pulm(chapter 3-flashcard machine)
1
Q
reason for hospitalization of pneumonia
A
neutropenia, more than one lobe affected, poor host, Over 50 with co-morbidities
2
Q
pneumocystis manisfestations
A
immunosuppression, slow onset, hypoxemic, interstitial infiltrates, increased lactate dehydronase
3
Q
noscomial pneumonia tx
A
cefepime, ticarcillin/clavulanic, pipercillan/tazobactum, meropenem.
4
Q
lung cancer labs
A
cytologic exam of sputum and PET
5
Q
infectious granulomas from old/active TB(or fungal inf, FB inf)
A
solitary pulmonary nodule. 40% malignant
6
Q
SPHERE(lung cancer complications)
A
SVC syndrome, pancoasts tumor, horners syndrome, endocrine, recurrent laryngeal nn, effusions
7
Q
SVC syndrome
A
plethora(excess blood), HA, mental status change
8
Q
Pancoasts tumor
A
Lung apex tumor, causes horners syndrome, shoulder pain,
9
Q
horners syndrome
A
unilateral facial anhidrosis(lack of sweating), ptosis(droopy eyelid), miosis(constriction of pupil)
10
Q
carcinoid syndrome
A
flushing, diarrhea, telangiectasias(small blood vessels), wheezing, hypoTN
11
Q
carcinoid tumors common sx
A
usually asymptomatic;can have hemoptysis, cough, focal wheezing, recurrent pneumonia, obstruction
12
Q
bronchoscopy reveals pink or purple central lesion that is well vascularized. may be pedunculated or sessile
A
carcinoid tumor, do a CT and octreotide scintigraphy to localize. no radiation or chemo, do surgical excision
13
Q
stongest predisposing factor to asthma
A
atopy(triad is wheeze, excema, seasonal rhinitis)
14
Q
Pa02 <60mmHg and PaCO2 >40mmHg.
A
asthma
15
Q
methocholine challenge
A
bronchial provocation test, FEV1 decrease >20% is diagnostic(do when PFT nml and asthma is expected)
16
Q
What is bronchiectasis?
A
abnormal permanent dilatation from bronchi causing destruction of bronchial walls. usually congenital(CF), recurrent infections, obstruction(tumor), or injury
17
Q
bronchiectasis sx, PE, labs, tx
A
sx: chr purulent sputum(yellow/green/fowl smell), hemoptysis, chr cough, recur.pneumona;
PE: rales, wheeze, localized crackles and clubbing;
DX: **high resolution CT(definitive test: shows dilated tortuous airways), abn CXR(tram lines, honeycombing, atelectasis, crowded bronchial markings, & basal cystic spaces)
bronchoscopy for eval of hemoptysis, remove secretions, rule out obstructing lesions;
tx is antibx, bronchodilators(acute exacerbations), chest physiotherapy, surgery/transplant if necessary
18
Q
CXR shows crowded bronchial markings and basal cystic spaces, tram track lung markings, honeycombing, atelectasis
A
bronchiectasis
19
Q
bronchiectasis antibx tx
A
10-14 days. amox, augmentin, bactrim, Cipro
20
Q
pink puffers clinical findings
A
emphysema; exertional dyspnea, thin, no peripheral edema, *barrel chested, hyperventilation, wasted appearance with pursed lips, minimal cough
21
Q
pink puffer CXR
A
parenchymal bullae and subpleural blebs!! decreased lung markings, hyperinflation, decreased lung markings at apices, small thin heart, flattened diaphrams
22
Q
blue bloaters clinical findings
A
bronchits; overweight, chr prod cough, peripheral edema, *pursed lip breathing, noisy lungs
23
Q
blue bloaters CXR
A
increased interstitial markings at bases, diaphrams not flattened
24
Q
What is emphysema?
A
enlarged air spaces due to destruction of alveolar septae; may be secondary to smoking; pink puffer
25
parenchymal bullae and blebs
emphysema; pink puffer
26
What is chr bronchits/COPD?
chr cough prod of phlem for most of 3 months for 2 years; blue bloater
27
Rhonchi on exam; breathing raspy and loud; rhonchi definition
chr bronchitis; rhonchi(secretions in airways)
28
CBC shows polycythemia(caused by chr hypoxemia); FEV1/FVC is decreased
COPD
29
sweat chloride test(>60) on 2 days
CF
30
clubbing, chronic cough, increased AP diameter, apical crackles, nasal polyposis, hemoptysis
CF
31
CF ABG
hypoxemia and advanced d/s has chronic compensated resp acidosis
32
pneumothorax sx
increased unilateral chest expansion, decreased tactile fremitus, hyperresonance, diminished breath sounds
33
pneumothorax labs/xray
CXR shows presence of pleural air, visceral pleural line is evidence. ABG analysis shows hypoxemia.
