Module 5 Buttaro Ch 84-97 Flashcards
(37 cards)
A patient develops a dry, nonproductive cough and is diagnosed with bronchitis. Several days
later, the cough becomes productive with mucoid sputum. What may be prescribed to help
with symptoms?
a. Antibiotic therapy
b. Antitussive medication
c. Bronchodilator treatment
d. Mucokinetic agents
b. Antitussive medication
Acute bronchitis is characterized by a cough that last 1-3 weeks. 90% of cases is caused by viral (influenza). May or may not have purulent colored mucus. May have wheeze or low grade fever but vitals are stable. Typically dx with a cough last ~ 7 days. Average duration 7-10 days. self-limiting. but antitussive can help (dexamethorophan, codeine)
Other treatment: humidified air, increase in fluid intake
Antibiotic
therapy is generally not needed and should be avoided unless a bacterial cause is likely.
Bronchodilator medications show no demonstrated reduction in symptoms and are not
recommended.
Mucokinetic agents have no evidence to support their use.
An adult patient who had pertussis immunizations as a child is exposed to pertussis and develops a runny nose, low-grade fever, and upper respiratory illness symptoms without a paroxysmal cough. What is recommended for this patient?
a. A prescription for a macrolides
b. Isolation if paroxysmal cough develops
c. Pertussis vaccine booster
d. Symptomatic care only
a. A prescription for a macrolides
cough lasting ~ 2 weeks with symptoms of paroxysmal cough is typical of pertussis even though this patient does not have the typical pertussis symptoms he was exposed and therefore should be treated like he has it. treatment is macrolides antibiotics (azithromycin)
Trimethoprim-sulfamethoxazole is prescribed for
pertussis when macrolides are not an option.
Adults previously immunized against pertussis may still get the disease without the classic
whooping cough sign seen in children and are contagious from the beginning of the catarrhal
stage of runny nose and common cold symptoms.
Macrolide antibiotics are useful for
reducing symptoms and for decreasing shedding of bacteria to limit spread of the disease.
Patients should be isolated for 5 days from the start of treatment.
Pertussis vaccine booster
will not alter the course of the disease once exposed. Symptomatic care only will not reduce
symptoms or decrease disease spread.
A 35-year old patient develops acute viral bronchitis. Which is the focus for the management of symptoms in this patient? a. Trimethoprim-sulfamethoxazole therapy b. Antibiotic therapy c. Supportive care d. Antitussive therapy
c. Supportive care
Acute bronchitis is characterized by a cough that last 1-3 weeks. 90% of cases is caused by viral (influenza). May or may not have purulent colored mucus. May have wheeze or low grade fever but vitals are stable. Typically dx with a cough last ~ 7 days. Average duration 7-10 days. self-limiting. but antitussive can help (dexamethorophan, codeine)
Other treatment: humidified air, increase in fluid intake
Data suggest that 85% of patients diagnosed with acute bronchitis will
improve without specific treatment.
Trimethoprim-sulfamethoxazole is prescribed for
pertussis when macrolides are not an option.
Antibiotic therapy is not effective in treating
viral acute bronchitis.
A patient is seen in clinic for an asthma exacerbation. The provider administers three
nebulizer treatments with little improvement, noting a pulse oximetry reading of 90% with 2 L
of oxygen. A peak flow assessment is 70%. What is the next step in treating this patient?
a. Administer three more nebulizer treatments and reassess.
b. Admit to the hospital with specialist consultation.
c. Give epinephrine injections and monitor response.
d. Prescribe an oral corticosteroid medication.
b. Admit to the hospital with specialist consultation
Patients having an asthma exacerbation should be referred if they fail to improve after three
nebulizer treatments or three epinephrine injections, have a peak flow less than 70% and a
pulse oximetry reading less than 90% on room air.
Giving more nebulizer treatments or
administering epinephrine is not indicated. The patient will most likely be given IV
corticosteroids; oral corticosteroids would be given if the patient is managed as an outpatient.
