7 - Pulm 2 Flashcards
Most common PE finding in asthma
end expiratory wheezing with prolonged expiration phase
t/f: asthma patients have decreased sputum production and usually cough only during exacerbations
false (increased, chronic cough)
What PE findings in asthma indicate more severe disease?
a) tachycardia
b) wheezing
c) tachypnea
d) decreased breath sounds
d) decreased breath sounds
What is the most useful test to determine severity of asthma?
peak flows
when should you order a CXR for asthma patients?
1) patients with status asthmaticus
2) no h/o wheezing
What labs should be ordered in asthma patients? why?
1) BMP–monitor K+ for patients uring nebulizers
2) CBC–if suspect infection, (little use in diagnosing asthma)
Patient’s CBC shows left shift after being given steroids in the ED for asthma attack. What should you do?
Nothing, this is normal after steroids
Asthma tx:
1) corticosteroids
2) bronchodilators
What are the pharmacology mechanisms of bronchodilators?
1) Beta agonists
2) anticholinergics
3) Mg
Patients with PFR < ____% need to be admitted, and PFR > _____% can be discharged. (In between is discretionary)
40%, 70%
Your 60 year old patient with 40 pack year history comes into the office with a productive cough for the last 3 months, SOB and mild respiratory distress comes into the office. What is the most likely dx?
COPD
What are the 2 types of COPD?
1) chronic bronchitis
2) emphysema
What is the dx criteria for chronic bronchitis?
Productive cough x 3 months of the year x 2 consecutive years.
What is the physiological definition of emphysema?
Permanent enlargement of the alveoli without fibrosis
When is pulse ox useful in COPD evaluation?
to monitor changes rather than using absolute value
When do you perform an ABG for a COPD pt?
severe exacerbation with AMS
On CXR, these 3 findings indicate chronic changes
1) hyperinflation (barrel chest)
2) decreased vascular markings
3) small cardiovascular silhouette
On CXR, these 3 findings indicate acute and treatable exacerbation:
1) pna
2) pneumothorax
3) tumor
COPD tx options:
1) O2 support (NC, CPAP, NRB, intubation) to get > 90% sat
2) steroids
3) bronchodilators
4) Abx, PRN
Name the 2 most common mainstays of bronchodilators used for COPD exacerbation which are used synergistically
1) Beta agonist: Albuterol
2) anticholinergic: Ipratropium
What are the most common pathogens responsible for COPD exacerbation?
1) strep pna
2) h. flu
3) M. catarrhalis
(same as OM)
What abx are used for COPD exacerbations?
1) Azith
2) Doxy
3) 3rd gen Ceph
4) Augmentin
5) Levaquin/Piper/4th ceph for pseudomonas
Your 65 year old male patient presents c/o cough w/ blood tinged sputum, SOB, fever, rigors, and malaise. He c/o night sweats. You r/o TB. What is first on DDx?
PNA
What is the PE for a PNA patient?
rales, dull to percussion, egophony (alveolar). And rhonchi/wheezing (bronchial).
