Lower Airway Disorders
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| Define bronchitis: | Inflammation of the mucous membranes of the major bronchi and their branches
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| Bronchitis is usually secondary to what? | Upper respiratory infections
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| List 3 clinical manifistations of bronchitis | *Productive cough *Low grade fever *Diffuse rhonchi/wheezes, dyspnea *Chest pain *Generalized malaise, and headache
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| What do you question a PT about during an assessment if bronchitis is suspected? | health, presence of headache, and/or aching chest pain
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| PTs with bronchitis are at increased risk of what, and why? | Respiratory infections, Due to retained pulmonary secretions.
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| What causes legionnaires disease? | Legionella Pneumophilia (Gram-negative)
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| Legionaires disease progresses on what two courses? | *Influenza *Legionella disease (results in life threatening pneumonia)
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| List 3 clinical manifistations of legionaires disease | *Significantly elevated temperature 102f - 105f (38.8c - 40.5c) *Headache *Diarrhea *General malaise *NONPRODUCTIVE cough with tachypnea *crackles and wheezing *Signs of shock *HEMATURIA indicating renal failure
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| Anthrax most commonly infects what? | wild and domestic hoofed animals
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| How is anthrax spread? | Through direct contact with bacteria and its spores.
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| True or False: A person infected with anthrax is at high risk for infecting others. | False. It is not contagious by person-to-person
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| What is the most common form of anthrax? | Cutaneous
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| What is the least common form of anthrax? | GI
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| What do anthrax bacterial toxins cause? | Hemorrhage, necrosis, and lymph edema
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| How does anthrax appear at first? | It appears first like an insect bite (macule/papule), then black eschar formation and edema to site appears.
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| The initial symptoms of anthrax resembles what? Excluding what? | The common cold or influenza, except infected persons will not develop nasal secretions
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| What does death usually result from in a PT with Anthrax? | Blood loss and shock
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| How does an x-ray of inhaled anthrax differ from an x-ray of pneumonia? | *Inhalation anthrax (widened mediastinum) *Pneumonia (infiltrates)
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| What is the most reliable screening for inhalation anthrax? | Trick question. No single reliable screening is available.
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| What is the most reliable screening for cutaneous and GI anthrax? | Culture
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| What antibiotic is the treatment of choice for anthrax, and how long should it be taken? | Ciprofloxacin, 60 day course recommended.
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| What is the treatment of anthrax for soldiers? | 30 days antibiotic and 3 doses of anthrax vaccine
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| How is tuberculosis aquired? | Inhalation
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| What does tuberculosis result in? | inflammatory infiltrations
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| True or False: tuberculosis has rapid onset. | False. TB is usually latent in the early stages of infection and has potential for recurrence.
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| How does tuberculosis spread to susceptable organs? | Via the blood and lymphatic system.
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| What precipitates tuberculosis disease, and what percentage results in disease? | Tuberculosis infection. Only 10% of infections progress to disease.
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| What is the bacteria involved with tuberculosis? | Mycobacteria
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| The rate of TB in foreign born americans increased how much since 1986? | 65%
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| Approximately how many americans are infected with TB? | 15 million
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| True of False: PTs with TB are easily identifiable by their symptoms. | False. Many PTs with TB disply no s/s.
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| List 3 early signs of TB | *Fatigue *Anorexia/weight loss *Productive cough *Fever *Weakness
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| What are the late signs of TB? | *Daily reoccurring fever with chills *Night sweats *Hemoptysis (blood stained sputum)
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| What is done to confirm the Dx of active TB? | Sputum culture
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| What kind of room do TB PTs require, and what is needed upon exiting room? | Negative pressure room, must wear particulate matter mask when leaving room
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| True or False: Infants and children with TB dont usually require isolation. | True.
