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Pulmonary Flashcards

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1
Q

Wheezing

A

high pitched whistle
Usually louder in Expiration

Obstructive dz: asthma, COPD, lung CA, sleep apnea, CHF, GERD, Fb

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2
Q

Ronchi

A

continuous, low pitched rumble

may clear with Cough or suction

d/t increased secretions or obstruction in bronchial airway

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3
Q

Crackles/Rales

A

discontinuous
high pitched

during Inspiration

not changed by cough
d/t popping open of collapsed alveoli

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4
Q

Crackles/Rales are seen with

A 
PNA
Atelectasis
Bronchitis
Pulm edema
Pulm fibrosis
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5
Q

Stridor

A

loudest over anterior neck d/t narrowing of larynx of anywhere over trachea

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6
Q

COPD includes:

A

Emphysema

Chronic Bronchitis

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7
Q

COPD is

A

largely irreversible airflow obstruction

Chronic bronchitis: episodic

Emphysema: steady decline

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8
Q

Risk factors for COPD

A

Cig smoking
A1 antitrypsin def
Occupation exposure
Recent airway infection

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9
Q

Emphysema

loss of elastic recoil

A

Permanent enlargement of terminal airspace- distal to the bronchioles

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10
Q

Pathophys of Emphysema

A

decreased protective enzymes and increased damaging enzymes –>

Alveolar capillary and Wall damage
–>

Expiration is now active process
Increased airway trapping

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11
Q

Hallmark of Emphysema

A

simply Dyspnea: hard to breath and chronic cough (wet or dry)

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12
Q

PE of Emphysema

A

“Pink puffers”
Dec breath sounds
BARREL CHEST
Hyperresonance on percussion

Severe dz: pursed lip expiration

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13
Q

Gold standard to dx both Emphysema and Chronic Bronchitis

A

PFT: pulmonary function test

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14
Q

PFT results of COPD

A

Decreased FEV1

Ratio of FEV1/FVC <70%

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15
Q

What will you see on CXR in both types of COPD?

A

Increased AP diameter

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16
Q

CXR of Emphysema specifically

A

Flattened diaphragms

Bullae

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17
Q

Chronic Bronchitis (a sub category of COPD)

A

WET cough for at least 3 months per year, 2 years in a row

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18
Q

Pathophys of Chronic Bronchitis

A

Mucous gland hyperplasia

increased risk of infection!!! (S.PNA and H.Flu)

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19
Q

Cardinal sx of Chronic Bronchitis

A

Dyspnea and WET cough

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20
Q

PE of Chronic Bronchitis

A

Crackles/Rales
Wheezing

Cor pulmonale
Enlarged, tender LIVER (RUQ)
JVD
Periph edema

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21
Q

Cyanosis and Obesity

“Blue bloaters”

