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Test 1 PC2 > Pulmonary > Flashcards

Pulmonary Flashcards

(170 cards)

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1
Q

5 densities on x-ray

A 
gas
fat
fluid
bone
metal
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2
Q

The closer an object is to x-ray

A

the sharper the borders

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3
Q

The farther away an object on x-ray

A

the more magnified and fuzzy it is

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4
Q

Best view for x-ray

A

AP

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5
Q

When two structures are the same density on x-ray

A

the border between them cannot been seen

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6
Q

adequacy for chest x-ray evaluated for

A

inspiratory effort
penetration
rotation

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7
Q

Disadvantages to AP check x-ray

A

increased exposure time
changes in magnification
less precise

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8
Q

Inspiration on chest x-ray

A

helps determine if there are intrapulmonary abnormalities

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9
Q

How to tell if there is adequate inspiration

A

diaphragm at about 8th-10th pos. rib or 5-6th ant. rib

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10
Q

Pitfall of poor inspiration

A

crowds lung markings and make it appear as airspace disease

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11
Q

posterior ribs on x-ray

A

most apparent

run horizontally

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12
Q

anterior ribs on x-ray

A

harder to see

run 45 degree angle

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13
Q

Sign of good penetration on x-ray

A

thoracic spine barely visible through the heart

spine appears to darken as you move caudally

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14
Q

Adequate rotation on x-ray

A

if the spinous process of the vertebral body is equidistant from the medial ends of each clavicle then no rotation present

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15
Q

Measuring the heard on x-ray

A

should not take up more than 1/2 of thoracic cavity

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16
Q

Costophrenic angles

A

should curve downward

blunted angles could indicate pleural effusion

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17
Q

5 items to look for on x-ray of chest

A 
gastric bubble
breast shadows
clavicles
ribs
spine
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18
Q

Silhouette sign on x-ray

A

no border between two structures of the same density structures

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19
Q

causes of Kerley B lines

A 
pulmonary edema
lymphangitis
cancer
pneumonia
pulmonary fibrosis
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20
Q

Interstitial pattern on chest x-ray

A

thin white random lines
infection of the interstitium
from virus or mycoplasma

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21
Q

Air space disease pattern on chest x-ray

A

patch of white opacity resulting from presence of fluid in alveoli
also called consolidation
pneumonia

