Sepsis
* Pregnancy
* Severe anemia
127
What is the purpose of the Tic Tac Toe Method in ABG interpretation?
To identify primary etiology and compensation status based on pH, PaCO2, and HCO3 values.
128
What values indicate respiratory acidosis?
Caused by acute or chronic alveolar hypoventilation due to factors like CNS depression, sedation, chest wall injury, or respiratory obstruction.
129
What are the mechanisms of hypoxemia?
* Hypoventilation
* VQ mismatch
* Right-to-left shunt
* Diffusion impairment
* Reduced inspired O2
130
Fill in the blank: Hypoxemia is defined as _______ in blood.
low O2
131
What is the definition of hypoxia?
Low O2 in body or organ.
132
What is the normal range for pH in ABG results?
7.35 – 7.45
133
What is the normal range for PaCO2?
35 – 45 mmHg
134
What does SaO2 measure?
O2 bound to circulating RBCs.
135
What are the limitations of pulse oximetry?
* SpO2 < 80%
* Movement
* Bright light interference
* Intravascular interference
* Extravascular interference
* Non-functional hemoglobin
* Reduced blood flow
136
What indicates the need for ABG testing?
* Acid-base monitoring
* PaO2 or PaCO2 measurement
* Assess interventions
* Abnormal hgb evaluation
* Emergency labs when unable to establish venous access
137
What is the purpose of the A-a gradient?
To assess the PAO2 to PaO2 gradient.
138
In the ROME mnemonic, what does 'Respiratory = Opposite' mean?
pH is high, PaCO2 is low (alkalosis); pH is low, PaCO2 is high (acidosis).
139
What is the Rule of Thumb regarding pCO2 and pH changes?
For each 10 change in pCO2, pH will change by 0.1 from their base values.
140
What is the significance of the PaO2/FiO2 ratio?
It indicates oxygenation in ventilated patients.
141
What are the normal values for HCO3 in ABG results?
22 – 26 mEq/L
142
What is the effect of tissue hypoxia on brain cells compared to skeletal muscle?
Brain cell damage is irreversible within 4-6 minutes; skeletal muscle takes > 30 minutes.
143
What is the definition of oxygenation?
The process of getting O2 into the blood.
144
What is the normal range for PaO2?
80 - 100 mmHg
145
What is the definition of cellular hypoxia?
Insufficient O2 to meet tissue demand due to ischemia and/or reduced O2 content.
146
What does the pH Approach to ABG interpretation entail?
* Assess pH
* Assess PaCO2
* Assess HCO3
* Assess compensation
147
What factors can lead to inaccurate oximetry readings?
* Signal issues
* Hypoperfusion
* Hypothermia
* Abnormal Hgb
* Dyes
148
What does CXR stand for?
Chest X-ray
149
What is the primary purpose of a CXR?
Lung and heart imaging
150
List three indications for performing a CXR.
* Infection evaluation
* Acute chest pain or dyspnea
* Chronic dyspnea
151
What does CT stand for in pulmonary testing?
Computed Tomography
152
What is the primary purpose of a CT scan?
Detailed lung and thorax imaging
153
What does PFT stand for?
Pulmonary Function Testing
154
What does PFT assess?
Lung function
155
What color on an X-ray indicates bone or metal?
White
156
Fill in the blank: Abnormal findings on an X-ray that indicate water or soft tissue appear _______.
White to gray
157
What does a black color indicate on an X-ray?
Gas / air
158
What are the lobes of the lung?
* Right Upper Lobe (RUL)
* Right Middle Lobe (RML)
* Right Lower Lobe (RLL)
* Left Upper Lobe (LUL)
* Left Lower Lobe (LLL)
159
What is the importance of a lateral view in CXR?
Visualizes lower portion of the lower lobes that are limited by heart overlap in the AP view
160
What does the acronym A, B, C, D, E, F refer to in CXR review?
* A: Airway
* B: Bones
* C: Circulation
* D: Diaphragm
* E: Edges / Everything else
* F: Fields
161
What is the proper location for an ET tube in relation to the carina?
