Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emed > #6: Pulm > Flashcards

#6: Pulm Flashcards

1
Q

Signs of Acute Respiratory Distress

  1. RR > ___
  2. Retractions/use of _____
  3. _____ abd wall movement w/inspiration
  4. Pulse ox < _____
  5. ______ (coloring)
  6. Unable to speak more than _____
  7. ______ or_______ (behav/alertness)
A

Signs of Acute Respiratory Distress

  1. RR > 30
  2. Retractions/use of accessory muscles
  3. Paradoxical abd wall movement w/inspiration
  4. Pulse ox < 90%
  5. Cyanosis (coloring)
  6. Unable to speak more than 1 word or short phrase
  7. agitated or lethargy (alertness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Management of Acute Respiratory Distress

  1. what is always done 1st?
  2. What 2 types of meds can you give
  3. 2 advanced measures of treatment
A

Management of Acute Respiratory Distress

  1. 1st = ABCs
  2. meds = albuterol, ipatroprium
  3. 2 advanced measures = intubation, chest decompression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

2 major Sxs in asthma

A

Asthma Sxs

  1. Wheezing
  2. SOB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Labs in Asthma

  1. What seen on CBC
  2. what seen on Chemistries
  3. what ABG levels a/w severe asthma
A

Labs in Asthma

  1. CBC - leukocytosis
  2. Chemistries - LOW electrolytes
  3. ABG levels a/w severe asthma
    - PaCO2 > 40 and PaO2 < 60
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

CXR in asthma

- reasons why to get on for asthma (7)

A

CXR in asthma: indications

  1. r/o other pulm d/o
  2. new onset asthma
  3. fever
  4. aytypical exam
  5. refractory to tx
  6. elderly
  7. Possible aspiration/FB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What 2 signs are a/w severe obstruction in asthma

A

2 signs a/w severe obstruction in asthma

  1. silent chest
  2. Pulsus paradoxus > 20
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Asthma Tx

- what is the mainstay of tx (gen + spp)

A

Asthma Tx

- mainstay = beta agonists –> albuterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Asthma Tx

  1. what gets added to albuterol Tx
  2. what other class of drugs can be given
    - what 2 spp drugs in class, which for severe
  3. what can be given for severe cases that is a smooth muscle relaxer
  4. what is Heliox 80:20
    - how does it help asthma (2 ways)
A

Asthma Tx

  1. Anticholinergic (ipatroprium) added to albuterol Tx
  2. CCS (prednison, IV methyl if severe)
  3. Mg = severe cases (smooth muscle relaxer)
  4. qHeliox 80:20 = 80:20 mix of helium + O2
    - decr resistance + helps meds distribute further into tree
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Asthma: Home vs inpatient

  1. when can pts go home (peak flow)
  2. what 2 things necessitate ICU care
A

Asthma: Home vs inpatient

  1. home if peak flow > 70% of their best + improved in ER
  2. what 2 things necessitate ICU care
    - resp insuffic
    - refractory to tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pt presents w/ tachypnea, productive cough, insp/expiratory wheezing, decr air movement, accessory muscle use, pursed lip breathing, confusion and LV dsyfunction seen w/testing

Dx?

A

COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. Tachypnea
  2. Tachycardia
  3. Cyanosis
  4. agitation
  5. HTN
  6. resp acidosis

are signs of ______

A

signs of of hypoxemia

  1. Tachypnea
  2. Tachycardia
  3. Cyanosis
  4. agitation
  5. HTN
  6. resp acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dx of COPD

  1. what is seen on CXR
  2. what is seen on EKG + and lead to ____
  3. What is best test for measuring Tx response
  4. suspect resp acidosis - what test to do?
A

Dx of COPD

  1. CXR - hyperinflation + flattened diaphargm
  2. EKG - hypoxia: can lead to ischemic changes
  3. best test for measuring Tx response = PFTs
  4. suspect resp acidosis –> ABG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

COP Tx goals

  1. for O2 sat
  2. for PaO2
  3. meds you give (sim to what)
A

COP Tx goals

  1. O2 sat goal = 90-92%
  2. PaO2 goal > 60
  3. meds = sim to asthma
    (albuterol, ipatroprium, CCS - pred/methyl)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