34
virchows triad
hypercoagulable state, venous stasis, vascular intimal inflammation/injury
35
3rd leading cause of deaths in hospitalized pts
DVT
36
PE pt sx
pleuritic chest pain, dyspnea, apprehension, cough, hemoptysis, diaphoresis
37
PE exam findings
accentuation of pulmonary component of 2nd heart sound, tachypnea, tachycardia, crackles,low fever
38
ABG finding in PE
acute respiratory alkalosis secondary to hyperventilation
39
PE test to order
*pulmonary angiography(invasive); do spiral CT first
40
EKG shows S1Q3T3
cor pulmonale seen in 20% of pt with symptomatic PE
41
PFT shows FEV1/FVC ratio nml and decreased lung volume
restrictive. idiopathic pulm fibrosis
42
4 appropriate meds for CAP
doxy, emycin, macrolide, FQ
43
interstitial infiltrates
pneumocystis
44
legionella comes from what
exposure to contaminated water droplets from cooling and ventilation systems
45
segmental unilateral lower lung zone infiltrates or diffuse infiltrates
atypical CAP
46
what is a neuramididase inhibitor
antiviral for atypical CAP; inhaled zanamivir or oral oseltamivir
47
diffuse or perihilar infiltrates on CXR
HIV pneumo
48
pneumocystis sx
fever, non prod cough, tachypnea, dyspnea
49
post tussive rales
TB
50
hilar/paratracheal lymph node enlargement, segmental atelectasis
primary TB
51
fibrocavitary apical disease(upper lung lobes)
reactivation TB
52
ghon complexes
calcified primary focus(TB)
53
ranke complexes
calcified primary focus and calcified hilar lymph nodes (TB)
54
definitive diagnosis for TB
from cultures, DNA or RNA amplification techniques. bx shows noncaseating granulomas
55
bx shows noncaseating granulomas
TB histologic hallmark
56
bacille calmette-guerin
vaccine for TB neg people with high risk.
57
expiratory rhonchi or wheeze; neg CXR
acute bronchitis
58
tx for acute exacerbations of chronic bronchitis
1st line: second gen ceph; 2nd line is macrolide or bactrim
59
sx of resp distress in brochiolitis
nasal flaring, tachypnea, retractrions
60
CXR in bronchiolitits
nml but can show air trapping and peribronchial thickening
61
what has reduced epiglotitits
H influenza vaccacine(HIB)
62
high fever, severe dysphagia, drooling
epiglotitits
63
viral laryngotracheobronchitis is also called what
croup
64
what can help aid in dx bronchogenic carcinoma
positron emission tomography
65
solitary pulmonary lesion with low probability of malignancy tx
CT every 3 months for a year, if stable then every 6 months for 2 yrs
66
solitary pulmonary lesion with high probability of malignancy tx
resection ASAP!
67
solitary pulmonary lesion with intermediate probability of malignancy tx
transthoracic needle bx or bronchoscopy if perpheral. **high resolution CT or PET can help.
68
malignancy of solitary pulmonary nodule
40% malignant and represent carcinoma, hamartoma, mets(multiple) as well as bronchial adenoma(95% carcinoid tumors); malignancy rare under 30 y/o and high risk in smokers
69
benign/malignancy criteria of solitary pulmonary nodule
benign if it hasn't enlarged in 2 years; malignant are symptomatic, age over 45, over 2cm, indistinct margins, rapid progression
70
carcinoid tumors common where
GI tract
71
asthma definition and 3 components
def: chr inflammation leading to airway narrowing and inc mucus production
1) obs of airflow
2) bronchial hyperactivity
3) inflammation of airway
72
asthma sx(5) and when are the sx worse
dry cough, episodic wheeze, chest tightness, wheezing(only 1/3 of pts), prolonged EXPIRATION with wheeze, sx worse at night
73
exacerbation factors of asthma (7)
NSAIDs, aspirin, post-nasal drip, GERD, ACE, cold air, stress
74
atopy triad
atopy(triad is wheeze, excema, seasonal rhinitis)
75
dry cough, episodic wheeze, chest tightness, wheezing(only 1/3 of pts), prolonged EXPIRATION, sx worse at night or early morning
asthma sx
76
test for asthma
PFT: gold standard in making the diagnosis. reversible obstruction (decreased FEV1, decreased FEV1/FVC ratio, increased RV, TLC, and RV/TLC)
77
when to do an ABG in asthma
if pt is ill; severe asthma will show hypoxemia, hypercapnia, Pa02 <60; PaCO2 >40; acute respiratory alkalosis.