3 to 5 cm above carina
162
True or False: A pleural effusion requires 200 to 400 mL of fluid to be visualized on an X-ray.
True
163
What is the silhouette sign associated with?
Pneumonia
164
What does ARDS stand for?
Acute Respiratory Distress Syndrome
165
Chest CT is preferred over MRI for most _______ indications.
pulmonary
166
What is the primary indication for pulmonary function testing?
Assessing lung function
167
What two types of lung diseases can PFT help assess?
* Obstructive lung disease
* Restrictive lung disease
168
What does DLCO stand for?
Diffusing capacity of the lungs for carbon monoxide
169
What is a clinical pearl regarding PFTs in hospitals?
Used primarily for diagnosing suspected COPD / asthma
170
What is the significance of the FEV1/FVC ratio in PFT?
Helps evaluate COPD / asthma
171
Fill in the blank: A central venous catheter should be located in the _______.
Superior vena cava above right atrium
172
What is indicated by a ground glass appearance on an X-ray?
Pulmonary edema
173
What should be assessed before administering contrast for a CT scan?
Creatinine / renal function
174
What is Obstructive Sleep Apnea (OSA)?
Repetitive narrowing/closure of upper airway during sleep, resulting in intermittent oxygen level reduction
## Footnote
OSA can range from snoring to complete airway closure.
175
What are common physiologic reactions to OSA?
* Neurologic: brain arousal & disruption of sleep
* Cardiovascular: SNS activation, ↑ HR, ↑ BP
* Endocrine: ↑ BG, ↑ nocturia
## Footnote
SNS stands for sympathetic nervous system.
176
What is the prevalence of OSA in males aged 50-70?
29%
## Footnote
This prevalence increases with age and BMI.
177
What is the STOP-Bang OSA Risk Assessment used for?
To assess the risk of OSA using both subjective and objective data
## Footnote
It includes criteria like snoring, tiredness, observed apneas, and BMI.
178
What does a score of ≥5 on the STOP-Bang indicate?
High risk for OSA
## Footnote
A score of 3-4 indicates intermediate risk.
179
What are common symptoms of OSA during the day?
* Sleepiness
* Non-restorative sleep
* Fatigue
## Footnote
Symptoms can vary significantly across individuals.
180
What are common night symptoms of OSA?
* Awakenings
* Gasping/choking
* Insomnia
* Nocturia
## Footnote
Bedpartners may observe snoring and apneas.
181
What is the Epworth Sleepiness Scale (ESS)?
A tool with a total of 24 points where >10 indicates significant sleepiness
## Footnote
It assesses the severity of sleepiness but is not specific to OSA.
182
What are the main goals of chronic OSA therapy?
* Dilate/stabilize airway during sleep
* Manage side effects
* Assess adherence
## Footnote
Treatment options include PAP machines, dental appliances, or surgery.
183
What is the most common treatment for OSA?
PAP machine
## Footnote
Patients often use masks at home for therapy.
184
What are the objectives of inpatient OSA management?
* Identify high risk, untreated OSA
* Monitor high risk patients
* Maintain PAP therapy
## Footnote
Continuous oximetry is often used during treatment.
185
What complications may arise in patients with complicated OSA?
* Lung disease with hypoxia
* Heart failure
* Neuromuscular disease
* Obesity hypoventilation
## Footnote
These conditions may require non-invasive ventilation.
186
What does CPAP stand for?
Continuous Positive Airway Pressure
## Footnote
It is a common treatment modality for OSA.
187
Fill in the blank: The mnemonic for OSA symptoms is ______.
I SNORED
## Footnote
Each letter represents a symptom associated with OSA.
188
What is the recommended action for a patient using a PAP machine after hospitalization?
Do NOT use supplies used in the hospital and call DME company for new disposable supplies
## Footnote
This is to reduce the risk of infection transmission.
189
What does AHI stand for in the context of OSA testing?
Apnea-Hypopnea Index
## Footnote
It measures the severity of OSA based on the frequency of abnormal breaths.
190
True or False: Home OSA testing is contraindicated in patients with serious lung, heart, or neurological diseases.
True
## Footnote
These conditions require more controlled testing environments.