COPD Tx

  1. what is the ratio for albuterol/ipratropium
    - then what given
  2. When are ABX given for COPD exacerbation
  3. alternative options to mechanical ventilation
A

COPD Tx

  1. albuterol/ipratropium 2:1 then continous albuterol
  2. ABX ALWAYS given for COPD exacerbation
  3. alt to mechanical ventilation = CPAP/BiPAP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. muscle fatigue
  2. worsening acidosis
  3. AMS
  4. refracotry hypoxia
  5. awake/alert pts needing short term assistance

are indications for _______

A

indications for CPAP/BiPAP for COPD

  1. muscle fatigue
  2. worsening acidosis
  3. AMS
  4. refracotry hypoxia
  5. awake/alert pts needing short term assistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. worsening despite max therapy
  2. incr fatigue w/worse vital
  3. incr agitation/restless d/t hypoxia
  4. decr LOC d/t hypercarbia

are indications for _______

A

indications for intubation in COPD tx

  1. worsening despite max therapy
  2. incr fatigue w/worse vital
  3. incr agitation/restless d/t hypoxia
  4. decr LOC d/t hypercarbia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are 2 severe Sxs that indicate pts w/COPD need admitted to ICU

A

Severe Sxs —> ICU for COPD

  1. AMS
  2. Acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

COPD D/c after acute exacerbation

  1. when can pts go home
  2. what should be done to daily meds and what added

tell them to stop smoking (duh)

A

COPD D/c after acute exacerbation

  1. go home when no lab/XR abn
  2. incr daily meds and add Steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pt presents w/ productive cough, SOB, fever, chills and pleuritic CP. On exam you find focal rales, decr breath sounds, egophany and rhonchi. CXR show lobar consolidation and effusion

What type of PNA is this

A

Typical PNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  1. S. Pneumo
  2. Viral
  3. S. aureus
  4. Klebsiella
  5. H flu
  6. pseudomonas
  7. M cattaralis

Are causes of which type of PNA

A

Causes of Typical PNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pt presents w/ non-productive cough, mild SOB, Malaise, and insidious Sxs as well as ear pain. On exam you note focal rales and bullous myringitis. On CXR you see segmental infiltrates.

What type of PNA is this
- what spp organism is the cause

Tx for this type of PNA in general?

A

Atypical PNA
- spp organism = Mycoplamsa (bullous Myringitis)

  • Tx = Macrolides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
  1. Legionella
  2. Chlamydia
  3. Mycoplasma

Are causes of which type of PNA

A

Causes of Atypical PNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

ill looking, cachectic, HIV pt presents w/ cough, elevated LDH and patchy infiltrate on CXR

What type of PNA is this/cause
Tx? (2 things)

A

PJP

Tx = Steroids and Bactrim

24
Q

What cause of PNA is MC in winter/spring, a/w watery diarrhea, bradycardia in elderly and HYPOnatremia

A

Legionella

  • MC in winter/spring, a/w watery diarrhea, bradycardia in elderly and HYPOnatremia
25
Q

What cause of PNA is in upper lobes, a/w bloody sputum, empyema is complication and commonly seen in alcoholics, DM, and COPD

A

Klebsiella

  • upper lobes, a/w bloody sputum and empyema and commonly seen in alcoholics, DM, and COPD
26
Q

Causes of PNA

  1. What cause of PNA is MC in pts w/CF
  2. What cause is a/w IVDU
A

Causes of PNA

  1. pts w/CF = MC cause is P. aeruginosa
  2. MC in IVDU = S. aureus
27
Q

if elderly pt comes in w/AMS what test should always be done and why

A

elderly + AMS –> ALWAYS get CXR to r/o PNA

28
Q

Labs for PNA

  1. what types of pts should get labs for
  2. what basic labs should you get
  3. when to get lactate level
  4. when to get LDH
  5. what type of cult
A

