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Flashcards in pulmonary Deck (61):
1

pulmonary embolism

cough, frothy pink tinged sputum. "IMPENDING DOOM"

2

impending respiratory failure (asthma pt)

RR >25bpm, tachy, cyanosis, "quiet" lungs no wheezing.

Adrenaline injected STAT, call 911. 02 4-5L, albuterol.

after tx, good sign is breath sounds and wheezing.

3

normal findings of lungs

upper lobes: bronchial breath sounds (louder)
lower lobes: vesicular (soft and low)

4

normal egophonys

normal: "eee"
abnormal "bah"
normal "eee is louder over the large bronchi" vs lower lobe

5

tactile fremitus

normal: stronger vibrations on the upper lobes

6

whispered pectoriloquy

patient to whisper "99 or 1-2-3"
normal: voice lounder upper lobes, muffled lower lobes
abnormal: clear sounds lower, muffled upper

7

percussion

normal: resonance
tympany or hyperresonace: COPDY, emphsema
dull: pneumonia with consolidation, pleural effusion (liquid or tumor), solid organ (liver)

8

pulmomary fxn tests

obstructive dysfuncion - reduction in airflow
asthma, copd

restrictive- reduction of lung volume dt decreased lung compliance
ie; pulmonary fibrosis, pleural disease

9

COPD

includes both emphysema and chronic bronchitis

loss of elastic recoil of the lungs and alveolar damage

risk: smoking and age

10

chronic bronchitis

cough with excessive mucus 3 months or more
for a minimum of 2 or more consecutive years

11

emphysema

permanent alveolar damage
expiratory respiratory phase is longer

risk: smoking, age, occupation, alpha 1 trypsin deficiency
classic case: elderly male, smoker, c/o sob during exertion. frequent cough, yellow sputum, barrel chest, weight loss (emphysema).

objective: >AP diameter,

12

copd general tx

smoking cession
flu, penumococcal vaccine
pulmonary drainage

13

copd medications

1st line: anticholinergics Ipatropium (atrovent) or tiotropium (spiriva)

and/or

b2 agonist: salmetrol (serevent), formoteral, albuterol (combivent)

2nd line: prednisoe (medrol dose pack), fluticason, adviar

14

copd medications safety

albuterol (b2 agonist)- careful with htn, hyperthyroid

anticholingergics (atrovent, spiriva), avoid if narrow angle glaucoma, bhp, bladder neck obstruction dt vasoconstriction

15

long term use of corticosteroids >6mos= risk of pneumonia

when treating COPID, pick antibiotic doxy or fluoro (agains H. influenza gram -

true

16

CAP

bacterial infection
s. pneumoniae
h.influenze
m. catarrhalis
cystic firbosis

classic case: elder with high fever, productive cough, rust colored sputum, pleuritic chest pain

objective: rhonchi, wheeze, crackles, dullness on percussion

INCREASE tactile fremitius and egophany

xray is gold standard for diagnosing CAP ( NOT sputum), repeat 6 wks after clearing

cxr lobar consolidation

17

tx of CAP

Macrolide or doxy (tetracycline)

with comorbidity (kidney, chf, liver) fluroquinolonie as ONE drug therapy (leva, gemi, maxi)

or

high dose amoxi (augmentin) plus macrolide

18

curb 65

confusion, urea in blood, rr>30bpm, blood pressure

19

prevention of pneumonia

flu for everyone >50 yo
pneumovax if >65 yo

healthy patients - one lifetime dose at 65 yo

20

prevent of pneumonia for high risk patients

pneumovax booster in 5-7 years
19 yo if asplenia

21

atypical pneumonia

children/young adults
"walking pneumonia" highly contagious

M. Penumoniae
C. Penumoniae
Legionella pneumoniae- found in moisture (water, air conditioners)

classic case; youg adult several weeks fatigue, coughing non productive, cold like s/s.

wheezing, pus in throat, diffuse interstitial infiltrates on X-ray.

medications: macrolide (same as 1st line CAP), anitussive prn (dextromethorphan, tessalon perles)

22

acute bronchitis

aka treacheobronchitis, usually viral and self limiting
tx: fluids, antitusstives (dextromethorphan, tessalon perles, f

guaifensin prn, albuterol, if severe medrol dose pack

23

pertussis

bacterial
whopping cough

last 2 weeks or longer, "hacking cough", may vomit.

labs: nasopharyngeal swab (PCR), ELISA, cbc

tx: marcolides
TDAP booster

24

typical vs atypical pneumonia

typical: (CAP) older pt. high fever (>100.4), productive cough, rust colored sputum, chest pain
* S. pneumoniae, H. inlfluenzae, M. catarrhalis

atypical: children/young adults. fatigue, nonproductive cough, low grade fever (cold like s/s)
**M. pneumonia, C. pneumoniae, Legionella penumonaie

25

COPD 1st line

atrovent add salmeterol if poorly controlled

26

COPD plus smoker

most likely H. Influenza

27

if healthy adult has cough for >2-3 weeks and previously treated with antibiotic, assume pertussis. r/o pneumonia

true

28

what age tdap vs td

11 and up

29

best mucolytic

fluid

30

afrin dosage

bid up to THREE days only. >3 days=rebound rhinitis medicamentosa

31

common cold s/s and tx

s/s: acute fever, sore throat, sneezing, clear mucus (coryza.
tx: fluids, rest, acetaminonphen, nsaids

oral decongestants- sudafed/psudoephedrine
topical nasal decong-afrin
antitussives (robitussin/dextromethorphan)
antihistamine (diphenhydramine/benadryl)

32

TB

lungs most common (85%)
latent TB: not infectious.