191
What are common co-morbidities associated with OSA?
* Hypertension
* Coronary artery disease (CAD)
* Congestive heart failure (CHF)
* Atrial fibrillation (a-fib)
* Type 2 diabetes mellitus (DM)
## Footnote
Mood disorders such as depression and anxiety are also common.
192
What is the significance of a neck circumference greater than 15.7 inches in OSA assessment?
It indicates a higher risk for OSA
## Footnote
Neck circumference is one of the physical exam findings assessed.
193
What is pneumonia?
An inflammatory response in the lung parenchyma primarily caused by microorganism infection (ex: bacterial, viral, fungal)
## Footnote
Causes can also be non-infectious.
194
What are the types of pneumonia?
* CAP: Community acquired
* HAP: Hospital-acquired
* VAP: Ventilator-associated
* Aspiration
* Atypical (ex: legionella, mycoplasma)
* Viral (ex: influenza, SARS, RSV)
* Fungal (ex: pneumocystis jiroveci)
## Footnote
Anaerobic and lung abscess occur in both settings.
195
What are common symptoms of pneumonia?
* Cough
* Dyspnea (on exertion / at rest)
* Sputum
* Fever / chills / sweats / rigors
* Chest discomfort / pleuritic pain
* Scant hemoptysis
* Malaise, myalgia, fatigue, anorexia
* Headache
* Abdominal pain
## Footnote
Symptoms can vary based on the age and health status of the patient.
196
What factors should be assessed in the history for pneumonia?
* Travel (host exposure & ddx considerations)
* Sick contacts
* Immunization status (influenza, pneumococcal)
* Smoking / e-cigarette / vaping status
* Comorbidities
* Immunocompromised status
* Recent treatment for presenting complaint
## Footnote
Understanding these factors can help identify the underlying cause.
197
What are key physical exam findings in pneumonia?
* Cough (dry or productive)
* Lung consolidation
* Percussion: dullness
* Palpation: Tactile fremitus - spoken '99' ↑ over consolidation
* Auscultation: increased lung sounds over consolidated areas, adventitious sounds (crackles, rhonchi, wheezing)
* Vital signs: ↑ temp, ↑ RR, ↑ HR, ↓ BP, ↓ SpO2
## Footnote
Severe signs include cyanosis and respiratory distress.
198
How does pneumonia present differently in older adults?
Symptoms may be more subtle or non-specific, such as confusion, drowsiness, fatigue, headache, falls, functional decline, nausea, loss of appetite. Fever response may be blunted or absent in 25% of cases
## Footnote
Increased respiratory rate and hypoxemia suggest poorer prognosis.
199
What is the CURB-65 scoring system used for?
To guide admission decisions for pneumonia based on:
* Confusion
* BUN > 19 mg/dL
* Respiratory rate ≥ 30
* SBP < 90 or DBP ≤ 60 mmHg
* Age ≥ 65
## Footnote
A score of 2 or more suggests admission, while 3 or more indicates assessment for ICU care.
200
What are common laboratory tests used in pneumonia assessment?
* CBC with differential
* Chemistry panels (electrolytes, renal function)
* Blood cultures (if bacteremia suspected)
* Procalcitonin
* ABG (assess oxygenation & ventilation)
## Footnote
Procalcitonin helps differentiate bacterial vs. viral infections.
201
What radiographic tests are used for pneumonia diagnosis?
* CXR 2 view (preferred)
* CT (used in select cases only)
## Footnote
Findings may include infiltrate, opacity, consolidation, cavitary lesions, and pleural effusion.
202
What are the goals of acute pneumonia management?
* Identify signs of clinical deterioration
* Treat underlying microbial cause
* Support oxygenation and hemodynamics
* Support co-morbid conditions
* Reduce risk of complications
* Discharge planning / transition of care
## Footnote
Goals include minimizing readmission rates.
203
What are the considerations for antibiotic initiation in pneumonia?
* Environmental factors
* Host factors (immunocompromised, comorbidities)
* Allergies, recent antibiotics
* Etiology (bacterial, non-bacterial)
## Footnote
Recent antibiotic therapy increases the risk of drug resistance.
