Fam Ii Test 1

Front 1

Upper Respiratory Tract Infections (URIs): 7

Back 1

Viral pharyngitis Bacterial pharyngitis The common cold Viral tonsillitis Bacterial tonsillitis Rhinitis Sinusitis

Front 2

Respiratory Syncytial Virus (RSV)

Back 2

supportive tx

Front 3

Bronchiolitis. viral or bacterial?

Back 3

mostly viral

Front 4

Croup: most common age/gender, upper or lower airway?

Back 4

young boys, upper airway

Front 5

Pertussis: age at risk and prevention?

Back 5

"whooping cough" kids prevent: immunizations

Front 6

Cystic fibrosis

Back 6

cf

Front 7

Asthma

Back 7

step 1-6. questions based on severity. cannot dx the level during an acute exacerbation. will get a scenario of a pt and have to tell severity and what will prescribe.

Front 8

Pneumonia: atypical: who's at risk? CAP: who's at risk and tx:

Back 8

atypical: young adults get this CAP: children from : virus: RSV children Bacterial - adults: 20-60% Strep pnm 10-15% H flu B lactam PLUS Macrolid (azithromycin) or Fluoroquinolone

Front 9

The common cold:

Back 9

viral URI sneezing, malaise, watery nasal discharge, mild sore throat, +/- fever tx: NO antibiotic. tx pain and fever

Front 10

The FDA recommendations for <6yo cold/cough meds

Back 10

Recommended that oral OTC cough and cold ingredients should no longer be available for children under 6 years of age

Front 11

Most frequent cause of hospitalizations of infants?

Back 11

bronchiolitis

Front 12

Causes of Bronchiolitis

Back 12

predominately viral RSV >50% of cases

Front 13

pathophysiology of bronchiolitis:

Back 13

Bronchiolar obstruction due to edema Accumulation of mucus and cellular debris Invasion of the smaller bronchial tubes by virus Ball valve respiratory obstruction leading to air trapping and overinflation

Front 14

RSV symptoms

Back 14

Pharyngitis, +/- fever, occasionally otitis media, coryza, bronchitis/bronchiolitis, pneumonia

Front 15

Croup caused from and s/s

Back 15

viruses laryngotracheobronchitis symptoms worse at night inspiratory stridor

Front 16

Pertussis: organism and s/s

Back 16

"whooping" cough organism: bordatella pertussis cough starts as a dry intermittent hack post tussive emesis is common

Front 17

Pertussis tx:

Back 17

erythromycin

Front 18

Cystic Fibrosis

Back 18

multisystem genetic disorder: GI, COPD, exocrine dysfunction, malabsorbtion of nutrients by pancreas

Front 19

PNM: 3 types

Back 19

Lobar Interstitial Bronchopneumonia

Front 20

Lobar PNM:

Back 20

involves depositions in the alveolar space that result in consolidation all or part of a lobe of the lung

Front 21

Interstitial PNM:

Back 21

cellular infiltrates attack the interstitium, which makes up the walls of the alveoli, the alveolar sacs and ducts, and the bronchioles (typical of acute viral infections)

Front 22

Bronchopneumonia PNM:

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inflammation is centered in the bronchioles and is characterized by mucopurulent exudate->patchy consolidation involves more than 1 lobe

Front 23

causes of PNM:

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viral or bacterial RSV, flu, adenovirus, parainfluenza

Front 24

S/S PNM:

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high fever, cough/wheezing/stridor, restlessness, chills, nasal flaring, grunting, retractions, tachypnea, abd pain

Front 25

Viral PNM tx:

Back 25

antipyretics, hydration, rest can use amoxacillin

Front 26

Asthma defined as:

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an immunohistopathologic response

Front 27

asthma described:

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This response produces shedding of airway epithelium, edema, mast cell activation, and inflammatory infiltration by eosinophils, lymphocytes, and neutrophils The result: airway inflammation, acute bronchospasm, airway edema, mucus plugs

Front 28

dx asthma: 5 years or older

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Spirometry: gold standard An increase in FEV1 of ≥12 percent from baseline or An increase ≥10 percent of predicted FEV1 after inhalation of a short-acting bronchodilator

Front 29

Classifications of Asthma

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Step 1: Intermittent Step 2: Mild persistent Step 3: Moderate Persistent Step 4: Severe Persistent

Front 30

Intermittent:

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Symptoms ≤ 2× per week Nighttime symptoms ≤ 2× per month No interference with normal activity FEV1/FVC normal

Front 31

Mild persistent

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Symptoms >2 days/ week but not daily Nighttime asthma symptoms 3-4× per month Minor limitation to activity FEV1/FVC normal

Front 32

Moderate persistant

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Daily symptoms Nighttime asthma symptoms >1× per week but not nightly FEV1/FVC reduced 5%

Front 33

Severe persistant

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Symptoms throughout the day Often 7×/week night time wakening FEV1/FVC reduced >5%

Front 34

management of asthma

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for tx: tx at the level they present to rapidly control symptoms and then taper down to achieve control of symptoms.

Front 35

what is the most common cause of childhood hospitalization?