An adult develops chronic cough with episodes of wheezing and shortness of breath. The
provider performs chest radiography and other tests and rules out infection, upper respiratory,
and gastroesophageal causes. Which test will the provider order initially to evaluate the
possibility of asthma as the cause of these symptoms?
a. Allergy testing
b. Methacholine challenge test
c. Peak expiratory flow rate (PEFR)
d. Spirometry
d. Spirometry
spirometry
- is the most common type of PFT
- shows how much air you can breath in and out of your lungs
- used to confirm asthma
- used to determine efficacy of treatment
- used to monitor lung disease and determine treatment
Peak expiratory flow rate
- is a measure of how fast one can forcefully exhale after a full inhalation
- can help determine if a patient’s airway is narrowing.
- used by patients to keep their SYMPTOMS under control
- patients use this at home to determine action plan
PEF 50%-79% pt is in need of SABA
PEF > 50% need emergency care
Allergy testing is performed only if allergies are a possible trigger. \
The methacholine
challenge test is performed if spirometry is inconclusive.
A patient diagnosed with asthma calls the provider to report having a peak flow measure of
75%, shortness of breath, wheezing, and cough, and tells the provider that the symptoms have
not improved significantly after a dose of albuterol. The patient uses an inhaled corticosteroid
medication twice daily. What will the provider recommend?
a. Administering two more doses of albuterol
b. Coming to the clinic for evaluation
c. Going to the emergency department (ED)
d. Taking an oral corticosteroid
a. Administering two more doses of albuterol
The patient is experiencing an asthma exacerbation and should follow the asthma action plan
(AAP) which recommends three doses of albuterol before reassessing.
The peak flow is above
70%, so ED admission is not indicated. >70% usually treated at home
possible short course of oral systemic corticosteroid up to provider.
A patient presents to an emergency department reporting chest pain. The patient describes the pain as being sharp and stabbing and reports that it has been present for several weeks. Upon questioning, the examiner determines that the pain is worse after eating. The patient reports getting relief after taking a friend’s nitroglycerin during one episode. What is the most likely cause of this chest pain?
a. Aortic dissection pain
b. Cardiac pain
c. Esophageal pain
d. Pleural pain
c. Esophageal pain
Emergent Cardiac = sudden onset, associated with SOB, dyspnea, radiates to back, sharp pain
fever, weight loss, fatigue = sx of malignancy
GERD r/t pain and cardiac problems have the most similar symptoms most noted is that they both can be relived with nitro. However Pain that is constant for weeks or is sharp and stabbing is not likely to be cardiac in origin. esophageal pain does not radiate
Aortic dissection will cause an abrupt onset with the greatest intensity at the beginning of the pain.
Pleural pain is usually related to deep breathing or cough or wheeze.
also cannot re-produce cardiac pain if tenderness to palpation in a spot = not cardiac.
hen a patient reports experiencing chronic chest pain that occurs after meals, the provider suspects gastroesophageal reflux disease (GERD) and prescribes a proton pump inhibitor. After 2 months the patient reports improvement in symptoms. What is the next action in treating this patient?
a. Wean patient from proton pump inhibitor (PPI).
b. Order esophageal pH monitoring.
c. Refer the patient to a gastroenterologist.
d. Schedule an upper endoscopy.
a. Wean patient from proton pump inhibitor (PPI).
once again GERD is hard to distinguish from Cardiac problem if not sure can try PPI and if pain improve then GERD.Often the effectiveness of treatment with a PPI is diagnostic and is equal to or better than more invasive and expensive testing.
Pain that is constant for weeks or is sharp and stabbing is not likely to be cardiac in origin. esophageal pain does not radiate
Emergent Cardiac = sudden onset, associated with SOB, dyspnea, radiates to back, sharp pain
fever, weight loss, fatigue = sx of malignancy
If the patient continues to show improvement, the patient is weaned off of the PPI.
Most patients do well and there is no need to order tests or refer for evaluation. If patients do not do well, further testing is needed.
A high school athlete reports recent onset of chest pain that is aggravated by deep breathing and lifting. A 12-lead electrocardiogram in the clinic is normal. The examiner notes localized pain near the sternum that increases with pressure. What will the provider do next?
a. Order a chest radiograph.
b. Prescribe an antibiotic.
c. Recommend an NSAID.
d. Refer to a cardiologist.
c. Recommend an NSAID.
