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Med Surg 1 > FINALS: Pulmonary Conditions > Flashcards

FINALS: Pulmonary Conditions Flashcards

1
Q

Common manifestations of respiratory diseases

A

Dyspnea: Difficulty breathing; can be acute or chronic, orthopnea, platypnea, nocturnal, or constant.
Cough:
Acute: Post-viral/post-bacterial
Chronic: Chronic bronchitis, ACE inhibitors

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2
Q

Affects airways, causing narrowing/blockage.
Examples: Asthma, emphysema, chronic bronchitis.
Analogy: “Trying to breathe out through a straw.”

A

Obstructive lung diseases: Characteristics

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3
Q

Anticholinergic drugs for COPD: Examples

A

Drugs: Ipatropium, Tiotropium
Action: Block muscarinic receptors causing bronchodilation
Adverse effects: Dry mouth, dizziness, urinary retention

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3
Q

Affects lung tissue structure, preventing full expansion.
Examples: Pulmonary fibrosis, sarcoidosis.
Analogy: “Wearing a too-tight sweater or vest.”

A

Restrictive lung diseases: Characteristics

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4
Q

COPD: Key symptoms

A

Cough
Sputum production
Dyspnea on exertion
Hallmark: Frequent exacerbations

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4
Q

COPD: Spirometry classifications

A

Mild (Stage I): FEV1/FVC < 70%, FEV1 > 80% predicted
Moderate (Stage II): FEV1/FVC < 70%, 50% < FEV1 < 80%
Severe (Stage III): FEV1/FVC < 70%, 30% < FEV1 < 50%
Very severe (Stage IV): FEV1/FVC < 70%, FEV1 < 30%

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4
Q

COPD: Risk factors

A

Genetic: Alpha-1 antitrypsin deficiency
Tobacco smoke
Occupational dusts/chemicals
Indoor and outdoor pollution
Low birth weight (LBW) and respiratory infections during childhood

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4
Q

Differential diagnosis: COPD vs. Asthma

A

COPD: Mid-life onset, progressive symptoms, long smoking history, irreversible airflow limitation.
Asthma: Early-life onset, variable symptoms, allergy/rhinitis/eczema history, reversible airflow limitation.

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5
Q

Chronic bronchitis vs. Emphysema: Definition

A

Chronic bronchitis: Inflammation and thickening of bronchial walls causing cough and mucus overproduction.
Emphysema: Alveolar destruction, narrowing, or collapse leading to reduced gas exchange.

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5
Q

What microorganisms are commonly associated with bronchiectasis infection?

A

Pseudomonas aeruginosa
Haemophilus influenzae
Staphylococcus aureus
Klebsiella
Anaerobes
Bordetella pertussis (in childhood)
Mycobacterium avium complex

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6
Q

Beta-2 agonists for COPD: Examples

A

Short-acting (Relievers): Albuterol, Terbutaline
Long-acting (Controllers): Salmeterol, Formoterol
Adverse effects: Tremors, nervousness, tachycardia

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6
Q

What are common clinical manifestations of bronchiectasis?

A

Persistent or recurrent cough
Purulent respiratory infections
Hemoptysis
Inflammation of airway mucosa
Fatigue, weight loss, and myalgia

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6
Q

What is the usual cause of saccular (cystic) bronchiectasis?

A

Infection is the usual cause, particularly microorganisms like Pseudomonas aeruginosa, Haemophilus influenzae, and others that injure the respiratory epithelium and impair mucociliary clearance.

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6
Q

What preventive measures are available for cystic fibrosis?

A

Gene therapy, inhaled mucolytics (Pulmozyme), antibiotics (Tobramycin), and hypertonic saline for better mucus clearance.

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6
Q

What are some non-infectious causes of bronchiectasis?

A

Ammonia or aspiration of acidic gastric contents
Yellow nail syndrome

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7
Q

What radiographic findings suggest bronchiectasis?

A

High-resolution CT shows dilated airways, particularly in the lower lobes and lingula
Cross-section of dilated airways appears ring-like.

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7
Q

What are common infectious causes of bronchiectasis?

A

Adenovirus and influenza virus (lower respiratory tract involvement)
Staphylococcus aureus, Klebsiella, and anaerobes
Bordetella pertussis in childhood

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7
Q

What are key diagnostic tests for bronchiectasis?

A

High-resolution CT scan
Fiberoptic bronchoscopy for focal disease
Sweat chloride test for cystic fibrosis (CF)
Pulmonary function tests showing airflow obstruction

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8
Q

What is the mainstay treatment for bronchiectasis?

