Respiratory

Question 1

s/s of pulmonary emboli

Answer 1

dyspnea, coughing up pink-frothy sputum, tachycardia

Question 2

s/s of impending respiratory failure in asthmatic patient

Answer 2

tachypnea, cyanosis, “quiet” lung sounds without breath sounds

Question 3

trx for impending respiratory failure in asthmatic patient

Answer 3

adrenaline injection STAT, call 911, apply oxygen, albuterol neb

Question 4

vesicular breath sounds are common in

Answer 4

lower lobes

Question 5

normal egophony

Answer 5

“eee”; abnormal is “bahh”

Question 6

normal tactile fremitus

Answer 6

when patient says “ninety nine”, strong vibrations felt on upper lobes, softer on lower lobes

Question 7

normal percussion to lungs

Answer 7

resonance

Question 8

abnormal percussion to lungs

Answer 8

hyperresonance in COPD; dull in pneumonia

Question 9

COPD is characterized as

Answer 9

loss of elastic recoil and alveolar damage

Question 10

chronic bronchitis is characterized as

Answer 10

cough with mucus production for more than 3 months for at least 2 consecutive years

Question 11

risk factors for COPD

Answer 11

smoking, increased age, occupational exposure, alpha1 typsin genetic deficiency

Question 12

physical exam in those with COPD

Answer 12

barrel chest, prolonged expiration, hyperresonance on percussion, decreased tactile fremitus

Question 13

contraindications for anticholinergic inhalers

Answer 13

BPH, glaucoma, bladder neck obstruction

Question 14

treatment for mild COPD (Class I)

Answer 14

short acting anticholinergic or SABA PRN

Question 15

treatment for moderate COPD (Class II)

Answer 15

Long acting anticholinergic or LABA + SABA PRN

Question 16

treatment for severe COPD (Class III)

Answer 16

ICS + LABA or LA anticholinergic + SABA PRN

Question 17

treatment for very severe COPD (Class IV)

Answer 17

ICS + LABA + LA anticholinergic + SABA PRN

Question 18

long acting beta agonists (LABA) examples

Answer 18

salmetrol, formoterol

Question 19

short acting beta agonists (SABA) examples

Answer 19

albuterol (Proair, ventolin), levoalbuterol (Xopenex)

Question 20

acute cough is for

Answer 20

less than 3 weeks

Question 21

subacute cough is for

Answer 21

3-8 weeks

Question 22

chronic cough is for

Answer 22

more than 8 weeks

Question 23

common causes of cough

Answer 23

asthma, GERD, infection

Question 24

Most common cause of acute bronchitis

Answer 24

virus

Question 25

common cause of community acquired pneumonia

Answer 25

Streptococcus pneumoniae

Question 26

common cause of atypical pneumonia

Answer 26

Mycoplasma pneumonia, chlamydophila pneumonia

Question 27

Suspect DRSP in these people

Answer 27

age greater than 65, abtx therapy in the past 3 months, alcoholics, those with co-morbids, immunosuppression, exposure to children

