Correct Answers
A 64 year old with HTN and DM presents with productive cough, fever, body aches. What diagnosis is most
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likely?
a. Acute bronchitis
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b. Chronic bronchitis
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c. Pneumonia
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d. Pertussis - correct answer c. Pneumonia
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1st clue: 64 year oldc c c c
2nd clue: multiple comorbidities c c c
3rd clue: cough, fever c c c
what was the stem of the question? c c c c c c
Indications for a chest xray with acute cough - correct answer abnormal vital signs (increased RR or HR, temp
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>38c, 100.4F c
rales, consolidation c
> or equal 75 years of age with cough***
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,***Pneumonia in older patient: tachypnea, decreased O2 sat, OR change in mental status or behavior c c c c c c c c c c c c c c
A 75 year old patient wo smokes and has COPD presents with a worsening cough, weight loss, fatigue, and an
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enlarged right supraclavicular node. Which finding is most indicative of a right lung tumor?
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1. worsening cough
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2. weight loss
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3. fatigue
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4. supraclavicular node - correct answer 4. supraclavicular node
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most important stem clue because this lymph node drains the chest and breast. It's a BIG deal!
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If the stem gives a unilateral finding, look for a unilateral diagnosis
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What symptoms most commonly accompany acute bronchitis?
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1. Fever, runny nose
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2. Cough, fever
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3. Cough and URI symptoms
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4. Cough, URI, and headache - correct answer 3. Cough and URI symptoms
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Remember that bronchitis is an inflammation of the bronchioles, bronchi, and trachea; usually follows an
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upper respiratory infection c c
Starts above the shoulders and drops down into chest.
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A 35 year old patient with acute bronchitis has no underlying lung disease. He asks, "How long before my
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cough goes aways?" The NP responds: c c c c c
1. <1 week
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2. about 1 week
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3. 1-3 weeks
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4. >3 weeks - correct answer 3. 1-3 weeks
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, The patient with bronchitis will have evidence of upper AND lower airway symptoms.
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COUGH, COUGH, COUGH, usually worse at night! c c c c c c
What is the management of bronchitis? - correct answer Treat symptoms!
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Time is the only thing for bronchitis
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ABX usually prescribed, but usually not necessary
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Differential Diagnosis for Acute Bronchitis - correct answer PND c c c c c c c c
Asthma
PNA
Pertussis
TB
Supraclavicular nodes: associated with high rates of malignancy. What organs are on the right vs left? - correct
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answer RT: Lungs, mediastinum, esophagus c c c c
LT: Abdominal malignancy: stomach GB liver pancreas ovaries prostate
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Pneumonia Vaccine c
Who?
Who else? c
When is it given again? - correct answer Who-Prevention: Pneumococcal polysaccharide vaccination (PPSV)
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given once in a lifetime to immunocompetent adults > or equal 65 years
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Who else-Adults 19-64 with
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--chronic CV, lung, liver disease c c c c
--smokers, DM, ETOH, or asplenic c c c c
--chronic care facilities c c
--immunocompromising conditions c
When again-one time 5 years after for CRF, nephrotic syndrome, asplenia, sickle cell, immunocompromising
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conditions