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Primary Care 2 > Respiratory > Flashcards

Flashcards in Respiratory Deck (72):
1

Streptococcus pneumoniae

inhabits the oropharynx, gram positive coccus in pairs of diplococci. aquired in the community. frequently follows a URI. Polysaccharide capsule responsible for most cases of nonresolving pneumonia syndromes. causes lobar pneumonia.

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physical findings supporting asthma

nasal polyps, pale nasal lining indicating allergi rhinitis and allergic asthma, atopic dermatitis with lichenified plaques

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consolidation with a blocked airway

percusson dull, fremitius decreased, breath sounds decreased, voice transmission decreased, crackles absent

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greater prevalence of asthma within menstrual cycle

periovulatory days 12-18, perimenstruall days 26-4

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pulmonary function testing

tests airflow limitation

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moderate asthma

dyspnea - while at REST, prefers sitting. talks in PHRASES. usually agitated. common accessory muscles. loud wheeze through out exhalation. pulse 100-120. pulsus 10-25.

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mast cells causes

smooth muscle hypertrophy

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peak expiratory flow

measured during a brief forceful exhalation. take large breathe in, put peak flow in mouth then blow hard and fast three times and take the highest measurement. if peak improved by 20 percent 20 minutes after bronchodilator then dx asthma

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severe asthma

dyspnea at rest, SITS UPRIGHT. talks in words, agitated, loud through out inhalation and exhalation wheeze, pulse > 120, paradoxus >25.

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Staph aureus pneumonia

gram positive in clusters can occur secondary to the flu, within the oropharynx of a hospitalized patient or a complication of staph in the blood stream.

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eosinophils causes

mucus hypersecretion, airflow limitation

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Exercise induced asthma

exercise and 5-15 minutes after have asthma s/s resolve over 30-60 minutes

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consolidation or atelectasis with a patent airway

percussion dull, fremitius increased, breath sounds bronchial, voice transmission bronchophony, whispered pectoriloquy, egophony, crackles present

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chlamyodphila

tetracyclin, macrolide

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aspiration pneumonia

anaerobic organisms affecting those with impared consciousness or difficultly swallowing, poor dentition - gradual onset, sputum with foul odor suggesting anaerobic infecion necrosis and abscess formation may follow. occurs in dependent areas of the lung. lower lobe in upright pts or superior lower lobe in supine patients -- can have pleural effusion or empyema

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H influenzae pneumonia

gram negative coccobacillary in the nasopharynx and in lower airways of patients with COPD. COPD is a predisposing factor

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outpatient w history of cardiopulmonary disease

same as without cardiopulm PLUS anaerobes, aerobes gram neg bacilli -- treat quinolones or beta lactam plus macrolide

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bronchodilator response

2 puffs of bronchodilator and repeat spirometry 15 minutes later, increased FEV of 12 percent and FVC at least 200 is a bronchodilator response

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pathological process common to all pneumonia

infection and inflammation of the distal pulmonary parenchyma

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inflamm cascade of asthma

epithelial cells, mast cells, cd4, eosinophils

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Extrinsic asthma

external - early in life, allergic, allergens, food, pollen, dust, occupational, aspergillosis. type 1 hypersensitivity

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spirometry

maximal inhalation followed by a rapid and forceful complete exhalation into the spirometer will measure forced expiratory volume FEV1 and forced vital capacity FVC. need this baseline in all asthma pts.

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Intrinsic asthma

viral infection, medication, cold, exercise, no hx of allergic reaction, develops later in life

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hae influenzae pneumonia

2nd or 3rd cephalosporins (cef), bactrim

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site of disease for copd and asthma

copd - peripheral airways and lung parenchyma leading to squamous metaplasia, small airway fibrosis and parencymal destruction... small bronchodilator response, poor response to steroids.

asthma - proximal airways leading to basement membrane and bronchoconstriction... large bronchodilator response. good response to steroids.

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obstructive airflow pattern on spirometry level

FEV1/FVC

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clinical features of copd

midlife, slowly progressive, long history of tobacco smoking, dyspnea during exercise, irreversible airflow limitation

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pneumonia and contributing factors

infection and inflammation of the distal pulmonary parenchyma. contributing factors are viral upper resp tract infection, alcohol abuse, cigarette smoking, heart failure, copd

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pleural effusion

dull percussion, decreased fremitus, voice and breath sounds, absent crackles

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pneumonia results in this process

ventilation perfusion mismatch and hypoxemia

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most common cause of bacterial pneumonia

step pneumoniae

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persistent severe asthma

symptoms through out the day needing meds, awakening 7times a week, extreme limitations in activity, FEV 5%

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Worse time for s/s

night and early morning

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Klebsiella pneumoniae

gram negative rod found in the GI tract, found with underlying alcoholism. leads to lobar pneumonia (same as step pneumonia --> lobar)

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copd inflammatory mediators

cd8, macrophages, neutrophils

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outpatient no cardiopulmonary disease

common organisms: s pneumo, m pneumo, c pneumo, resp virus, h influenzae -- therapy: macrolide azithromycin or clarithromycin or doxy

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Triggers

allergen, cold, exercise, viral infection, cold air

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bacterial pneumonia characterized by an outpouring of

PMNs polymorphocnuclear leukocytes to fight the infection

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neutrophils cause

subbasement membrane fibrosis, airway hyperresponsiveness

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What is asthma?

