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final Flashcards

1
Q

What are symptoms of a Pulmonary embolism?

A

• Chest pain
• Tachycardia
• Often have an area that is red, hot and swollen
o From DVT

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2
Q

If a patient is experiencing tachycardia, hypoxia and has no lung history and has normal breath sounds what should I think the issue is?

A

• Think circulatory

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3
Q

What are risk factors for DVT’s and PE’s?

A
  • Sedentary job
  • Been sedentary for an extended time like long road trip
  • Vessel wall injury- from trauma, surgery or central venous catheters
  • Hypercoagulability from malignancy or birth control
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4
Q

What are hemodynamic effects of a PE?

A
  • Obstructs blood flow to the lungs
  • Can cause acute pulmonary hypertension
  • Big embolism can cause systemic hypotension
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5
Q

How does a PE cause Hypoxemia?

A
  • Bronchoconstriction and atelectasis
  • More blood is forced to go to less healthy area of the lungs
  • Increase in dead space ventilation. There is airflow but there isn’t perfusion to bring the O2 throughout the body
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6
Q

What is the best way to diagnose a PE?

A

• Chest CT angiogram

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7
Q

How can a D-dimer test be used to help diagnose (or exclude) a PE?

A
  • A negative d-dimer test combined with a low clinical suspecison of a PE rules out a PE
  • A positive d-dimer is non-specific- can be a PE or DVT and required more testing
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8
Q

In general terms, How do we treat a PE?

A
  • Stable patient- anticoagulants (blood thinner)

* Unstable patient- thrombolytic followed by anticoagulants

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9
Q

What are SCD’s and what do they do?

A
  • Sequential compression devices

* They wrap around the patients legs and help prevent a DVT from forming

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10
Q

What are the 5 classes of Pulmonary Hypertension (WHO)

A
  1. Pulmonary arterial hypertension
    a. Direct damage to small arteries
  2. Pulmonary hypertension due to left heart disease
    a. Left ventricular failure (heart doesn’t squeeze well)
    b. Heart valve disease
  3. Pulmonary hypertension due to lung disease and/or hypoxemia (chronic lung dz)
    a. Via destruction of pulmonary vasculature
    i. COPD or fibrosis
    b. Via hypoxemic pulmonary artery vasoconstriction
    i. Sleep apnea
    ii. Severe lung dz
  4. Chronic thromboembolic pulmonary hypertension
  5. Pulmonary hypertension from rare causes
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11
Q

What are symptoms of Pulmonary hypertension?

A
  • The #1 symptom is slow progressive dyspnea

* Fatigue, chest pain

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12
Q

How do we diagnose pulmonary hypertension?

A

• Echocardiogram

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13
Q

What is an invasive way we can monitor pressures in the arteries?

A

• PA catheter

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14
Q

How do we treat pulmonary hypertension?

A
  • IV and oral meds to relax (vasodilate) pulmonary arteries
  • Inhaled vasodilators
  • Chronic O2 therapy
  • Surgical removal of old PE
  • Treatment of underlying left heart dz, lung dz or sleep apnea
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15
Q

What is Asthma?

A
  • Reactive airway dz
  • Clinical syndrome of airway obstruction, inflammation and hyper-responsiveness
  • EPISODIC wheezing, SOB, chest tightness and/or cough
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16
Q

What causes asthma?

A
  • Mast cells in the aireways releasing histamine

* Smooth muscle constriction and vascular congestion and leakage

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17
Q

What are some asthma triggers?

A
  • Allergens
  • Respiratory infection
  • Stress
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18
Q

How is asthma diagnosed?

A

• PFT may be normal or show obstruction
• Must be reversible. Shown by:
o Increase in FEV1 or FVC by 12% AND 200ml following a bronchodilator
o 15% or more variation in PEFR

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19
Q

What would a CXR in an asthma patient look like?

A
  • Usually normal

* Sometimes will see hyperinflation or atelectasis

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20
Q

What is a controller medication?

A
  • A medication that lessens the impact of daily symptoms but does not treat acute symptoms
  • Decreases severity and frequency of symptoms
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21
Q

What is a mast cell?

A
  • A mast cell is a cell that contains histamine

* When a mast cell becomes degranulated(explodes) it releases the histamine into the body

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22
Q

What is a mast cell stabilizer?

A

• A medication that helps stabilize mast cells so they do not degranulate and cause asthma symptoms

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23
Q

What are leukotriene inhibitors?

A
  • They block the hyperactive response

* Singular

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24
Q

What is the MOA of Omalizumab?

A

• Binds to the free IgE antibodies to prevent them from binding to mast cells which then release histamine

25
Q

What is Bronchial Thermoplasty?

A

• Heat is applied to the bronchial walls to impair smooth muscle contractility

26
Q

How can you tell the difference between a pleural effusion and a pneumothorax on a CXR?

A
  • A pleural effusion is water in the pleural space. It will be white with a meniscus sign
  • A pneumo will be black
27
Q

What happens in the lungs when some one has a pleural effusion?

A
  • Some of the fluid pushes up causing collapse of the adjacent lung
  • 2/3 of the fluid pushes down on the diaphragm and out on the chest wall causing an increased WOB
28
Q

What are symptoms of Pleural Effusions?

A
  • Dyspnea
  • Pain
  • Cough
29
Q

What are signs of a pleural effusion?

A
  • Dull percussion
  • Diminished or absent breath sounds
  • Extrapulmonary findings—CHF, joint dz
30
Q

How do we treat a pleural effusion?

A

• Thoracentesis or chest tubes

31
Q

What is the difference between an exudative and transudative effusion?

A

• Exudative- inflammatory
o CHF- anything that may upset the pleural lining
o cancer
• Transudative- non-inflammatory

32
Q

What is VATS and why is it use?

A
  • Video-assisted thoracoscopy

* Used to directly visualize inside the pleural space

33
Q

What is pleurodesis?

A
  • When the parietal and visceral pleurae is fused together

* Most often used for large recurrent effusions from cancer

34
Q

What is compression atelectasis?

A
  • Mediastinum shifts away from the involved side

* effusion

35
Q

What is resorption (obstruction) atelectasis?

A
  • Mediastinum/heart shifts toward the involved side
  • Gas distal (away from center) to obstruction of airway is resorbed—distal lung collapses
  • Mucus plug, cancer, foreign body
36
Q

What is a pneumothorax?

A

• Air in the pleural space

37
Q

What is a spontaneous pneumothorax?

A
  • Primary- in otherwise healthy individuals

* Secondary- underlying lung dz

38
Q

What is a traumatic pneumothorax?

A

• Blunt or penetrating trauma—stabbed or surgery error

39
Q

What are symptoms of a pneumothorax?

A
  • Pleuritic chest pain

* Dyspnea

40
Q

What are exam findings of someone with a pneumothorax?

A
  • Hyperresonance to percussion. (air makes it sound like drum)
  • Decreased breath sounds
  • Tracheal deviation
  • Hemodynamic instability if it’s a tension pneumo
41
Q

What is subcutaneous emphysema?

A

• Air that is trapped under the skin

42
Q

Why do people get pneumonia?

A

• Micro aspiration of bacterias or virus

43
Q

What is the difference between a typical and atypical pneumonia?

A
  • Common (typical) has a normal CXR for pneumonia

* Atypical has a atypical CXR

44
Q

What bacteria causes a common pneumonia?

A
  • Streptococcus

* Hemophilus influenza

45
Q

What bacteria cause an atypical pneumonia?

A
  • Legionella

* Mycoplasma

46
Q

What are two fungi that cause pneumonia in our area?

A
  • Histoplasmosis

* Blastomycosis

47
Q

What are common complications of pneumonia?

A
  • Pleural effusion on the same side
  • Abscess
  • ARDS
48
Q

What is an abscess?

A
  • Cavity that fills with pus or fluid

* Happens if the pneumonia wasn’t treated properly or at all

49
Q

What is the difference between pneumonia and bronchitis?

A

• Bronchitis is in the upper airways so it will not been seen in a CXR

50
Q

What antigens can be detected in urine?

A
  • Legionella
  • Histoplasma
  • Blastomyces
  • Pneumococcal
51
Q

What antigens can be detected in a nasal swab?

A
  • Influenza

* RSV

52
Q

What are some ways to get a lower respiratory sample

A
  • Expectoration
  • ETT suctioning
  • Bronchoalveolar lavage
53
Q

What are some ways to prevent pneumonias?

A
  • Flu vaccine
  • Pneumococcal vaccine
  • Avoid sick
  • Wash your hands
54
Q

What else could suspected pneumonia be if we see the CXR?

A
  • Lung CA

* ARDS

55
Q

What do we give someone with a bacterial pneumonia?

A

• Antibiotics and supportive care

56
Q

What are 5 common viruses?

A
  • Influenza
  • Parainfluenza
  • RSV
  • Adenovirus
  • Corona virus
57
Q

What is acute bronchitis?

A

• Cough with sputum productions
o No pneumonia on CXR
o Usually no hypoxemia, tachypnea (High RR)
• Can have chest pain and wheezing
• Does not typically respond to bronchodilators because it is in the upper airway

58
Q

What are some clues in diagnosing viral pneumonia?

A

• Absent sputum production
• Sore throat, rhinitis, myalgias (muscle aches)
A bacterial infection will last longer than the 10-14 days that a viral infection lasts

pathophys final (1 decks)

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