33

reactived TB on cxr

cavitations and adenopathy and graulomas on the hila of the lungs

34

prior BCG vaccine

if >5 yrs since last bcd, a positive TB is most likely a TB infection

35

first line rx TB

isoniazid
rifampin

36

miliary TB

affects multiple organs, more common

37

infectious TB or reactivated TB

90 % are reactived in US dt low immunity

38

tx plan for TB

report TB to local health department
all TB test for HIV
use 4 drugs, INH, rifampin, ehtambutal, and pyrazidamide tid (then narrow down drugs after C&S)

classic case: adult c/o fever, night sweats, cough, weight loss (late sign), blood in cough ( late sign)

39

warning for ethambutal rx

can cause optic neuritis. avoid if pt has abnormal vision (blindness, etc)

40

medications INH for tb (hiv vs non hiv)

non hiv- INH 300 mg for 9 months
HIV- for 12 mos

chest baseline liver fxn and monitor

41

PPD test result

look for induration, NOT RED!. i.e.: bright red color but no induration = negative

5mm or less: HIV, immunocompromised, previous TB on chest X-ray, child with close TB contact

10mm or less: recent immigrant, child 15mm- no known risk factor for TB

42

tb skin test

mantoux. inject .1ml of 5th-ppid sub dermal.

43

tb blood test

quantiFERon-tb gold or t-spot (aka igra). blood test measure y-interferon.

igra-results available in 24 hours. use if hx of previous bcg vaccine

44

TB

hiv
recent contacts with infectious TB
chest x ray with fibrotic changes ( previous tb)
any child who had close contact or has tb symptoms (

45

TB

recent immigrants last 5 years (asia, africa, latin america, india, pacific islands)
child

46

asthma

reversible airway obstruction caused by inflammation of the bronchial tree.

goal: less than 2 days/week of rescue medication (albuterol)

objective -wheezing with prolonged expirator phase, tacky

47

asthma medication
"rescue'

short acting b2 agonist

albuterol (ventolin HFA)
pirbuterol (Maxair)
levalbuterol (xopenex)
2 inhalations q 4-6 hrs prn

onset: 15-30 min, lasts 4-6 hours

48

long term asthma medication

take every day
long acting b2 agonist (LABA), bid.
LABA- increase death with asthma
LABA not to be used as rescue drugs

49

LABA rx

salmeterol (serevent) bid
formeterol (foradil) bid
salmetrerol plus fluticasone (advair)

50

sustained release theophylline

acts as bronchodilator
monitor: macdrolides, quinolones, anticonvsulants, chest blood level

use of spacer or chamber.

51

1st line tx for asthmatic exacerbation

adrenaline injection

52

long term inhaled steroids recommendation

supplement calcium with bit D 1500mg for menopausal women ( high risk osteoporosis), bone density (males and females), eye exams (risk of cataracts/glaucoma)

53

asthma tx in a nutshell

1) every pt on b2agonist (albuterol)
2) inhaled corticosteroids (Triamcinolone/azmacort, Fluticasone/flovent bid. (oral thrush risk, rinse with h20)
3) add b2 long actin (salmeterol or combo, adviar)
4) add leukotriene inhibitors, theophilline, or mast cell

54

asthma exacerbation

PEF

55

PEF

measure effectiveness of tx. blow hard during expiration using spirometer (3 times). highest value is PR

HAG (heigh, age, gender)

56

spirometer paramters

green - 80-100% (maintain or reduce medications)
yellow (50-80%), increase therapy
red zone (

57

step 1
>80% PEF, s/s

albuterol (ventolin) prn

58

step 2
>80%
>2 days/ week symptoms

albuterol (ventolin) PLUS

ICS (fluticasone/flovent)
triamcinolone (azmacort)

risk of oral thrush

59

step 3
PEF 60-80, daily s/s

albuterol
ICS
LABA

ICS
(fluticasone/flovent)
triamcinolone (azmacort)

LABA- salmeterol (ADVAIR)


60

step 4

high dose ICS (fluticasone/flovent)
triamcinolone (azmacort)
LABA- salmeterol (ADVAIR)

oral corticosteroid ( prednisone) daily

61

exercise asthma

use 2 puffs of saba (albuterol/ventolin, levalbuterol/xopenex, pirbuterol/maxair) 10-15 min before exercise. last 4 hours