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PANRE > Pulmonology > Flashcards

Pulmonology Flashcards

(49 cards)

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1
Q

Tactile Fremitus is?
Incr in what?
Decr in what?

A

Palpable vibrations transmitted through
bronchopulmonary tree to chest wall when patient speaks (i.e. “99”)
- Incr with pneumonia
- Decr w/ COPD

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2
Q

Percussion of chest wall

A
  • Resonant —>generally healthy lung
  • Flat or dull —> lobar pneumonia or pleural effusion
  • Hyperresonant (low, loud, booming sound) —> COPD or pneumothorax
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3
Q

FEV1/FVC Ratio is ? Nl is ?

A

volume exhaled in 1 sec / total volume exhaled after maximal exhalation
nl is 75-85%

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4
Q

ABGs: CO2 acts how in the body?

Does what to pH?

A

CO2 acts as an acid in the body (Opposite!)
• As CO2 incr = incr acid = decr pH (respiratory acidosis)
• As CO2 decr = decr acid = incr pH (respiratory alkalosis)

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5
Q

ABGs: HCO3 acts how in the body?

Does what to pH?

A

HCO3 acts as a base in the body (SAME!)
• As HCO3 incr = incr base = incr pH (metabolic alkalosis)
• As HCO3 decr = decr base = decr pH (metabolic acidosis)

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6
Q

Normal ABG Values?

A 
pH 7.35-7.45
pO2 80-100 mmHg
pCO2 35-45 mmHg
HCO3 22-26 mEq
SaO2 97-100%
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7
Q

Causes of Respiratory Acidosis

A

Caused by any process which decr ability of lungs to exchange CO2 for O2.
• Ex. COPD, asthma, heart failure, pneumonia

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8
Q

Causes of Respiratory Alkalosis

A

Caused by any process which incr respiratory rate

• Ex. fever, anxiety, mechanical overventilation

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9
Q

Causes of Metabolic Acidosis

A

Caused by any process that incr accumulation of acids or decr amount of bicarbonate
• Ex. diabetic ketoacidosis, renal failure

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10
Q

Causes of Metabolic Alkalosis

A

Caused by any process that decr acid or incr bicarbonate

• Ex. prolonged vomiting / nasogastric suction

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11
Q

Intermittent Asthma

A

Daytime Sxs: /= 80% predicted

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12
Q

Mild Persistent Asthma

A

Daytime Sxs: >2 x wk but not daily
Nocturnal Sxs: > 2 x mo
FEV1 or PEF: >80% predicted

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13
Q

Moderate Persistent Asthma

A

Daytime Sxs: daily B-agonist use (exacer 2 or more / wk)
Nocturnal Sxs: > 1 x a mo
FEV1 or PEF: >60% to

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14
Q

Severe Persistent Asthma

A

Daytime Sxs: continual
Nocturnal Sxs: frequent
FEV1 or PEF: = 60% predicted

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15
Q

Asthma: S/S of impending airway failure

A
  • Decreased wheezing or breath sounds
  • Fatigue
  • Diminished respiratory effort/bradypnea
  • Cyanosis
  • Inability to speak full word sentences
  • Increased accessory muscle use
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16
Q

Diagnostic criteria for Airway Obstruction using spirometry (for Asthma w/u)?

A

• Airway obstruction = reduced FEV1/FVC (

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17
Q

Diagnostic criteria for “reversibility” using spirometry (for Asthma w/u)?

A

Reversibility is defined by an increase of >/=12% and 200mL in FEV1 or >/=15% and 200mL in FVC after administration of a
short-acting bronchodilator

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18
Q

Diagnostic eval for asthma (in stable patient).

A
  1. Spirometry: looking for both obstruction and reversibility (necessary for Dx)
  2. bronchoprovacation test (methocholine challenge) if spirometry nondiagnostic and high clinical suspicion.
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19
Q

Diagnostic eval for asthma (in unstable patient).