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22
Q

Honeycomb pattern on chest x-ray

A

long standing interstitial lung disease and irreversible scaring

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23
Q

Miliary pattern on chest x-ray

A

TB

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24
Q

Emphysema on chest x-ray

A

more air than normal in the lungs
air trapping
flattening of diaphragm

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25
Atalectasis on chest x-ray
loss of lung volume
26
Large bowel on x-ray
haustral markings | peripheral
27
Small bowl on x-ray
valvulae | central
28
Extraluminal gas on x-ray
most seen under right diaphragm | occurs with viscus perforation
29
ABC's of bone x-ray
A: Alignment B: bone C: cartilage S: soft tissues
30
Greenstick bone fracture
partial crack and bend in to bone but not a break through | only in children
31
Spiral fracture
sharp triangular bone ends
32
Comminuted fracture
broken in multiple pieces
33
Transverse fracture
clean square break dividing bone cleanly across
34
Compound fracture
wounds that communicated with the fracture and may expose bone
35
Compression fracture
bone collapses into itself
36
Avulsion fracture
small fragments of bone detach from tendons or ligaments
37
Obstructive Sleep apnea observed
``` pausing in breathing gasping for air morning HA daily sleepiness frequent night time urination poor school performance night time bed wetting ```
38
Risk factors for sleep apnea
``` male post menopausal female pregnancy obesity large girth neck small mandible down syndrome lung disease heart disease DM neuromuscular disease ```
39
How to dx sleep apnea
``` sleep study (polysomnography) brain waves with EEG, EKG, breathing pulse ```
40
What causes snoring
``` increased resistance deviated septum URI rhinitis soft palate or uvula that is enlarged or relaxed ```
41
Symptoms of snoring
being told walking self up morning HA not refreshed
42
hypopnea
shallow breathing
43
apnea
no air movement | either obstructive or central
44
Classification of sleep apnea
5-15 events per hour = mild 15-30 per hour = moderate >30 = severe
45
Tx for snoring
nasal steroid surgery oral appliance weight loss
46
Tx mild-mod apnea
wt loss oral appliance ENT consult tennis ball in shirt to keep from rolling over
47
Tx of severe apnea
CPAP | Wt loss
48
When writing a Rx for CPAP
write CPAP plus supplies | include pressure from sleep study
49
Factors that worsen snoring and sleep apnea
``` sleep deprivation wt gain URI allergies sedating meds alcohol cold medication ```
50
Chronic cough defined
> 15 years of age and cough lasting 8 weeks or more
51
Subacute cough defined
>15 years of age lasting 3-8 weeks
52
Cough defined
``` normal protective reflex protects from: irritants accumulated secretions aspirated fluid inhaled irritants ```
53
Regulator of involuntary coughing
vagal sensory receptors | in mucosa of carina, bronchi and pharynx
54
Social history with cough
``` live urban or rurual pets occupation exposure to chemicals tobacco alcohol ```
55
Exam for cough
``` start with x-ray bronchoscopy barium CT 25-50% have multiple causes of cough ```
56
3 most common causes of cough
upper airway cough syndrome, post nasal drip asthma GERD
57
Upper airway cough syndrome
most common cause of chronic cough in nonsmoking adults with normal chest x-ray from mucous or drainage
58
How is accurate dx of cough confirmed
by resolution or marked improvement of cough following specific tx
59
Causes of subacute cough
post infection: pneumonia, pertussis, bronchitis new onset or exacerbation: asthma, GERD bronchitis
60
Chronic cough in children
lasts longer than 4 weeks asthma URI GERD
61
Diff dx of children with chronic cough and no wheeze
``` recurrent bronchitis postinfectious cough pertussis UACS psychogenic GERD ```
62
Evaluation for children with chronic cough
should always include chest radiograph and spirometry at minimum
63
COPD explained
gradual progression of irreversible airflow obstruction and increased inflammation in the airway and lungs that is different than inflammation caused by asthma, smoking or occupational exposure
64
COPD defined
cluster of disorders or bronchi, conducting airways and lung parenchyma airflow limitation progressive not reversible
65
Bronchitis of COPD defined
chronic, persistent cough or sputum production for 3 consecutive months each year for 2 years periodic acute exacerbations does not include other lung disease
66
Emphysema of COPD defined
permanent and abnormal enlargement of any part of the air spaces distal to the terminal bronchioles destruction of alveolar walls without fibrosis
67
COPD epidemiology
leading cause of death and disability | 4th leading cause of death
68
Risk factors of COPD