A

Antibiotics for infection
Mechanical methods and devices to clear secretions
Mucolytic agents
Bronchodilators

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9
Q

What antibiotics are used to treat bronchiectasis in mild to moderate cases?

A

Amoxicillin
Tetracycline
Trimethoprim-Sulfamethoxazole
Macrolides (e.g., azithromycin)
Second-generation cephalosporins
Fluoroquinolones

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10
Q

What is the mainstay treatment for patients with moderate-to-severe bronchiectasis symptoms?

A

Parenteral antibiotics (e.g., aminoglycosides, antipseudomonal penicillin, third-generation cephalosporins)
Tobramycin for CF patients with Pseudomonas infection

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10
Q

What are common clinical features of Cystic Fibrosis?

A

Chronic sinusitis
Nasal polyps
Cough with purulent and viscous secretions
Weight loss and decreased pulmonary function

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11
Q

What is Cystic Fibrosis (CF)?

A

A genetic, inherited disorder causing thick, sticky mucus in the lungs and digestive tract
Common in children and young adults, leading to chronic lung disease and early death

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11
Q

What are the primary pathologic features of Cystic Fibrosis?

A

Chronic airway infection (bronchiectasis)
Exocrine pancreatic insufficiency
Abnormal sweat gland function
Urogenital dysfunction

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12
Q

What is the genetic cause of Cystic Fibrosis?

A

Autosomal recessive inheritance
Mutation in the CFTR gene located on chromosome 7

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12
Q

What is the treatment for Cystic Fibrosis to manage mucus?

A

Inhaled mucolytics like Pulmozyme
Antibiotics for infection (e.g., TOBI for Pseudomonas aeruginosa)
Hypertonic saline to help clear mucus

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12
Q

What are common adverse effects of mucolytics like Pulmozyme for CF?

A

GI upset
Stomatitis
Rhinorrhea
Bronchospasm

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12
Q

What diagnostic tests are used for Cystic Fibrosis?

A

Sweat test (measuring salt content)
IRT (immunoreactive trypsinogen test)
Genetic CF testing
Chest X-rays
Lung function tests

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12
Q

What are significant lung findings in Cystic Fibrosis?

A

Hyperinflation due to small airway obstruction
Mucus impaction and bronchiectasis

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12
Q

What are common adverse effects of aminoglycosides like Tobramycin?

A

Nausea, vomiting, diarrhea (oral)
Nephrotoxicity and ototoxicity (parenteral)

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13
Q

What is the role of ibuprofen in Cystic Fibrosis?

A

Slows the decline of lung function in CF patients, but requires close monitoring due to potential side effects.

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13
Q

What is saccular (cystic) bronchiectasis usually caused by?

A

Infection, often due to microorganisms like Pseudomonas aeruginosa, Haemophilus influenzae, and others that impair mucociliary clearance.

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13
Q

Which microorganisms are commonly involved in bronchiectasis?

A

Pseudomonas aeruginosa, Haemophilus influenzae, Staphylococcus aureus, Klebsiella, Mycobacterium avium complex, and Bordetella pertussis.

13
Q

What are the non-infectious causes of bronchiectasis?

A

Ammonia exposure, aspiration of acidic gastric contents, and Yellow Nail Syndrome.

13
Q

What are the clinical manifestations of bronchiectasis?

A

Persistent cough, purulent respiratory infections, hemoptysis, inflamed airway mucosa, systemic symptoms like fatigue, weight loss, and myalgia.

14
Q

What radiographic findings are common in bronchiectasis?

A

High-resolution CT scans show dilated airways with a ringlike appearance, often in the lower lobes and lingula.

14
Q

What is the treatment approach for bronchiectasis?

A

Treat infection during acute exacerbations, improve clearance of tracheobronchial secretions, reduce inflammation, and address underlying issues.

14
Q

What is cystic fibrosis (CF)?

A

CF is an inherited disease that causes thick, sticky mucus to build up in the lungs and digestive tract, leading to chronic respiratory and gastrointestinal issues.

14
Q

Which antibiotics are commonly used for bronchiectasis treatment?

A

Amoxicillin, Tetracycline, Trimethoprim-Sulfamethoxazole, Macrolides, Second-generation cephalosporins, and Fluoroquinolones.

14
Q

What are the adverse effects of Azithromycin?: GIT distress and cholestatic jaundice.