This patient has symptoms consistent with chest wall pain because chest pain occurs with specific movement and is easily localized. CARDIAC PAIN CANNOT BE REPLICATED WITH PALPATION Since the ECG is normal, there is no need to refer to a cardiologist. The patient does not have symptoms of pneumonia, so a radiograph or antibiotic is not needed.
NSAIDs are recommended for comfort. probably diagnosis in costochondritis
A patient recovering from a viral infection has a persistent cough 6 weeks after the infection. What will the provider do?
a. Perform chest radiography to assess for secondary infection
b. Perform pulmonary function and asthma challenge testing
c. Prescribe a second round of azithromycin to treat the persistent infection
d. Reassure the patient that this is common after such an infection
d. Reassure the patient that this is common after such an infection
Postinfection cough is common after a viral infection and may persist up to 8 weeks after the infection; this type of cough generally needs no intervention.
Cough in a supine position could mean GERD
It is not necessary to perform chest radiography unless secondary infection is suspected.
Antibiotics are not indicated. Unless the cough persists after 8 weeks, asthma testing is not indicated.
A nonsmoking adult with a history of cardiovascular disease reports having a chronic cough without fever or upper airway symptoms. A chest radiograph is normal. What will the provider consider initially as the cause of this patient’s cough?
a. ACE inhibitor medication use
b. Chronic obstructive pulmonary disease
c. Gastroesophageal reflux disease
d. Psychogenic cough
a. ACE inhibitor medication use
About 10% of patients taking ACE inhibitors will develop chronic cough. If it is the medication, once ace inhibitors are stopped cough should go away in about 1-4 weeks. Might have to switch to ARB
COPD will have cough with dyspnea and sputum production
GERD cough with lying down, with chest pain described burning feeling does not radiate
A young adult patient develops a cough persisting longer than 2 months. The provider prescribes pulmonary function tests and a chest radiograph, which are normal. The patient denies abdominal complaints. There are no signs of rhinitis or sinusitis and the patient does not take any medications. What will the provider evaluate next to help determine the cause of this cough?
a. 24-hour esophageal pH monitoring
b. Methacholine challenge test
c. Sputum culture
d. Tuberculosis testing
b. Methacholine challenge test
Chronic cough without other symptoms may indicate asthma. If PFTs are normal, a methacholine challenge test may be performed.
24-hour esophageal pH monitoring is sometimes performed to evaluate for GERD, but this patient does not have abdominal symptoms and this test is usually not performed because it is inconvenient.
MethacholineTest is a test performed to evaluate how “reactive” or “responsive” your lungs are. Evaluates symptoms that are suggestive of asthma, such as cough, chest tightness and shortness of breath, and help diagnose whether or not you have asthma.
During the test, you will be asked to inhale doses of methacholine, a drug that can cause narrowing of the airways. A breathing test will be repeated after each dose of methacholine to measure the degree of narrowing or constriction of the airways.
Which is characteristic of obstructive bronchitis and not emphysema?
a. Damage to the alveolar wall
b. Destruction of alveolar architecture
c. Mild alteration in lung tissue compliance
d. Mismatch of ventilation and perfusion
c. Mild alteration in lung tissue compliance
Obstructive bronchitis causes much less parenchymal damage than emphysema does, so there is milder alteration in lung tissue compliance. The other symptoms are characteristic of emphysema.
Emphysema is a progressive lung disease caused by over-inflation of the alveoli. Normal lung tissue looks like a sponge, blood flow is impaired and air is trapped
COPD- is an umbrella term used to describe a group of lung conditions (emphysema is one of them) which are characterized by increasing breathlessness. A person with emphysema has COPD; however, not everybody with COPD has emphysema. sx cough, dyspnea and sputum
COPD preventable and treatable, characterized by air flow limitation (inspiration and expiration) that is progressive and not fully reversible. Leads hyperventilation, hypercapnia, hypoxia, diagnosed spirometry (FVC/FEV)
treated by breathing techniques, exercise, nutrition,
daily symptoms, anticholinergic = 1st line
Late stages: LABA with ICS * never use ICS alone**
SABA used PRN for broncho spasms LABA preferred
Which test is the most diagnostic for chronic obstructive pulmonary disease (COPD)?