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| What medications are used to treat TB? | Isoniazid (INH), Streptomycin, and rifampin
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| Approximately how many PTs fail to complete their tuberculosis Tx? | 50%
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| Why is rifampin used in TB PTs? | prevention of meningococcal meningitis
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| What should you avoid while taking isoniazid for TB? | food with tyramine and histamine... eg. Tuna, aged cheeze, red wine, soy sauce, yeast extracts
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| Why must foods with tyramine and histamine be avoided while on isoniazid? | may cause lightheadedness, flushing, hypotension, headache and other symptoms
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| What can be taken to minimize the s/s when foods with tyramine/histamine are taken with isoniazid? | 50-200mg of vitamin B6 daily
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| What happens when antiacids are taken with isoniazid? | Decreased absorption of isoniazid
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| What happens when alchohol is taken with isoniazid? | Toxicity
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| List three 2nd line anti-TB drugs | *amikacin *Capreomycin *Cycloserine *Ethionamide *Levofloxacin *Ofloxacin *Para-aminosalicylic acid (PAS)
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| Rifampin and isoniazid are 1st or 2nd line drug? | 1st line
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| Which anti-TB drug requires an opthalmologic follow up? | Ethambutol
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| What is an expected adverse effect of rifampin? | discoloration of all body fluids (red)
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| isoniazid inhimibts the metabolism of what? | phenytoin
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| rifampin significantly decreases levels of what drug? | saquinavir
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| How would you administer anti-TB drugs if GI upset/irritation occures | Administer with food
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| What is pneumonia? | An inflammatory process of the respiratory bronchioles and alveolar spaces that is caused by an infection
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| What times of the year are cases of pneumonia most common? | Winter and spring
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| Who are cases of pneumonia most common in? | Infants and elderly
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| List 3 causes of pneumonia | *Bacterial pneumonia *Aspiration pneumonia *Viral pneumonia *Fungal *Chemical
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| list 3 clinical manifistations of pneumonia | *Sudden onset of pleurisy *Severe chills *Elevated temperature and night sweats *Painful productive cough *Increased heart rate *Tachypnea with difficult expiration
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| What are manifistations of Streptoccocal /pneumococcal pneumonia? | Rust colored sputum; possible friction rub
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| What are manifistations of staphylococcal pneumonia? | *Rust colored sputum *possible friction rub *COPIOUS SALMON COLORED SPUTUM
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| What are manifistations of klebsiella pneumonia? | Same as stRep + more of a gradual onset; more inflam of the terminal brochioles and alveoli (bronchopneumonia); if tx delayed beyond second day>>critically ill pt w/ increased risk of mortality rate
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| What are manifistations of Hemophilus pneumonia? | *Croupy cough *Arthralgias (joint pain) *Yellow or green sputum
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| What form of pneumonia commonly follows a URI? | Hemophilus
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| What are manifistations of mycoplasmal pneumonia? | *Severe, non-productive cough *Crackles *Decreased breath sounds
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| What are the manifistations of viral pneumonia? | *generally mild s/s *Cold symtoms *Irrating cough that produces mucopurulent or bloody sputm
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| List 2 antibiotics used to treat pneumonia | *penicilin *e-mycin *cephalosporin *tetracycline
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| List 4 Tx in the medical management of pneumonia | *Antibiotic therapy *O2 therapy *Analgesics/antipyretics *Expectorants *Bronchodilators *Vaccine *Physiotherapy *Humidification
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| True or False: Deep breathing exercises are discouraged for pneumonia PTs due to the inflammation to the lungs and pleural rub | False. Deep breathing/coughing exercises are encouraged to open the airways and clear the lungs of mucous.
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| Pneumonia is a major cause of disease and death in who? | Critically ill PTs
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| True or False: Pneumonia os the most common cause of death in North America | True
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| What form of pneumonia carries a poor prognosis? | Bacterial aspiration
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| How do the s/s of pneumonia differ in older adults? | s/s of pneumonia often atypical (fever, sputum, cough often absent)
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| How do antitussives differ from expectorants? | *Antitussives work by suppressing cough *Expectorants work by breaking down and thinning secretions, relying on coughs to expel mucus
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| What is the use of antitussives? | To treat NON-PRODUCTIVE coughs occurring in pneumonia, bronchitis, TB, cystic fibrosis, and emphysema
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| What is the action of antitussives? | Suppressing the cough reflex by direct action on the cough center in the medulla
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| What is the action of expectorants? | Expectorants act by liquefying and reducing the viscosity of thick, tenacious secretions.
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| True or False: Antitussives and Expectorants fall under different categories | False. They both fall under the 'antitussive' category.
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| What are the contraindications of antitussives? | *Hypothyroidism *Pregnancy *Lactation
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| What are the precautions of antitussives? | *Asthmatics *Geriatrics *Debilitated patients
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| True or False: Antitussives fall under Opioid and Non-opioid categories. | True.
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| What are the most common adverse effects of antitussives? | *Dizziness *Drowsiness *Nausea *Vomiting
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| Define Pleurisy: | An inflammation of visceral and parietal pleura
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| List 3 causes of pleurisy | *Bacterial *Tuberculosis *Pleural trauma *Pulmonary infarction *Lung cancer *Viral infections of intercostal muscles
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| What are the clinical manifistations of pleurisy? | *SHARP PAIN ON ISNPIRATION *Fever and dry cough *Dyspnea *Elevated temperature
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| When does the pain of UNTREATED pleurisy subside? | When pleural effusion developes
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| How should a PT with pleurisy lay in bed? | On the affected side
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| Define pleural effusion: | Fluid accumulation in the pleural space
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| Define pleural empyema: | INFECTED fluid accumilation in the pleural space.
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| How does a fever associate with pleural empyema differ? | Fever persists despite antibiotics.
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| What is the medical management of a pleural effusion/empyema? | *Thoracentesis *Chest tube placement *Antibiotics
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| What is a chest tube inserted for (Tx, not disease) | Continuous drainage and medication instillation
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| Is chest tube a closed or open system? | Closed
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| True or False: A single chest tube is placed at the base of the affected plural space to drain accumilated fluids. | False. A chest tube is place at the anterior and posterior of the affected pleural space and drains into 2 or 3 glass bottles or a 3 chamber drainage system.
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| How should a PT with chest tubes be placed, and why? | On the unaffected side to prevent kinks.
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| List 3 potential causes of atelectasis | *Hypoventilation *Shallow breathing post-op *Mucus accumulation *Compression from tumors *Stasis pneumonia *Aspiration
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| What is atelectasis? | The collapse of alveoli, preventing respiratory exchange of CO2 and O2
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| What causes atelectasis? (mechanism, not diseases) | Air blockage to a portion of the lung
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| What are the symptoms of atelectasis? | *May cause few, if any, symptoms. *Fever, dyspnia, hypertension, TACHYPNEA if symptoms do occur.
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