MYE SPE (Cough) condensed Flashcards by Kyle Campbell

Acute vs. Chronic Bronchitis (hint: think time)?

Acute = 5+ days (usually 1-3 weeks)

- Chronic = 3+ months of year for 2 consecutive years

How well did you know this?

Not at all

Perfectly

What is the MC etiology of Acute Bronchitis? Give an example of two pathogens

VIRAL

Influenza
Parainfluenza

How well did you know this?

Not at all

Perfectly

What does the presence of purulent sputum indicate with Bronchitis?

NOTHING

- Purulent sputum does NOT mean bacterial infection

How well did you know this?

Not at all

Perfectly

How do you dx Bronchitis?

Clinical

- CXR is NOT necessary (non-specific findings)

How well did you know this?

Not at all

Perfectly

What is the recommended tx for Bronchitis (4)?

Symptomatic relief…

NSAIDs, ASA, Acetaminophen
ICS
Antitussives
Beta-2 Agonists

How well did you know this?

Not at all

Perfectly

WHEN would abx be indicated in tx of Bronchitis?

Pertussis = BACTERIAL

How well did you know this?

Not at all

Perfectly

What is the pathogen associated with Pertussis? What three sxs (triad) are associated with this condition?

Bordetella pertussis

Coughing spells (paroxysms of cough)
Inspiratory whoop
Posttussive emesis

How well did you know this?

Not at all

Perfectly

What are the three phases of Pertussis (describe each), and how long does each last?

Catarrhal = URI sxs, fever for 1-2 weeks
Paroxysmal = triad of sxs (cough paroxysms, inspiratory whoop, posttussive emesis) for 2-6 weeks
Convalescent = cough gradually improves for weeks/months

How well did you know this?

Not at all

Perfectly

What dx test is the GOLD standard for Pertussis?

Culture (bacterial)

How well did you know this?

Not at all

Perfectly

What is the recommended tx for Pertussis? What is an alternative option?

WHAT is the purpose of initiating tx?

Macrolides = Azithromycin
- Bactrim

Abx decrease transmission (do NOT resolve sxs)

How well did you know this?

Not at all

Perfectly

Which are four examples of pathogens/conditions that cause cough and are reportable to the State Health Department?

Pertussis
COVID-19
Influenza
TB

How well did you know this?

Not at all

Perfectly

What populations are at increased risk for VIRAL Bronchitis aka Influenza (7)?

Children <2
Adults 65+
Comorbidities
IC
Pregnant
Morbidly obese
Nursing home resident

How well did you know this?

Not at all

Perfectly

What four symptoms are often seen with Influenza? What is the typical onset, and when is it most contagious?

ABRUPT onset of…

Fever
Myalgias
Malaise
HA

First 2 days

How well did you know this?

Not at all

Perfectly

If outpatient, when is testing recommended for Influenza (3)? If inpatient, when is it recommended?

What additional test is also often ordered as the GOLD standard?

OP: NOT recommended unless high risk = 65+, children <5 years or IC

IP: ANY patient with sxs upon admission or during admission

GOLD standard = viral culture (3-10 days for results)

How well did you know this?

Not at all

Perfectly

What is the MC complication of Influenza?

PNA

How well did you know this?

Not at all

Perfectly

What is the recommended treatment for Influenza if severe or high-risk, and what is the window for giving it? How does this affect prognosis (2)?

Tamiflu (Oseltamivir) within 48 hours of sxs onset

- Reduces complications and shortens course by 1-2 days

How well did you know this?

Not at all

Perfectly

What is the MC transmission of CAP?

Aspiration of oropharynx

How well did you know this?

Not at all

Perfectly

What is the MC TYPICAL pathogen associated with CAP?

Streptococcus pneumoniae

How well did you know this?

Not at all

Perfectly

What is the MC ATYPICAL pathogen associated with CAP?

Mycoplasma pneumoniae

How well did you know this?

Not at all

Perfectly

What is the MC etiology of CAP (and what pathogen)? What is the 2nd MC etiology (and what pathogen)?