Back 35

asthma

Front 36

Pharmacological tx for asthma, quick-relief meds:

Back 36

short acting beta 2 agonist (SABA): albuterol, levalbuterol Inhaled anticholinergics: atrovent systemic corticosteroids: mythylprednisone/prednisone

Front 37

Pharmacological Therapy: Long-Term Control Medications

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corticosterids inhaled: flovent long acting inhaled beta 2 agonist: LABA

Front 38

do not use ___ in acute exacerbations

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long acting B2 antagonists

Front 39

IH vs IV

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Of note, studies suggest that if patients do not respond to inhaled they won't respond to parenteral Epinephrine 1:1000 (1mg.ml) – 0.3-0.5 q 20 min SQ × 3 doses Terbutaline (1mg/ml) – 0.25mg q 20 min SQ × 3 doses

Front 40

Role of anticholinergics

Back 40

Meta-analysis reviewed 10 studies- modest improvement in PFT’s noted and significant decrease in hospitalization rates noted

Front 41

recommendations for systemic corticosteroids:

Back 41

Recommended for most patients. Early treatment with corticosteroids dramatically reduces need for hospitalization and probably reduces the likelihood of death from acute asthma. Recommended if not responding to β2 agonists

Front 42

Magnesium

Back 42

Intravenous has bronchodilator activity in acute asthma Magnesium 2 GMs over 20 minutes Safe Contraindicated in renal insufficiency

Front 43

Not recommended for asthma tx:

Back 43

mucolytics, abx,

Front 44

predictor of hospitalization:

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FEV1 and s/s scores 1 hour after initial tx improve ability to predict need for hospitalization

Front 45

Community Acquired PNM

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Associated with at least 2 symptoms of acute infection Fever or Hypothermia Diaphoresis Shaking chills Cough with or without sputum production, or change in the color of sputum in a patient with chronic cough, pleuritic chest pain or dyspnea

Front 46

Who's at risk for CAP?

Back 46

<2 yo and >65 yo bc decreased immunity

Front 47

CAP : s/s

Back 47

decreased appetite, cough, fever, dypsnea, elderly who are around young children

Front 48

CAP caused by what organisms: adults children

Back 48

20-60% Strep pnm 10-15% H flu leading cause in children: RSV

Front 49

Strep pnm usually causes what type of pnm?

Back 49

lobular

Front 50

s/s pnm in elderly:

Back 50

mental status changes or increased resp rate

Front 51

if have CAP and pregnant, tx with:

Back 51

B lactam PLUS Macrolid Do not use fluoroquinolones in pregnancy if preg don't use fluoro or you may hurt the baby

Front 52

CAP and not pregnant, tx:

Back 52

B lactam PLUS Macrolid (azithromycin) or Fluoroquinolone

Front 53

CURB-65: 1 point for everything they have: if confusion, 1 point. admission consideration criteria

Back 53

Confusion (new disorientation to person, time and place) Elevation of Blood Urea Nitrogen (BUN) Level above 7mmol/L(urea) or 20mg% BUN Respiratory rate over 30 breaths/min Low BP ( Age >65 years 1 point for each criteria-consider admission for score >2

Front 54

Atypical Pneumonia pathogen

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Atypical Pathogen: not a bacteria. not a cocci or bacillus. They are obligate intracellular organisms that need to live inside our cells.

Front 55

Atypical Pneumonia s/s

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No evidence of lung consolidation on physical examination or radiographic examination. Radiographic findings are patchy infiltrate if anything. known as walking mans pneumonia More diffuse illness. low grade fever, cough, upper resp symptoms.

Front 56

atypical pnm types:

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Mycoplasma Pneumoniae Chlamydophila Pneumoniae Legionella pnm

Front 57

Legionella Pneumphila

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pnm with hyponatremia, bradycardia

Front 58

What is the definition of Hospital Acquired Pneumonia (HAP)?

Back 58

occurs 48 hours or more after admission. There was no evidence of incubating pneumonia at the time of admission.

Front 59

What causative pathogens do you need to consider for a patient with HAP?

Back 59

Aerobic gram-negative bacilli P. aeurginosa, E. coli, Klebsiella pneumoniae, Acinetobacter spp. Gram positive cocci Staphylococcus aures, MRSA (MRSA can be hospital acquired or community acquired.. which are different resistance) Oral bacteria Streptococcus virdins

Front 60

Early and Late Onset of HAP or VAP prognosis

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Early onset of HAP or VAP (Ventilator Acquired PNA) Occurs in first 4 days of hospitalization Late onset HAP or VAP Poor prognosis Higher mortality rate

Front 61

HAP tx for early onset and no known risk factors for MDRP

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Ceftriaxone Levofloxacin ampicillin Ertapenem

Front 62

Late onset or risk for MDRP: Pathogen and tx

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acinetobacter tx: cefepime, meropenem, zosyn

Front 63

Peak incidence of bronchiolitis

Back 63

6 months

Front 64

PMN incidence increases w age?

Back 64

true

Front 65

tx for CAP?

Back 65

Azythromycin