204
What are the antibiotic choices for outpatient treatment of CAP?
* Healthy: macrolide (ex: clarithromycin or azithromycin) or tetracycline (doxycycline)
* More complicated patient: respiratory fluoroquinolone (ex: levofloxacin) or macrolide + beta-lactam (amoxicillin)
## Footnote
Choice depends on patient health status.
205
What is the SMART-COP tool used for?
To score the need for ICU admission based on:
* Systolic BP
* Multilobar involvement
* Respiratory rate
* Tachycardia
* New-onset confusion
* Poor oxygenation
* Low arterial pH
## Footnote
It helps in assessing the severity of pneumonia.
206
What are the major criteria for ICU admission in pneumonia cases?
* Septic shock with vasopressor support
* Respiratory failure with ventilatory support
## Footnote
Minor criteria include RR ≥ 30, hypoxemia, confusion, and multilobar pulmonary opacities.
207
What is the recommended antibiotic regimen for critically ill patients with Pseudomonas risk?
Anti-pneumococcal, antipseudomonal beta-lactam (ex: pip-tazo) PLUS azithromycin or respiratory fluoroquinolone
## Footnote
Alternative options include aminoglycosides like gentamicin.
208
In the treatment of MRSA, which antibiotics can be added?
Vancomycin or linezolid
## Footnote
This addition is critical for patients at risk for MRSA.
209
What factors increase the risk of multi-drug resistant (MDR) organisms?
* Prior antibiotics within 90 days
* Unit has high resistance rates
* Acute renal replacement therapy pre-PNA
* Co-morbidities / illnesses
## Footnote
These factors are essential to consider in treatment planning.
210
What are the first-line antibiotic options for HAP without multi-drug resistance risk factors?
* Piperacillin-tazobactam
* Cefepime
* Levofloxacin
* Imipenem
* Meropenem
## Footnote
These options are based on current guidelines.
211
What is the treatment approach for HAP with high mortality risk or VAP with MRSA and MDR/Pseudomonas risk?
Choose ONE agent from EACH category:
1. Antipseudomonal Beta-lactam (ex: cefepime, imipenem, piperacillin-tazobactam)
2. Second antipseudomonal (ex: respiratory fluoroquinolone or aminoglycoside)
3. MRSA coverage (vanco IV or linezolid IV)
## Footnote
This multi-faceted approach is crucial for managing high-risk pneumonia.
212
What is the recommended antiviral treatment for influenza?
Oseltamivir
## Footnote
This is the standard antiviral recommended for influenza infection.
213
For older adults with community-acquired pneumonia and no comorbidities, what is the treatment?
Macrolide or doxycycline
## Footnote
This treatment is effective for otherwise healthy older adults.
214
In older adults with co-morbidities, what antibiotics are considered for CAP?
Respiratory fluoroquinolone or beta-lactam + macrolide
## Footnote
This combination is recommended to cover potential complications.
215
What are the risk factors for aspiration/anaerobic pneumonia?
* Aspiration
* Decreased LOC
* Seizures
* General anesthesia
* CNS disease
* Esophageal disease
* Disrupted defenses (e.g., trach, NG)
* Periodontal disease / poor dental hygiene
## Footnote
These factors contribute to the likelihood of developing anaerobic pneumonia.
216
What are clinical findings indicative of aspiration/anaerobic pneumonia?
* Pneumonia symptoms
* Sputum purulent, foul smelling
* Effect dependent lung zones at time of aspiration
## Footnote
These findings help in diagnosing and managing the condition.
217
What describes a lung abscess?
* Thick walled
* Cavitary
* Air-fluid level
* Solitary lesion
## Footnote
Lung abscesses require prolonged treatment until resolution.
218
In immunocompromised hosts, what types of pneumonia should be considered?
* Fulminant pneumonia – think bacterial
* Insidious pneumonia – consider viral, fungal, protozoa, mycobacterium
## Footnote
Understanding the type of pneumonia helps tailor appropriate treatment.
219
What is a key consideration in the treatment of immunocompromised hosts with pneumonia?
Empiric therapy may be warranted vs. invasive diagnostic approaches
## Footnote
This decision is crucial due to the complexity of infections in these patients.