``` smoking airway hyperactivity childhood resp. infections occupational air pollution poor nutrition crowded living conditions family with COPD Alpha ! antitrypsin deficiency white ```
69
Symptoms of COPD
dyspnea coughing sputum production orthopnea soon after reclining
70
Dx of COPD
based on objective airflow limitation defined as a forced expiratory volume in one second/forced vital capacity ratio of less than 0.70 and symptoms
71
HPI/PMH on assessment with COPD
``` history of cough, sputum or dyspnea hx recurrent resp. infections ashtma bronchitis recurrent sinus infections nasal polyps cigarette smoke hazardous environment ```
72
Physical exam with COPD
``` diminished breath sounds early inspiratory crackles wheezing with forced expiration prolonged expiratory time increased resonance on chest percussion barrel chest use of accessory muscles of respiration pursed lip breathing clubbing of fingernails diminished muscle mass in thighs and legs ```
73
Significant edema in COPD
indicated right side heart failure and cor pulmonale in pts with pulmonary hypertension lung disease causes hypertrophy of right ventricles
74
Consider a dx of COPD in any pt with
dyspnea chronic cough sputum production or a history of exposure to risk factors for the disease.
75
Confirm dx of COPD with
spirometry
76
Other diagnostics in COPD
``` spirometry pulse oximetry CBC ABGs EKG chest x-ray ```
77
Mainstay of drug therapy for COPD
short acting anticholinergics (inhaled) beta 2 agonists (inhaled) methylxanthines (po)
78
Anticholinergics for COPD
Ipratoprium bromide metered dose inhaler 18mcg/inhalation, 2-4 puffs, 4-6 times a day or neb 500mcg/2.5ml
79
Beta 2 agonists for COPD
Albuterol 90mcg/inhalation 1-2 puffs, 3-4x/day | neb 0.5ml of 0.5% solution 3-4 x/day
80
Methylxanthines for COPD
Theophylline immed. release tabs 10mg/kg/d in 4 doses | sustained release 10mg/kg in 1-3 doses
81
Oral corticosteroids for COPD exacerbation
methylprednisone 40-48mg/kg/d divided 3-4 days prednisone 40-60mg/day, taper by 10mg every 4-5 days, ending with 4-5 days of 5mg/day in 1-3 doses
82
Inhaled corticosteroids for COPD
beclomethasone dipropionate 42mcg/inhalation 2 puffs 3-4x/day or 4 puffs 2x/day ax 20 puffs/day
83
Asthma defined
``` chronic disease of the airway that causes repeated episodes of wheezing breathlessness chest tightness nighttime or morning coughing ```
84
asthma can be controlled
by knowing warning signs staying away from triggers following healthcare provider advice
85
what happens during an asthma attack
airway narrows from muscle constriction swelling of inner lining mucus production
86
who does asthma affect
``` anyone but common in children 5-17 years old boys more than girls women black low income families ```
87
extrinsic factors associated with high prevalence, morbidity and mortality
poverty urban living indoor allergens inadequate disease management
88
Risk factors for developing asthma
genetics occupational exposures environmental exposure
89
Genetics and asthma
``` Atopy = body's predisposition to develop an antibody (IgE) in response to allergens rhinitis asthma hay fever eczema ```
90
environmental exposures for asthma
``` house dust mites cockroaches RSV tobacco smoke pets molds birds formaldehyde fragrances trees grass pollen ```
91
Reducing exposure to house dust mites
wash beds weekly avoid down products limit stuffed animals less humidity
92
Treatment of asthma
based on severity, control and responsiveness reduce exposures to irritants provide pt education for self management
93
4 essential components of asthma
assessment and monitoring pt education control factors that contribute to asthma pharmacologic tx
94
GIP's six key messages
``` inhaled steroids asthma action plan asthma severity asthma control follow up visits allergen and irritant exposure control ```
95
Medical history s/s of asthma
``` cough wheeze sob chest tightness pattern of symptoms family history troublesome cough at night cough or wheeze after physical activity seasonal colds lasting more than 10 days relief with tx ```
96
Testing for asthma
peak flow | spirometry
97
Two major categories of asthma tx
long term control | quick relief
98
Long term asthma control
``` taken daily reduce inflammation, relax airway and improve lung fx inhaled corticosteroids long acting beta agonists leukotriene modifiers ```
99
Quick relief asthma control
used in acute episodes | generally short acting beta agonists
100
Spacers purpose on inhalers
help pts who have difficulty with inhaler use and can reduce potential adverse effects
101
Asthma management goals
``` achieve control of symptoms maintain normal activity levels maintain pulm fx as close to normal prevent exacerbations avoid adverse effects of meds prevent asthma mortality ```
102
Using a peak flow meter with mod to severe asthma
