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Pulmonary Flashcards

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1
Q

Acute bronchitis organisms

A

most likely viral
adenovirus
coronavirus
RSV

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2
Q

Acute bronchitis treatment

A

symptomatic

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3
Q

Pertussis organism

A

Bortadella pertussis (G-)

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4
Q

Pertussis stages

A

catarrhal
paroxysmal
convalescent

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5
Q

Most infectious stage of pertussis

A

catarrhal

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6
Q

Pertussis labs

A

nasopharyngeal swab

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7
Q

Pertussis treatment

A

1st line: Macrolides
-Azithromycin
Tdap booster
Prophylaxis for close contacts

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8
Q

CAP organisms

A
  • Streptococcus pneumoniae

- Haemophilus influenza

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9
Q

Gold standard for CAP diagnosis

A

CXR

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10
Q

CAP lab results

A
  • leukocytosis

- bandemia

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11
Q

CAP treatment for low risk patients

A
  • amoxicillin
  • doxycycline
  • macrolide
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12
Q

CAP treatment for high risk patients, used abx within last 3 months

A

-Augmentin or cefpodoxime or cefuroxime AND
Macrolide or doxycycline
-Levaquin

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13
Q

CAP high risk patients

A
  • > 65
  • immunocompromised
  • multiple comorbidities
  • recent antibiotic use
  • day care attendance, LTC facilities
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14
Q

PPSV23 only

A 
increased risk patients
-asthma
COPD
smoking
CVD
DM
liver disease
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15
Q

pneumococcal schedule for very high risk patients

A

PCV13 now
PPSV23 in 8 weeks
PPSV23 in 5 years (booster)

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16
Q

pneumoccoccal for >65 and healthy

A

PPSV23 only

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17
Q

> 65 and immunocompromised for pneumococcal

A

PCV13 now

PPSV23 in 1 year

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18
Q

Pneumococcal dosing for <2 years old

A

2 months
4 months
6 months
12-15 months

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19
Q

Children >2 who have not been pneumococcal vaccinated

A

1 dose PCV13

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20
Q

Atypical PNA organisms

A
  • mycoplasma pneumoniae
  • chlamydia pneumoniae
  • Legionella pneumoniae
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21
Q

Atypical PNA treatment

A

-macrolide
azithromycin
clarithryomycin
erythromycin

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22
Q

Phlegm color in bacterial PNA

A

rust colored

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23
Q

COPD components

A
  • emphysema
  • chronic bronchitis
  • possible asthma
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24
Q