A
  1. Peak Flow (measures trends in asthma control, not used to diagnose asthma).
  2. O2 Saturation
  3. ABGs
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20
Q 
Asthma Tx (Rx)
Rescue Meds:
Study These Flashcards
A
  1. Inhaled B-agonists (albuterol): relax smooth muscle

2. Inhaled anticholinergics (Ipratropium): reverse vegally-mediated bronchospasm. Most useful in severe exacerbations (

21
Q 
Asthma Tx (Rx)
Maintenance Meds
Study These Flashcards
A
  1. Inhaled corticosteroids (ICS): Mainstay for persistent asthma. takes 1-2 wks (why needs oral after exacerbation). rinse & spit
  2. Long Acting Beta Adrenergics (LABA): salmeterol or formoterol. black box for monotherapy. LABA commonly mixed with ICS in same inhaler (i.e. advair)
  3. Leukotiene Modifiers (montelukast): more effective in pts with allergen-related asthma
22
Q

Two types of COPD and sxs of each

Study These Flashcards
A

1) Pink puffers (emphysema) –>mostly dyspnea
• Cough rare, scant clear sputum, breath sounds quiet
2) Blue bloaters (chronic bronchitis) –> chronic cough /purulent sputum / ↑ pulmonary infections
• Dyspnea mild, rhonchi variable, wheezes common
• May appear cyanotic

23
Q

Tx for COPD: General Measures

Study These Flashcards
A
  1. Education (COPD + Smoking Cessation)
  2. Pneumococcal and yearly influenza vaccines
  3. Stress consistent and proper inhaler use
  4. Pulmonary Rehab
24
Q

Tx for COPD:

