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primary 3 chronic conditions final exam > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is going to be that predominant symptom we see on asthma patients?

A

COUGH

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2
Q

In asthma, what about the order severity in asthma?

A

Intermittent, mild, moderate, and severe

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3
Q

How are we going to know if our treatment is successful for our pt with asthma?

A

Have them do peak flow meter at home, but the biggest thing to remember is that we don’t determine the success of their treatment by how often they are using their rescue inhaler. If they say they have only used their inhaler one day a wk and it used to be 5 days a week; well that is wonderful but that doesn’t mean necessarily that we are going to scale back their treatment.
That might just mean that whatever medication they are on must be working really well to control their asthma.

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4
Q

What medication is now the cornerstone treatment of asthma since the update?

A

Low dose ICS, every patient according to the new guidelines should have a low dose ICS as they have been found to decrease overall mortality in these patients.

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5
Q

What are going to be those three things that will impact peak flow meter reading results?

A

Height, age and gender. Use the mnemonic “HAG”.

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6
Q

what do bronchodilators end in?

A

-terol

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7
Q

What do steroids end in?

A

-sone or -ide
* Examples: Budesonide or fluticasone

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8
Q

For intermittent symptoms of asthma

A

we are going to use an ICS LABA mix as needed,

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9
Q

when symptoms of asthma increase and become more mild in nature

A

the pt can start using that low dose ICS daily

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10
Q

and then when asthma symptoms become more moderate

A

they can utilize an inhaled corticosteroid laba mix daily or they can add on a low dose ICS with a leukotriene receptor antagonist like a Singulair.

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11
Q

Anything in the sever category of asthma

A

we want to go ahead and refer out to pulmonology for the very best care of the patient. So, if you are in your exam and you are feeling unsure your best bet is to always pick an answer with a low dose inhaled corticosteroid.

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12
Q

asthma intermittent

A
  • : s/s < 2 days/wk OR < 2 nights/mth; brief exacerbations
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13
Q

asthma mild persistent:

A

*s/s >= 2 days/wk, but < 1/day OR < 2 nights/mth

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14
Q

asthma moderate persistent:

A

daily s/s OR > 3-4 nights/mth

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15
Q

asthma severe persistent:

A

continual s/s OR frequent nighttime s/s > 1 night/mth

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16
Q
  • Exercise-induced asthma treatment
A

SABA 15-30 minutes prior to exercise

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17
Q

To diagnosis of COPD, the FEV1/FVC ratio is?

A

For diagnosis of COPD the FEV1/FVC ration will be < 0.70

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18
Q

What are we going to expect our pt to look like if they have COPD?

A

Barrel chest, maybe clubbing of the fingers, chronic cough.

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19
Q

What sound will we hear on percussion of a chest of a COPD patient?

A

Hyper-resonant

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20
Q

What are those 2 things that may make up COPD?

A

Chronic bronchitis and emphysema.

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21
Q

What is a drug that we expect to give to a chronic bronchitis or emphysema pt that does not have full blown COPD yet?

A

BRONCHODILATOR

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22
Q

hyperesonant

A

If the percussion produces a drum-like sound known as hyperresonance, it could indicate air has filled the space around your lungs and is prohibiting them from expanding fully. It may also suggest that air is trapped inside the small airways and alveoli (air sacs) of your lungs.

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23
Q

Group A COPD

A

group A patients get that SABA (usually albuterol)

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24
Q

Group B COPD

A

group B patients get a LABA (formoterol)

25
Q

Group C COPD

A

group C get the LAMA

26
Q

Group D COPD

A

group D usually gets that combination drug with the inhaled corticosteroid

27
Q

Groups of COPD

A

Based on all of these things – your symptoms, spirometry results, and exacerbation risk –
Group A: Low risk, fewer symptoms.
Group B: Low risk, more symptoms.
Group C: High risk, fewer symptoms.
Group D: High risk, more symptoms

28
Q

What if your COPD patient comes in today and says hey “ I have lost 17 pounds” since the last visit a couple of months ago. Are we going to congratulate this pt?

A

Were they trying to lose weight or was this unintentional because if it is unintentional then something is going on. Unfortunately, it might be cancer.could just be burning so many calories working to breathe that they are not getting enough into their system to account for that calorie loss. So that COPD patient might need to start doing some high calorie, high protein small meals 5-6 times a day to catch up with their nutritional

29
Q

What cancer is a COPD patient really at high risk for?

A

Lung cancer.

30
Q

We are not in the lower lobes anymore, what do we typically see in the upper lobes?

A

TUBERCULOSIS
So, remember we typically see pneumonia in the lower lobes, and TB in the upper.

31
Q

With TB we usually require treatment for a long time sometimes up to 1 year.

A

They usually also need at least 3 drug treatments; it is HEAVY DUTY TREATMENT.

32
Q

For HIV and immunocompromised patients; at what induration on the TB test are they going to be considered positive for TB?

A

> 5mm

33
Q

What about in the general public for TB?

A

> 15mm of induration

34
Q

What about in immigrants?