Chronic inflammatory disorder of the airways. Bronchial hyperresponse and inflammation leading to airway obstruction Recurrent, reversible

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staph pneumonia

oxacillin, nafcillin, cefazolin, vancomycin

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lobar pneumonia

process not limited to segmental boundaries but tending to spread through out an entire lobe of the lung from alveolus to alvelous through interalveolar pres of Kohn. Step pneumoniae and lobar pneumoniae

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emphysema and pneumothorax

hyperressonant on percussion, decreased fremitus, decreased breath sounds, decreased voice, absent crackles

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Allergens commonly causing asthma

furry animals, dust mites, cockroaches, mold, pollen

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work induced asthma

10 percent of new asthma cases, workplace related exposure confirmed with airflow variable before and after workshift. support with igE specific antibodies in the blood

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anaerobes

pcn, clindamycin

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intermittent asthma

80, exacc needing corticosteroids 0-1 yearly

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Pseudomonas aeroginosa

found in environmental sources within the hospital environment seen in patients who are debilitated, hospitalized and often previously treated with abx

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persistent moderate asthma

daily symptoms needing meds, nighttime awakening > 1 week, some limitation with activity, fEV 60-80, FEV/FVC reduced 5%

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What are the main s/s of asthma?

Wheezing, SOB, Cough

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resp arrest

dyspnea while at rest, sits upright, talks in words, DROWSY CONFUSED. paradoxical abdominal accessory muscles. wheeze absent. bradycardia. no paradoxus.

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Mycoplasmal pneumonia

slower, insidious onset with a *nonproductive cough,

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copd inflamm cascade

macrophage, epithelial cells, cd8, neutrophils

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most common causes of chronic cough

The most common etiologies of chronic cough are upper airway cough syndrome (due to postnasal drip), asthma, and gastroesophageal reflux. Cough may also be a complication of drug therapy, particularly with angiotensin converting enzyme (ACE) inhibitors.

Other less common causes of chronic cough include a number of disorders affecting the airways (nonasthmatic eosinophilic bronchitis, chronic bronchitis, bronchiectasis, neoplasm, foreign body) or the pulmonary parenchyma (interstitial lung disease, lung abscess)

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s pneumoia abx

PCN, macrolide (mycins)

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mild asthma

dyspnea - while WALKING, can lie down. talks in SENTENCES. alert may be agitated. Usually no accessory muscles. moderate wheeze only on expiratory.pulse

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interstitial pneumonia

exuberant inflammatory process but not highly destructive. inflammatory process is within the interstitial walls rather than the alveolar spaces. classically, viral pneumonia begins like this. also, pneumococcal pneumonia behaves this way -- healing process restores normal architecture... when organisms are more destructive, tissue necrosis and cavity formation will occur in the parenhyma -- cavitary.

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legionella

macrolides, quinalones

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spirometry determines what

if obstruction is present - reduced FEV1/FVC ratio, assess the reversibility, determine severity of airflow limitation

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allergic asthma eosinophil

>1,500

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clinical features in patients with pneumonia

fever with or without chills, cough w or without sputum, dyspnea, pleuritic chest pain, crackles, dullness, bronchial breath sounds and egophony with consolidation, polymorphic

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most frequent cause of pneumonia in young healthy adults

mycoplasma - the smallest known free living organism

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persistent mild asthma

> 2 days a week symptoms needing meds, not daily. awakening 3-4 a month, minor limits with daily activity, fEV > 80 normal, exacc > 2 times yearly.

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bronchopneumonia

*distal airway inflammation* is prominent along with alveolar disease and spread of infection and inflammatory process occurs through airways not alveoli -- patchy in distribution. staphylocci and a variety of gram neg bacilli may produce this

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mycoplasma

macrolides (mycins), quinolones

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gram negative rods

3rd or 4th cephalosporins, extended pcn with beta lactamase inhibitor

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airway inflammation in asthma

air is trapped in alveolis, central and peropheral airways are involved, dysregulation of cells - epithelial, eosinophils, lymphocytes, mast cells, alveolar macrophages, neutrophils, -- cells regulate airway inflammation and initiate airway remodeling and permanent airway structure

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normal lung

percussion resonant, fremitus normal, breath sounds vesicular at bases, voice transmission normal, no crackles

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staph or gram negative pneumonia appearance with pt

very ill with complex underlying health problems

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bronchoprovocative testing

provocative metacholine, mannitol, exercise or hyperventilation of cold, dry air. positive test is a 20 percent decrease in FEV of methacholine 8mg or less

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Aspirin and asthma

cough, wheeze or chest tightness 30-120 minutes after aspirin or cyclooxygenase inhibitor

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pneumococcal pneumonia

abrupt onset with sudden development of shaking chills and high fever - cough may be productive of yellow green or blood tinged. before this pneumonia they often have an URI.