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APEA review > respiratory/pulmonary > Flashcards

respiratory/pulmonary Flashcards

1
Q

pulmonary disorder s/s

A

cough, SOB, pain in chestt

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2
Q

differentiate dx for cough

A

pneumonia
bronchitis.
postnasal drip
heart failure

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3
Q

SOB link to respiratory issue s/s

A

clubbing
barrel chest
cyanosis
pursed-lip breath
hemoptysis

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4
Q

chronic bronchitis treatment

A

its s a viral treatment with fluid and rest
also advise the pt that the cough can lass as long as 21 days

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5
Q

heart failure chest x ray result

A

when an x-ray show bilateral congestion most likely is heart failure

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6
Q

most common pathogen in CAP

A

strep pneu

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7
Q

patient with a penicillin allergy with ATB for CAP

A

doxycycline 100mg daily
clarithromycin 500mg bid
azithromycin 500mg 1st day then 250mg daily

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8
Q

doxycycline produce GI symptoms

A

stop doxycycline and give a macrobile azithromycin or clarithromycin

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9
Q

levofloxacin contraindication (quinolones)

A

impaired bone formation contraindicated in age<18
prolonged QT torsade de pointe
dehydration
history of the biceps Tendon
pregnancy

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10
Q

bupropion

A

increase risk of seizure

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11
Q

primary
secondary
Tertiary

A

prevention
screening
treatment

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12
Q

pneumonia

A

infection and inflammation of the alveoli

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13
Q

Dx of pneumonia

A

a chest x-ray will show infiltrates, consolidation or opacity

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14
Q

ATS/IDA guideline for CAP treatment without comorbidities

A

1-Amoxicillin 1g (1000mg) 3 times a day: Best evidence
2-Doxycycline 100mg twice daily-conditional recommendation- low quality evidence
3-Macrolide (azithromycin, clarithromycin SR or ER)-conditional recommendation- mod quality evidence

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15
Q

CAP in pt with comorbidities can be managed with combination therapy or monotherapy guidelines do not specify preference

A

-chronic disease of major organ system(heart, lung, liver, kidney) or malignancy
-alcoholism
-Asplenia (The absence of a spleen)

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16
Q

ATS/IDA guideline for CAP treatment with comorbidities

A

-combination therapy
Amoxicillin/clavulanate or Cefpodoxime or cefuroxime
PLUS
Macrolide or Doxycycline
-Monotherapy
Respiratory fluoroquinolone (levofloxacin,moxifloxacincin, gemifloxacin)

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17
Q

pt with CAP test positive for influenza should be still treated with ATB

A

YES
guideline recommended treated for bacteria
viral/bacterial pneumonia often occurs

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18
Q

How long should should the pt with CAP BE TREATED

A

usually 5-10days
At least 5 days plus clinical improvement
-normalization of vitals and adequate dietary intake
follow up imaging is no longer recommended in patients with expected clinical improvement

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19
Q

pneumonia prevention

A

vaccination
pneumonia
influenza one dose annually
Sars-Cov2-primary series plus booster

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20
Q

what is the implication of increased tactile fremitus and dullness to percussion in a person with pneumonia?

A

Increased intensity of tactile fremitus generally occurs as a result of increased density within the lung tissue. This commonly occurs as a result of lung consolidation, which refers to the replacement of the air within healthy lung tissue with another substance; either inflammatory exudate, blood, pus, or cells.

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21
Q

COPD which guidelines should you know

A

2022 global initiative for chronic obstructive lung disease (GOLD) guidelines

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22
Q

when to suspect COPD

A

history/physical finding
-chronic tobacco use or noxious lung exposure from pollution, indoor stove, occupational
-genetic factors, family hystory or childhood predispositions
symptoms
presence of chronic productive cough with frequent lower respiratory tract infection

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23
Q

COPD -WHEN TO SUSPECT

A

Physical exam often normal may have barrel chest, wheezing. pursed lip breathing. decrease breath sounds

24
Q

COPD DX

A

spirometry is required for Dx
post-bronchodilator FEV1/ FVC ration <0.7
in other words, the pt can forcefully expel less than 70% of the air in their lungs even after using a bronchodilator

25
Q

COPD TREATMENT

A

-Beta-agonists produce bronchodilation by stimulating beta receptors in the heart and
lungs End in -TEROL
-Inhaled antimuscarinics prevent bronchoconstriction by blocking the action of acetylcholine at muscarinic receptors
End in TROPIUM
-COMBO AGENTS
SAMA+SABA
LAMA+LABA
LABA+ICS
LABA+LAMA+ICS

