Primary Care: Respiratory

Front 1

90% of acute bronchitis is of _______ origin.

Back 1

Viral

Front 2

Acute bronchitis results from....

Back 2

inflammation or infection of the bronchial epithelium of the trachobronchial tree. No alveolar involvement.

Front 3

Acute bronchitis presentation?

Back 3

Cough, chest px, low grade fever, phelgm, rhinorrhea, sore throat, ha, postnasal drip. Wheezing, ronchi, low pleakflow readings. Sounds alot like asthma! (Think asthma if worse at night and with cold or exercise)

Front 4

Will you find dullness on percussion of the lungs with bronchitis?

Back 4

No, this suggests pneumonia.

Front 5

any labs for bronchitis?

Back 5

No. Not even CXR or culturesfor uncomplicated cases.

Front 6

Is bronchitis treated with antibiotics?

Back 6

No, it is mostly a viral infection.

Front 7

So, what is one to do with bronchitis?

Back 7

Rest, fluids. Meds to relieve cough: bronchodilator, antihistamine (if related to allergic rhinnitis), choose either an antitussive or an expectorant if they have phlegm

Front 8

What is chronic bronchitis?

Back 8

Persistent cough and overproduction of sputum for 3+ months

Front 9

Do we manage these pts?

Back 9

No, they should see a pulmonologist.

Front 10

What kinds of agents are used to manage pts with chronic bronchitis?

Back 10

Bronchodilators, O2, antibiotics, corticosteriods, Beta-agonists like albuterol, anticholinergics too.

Front 11

What are 4 factors that increase the chance of infection with tuberuclosis?

Back 11

1. Number of organisms released into the air.
2. Concentration of bacteria inrelation to space and ventilation
3. Immune status of exposed persion
4. Length of exposure to environment

Front 12

How is it possible that TB can be dormant in someone for years?

Back 12

Upon infection, a granuloma of inflammatory tissue is formed and prevents further replication of the org. A small amount remains though in the granuloma and can be reactivated even years later.

Front 13

Is someone with Latent TB at risk for exposing others?

Back 13

no but she is at risk for developing active TB herself.

Front 14

Who should receive TB skin testing?

Back 14

Those with risk for exposure to TB and those who have a current medical condition that increases their risk for conversion from latent to active TB.

Front 15

Are all positive tests treated?

Back 15

Yes

Front 16

Who should be screened for TB?

Back 16

Ppl born in ctys with high incidence of prevalence of TB
Ppl who had ocntact with a know or suspected case of TB
Ppl who visit or lvie in residential facilities or group settings
Ppl involved in high risk residential facilities or group settings (college entrance)
Health care workers

Front 17

Who is at risk for conversion from latent TB?

Back 17

Hiv+, ETOH abuse, IV rx user, low SES, immunosuppressed

Front 18

Reading of a TB skin test is based on...

Back 18

Area of induration not erythema.

Front 19

Can the following peeps get the TB skin test: infants, children, pregnant women, HIV+, immunosuppressed ppl, ppl who got BCG?

Back 19

Yes

Front 20

If someone has been exposed to TB and has a neg test, should it be repeated? if so, when?

Back 20

Yes, retest in 10-12 weeks

Front 21

If a TB skin test is 5-10mL, it is considered + for whom?

Back 21

HIV+
Recent contact with known TB+ person
CXR with granulomatous changes
Orang transplant ot other immunocompromised peeps

Front 22

If a TB skin test is 10-15mL this is ocnsidered + for whom?

Back 22

Foreign born peeps in US<5yrs
injection drug users
Residents or employees of high risk settings
lab personnel
kids undder 4 years of age
infants, kids and ados exposed to adults in high risk categories
recipient of BCG

Front 23

For whom is a TB skin test >15mL considered +?

Back 23

no known risk factors

Front 24

What is the preferred tx for latent TB?

Back 24

Isoniazid 300mg QD x 9mo.
Alt: rifampin
a/e for both: hepatotoxicity
rifampin a/e: renal failure and it interacts with OCPs so need another method!