220
What is the significance of Alpha 1 antitrypsin deficiency in COPD?
Consider with family history of COPD, particularly if presentation at ages 30’s – 40’s and/or non-smokers.
## Footnote
Alpha-1 antitrypsin level <20 – 30% normal needs further testing.
221
What are the acute conditions to differentiate in COPD differential diagnosis?
* Heart Failure (HF)
* Pulmonary Embolism (PE)
* Infection
* Cardiac disorders
## Footnote
Assess infectious symptoms and overlapping disorders.
222
What are the chronic conditions to consider in COPD differential diagnosis?
* Asthma
* Infection (e.g., TB)
* Malignancy
* PE
* Obstructive Sleep Apnea (OSA)
* Hypothyroidism
* Neuromuscular disease
## Footnote
Assess overlapping disorders.
223
What are the key PFT findings for diagnosing COPD?
FEV1/FVC ratio <0.70 post-bronchodilator and absence of reversible airflow limitation.
## Footnote
Normal FVC >80% predicted.
224
What symptoms support the clinical diagnosis of COPD in patients older than 40?
* Progressive dyspnea
* Cough
* Sputum production
## Footnote
These symptoms are crucial for diagnosis.
225
What findings on a chest CT support a diagnosis of COPD?
Emphysema findings.
## Footnote
CT provides assessment of lung parenchyma.
226
What is the GOLD classification for mild COPD?
FEV1 ≥ 80% (GOLD 1).
227
What is the GOLD classification for moderate COPD?
FEV1 50 - 79% (GOLD 2).
228
What is the GOLD classification for severe COPD?
FEV1 30 – 49% (GOLD 3).
229
What is the GOLD classification for very severe COPD?
FEV1 < 30% (GOLD 4).
230
What are hallmark symptoms of COPD exacerbation?
* Worsening dyspnea
* Increased cough frequency/severity
* Change in sputum volume or character
## Footnote
Consider symptoms like myalgia, fever, and sore throat.
231
What are the components of the Modified Medical Research Council (MMRC) Dyspnea Scale?
Grade 0: Not troubled by breathlessness except on strenuous exercise.
Grade 1: Shortness of breath when hurrying on level or walking up slight hill.
Grade 2: Walks slower than people of same age due to breathlessness.
Grade 3: Stops for breath after walking about 100 m.
Grade 4: Too breathless to leave the house.
## Footnote
GOLD criteria define “more symptoms” as mMRC ≥ 2.
232
What pharmacologic agents could be used in COPD management?
* Phosphodiesterase inhibitors
* Methylxanthines
* Mucolytics
* Alpha-1 Antitrypsin augmentation therapy
* Antibiotics for exacerbation
## Footnote
Alternate agents may be considered based on individual patient needs.
233
What are the goals of COPD chronic management?
* Reduce symptoms
* Reduce frequency and severity of exacerbations
* Improve health status and exercise tolerance
* Control chronic inflammation
* Prevent/treat exacerbations
## Footnote
GOLD publications provide extensive recommendations.
234
What are the indicators for hospitalization in COPD patients?
* Significantly increased symptoms
* Severe underlying COPD
* Failure to respond to outpatient management
* Serious comorbidities
* Frequent exacerbation history
* Older age
* Insufficient home support
## Footnote
Hospitalization may be necessary for various acute and chronic factors.
235
What does a FEV1 < 30% predicted indicate in older adults with COPD?
Predictors of poor prognosis.
236
What is the definition of chronic bronchitis?
Clinical finding of persistent cough/sputum production due to abnormal enlargement of mucous glands.
237
What is the definition of emphysema?
Pathologic finding of permanent enlargement of air spaces due to alveolar wall destruction and deformation.
238
What are common physical exam findings in advanced COPD?
* Barrel-shaped chest
* Low diaphragm
* Prolonged expiratory phase
* Accessory muscle use
* Adventitious breath sounds
## Footnote
Clubbing is not a COPD specific symptom.
239
What should be assessed in acute exacerbation management of COPD?
