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Exam II will cover Peripheral Vascular System, Respiratory system, and Renal Disorders. 40 questions over 60 minutes. This is a proctored exam. Opens on Thursday March 24that 12:01 am and closes on March 24th11:59pm/Exam 2 Outline: Main TopicsRespiratory ProblemsUpper Respiratory Infection (URI)Bacterial infections: 25%InfluenzaCommon coldAcute laryngitisAcute epiglottitisRespiratory syncytial virus (RSV)URI: ManagementDiscussion of antibiotics, oseltamivir, zanamivirCough suppressantsRestFluidsAntipyreticsAsthmaThree principle triggers1.Allergens and environmental factorsInhaled substancesFood additivesMedications2.InfectionsUpper respiratory infection3.Psychological factorsStressAsthma: ManagementIdentification of exacerbating factorsDaily monitoring of peak expiratory flowSee online resource on asthma attack trigger diaryWritten instructions to manage an acute attackEducation and follow-upAsthma: MedicationsRelieversSABA- Albuterol, for acute or immediate relief ControllersOral systemic corticosteroidsLow, medium, or high-dose ICSLTRA, cromolyn, nedocromil, or theophylline, zileutinLABA- Corticosteriods, not for immediate relief, to be used to reduce inflammation
Step-up and step-down therapySix stepsReview classifications of asthma. Chronic Obstructive Pulmonary Disease (COPD)Obstructive (impaired expiratory flow rate)ReversibleAsthmaIrreversibleChronic bronchitis and emphysemaRestrictive (reduced lung volumes)Musculoskeletal disordersTumorsLung resection, ILDChronic Obstructive Pulmonary Disease (COPD) (cont’d)“Blue bloaters”Chronic bronchitis and pulmonary hypertensionEdema, cyanosis, polycythemia“Pink puffers”Emphysema, severe dyspneaRelatively normal ABGs“Barrel chest”COPD: Objective FindingsAP/lateral chest diameter 1:1Distant breath soundsEnd-expiratory wheezesProlonged exhalationNeck vein distensionPedal and ankle edemaClubbingFatigueCOPD: Diagnostic TestsPFTsFEV1/FVC ratio <70% diagnostic for COPDChest x-ray (although normal in early COPD)Chest CTCBC with diff, blood chemistry, alpha1-antitrypsinSputum with Gram stainECGCOPD: Pharmacological TherapyInhaled beta-2 agonist bronchodilatorsInhaled anticholinergic bronchodilatorsCorticosteroidsXanthinesAntibioticsDiureticsMucolytics and expectorantsCOPD: Requirements for Home Oxygen
PaO2of 55 mm Hg or lessOxygen saturation below 85%A PaO2of 55 to 59 mm Hg if erythrocytosis (HCT of 56% or more), cor pulmonale (P wave more than 3 mm in leads II, III, and aVF), edema, or CHFGoal on 1-2 L/min for 15 hours day is O2sat. of 90% or PaO2of 60 mm HgCOPD: Patient EducationSmoking cessationYearly influenza shot and every 5 year pneumovaxPhysical rehabilitation