Labs for PNA

  1. high risk pts should get labs
  2. basic labs = CBC, CMP
  3. get lactate level if suspect sepsis
  4. get LDH if HIV+ or at risk
  5. blood culture
    - note: sputum cult = rare
29
Q

PNA Tx

  1. Anaerobes
  2. S. Pneumo
  3. S. aureus
  4. H flu
  5. Legionella
A

PNA Tx

  1. Anaerobes = Clinda
  2. S. Pneumo = PCN
  3. S. aureus = oxacillin
  4. H flu = Ceftriaxone
  5. Legionella = Erythromycin
30
Q

Aspiration PNA

  1. how long after aspiration does it present
  2. what area of lung is it MC
  3. What must Tx cover

note: a/w delayed CXR findings

A

Aspiration PNA

  1. presents w/in 1 hr of aspiration
  2. MC in RLL
  3. Tx cover aerobes + anaerobes
31
Q

PNA d/c

what is used to determine if pt can go home (2 things)

A

PNA d/c based on

  1. PORT score
  2. PSI
32
Q

what dz is charac by diffuse bilat pulm infiltrates and severe hypoxemia and is d/t diffuse alveolar injury

A

ARDS

33
Q

Dx of ARDS

  1. what measure used to r/o cardiogenic pulm edema
  2. what is classic sign on CXR
A

Dx of ARDS

  1. PCWP <18 = r/o cardiogenic pulm edema
  2. WHITE OUT ON CXR
34
Q

Tx of ARDs

  1. admit to ___
  2. what type of support do they need
  3. what types of meds
  4. severe cases –>
A

Tx of ARDs

  1. admit to ICU
  2. resp support (intubate)
  3. meds = pressors
  4. severe cases –> ECMO
35
Q

FB aspiration

  1. what is main Sx (other = wheezing)
  2. What type of CXR films should you get
  3. What type of neck XRs to get
A

FB aspiration

  1. what is main Sx = STRIDOR (other = wheezing)
  2. type of CXR films = decubitus expiratory films
  3. type of neck XRs = neck AP/Lat soft tissue
36
Q

FB aspiration Tx

  1. what to do if pt NOT spont breathing
  2. what to do if pt in distress
  3. what is last resort if FB inferior to vocal cords
A

FB aspiration Tx

  1. pt NOT spont breathing –> hemlich + prep surg airway
  2. pt in distress –> surgical airway or OR
  3. last resort if FB inferior to vocal cords
    - push it into mainstem bronchus w/ambo bag or ET tube
37
Q

clot in pulm artery –> decr perfusion –> infarct/death

A

PE (Pulmonary Embolism)

38
Q

Pathophys of PE: Virchow’s Triad

- whats included in it that leads to clot formation

A

Pathophys of PE: Virchow’s Triad

  1. endothelial damage
  2. venous stasis
  3. hypercoagulability
39
Q

PE Presentation

  1. MC Sx and MC sign
  2. What is the classic triad
A

PE Presentation

  1. MC sx = pleuritic CP and MC sign = tachypnea
  2. Classic Triad = hemoptysis, dyspnea, CP
40
Q

Pt presents w/ SOB, DOE, pleuritic CP, calf pain, anxiety, palpitations, hemoptysis. PE shows tachycardia, tachypnea, hypoxia, rales, wheezes, fever and swollen R lower leg

Dx?

A

Dx = PE

41
Q

Dx of PE: When is D-dimer useful for PE

  • what types of pts
  • what does low # mean
A

D-dimer

  • useful for LOW risk pts
  • low # = low risk of PE –> helps r/o PE
42
Q

Dx of PE: Wells Criteria

  1. what value gives you high likelihood of PE
  2. what value gives low likelihood
A

Dx of PE: Wells Criteria

  1. > 6 = high likelihood of PE
  2. < 4 = low likelihood
43
Q

Dx of PE: PERC score (rule out criteria)

  1. if pt answers yes to 1 what does that mean
  2. if pt answers no to all what does that mean
  3. what is it trying to determine
A

Dx of PE: PERC score (rule out criteria)

  1. if pt answers yes to 1 –> CANT r/o PE
  2. if pt answers no to ALL –> very unlikely have PE –> d/c
  3. trying to determine whether any further dx testing is needed
44
Q

