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6011 Test 1 > Respiratory > Flashcards

Respiratory Flashcards

(83 cards)

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1
Q

Most Common Chief Complaints

A

Cough - cold, COPD, pneumonia, asthma allergies, GERD
SOB
Chest Pain

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2
Q

Social Determinants of Health

A 
What to do? --> Use resources!
NHLBI
American Thoracic Society
AAFP
IDSA
CDC
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3
Q

Maximizing Resilience

A

Vaccines / Infection Control / Nutrition & exercise / Management of ambient temp (ex. apartments with no AC) / Avoidance of stressors, Air quality info

Other (social order) things that help: rich community life, neighborliness, competence, self-reliance, human scale, ecological durability

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4
Q

Air Quality Numbers

A

1 - 3 Low Risk (at risk, enjoy / general, ideal)
4 - 6 Moderate Risk (at risk, consider rescheduling)
7 - 10 High Risk (at risk, reduce or reschedule / general, consider reducing or rescheduling)
10+ Very High Risk (at risk, avoid / general, reduce or reschedule)

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5
Q

Key Preventive Care Points

A
  1. Smoking: Cessation and Avoidance
  2. Exposures (past and present) to pollution, local environment, respiratory pathogens
  3. Vaccines: Influenza, Pneumovax, TB skin tests, childhood immunizations
  4. Optimal management of chronic diseases
  5. Screenings: CXR / CT in smokers / PPDs
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6
Q

When to consider a CT scan?

A

Patients 55 - 80 yo and have smoked at least a pack a day for 30 years

Smoked 2 PPD for 15 years, and are still smoking or have quit less than 15 years ago

In high risk smokers, the benefits of CT scans may be greater than the risks.

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7
Q

Pneumovax

A

65+

Smokers 19+

Cochlear implants (for damaged inner ear)

Immunocompromised adults > 2 (asplenia, sickle cell, HIV, leukemia, Hodgkin’s, Immunosuppressive therapy, renal failure, organ transplant)

2 - 64 with chronic illness, including alcoholism, chronic liver disease, cirrhosis, chronic CVD excluding HTN, chronic pulmonary disease (including asthma for those over 19), diabetes

*Chronic Illness (minus HTN)

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8
Q

Flu Vaccine

A
  • Adults with chronic pulmonary and medical conditions, immunosuppressed or morbidly obese
  • pregnant women (SHOULD get it)
  • residents of nursing homes and LT care
  • American Indian and Alaskan Natives
  • Health care workers
  • Household contacts and caregivers of kids under 5, or 50+ with medical risk for complications
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9
Q

High Risk for TB

A

Migrant works
Homeless
Nursing homes, prisons (ppl in institutions)
Nurses

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10
Q

Anxious + Chest Pain

A

PE

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11
Q

Inspiration vs. Expiration

A

1:2 1:3
Inspiration increases with fibrotic lung diseases
Expiration increases with obstruction

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12
Q

Barrel chest

A

Sign of COPD

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13
Q

Pectus Excavatum

A

Sunken appearance of chest

Usually congenital

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14
Q

Pectus Carinatum

A

Protrusion of sternum and ribs

Congenital, or after open heart surgery

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15
Q

Palpation

A

Look for unilateral changes in expansion

Focus on tenderness, expansion, fremitus, masses or lesions

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16
Q

Thoracic Expansion

A

Place hands on either side of chest at 10th rub
Looking for symmetrical movement of hands
Normal is 1 - 3 cm

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17
Q

Rib Excursion Findings

A

Symmetrically decreased (more than the normal 1-3cm) think obstructive lung diseases.

Asymmetrically decreased: pneumonia, pleural effusion, obstruction, pnemothorax (fracture)

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18
Q

Tactile Fremitus

A

Feel for lateral symmetry
Looking for increased vibration.

Increased vibration: consolidation = pneumonia

Decreased vibration: pleural effusion or pneumothorax (air outside lung prevents expansion) / COPD

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19
Q

Flatness - high pitched

A

Represents: water, fatty tissue or dense bone

Practice on thigh

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20
Q

Dullness - soft bass

A 
Fluid filled (consolidation)
Liver - 1 inch above RCM
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21
Q

Resonance - longer, louder bass

A

Air filled lung tissue

2nd right interspace

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22
Q

Tympany - musical, light

A

Air filled chamber

Puffed out cheek

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23
Q

Hyperresonance - booming bass

A

Hyperinflated lung (COPD)