Question 28

suspect atypical pneumonia in these people

Answer 28

healthy adults

Question 29

s/s of pneumonia

Answer 29

cough, purulent sputum, fever, chills, SOB

Question 30

trx for healthy individuals with atypical pneumonia

Answer 30

macrolide or doxycycline

Question 31

trx for those with DRSP

Answer 31

respiratory quinolone

Question 32

trx for those with DRSP who are allergic to quinolones

Answer 32

beta lactam + macrolide or doxycycline

Question 33

consider referral to hospital in these people with pneumonia

Answer 33

``` CRB65: Confusion RR greater than 30 BP less than 90/60 Age greater than 65 ```

Question 34

Pneumonia vaccine recommendations

Answer 34

PPSV23 for adults 19-64 who are at increased risk (asthma, COPD, heart surgery); PCV13 and PPSV23 1 year later in ALL adults older than 65, and in those 19-64 with asplenia, immunocompromised

Question 35

symptoms of COPD

Answer 35

chronic and progressive dyspnea, cough, and sputum production

Question 36

Diagnosis of COPD

Answer 36

spirometry shows FEV1/FVC less than 70%

Question 37

characteristics of COPD stage I

Answer 37

FEV1/FVC less than 70%; | FEV1 is greater than 80%

Question 38

characteristics of COPD Stage II

Answer 38

FEV1/FVC less than 70%; | FEV1 is between 50-80%

Question 39

characteristics of COPD stage III

Answer 39

FEV1/FVC less than 70%; | FEV1 is between 30-50%

Question 40

characteristics of COPD stage IV

Answer 40

FEV1/FVC less than 70%; | FEV1 is less than 30%

Question 41

short acting bronchodilators have a greater risk of this kind of arrhythmia

Answer 41

afib and aflutter

Question 42

types of bronchodilators

Answer 42

beta 2 agonists and anticholinergics

Question 43

SE of inhaled anticholinergics

Answer 43

"Oh this drug, it makes me pink. Sometimes, I can't think or even blink. I can't see, I can't pee, I can't spit, I can't shit". Flushing, confusion, glaucoma, urinary retention, dry mouth, constipation.

Question 44

Inhaled steroids are started in COPD when

Answer 44

stage III or IV

Question 45

trx for exacerbations of COPD

Answer 45

prednisone 40 mg daily x 5 days

Question 46

Most effective intervention for preventing exacerbations and progression of COPD

Answer 46

stop smoking

Question 47

health promotion for COPD

Answer 47

annual flu, pneumonia vaccine, exercise

Question 48

Goal of asthma management

Answer 48

prevent exacerbations

Question 49

triad s/s of asthma

Answer 49

wheezing, cough, SOB; symptoms worse at night

Question 50

risk factors of asthma

Answer 50

young age, family hx, atopic disease

Question 51

intermittent asthma

Answer 51

symptoms less than twice a week

Question 52

mild persistent asthma

Answer 52

symptoms more than twice a week but not daily

Question 53

moderate persistent asthma

Answer 53

symptoms daily

Question 54

severe persistent asthma

Answer 54

throughout the day

Question 55

trx for intermittent asthma

Answer 55

SABA

Question 56

trx for mild persistent asthma

Answer 56

low dose ICS + SABA

Question 57

trx for moderate persistent asthma

Answer 57

medium dose ICS + LABA + SABA

Question 58

Education for asthma patient

Answer 58

RTC if SABA is used more than twice a week, patient needs step up therapy.

Question 59

LABA can be used alone in

Answer 59

COPD

Question 60

med combination with highest risk of death in asthma patient

Answer 60

LABA and SABA; all patients with asthma need a form of ICS

Question 61

physical exam of those with pneumonia

Answer 61

crackles, dull percussion, increased tactile fremitus

Question 62

trx for acute bronchitis

Answer 62

symptomatic

Question 63

trx for pertussis

Answer 63

macrolides

Question 64

s/s of common cold

Answer 64

fever, sore throat, runny nose, nasal congestion; self-limited for 4-10 days

Question 65

Prior BCG vaccine

Answer 65

not a contraindication for PPD testing if more than 5 years

Question 66

trx for TB

Answer 66

at least two drugs (rifampin and INH) to prevent resistance

Question 67

ethambutal for TB can cause

Answer 67

optic neuritis

Question 68

PPD is positive if less than or equal to 5 mm in people with

Answer 68

hx of HIV, recent contact with infected TB person, children with symptoms, immunocompromised

Question 69

PPD is positive if less than or equal to 10 mm in people with

Answer 69

immigrants, drug users, healthcare workers, homeless, jail, nursing home

Question 70

two step testing for TB

Answer 70

do first PPD, if negative, then repeat in 1-3 weeks, if still negative, then patient is truly negative

Question 71

theophylline

Answer 71

can be used for asthma as a bronchodilator; however it has a narrow level and has many drug interactions

Question 72

Leukotriene inhibitors

Answer 72

montelukast, zileuton

Question 73

mast cell stabilizer

Answer 73

cromolyn sodium

Question 74

Zileuton requires

Answer 74

monitoring LFTs

Question 75

peak expiratory flow is measured by

Answer 75

HAG: height, age, gender

Question 76

croup is mostly caused by

Answer 76

parainfluenza type 1

Question 77

croup is common in those

Answer 77

less than 3

Question 78

s/s of croup

Answer 78

stridor, barking cough, fever

Question 79

Primary spontaneous pneumothorax occurs mostly in

Answer 79

tall, thin men who smoke

Question 80

complication of COPD

Answer 80

right ventricular hypertrophy (cor pulmonale)

Question 81

cautiously give nicotine in those with

Answer 81

coronary artery disease, nicotine is a potent vasoconstrictor

Question 82

black box warning with Chantix

Answer 82

increase in hostility, agitation, suicide; increase risk of heart attacks

Question 83

common causes of pleuritic chest pain

Answer 83

viral, bacterial infections; TB

Question 84

trx for pleuritic chest pain

Answer 84

indomethacin