* Short acting inhaled β-agonist
* Systemic corticosteroids
* Broad spectrum antibiotics
* Supplemental oxygen
* Non-invasive ventilation if needed
## Footnote
Review text and reading materials for detailed recommendations.
240
What is the role of oximetry in COPD management?
Assess for worsened hypoxemia from baseline.
241
What is the significance of medication adherence in COPD management?
Essential for assessing COPD control and preventing exacerbations.
242
What does a lack of reversibility with bronchodilators indicate?
Diagnosis of COPD, unlike asthma.
243
What is the typical age presentation for Alpha-1 antitrypsin deficiency related COPD?
Presentation in the 30s or 40s.
244
What is asthma?
Chronic inflammatory disorder of the airways
245
What characterizes airflow obstruction in asthma?
At least partially reversible component
246
What are common symptoms of asthma exacerbations?
Worsened symptoms compared to baseline
247
What is the strong association related to asthma?
Atopy
248
What can trigger asthma exacerbations?
Identifiable triggers
249
What is the severity classification for asthma exacerbation based on initial PEF?
Mild: ≥ 70%, Moderate: 40-69%, Severe: < 40%, Life threatening: < 25%
250
What initial PEF percentage indicates a mild asthma exacerbation?
≥ 70%
251
What is a critical PEF percentage for life-threatening asthma exacerbation?
< 25%
252
Which conditions are common causes of nocturnal cough in older adults?
Asthma, COPD, and HF
253
What should be assessed to determine asthma control?
PEF or FEV1, symptom control, rescue therapy frequency, current therapy
254
Fill in the blank: A decrease of _____ from baseline indicates poor asthma control.
20%
255
What factors increase the risk of asthma exacerbation?
Poor clinical control, frequent exacerbations, admission to critical care, exposure to risk factors
256
What is a key diagnostic feature for asthma?
↓ FEV1/FVC ratio (< 0.70) with significant reversibility
257
What does a normal FVC indicate in asthma diagnosis?
Normal FVC (> 80% predicted)
258
What is the purpose of allergy testing in asthma assessment?
Evaluating the role of allergy in asthma
259
What are common triggers for asthma?
* Allergen mediated
* Inhaled irritants
* Upper respiratory infections
* Exercise
* Anxiety / Stress
* GERD
260
What are the goals of asthma care?
Risk reduction, minimize symptoms, prevent exacerbation, reduce ED visits/hospitalization
261
What is the initial management for a mild asthma exacerbation?
Short acting inhaled β-agonist (SABA)
262
What additional interventions may be needed for severe asthma exacerbations?
Ipratropium bromide, non-invasive/invasive ventilation, Mg sulfate IV
263
What mnemonic is used to remember signs of life-threatening asthma exacerbation?
SHOCK: Silent chest, Hypotension, One third of best PEF, Cyanosis, Konfusion
264
What are the classes of bronchodilators primarily used in asthma?
* Short acting beta agonist (SABA)
* Long acting beta agonist (LABA)
* Inhaled anticholinergics
265
What is the role of inhaled corticosteroids in asthma management?
Airway inflammation mediators, routinely administered
266
What medication is reserved for exacerbations or difficult to control asthma?
Oral steroids
267
What should be considered in older adults when prescribing asthma medications?
Cautions with beta-blockers, ACE inhibitors, NSAIDs
268
True or False: All asthma medications can cause side effects.
True
269
What is a pneumothorax?
A pneumothorax occurs when air is allowed into the pleural space.
270
What are common causes of pneumothorax?
Causes include trauma, medical procedures, or spontaneous occurrence.
271
Who is at higher risk for spontaneous pneumothorax?
Young men, particularly those around 10 years old.
272
What can happen when air pressure builds within the pleural space?
A tension pneumothorax can occur, causing mediastinal shift and impaired venous return to the heart.
273
What should be included in the history of present illness (HPI) for pneumothorax?
Recent procedures or trauma, acute onset dyspnea, and possibly pain.
274
What signs may indicate a developing tension pneumothorax?
Evidence of hemodynamic instability and mediastinal shift.
275
What findings may be noted on physical exam for tension pneumothorax?
