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Flashcards in Respiratory Deck (84):
1

s/s of pulmonary emboli

dyspnea, coughing up pink-frothy sputum, tachycardia

2

s/s of impending respiratory failure in asthmatic patient

tachypnea, cyanosis, "quiet" lung sounds without breath sounds

3

trx for impending respiratory failure in asthmatic patient

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

4

vesicular breath sounds are common in

lower lobes

5

normal egophony

"eee"; abnormal is "bahh"

6

normal tactile fremitus

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

7

normal percussion to lungs

resonance

8

abnormal percussion to lungs

hyperresonance in COPD; dull in pneumonia

9

COPD is characterized as

loss of elastic recoil and alveolar damage

10

chronic bronchitis is characterized as

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

11

risk factors for COPD

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

12

physical exam in those with COPD

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

13

contraindications for anticholinergic inhalers

BPH, glaucoma, bladder neck obstruction

14

treatment for mild COPD (Class I)

short acting anticholinergic or SABA PRN

15

treatment for moderate COPD (Class II)

Long acting anticholinergic or LABA + SABA PRN

16

treatment for severe COPD (Class III)

ICS + LABA or LA anticholinergic + SABA PRN

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treatment for very severe COPD (Class IV)

ICS + LABA + LA anticholinergic + SABA PRN

18

long acting beta agonists (LABA) examples

salmetrol, formoterol

19

short acting beta agonists (SABA) examples

albuterol (Proair, ventolin), levoalbuterol (Xopenex)

20

acute cough is for

less than 3 weeks

21

subacute cough is for

3-8 weeks

22

chronic cough is for

more than 8 weeks

23

common causes of cough

asthma, GERD, infection

24

Most common cause of acute bronchitis

virus

25

common cause of community acquired pneumonia

Streptococcus pneumoniae

26

common cause of atypical pneumonia

Mycoplasma pneumonia, chlamydophila pneumonia

27

Suspect DRSP in these people

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

28

suspect atypical pneumonia in these people

healthy adults

29

s/s of pneumonia

cough, purulent sputum, fever, chills, SOB

30

trx for healthy individuals with atypical pneumonia

macrolide or doxycycline

31

trx for those with DRSP

respiratory quinolone

32

trx for those with DRSP who are allergic to quinolones

beta lactam + macrolide or doxycycline

33

consider referral to hospital in these people with pneumonia

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

34

Pneumonia vaccine recommendations

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

35

symptoms of COPD

chronic and progressive dyspnea, cough, and sputum production

36

Diagnosis of COPD

spirometry shows FEV1/FVC less than 70%

37

characteristics of COPD stage I

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

38

characteristics of COPD Stage II

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

39

characteristics of COPD stage III

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

40

characteristics of COPD stage IV

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

41

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

afib and aflutter

42

types of bronchodilators

beta 2 agonists and anticholinergics

43

SE of inhaled anticholinergics

"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.

44

Inhaled steroids are started in COPD when

stage III or IV

45

trx for exacerbations of COPD

prednisone 40 mg daily x 5 days

46

Most effective intervention for preventing exacerbations and progression of COPD

stop smoking

47

health promotion for COPD

annual flu, pneumonia vaccine, exercise

48

Goal of asthma management

prevent exacerbations

49

triad s/s of asthma

wheezing, cough, SOB; symptoms worse at night

50

risk factors of asthma

young age, family hx, atopic disease

51

intermittent asthma

symptoms less than twice a week

52

mild persistent asthma

symptoms more than twice a week but not daily

53

moderate persistent asthma

symptoms daily

54

severe persistent asthma

throughout the day

55

trx for intermittent asthma

SABA

56

trx for mild persistent asthma

low dose ICS + SABA

57

trx for moderate persistent asthma

medium dose ICS + LABA + SABA

58

Education for asthma patient

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

59

LABA can be used alone in

COPD

60

med combination with highest risk of death in asthma patient

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

61

physical exam of those with pneumonia

crackles, dull percussion, increased tactile fremitus

62

trx for acute bronchitis

symptomatic

63

trx for pertussis

macrolides

64

s/s of common cold

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

65

Prior BCG vaccine

not a contraindication for PPD testing if more than 5 years

66

trx for TB

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

67

ethambutal for TB can cause

optic neuritis

68

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

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

69

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

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

70

two step testing for TB

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

71

theophylline

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

72

Leukotriene inhibitors

montelukast, zileuton

73

mast cell stabilizer

cromolyn sodium

74

Zileuton requires

monitoring LFTs

75

peak expiratory flow is measured by

HAG: height, age, gender

76

croup is mostly caused by

parainfluenza type 1

77

croup is common in those

less than 3

78

s/s of croup

stridor, barking cough, fever

79

Primary spontaneous pneumothorax occurs mostly in

tall, thin men who smoke

80

complication of COPD

right ventricular hypertrophy (cor pulmonale)

81

cautiously give nicotine in those with

coronary artery disease, nicotine is a potent vasoconstrictor

82

black box warning with Chantix

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

83

common causes of pleuritic chest pain

viral, bacterial infections; TB

84

trx for pleuritic chest pain

indomethacin