COPD
What are the cardinal signs?
Progressive, gradual dyspnea and cough
Wheezing, Dyspnea, Cough, Chest Tightness
What are the likely pathogens for pediatric age ranges: 3-11 weeks, 3months- 5 years, 5-18 years?
3-11 weeks: chlamydial
3mon-5 year: viral (RSV)
5-18 years: mycoplasma, strep PNA
What is "whooping cough"? what are the symptoms? how long does it last? how do we treat (what abx is #1 choice)? tell me about the vaccines.
Pertussis bacterial infection
high pitch cough on inhalation
duration: weeks to months
tx: supportive, azithromycin (macrolides)
Tdap = texting = older than 11 years (2 doses)
Dtap = younger than 11 (5 doses)
What is the difference between spirometry and plethysmography?
spirometry: VENTILATED gas measurement
Plethysmography: ALL gas measurement
What is the gold standard for diagnosis? What is the result that would indicate COPD?
Spirometry
FEV1/FVC <70%
Describe the Atopic Triad & Hygiene Hypothesis
Atopic Triad: asthma, allergic rhinitis, atopic dermatitis
Hypothesis: early exposure to animals/ kids/ farm life and little abx use results in reduced risk for asthma
Causative Agents for typical vs atypical PNA
typical: #1 = strep PNA, staph aureus, klebsiella, morazella cat., H influenzae
Atypical: #1 = mycoplasma, legionella, chlamydia, fungi, oral anaerobes, viral
What are the s/s of RSV
wheezing
tachypnea
cough
fever
nasal congestion
Describe peak flow meter zones and expected readings. What should the patient do for each zone?
Green: >80% -> maintain treatment plan
Yellow: 50-80% -> caution, increased checking, notify provider, take as needed
Red: <50% -> ER
If Mary Ann was hospitalized last year for her COPD, what COPD group would you classify her? What medication would she be on? What would you include in her treatment plan?
E
LABA+LAMA
(add ICS if eso >300 OR recurrent hospitalizations)
PULM REHAB FOR ALL E+B PATIENTS
Describe typical PFT results for asthma.
INCREASED- TLC
Post: Normalized numbers
KEY FINDING: significant improvement in FEV1 & change % > 10-15
What is the gold standard for diagnosis and differentiating PNA?
enlarged red
frothy mucous
stridor, drooling, cyanosis, fever, malaise
-> ER, need abx and airway protection
What is RAST?
radioallergosortbent test for FOOD
serum blood test of IgE
does NOT tell you how severe reaction may be
Recall GOLD grades 1-4 & what they indicate
What is the MRC scale and CAT assessment used for?
2:mod, FEV1 50-80%
3: severe, FEV1 30-80%
4: very severe, <30%
MRC- dyspnea rating
CAT- symptom rating
REVERSIBLE airway obstruction
bronchial inflammation, edema, and constriction
What is the CURB 65 criteria? Interpret the scores.
What is the treatment for CAP?
CURB65: determines outpt vs inpt treatment for PNA needed (confusion, BUN, RR, blood pressure, >65)
No comorb/MRSA/pseudo: amoxicillin OR doxy OR zpack
w/ comorb: augmentin or cephalo PLUS zpack or doxy
OR monotherapy with fluoroquinolone (-floxacins)
What are the signs and symptoms of influenza? What complications can arise? Tell how you would treat.
s/s: DRY COUGH, fever, chills, malaise, body aches, sore throat
Complications: viral PNA, croup, COPD exacerbation, reye syndrome
Tx: symptoms, antivirals (48 hrs onset, prophylactic, high risk for deterioration)
Tell me what I would see on CXR for...
Bronchitis (acute vs chronic)
Emphysema
Typical PNA
Atypical PNA
TB
Bronchitis acute- negative, chronic- peribronchial thickening & increased lower lobe markings
Emphysema- hyperinflation (diaphragm flat, small cardiac silhoutte)
Typical: dense homogenous, lobar infiltrates (lower lobes)
Atypical: diffused, patchy interstitial infiltrates
TB: unilateral, cavities, upper lobes, hilar lymphodenopathy
What is used in the treatment for COPD exacerbations and why?
SABA- immediate relief and airway opening
PO steroid- reduced inflammatory response and mucus production
Azithromycin x5 days- treat underlying cause/ prevent infection
If 15 year old Lucy's asthma is persistent, moderate How often is she having symptoms? How often is using her rescue? What treatment step/ treatment plan would you initiate according to GINA guidelines?
Daily symptoms
Waking up at least once a week
Daily rescue use
Step 3: SMART: Daily low dose ICS-Formoterol & PRN ICS-Formoterol
YES.
Preferred: PCV20 or PCV 21
If they have had PCV 15 -> give PPSV23
If they have no had 20, 21 or 15+23 -> give 20 or 21.
Spread by 1 year
Describe the following for Croup
Causes, Signs and Symptoms, Duration, Tx, and who is most likely to get it
cause: viral infection (flu, rsv, parainflu)
s/s: low BARKY cough, Seal bark
duration: day 3-5 is worst, cough lasts 2 weeks
tx: supportive - cool mist, tylenol, fluid (steroids MAYBE)
Group at increased risk: boys, 6 month- 3 years old