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Pulmonary Flashcards

1
Q

s/s PE

A

sudden onset of SOB and cough. + productive ( pink) sputum, tachy, impending doom. Most common cause is a DVT emboli

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2
Q

what type of reaction is a anaphalxisis

A

type 1 igE-mediated

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3
Q

how many lobes does the L and R lung have

A 
R = 3
L= 2
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4
Q

What does the normal resp drive respond too?

A

changes in the aterial C02 ( hypercapnia)

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5
Q

Norm base/lower lung sounds

A

vesicular

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6
Q

norm bronchi/upper airways sounds

A

bronchial or bronchovesciular

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7
Q

normal sound with percussion?

A

reasonance

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8
Q

When you hear dull percussion on lungs?

A

lobar pnuemonia , blood fluid, tumor

over ribs/bone, liver and heart

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9
Q

when do you hear hyperreasonace/tympany?

A

“too much air in heart” = emphysema

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10
Q

Do upper or lower lobes have more fremitus?

A

upper have more vibration

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11
Q

Increased fremitus on one lower lobe indicates what?

A

lobar pnuemonia

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12
Q

decreased fremitus indicates?

A

emphysema/copd

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13
Q

What is egophony?

A

when pt says “ee” but it sounds like ‘aa”, if that is true = positive = lobar pnuemonia over affected lobe ( consolidation)

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14
Q

What is the diagnostic test for COPD

A

PFT’s with a FEV1/FVC ration

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15
Q

what will a CXR look like with a pt with COPD?

A

hyperinflation/hyperexpansion with increased chest size and flattened diaphram

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16
Q

What is COPD? what is the #1 risk factor?

A

irreversible loss of elastic recoil of the lungs and aveolar damage

smoking

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17
Q

what is chronic bronchitis?

A

chronic cough w/ increased mucus on most days for at least 3 months per year for at least two consecutive years.

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18
Q

what is emphysema? on physcial exam?

A

increased AP diameter, decreased breath and heart sounds , expiratory phase prolonged, pursed lip breathing

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19
Q

what would you see on PE for emphysema?

  • percussion
  • fremitus
  • egophony
A

Hyperresonance
decreased tactile fremitus
decreased egophony

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20
Q

What would you see on spirometry for dx of COPD?

A

FEV 1 <80%

O2 < 92%

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21
Q

examples of ICS:

A

Fluticansone, budesonide

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22
Q

examples of SABA

A

Albuterol

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23
Q

examples of SAMA

A

short-acting anticholingeric atrovent (iprtropium)

