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Clinical Disciplines-ER > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Define Dyspnea

A

SUBJECTIVE feeling of difficult, labored breathing

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2
Q

What is orthopnea MCly seen in?

A

CHF

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3
Q

Define hypoxemia

A

low ARTERIAL oxygen, Pa02 under 60 mmHg

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4
Q

Define stridor and causes for it

A 
Upper airway, Inspiratory
Causes:
1. FB
2. Croup
3. Epiglottis
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5
Q

Define wheezing and causes

A 
Lower airway, expiratory
Causes:
1. Asthma
2. COPD
3. FB
4. Cardiogenic pulmonary edema
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6
Q

Define Rales and causes

A

Lower airway, velcro sound
Causes:
CHF

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7
Q

Define Rhonchi/crackles and causes

A

Lower airway
Causes:
Pneumonia

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8
Q

Define Respiratory Distress or Failure

A

Inadequate oxygenation and/or ventilation

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9
Q

What organism is associated with bradycardia and hyponatremia in pneumonia?

A

Legionella

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10
Q

What organism is associated with bullies myringitis in pneumonia?

A

Mycoplasma pneumonia

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11
Q

Define CAP

A

PNA in patient who has not been hospitalized or resident of long-term care facility for 14 days prior to presentation

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12
Q

Define Hospital-acquired (nosocomial) and Ventilator-acquired PNA

A

PNA occurring > 48 hours after admission or intubation

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13
Q

MC cause of pneumonia

A

Streptococcus Pneumoniae

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14
Q

MC presentation in Streptococcus Pneumoniae

A
  1. Sudden onset fever
  2. Rigors
  3. Productive cough
  4. Dyspnea
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15
Q

CXR findings in Streptococcus Pneumoniae

A
  1. Lobar infiltrate

2. Para-pneumonic pleural effusion (25%)

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16
Q

What organism causes a secondary bacterial pneumonia following influenza?

A

S. aureus

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17
Q

Define high altitude illness

A
  1. Hypoxic environment

2. Partial pressure changes with elevation

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18
Q

@ what elevations do we see high altitude illness?

A

5,000 feet

MC @ 8,000-14,000 ft

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19
Q

Ventilation acclimization

A

Increased ventilation rate

Induces respiratory alkalosis

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20
Q

Blood acclimization

A

Increased red cell mass

Begins 2 hrs. after ascent

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21
Q

Fluid acclimization

A
  1. Peripheral venoconstriction- increases central blood volume
  2. ADH and aldosterone suppressed- Diuresis
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22
Q

Cardiovascular acclimization

A
  1. Decreased SV, Increased HR
  2. Pulmonary vessels constrict
  3. Increased cerebral blood flow
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23
Q

Sleep acclimization

A

Cheyne-stokes breathing

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24
Q

Acute mountain sickness sx’s

A
  1. Lightheaded
  2. HA-Worse with valsava or bending over
  3. Breathlessness with activity
  4. Weakness
  5. Irritability
  6. Nausea
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25
Q

What is the hallmark findings in Acute mountain sickness

A

Fluid retention

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26
Q

Pathophysiology of Acute mountain sickness

A

D/t hypobaric hypoxia

Cerebral blood flow increases–>brain enlarges–>vasogenic edema

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27
Q

Acute mountain sickness treatment

A
  1. Discontinue ascent
  2. Oxygen
  3. Acetazolamide
  4. ASA, Tylenol, Motrin
  5. Dexamethasone
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28
Q

Acute mountain sickness prevention

A
  1. Gradual onset
  2. Avoid overexertion
  3. Avoid alcohol
  4. High carb meal
  5. Acetazolamide
  6. Dexamethasone
29
Q

High Altitude Cerebral Edema sx’s

A
  1. AMS

2. Neurologic sx’s: CN 3 & 6 Palsy- Eye is down and out

30
Q

What is the most lethal high altitude illness

A

High Altitude Pulmonary Edema

31
Q

High Altitude Pulmonary Edema etiology

A

Pulmonary HTN

32
Q

High Altitude Pulmonary Edema sx’s

A
  1. Dry cough–>productive cough
  2. Increasing dyspnea
  3. Coma, death
33
Q

What is the treatment of choice in High Altitude Pulmonary Edema

A
  1. Immediate descent
  2. Nifedipine
  3. Oxygen
34
Q

What is the MC reason for admission in medicare pt’s?

