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Flashcards in Dr. Brignal said on test Deck (31):
1

Influenza:
Pregnant Women

Pregnant women have high risk in influenza infection, up to 20% mortality from severe infection.

2

Influenza Diagnosis

-In absence of a local outbreak, clinical sx positive predictive value ~0.
-WITH virus in community, 1 resp sx + fever >100.2F => over 80% sensitivity and specificity
-can confirm with rapid flu test, but likely unnecessary

3

-most common cause of chronic cough in adults?

*Post nasal drip (PND)

Sinusitis and post nasal drip -- Frequent sinus infections can cause post-nasal drip, (sometimes called “a tickle in the back of the throat”), and drainage can trigger chronic cough.

4

-most common cause in children

Asthma

5

Chronic Cough DDx (most common)

90% of non-smokers with a cough will either be PND, Asthma, or GERD

smoking 90% of cases=>Chronic Bronchitis

6

smoking causes 90% of cases

Chronic Bronchitis

7

Biopsies of Solitary Pulmonary Nodule (2)

a) Bronchoscopy
-less invasive, but often inconclusive especially with smaller lesions

b) Transthoracic needle aspiration
-more likely to get a definitive dx, but still frequently misses
-rate of pneumothorax is 25%

8


Pulmonary Embolus->Indications of Shunting?

*Decreased VQ ratio (ventilation/perfusion) indicates shunting

-COPD, asthma, atelectasis, respiratory distress

9

Arterial Blood Gases:
Metabolic vs Respiratory Acidosis/Alkalosis:

Is there alkalosis or acidosis-PH?

Is there alkalosis or acidosis? pH < 7.35 = acidosis, pH > 7.45 = alkalosis

10

Respiratory - the pH and PaCO2 change in which direction?

Respiratory - the pH and PaCO2 change in opposite directions
**Respiratory acidosis - pH is low, PaCO2 is high
**Respiratory alkalosis - pH is high, PaCO2 is low

11

Metabolic - the pH and HCO3- change in the which direction?

Metabolic - the pH and HCO3- change in the same direction
**Metabolic acidosis - pH is low, HCO3- is low
**Metabolic alkalosis - pH is high, HCO3- is high

12

Respiratory Compromise occurs at what Hg PaO2?

Respiratory Compromise occurs at <60mmHg PaO2

13

Restrictive lung diseases?

Restrictive lung diseases are a category of extrapulmonary, pleural, or parenchymal respiratory dz's that restrict lung expansion equal:

1. Decreased lung volume,
2. Increased work of breathing,
3. Inadequate ventilation and/or oxygenation.

*Pulmonary function test demonstrates a decrease in the forced vital capacity.

14

*Definitions of Intrinsic Restrictive vs Extrinsic Restrictive Dzs

*Causes of each

Restrictive lung dz's mb d/t specific causes which can be intrinsic to the parenchyma of the lung, or extrinsic to it.

Intrinsic:
-TB
-Rheumatoid Arthritis
-Pneumoconiosis
-Radiation fibrosis
-Hypersensitivity pneumonitis
-Acute respiratory distress syndrome (ARDS)

Extrinsic:
Nonmuscular diseases of the upper thorax such as:
-kyphosis,
-pectus carinatum
-pectus excavatum

Diseases restricting lower thoracic/abdominal volume: -Obesity,
-Diaphragmatic hernia
-Presence of ascites
-Pleural thickening

15

COPD-Malnutrition

-Warn patients to notify you if there is a change of >5 lbs in a week

16

NAC in removing mucus side effect?

-gas and bloating

17

Supplements for Exercise Induced Asthma (EIA)

-Vitamin C, Beta-carotene, Lycopene, Caffeine

18

Spirometry obstructive vs restrictive lung disease

The FEV1 is decreased in obstructive lung diseases and normal or minimally decreased in restrictive lung diseases.

In obstructive lung disease, the FEV1 is reduced due to an obstruction of air escaping from the lungs. Thus, the FEV1/FVC ratio will be reduced. ...

In restrictive lung disease, the FEV1 and FVC are equally reduced due to fibrosis or other lung pathology (not obstructive pathology).

19

Lung Infections Pharmacology:
Pneumonia?

Pneumonia: beta-lactam (like amoxicillin 500 TID or 875 BID)
-----> Empiric therapy: should always treat bacterial pneumonia aggressively w/ antimicrobials
Treat early, treat most likely pathogens (Strep/HiB/Staph), consider atypical agents

Community acq. Pneumonia (CAP) empiric therapy:
***Healthy outpatient  macrolide or doxycycline
***Outpatient at risk (like COPD)  fluoroquinolone or beta lactam + macrolide

20

Lung Infections Pharmacology:
Pseudomonas?

Tx: antipseudomonal beta lactam + cipro/levofloxacin

21

Lung Infections Pharmacology:
MRSA

Tx: linezolid or Vancomycin

22

Positive findings for pneumonia on PE

*Rales in lateral decubitus position is most predictive sign

23

Pulmonary Imaging:
CXR views

PA: standard
LAT: see lesions behind heart & mediastinal structures
AP: only for those bedridden or in hospital
LD: to evaluate pleural effusion, pneumothorax, cavity lesions
EE: to see focal air trapping

24

CXR Density?

*Air= black
*Fat & soft tissue= gray
*Bone & metal= white

25

Wells PE scoring:

Clinical signs--->3
Alt. Dx Unlikely-->3
Hrt rate >100-->1.5
Immobilization prev. 4 days--->1.5
Prev. DVT/PE--->1.5
Hemoptysis--->1
Malignancy (tx last 6 mo)--->1
-------------------------------------------------------------------------------
PE less likely = less than 4 pts
PE likely = More than 4 pts

26

Should pneumonia pt be admitted to hospital?
Predictive factors:

Predictive factors for hospitalization over 50, co-morbidity, abnormality in labs/visits.

27

Should pneumonia pt be admitted to hospital?
PSI calculator

PSI calculator (<70 0 tx outpatient, >130 ICU dt 28% mortality)

28

Should pneumonia pt be admitted to hospital?
CURB65

CURB65: 1pt ea - confusion, BUN>7 mmol/L, RR>30, BP<90/60, 65+; 2 pts: maybe inpat, 3+ def inpat.

29

Acute vs. chronic cough

Less than 3 weeks = Acute
More than 3 Weeks = Chronic

30

Action plan Asthma
Green, yellow, red

Green zone: breathing good, no early warning signs, PEF >80%, can play & seep  take recommended daily medication

Yellow zone: feel tired, chin or throat itches, cough, wheeze, tight chest, play interrupted, wake at night, PEF 50-80%

Red zone: very SOB, can’t do usual activities, medications not helping, PEF 50%

31

Pleural effusion:
Normal vs Pathologic sign of effusion

Normal fluid amount is 10mL.

Pathologic sign of effusion is 100 mL.
**Check for fluid in lateral decubitus position***