78
asthma tx pneumonic
albuterol, steroids, theophylline(rare), humidified O2, Mg, anticholinergics
79
FEV1 < FVC
obstructive
80
obstructive FEV1--FVC ratio
FEV1 < FVC
81
FEV1 > FVC
restrictive
82
restrictive FEV1--FVC ratio
FEV1 > FVC
83
TLC in obstructive vs restrictive
obs: nml to elevated; res: decreased
84
FEF 25%-75% in obstructive vs restrictive
obs: <80% and res: nml to elevated
85
FEV1/FVC in obstructive vs restrictive
obs: <80% and res: nml to elevated
86
```
ASTHMA SYMPTOM OCCURANCE DAY/NIGHT
intermittent
mild persistant
moderate persistant
severe persistant
```
- intermittent: 1-2 days/wk; 1-2 nights/month; nml activities fine
- mild persistant: over 2 days/wk(not daily); 3-4 nights/month; minor limitation
- moderate persistant: daily; over 1 night/wk; some limitation
- severe persistant: continual; often 7 nights a wk; extreme limitation
87
```
USE OF RESCUE ASTHMA MEDICATION
intermittent
mild persistant
moderate persistant
severe persistant
```
intermittent: under 2 days/wk
mild persistant: over 2 days/wk
moderate persistant: daily
severe persistant: several times a day
88
```
FEV1 in types of asthma
intermittent
mild persistant
moderate persistant
severe persistant
```
intermittent: under 80%
mild persistant: over 80%
moderate persistant: 60-80%
severe persistant: under 60%
89
```
FEV1/FVC ratio in asthma
intermittent
mild persistant
moderate persistant
severe persistant
```
intermittent: nml
mild persistant: nml
moderate persistant: reduced 5%
severe persistant: reduced over 5%
90
medications for asthma
intermittent
mild persistant
-all short acting prn bronchodilator
intermittent: no daily med
mild persistant: daily low dose inh CCS
91
medications for asthma
moderate persistant
severe persistant
- all short acting prn bronchodilator
- moderate persistant: low to medium inh CCS plus long actiing inh B2 agonists
- severe persistant: high dose inh CCS plus long acting inh B2 agonists; poss po CCS
92
B2 agonists
- albuterol: short acting; relaxes bronchial smooth mm
| - salmeterol: long acting for prophylaxis
93
muscarinic antagonists
ipratropium: competively blocks muscarinic receptors therefore preventing bronchoconstriction.
