Exit exam PULMONARY

most common cause of bronchiolitis

rsv

abx for strep

pcn, cephalosporins, or macrolides

organism for atypical pneumonia

mycoplasma pneumonia (community acquired pneumonia)

CURB for pneumonia

confusion, urea (bun >19), increased rr, blood pressure less than 90/60, age 65 or older. score of 2: may need to be admitted. 3 or more: hospital!

treatment for pneumonia in otherwise healthy pt w/o comorbidities

1. amoxicillin (preferred)

2. doxycycline (vibramycin)

3. azithryomycin (rising resistance rates)

abx for pneumonia with presence of comorbidities or recent abx use

1. augmentin PLUS a macrolide or doxy

2. respiratory fluroquinolone like levofloxacin

treatment for atypical pneumonia

macrolides (mycoplasma=macrolides)

cornerstone for asthma therapy

inhaled corticosteroids

spirometry test for asthma

fev1 before and after bronchodilator. normal is >80%

asthma step 1 treatment (rare symptoms 1-2/week)

low dose ics-formoterol as needed or before exposed to a trigger

asthma step 2 (more frequent symptoms 3-5 times/week) treatment

low dose ics-formoterol as needed

step 3 asthma treatment: symptoms most days of the week

low dose ics formoterol daily and also as needed

asthma step 4 treatment (daily symptoms including at night)

medium dose ics-formoterol; refer if you want

asthma step 5 treatment

refer

albuterol

saba - quick relief by relaxing bronchial muscles

LABA

salmeterol (severent) or formoterol (fast and furious choice): provide longer lasting relief. takes longer to start working. should not be given alone in asthma! need an ics with it

go to asthma treatment drug

symbicort (budesonide-formoterol). ISC+LABA combo. formoterol has a rapid onset of action but lasts about 12 hours

COPD spirometry diagnosis

post bronchodilator ration: fev1/fvc<0.7

COPD group A treatment

bronchodilator (laba or lama)

copd group b treatment

laba PLUS lama

copd group e treatment

e=exacerbation; laba PLUS lama, consider ics

LAMAs

tiotropium (drugs that end in ium); effective for reducing mucus production. key part in maintenance therapy in copd. anticholinergic se: dry mouth, constipation, urinary retention, blurred vision

drug examples of inhaled corticosteroids

budesonide, fluticasone

who would we screen for lung cancer and what kind of test

annual low dose ct scans for pts 50-80 who have a 20 pack year smoking hx who currently smoke or have quit w/in past 15 years

resonant pulmonary percussion tones

normal lung tissue

flat percussion tone

solid area such as muscle or bone

dull percussion tone

fluid filled areas such as pneumonia, atelactasis, or pleural effusion

tympanic percussion tone

normally heard over areas with excessive air such as pneumothorax or stomach

hyper-resonant percussion tone

heard over hyperinflated areas such as pneumothorax, asthma or emphysema