A

: GIT distress and cholestatic jaundice.

14
Q

What are the key characteristics of cystic fibrosis?

A

Chronic airway infection, exocrine pancreatic insufficiency, abnormal sweat gland function, and urogenital dysfunction.

15
Q

What are the main adverse effects of antibiotics used in bronchiectasis treatment?

A

Nausea, diarrhea, vomiting, abdominal pain, hypersensitivity reactions (with cephalosporins), and sun sensitivity (with Trimethoprim).

15
Q

What are the common lung findings in cystic fibrosis?

A

Hyperinflation, small airways obstruction, mucus impaction, bronchial cuffing, and bronchiectasis (e.g., ring shadow).

15
Q

What is the usual cause of inflammation in saccular (cystic) bronchiectasis?

A

Infection

15
Q

What are the clinical features of cystic fibrosis?

A

Chronic sinusitis, nasal polyps, cough with purulent secretion, weight loss, pulmonary function decline, and increased sputum volume.

15
Q

What is the genetic cause of cystic fibrosis?

A

It is an autosomal recessive disorder caused by mutations on chromosome 7 that lead to absent or defective CFTR (Cystic Fibrosis Transmembrane Conductance Regulator).

16
Q

Which microorganisms are commonly associated with cystic bronchiectasis?

A

Pseudomonas aeruginosa
Haemophilus influenzae
Adenovirus
Influenza virus
Staphylococcus aureus
Klebsiella
Bordetella pertussis (especially in children)
Mycobacterium avium complex.

16
Q

What is the effect of ibuprofen in cystic fibrosis?

A

It helps slow the rate of lung function decline and should be monitored closely by a physician.

16
Q

What are the adverse effects of common medications used in cystic fibrosis treatment?

A

Mucolytics (Pulmozyme) may cause GI upset, stomatitis, rhinorrhea, and bronchospasm. Aminoglycosides (Tobramycin) can cause nausea, nephrotoxicity, and ototoxicity.

16
Q

What are the diagnostic tests for cystic fibrosis?

A

Sweat test, IRT (immunoreactive trypsinogen test), CF genetic tests, chest X-rays, and lung function tests.

16
Q

What effect do microorganisms like Pseudomonas aeruginosa and Haemophilus influenzae have on the respiratory system in bronchiectasis?

A

They produce pigments, proteases, and toxins that injure the respiratory epithelium and impair mucociliary clearance.

16
Q

What are the adverse effects of Theophylline in cystic fibrosis treatment?

A

At levels above 20ug/ml: nausea, vomiting, insomnia, diarrhea, headache, irritability. At levels above 30ug/ml: hyperglycemia, hypotension, cardiac arrhythmia, seizures, and potentially death.

17
Q

What is the major cause of localized impairment of host defenses in bronchiectasis?

A

Endobronchial obstruction.

18
Q

What are the common non-infectious causes of bronchiectasis?

A

Ammonia or aspiration of acidic gastric contents
Yellow nail syndrome.

19
Q

What are the clinical manifestations of bronchiectasis?

A

Persistent or recurrent cough
Purulent respiratory tract infections
Hemoptysis
Inflamed airway mucosa
Systemic symptoms like fatigue, weight loss, and myalgia.

20
Q

What are the radiographic findings in bronchiectasis?

A

High-resolution CT scan shows dilated airways, especially in the lower lobes and lingula, with a ring-like appearance.

20
Q

What is the treatment strategy for bronchiectasis?

A

Treatment of infection, especially during exacerbations
Improved clearance of tracheobronchial secretions
Reduction of inflammation
Treatment of underlying conditions.

21
Q

What is Health Care-Associated Pneumonia (HCAP)?

A

HCAP is pneumonia occurring in patients who meet one of the following criteria:

Hospitalization for 2 or more days within 90 days of infection.
Resident of a nursing home or long-term care facility.
Received recent IV antibiotic therapy, chemotherapy, or wound care in the past 30 days.
Attended a hospital or hemodialysis clinic.

22
Q

What is Ventilator-Associated Pneumonia (VAP)?

A

VAP is pneumonia that arises more than 48-72 hours after endotracheal intubation.

23
Q

What is Hospital Acquired Pneumonia (HAP)?

A

HAP is defined as pneumonia occurring 48 hours or more after admission, which was not incubating at the time of admission.

24
Q

What are common microbiologic causes of HCAP?

