Flashcards in Respiratory Deck (69):
1
Define Dyspnea
SUBJECTIVE feeling of difficult, labored breathing
2
What is orthopnea MCly seen in?
CHF
3
Define hypoxemia
low ARTERIAL oxygen, Pa02 under 60 mmHg
4
Define stridor and causes for it
Upper airway, Inspiratory
Causes:
1. FB
2. Croup
3. Epiglottis
5
Define wheezing and causes
Lower airway, expiratory
Causes:
1. Asthma
2. COPD
3. FB
4. Cardiogenic pulmonary edema
6
Define Rales and causes
Lower airway, velcro sound
Causes:
CHF
7
Define Rhonchi/crackles and causes
Lower airway
Causes:
Pneumonia
8
Define Respiratory Distress or Failure
Inadequate oxygenation and/or ventilation
9
What organism is associated with bradycardia and hyponatremia in pneumonia?
Legionella
10
What organism is associated with bullies myringitis in pneumonia?
Mycoplasma pneumonia
11
Define CAP
PNA in patient who has not been hospitalized or resident of long-term care facility for 14 days prior to presentation
12
Define Hospital-acquired (nosocomial) and Ventilator-acquired PNA
PNA occurring > 48 hours after admission or intubation
13
MC cause of pneumonia
Streptococcus Pneumoniae
14
MC presentation in Streptococcus Pneumoniae
1. Sudden onset fever
2. Rigors
3. Productive cough
4. Dyspnea
15
CXR findings in Streptococcus Pneumoniae
1. Lobar infiltrate
2. Para-pneumonic pleural effusion (25%)
16
What organism causes a secondary bacterial pneumonia following influenza?
S. aureus
17
Define high altitude illness
1. Hypoxic environment
2. Partial pressure changes with elevation
18
@ what elevations do we see high altitude illness?
5,000 feet
MC @ 8,000-14,000 ft
19
Ventilation acclimization
Increased ventilation rate
Induces respiratory alkalosis
20
Blood acclimization
Increased red cell mass
Begins 2 hrs. after ascent
21
Fluid acclimization
1. Peripheral venoconstriction- increases central blood volume
2. ADH and aldosterone suppressed- Diuresis
22
Cardiovascular acclimization
1. Decreased SV, Increased HR
2. Pulmonary vessels constrict
3. Increased cerebral blood flow
23
Sleep acclimization
Cheyne-stokes breathing
24
Acute mountain sickness sx's
1. Lightheaded
2. HA-Worse with valsava or bending over
3. Breathlessness with activity
4. Weakness
5. Irritability
6. Nausea
25
What is the hallmark findings in Acute mountain sickness
Fluid retention
26
Pathophysiology of Acute mountain sickness
D/t hypobaric hypoxia
Cerebral blood flow increases-->brain enlarges-->vasogenic edema
27
Acute mountain sickness treatment
1. Discontinue ascent
2. Oxygen
3. Acetazolamide
4. ASA, Tylenol, Motrin
5. Dexamethasone
28
Acute mountain sickness prevention
1. Gradual onset
2. Avoid overexertion
3. Avoid alcohol
4. High carb meal
5. Acetazolamide
6. Dexamethasone
29
High Altitude Cerebral Edema sx's
1.AMS
2. Neurologic sx's: CN 3 & 6 Palsy- Eye is down and out
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What is the most lethal high altitude illness
High Altitude Pulmonary Edema
31
High Altitude Pulmonary Edema etiology
Pulmonary HTN
32
High Altitude Pulmonary Edema sx's
1. Dry cough-->productive cough
2. Increasing dyspnea
3. Coma, death
33
What is the treatment of choice in High Altitude Pulmonary Edema
1. Immediate descent
2. Nifedipine
3. Oxygen
34
What is the MC reason for admission in medicare pt's?
CHF
35
What BNP value is suggestive of CHF?
