Lower Respiratory Disorders

Question 1

What are the primary pathologies strep pneumoniae is implicated in?

Answer 1

Sinusitis, CAP, AOM, Bronchitis, Meningitis

Question 2

If you have a bacterial infection causing bronchitis, what do you give?

Answer 2

Macrolide, Doxycycline, or Bactrim.

Question 3

When would you hospitalize someone for asthma?

Answer 3

If initial FEV1 50% predicted after 1 hour.

Question 4

After taking an inhaled bronchodilator/B2 agonist, how much of an improvement would you expect to see in FEV1?

Answer 4

15%

Question 5

What is the primary purpose of B2 adrenergic agonists? What are examples?

Answer 5

short-acting, quick relief for symptoms or before exercise.

Ex= albuterol

Question 6

What is the primary purpose of inhaled corticosteroids? Any particular considerations?

Answer 6

For control/maintenance. Side effects include oral thrush/candida so patients need to be instructed to rinse their mouth out; and sore throat.
Ex. Budesonide (Pulmicort) and Triamcinolone (Azmacort).

Question 7

What is the progression/management of asthma?

Answer 7

SABA–> ICS–> increase ICS or add LABA–> add anticholinergics (ipratropium bromide) if secretions–> stabilizing/maintenance med such as leukotriene receptor antagonist.

Question 8

What is an example of a long-acting B2 agonist?

Answer 8

salmeterol (serevent)

Question 9

What is an example of a antileukotriene?

Answer 9

montelukast (singulair

Question 10

What airway diseases are obstructive in nature?

Answer 10

asthma, chronic bronchitis, and emphysema (= COPD)

Question 11

What differentiates chronic bronchitis from emphysema?

Answer 11

Chronic bronchitis: >35, copious purulent sputum production; stocky, obese; normal chest AP diameter; Hct increased.
Emphysema: >50, mild clear sputum, chest AP diameter increased; thin, wasted; hyperresonance; progressive, constant dyspnea

Question 12

What would you expect to see on a Chest XRay on someone with COPD?

Answer 12

flattened diaphargm

Question 13

What is the management of COPD?

Answer 13

1. Stop smoking
2. Avoidance of irritants or allergies
3. Postural drainage to clear excess secretions
4. Inhaled ipratropium bromide

Question 14

What are typical signs/symptoms of CAP?

Answer 14

fever/shaking chills, purulent sputum, lung consolidation, malaise, increased fremitus

Question 15

What are atypical sign/symptoms of CAP?

Answer 15

cough, HA, sore throat, excessive sweating, soreness in the chest

Question 16

What are atypical PNU pathogens?

Answer 16

Legionella pneumophilia, Mycoplasma pneumoniae, and Chlamydophilia pneumoniae

Question 17

What is the management of CAP in patients

Answer 17

A macrolide (Azithromycin, Clarithromycin, Erythromcycin) or Doxycycline.
*Monitor for QT prolongation with Azith

Question 18

What is the treatment for CAP in those with comorbid illness or who are >60?

Answer 18

Fluoroquinolone (Levofloxacin, Gemifloxacin, or Moxifloxacin).
*Monitor for achilles tendon rupture as reported by heel pain.

Question 19

What are the differential diagnoses in night sweats?

Answer 19

TB. Lymphoma. Menopause. AIDS/HIV. Endocarditis.

Question 20

What are the diagnostics for TB?

Answer 20

Culture of M. tuberculosis (AFB) x 3 and a small homogenous infiltrate in upper lobes by CXR

Question 21

What is your next step if your patient has a + PPD?

Answer 21

A Chest XRay

Question 22

What is your next step if you patient has a + PPD and a - Chest XRay?

Answer 22

Start on INH prophylaxis

Question 23

What do you do if your patient has a + PPD, + Chest XRay, and + Culture?

Answer 23

Start on 4-drug TB regimen with Isoniazid, Rifampin, Pyrazinamide, and ethambutol (RIPE) x 6-9 months.

Question 24

If the TB isolate proves to be fully susceptible to INH and Rif, what do you do?

Answer 24

Drop the ethambutol. Continue RIP daily x 2 months and then just IF daily x 4 months.

Question 25

What special considerations should be taken with patients taking ethambutol?

Answer 25

Visual acuity and red-green color perception testing

Question 26

What is considered to be a positive PPD test in those with HIV or have known contacts with TB?

Answer 26

5mm

Question 27

What is considered a positive PPD test for someone with no risk factors?

Answer 27

15mm

Question 28

What is considered a positive PPD test for healthcare workers or for immigrants from high prevalence countries?

Answer 28

10mm

Question 29

Which PFTs test lung volume?

Answer 29

TLC (volume of gas in lungs after inspiration), FRC (functional residual capacity), RV (volume of gas remaining in lungs after maximal expiration)

Question 30

What does FVC represent?

Answer 30

volume of gas forcefully expelled from the lungs after maximal inspiration

Question 31

What PFTs would you expect to find in obstructive diseases?

Answer 31

(can't get air out) reduced airflow rates, therefore volumes will be WNL

Question 32

What PFTs would you expect to find in restricitive disease (PNU)?

Answer 32

reduced volumes (can't get air in), normal expiratory flow rates.

Question 33

What do F values represent?

Answer 33

Airflow rates

Question 34

How is intermittent asthma treated? What are some characteristics of intermittent asthma?

Answer 34

nighttime awakenings 0-2/month. use of SABA

Question 35

You have a patient who reports asthma symptoms at least two days/week, with nighttime awakenings 2 times/month. He reports some limitation in his activities. His PFTs are normal. Where would you classify his asthma as of today?

Answer 35

Mild Persistent. | *Treated with Low-dose ICS.

Question 36

What are the four classifications of asthma?

Answer 36

Intermittent. Mild Persistent. Moderate Persistent. Severe Persistent.

Question 37

When would you consider adding a short course of oral steroids into the regimen for asthma management?

Answer 37

If asthma moderate-severe persistent.

Question 38

When would you consult with an asthma specialist for a child 0-4 yrs old? 5-12? > 12yrs?

Answer 38

0-4yrs: at step 3, possibly step 2 5-12yrs: step 4, possibly step 3 >12yrs: step 4, possibly step 3

Question 39

What is a normal ESR range, encompassing men and women of any age?

Answer 39

15-30