Reduced breath sounds and splinting by the patient.
276
What is the main diagnostic tool for pneumothorax?
Chest x-ray.
277
Why can small-volume pneumothorax be difficult to detect?
Small-volume pneumothorax may be challenging to visualize, requiring optimal patient positioning.
278
What additional imaging may be used for smaller pneumothorax?
CT scan.
279
What role do arterial blood gas and EKG play in pneumothorax evaluation?
They are used for differential diagnosis and patient evaluation, not for diagnosing pneumothorax.
280
What are other potential causes of acute dyspnea to consider?
Pulmonary embolism and pneumonia.
281
When may a clinical diagnosis of pneumothorax be sufficient?
When rapid intervention is needed without radiographic imaging.
282
What are the initial goals of care for a patient with pneumothorax?
Stabilization and intervention in unstable patients.
283
What is a potential emergency intervention for tension pneumothorax?
Straight needle decompression.
284
What is the temporary measure for an open pneumothorax?
Three-sided occlusive dressing.
285
What management may be appropriate for small-volume pneumothorax?
Supplemental oxygen and frequent clinical monitoring with serial chest x-ray follow-up.
286
Where is a standard chest tube typically placed?
Between the fourth and fifth intercostal space at the mid-axillary line.
287
What is a consideration for surgical intervention in pneumothorax?
Surgery may be considered to reduce recurrence in select patients.
288
What should patients be educated about regarding pneumothorax?
Behavioral modifications to reduce risk.
289
What are pleural effusions?
Accumulation of fluid within the pleural space causing increased work of breathing, reduced lung expansion, and potentially hypoxemia and hypercarbia.
290
Where do free-flowing pleural effusions typically accumulate due to gravity?
In the lung bases.
291
What is a common outcome for patients with underlying cancer regarding pleural effusion?
It is a common outcome but a poor prognostic sign, especially in breast and lung cancer.
292
What are the two main types of pleural effusions based on etiology?
Transudative and exudative.
293
What condition is most commonly associated with transudative effusions?
Heart failure.
294
What types of conditions can cause exudative effusions?
* Infections
* Malignancy
* Pleural disease.
295
How do chronic diseases typically affect the onset of pleural effusions?
The onset is typically more insidious.
296
What symptoms may present in patients with larger pleural effusions?
* Decreased breath sounds
* Abnormal findings on percussion
* Increased work of breathing
* Anxiety.
297
What is the initial imaging modality used to detect pleural effusion?
Chest x-ray.
298
What additional imaging techniques can be used to identify pleural effusion?
* Ultrasound
* CT scan.
299
What is thoracentesis?
A procedure to remove fluid from the pleural space for diagnosis or treatment.
300
What laboratory tests are typically ordered for pleural fluid analysis?
* Serum analysis
* Complete blood count.
301
Why may older adults tolerate pleural effusions more poorly than younger individuals?
Due to age-related changes in pulmonary reserve and overall health.
302
What similar conditions may present with findings similar to pleural effusion?
* Pulmonary edema
* Pulmonary infection.
303
What criteria are commonly used to diagnose an exudative effusion?
Light's criteria.
304
How does a transudative effusion differ from an exudative effusion?
Transudative effusions are typically not characterized by the presence of protein and have a low white blood count.
305
What factors should be assessed when evaluating a patient with pleural effusion?
* Size of the effusion
* Rate of accumulation
* Patient tolerance.
306
What is a potential intervention for a patient with a progressive or large pleural effusion?
Hospital admission for observation and potential intervention.
307
What supportive care may unstable patients with pleural effusions require?
Respiratory support.
308
What are the acute interventions for managing pleural effusions?
* Respiratory support
* Pharmacologic interventions for pain and dyspnea.
309
What complications should be monitored for after thoracentesis?
* Hypertension
* Pulmonary edema
* Inflammatory reactions.
310
What is pulmonary tuberculosis caused by?
Mycobacterium tuberculosis complex
## Footnote
Mycobacterium tuberculosis is an acid-fast bacillus.
311
How is pulmonary tuberculosis primarily spread?
Through respiratory droplets
312
What type of disease is tuberculosis characterized as?