A

> 10 mm of induration

35
Q

When does HIV turn into AIDS ?

A

with CD4 count < 200

36
Q

What prophylactic abx do we start for that pjp when

A

that CD4 count is < 200? BACTRIM

37
Q

How do we confirm a TB diagnosis?

A

SPUTUM CULTURES

38
Q

if patient has chronic sinusitis what can they be at risk for?

A

nasal polyps

39
Q

What is our first line recommendation for allergic rhinitis?

A

Hands down AVOID the TRIGGERS. Then we can talk about meds.

40
Q

What are our first line of meds to give for allergic rhinitis?

A

Intra Nasal Corticosteroids like Flonase

41
Q

And what is our second line of treatment?

A

Antihistamine like a Benadryl.

42
Q

In what type of patient population do we want to avoid antihistamine at all cause?

A

Elderly population because we worry about anticholinergic side effects.

43
Q

What are those anticholinergic side effects that we worry about in the elderly?

A

Can’t see, can’t pee, can’t spit, can’t poop.

44
Q

Now if we were looking at some immunoglobulin labs, which immunoglobulin lab usually indicates allergies or more specifically allergic reaction?

A

IgE.

45
Q
  • Exercise-induced asthma treatment
A

Prevention
* In pts > 4: albuterol/Ventolin 2 puffs 15-30 minutes before exercise
* In pts < 4: Singular/montelukast take 2 hrs prior to exercise

46
Q

***asthma classifications

A

Mild intermittent: < 2 OR < 2 brief
Mild persistent: > 2 but < 1/day OR < 2
Moderate persistent: daily OR > 3-4
Severe persistent: continual s/s OR frequent nighttime > 1 night/mth

47
Q
  • If an asthmatic patient is not relieved by a rescue inhaler, what is the next step?
    *
A

LOW DOSE ICS (Budesonide/Pulmicort or Fluticasone/Flovent)

48
Q

TB skin test, what is considered positive for patients? For Healthcare workers?

A

Palpable induration is Measured in mm
o 0mm=negative
o >5mm is positive in people with immunosuppression

o >10mm is positive for kids < 4, high-risk adults/teens, immigrants, nursing homes, IV drug users
* For Healthcare workers?
o >10mm is positive for those who

o >15mm is positive in patients with no known hx or risk factors

49
Q

What is your next step for a positive test?

A

Obtain CXR, then sputum culture/AFB or bronch

50
Q
  • What is the gold standard for diagnosing asthma and COPD?

*

A
  • Spirometry (before and after SABA): FEV1/FVC: normal > 80%
  • FEV1: forced expiratory volume in 1 second (shows the severity of airflow limitation)
     The volume of air that is forcefully exhaled in the first second of exhalation after a deep breath
     Assesses for airway obstruction
  • FVC: forced vital capacity (how much air is left after a max exhale)
51
Q

COPD s/sx

A

Signs and symptoms of COPD?
* Chronic dyspnea, chronic cough, chronic sputum production

52
Q

What are differential diagnoses COPD?
*

A

Asthma, CHF, pneumonia, bronchiectasis (widened airways with mucus buildup), lung CA, TB

53
Q

What is the gold standard for diagnosing COPD?
*

A

Post-bronchodilator spirometry
Mild: FEV1>80%
 Moderate: 50-80%
 Severe: 30-50%
 Very severe: FEV1<30%

54
Q
  • What is considered treatment plan?
    *
A

Categories from GOLD (global initiative for obstructive lung disease)
 Category A (GOLD 1-2): minimal s/s
* SABA prn alone; or combo SABA w/ SAMA OR LAMA
 Category B (GOLD 1-2): more s/s, low risk of exacerbation
* LABA w/ SAMA. OR LAMA w/ SABA
* May use SABA prn
 Category C (GOLD 3-4): minimal s/s, but high risk for exacerbations
* LAMA is 1st line
* If poor control, use combo LABA and LAMA
* Long-term therapy with oral steroids is NOT recommended
 Category D
* high risk, refer to pulmonology

55
Q

Step approach: for COPD

A

SABA, then add LABA, then add SAMA, then add LAMA
* Purpose of therapy is symptom reduction, decrease exacerbations, improve exercise tolerance, improve overall health status

56
Q

F/U COPD

A
  • F/U every 3-6 months for stable patients; every month for more unstable pts; f/u within 1 month of discharge of any hospitalizations
57
Q
  • Lung CA: What are the signs and symptoms?
A

Signs and symptoms
 *Hemoptysis, dyspnea, chest pain, shortness of breath, wheezing

58
Q

Lung CA What are differential diagnoses?

A

Pneumonia, bronchitis, other CA, infectious granuloma, TB, tracheal tumors, thyroid mass, lung abscess

59
Q
  • Side effects of rescue inhaler
A
  • Increased HR, BP, QT prolongation, ST depression
  • Caution in pts with cardiac arrythmias, SZ and hyperthyroidism
  • EXTREME caution in pts on MAOIs and beta blockers
  • May cause hypokalemia
  • May decrease digoxin levels

primary 3 chronic conditions final exam (16 decks)

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