A

CHF

35
Q

What BNP value is suggestive of CHF?

A

200

36
Q

EKG findings in CHF

A

LV hypertrophy

37
Q

What imaging has both the highest sensitivity and specificity in CHF?

A

US

38
Q

CXR findings in CHF

A
  1. Cardiomegaly
  2. Enlarged pulmonary artery
  3. Pleural effusions
  4. Kerley B lines
39
Q

US findings in CHF

A

B lines

40
Q

What does an echo evaluate in CHF?

A
  1. LV and valvular function
  2. Tamponade
  3. VSD
41
Q

Pharmacologic treatment in CHF

A
  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
Q

What medications do you want to avoid in CHF?

A
  1. CCB
  2. NSAIDs
  3. Anti-arrhythmias
43
Q

Virchows triad

A
  1. Venous stasis
  2. Vessel wall inflammation/injury
  3. Hypercoagulability
44
Q

PE risk factors: MOIST CAMEL

A 
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
Q

Triad of sx’s in PE

A
  1. Pleuritic CP
  2. Dyspnea
  3. Hemoptysis
46
Q

CXR findings in PE

A
  1. Hampton’s Hump
  2. Westermark’s sign
  3. Fleischner sign
47
Q

What is considered by most to the dx test of choice in PE

A

CT scan

48
Q

What echo findings indicated a poor prognosis in PE

A

RV enlargement + RV dysfunction= large clot

49
Q

MC EKG finding in PE

A

Sinus tachycardia

Followed by T wave inversion

50
Q

“Classic” EKG findings in PE

A

S1Q3T3

51
Q

Anticoagulation treatment in PE

A
  1. Heparin
  2. Coumadin
  3. Lovenox
  4. Rivaroxaban (Xeralto)- factor Xa inhibitor
52
Q

Indications for thrombotic treatment in PE

A

Massive PE

Hemodynamically unstable

53
Q

Asthma pathophysiology triad

A
  1. Airway inflammation
  2. Obstruction to airflow
  3. Bronchial hyperresponsiveness
54
Q

Asthma clinical triad

A
  1. Dyspnea
  2. Wheezing
  3. Cough
55
Q

COPD definition

A

Chronic irreversible disorder

56
Q

Define Chronic Bronchitis

A
  1. Presence of chronic productive cough for 3 months in 2 successive years
  2. Clinical diagnosis
57
Q

Define Emphysema

A
  1. Destruction of bronchioles and alveoli

2. Pathologic diagnosis

58
Q

What does FEV1 measure?

A

Severity of pt’s airway restriction

59
Q

What are the treatment goals in COPD?

A
  1. Reverse airflow obstruction
  2. Provide adequate oxygenation
  3. Relieve inflammation
60
Q

What is the cornerstone of therapy in Asthma/COPD?

A
  1. Beta Agonist: Albuterol

2. Corticosteroids (high-dose): Prednisone, Methylprednisolone, Dexamethasone

61
Q

Role of Epinephrine in COPD?

A

Acts as a bronchodilator

NOT beta selective

62
Q

What location of the airway does Ipratropium Bromide (anti-cholinergic) primarily work at?

A

Large central area

63
Q

What is Magnesium Sulfate reserved for?

A

Severe exacerbations

64
Q

What is Heiolx reserved for?

A

Severe reactions in pediatrics

65
Q

BiPAP indications

A
  1. Cooperative patient
  2. Dyspnea (moderate to severe)
  3. Tachypnea (>24 breaths per minute)
  4. Increased work of breathing
  5. Hypoxemia
66
Q

BiPAP contraindications

A
  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
Q

What age groups does FB aspiration MCly occur in?

A

< 1 year and >75 years of age

68
Q

Adult risk factors in FB aspirations?

A
  1. Altered level of consciousness
  2. Impaired swallowing mechanism
  3. Stroke related dysphagia
  4. Alzheimer’s dementia
  5. Parkinson’s disease
69
Q

Where is the MC location for FB? What’s significant about this location?

A

Thoracic inlet

  • Site of anatomical change from skeletal to smooth muscle
  • Cricopharyngeus muscle

Clinical Disciplines-ER (4 decks)

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