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Flashcards in pulmonology Deck (27):
1

3 components of asthma

1.obstruction of airflow
2.bronchial hyperreactivity
3.inflammation
It is a disease of chronic inflammation leading to airway narrowing and increased mucous prod

2

Strongest predisposing factor to asthma

atopy
atopy tirad= wheeze, eczema, seasonal rhinitis

3

Stage 1 of asthma- mild intermittent

Daytime asthma sxs occur 2 or fewer days/week
2 or fewer nocturnal awakening/month
use SABA fear then 2x/week
no interference w/ normal activity
FEV1>80%
FEV1/FVC is normal
use only oral steroids 1 time or less/year

TX-SABA (albuterol)-PRN

4

Stage 2- mild persistent

Daytime sx >2x a week
3-4 nocturnal awakenings/month
use SABA >2x/ week
minor limitation in activity
FeV1>80%
FEV1/FVC is normal
2 or more oral uses

TX-
SABA
either inhaled steroid (low dose) OR cromolyn/nedocromil or can do leukotriene inhibitor

5

Stage 3 moderate persistent

Daily sxs
nocturnal awakenings at least once a week
daily need of saba
some limitation of activity
FEV1 is between 60-80%
FEV1/FVC-reduced by 5%
same for oral steroids

TX-
SABA (albuterol) prn
either Inhaled steroid (med dose) OR inhaled steroid (low-med dose) AND long acting Beta agonist
if needed can use inhaled steroid (med-high) dose AND long acting beta agonist

6

4- severe persistent

asthma sxs throughout day
nocturnal awakenings nightly
SABA several times a day
limited physical activity
FEV1 5%

TX-
SABA
Inhaled steroid (high dose) AND long acting beta agonist AND oral steroids

7

Bronchiectasis definition

abnormal, permanent dilation of the bronchi and destruction of bronchial walls. can be congenital (cystic fibrosis) or acquired from recurrent infxns or tumor
results from bronchial injury subsequent to severe infxn and/or inflammation
cystic fibrosis causes 50% of cases

8

sxs of bronchiectasis

foul smelling sputum, hemoptysis, chronic cough, and recurrent pneumonia
chest crackles and clubbing

9

comparison of emphysema and bronchitis

Emphesema bronchitis
exertional dyspnea mild dyspnea
cough is rare chronic prod cough
quiet lungs noisy lungs (wheeze and rhochi)
no peipheral edema edema
thin; weight loss overweight; cyanotic

10

emphysema

airspaces enlarged as a consequence of destruction of alveolar septae

11

bronchitis

characterized by a chronic cough that is productive of phlegm occurring most days for 3 months of the year for 2 or more consecutive years w/out otherwise acute cause

12

idiopathic pulmonary fibrosis

most common diagnosis among pts w/ interstitial lung disease
sxs- dry cough, exertional dyspnea, fatigue, malaise, clubbing, crackles

13

sarcoidosis

multi organ disease of idiopathic cause. characterized by noncaseating granulomatous inflammation in affected organs.
90% have lung involvement
sxs- cough, dyspnea (insidious onset), chest discomfort, may present w/ fever, malaise
Tx- steroids

14

ARDS

underlying problem is increased permeability o fthe alveolar capillary membranes, which leads to development of protein rich pulmonary edema
clinical fxs- rapid onset of dyspnea, tachypnea, frothy pink or red sputum, crackles, cyanotic
denotes acute hyperemic respiratory failure following a systemic or pulmonary insult w/out evidence of heart failure.

15

pulmonary func test

Increases in TLC, FRC, and RV may occur as a result of obstructive disease
Reduction in VC, TLC, FRC, and RV result from restrictive disease

16

5 causes of hypoxemia

high altitude
alterations in diffusion
hypoventilation
shunting
V/Q mismatch

17

A-a gradient

Helps to determine if there are problems on either side of the basement membrane in the pulmonary circulation

18

ARDS characterized by

bilateral, widespread pulmonary infiltrates, normal pulmonary capillary wedge pressure
rapid onset of profound dyspnea that occurs 12-24 hours after initiating event. labored breathing, tacypnea, crackles are noted

19

“Restriction” in lung disorders always means a decrease in lung volume (FVC)

true

20

interstitial lung disease

insidious onset of progressive dyspnea and nonproductive chronic cough
septal thickening
tachypnea, small lung volume, bibasilar rales, and right heart failure w/ adnaved disease

21

most common lung cancer spreads

breast, colon, prostate, bladder

22

lung cancer is most common death from a cancer

true

23

clinical presentation of cancer

centrally located lesions (cough, hemoptysis, wheezing, atalectasis)
peripheral located lesions- (pain due to pleural or chest wall invasion)
with metastasis- bone pain, back pain, difficulty breathing , HA, seizures, mental changes, weight loss, fevers,

24

90% of lung cancer spread to lungs

true

25

most common comp of lung cancer

dysphagia, hoarsness, horners syndrome, pleural effusion, tapanade, svc syndrome, pancoast syndrome

26

pancoast

shoulder pain radiating down arm ulnar distribution

27

work up of cancer pt

history and physical
cxr
labs-cbc,cmp
biopsy