A

Chronic Bronchitis

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22
Q

EKG of Chronic Bronchitis (a subcategory of COPD) may show

A

Cor pulmonale- RVH, right atrial enlargement, RAD

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23
Q

CBC of Chronic bronchitis pt may show

A

Increased Hgb and Hematocrit- chronic hypoxia causes this

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24
Q

ABG of Chronic bronchitis pt may show

A

Respiratory acidosis

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25
Cor pulmonale
alteration of RIGHT ventricle as a result of a Respiratory problem
26
Peripheral edema and Cyanosis go with what category of COPD
Chronic Bronchitis the resp affects are starting to affect the Right side of heart
27
Which type of COPD has a severe V/Q mismatch?
Chronic Bronchitis
28
Hypercapnia (too much CO2) is assoc w what type of COPD
Chronic Bronchitis
29
CXR shows flattened diaphragms, DEC vascular markings, and BULLAE (dark circles signify airspace loss)
Emphysema
30
CXR shows INCreased vascular markings, Right heart enlargement
Chronic Bronchitis
31
4 types of Obstructive airway dz
Asthma Emphysema, Chronic Bronchitis (COPD) Cystic Fibrosis Bronchiectasis
32
Order of airway breakdown
Trachea (windpipe) Bronchi Bronchioles Alveoli
33
What is Bronchiectasis?
Irreversible DILATION of bronchial airways and impairment of mucociliary escalator
34
If someone has Bronchiectasis, what's the big deal?
It leads to - Repeat infections - Airway obstruction - Peribronchial fibrosis
35
Sx of Bronchiectasis
Persistent wet cough SOB Pleuritic CP Hemoptysis (BLOOD, d/t bronchial artery erosion)
36
PE of Bronchiectasis is non specific
Crackles usually Wheezing Rhonchi
37
Preferred imaging of choice to diagnose Bronchiectasis (but not the gold standard)
High resolution CT thick bronchial walls, airway dilation, tram-track appearance, signet ring sign
38
Gold standard to dx Bronchiectasis
PFT: pulmonary fx test showing Obstructive pattern
39
Tx for Bronchiectasis
Conservative: chest physiotherapy, mucolytics, bronchodilators Abx often needed: Macrolides, Ceph, Augmentin, FluoroQ Surgery if severe/refractory
40
"Tram track" on CXR
Bronchiectasis
41
Signet ring sign | a pulmonary artery coupled with dilated bronchus
Bronchiectasis
42
Abx for Acute exac of COPD
Macrolide (Azithromycin, "Z pack) Ceph Augmentin FluoroQ
43
Category A COPD tx
SABA (Albuterol) or | SAMA (Ipratropium)
44
Category B COPD tx
LAMA Lama: Tiotroprium (inhaled powder)
45
Category C COPD tx
``` LAMA (Tiotropium) + LABA (Salmeterol) or LAMA (Tiotropium) or LABA (Salmeterol) + Glucocorticoid (Fluticasone) ```
46
When to use Oxygen in COPD? it reduces mortality and improves QOL in severe COPD
if Cor pulmonale (R heart changes) O2 sat < 88% PaO2 <55 mmHg
47
Asthma 3 components
Airway hyperreactive Bronchoconstriction Inflammation
48
IgE response in Asthma
increased IgE binds to mast cells --> inflammatory response --> increased Leukotrienes
49
Samter's Triad | Aspirin exacerbated
Asthma + Chronic runny nose + Nasal polyps + sensitive to ASA or NSAIDs
50
Atopic Triad
Asthma Allergic rhinitis Eczema (atopic dermatitis)
51
Classic triad of Asthma
SOB Wheezing Cough (esp at NIGHT) maybe chest tightness and fatigue
52
Clues to severity of Asthma
Previous intubation, hospital admission, ICU visit
53
PE shows wheezing, hyperresonance, dec breath sounds, tachycardia, tachypnea, use of Acessory muscles
ASTHMA
54
Dx of Asthma in office
PFT test Methacoline challenge Bronchodilator challenge
55
Dx of Asthma in acute exacerbation
Peak expiratory flow rate in order to d/c pt, the PEFR must be >70% or improved by 15% from 1st attempt
56
CXR of asthma
generally not helpful | used to r/o other conditions
57
normal BUN level "teenager years"
7-18
58
normal Cr
0.6-1.2
59
normal Bicarb level "the twenties", when many people come out as Bi
22-29
60
Normal K (potassium) level
3.5-5
61
Normal Na (sodium) level
135-145
62
Asthma: Sx 1x per week SABA use 1x per week Nighttime awaken <2 x per MONTH No limit to daily actvitiy
Intermittent Asthma Tx: SABA prn
63
Asthma: Sx 3-4 per week SABA use a fewx per week Nighttime awaken a fewx per Month Minor limit to normal activity
Mild Pers Asthma Tx: Inhaled corticosteroid (and SABA prn)
64
Asthma ``` Sx daily SABA use daily Nighttime awakening a fewx per WEEK, but not nightly Some limit to normal activity FEV1 60-80% of predicted ```
MODERATE pers Asthma when you see the word "daily" Tx: Low dose Inhaled corticosteroid + LABA OR just Med dose Inhaled corticosteroid can add LTRA (Montelukast)
65