Study These Flashcards
A

Bronchodilators = mainstay of therapy

  1. Short-acting Inhaled “Rescue” Agents (all patients)
    - β2-agonist plus anticholinergic (generally) (i.e. Albuterol plus Ipratropium)
  2. Long-Acting Inhaled “Maintenance” Agents –> advanced patients
    • Long-acting anticholinergics (ex. tiotropium, aklidinium)
    • Long-acting β2-agonists (LABAs) (ex. salmeterol, formoterol, indacaterol)
  3. Inhaled corticosteroids (ICS): generally for all stage III-IV with >/= 3 exacerbations per year
25
Roflumilast (Daliresp®) is used for? indication?
COPD (new 2011): Modestly improved lung function & reduced frequency of moderate to severe exacerbations in patients with severe COPD associated with bronchitis
26
Bronchiectasis is ?
Disorder of large bronchi characterized by permanent dilation / destruction of bronchial walls
27
Who to screen for lung cancer?
Recommended for: | - pts 55-74 yrs who have smoked ≥30pk-yrs - who either continue to smoke or have quit within past 15 yrs
28
Location of Lung Tumors?
HASSLE: 1. peripheral (A and L): Adenocarcinoma and Large cell 2. central (SS): Squamous cell carcinoma and Small cell carcinoma
29
Most common sites for lung CA metastasis?
1. Bones (pain, pathologic Fx) 2. Liver (poor prognosis) 3. Brain (HA, N/V, seizure, focal neuro change) - lung CA (adeno and small cell) account for 70% of symptomatic brain tumors
30
Paraneoplastic Syndromes
Hypercalcemia - SCC | SIADH - SCLC
31
Acute Bronchitis clinical manifestations
cough, usually with sputum production (50%), & evidence of concurrent URI (ex. nasal symptoms) • Fever is a relatively unusual sign in acute bronchitis (when present consider influenza or pneumonia) - Note: Purulent sputum doesn’t predict bacterial involvement - Acute bronchitis cannot be distinguished from URIs in 1st few days • Acute bronchitis is suggested by persistence of cough for >5d • Acute bronchitis cough typically lasts 10-20 days
32
Indications for CXR in patients with an acute cough syndrome? Purpose?
1) Abnormal vital signs (P >100/min, RR >24, or T >38 ºC) 2) Pulmonary exam findings Purpose: exclude pneumonia
33
Acute Exacerbation of COPD (AE-COPD): | Dx and Tx
Dx: (70-80% infectious) • Sputum gram stain / culture (?) • Viral Studies (nasopharyngeal swab) (?) • CXR --> R/O pneumonia (if fever +/- hypoxia) Tx: Supplemental O2 is critical • Bronchodilators - Albuterol + ipratropium (may be nebulized) • Systemic steroids-->taper over 5-10 days • Antibiotic Therapy - Uncomplicated exacerbation: Doxycycline, cefuroxime, TMP-SMX, azithromycin(?) - Complicated exacerbation: Amoxicillin / clavulanate or levofloxacin
34
Acute Exacerbation of COPD (AE-COPD): | Clinical Manifestations
* ↑ volume or change in character of sputum * ↑ frequency & severity of cough * ↑ dyspnea / respiratory rate
35
Community-Acquired Pneumonia: Clinical Manifestations
Often present with >/= 1 of following: • Fever or hypothermia • Rigors & sweats • New cough +/- sputum production • Dyspnea • Constitutional symptoms (fatigue, myalgias, abdominal pain, anorexia, or headache) common
36
Clinical presentation Pearls for S. pneumoniae CAP
* Single rigor (often r/t transient bacteremia) | * Pleurisy (pleural effusions common)
37
Clinical presentation Pearls for H. influenzae CAP
Common in patients with underlying obstructive lung disease (ex. COPD)
38
"Typical" CAPs and presentations pearls
1. S. Peneumoniae: Single Rigor; Pleurisy 2. H. influenzae: common in COPD 3. M. catarrhalis: nothing special
39
"Atypical" CAPs and presentation pearls
1. L. pneumophila • May present with high fever, hyponatremia, & diarrhea • Appear more ill than their CXR would predict 2. M. pneumoniae • Cough illness presentation common • Extrapulmonary symptoms common (ex. bullous myringitis) • More common in healthy kids & young adults (“Walking Pneumonia”) 3. C. pneumoniae • Similar to M. pneumoniae but often older patients
40
Management of TB (i.e. + TST or IGRA/Quant-Gold)
If (+) TST or IGRA--> refer to rule out active TB prior to treatment for LTBI 1) Evaluate for symptoms (ex. fever, cough, weightloss, etc.) & perform exam 2) CXR • If (-) --> treat for LTBI • If (+) --> work-up & treat for active TB Make sure to check HIV status.
41
Treatment for active TB
4 drugs for 2 months then 2 drugs for 4 months “RIPE drugs” - 4 drugs: Rifampin (RIF), Isoniazid (INH), Pyrazinamide(PZA), Ethambutol(EMB) x 8 wks Then: • 2 drugs (INH & RIF) X 16 wks
42
Treatment of Latent Tuberculosis
Isoniazid (INH) X 9 months has most data
43
Sarcoidosis Clinical Manifestations
Incr. incidence in North American blacks & northern European whites 1. Pulmonary: >90% present with pulmonary findings (DOE, dry nonproductive cough, BIL perihilar lymphadenopathy) 2. Non-Pulmonary: • Skin: erythema nodosum, lupus pernio • Heart: conduction abnormalities • Ocular: uveitis • Parotid gland enlargement 3. Biopsy (bronchoscopy or mediastinoscopy) is definitive diagnosis--> shows noncaseating granulomas
44
Transudate vs Exudate W/U
1. CXR/Chest CT 2. thoracentesis 3. protein and LDH (exudate vs transudate) - Exudate: >0.5 protein, >0.6 LDH, low glucose 4. pH, total cell count w/ diff, glucose, cytology, gram stain/Cx
45
“Virchows Triad” is: | describes what?
• 1) Hypercoagubility • 2) Venous stasis • 3) Endothelial injury Describes pathophysiology of venous thromboembolism
46
Common acquired ETIOL of venous thromboembolism:
``` • Major surgery • Trauma • Malignancy • Age (>45yrs) • OCP or HRT • Pregnancy / postpartum • Medical conditions (ex. serious infection) ```
47
Clinical presentation of DVT
* Ipsilateral edema * Ipsilateral pain * Ipsilateral warmth * Palpable cord (reflects a thrombosed vein) * Homan’s sign unreliable
48
Clinical presentation of PE
* Sudden / unexplained dyspnea * Pleuritic chest pain * Cough * Tachypnea * Tachycardia
49
Dx of PE
Nonspecific Measures 1. ECG abnormal (70%) • S1Q3T3 classic; new-onset sinus tachycardia most common 2. CXR • Usually reveals atelectasis, parenchymal infiltrates, & pleural effusions • Historic Findings - Westermark’s Sign: prominent central pulmonary artery with local oligemia - Hamptom’s Hump: increased opacity from intraparenchymal hemorrhage Specific Measures 1. Helical (Spiral) CT = CT Angiography (CTA = “PE Protocol” 2. Ventilation / Perfusion Lung Scanning (V/Q Scan) 3. Pulmonary angiography = gold standard

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