every morning every evening after an exacerbation before inhalation of meds
103
Indications of a severe asthma attack
``` breathlessness at rest hunched forward speaks in words, not sentences agitated peak flow less than 60% of normal ```
104
Important things those with asthma can do
have an individual plan educated yourself about plans and environmental triggers seek help from asthma resources join an asthma support group
105
Key aspects in asthma tx
requires a team effort coordinate health to involve: mental and physical health, education, environment, family and community efforts assess needs of schools focus on students with symptoms, heath room visits and absenteeism
106
Cystic Fibrosis defined
multisystem disease autosomal recessive mutations in cystic fibrosis trasmembrane regulator protien body produces thick sticky mucous that clogs lungs and obstructs the pancrease
107
How common is cystic fibrosis
most common fetal autosomal recessive disease among Caucasians
108
CF characterized by
dehydration of the airway surface liquid and impaired mucocillary clearance leading to difficulty clearing lungs and chronic infection
109
symptoms of CF
``` very salty-tasting skin persistent cough with phlegm frequent lung infections wheezing and SOB poor growth/weight gain frequent greasy, bulky stools ```
110
CF survival
70% dx by age 2 female survival worse than males (2-20 yrs old) Median survival is 37
111
Diagnosis of CF
``` sweat chloride concentration >60meql/L with one of the following chronic sinopulmonary disease pancreatic insufficiency salt loss syndomes obstructive azoospermia family history ```
112
Pts that should be tested for CF
Infants with pos CF newborn screen, rpt after 2 weeks and 2kg if asymptomatic infants with symptoms suggestive of CF such as meconium ileus siblings of a patient with confirmed CF
113
Facts about sweat chloride test
more likely to be false neg in those <6 months
114
Other tests for CF
nasal potential difference immunoreactive trypsin stool fecal fat pancreatic enzyme secreation
115
Organs affected by cystic fibrosis
``` airways liver pancrease small intestine reproductive ```
116
cause of organs affected in CF
deranged transport of chlorid, sodium, bicarb which leads to an increase in secretions in these areas
117
respiratory clinical manifestations of CF
``` persistent productive cough hyperinflamation of lung fields pulmonary fx testing showing obstructive airway bronchiolitis pneumonia nasal polyposis sinusitis digital clubbing ```
118
bronchiolitis exacerbation in CF
an increased cough with tachypnea dysplea malaise anorexia/wt loss
119
Effect of CF on sinuses
majority will develop sinus disease | panopacification of paransal sinus
120
Infections with CF
most common cause in small children is s.aureus and h.influenza as we age its pseudomonas aeruginosa
121
Digital clubbing with CF
bulbous swelling at end of finger | schamroth sign = loss of normal angle between nail and nail bed
122
Nutrition deficiency in CF
due to pancreatic insufficiency insufficient secretion of digestive enzymes such as lipase, leads to malabsorption of fat and protein leads to failure to thrive fat soluble vit deficiency
123
Infants with CF may present with
hypoproteinemia edema electrolyte loss anemia
124
How to reverse nutritional malabsorption
vit A D E K
125
Biliary Disease in CF
focal biliary cirrhosis caused by inspissated bile elevations of alkaline phosphatase and lobular hepatomegaly leads to portal hypertension
126
Infertility with CF
men have abnormal embryologic development of the epididymal duct and vas deferens females it is r/t to malnutrition as well as thick cervical mucous
127
The sweat chloride test
chemical that stimulates sweating placed under electrode pad on arm current passed through and sweat is collected pos if 60-165 normal is 0-40
128
validity of sweat test
used for the primary dx of CF | a normal sweat chloride result is sufficient to rule out CF in most
129
prenatal screening for CF
blood draw in first trimester
130
aerosolized abx for CF
for the eradication of initial infection and suppression of chronic infection tobramycin azithromycin inhaled adrenergic receptor agonist ibuprofen
131
Human DNase in CF
dornase alfa | improve lung fx and reduce exacercations by altering mucous
132
Lung cancer prevalence
overall survival rate for all stages of lung cancer is 15% at 5 years
133
Term used for lung cancer
bronchogenic carcinoma small cell lung cancer non-small lung cancer
134
most important risk factor for lung cancer
smoking | 20x higher risk of someone who smokes versus someone who doesn't
135
Other risk factors for lung cancer