a. COPD Assessment Test
b. Forced expiratory time maneuver
c. Lung radiograph
d. Spirometry for FVC and FEV1
d. Spirometry for FVC and FEV1
COPD preventable and treatable, characterized by air flow limitation (inspiration and expiration) that is progressive and not fully reversible. Leads hyperventilation (air trapping), hypercapnia, hypoxia, diagnosed spirometry (FVC/FEV)
chest xray typically normal in COPD
A patient diagnosed with chronic obstructive pulmonary disease reports daily symptoms of dyspnea and cough. Which medication will the primary health care provider prescribe?
a. Ipratropium bromide
b. Pirbuterol acetate
c. Salmeterol xinafoate
d. Theophylline
a. Ipratropium bromide = anti-chilinergic +
COPD preventable and treatable, characterized by air flow limitation (inspiration and expiration) that is progressive and not fully reversible. Leads hyperventilation, hypercapnia, hypoxia, diagnosed spirometry (FVC/FEV)
Ipratropium bromide is an anticholinergic medication and is used as first-line therapy in patients with daily symptoms. Pirbuterol acetate and salmeterol xinafoate are both beta2-adrenergics and are used to relieve bronchospasm; pirbuterol is a short-term medication used for symptomatic relief and salmeterol is a long-term medication useful for reducing nocturnal symptoms. Theophylline is a third-line agent
treated by breathing techniques, exercise, nutrition,
daily symptoms, anticholinergic = 1st line
Late stages: LABA with ICS * never use ICS alone**
SABA used PRN for broncho spasms LABA preferred
A young adult patient without a previous history of lung disease has an increased respiratory rate and reports a feeling of “not getting enough air.” The provider auscultates clear breath sounds and notes no signs of increased respiratory effort. Which diagnostic test will the provider perform initially?
a. Chest radiograph
b. Complete blood count
c. Computerized tomography
d. Spirometry
b. Complete blood count
This patient has no signs indicating lung disease but does exhibit signs of hypoxia. A CBC would evaluate for anemia, which is a more common cause of hypoxia in otherwise healthy adults. Chest radiography is used to evaluate infectious causes. CT is used if interstitial lung disease is suspected. Spirometry is useful to diagnose asthma and COPD.
A patient reports shortness of breath with activity and exhibits increased work of breathing with prolonged expirations. Which diagnostic test will the provider order to confirm a diagnosis in this patient?
a. Arterial blood gases
b. Blood cultures
c. Spirometry
d. Ventilation/perfusion scan
c. Spirometry
The patient has signs of either asthma or COPD. Spirometry is essential to both the diagnosis and management of these diseases. ABGs are useful when evaluating severity of exacerbations but are not specific to these diseases. Blood cultures are drawn if pneumonia is suspected. A ventilation/perfusion scan is performed to evaluate for pulmonary thromboembolic disease.
An older adult patient diagnosed with chronic obstructive lung disease (COPD) is experiencing dyspnea and has an oxygen saturation of 89% on room air. The patient has no history of pulmonary hypertension or congestive heart failure. What will the provider order to help manage this patient’s dyspnea?
a. Anxiolytic drugs
b. Breathing exercises
c. Opioid medications
d. Supplemental oxygen
b. Breathing exercises
other: nutrition, exercise both for mild Anticholinergic (daily symptoms) SABA for spasms short term) LABA preferred. ICS+LABA = late stages (never use ICS alone)
Medicare does not approve oxygen supplementation unless saturations are less than 88% on room air or for patients who have pulmonary hypertension or CHF who have saturations <89%.
A patient with a smoking history of 35 pack years reports having a chronic cough with recent symptoms of pink, frothy blood on a tissue. The chest radiograph shows a possible nodule in the right upper lobe. Which diagnostic test is indicated?
a. Coagulation studies
b. Computed tomography (CT)
c. Fiberoptic bronchoscopy
d. Needle biopsy
b. Computed tomography (CT)
CT is suggested for initial evaluation of patients at high risk of malignancy, such as a smoker with >30 pack years, who have suspicious findings on chest radiography.
pink frothy, bright blood, clot= signs of blood from airway
coffe ground, dark brown/black = GI bleed
Coagulation studies are performed for patients taking anticoagulants or a history of coagulopathy.