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24
Q

Percussion Notes

A

Can help determine air vs. water… where pneumonia is potentially

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25
Auscultation
Instruct patient to breath in and out of MOUTH
26
Normal Breath Sounds by location
Bronchial - up at neck Vesicular - over lung area Bronchovesicular - by sternum
27
Rhonchi
Snore-like, low | Bronchitus
28
Wheeze
Musical, high-pitched, whistling | Asthma, COPD
29
Crackles (rales) - med, fine, course
High to low pitched, popping Popping open of collapsed alveoli When you first wake up
30
Rubs
Walking in snow | Inflammation of pleura
31
Transmitted voice sounds
When you suspect consolidation (pneumonia, pleural effusion) Have patient say "e" and what you hear is "a" over areas of consolidation
32
Egophony
Patient says "e" and you hear "a" over consolidation
33
Whispered Pectoriloquy
Patient whispers "1,2,3" - whispered voice is heard more clearly over areas of consolidation
34
Bronchophony
Have patient say "99" - sounds louder and clearer over areas of consolidation
35
Consolidation
Fluid filled
36
Additional tests used in primary care
``` Pulse Oximetry - 02 sats Spirometry and Peak Flow Meters CXR EKG/Echo - dyspnea CBC - white cell count, anemia (women child bearing age) as a cause of dyspnea Physical Exam Tests... ```
37
Chest X-ray
Only do chest x-ray when it will change the results of what you do Need signoff from radiologist
38
How do you determine what tests to do on people
(1) Only if it will change management | (2) CT scan - if you suspect cancer
39
Peak Flow Meters
Used most commonly in asthma Not as sensitive as spirometers Use in asthma at regular intervals Measures peak flow: highest speed blowing air out of lungs Not diagnostic!! Need PFts or spirometry to diagnose COPD
40
Use Peak Flow Meters (PFM)
To regularly monitor lung function and response to treatment over the short and long term To determine the severity of an asthma attack To assess response to treatment during an attack *Measure peak flow before/after albeuterol treatment
41
Spirometry
Done and interpreted by pulmonologists
42
Risk Factors for COPD
Cigarette smoke Occupational dust / chemicals Environmental tobacco smoke Indoor and Outdoor air pollution
43
HPI in Chronic Diseases
Status of illness/control. Exacerbations, use of albeuterol, hospitalizations, trips of ED
44
COPD vs. Asthma
COPD (1) onset in mid-life (2) symptoms slowly progressive (3) long smoking history
45
COPD vs. Asthma
COPD (1) onset in mid-life (2) symptoms slowly progressive (3) long smoking history ASTHMA (1) onset early in life (2) symptoms vary from day to day (3) symptoms worse at night/early morning (4) allergy, rhinitis, and/or eczema also present (5) family history of asthma
46
Asthma
Patient will present with wheezing, night-time cough, exercise induced asthma, pts who recently started swimming (chlorine), roaches, smoke, pets
47
Asthma - S&S
Intermittent breathlessness Chest tightness Nonproductive cough On exam: expiratory wheezes, may have increased expiration time, accessory muscles used in breathing, increased resp rate, cyanosis, pulse ox Airway obstruction (may be reversible) Airway inflammation Airway hyper-responsive to stimuli Recurrent inflammation induces bronchospasm
48
Asthma - Acute management guidelines
``` Increased risk for mortality 3+ ED visits last year for asthma 2+ canisters of SABA per month Recent cessation of oral steroids Large fluctuations in peak flow Low socioeconomic status Mental disorder or substance abuse ``` ``` SEND TO ER!! Peak flow less than 40% predicted normal No improvement with B2 agonist Severe wheeze or cough Extreme anxiety due to breathlessness Gasping, sweaty, cyanotic Retractions, Nasal flaring, Tripod ```
49
COPD
Cough with clear sputum Dyspnea on exertion Worsening dyspnea On exam: scattered inspiratory and expiratory wheezes and crackles, cyanosis, signs of right sided heart failure, I:E is 1:4 or greater
50
Chronic Bronchitis
Productive cough | Inflammation and excess mucus
51
Emphysema
Reduction of in expiratory airflow due to tissue destruction Alveolar membranes break down **To make a diagnosis, you need to have spirometry**
52
Assessing COPD Patients
How well do you feel you are being treated? Current level of patient's symptoms Severity of the spirometric abnormality Frequency of exacerbations Presence of comorbidities
53
Diagnosis of COPD
