42 Questions
What percentage of community-acquired pneumonia cases are attributed to Streptococcus pneumoniae?
30-35%
What is the percentage of atypical pneumonia in community-acquired pneumonia cases?
37%
Which of the following is NOT a common cause of community-acquired pneumonia in healthy adults?
Nosocomial gram negatives
What is the definition of community-acquired pneumonia?
Infection of the lung not acquired in the hospital, LTC, or other recent contact with a health care system
What is the percentage of community-acquired pneumonia cases that require hospitalization?
10%
Which of the following is a common cause of community-acquired pneumonia in older adults?
Nosocomial gram negatives
What is the primary purpose of measuring lung function in asthma patients?
To monitor progress and adjust treatment
What is the evidence of consolidation on CXR?
Sign of pneumonia
What is the name of the guidelines for the treatment of community-acquired pneumonia?
IDS/ATS guidelines
How is asthma severity typically assessed?
Retrospectively based on the level of treatment required
What is a limitation of using lung function to adjust treatment?
There is significant between-visit variability of FEV1
What is the recommended frequency of lung function measurement in most adults?
Every 1-2 years
What is an independent predictor of exacerbation risk in asthma patients?
Low FEV1
In which patients may long-term PEF monitoring be considered?
Patients with severe asthma or impaired perception of airflow limitation
What is the primary focus of assessing symptom control in asthma?
Assessing symptom control over the last 4 weeks
What is the purpose of asking about side-effects in asthma treatment?
To address treatment issues
Which of the following comorbidities is likely to contribute to symptoms and poor quality of life in asthma?
Obstructive sleep apnea
What is the definition of 'uncontrolled' asthma symptom control according to the GINA assessment?
Reporting 3-4 of the assessed symptoms
What is the purpose of asking about a patient's attitudes and goals for their asthma?
To develop a personalized treatment plan
What is the significance of assessing reliever use in asthma control?
To assess symptom control
What is the primary benefit of having a written asthma action plan?
To empower patients to manage their asthma
What is the purpose of assessing risk factors for poor outcomes in asthma?
To predict and prevent future complications
What is a crucial aspect to consider when prescribing NSAIDs or beta-blockers to patients with asthma?
Always asking about asthma before prescribing
What is an indication for considering referral to an expert for patients with asthma?
Difficulty confirming the diagnosis of asthma
What is a key component of guided asthma self-management and skills training?
Providing patients with written asthma action plans
What percentage of patients believe that regular use of medications will reduce their effectiveness?
58%
What is a consideration to keep in mind when assessing patient adherence to treatment plans?
Patients' overestimation of the seriousness of asthma
What is an indication for referral in patients with asthma and symptoms suggesting chronic infection or cardiac disease?
Referred for subspecialty care and pharmacological treatment
What is an essential consideration when choosing an inhaler device for patients with asthma?
Choosing an appropriate device before prescribing
What is a potential consequence of patients underestimating the seriousness of asthma?
They may be less likely to follow the treatment plan
What is a key aspect of remediation of dampness or mold in homes for patients with asthma?
Reducing asthma symptoms and medication use in adults
What is an indication for considering referral in patients with asthma and features of both asthma and COPD?
When in doubt about treatment
What is the primary goal of stepwise management in asthma?
To achieve symptom control and minimize risk
What is a crucial aspect of asthma management, according to the diagram?
Inhaler technique and adherence
Which medication is not indicated for children?
800 μg
What is a key factor in determining the appropriate step in asthma management?
Symptom control and risk factors
What is the primary focus of step 5 in asthma management?
Refer for further evaluation
Which of the following is not a consideration in determining the appropriate asthma medication?
Lung function
What is the purpose of non-pharmacological strategies in asthma management?
To treat modifiable risk factors
What is the dosage range for Ciclesonide (HFA) in step 3?
160-320 μg
What is the primary focus of step 4 in asthma management?
Adjust medication dosage
Which of the following is a critical aspect of asthma diagnosis?
Lung function assessment
Study Notes
Community Acquired Pneumonia (CAP)
- Infection of the lung not acquired in the hospital, LTC, or other recent contact with a health care system
- Evidence of consolidation on CXR
- Treatment guidelines from IDS/ATS and management of CAP in older adults from TAID
Etiology
- Streptococcus pneumoniae (30-35%)
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Legionella
- Influenza viruses
- H. influenzae
- Atypical PNA accounts for 37% of CAP and 10% of those who are hospitalized
- Nosocomial gram negatives—often seen in elderly nursing home residents
Asthma Management
- GINA assessment of symptom control:
- Daytime asthma symptoms more than twice a week
- Any night waking due to asthma
- Reliever needed for symptoms more than twice a week
- Any activity limitation due to asthma
- Risk assessment:
- Low FEV1 is an independent predictor of exacerbation risk
- Measure lung function to monitor progress
- Adjusting treatment:
- Utility of lung function for adjusting treatment is limited by between-visit variability of FEV1 (15%)
Assessing Asthma Severity
- Asthma severity is assessed retrospectively from the level of treatment required to control symptoms and exacerbations
- Stepwise management:
- Symptoms
- Exacerbations
- Side-effects
- Patient satisfaction
- Lung function
- Patient preference
- Treat modifiable risk factors
Occupational Asthma
- Ask patients with adult-onset asthma about work history
- Remove sensitizers as soon as possible
- Refer for expert advice, if available
Additional Interventions
- Avoid medications that may worsen asthma
- Remediation of dampness or mold in homes
- Sublingual immunotherapy (SLIT) for adult HDM-sensitive patients with allergic rhinitis
- Consider referral for:
- Difficulty confirming the diagnosis of asthma
- Symptoms suggesting chronic infection, cardiac disease, etc.
- Suspected occupational asthma
- Persistent uncontrolled asthma or frequent exacerbations
- Risk factors for asthma-related death
Patient Considerations
- If the family/patient thinks asthma is not serious, they are less likely to follow the treatment plan
- Fears about medications:
- 39% believe medicines are addictive
- 36% believe medicines are not safe to take over a long period
- 58% believe regular use will reduce effectiveness
Guided Asthma Self-Management
- Essential components:
- Skills training to use inhaler devices correctly
- Encouraging adherence with medications, appointments
- Asthma information
- Guided self-management support
- Self-monitoring of symptoms and/or Peak Expiratory Flows
- Written asthma action plan
- Regular review by a health care provider
Learn about the causes, diagnosis, and treatment of community-acquired pneumonia, including guidelines for older adults. Test your knowledge of this common infection.
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