Chronic granulomatous disease
313
What has contributed to the resurgence of tuberculosis?
The HIV pandemic
314
What is a major challenge in treating tuberculosis?
Resistance to multiple drugs
315
What characteristics were historically used to identify tuberculosis?
Acid-fastness and resistance to de-colorization techniques
316
What does latent TB mean?
Exposure without clinical disease
317
Which type of tuberculosis is more common in HIV patients?
Reactivation tuberculosis
318
What are common symptoms of tuberculosis?
* Cough
* Night sweats
* Anorexia
* Weight loss
* Fever
* Chest pain
* Dyspnea
319
What is a significant part of patient assessment for tuberculosis?
Risk factors
320
What does the tuberculin skin test assess?
Exposure to tuberculosis
321
What is the main diagnostic tool for evaluating tuberculosis?
Chest x-ray
322
What findings on a chest x-ray are common in tuberculosis?
* Patchy opacities
* Consolidation
* Cavitation
* Hilar adenopathy
323
What should be assessed in older adults regarding tuberculosis?
Higher risk of developing tuberculosis and risk of death
324
What are the two phases of chronic treatment for tuberculosis?
* Intensive phase
* Continuation phase
325
What is the typical duration for continuation therapy in tuberculosis treatment?
Four months
326
How is the intensive phase of tuberculosis treatment typically administered?
Four-drug therapy regimen daily
327
What is a key consideration before initiating therapy in newly diagnosed tuberculosis patients?
Patient adherence to medication therapy
328
What should be done if a patient presents with known tuberculosis?
Consider isolation awaiting negative sputum findings
329
What is the approach to treating latent TB compared to active TB?
Utilizes fewer medications
330
What organization provides extensive information on tuberculosis management?
Centers for Disease Control and Prevention
331
What is the typical method for assessing sputum in tuberculosis diagnosis?
AFB staining
332
What is an alternative method for assessing tuberculosis exposure?
Blood test
333
True or False: Chest x-rays are diagnostic for tuberculosis.
False
334
Fill in the blank: Tuberculosis is spread from person to person through _______.
respiratory droplets
335
What is influenza?
A highly contagious respiratory virus that can cause significant morbidity and mortality
336
How does the severity of influenza vary?
It varies dramatically from year-to-year due to variation in strain prevalence
337
What are the types of influenza?
Types A, B, and C, with subtypes H and N used to further classify type A
338
Which influenza types primarily infect humans?
Types B and C are primarily human-based viruses
339
Who are at highest risk of morbidity and mortality from influenza?
Specific high-risk groups such as the elderly, young children, and individuals with chronic illnesses
340
What are common systemic symptoms that distinguish influenza from the common cold?
Fever, chills, rigors, and malaise
341
What atypical presentation may older patients have with influenza?
Altered mental status or absence of typical respiratory symptoms
342
What testing options are available for diagnosing influenza?
Multiple testing options, with immediate tests losing sensitivity compared to longer tests
343
What additional evaluations may be considered in suspected systemic illness or respiratory complications?
Blood tests and a chest x-ray
344
What should be done if a febrile illness is suspected to be infectious?
Take a careful travel and sick contact history and consider isolation measures
345
What is the goal when managing a person with suspected influenza?
Rapid access to antiviral therapy unless contraindicated
346
What routes can antiviral therapy be delivered?
Oral, inhaled, or intravenous routes
347
What measures should be taken during hospitalization for suspected influenza?
Reduce the chance of disease spread to hospital workers, family members, and other patients
348
What role do patients play in reducing disease spread?
Practice hand hygiene and cough etiquette, and limit exposure to others
349
What is recommended for high-risk groups during influenza season?
Aggressive promotion of immunization
350
What should healthcare workers do to control disease transmission?
Get immunized against influenza
351
What is the importance of education in controlling influenza transmission?
Helps reduce morbidity and mortality and informs on hygiene and immunization
352
Where can additional resources about influenza be found?
CDC website and local public health agencies
353
True or False: Influenza can present without respiratory symptoms.
True
354
Fill in the blank: Influenza testing must be determined on a _______ basis.
case-by-case