A

Non-MDR pathogens: Streptococcus pneumoniae, Haemophilus influenzae, MSSA, Escherichia coli, Klebsiella pneumoniae, and others.
MDR pathogens: Pseudomonas aeruginosa, MRSA, Acinetobacter spp., Enterobacter spp., Legionella pneumophila, and others.

25
Q

What are the common clinical conditions associated with HCAP and their likely pathogens?

A

Hospitalization for ≥48 hours: Pseudomonas aeruginosa, Acinetobacter spp., MRSA, Enterobacteriaceae.
Nursing home or extended care residence: MRSA, Pseudomonas aeruginosa.
Recent antibiotic therapy: MRSA, Pseudomonas aeruginosa.
Chronic dialysis: MRSA, Acinetobacter spp.
Home infusion therapy: Pseudomonas aeruginosa, Enterobacter spp.

26
Q

What factors can cause overdiagnosis of Ventilator-Associated Pneumonia (VAP)?

A

Tracheal colonization with pathogenic bacteria.
Alternative causes of radiographic infiltrates.
High frequency of other sources of fever in critically ill patients.

26
Q

What are the clinical manifestations of pneumonia?

A

Fever
Leukocytosis
Increased respiratory secretions
Consolidation on physical examination
Tachypnea, tachycardia
Worsening oxygenation
New or changing radiographic infiltrates

27
Q

What is the empirical antibiotic treatment for HCAP without risk factors for MDR pathogens?

A

Ceftriaxone 2g IV q24 hours or
Moxifloxacin 400mg IV q24 hours or
Ciprofloxacin 400mg IV q8 hours or
Ampicillin/Sulbactam 3g IV q6 hours.

28
Q

What is the empirical antibiotic treatment for HCAP with risk factors for MDR pathogens?

A

Beta-lactam: Ceftazidime, Cefepime, Piperacillin/Tazobactam, Meropenem.
Second agent against gram-negative pathogens: Gentamicin, Tobramycin, Amikacin, Ciprofloxacin, Levofloxacin.
Agent against gram-positive pathogens: Linezolid or Vancomycin.

29
Q

What are some complications of HCAP?

A

Death
Prolonged mechanical ventilation
Prolonged hospital stay
Development of necrotizing pneumonia
Long-term pulmonary complications
Inability to return to independent function

30
Q

What factors help streamline empiric antibiotic therapy for pneumonia?

A

Cough resolution, normalization of respiratory rate.
Afebrile for >24 hours.
Low-risk etiology (non-virulent or resistant pathogen).
No unstable co-morbidities or life-threatening complications.

31
Q

What are the prevention strategies for Ventilator-Associated Pneumonia (VAP)?

A

Hand washing and infection control measures.
Avoidance of prolonged antibiotic courses.
Short courses of prophylactic antibiotics for comatose patients.
Postpyloric enteral feeding to reduce gastroesophageal reflux.
Elevation of the head of the bed to reduce aspiration risk.

32
Q

What medication regimen is typically used for pneumonia in patients with chronic illnesses?

A

Fluoroquinolones (Levofloxacin, Sparfloxacin, Gemifloxacin).
High-dose Amoxicillin or Amoxicillin-Clavulanate plus a macrolide.
Cephalosporins (Cefuroxime or Cefpodoxime) plus a macrolide.

32
Q

How is hypoxia detected in blood gas analysis?

A

Hypoxia is detected by measuring PaO2 (less than 60 mmHg on room air) or using the PaO2/FiO2 ratio for patients receiving oxygen supplementation.

32
Q

What is Hypercapnia, and how is it related to respiratory failure?

A

Hypercapnia is characterized by elevated PaCO2 levels. It helps differentiate between type I (normal or low PaCO2) and type II (high PaCO2) respiratory failure.

32
Q
A
32
Q

What is Acute Respiratory Failure, and how is it assessed?

A

Acute Respiratory Failure is assessed via arterial blood gas (ABG) sampling to measure oxygenation, ventilation, and acid-base balance. Conditions diagnosed include respiratory acidosis, alkalosis, and metabolic imbalances.

33
Q
A
33
Q

What are common diagnostic methods for pneumonia?

A

Blood culture
Endotracheal aspiration
PSB (protected specimen brush) or BAL (bronchoalveolar lavage) via bronchoscopy

33
Q

What is the recommended medication for mild pneumonia in healthy individuals?

A

Oral macrolides like Azithromycin, Clarithromycin, or Erythromycin.

34
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36
Q
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Med Surg 1 (15 decks)

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