* never use alone for asthma
94
corticosteroids for asthma
- inh CCS 1st line for long term control
| - becomethasone, prednisone: inhibit synthese of cytokines
95
methylxanthines
theophylline: bronchodilation. careful due to narrow therapeutic-toxic index. (cardio and neurotoxicity)
96
cromolyn
prevents release of vasoactive mediators from mast cells. good for exercise induced bronchospasm. *only for prophylaxis- not during an attack
97
antileukotrines
montelukast and zafirlukast: blocks leukotrine receptors
98
tram lines
bronchiectasis
99
crowded bronchial markings with basal cystic spaces
bronchiectasis
100
CT shows dilated tortuous airways
bronchiectasis
101
chronic purulent sputum, recurrent pneumonia, chr cough, hemoptysis
bronchiectasis
102
CF sx
clubbing, chronic cough, increased AP diameter, apical crackles, nasal polyposis, hemoptysis, bronchiectasis
103
hyperresonance to percussion; nasal polyposis
CF
104
def of CF
autosomal RECESSIVE d/p caused by mutation on chromosome 7 resulting in abn production of mucos by ALL exocrine glands, causing obs of those glands and ducts
105
most common severe genetic disease in US
CF
106
CF frequently occurs in what race
whites
107
CF has increased risks of what
malignancies in GI tract, osteopenia, arthropathies
108
CF usually seen when
newborn screening due to obs of distal ileum due to abnormally thick meconium
109
Why is there FTT in CF in babies
due to pancreatic insufficiency
110
pancreatic insufficiency sx(8)
greasy stools, flatulence, pancreatitis, rectal prolapse, HYPOproteinuria, biliary cirrhosis, jaundice, esophageal varieces
111
abnormal sx in CF (4)
type 2 DM, salty tasting skin, male infertility(ageosis of vas def), unexplained hyponatremia
112
malabsorption in CF
fat soluble vitamin deficiency: A, D, E, K; look for night blindness, rickets, neuropathy, coagulopathy
113
greasy stools, flatulence, pancreatitis, rectal prolapse, HYPOproteinuria, biliary cirrhosis, jaundice, esophageal varieces
pancreatic insufficiency sx
114
how to confirm CF besides sweat chloride test
genetic DNA testing
115
PFT in CF
mixed obs/rest pattern
116
CXR in CF
hyperinflation, peribronchial cuffing, mucous plugging, bronchietasis(thin cut CT shows too), inc intersitial markings, small round peripheral opacities, focal atelectasis, pneumothorax
117
hyperinflation, peribronchial cuffing, mucous plugging, bronchietasis, inc intersitial markings, small round peripheral opacities, focal atelectasis, pneumothorax
CXR in CF
118
tx in CF
1) manage pulm manisfestations, chest PT, bronchodilators, CCS, antibx for pseudomonas, DNase
2) maybe give pancreatic enzymes or fat soluble vitamins
3) high calorie and high protein diet
4) ?transplant
119
parenchymal bullae and subpleural blebs!! decreased lung markings, hyperinflation, decreased lung markings at apices, small thin heart, flattened diaphrams
emphysema; pink puffer
120
*barrel chested, hyperventilation, wasted appearance with pursed lips
emphysema; pink puffer
121
```
emphysema and chr bronchitis:
dyspnea
cough
lungs
peripheral edema
weight
```
```
emphysema and chr bronchitis:
dyspnea: exertional/mild
cough: rare/chr productive
lungs: quiet/noisy with rhonchi and wheeze
peripheral edema: none/yes
weight: thin; overweight and cyanotic'
```
122
emphysema and chr bronchitis CXR
1) lung markings
2) diaphrams
1) emphysema has dec lung markings at apices and flattened diaphrams
2) chr bronchitis CXR has inc interstitial markings at bases and diagphrams not flattened
123
emphysema and chr bronchitis CXR:
| acid-base status
1) emphysema has late hypercarbia/hypoxia- hence pink 2) chr bronchitis has early hypercarbia/hypoxia- hence blue
124
pollutants, recurrent URIs, eosinophilia, bronchial hyperresponsiveness, alpha 1 antitrypsin deficiency
other causes of COPD
125
percussion, auscultation, and wheezing in COPD
- percussion yields resonance
- auscultation reveals dec breath sounds and early inspiratory crackles; long prolonged expiration
- wheezing not present at rest but can be provoked with forced expiration or exertion
126
COPD tx
anticholinergic inh(...tropiums) for bronchodilation, short acting BD for acute exacerbations, oral antibiotics, supplemental oxygen(pts with resting hypoxemia of PaO2 <55% or SaO2 <88%)
127
Pa02 < what; PaCO2 > what in asthma
Pa02 <60; PaCO2 >40
128
* PE of asthma
hyperresonance to percussion, decreased breath sounds, tachycardia, tachypnea, use of accessory muscles
129
* PE of severe asthma
inability to speak in full sentences, tripod position, silent chest(no air movement), altered mental status, pulsus paradoxus(inspiratory blood pressure > 10mmhg), PEFR<40% predicted.
130
* bronchoprovocation for asthma
methacholine challenge (>20% decreased in FEV1) followed by brochodilator challenge (increase of FEV1 >12% expected)
131
* how to do a dx of an acute asthma exacerbation
* peak expiratory flow rate, discharge criteria: PEFR>70% or PEFR>15% initial attempt, subjective improvement.
*pulse ox: Sa02 <90% indicative of resp distress
*ABG not usually ordered. Respiratory alkalosis expected(from tachypnea).
*CXR nml
132