26
Q

SABA SHORT ACTING BETA ANTAGONIST

A

Albuterol
levalbuterol
onset <5mn
duration 4-6 hours 8hours

27
Q

LABA long-acting BETA ANTAGONIST

A

Salmeterol
onset 10-20mn
duration 12-24hrs

28
Q

SAMA SGORT ACTING MUSCARIN ANTAGONIST

A

Ipratropium (Atrovent)
duration 6hours

29
Q

LAMA

A

Tiotropium (Spiriva)
duration 24hours
nb. work well with long-acting beta-agonists

30
Q

prescribing strategy for stable COPD

A

-SAMA PRN OR SABA prn
-LABA AND LAMA PLUS RESCUE MED
-ICS+( LABA or LAMA)
-ICS + (LABA and/or LAMA)

31
Q

COPD EXECERBATION KEY SYMPTOMS and management

A

increase dyspnea
-Mild
SABA Albuterol
-Moderate
SABA +ATB (5-7days) and/or oral corticosteroid
-severe
ED or hospitalization
severe SOB, mental status change, low BP

32
Q

considered differentia dx

A

pneumonia-CXR
-pulmonary embolism-D-dimer, chest CT,PE protocol
-Afib /flutter-ECG
pleural effusion-CXR

33
Q

COPD comorbidities

A

-cardiovascular disease (HF, CAD, tachyarrhythmias, afib,
-metabolism syndrome
-osteoporosis
-depression/anxiety
-lung cancer

34
Q

SUPRACLAVICULAR LYMPH NODES is associated with high rates of malignancy

A

Right
-lungs
-mediastinum
-Esophagus

left
-Abdominal Malignancy
stomach
gallbladder, liver, pancreas, ovaries, prostate

35
Q

lung cancer screening guidelines
USPSTF RECOMMENDATION

A

adult aged 50-80 years who have >20 pack-year smoking history AND currently smoke OR quit within the past 15 years
screen Annually with low-dose CT

36
Q

ASTHMA S/S

A

Wheeze, SOB, chest tightness, and cough varies in intensity over time
s/ occurs or worsens at night with exercise viral infection, exposure to allergens, or irritants, hard laughing or crying, stress,
personal family history of asthma, atopic disease, eczema

37
Q

Asthma dx criteria

A

presence of asthma feature (history)
reversible airway obstruction
spirometry demonstrates airways are at least partially reversible after SABA > 12% improvement from baseline or Fev>200ml or after 4 weeks on ICS
nothing else could be causing symptoms

38
Q

NB pick flow is use for monitoring not for dx

A

using symbercort as rescue is not FDA approve.NEVER answer Symbercort as rescue on exam

39
Q

nb when asthma pt out of control

A

the drug to add is steroid to the SABA like Budesonide

40
Q

when rescue steroid don’t work

A

increase to moderate dose

41
Q

Long acting bronchedilator

A

never use alone in asthma can cause sudden death
always combine with steroid

42
Q

why is Timolol contraindicated in pt with asthma

A

is a beta blocker that can xce bronchoconstriction in pt with asthma

43
Q

SABA

A

Albuterol
levabulterol

44
Q

inhaled steroid suffix one

A

flucasone
monetasome budesonide

45
Q

Asthma treat

A

1-interminittent
SABA rescue prn
no symptoms most day< 2 weeks
-persistent
daily low dose ICS plud SABA prn
or PRN low-dose ICS/SABA comb (symbicort)

46
Q

risk factors for asthma related death

A

-history of intubation /ventilation or hospitalization for asthma in a last year
- not currently using ICS poor adherence to ICS SABA overuse (1 canister/month)
psychiatric disease, psychosocial problems
-lack of an asthma action plan

46
Q

risk factors for asthma related death

A

-history of intubation /ventilation or hospitalization for asthma in a last year
- not currently using ICS poor adherence to ICS SABA overuse (1 canister/month)
psychiatric disease, psychosocial problems
-lack of an asthma action plan

47
Q

Asthma severity
Mild intermittent

A

-symptoms < ou egale 2 days /weeks or
< ou egale 2 nights /month
exacerbation is brief

48
Q

mild persistent

A

symptoms > 2 times/week but not daily
or
3-4 times/month at nighttime

49
Q

moderate persistent

A

daily symptoms or
>1 night/week, but not nightly

50
Q

severe persistent

A

symptoms throughout the day often 7 night /week

51
Q

most common pathogen implication in pneumonia

A

0-4years viral
>5 bacterial: atypical pathogen (mycoplasma and Chlamydophila

52
Q

rust-colored sputum is associated with strep pneumonia but scant watery sputum is associate with atypical pathogen

A
53
Q

patient with penicillin allergy can take

A

tetracyclines -doxycycline
quinolones-ciprofloxacin
Macrolides -clarithromycin, azithromycin,
aminoglycosides(gentamicin
glycopeptides(vancomycin

54
Q

ATB to avoid with penicillin allergy

A

cephalosporin
beta-lactam ATB
cefazolin
cephalexin
cefuroxime,cefoxitin
ceftriaxone
ceftazi

APEA review (9 decks)

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