MC = BACTERIAL: Streptococcus pneumoniae

- 2nd MC = VIRAL: Influenza

How well did you know this?

Not at all

Perfectly

What three sxs are seen with TYPICAL CAP?

Acute onset
Fever
Cough

How well did you know this?

Not at all

Perfectly

What three sxs may be seen with ATYPICAL CAP?

Subacute onset
NON-productive cough
Viral prodrome

How well did you know this?

Not at all

Perfectly

What three PE findings are indicative of CAP (Typical or Atypical)?

Decreased breath sounds
Crackles/rales
Signs of consolidation (dullness to percussion, tactile fremitus, bronchophony, egophony)

How well did you know this?

Not at all

Perfectly

What are four signs of consolidation, and what condition are these associated with?

CAP

Dullness to percussion
Tactile fremitus = put medial side of hand on pt back and have them say “99” with increased vibration
Bronchophony = spoken words louder/clearer
Egophony = spoken “e” heard as “a”

How well did you know this?

Not at all

Perfectly

What is the GOLD standard finding on CXR for CAP? What other two findings may be seen?

Infiltrates | - Also, consolidation and/or cavitation

What are three complications of PNA?

- Bacteremia (in blood) - Sepsis (bacteremia/other infection triggers systemic infection) - Abscess

What is CURB-65 and what condition is it associated with? What is it used to determine?

If 2+ present = admit for PNA (3+ = ICU) - Confusion - Urea of 7+ - RR of 30+ - BP <90/60 - 65+ years old

What is the recommended OUTPATIENT tx for bacterial PNA if uncomplicated (1, 1) vs complicated (2, 1)?

- OP uncomplicated = Azithro OR Doxy | - OP complicated = Augmentin + Azithro OR Levofloxacin

What is the recommended OUTPATIENT tx for bacterial PNA if uncomplicated (2)?

- Azithromycin | - Doxy

What is the recommended OUTPATIENT tx for bacterial PNA if complicated (2 or 1)?

- Augmentin + Azithro | - Levofloxacin

What is the recommended INPATIENT tx for bacterial PNA (2, 2)?

- Augmentin + Azithro | - Augmentin + Levofloxacin

What is the minimum length of abx OP tx for PNA?

5 days

What is the dx criteria for HAP/VAP PNA (__ AND 2/3)

New/progressive lung infiltration on imaging PLUS 2+... - Fever - Purulent sputum - Leukocytosis

What etiology of PNA is most associated with HIV, and what is the pathogen?

FUNGAL | - Pneumocystis jirovecii

What two sxs are associated with PCP (Pneumocystis jirovecii) PNA? What finding is seen on CXR?

- Fever - NON-productive cough Ground glass opacities seen on CXR

What is the preferred tx for PCP (Pneumocystis jirovecii) PNA?

Bactrim

What is the MC finding seen on CXR for Aspiration PNA?

RLL infiltrate

What is the MC etiology and pathogen associated with Common Cold/URI?

VIRAL | - Rhinovirus

What four sxs are often seen with Common Cold/URI? When is it most contagious?

- NON-productive cough - Clear/watery rhinorrhea - Nasal congestion - Sore throat (dry/scratchy) First 2-3 days

What are two possible complications of Common Cold/URI?

- Acute rhinosinusitis | - AOM

What is the typical course of Common Cold/URI, and what is the treatment (2)?

SELF-LIMITING (1-2 weeks) - NSAIDs/Acetaminophen - Antihistamines (Sudafed)

Compare mild intermittent, mild persistent, moderate persistent and severe persistent Asthma (3 components each)?

- Mild intermittent = <2 days/week, night awake <2 x/month, FEV1 80%+ - Mild persistent = 2+ days/week, night awake 3-4 x/month, FEV1 80%+ - Moderate persistent = daily, weekly, FEV1 60-80% - Severe persistent = throughout day, awake nightly, FEV1 <60%

What three sxs are associated with Asthma?

- SOB - Wheezing - Cough (worse at night)

What two findings may be seen on sputum culture with Asthma?