Fiberoptic bronchoscopy (direct visualization to ariway, typically used to located bleed)is used with CT but is not the initial test.
Needle biopsy is performed if other tests indicate a tumor.
A patient reports coughing up a small amount of blood after a week of cough and fever. The patient has been previously healthy and does not smoke or work around pollutants or irritants. What will the provider suspect as the most likely cause of this patient’s symptoms?
a. Infection
b. Lung abscess
c. Malignancy
d. Thromboembolism
a. Infection
In a healthy patient without risk factors who has a cough and fever, infection is the most likely cause. Lung abscess may occur but is less likely. Malignancy is also less likely. Thromboembolism is more likely after surgery or with trauma.
A patient with hemoptysis and no other symptoms has a normal chest radiograph (CXR), computed tomography (CT), and fiberoptic bronchoscopy studies. What is the next action in managing this patient?
a. Observation
b. Prophylactic antibiotics
c. Specialist consultation
d. Surgical intervention
a. Observation
Patients with negative findings on CXR, CT, and bronchoscopy, with no risk factors may be observed for 3 years. Antibiotics are not indicated, since signs of infection are not present. Specialty consultation and surgery are not indicated.
A patient with a cough has a suspicious lung lesion, a mediastinal lymph mass, and several bone lesions. What test is indicated to determine histology and staging of this cancer?
a. Biopsy of a bone lesion
b. Bone marrow aspiration and biopsy
c. Bronchoscopy with lung biopsy
d. Thoracentesis and pleural fluid cytology
a. Biopsy of a bone lesion
The diagnosis and stage should be determined in the least invasive manner possible. A single biopsy of the bone lesion can determine histology and staging.
symptoms of lung cancer: Cough (typically seen with SCC and SCLC), weight loss (>10lbs), Dyspnea, chest pain,
*changes in chronic cough may or re-occurrent pneumonias also be a sign of lung cancer
symptoms of mets: >1cm lymphadenopathy, bone tenderness,
USPST reccomends lung cancer screening 55-80 years old with a >30 pack/ year smoking history, current smoker or quite in the last 15 years.
A patient with limited stage small cell lung cancer (SCLC) has undergone chemotherapy with a good initial response to therapy. What will the provider tell this patient about the prognosis for treating this disease?
a. Surgical resection will improve survival chances dramatically.
b. That relapse is likely with a 2-year overall survival of 50%.
c. There is an 80% chance of 5-year survival.
d. Treatment will proceed with curative intent.
b. That relapse is likely with a 2-year overall survival of 50%.
Although SCLC often responds very well initially to chemotherapy, the majority of patients will relapse and the 2-year survival rates are approximately 50%.
Surgical resection does not play a significant role in the management of SCLC because the majority of patients have metastatic disease at diagnosis. Treatment is generally palliative. SCLC is very bad, it grows so fast* by the time patients catch it is usually advanced and has spread**
NSCLC is stageable associated slow growing
stage 1 and 2 surgical resection (small-mediums tumors with with or with out lymph involvement)
stage 3 surgical resection also chemo,, 35% survival rate in 5 years (large tumors that have spread to multiple adjacent structures, heart, trachea, also any tumor that has spread to opposite lymph)
stage 4=palliative not curable (mets)
When screening for metastatic cancer in a patient with lung cancer, what will the provider assess for? (Select all that apply.)
a. Reports of headache
b. Increased presence of a cough
c. Diagnostically confirmed low hematocrit
d. Existence of lymph nodes greater than 1 cm
e. Presence of unexplained weight gain greater than 10 pounds
a. Reports of headache
d. Existence of lymph nodes greater than 1 cm
e. Presence of unexplained weight gain greater than 10 pounds
Headaches may indicate brain metastases. Low hematocrit and lymphadenopathy with nodes greater than 1 cm also indicate metastasis. Increased cough is a sign of lung cancer itself, not metastasis. Patients with metastatic cancer have unexplained weight loss of more than 10 pounds.
symptoms of mets: >1cm lymphadenopathy, bone tenderness, headaches