COPD with emphysema presentation

A
  • barrel chest
  • increased AP diameter
  • accessory muscle use
  • pursed lip breathing
  • weight loss
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25
COPD with chronic bronchitis presentation
- chronic cough - sputum production - coarse crackles
26
Inhaled anticholinergic mechanism
prevent bronchoconstriction
27
Beta agonist mechanism
produce bronchodilation
28
What to add to first line treatment for CODP
- SAMA, LABA | - SABA
29
Examples of SAMA
-ipratropium (Atrovent)
30
Examples of LAMA
-tiotropium (Spiriva)
31
Example of LABA
- salmeterol - indacaterol - olodaterol
32
SAMA SABA combo
Ipratropium/albuterol (Combivent)
33
alpha-1-trypsin deficiency
- rare - severe lung damage at early ages - early onset COPD
34
When to avoid SAMA/LAMA
narrow-angle glaucoma BPH bladder neck obstruction
35
General treatment of COPD
- smoking cessation - annual flu - pulmonary rehab therapy - treat lung infections aggressively
36
Consider which organism with PNA in COPD
Haemophilus influenzae | need gram - coverage antibiotics
37
Lung cancer screening recommendations
- annual low-dose CT for current smokers 55-80 with 30 pack-year history - patients who have quit smoking within the last 15 years
38
What level of prevention is lung cancer screening
secondary
39
Inhaled ICS examples
- Fluticasone (Flovent) - Triamcinolone (Azmacort) - Beclamethasone (Qvar) - Budesonide (Pulmicort)
40
Teaching needed for inhaled ICS
- oral thrush, wash out mouth after use | - HPA axis suppression
41
LABA patient education
-warm of increased risk of asthma deaths
42
Leukotriene inhibitor examples
- Montelukast (Singulair) | - Zileuton (Zyflo)
43
Montelukast monitoring
-nueropsychological effects
44
Zileuton monotiroing
LFTs
45
Mast cell stabilizer examples
- Cromolyn | - Nedocromil
46
Methylxanthine examples
-Theophylline
47
Immunomodulators
Omalizumab (anti-IgE)
48
Mild intermittent asthma
- FEV1/PEF >80% - symptoms <2x/week - SABA PRN
49
Mild persistent asthma
- FEV1/PEF >80% - Symptoms >2x/week - SABA PRN + low dose ICS - alt: Cromolyn, montelukast, theophylline, nedocromil
50
Moderate persistent asthma
- FEV1 or PEF 60-80% - daily symptoms - SABA PRN + low dose ICS with salmeterol (Advair) or medium-dose ICS - alt: low dose ICS plus Singulair, theophylline, or zileuton
51
Severe persistent asthma
- FEV1/PEF <60% - symptoms most of the day - high dose ICS +LABA plus daily oral steroid - SABA
52
Exercise induced asthma
- premedicate 10-15 minutes before activity | - effect lasts up to 4 hours
53
Asthma exacerbation treatment
- albuterol neb treatment - may repeat every 20 minutes up to 3 doses - if unable to use give epi IM
54
Peak expiratory flow rate
measures effectiveness of treatment, worsening symptoms, and exacerbations -blow hard three times onto spirometer, highest value is recorded as best
55
Mnemonic for PEF
HAG - height - age - gender
56
Spirometer green zone
- 80-100% expected | - maintain or reduce medications
57
Spirometer yellow zone
- 50-80% | - maintain or increase if having exacerbation
58
Spirometer red zone
<50% - call 911 if after treatment - if in respiratory distress, give IM epi and call 911
59
Chronic use of high-dose inhaled steroids
- osteoporosis - mild growth retardation - glaucoma - cataracts - immune suppression - HPA suppression
60
What to do if you suspect allergic asthma
- check serum IgG allergy panels | - refer to allergist
61
Menopausal women on me to high dose ICS long term
-consider calcium and vitamin D supplement
62
TB organism
-mycobacterium tuberculosis
63
most contagious TB
pulmonary pleural larygneal
64
Is latent TB infectious
no
65
Miliary TB
- infects multiple organ systems - younger children <5 - elderly - milia seed pattern on xray
66
First line drugs for TB
-isoniazid and rifampicin
67
Direct observed treatment for TB
- for non--compliant patients | - nurse needs to physically see them take their medication
68
What to do with positive PPD
- assess for s/sx | - order CXR
69
Latent TB treatment
- HIV (-): INH for 9 months - HIV (+): INH for 12 months - monitor LFTS
70
Who to treat latent TB
- recommended for <35yo | - less risk of liver damage
71
Positive TB test <5 mm
- HIV (+) - recent contact - CXR with fibrotic changes with previous TB - any child (<5) with close TB contact - IC
72
Positive TB for >10
- recent immigrant (within last 5 years) - child <4 or adolescent exposed - IVDU - Health care worker - homeless - employee in high risk setting
73
Positive TB >15
anyone with no known risk for TB
74
Preferred test for BCG vaccination
- IGRA | - available within 24 hours
75
Purpose of 2 step TB test
- booster phenomenon - person will have false negative to first test if not tested for many years - repeat in 1-3 weeks, will be positive if patient has TB
76
How many drugs should TB be treated with
at least 2 or 3
77
Category A (GOLD 1-2) treatment
-SABA PRN OR -SABA/SAMA
78
Category B (GOLD 1-2) treatment
- LABA or LAMA | - SABA PRN
79
Category C (GOLD 3-4) treatment
- LAMA | - if poor control use LABA and LAMA
80
Category D (GOLD 3-4) treatment
- high risk | - refer to pulmonologist
81
Most common cause of COPD exacerbations
bacterial or viral cause
82
COPD exacerbation antimicrobial treatment options
- Concern for Haemophilus influenzae infection - Bactrim DS, doxycyline, or Ceftin - severe: Augmentin or respiratory quinolones - Medrol dose pack
83
#1 cause of CAP in cystic fibrosis patients
Psudomonas aeruginosa
84
COPD lung changes
- reduction in FEV1 - increase RV - increase TLC

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