Asthma ``` Sx throughout day SABA use throughout day Awaken nightly Activity very limited FEV1 <60% of predicted ```
Severe pers Asthma Tx: High dose ICS + LABA can add Omalizumab if severe and uncontrolled
66
Tx for Asthma exacerbation
SABA- Albuterol Steroid- Prednisone Anticholinergic/SAMA- Ipratropium
67
SABA and | LABA
Albuterol | Salmeterol, Formeterol
68
SAMA and | LAMA
Ipratropium | Tiotropium
69
LTRA
Montelukast
70
Mast cell stab
Cromolyn
71
Preferred tx, Step up therapy in Asthma
1: SABA prn 2: Low dose ICS 3: Low dose ICS + LABA 4: Med dose ICS + LABA 5: High dose ICS + LABA 6: High dose ICS + LABA + steroid
72
Note, anytime you see LABA (Salmeterol, Formeterol) you can substitute with
LTRA (Montelukast) as an alternate
73
When can you consider stepping down therapy?
If sx have been controlled for >3 months
74
Corticosteroids (for acute Asthma exacerbation)
Prednisone Methylprednisolone Prednisolone
75
Inhaled Corticosteroids (for maintenance therapy of Asthma)
Triamcinolone | Beclomethasone
76
LABAs are added in Asthma tx starting in step 3, what is a LABA?
Long acting beta agonist Formoterol Salmeterol
77
Pt has daily SABA use, daily sx and a few PM wakenings per week What is the treatment?
This person has MODERATE persistent asthma Tx: Low dose ICS + LABA
78
This person has sx and uses SABA throughout the day, awakens nightly, and <60% FEV1 What is the treatment?
This person has SEVERE persistent asthma Tx: Med/High dose ICS + LABA can add Omalizumab
79
This person has sx and SABA use 1-2x per week 1-2 nighttime wakening per MONTH What is the tx?
This person has only INTERMITTENT asthma Tx: SABA prn
80
This person has 3-4 sx and SABA use per week 3-4 nighttime wakenings per MONTH What is the tx?
This person has MILD persistent asthma Tx: Low ICS
81
When do you start adding the LABA (Formoterol, Salmeterol) to the ICS?
in step 3, MODERATE persistent | when stuff is "DAILY"
82
Acute Bronchitis
Usually VIRAL- Adenovirus, Infleunza, Corona, Coxsackie
83
Acute Bronchitis if bacterial (rare), what are the causative organisms?
S. PNA M. cat H. flu the "SMH" pathogens
84
Clinical sx of Acute Bronchitis
Cough for at least 5 days, often 1-3 weeks! productive Malaise, SOB, wheezing, low grade fever, malaise MAYBE HEMOPTYSIS
85
2 most common causes of Hemoptysis (bloody cough)
Acute Bronchitis | Bronchogenic carcinoma
86
PE and CXR of Acute Bronchitis
PE often normal, with maybe wheezing/ronchi CXR not needed! Imaging not needed usually If CXR obtained, will be normal or nonspecific
87
Tx for Acute Bronchitis
Supportive (fluids, antitussive, antipyretic, analgesics) | Abx not usually needed
88
Pertussis | "whooping cough"
Bacteria: Bordetella pertussis Transmission: resp droplets during coughing fits Catarrhal: URI sx 1-2 weeks. most contagious!! Paroxysmal: Severe cough fit, posttussive emesis, 2-4 wks Convalescent: resolution, cough may last up to 6 wks
89
Tx of Pertussis | "whooping cough"
Supportive | Abx to decreases contagiousness: Macrolide (Azithromycin "Z pack")
90
2nd line Abx tx for Pertussis "whooping cough" Azithromycin "Z pack" is 1st line
Bactrim is 2nd line
91
Complications of Pertussis "whooping cough"
PNA, Encephalopathy, Ear infection, Seizure in infants, deaths often d/t Apnea/ cerebral HYPOXIA d/t coughing fits
92
Pertussis Vaccine (5 doses!!! + booster later)
DTaP 2,4,6, 15 mo and 4-6 YO then booster 11-18 YO
93
Bronchiolitis infection AND inflammation of bronchioles
RSV most common!!! 2 mo-2 yo
94
Acute Bronchiolitis- RSV
Viral prodrome- fever and URI for 1-2 days THEN Respiratory distress- wheezing, tachypnea, nasal flaring, cyanosis, retractions, rales
95
Tx for RSV Bronchiolitis
Mostly supportive: oxygen, antipyretic- Acetaminophen, fluids Meds limited role: beta agonist, epi
96
If RSV Bronchiolitis pt has severe Lung or Heart dz or is Immunocompromised, what should you consider giving them?
Ribavirin
97
Prevention of RSV Bronchiolitis in high risk patients ``` Premature <29 wks Chronic lung dz Cong Heart dz Neuromusc difficulties Immunodef ```
Palivizumab and WASH HANDS
98
Triple D's: drooling, dysphagia, distress Stridor Thumb sign on CXR Tx is to maintain airway, maybe intubate, and Ceftriaxone (Rocephin)
Acute Epiglottitis!!!
99
How can we prevent Acute Epglottitis
Hib vaccine | Rifampin given to close contacts
100
Barking seal cough "Steeple sign" inflammation of Larynx and subglottic airway Tx is based on severity 1. supportive, o2, air mist, fluids, and dexamethasone GO HOME 2. dexamethasone and nebulized Epi STAY FOR 3-4 HOURS 3. dexamethasone + nebulized Epi + ADMIT
Croup! Laryngotrachetiits

Clinical Prep (41 decks)

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