- Curschmann's spirals | - Charcot-Leyden crystals

What are the six steps of Asthma treatment, and how do they relate to the Asthma classifications (1, 1 or 1, 1 or 2, 2 or 2, 2, 3)?

- Step 1 = Mild Intermittent: SABA PRN - Step 2 = Mild Persistent: low-dose ICS daily OR LTRA (Montelukast) - Step 3 = Moderate Persistent: medium-dose ICS daily OR low-dose ICS + LABA; consider referral - Step 4 = Severe Persistent: medium-dose ICS + LABA OR medium-dose ICS + LTRA; REFER - Step 5 = been referred: high-dose ICS + LABA - Step 6 = been referred: high-dose ICS + LABA + oral steroids

What six sxs are associated with GERD?

- Heartburn (30-60 min postprandial) - Regurgitation - CHRONIC COUGH - Wheezing - Hoarseness - Dental enamel loss

What is the recommended dx test for GERD?

Upper endoscopy

What is the recommended tx for GERD (2)?

1. Lifestyle modifications | 2. H2 Blockers (Ranitidine) vs. PPIs (Omeprazole)

What four symptoms are seen with LEFT-sided CHF?

LEFT: - DOE - PND - Orthopnea - Fatigue

What four symptoms are seen with RIGHT-sided CHF?

RIGHT: - JVD - Hepatic congestion - Ascites - Edema

What condition can present with pulsus alternans?

LEFT-sided CHF

What is the recommended treatment for ACUTE exacerbation of CHF (5)?

LMNOP - Lasix - Morphine - Nitrates - O2 - Position (sit up)

What four drugs/groups of meds can be used to treat CHF? What other patient education should be provided to CHF patients (4)?

- Loop diuretics - ACE-I - BBs - Entresto (Sacubitril/Valsartan) Can consider... - Aldosterone Antagonists - Hydralazine/Nitrates Education: weight loss, low sodium, lower fluids, daily weight monitoring

What two condition are you at increased risk for with Asbestosis?

- Bronchogenic Carcinoma | - Malignant Mesothelioma

How can you differentiate a nodule from a mass with Solitary Pulmonary Nodules (SPNs)? What is there increased chance of with a mass? What are the MC type of SPN?

- Nodule = <3 cm - Mass = 3+ cm; greater change of CA MC = infectious granulomas (TB, Cocci, abscess)

What three findings are indicative of a BENIGN Solitary Pulmonary Nodule (SPN)?

- SLOW growth - Round/smooth - Calcifications

What three findings are indicative of a MALIGNANT Solitary Pulmonary Nodule (SPN)?

- RAPID growth - Irregular/speculated - Cavitation with thick walls

What is the greatest RF associated with Bronchogenic Carcinoma?

SMOKING

What are the two types of Bronchogenic Carcinoma, and what are the subtypes of each (1, 3)?

SCLC - Oat Cell NSCLC - Adenocarcinoma - SCC (Squamous Cell) - LCC (Large Cell)

Which two subtypes of Bronchogenic Carcinoma present most often with cough?

- SCLC (Oat Cell CA) | - Squamous Cell CA (type of NSCLC)

What are three major RF associated with COPD, and which is most common?

- SMOKING = MC - Secondhand smoke - Alpha-1 Antitrypsin Deficiency

What three sxs are often seen with COPD?

- Excess sputum production - Cough - DOE

What value are the four grades of COPD based on (GOLD), and what are the four grades?

Based on FEV1... - GOLD 1 = FEV1 of 80%+ - GOLD 2 = FEV1 of 50-70% - GOLD 3 = FEV1 of 30-49% - GOLD 4 = FEV1 of <30%

What are the four categories of treatment of COPD (1, 2 or 2, 2, 2 or 3)

- Category A = SABA - Category B = SABA + LABA, SABA + LAMA - Category C = SABA + LAMA - Category D = SABA + LAMA, SABA+ LABA + LAMA

MYE SPE (Cough) condensed Flashcards

(64 cards)