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24
Q

examples of LABA

A

formeterol

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25
examples of LAMA
tiotropium / sprivia
26
GOLD A and B are based on two things?
exacerabation in the last 12 months and hospitalization
27
other options for COPD
Oxygen only 2-3 liters - dont go above 92% pulmonary rehab flu and pnuemococcal vaccine
28
what pathogen is responsible for a secondary bacterial infection ? s/s ? tx?
H. influenza pneumonia acute onset fever, + purulent sputum, wheezing Bactrim, doxy or ceftin BID for 10 days
29
who should get the pnuemonia vaccine? which one?
anyone over 65 get PCV 13 then a year later PPSV23 if you give it prior to 65 you want to give again in 5 years
30
who is considered high risk for getting pnuemonia
no spleen / damaged spleen, scc, HIV/AIDS, chronic heart or lung dx, chemo, people on steroids, cochlear inplant , renal failure
31
CAP s/s and PE
acute onset fever/chills, w/ productive cough and pluertic chest pain cough productive of yellow, green - rusty colored phelgm rusty/blood tinged sputum = strep. pneumoniae PE if consolidation present: - positve tactile fremitus, egophany and whispered petroliguy - dullness on precussion
32
what is the gold standard for dx the CAP
Chest xray showing infiltrates or lobar consolidation w/ CLINICIAL SYMPTOMS you should repeat CXR after tx expecially w/ high risk pt
33
What labs would see on CAP
increased WBC elevated nuetrophils > 70 % shift to the left increase in bands if bacterial
34
What is the CURB65 criteria
indicates if out pt tx or inpatient tx is needed to tx CAP A score GREATER than 1 = inpt tx ``` Confusion Urea (BUN >19 ) Resp rate >30/min BP <60 or <90 Age 65 or older ```
35
What are the top two pathogens for CAP
Strep. pnuemoniae ( alcoholics | H. influenza ( more common in copd and smokers
36
CAP pathogen in young adults?
mycoplasma pnumoniae
37
TX for CAP out pt? comormidities or not
No commormidities : Macrolides Azithromycin x 5 days Doxy if allergic to macrolides Comordities ( renal, lung, heart , asplenia, DM, Alcoholics) Fluoroquinolones : Moxifloxacin QD 5-7 days, Levofloxacin 750 mg X 5 days
38
Adverse effects of Fluoroquinolones? Name 3
Hypo/hyperglycemia, QTc prolongation, confusion, achiles tendon rupture, nueropathy, AKI Cipro, anything ending in floxin, levaquin)
39
What type of bacteria causes Atypical Pnuemonia? TX
Mycoplasma pnuemoniae and Chlamydia TX: doxycline
40
Viral URI
acute onset of sneezing, runny nose, sore throat, nasal congestion resololves on own can use dextromethropan for cough pseaudophedrine for nasal congeston guiafenesin ( mucoltic )
41
ACEI / ARB cough
new cough, dry stop ACE and try ARB if not better switch classes
42
Acute Bronchitis s/s, organism, tx
Recent history of a cold but longer duration x 2 weeks may have chest wall pain organisms ( viruses and chlamydia ) TX: no antibiotics - antitissuves ( honey, dextromethorpan, tessalon) - cough - Wheezes - albuterol - mucolytic - increased fluids and guiafenesin
43
What is asthma?
chronic airway inflammation results in hyperresponsive airways and bronco-contriction ( which is reversible)
44
presentation of asthma and PE
history of a "bad cold" or acute bronchitis, increase use of inhaler, w/ no relief. Complains of chest tightness especially at night PE: inspiritory and expiriotry wheezes or heard to hear lung sounds
45
what is the rescue drug for asthma ?
SABA PRN - albuterol to treat wheezing
46
what are asthma controller agents?
Inhaled corticosteriod ( ICS) flovent 2 puff BID * first line* can also use - singulair - LABA ( advair diskus) which is a combo of a LABA and ICS
47
What concerns to we have with theophylline ?
Blood levels and drug interactions
48
safety concerns with ICS
osteoporosis, cateracts, gluacoma thrush ( rinse mouth with water after use)
49
safety concerns with LABA
increase risk of death and pneumonia
50
safety concerns with albuterol
arrythmias, MI, angina
51
What are the variables that are used to figure out someones PEF ( volume lung can hold)
H eight A ge G ender / sex
52
Step 1 asthma ( called, symptoms, nighttime awakenings, PEF)
intermittent ( everything less than two) (symptoms less than 2 week, using SABA less than 2 x month N : < 2 a month >80 PEF
53
Step 2 asthma ( called, symptoms, nighttime awakenings, PEF)
mild persistent > two days a week, > SABA use 2 days a week ( not daily) N: 3/4 a month > or equal to 80%
54
Step 3 asthma ( called, symptoms, nighttime awakenings, PEF)
MODERATE persistent *** Daily attacks, SABA use daily N : > night a week ( but not daily) 60-80 percent
55
Step 4 asthma ( called, symptoms, nighttime awakenings, PEF)
Severe Persistent daily attacks markedly imparied function and activity N: nightly <60 %
56
What type of asthmatics should use an ICS
all BUT step one ( intermittent) | all should be using albulterol
57
What is the tx for Exerisce-Induced bronchospams?
pre-tx before excerise : 5-15 min with SABA Education: use a mask/scarf for cold-induced EIB. Warm up period encouraged
58
Emergency care for asthma
1. assess severity ( check PEF, s/s, resp distress, check o2 2. tx with continuous SABA with inhaled ipratripium 3. monitor response 4. if PEF is less than 50 % of expected or <91 % send to ED`
59
What does it mean if you cant hear lung sounds in an asthmatic
severe bronchoconstriction
60
What is a PFT
pulmonary function test : measure of severity of obstructive and restrictive pulmonary dysfunction
61
what are examples of obstructuve diseases
reduction in airflow rates | COPD, Asthma
62
what are examples of restrictive diseases
reduction in lung volumes | pulmonary fibrosis, plerual dx, diaphram obstuction

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