Front 25

Which labs might you draw throughout treatment?

Back 25

AST, ALT and bilirubin (for liver)
BUN, Cr, and CBC/PLT

Front 26

In most women, should latent TB be treated in pregnancy?

Back 26

yes

Front 27

What should the pregnant woman being treated for TB also take?

Back 27

Vit B6

Front 28

Where can active TB occur in the body?

Back 28

Lung, kidneys, bone, lymph nodes, brain, and soft tissue.

Front 29

What might you see on a CXR of a person with active TB

Back 29

Calcified nodules

Front 30

What do you think if a pt has a bilateral mild-mod intensity HA with neg. N/V and can have either photo or phonophobia but not both.

Back 30

Tension headache

Front 31

What kin of assessment should you do on a person witha headache?

Back 31

Physical to ru/o organic causes. Assess mental status, CN, sensory and motor fxn, coordination, deep tendon reflexes.

Front 32

Any lifestyle suggestions for woman with tension headache?

Back 32

healthy diet, sleeping habits, exercise, avoid tobacco and ETOH

Front 33

Rx for treatment of tension headache?

Back 33

acetaminophen, NSAIDs, aspirin, + caffeine. Can try tricyclic antidepressant prophylcactically

Front 34

What about the headache that is unilateral, pulsating, mod-severe, aggravated by daily activities and has one or more of N/V, photo/phonophobia?

Back 34

It's a migraine

Front 35

There are 3 main classes of drugs for abortive treatment of migraine, what are they?

Back 35

NSAIDS triptans, and Ergots
Not safe during pregnancy

Front 36

How do triptans work?

Back 36

Mimic serotonin by binding to serotonin receptors causing blood vessels to contrict.

Front 37

What rx can be used to prevevent migraines?

Back 37

B-blockers, antidepressants (TCAs), NSAIDS, anti-seizure drugs, Botox

Front 38

What is an ominous headache and what do you assess if you suspect this?

Back 38

h/a that is a sx of a serious medical problem.
Think SNOOP: systemic symptoms? or secondary RF?
Neurological sx
Onset sudden? SPlit second?
Older that 50?
Previous h/a hx: worst h/a ever?

Front 39

How might a cluster h/a present?

Back 39

strikes very quickly, intense sharp, burning, pain on the same side. Tearing and redness of affected eye. N
Neg FH, male, age 20-40, smokers, ETOH

Front 40

What happens with a middle ear effusion (aka serrous otitis media)?

Back 40

eustachian tube becomes blocked and air can't get into the middle ear. It accumulates behind the ear drum and pt may have muffled hearing or fullness in one ear.

Front 41

What are the findings that allow one to make a diagnosis of AOM?

Back 41

Hx of acute onset s/s
Presence of middle ear effusion
s/s of middle ear inflammation

Front 42

Tx for AOM?

Back 42

Watch and wait for 48-72hrs. Give OTC px relievers.
If abx used, amoxicillin x 5dMay take 3 mo. for effusion to resolve

Front 43

How does otitis externa occur?

Back 43

The ususal protective mechanisms of the ear fail and an infection takes place

Front 44

Tx of otitis externa?

Back 44

Acetic acid or corticosteriod ear drops +/- antibiotic drop(floroquinolones or cipro).
Sx should improve in 48-72hrs

Front 45

How does allergic conjunctivitis present?

Back 45

redness, eyelid edema, itching, tearing, stringy white discharge, nasal congestion, no vision changes, normal funduscopic exam.

Front 46

How does bacterial conjunctivitis present?
tx?

Back 46

sudden onset of diffuse redness, also a purulent discharge and swelling of conjunctiva, normal vision and nl funcoscopic exam.
Tx with antibiotic eye drops

Front 47

Viral conjunctivitis?

Back 47

often has concomitant URI. Redness, blah blah blah, blurry vision, poss preauricular node edema, clear discharge

Front 48

Tx for a stye?

Back 48

Warm compresses 15mins 4x qd