What is the BEST imaging modality for PE

what 2 tests = best to r/o other causes

A

CT pulm angiography = best test for PE

r/o other causes = CXR and EKG

45
Q

EKG and PE

  1. MC finding
  2. what triad also seen
A

EKG and PE

  1. MC = sinus tachycardia
  2. triad = S1Q3T3
    - deep S in 1
    - Q in 3
    - inverted T in 3

other findings: RBBB, a-fib

46
Q

Tx of PE

  1. stable pt
  2. unstable pt
  3. shock tx
  4. severe HoTN –>
  5. shock, resp distress or cardiac arrest –> what types of meds given
  6. unstable, proven PE, on pressors –> what can be done (but rare)
A

Tx of PE

  1. stable pt –> Lovenox
  2. unstable pt –> Heparin
  3. shock tx –> IV fluids
  4. severe HoTN –> DA
  5. shock, resp distress or cardiac arrest –> what types of meds given –> Thrombolysis (tPA, streptokinase)
  6. unstable, proven PE, on pressors –> Embolectomy (rare)
47
Q

If a pt is high risk for PE what is next step

A

high risk for PE –> CT pulm angiography

48
Q

Pleural Effusion

  • 4 MC causes
  • main Dx test to Dx
A

Pleural Effusion: MC causes

  1. CHF
  2. PNA
  3. CA
  4. PE

main dx test = CXR

49
Q

Pt presents w/ dyspnea, cough, CP, LE edema, orthopnea, night sweats and wt loss, fever and purulent sputum. On PE you hear diminished breath sounds, dullness to percussion, egophony and pleural friction rub

Dx?

A

Dx = Pleural effusion

50
Q

Transudate vs exudate
- which is bilat + a/w CHF, fluid overloa,d cirrhosis, hypoablumin

  • which is unilat + a/w infxn, connective tissue dz, pancreatitis, CA
A

Transudate vs exudate
- Transudate = bilat + a/w CHF, fluid overloa,d cirrhosis, hypoablumin

  • Exudate = unilat + a/w infxn, connective tissue dz, pancreatitis, CA
51
Q

Tx for Pleural Effusion

  1. 2 options if its large
  2. what procedure to do if want cells for malig
  3. what procedure for recurrent malig effusions
A

Tx for Pleural Effusion

  1. large –> thoracentesis or chest tube
  2. want cells for malig –> thoracentesis
  3. recurrent malig effusions –> pleurodesis
52
Q

Pt presents w/ acute onset of L sided CP and decr breath sounds on. Vitals: RR = 26, HR = 130 and BP 90/56. PE and further testing shows subQ emphysema and hyperresonance

Dx?

A

Dx = Pneumothorax

53
Q

When pt has spont pneumothorax w/PNA

- what 3 organisms are likely the cause

A

Causes of spont pneumothorax w/PNA

  1. PJP
  2. TB
  3. S. aureus
54
Q

Dx Pneumothorax

  1. what types of CXR films want
  2. why need to get CT
  3. what does CXR show if tension pneumo
A

Dx Pneumothorax

  1. types CXR films = upright inspir/expiratory films
  2. need to get CT to determine % of PTX
  3. Tension pneumo on CXR –> mediastinal shift to unaffected side
55
Q

Tx of Pneumothorax

  1. what is main for of Tx and what is always given w/it
    2 what procedure done for it
  2. what procedure do some pts need eventally
  3. tx for tension pneumo
A

Tx of Pneumothorax

  1. air resorption at 1-2%/day w/ 3-4 of O2
  2. procedure = chest tube
  3. eventually some need thoracostomy
  4. tension pneumo –> IMMED needle decompression
56
Q

Tx of Pneumothorax: Primary vs Secondary

  1. what is tx for primary + < 15% PTX by CT
  2. what is tx for primary + > 15% AND secondary
A

Tx of Pneumothorax: Primary vs Secondary

  1. Tx for primary + < 15% PTX by CT = observe
  2. primary + > 15% AND secondary = chest tube + H2O suction

Emed (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions