Clinical Aspects of Pulmonary Diseases Flashcards
2 main mechanisms leading to sensation of dyspnea
Impaired ventilatory mechanics (airway/muscle wall pathologies)
Increase in respiratory drive (pulmonary parenchymal/cardiac/pregnancy pathologies)
Patients with what DOE SX should be transferred to an acute care setting (3)
Tachypnea
Accessory muscle use
Conversational dyspnea
MRC Dyspnea Scale (1-5)
1 Only breathless during exercise
2 SOB when hurrying on level ground or walking up a slight hill
3 Walks slower than most and will stop after a mile, or after 15 minutes at their own pace
4 Stops for breath after walking approx. 100 yds or a few minutes
5 Too breathless to leave the house
Acute dyspnea develops how quickly?
Over mins to a day
What are some cardiovascular causes of acute dyspnea? (2)
Decreased LV function
Increased pulmonary capillary pressures
1st diagnostic tool for someone presenting with DOE
CXR
Chronic dyspnea is dyspnea for…
Over 1 mo
Acute cough is a cough for…
Subacute couch is for…
Less than 3 wks
3-8 wks
Clinical criteria for Dx of flu is:
Temp > 37.7 C (100 F)
At least one of: cough, pharyngitis, rhinorrhea.
When is antiviral therapy indicated for patients with a flu infection? When should it be started?
Hospitalized pts. and those with severe, complicated or progressive illness.
Within first 2 days SX onset.
When should chemoprophylaxis be given for the flu?
Only pts. living in assisted-living facilities during an influenza outbreak, people with increased risk for flu infection and contact with people who recently had the infection, or unvaccinated healthcare workers in close contact with others.
Drugs of choice for H1N1 flu
Oseltamivir
Zanamivir
What are some non-viral causes of acute bronchitis?
B. pertussis
Mycoplasma pneumonia
Chlamydia pneumonia
What does not have an effect on the outcome of acute bronchitis?
What is the exception?
ABX
Pertussis, but it is hard to identify if a pt. has it. Should only treat if the doctor believes clinically they have Pertussis (>2 wks of cough w/o cause or whoop, paroxysms, etc.)
Dx standard for recovery of bacteria in culture is…
PCR
Chronic cough is cough for…
> 8 wks
Cessation of what should be recommended for 4 wks before additional workup for chronic cough?
Smoking
ACE-inhibitors
Upper airway cough syndrome (UACS) is best treated with:
Chronic or acute cough?
If pts. don’t respond to this therapy, what should be done next?
Non-sedating anti-histamines
Decongestants
Chronic cough
Sinus CT
Cough-variant asthma is suggested by:
If Dx is uncertain, what should be done next?
When might cough-variant asthma receive max benefit from therapy?
Airway hyperresponsiveness and confirmed when cough resolves w/ asthma meds
Bronchoprovacation test (if negative, then 100% r/o).
6-8 wks
Most common mechanism for GERD-caused aspiration:
Vagally mediated distal esophageal-tracheobronchial reflex
Best test for GERD is…
But what is recommended first instead?
How long might it take for SX to improve?
24-hr esophageal pH monitoring
Give a PPI ans see if SX resolve
3 mo
Non-asthmatic eosinophilia bronchitis is considered when…
What is it?
What is the Tx?
Normal CXR/CT, normal spiro, and negative methacholine test.
Chronic cough by presence of airway eosinophilia and improvement with Tx.
Steroids and avoidance of allergens
Cryptogenic hemoptysis is…
Hemoptysis of unknown origin
Should be considered after detailed workup
30% of hemoptysis cases
Massive hemoptysis =
What should be done urgently?
> 200 mL/day
Bronch and bronchial a. embolization because of increased risk of asphyxiation (need airway support)
How long does it take for ARDS to occur post inciting cause?
3-5 days
Aside from the common manifestations of ARDS, what should prompt “immediate action”?
Presence of hypercapnia along with tachypnea
CXR findings for ARDS
BL airspace opacities
Exudative stage of ARDS
What dominates the clinical picture at this stage?
Alveolar-capillary barrier loses its ability to limit passage of fluids and debris and leads to accumulation of proteinaceous pulmonary edema.
Shunting and hypoxemia
Proliferative stage of ARDS
Type 1 (epithelium) and 2 (surfactant) pneumocytes proliferate with fibrosis.
What 3 infections may present similar to ARDS?
Pneumocystis jirovecii
Pneumonitis secondary to viral infection
Severe bacterial community-acquired pneumonia
What can be given for ARDS?
What does not help much?
Surfactant therapy Inhaled NO Lisofylline Ketoconozole PDE inhibitors Activated protein C
Steroids
Extracorporeal membrane oxygenation (ECMO) has the advantage of…
Supporting hypoxemia w/o potentially injurious ventilator settings
If a patient is needing high O2 by day 7 or presentation may suggest…
A protracted ICU course at increased risk for long-term ventilatory dependency in ARDS
GOLD criteria for COPD (I-IV)
I (Mild) - FEV1/FVC < 70%; FEV1 > 80%. With or without chronic sx.
II (Moderate) - FEV1/FVC < 70%; FEV1 > 50%. With or without chronic sx.
III (Severe) - FEV1/FVC <70%; 30% < FEV1 <50% predicted. With or without chronic sx.
IV (very severe) - grade II with chronic respiratory failure
6 min walk is used for…
Evaluating risk of admit and long-term prognosis of COPD