200
36
EKG findings in CHF
LV hypertrophy
37
What imaging has both the highest sensitivity and specificity in CHF?
US
38
CXR findings in CHF
1. Cardiomegaly
2. Enlarged pulmonary artery
3. Pleural effusions
4. Kerley B lines
39
US findings in CHF
B lines
40
What does an echo evaluate in CHF?
1. LV and valvular function
2. Tamponade
3. VSD
41
Pharmacologic treatment in CHF
1. NTG-Reduce preload and BP
2. Diuretic (Lasix)
3. Morphine sulfate- Reduces preload
4. Dobutamine-adjunct to NTG, use in hypotensive pt's
42
What medications do you want to avoid in CHF?
1. CCB
2. NSAIDs
3. Anti-arrhythmias
43
Virchows triad
1. Venous stasis
2. Vessel wall inflammation/injury
3. Hypercoagulability
44
PE risk factors: MOIST CAMEL
M-Malginancy
O-Obesity
I-Immobilizations
S-Surgery
T-Trauma
C-CHF
A-Age: 40+
M- Mobility (lack of)
E-Estrogen excess
L-Long bone fx
S-Smoker
45
Triad of sx's in PE
1. Pleuritic CP
2. Dyspnea
3. Hemoptysis
46
CXR findings in PE
1. Hampton's Hump
2. Westermark's sign
3. Fleischner sign
47
What is considered by most to the dx test of choice in PE
CT scan
48
What echo findings indicated a poor prognosis in PE
RV enlargement + RV dysfunction= large clot
49
MC EKG finding in PE
Sinus tachycardia
Followed by T wave inversion
50
"Classic" EKG findings in PE
S1Q3T3
51
Anticoagulation treatment in PE
1. Heparin
2. Coumadin
3. Lovenox
4. Rivaroxaban (Xeralto)- factor Xa inhibitor
52
Indications for thrombotic treatment in PE
Massive PE
Hemodynamically unstable
53
Asthma pathophysiology triad
1. Airway inflammation
2. Obstruction to airflow
3. Bronchial hyperresponsiveness
54
Asthma clinical triad
1. Dyspnea
2. Wheezing
3. Cough
55
COPD definition
Chronic irreversible disorder
56
Define Chronic Bronchitis
1. Presence of chronic productive cough for 3 months in 2 successive years
2. Clinical diagnosis
57
Define Emphysema
1. Destruction of bronchioles and alveoli
2. Pathologic diagnosis
58
What does FEV1 measure?
Severity of pt's airway restriction
59
What are the treatment goals in COPD?
1. Reverse airflow obstruction
2. Provide adequate oxygenation
3. Relieve inflammation
60
What is the cornerstone of therapy in Asthma/COPD?
1. Beta Agonist: Albuterol
2. Corticosteroids (high-dose): Prednisone, Methylprednisolone, Dexamethasone
61
Role of Epinephrine in COPD?
Acts as a bronchodilator
NOT beta selective
62
What location of the airway does Ipratropium Bromide (anti-cholinergic) primarily work at?
Large central area
63
What is Magnesium Sulfate reserved for?
Severe exacerbations
64
What is Heiolx reserved for?
Severe reactions in pediatrics
65
BiPAP indications
1. Cooperative patient
2. Dyspnea (moderate to severe)
3. Tachypnea (>24 breaths per minute)
4. Increased work of breathing
5. Hypoxemia
66
BiPAP contraindications
1. Need for emergent intubation
2. Cardiac or respiratory arrest
3. Inability to protect airway or clear secretions
4. Decreased LOC
5. Facial trauma or deformity
6. Recent esophageal surgery
67
What age groups does FB aspiration MCly occur in?
< 1 year and >75 years of age
68
Adult risk factors in FB aspirations?
1. Altered level of consciousness
2. Impaired swallowing mechanism
3. Stroke related dysphagia
4. Alzheimer’s dementia
5. Parkinson’s disease
69