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Flashcards in LOW RESPIRATORY DISORDERS Deck (73):
1

Define bronchitis

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

2

What viruses cause acute bronchitis

rhinovirus, coronavirus, adenovirus

3

What bacteria cause bronchitis

mycoplasma pneumoniae, step pneumoniae, H.Flu, Moraxella

4

s/sx of acute bronchitis

productive cough
HA
wheezing

5

Physical findings with acute bronchitis

NO EVIDENCE OF LUNG CONSOLIDATION
CTA
RESONANCE TO PERCUSSION
upper airway rhonchi CLEARS WITH COUGHING
afebrile or low grade for 10-15 days with viral
more pronounced fever with bacterial

6

What diagnostics for acute bronchitis

none unless diagnosis is unclear then do a CXR and sputum culture and sensitivity

7

Management of acute bronchitis

supportive
humidifiers
increase fluid intake
cough sup presents judiciously
analgesics for chest soreness or fever
B2 adrenergic agonist ALBUTEROL, PROVENTIL for wheezing
ANTIBIOTICS ONLY FOR BACTERIAL INFECTIONS-macrolides, doxy, TMP/SMZ

8

normal percussion

RESONANCE

9

HYPERRESONANCE to percussion indicates

air trappin

10

What are ominous signs and red flags of asthma

fatigue, absent breath sounds, paradoxical chest/abdominal movement, inability to maintain recumbency, cyanosis

11

what type of percussion for asthma

hyperresonance

12

what kind of labs/ diagnostics for asthma

slight elevation in WBC with eosinophilia
PFTs reveal abnormalities typical of obstructive dysfunction
Will generally see improvement in FVC or FEV1 of 15% or FEF 25-75 of 25% after an inhaled bronchodilator
initially respiratory alkalosis expected as the primary acid/base imbalance
chest xray is unnecessary unless to rule out other conditions; may show hyperinflation

13

what PFTs are you to consider hospitalization?

initial FEV150% predicted after 1 hour of treatment

14

Management of asthma step by step

1) SABA (albuterol, proventil) for symptom relief or before exercise
2) Daily maintenance inhaled corticosteroid (eg budesonide/pulmicort, triamcinolone/ azmacort
3)SABA for symptoms breakthrough
4) if symptoms persist, increase inhaled corticosteroids OR add LABA (salmeterol/serevent). other options theophylline or anti mediators
5) inhaled anticholinergics (ipratroprium bromide/atrovent) may be added if necessary
6) Antileukotrienes useful in the maintenance of chronic asthma (montelukast/singular)

15

what are some LABA

salmeterol (serevent)

16

what is an example of an anticholinergic

ipratroprium bromide (atrovent)

17

what is a SE of inhaled corticosteroid

candidal infection of the oropharynx, dry mouth, and sore throat

18

what are some inhaled corticosteroids

budesonide (pulmicort) and triamcinolone (azmacort)

19

define chronic bronchitis

characterized by excessive secretion of bronchial music and is manifested by productive cough for 3 months or more in at least 2 consecutive years

20

define emphysema

abnormal, permanent enlargement of the alveoli

21

s/sx of chronic bronchitis

intermittent mild to moderate dyspnea
onset after 35
copious sputum (purulent)
body habits (stocky, obese)
chest A-P diameter normal
percussion normal
hyperinflation on CXR
hematocrit increased

22

s/sx of emphysema

progressive, constant dyspnea
onset after 50
mild sputum (clear)
body habits (thin/wasted)
cest A-P diameter increased
percussion hyperresonant
hematocrit normal
total lung capacity increased

23

What are the labs/diagnostics for chronic bronchitis

Low flattened diaphragm by CXr
FEV1 and all other measurements of expiatory airflow reduced
TLC, FRC, and RV may be increased

24

What are the labs/diagnostics of emphysema

Low flattened diaphragm by CXr
FEV1 and all other measurements of expiatory airflow reduced
TLC, FRC, and RV may be increased

25

What position may help clear secretions

postural drainage

26

What is the mainstay of therapy for chronic bronchitis

inhaled ipratropium bromide (atrovent) or sympathomimetics

27

What is the mainstay of therapy for emphysema?

inhaled ipratropium bromide (atrovent) or sympathomimetics

28

What is the most common agent of CAP in adults?

streptococcus pneumoniae

29

What are s/sx of typical pneumonia

fever/shaking chills
purulent sputum
lung consolidation on physical exam
malaise
INCREASED FREMITUS

30

S/sx of atypical PNA

think ENT
cough
HA
sore throat
excessive sweating
fever
soreness in the chest

31

what is the other term for atypical PNA

walking PNA

32

Pathogens of atypical PNA

legionella pneumophilia, mycoplasma pneumoniae, and chlamydophila pneumoniae

33

labs/ diagnostics for PNA

elevated WBCs (may be low in immunocomproised or elderly
infiltrates by CXR
GS and culture if indicated
CXR and consider blood cultures as needed

