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Respiratory An adult has upper respiratory symptoms and cough for the past 14 days. What should be considered? Pertussis should always be considered in adults who present with acute cough of greate... r than 5 days’ duration. The incubation period for pertussis is about 7-10 days. Patients present with URI symptoms for 1-2 weeks. The classic paroxysmal cough usually begins in the second week of the illness. The duration of symptoms and cough are about 3 months even when treated with antibiotics. This is highly infectious and is a reportable disease. Mycoplasma pneumoniae is: Mycoplasma is an atypical pathogen and produces atypical pneumonia. It can be difficult to diagnose because symptoms can be varied and involve multiple body systems (extrapulmonary manifestations). Infection with Mycoplasma may present with a normal white blood cell count, maculopapular rash, GI symptoms, tender joints and aches, and, though rare, cardiac rhythm disturbances. Respiratory symptoms may not be pronounced. On chest X-ray there are some unique findings (peribronchial pattern) with Mycoplasma. These include thickened bronchial shadow, streaks of interstitial infiltration, and atelectasis. These are more likely to occur in the lower lobes. Which medication below is contraindicated in an asthma patient because it may increase risk of sudden death if used alone? A long-acting bronchodilator can be used to treat asthma when it is used in combination with an inhaled steroid. Otherwise, using a long-acting bronchodilator like salmeterol is contraindicated. There is an increased risk of sudden death with asthma exacerbations when this class is used solo to treat asthma. The other choices can be used to treat asthma. Choices vary depending on the patient. A 75-year-old female with emphysema who has been treated with inhaled steroids for many years should Older females are at higher risk than others for osteoporosis. This female patient, who has used inhaled steroids and smokes, has multiple risk factors for osteoporosis. Additionally, she probably has emphysema because she smoked (or still smokes). If she is Asian or Caucasian, she has still another risk factor. Screening for osteoporosis should be considered when managing patients with multiple risk factors. A patient received the pneumonia immunization at age 60 years. He is 65 years old and presents to your clinic today. What recommendation should be made about the pneumococcal immunization? This patient should receive another one today because he is 65 years old and at least 5 years has elapsed since his last one. The CDC does not recommend immunizing this patient every 5 years. Two immunizations are available, PCV13 and PPSV23. He needs both, but PCV13 should be administered today. PPSV23 should be administered at least 1 year later. Which of the following medications should be used cautiously in a patient who has asthma? Timolol is a beta blocker. This class of medications can precipitate bronchoconstriction in patients who have asthma. Even though timolol is being administered in the eye, it is absorbed through mucous membranes and can exert systemic effects. Beta blockers should be avoided in patients with asthma and used cautiously in patients with COPD. The other medications listed have no specific contraindications for patients with asthma. The most common symptom associated with acute bronchitis is: Fever (temp > 101°F) is an unusual symptom associated with acute bronchitis. Cough is the most common symptom associated with acute bronchitis. Purulent sputum is identified in more than 50% of patients with acute bronchitis. The color imparted to the sputum is usually due to sloughing of epithelial cells, not bacterial infection. Concurrent upper respiratory symptoms are typical of acute bronchitis. Pharyngitis is common. Mild persistent asthma is characterized by: Mild persistent asthma is characterized by symptoms that occur more than twice weekly but not daily; or 3-4 nocturnal awakenings per month due to asthma. It is treated with an inhaled steroid daily, and a bronchodilator PRN for exacerbations. If symptoms occur more than twice weekly, therapy should be stepped up. Generally, a long-acting bronchodilator is added to the steroid when therapy is stepped up. The chest circumference of a 12 month-old is: The chest circumference is not routinely measured at well-child visits, but is assessed if there is concern about the circumference of either the head or the chest. An exception to this observation can occur in premature infants where the head grows very rapidly. Normally, the head exceeds the chest circumference by 1-2 cm from birth until 6 months. Between 6 and 24 months the head and chest circumference should be about equal and by 2 years of age the chest should be larger than the head. The chest circumference is measured at the nipple line. A patient with cough and fever is found to have infiltrates on chest x-ray. What is his likely diagnosis? The finding of infiltrates on chest x-ray, in conjunction with clinical findings of fever and cough, should direct the examiner to consider pneumonia as the diagnosis. Other common clinical findings with pneumonia include chest pain, dyspnea, and sputum production. Though not common, some patients with pneumonia exhibit gastrointestinal symptoms like nausea, vomiting, and diarrhea. .............................................................................................continued....................................................................................... [Show More]

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