Symptoms: shortness of breath, chronic cough, sputum Exposure to Risk Factors: tobacco, occupation, pollution SPIROMETRY: Required to establish diagnosis
54
GOLD Guidelines
Used for treatment Big change: used to rely on this - now relying on how limited is their airflow (FEV) as well as exaccerbation history, and assessment of risk factors.
55
COPD co-morbidities
COPD patients are at increased risk for: cardiovascular diseases (many are smokers) Oseoporosis - steroids (often on inhaled steroids) Respiratory infections Anxiety and Depression (anxiety because you can't breath / can't do what you used to do. Chronic disease0 Diabetes - steroids Lung cancer - inflammation, smoking, steroids Bronchiectasis
56
Cancer
Big risk factors: unexplained weight loss, family history, cough that doesn't go away with treatment, night sweats, low back pain
57
Common Complaints
Cough, Dyspnea, Chest Pain
58
Cough - Timing
Acute < 3 weeks Subacute 3 - 8 weeks Chronic > 8 weeks Red flags include dyspnea, hemoptysis, weight loss, risk for TB/HIV, wheeze, fever / night sweats
59
Pneumonia
Consolidation of fluid, fever, tachycardia, HEENT - normal, may see erythemia if coughing a lot, look tired ROS: General - fever, malayse Cough, chest pain Hx of HIV Green sputum doesn't tell us anything "Oftentimes it is people who have a URI and think they are getting better - and then suddenly get worse" Feel terrible. Tachycardia? HEENT may be normal Pt will look tired, terrible Common cause in elderly is aspiration pneumonia.
60
PE
Physical exam: could be totally normal Searching for clots Common cause in otherwise healthy person is trauma, casted Chest pain, anxiety, can be totally asymptomatic
61
Hemotysis
Coughing up blood | Most common cause is bronchitis!! (Not TB)
62
Rule out Emergencies
Anaphylaxis: wheezing, skin rashes, edema | Acute exacerbations. CHF - chest pain, dyspnea, edema, orthopnea / Asthma - wheezing, retractions
63
Croup
Kids have "seal" cough
64
Common Outpatient Differentials: Non Critical
Acute - Viral URI Chronic - smoking. Also note: most common causes of cough in non-smokers are Post Nasal Drip (PND), Asthma, GERD For PND look at back of throat
65
Important
All patients presenting for a chronic cough (more than 8 weeks), undiagnosed need CXR and spirometry - could be cancer, COPD
66
HPI of cough (10)
(1) Improving / Worsening (2) Onset: gradual vs. sudden (3) Duration (4) Dry? If yes, think asthma, CHF, ACE inhibitors, GERD (5) Productive? volume, color, color of sputum (6) Quality: horse vs. barking? (7) Associated symptoms (8) Triggers / Aggravating factors (9) Alleviating factors (10) Impact on activity
67
Acute
URI, Sinusitis, Pneumonia, Bronchitis, PND, exacerbation of asthma, COPD, Gerd
68
Sub-acute
Post-viral, self limiting cough
69
Chronic
CXR. Asthma, COPD, GERD, PND, Bronchitis
70
Cough with Chest Pain...
Could be fracture, pneumonia (burning sensation)
71
Allergic Rhinitis
Watery eyes, boggy turbinites, itchy eyes, rinorhea ROS / Hx: itchying, worse when outside (such as smoke)
72
Pneumonia
PE: Signs of consolidation. increased tactile fremetis, dullness to percussion, Rhonchi, Rails, Diminish lung sounds
73
Acute Bronchitis
PE: < 3 months, history URI, hacking / productive cough. Course, fine crackles or rhonchi on auscultation. Wheeze also possible. Low-grade fever
74
COPD Exacerbation
PE: clubbing, cyanosis, barrel chested, rhonci, hyper-resonance, pulse ox low
75
Hemoptysis
True = lung | Can also be from GI, nasal, oral
76
pink and frothy
Worry about PE!
77
SOB
Often present as increased awareness of breathing Can be lung, cardiac, psychological Chronic - COPD, CHF, anemia
78
Pneumothorax
Hx: trauma
79
Costochondritis
Inflammation - 10% of chest pain complaints Is pain reproducable? YES Manage it with NSAIDs
80
CT Screen
Do not perform CT to evaluate for possible PE in patients with a low clinical probability and negative results of a highly sensitive dimer assay Do not perform CT screening for lung cancer among patients at low risk of lung cancer
81
Anemia
``` Menstrual History Hemoglobin 8 or less May hear a murmur (turbulant blood flow) Fast bleeding ulcer Dyspnea ```
82
Lupus
Butterfly rash, elevated creatine
83
PE
Sudden onset, sense of doom (apprehensive) Risk includes 60+ Pulmonary HTN, CHF, CVD, CA, CVA, Venous statsis, Medications, Recent trauma or immobility, OCPs

6011 Test 1 (6 decks)

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