34

management of CAP in healthy patients (

a macrolide, such as azithromycin (zithromax), clarithromycin (biaxin), erythromycin or doxycycline

35

management of CAP in patients with other health problems (e.g. COPD, diabetes, heart failure, or dance or >60 years old with no recent antibiotic use)

flouroquinolone, such as levofloxacin (levaquin), gemifloxacin (factive) or moxifloxacin (avelox)

36

what is the BBW on azithromycin

prolongation of QT interval

37

What are some sites of tuberculosis other than pulmonary?

lymphatics, GU, bone, meninges, peritoneum and the heart

38

what is the population with increased risk for TB

crowded living conditions, the institutionalized, HIV positive persons, and those affected with diabetes, chronic renal insufficiency, malignancy, malnutrition, and other forms of immunosuppression

39

s/sx of TB

MAJORITY ARE ASYMPTOMATIC
fatigue, anorexia
dry cough, progressing to productive and sometimes blood tinged
weight loss, low grade fever
NIGHT SWEATs

40

how do you make a definitive diagnosis of TB

culture of M.TB x3

41

what are AFB smears presumptive of

active TB

42

what would you see on CXR for TB

small homogeneous infiltrate in upper lobes by CXR (RUL)

43

what does a positive PPD indicate?

exposure. Not a diagnostic for active disease. Repeat CXR in 6 months. may consider 6-9 months of prophylactic INH

44

what is the management of TB

notify local health department
hospitalization is not required by should be considered if the patient is non-compliant or is likely to expose susceptible individuals (negative pressure room)

45

Medication regimen for TB

Isoniazid 300mg, rifampin 600mg, pyrazinamide 1.5gm-2gm and ethambutol 15mg/kg. If the isolate proves to be susceptible to INH and RIF, then the fourth drug may be dropped
continue the first 3 drugs daily for 2 months, then 4 more months of INH and RIF daily

46

how long should persons with HIV be treated for TB

9 months

47

what would you drop if rifampin and INH are effective for TB

drop the ethambutol

48

What kind of monitoring therapy is there for TB

pulmonary TB- weekly sputum smears and cultures for the first 6 weeks after initiation therapy then monthly until negative cultures documented

49

What would raise suspicion of TB drug resistance

continued symptoms or positive cultures after 3 months of therapy

50

What kind of baseline evaluation is needed for TB and therapy

LFTs, CBC, serum creatinine should be obtained at baseline
patients taking ethambutol should be tested for visual acuity and red-green color perception

51

Which patients should receive 6 months of INH?

Positive PPD
1)5mm for HIV infected persons, contacts of a known case or persons with a chest film typical for TB
2) a positive test 10mm for immigrants from high prevalence areas or those in high risk groups or healthcare workers
3) a positive test is 15mm for all others not in high prevalence groups

52

FVC

volume of gas forcefully expelled form the lungs after maximal inspiration

53

FEV1

Volume of gas expelled in the first second of the FVC maneuver

54

FEV25-75

maximal mid-expiratory airflow rate

55

PEFR

maximal airflow rate achieved in FVC maneuver

56

What PFTs characterize obstruction

reduced airflow rate:FVC, FEV1, FEV25-75, PEFR

57

What PFTs characterize restrictive disease?

reduced volumes and expiratory flow rates- TLC, FRC, RV

58

TLC

volume of gas in lungs after maximal inspiration

59

FRC

functional residual capacity

60

RV

volume of gas remaining in lungs after maximal expiration

61

What are causes of restrictive lung disease

obesity, cystic fibrosis, PNA, lung resection

62

transudates

clear

63

exudates

cream color- high in LDH content

64

empyema

pus

65

hemorrhagic

blood

66

what happens to total lung capacity and vital capacity in the gero population?

Total lung capacity remains constant but vital capacity (the volume of air that can be forcibly exhaled) decreases because residual volume increases (the amount of air remaining in the lungs after maximum expiration)

67

what happens to alveolar surface area in the gero population?

decreases up to 20% which reduces maximal oxygen uptake (i.e. overtime exercise capacity declines secondary to less reserve). alveoli also collapse more easily

68

what happens to response to hypoxia and hypercapnia in the gero population?

decreases

69

with PNA, at least___% of all cases are among adults over 65 years old

50%

70

Most common pathogens in of PNA in the elderly

strep pneumoniae, gram negative bacilli, (H flu, moraxella catarrhalis, klebsiella) and staph aureus

71

clinical finding of PNA in the elderly

classic, expected signs may be absent
weakness; decreased ADLs
anorexia, poor appetite
tachypnea and/or SOB
tachycardia
fever with cough productive of sputum
confusion or mental changes

72

How will CXR in gero look with PNA?

may have multiple presentations based on the offending pathogen
bacterial PNA can present with bronchopna, lobar pan, or other locations on CXR
Viral PNA
may be present as bilateral interstitial infiltrates
aspiration PNA may be localized to the right middle lobe or show diffuse involvement

73

what symptom is seen in asthma but not COPd?

pulsus paradoxus >12mmHg