radiation in those treated for other cancers environmental toxins: asbestos, radon, metals, hydrocarbons pulmonary fibrosis genetics dietary:antioxidants, cruciferous veges can decrease lung ca risk HIV Low socioeconomic class decreased education
136
Screening for lung cancer
annual low dose CT lung scan for older smokers age 55-80 who are at high risk of
137
Pathology types of lung cancer
most common are adenocarcidoma | then squamous cell
138
Signs and symptoms of lung CA
``` cough hemopysis chest pain dyspnea diaphragmatic paralysis hoarseness malignant pleural effusions ```
139
cough in lung CA
most freq with squamous cell and small cell carcinomas new onset of cough in smoker should raise concern
140
hemoptysis in lung CA
bronchitis most common cause of this so rule out first
141
Dyspnea with lung CA
pulmonary fx testing to show flattening of the expiratory and/or inspiratory flow volume from the presence of the tumor
142
Hoarseness in lung CA
could include persistent hoarseness including both laryngeal cancer and lung CA
143
Superior vena cava syndrome in lung CA
obstruction causing sensation of fullness in head and dyspnea dilated neck veins, prominent venous pattern on chest, facial edema x-ray shows widening of mediastium or right hilar mass
144
Horners sign in lung CA
bone destruction and atrophy of hard muscles
145
Lab tests for lung CA
CBC CMP lactate dehydrogenase sputum cytology
146
Interstitial lung disease aka
idiopathic fibrosing interstitial pneumonia sarcoidosis
147
Evaluation of interstitial lung disease
``` history and physical routine blood chest x-ray pulmonary fx testing arterial blood gas computed tomography ```
148
History for lung disease
``` age gender smoking? duration of illness prior meds family hx occupational hx environmental exposures ```
149
Symptoms to inquire with lung disease
``` dyspnea cough hemopysis wheezing chest pain (could be pleuritic due to arthritis or lupus) ```
150
Clinical findings consistent with connective tissue disease
``` muscle pain weakness fatigue fever joint pains or swelling photosensitivity Raynauds pleuritis dry eyes dry mouth ```
151
physical exam for lung disease
crackles: common in most ILD, less in granulomatous inspiratory squeaks: late high pitches rhonchi cor pulmonale: late sign clubbing extrapulmonary findings
152
Creatine kinase for interstital lung disease
for myositis (anti JO-1 antibodies)
153
Interstitial pattern on chest x-ray with obst airflow suggestive of
``` sarcoidosis lymphangioleiomyomatosis hypersensitivity pneumonitis tuberous sclerosis COPD with superimposed ILD ```
154
Biopsy in ILD
``` not required to make dx helps to assess disease activity to exclude neoplastic and infectious processes that occassionally mimic chronic, progressive disease identify a more treatable process to establish a definitive dx ```
155
Treatment of idiopathic pulmonary fibrosis (IPF)
controversial | no tx to improve survival
156
Sarcoidosis
multisystem inflammatory, granulomatous disease of unknown etiology young adults with: bilateral hilar adenopathy pulmonary reticular opacities skin, joint and/or eye lesions
157
symptoms of sarcoidosis
``` cough dyspnea chest pain fatigue fever wt loss systemic inflammation: muscle weakness and exercise intolerance maybe chills and night sweats ```
158
delay of tx in sarcoidosis
due to nonspecificity of symptoms
159
Lab testing in sarcoidosis
``` cbc cmp phosphorus ESR serum gamma globulin angiotensin-converting enzyme chest x-ray pul fx testing arterial blood gas ```
160
Lab finding with sarcoidosis
leukopenia hypercalciuria ESR elevated angiotenstion-converting enzyme elevation
161
This implies diffuse granulomatous hepatic involvement
mod elevation in serum alkaline phosphatase
162
Staging of sarcoidosis
Stages I-4
163
Stage 1
bilateral hilar adenopathy, accompanied by right paratracheal node enlargement
164
Stage 2
bilateral hilar adenopathy with reticular opacities 2/3 undergo spont. resolution while the remainder have progressive disease or little change over time
165
Stage 3
reticular opacities with shrinking of hilar nodes (upper lung zones)
166
Stage 4
evidence of volume loss in upper lung zones conglomerated masses with marked traction bronchiectasis extensive calcification and caviation
167
CT for sarcoidosis
``` hilar and mediastinal lymphadenopathy bronchial wall thickening ground glass opacification parenchymal masses cysts traction bronchiectasis fibrosis ```
168
PET scan with sarcoidosis
may be helpful to indentify occult lesions and reversible granulomatous disease
169
skin lesions with sarcoidosis
maculopapular rash on face and hairline | erythema nodosum
170
Tx for sarcoidosis
``` none for stage 1-2 NSAIDS for joint pain low dose prednisone 15-20mg/day inhaled corticosteroids methotrexate cyclophosphamide azathioprine ```

Test 1 PC2 (3 decks)

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