Pulmonology Flashcards
(85 cards)
What is acute bronchitis?
cough > 5 days with or without sputum production, lasts 2-3 weeks
- chest discomfort
- shortness of breath
- +/- fever
What is the etiology of acute bronchitis?
viruses (most common)
-cannot distinguish acute bronchitis from URTI in the first few days
What are the labs for acute bronchitis?
labs not indicated, unless pneumonia suspected (HR>100, RR >24, T>38, rales, hypoxemia, mental confusion, or systemic illness) - CXR
What is the tx for acute bronchitis?
antibiotic not recommended - mostly viral
- symptomatic-based treatment NSAIDs, ASA, Tylenol, and/or ipratropium
- cough suppressants - codeine-containing cough meds
- bronchodilators (albuterol)
What is the presentation of asthma?
most often young patients present with wheezing and dyspnea often associated with illness, exercise and allergic triggers
-airway inflammation, hyperresponsiveness, and reversible airflow obstruction
How do you diagnosis with asthma?
diagnosis and monitor with peak flow
- PFT’s: greater than 12% increase in FEV1 after bronchodilator therapy
- FEV1 to FVC ratio <80% (you would expect the amount of air exhaled during the first second (FEV1) to be the greatest amount
- in asthma, since there is an obstruction (inflammation) you will have a decreased FEV1 and therefore a reduced FEV1 to FVC ratio
What is the tx for mild intermittent asthma?
less than 2 times per week or 3-night symptoms per month
-step 1: short acting beta2 agonist (SABA) prn
What is the tx for mild persistent asthma?
more than 2 times per week or 3-4 night symptoms per month
-step 2: low-dose inhaled corticosteroids (ICS) daily
What is the tx for moderate persistent asthma?
daily symptoms or more than 1 nightly episode per week
- step 3: low dose ICS + long acting beta2 agonist (LABA) daily
- step 4: medium-dose ICS + LABA daily
What is the tx for severe persistent asthma?
symptoms several times per day and nightly
- step 5: high-dose ICS + LABA daily
- step 6: high-dose ICS + LABA + oral steroids daily
What is acute treatment for asthma?
oxygen, nebulized SABA, ipratropium bromide, and oral corticosteroids
What is forced vital capacity?
- forced expiratory volume (FEV) measures how much air a person can exhale during a forced breath
- the amount of air exhaled may be measured during the first (FEV1), second (FEV2), and/or third seconds (FEV3) of the forced breath
- forced vital capacity (FVC) is the total amount of air exhaled during the FEV test
- you would expect the amount of air exhaled during the first second to be the greatest amount
- in asthma, since there is an obstruction (inflammation) you will have a decreased FEV1 and therefore a decreased FEV1 to FVC ratio
What is bronchiectasis?
a condition in which the lungs’ airways become dilated and damaged, leading to inadequate clearance of mucus in airways
- mucus builds up and breeds bacteria, causing frequent infections
- a common endpoint of disorders that cause chronic airway inflammation (CF, immune defects, recurrent pneumonia, aspiration, tumor)
- 1/2 of cases are due to cystic fibrosis
What are the symptoms of bronchiectasis?
include a daily cough that occurs over months or years and production of copious foul-smelling sputum, frequent respiratory infections
How is bronchiectasis dx?
CXR=linear “tram track” lung markings, dilated and thickened airways - “plate-like” atelectasis; CT chest = gold standard
-crackles, wheezes, purulent sputum
What is the tx for bronchiectasis?
ambulatory oxygen, aggressive antibiotics for acute exacerbations, CPT (chest physiotherapy = bang on the back); eventual lung transplant
What is a carcinoid tumor?
a tumor arising from neuroendocrine cells = leading to excess secretions of serotonin, histamine, and bradykinin
What are the characteristics of carcinoid tumor?
- common primary sites include GI (small and large intestines, stomach, pancreas, liver), lungs, ovaries, and thymus
- carcinoid syndrome (the hallmark sign) is actually quite rare and occurs in approximately 5% of carcinoid tumors and becomes manifest when vasoactive substances from the tumors enter the systemic circulation escaping hepatic degradation
- carcinoid syndrome = diarrhea, shortness of breath, flushing, itching
How is carcinoid tumor dx?
octreotide scan, urine for 5-hydroxyindoleacetic acid (5-HIAA), serum niacin, CT scan to locate tumor
What is the tx for carcinoid tumor?
is by surgical excision and carries a good prognosis
- the lesions are resistant to radiation therapy and chemotherapy
- octreotide - a somatostatin analog which binds the somatostatin receptors and decreases the secretion of serotonin by the tumor
- niacin supplementation
What is chronic obstructive pulmonary disease?
a chronic inflammatory lung disease that causes obstructed airflow from the lungs due to loss of elastic recoil and increasing airways resistance
What are the characteristics of chronic obstructive pulmonary disease?
- includes emphysema and chronic bronchitis = both usually coexist with one being more dominant
- damage to the lungs from COPD can’t be reversed
- 30 pack-year history = low dose chest CT
What are the risk factors of chronic obstructive pulmonary disease?
- cigarette smoking/exposure is the most important risk
- alpha 1 antitrypsin deficiency = genetic and linked to COPD in patients <40 y/o (protects elastin in lungs from damage by WBCs)
What is emphysema?
- exposure to irritants (eg cigarette smoke) - degrades elastin in alveoli, airways - lose elasticity - low pressure during expiration pulls walls of alveoli inward - collapse - air-trapping distal to collapse - septa breaks down - neighboring alveoli coalesce into larger air spaces - decreased surface area available for gas exchange
- loss of elastin - lungs more compliant (lungs expand, hold air)
- alveolar air sacs permanently enlarge, lose elasticity - exhaling is difficult
- DOE = hallmark symptom
- hyperinflation of lungs + hyperresonance to percussion, decreased/absent breath sounds, decreased fremitus, barrel chest (increased AP diameter), quiet chest, pursed-lip breathing
- individuals are able to oxygenate blood (pink) but they have to purse their lips to do so (puffers) = Pink Puffers
- pursing lip increases pressure in airway - keeps the airway from collapsing - weight loss
- barrel chest due to air trapping and hyperinflation of lungs
- CXR reveals loss of lung markings, hyperinflation, increased anterior-posterior diameter
- PETs show FVC decreases (esp. FEV1) + increased TLC (due to air trapping)
- ABG/labs: respiratory alkalosis, mild hypoxemia, normal CO2
- cachectic with pursed-lip breathing - “pink puffers”