AANP board certification exam already passed

AANP board certification exam already passed how long will a cough last for acute bronchitis? up to three weeks is completely normal how do you treat acute bronchitis? 95% cases are viral-- tessalon pearls to help w ...

AANP board certification exam already passed how long will a cough last for acute bronchitis? up to three weeks is completely normal how do you treat acute bronchitis? 95% cases are viral-- tessalon pearls to help with cough. * prednisone is never the answer ** explain the following views of chest xrays: AP, PA, PA and lateral which one do you want for pneumonia patient? AP- shows the heart predominantly because its from front to back PA- shows the lungs predominantly because its back to front lateral shows fluid line what is the gold standard for diagnosing community acquired pneumonia chest xray- PA/lateral, repeat post treatment in 6 weeks (repeat not really done anymore) treatment guidelines for CAP- healthy adult no comorbidities MAD LUNG amoxicillin 1 gram TID (best choice) doxycycline 100 mg twice daily macrolide (mycin) in areas with low macrolide resistance so not the best choice treatment guidelines for CAP- adult with comorbidities monotherapy: respiratory quinolone (levofloxacin 750 mg daily) combination therapy: augmentin or cephalosporin PLUS macrolide or doxy what are common respiratory fluroquinolones? Think FLOXACIN-- moxifloxacin, gemifloxacin, levofloxacin what are common macrolides for CAP think "MYCIN" -- azithromycin, clarithromycin what are common tetracyclines for CAP doxycycline what are common beta lactams for CAP amoxicillin, augmentin (amox with clav), cefpodoxime, cefuroxime how would you treat a pregnant 29 year old with pneumonia? Amoxicillin 1 g TID-- cant give levaquine (flouroquinolones no in pregnancy due to fetal ligament destruction, doxycycline no in pregnancy stains tooth bones in fetus) how long do you give antibiotics to patient with pneumonia? 5-10 days, you always want to continue antibiotics for 3 more days after clinically stable (no fever) When do you get a chest xray for pneumonia? it is the gold standard for diagnosis, you do not need to do resolution chest xray unless things are lingering or you suspect something else. When do you give pneumococcal vaccine? adults > 65 years old you give PPSV23 or you can give both PCV 13 and PPSV23 but must be 1 year apart adults > 65 with immunocompromising condition give both pcv 13 and ppsv23 adults 19-64 at increased risk of pneumococcal disease (asthma, copd, smokers, cv dz) - give PPSV23 only adults 19-64 with asplenia, cochlear implants, csf leak-- give pCV13 NOW then PPSV23 in 8 weeks , then PPSV23 in 5 years. What is the diagnostic criterion for COPD FEV1/FVC ratio of < 0.70 What are characteristics of COPD midlife onset, symptoms slowly progressive, exposure to lung irritant, DOE is progressive, chronic cough and chronic sputum production what are characteristics of asthma onset early in life, symptoms vary widely from day to day, symptoms worse at nighttime/early AM, allergic rhinitis, eczema, family history, obesity what are characteristics of heart failure (when evaluating diff dx of COPD) chest xray with dilated heart, pulmonary edema what are characteristics of tuberculosis when ruling out for COPD patient onset all ages, chest xray with lung infiltrate, microbiologic confirmation what are the characteristics of bronchiectasis LOTS OF PURULENT SPUTUM, chest xray shows bronchial wall thickening and bronchial dilation What intervention has the greatest influence on slowing progression of a COPD patient? smoking cessation!! what are first line smoking cessation drugs? (3) varenicline (chantix), nicotine patch, buproprion extended release (zyban) what is second line smoking cessation drug? sertraline (zoloft) what smoking cessation drug would you give to someone with a history of a suicide attempt? nicotine patch-- NOT CHANTIX OR ZYBAN What are the short acting beta agonists albuterol, levalbuterol what are the long acting beta agonists "terols" Salmeterol Formoterol How do inhaled anticholinergic drugs work? used in COPD, prevent bronchoconstriction how do beta agonists work? stimulate beta 1 (tachycardia) and beta 2 (bronchodilation) what is the suffix for inhaled anti-cholinergic drugs? "tropium" think ipratropium (atrovent) SHORT ACTING, tiotropium (spiriva) long acting What is a SAMA? short acting antimuscarinic (anticholinergic) - Ipratropium what is a LAMA? long acting muscarinic antagonist (anticholinergic) Tiotropium (spiriva) what are the 4 steps of GOLD guidelines 1) SABA or SAMA prn 2) LABA or LAMA PLUS rescue med 3) ICS + LABA/LAMA plus rescue med 4) ICS+ LABA AND LAMA plus rescue med THEN REFER How to manage COPD exacerbation? figure out the cause mild: sabas with spacers / nebulizer moderate: SABAs plus AB and or steroid Severe: hospitalization right supraventricular nodes signal what malignancies? lungs, mediastinum, esophagus left supraventricular nodes signal what malignancies? abnormal (stomach, GB, liver, pancreas, ovaries, prostate) us preventive services task force routine lung cancer screening recommends what annual screening for current smokers aged 55-80 with 30 pack year history or have quit within the last 15 years? annual low dose CT (LDCT) how do you diagnose asthma > 5 years of age: presence of asthma features reversible airway obstruction on spirometry >12% improvement from baseline or FEV1 > 200 ml after SABA How do you treat asthma? saba always as rescue inhaler Step wise approach (GINA) Low dose ICS then ICS + LABA increase dosage strength acute bronchitis classic case symptoms cough that keeps awake at night dry cough but may be productive low grade fever or chest pain with cough wheezing and rhonchi median duration of cough is 18 days up to 3 weeks history of a cold before onset of symptoms objective findings in acute bronchitis lungs: clear to severe wheezing, rhonchi percussion: resonant CXR: normal afebrile to low grade fever treatment plan for bronchitis symptomatic treatment- increas fluids and rest tessalon perles, expectorant / mucolytic (guaifenesin) ventolin (albuterol) for wheezing for severe wheezing consider short term oral steroid complications of acute bronchitis exacerbation of asthma pneumonia from secondary bacterial infection pertussis "whooping cough" caused by bordetella pertussis (gram negative) coughing illness at least 14 days paroxysmal coughing, inspiratory whooping neonates / infants at highest risk for death three stages of pertussis catarrhal 1-2 weeks, if treated at this stage can shorten disease course paroxysmal: lasts 2-4 weeks, treatment has little influence but is useful to decrease spread convalescent: treatment goal is to eradicate carriage state / disease spread how to diagnose pertussis nasopharyngeal swab for culture - collect at 0-2 weeks following cough PCR may provide accurate results up to 4 weeks Pertussis antibodies by ELISA CBC with elevated WBCs and marked lymphocytosis cxr should be negative how to treat pertussis administer a course of antibiotics to close contacts iwthin 3 weeks of exposure first line: macrolides - azithromycin z pack x 5 days alternative bactrim x 14 days antitussives, mucolytics, rest, hydration, frequent small meals complications of pertussis sinusitis, otitis media, pneumonia, fainting, rib fractures from coughing signs of pulmonary embolism new onset dyspnea, hemoptysis, pleuritic chest pain, vital signs with tachycardia, tachypnea, may have signs of DVT