LA Pulm 1 Flashcards
COPD, CF, bronchiectasis, sarcoidosis, bronchitis, pertussis, bronchiolitis, croup, epiglottitis
1
Q
Vital capacity is what 3 things combined?
A
TV, IRV, ERV
2
Q
What is forced respiratory capacity?
A
ERV and TV
3
Q
What is inspiratory capacity?
A
TV and IRV
4
Q
what sound is louder during expiration?
A
wheezing
5
Q
what sound is heard best with inspiration?
describe reason for sound
A
crackles/rales; popping alveoli
6
Q
what sound is low pitched and sounds like snoring?
how to clear
A
rhonci, may clear with cough
7
Q
ratio for obstructive d/o
A
decreased and <70-80%
8
Q
pink puffer explanation
A
emphysema
pursed lip, non cyanotic. hyperinflation
9
Q
blue bloater explanation
A
chronic bronchitis;
obese and cyanotic
10
Q
hallmark for emphysema
A
dyspnea, mild cough
11
Q
3 cardinal symptoms for chr bronchitis
A
chronic cough, sputum production, and dyspnea.
12
Q
CXR: flattened diaphragms, increased AP diameter, decreased vascular markings, bullae
A
emphysema
13
Q
CXR: pulm HTN, enlarged right heart border, increased AP diameter and vascular markings
A
chronic bronchitis
14
Q
ABG in COPD
A
chronic bronchitis: respiratory acidosis!!
emphysema: poss resp acidosis if severe.
15
Q
CO2 in COPD
A
chronic bronchitis: hypercapnia
emphysema: CO2 often nml initially.
16
Q
hypoxemia in COPD
A
chronic bronchitis: severe!
emphysema: mild to moderate
17
Q
signs of cor pulmonale
A
enlarged tender liver, JVD, peripheral edema. think chronic bronchitis
18
Q
COPD in pt under 40 yo
A
think alpha 1 antitrypsin deficiency
19
Q
most common kind of emphysema
A
centrilobar (proximal acinar)/ smoking
20
Q
mucous gland hyperplasia, goblet cell mucus production, dysfunctional cilia, and infiltration of neutrophils and CD8 cells
A
chronic bronchitis
21
Q
oxygen therapy for which copd pts
A
paO2 <55 or air saturation <88%, or cor pulmonale
22
Q
antibiotics for chronic brochitis
A
macrolides, cephalosporins, augmentin, FQ
23
Q
what is tiotropium?
A
bronchodilator; LAMA, long acting, anticholinergic(antimuscarinic)
24
Q
anticholinergic SE:
A
dry mouth, thirst, blurred vision, urinary retention, diff swallowing
25
what is ipratropium
bronchodilator; short acting, SAMA. anticholinergic
26
what is salmeterol and formoterol?
LABA; beta 2 agonist
27
tx for minimally symptomatic COPD
SABA or SAMA as needed
28
tx for more symptomatic COPD (category B)
add LAMA or LABA to the (SAMA or SABA prn)
29
tx for minimally symptomatic day to day COPD(category C)
LAMA and/or LABA
30
tx for highly symptomatic COPD
LAMA plus inhaled glucocorticoid(fluticasone)
31
CF common in what race and describe genetics
autosome recessive; whites and north europeans
32
CF: abnormal ___ and water transport across ___ glands throughout body leading thick, viscous secretions of the lungs, ____, sinuses, intestines, ____, genitourinary tract
chloride; exocrine, pancreas, liver
33
meconium ileus, diarrhea from malabsorption
may lead to what
CF, may lead to rectal prolapse
34
most common cause of bronchiectasis in US
CF
35
fat soluable vitamins
ADEK
36
infertility due to what in CF
azoospermia
37
dx CF
sweat chloride test 60 or greater on 2 occasions after pilocarpine administration(cholinergic that induces sweating)
38
PFT in CF
obstructive
39
If CF is pseudomonas aeruginosa, tx?
inhaled tobramycin 28 days
40
PFT in obstructive and restrictive disorders
obstructive will have reduced ratio; FEV and FVC are decreased
restrictive will be normal or increased; FEV decreased.
41
lung volumes in hyperinflation
increased TLC, RV, FRC
42
decreased lung volume TLC...
decreased TLC, TV, FRC
43
name main obstructive disorders
ABBCCC
asthma,
brochiolitis, bronchiectasis
CF, COPD, cancer
44
sarcoidosis, pneumoconiosis, idiopathic pulm fibrosis, mesothelioma, scoliosis
restrictive disorders
45
coal workers pneumoconiosis is what patttern
obstructive
46
is bronchiectasis reversible?
no, it is permanent
47
organisms in bronchiectasis
pseudomonas aeruginosa most common cause due to CF;
h. influenza is the most common cause IF NOT due to CF
48
impairment of what in bronchiectasis leads to repeat infections
mucociliary escalator
49
bronchiectasis leads to increased risk for what 3 organisms
pseudomonas, aspergillus, mycobacterium avium complex
50
symptoms of bronchiectasis
persistant productive cough with thick sputum, dyspnea, and pleuritic CP. Hemoptysis if from brochial artery erosion.
51
PE in bronchiectasis
nonspecific, crackles most common. wheezing, rhonchi
52
imaging of choice for bronchiectasis
gold standard
high resolution CT, tram track sign, signet ring sign
gold standard: PFT, obstructive pattern.
53
what is the signet ring sign
increased airway diameter is > adjacent vessel diameter
bronchiectasis
54
name main restrictive disorders
MAI2 POSE (2 no E)
mesothelioma,
ARDS
interstitial lung ds,idiopathic pulm fibrosis
obesity, occupation related
pneumonia, pneumoconiosis
sarcoidosis, silicosis
effusion
55
idiopathic, chronic multisystem inflammatory granulomatous disease
sarcoidosis
56
population for sarcoidosis
female, black, northern europeans
57
what % of sarcoidosis are asymptomatic
50%
58
dry cough, dyspnea, rales, CP
hilar lymphadenopathy
sarcoidosis
59
sarcoidosis classic s/s
erythema nodosum and lupus pernio
60
lofgren syndrome
triad of erythema nodosum, bilateral hilar LAD, and polyarthralgias with fever
61
triad of erythema nodosum, bilateral hilar LAD, and polyarthralgias with fever
lofgren syndrom, sarcoidosis
62
erythema nodosum and lupus pernio
sarcoidosis
63
purple lesions on face, neck
lupus pernio, sarcoidosis
64
best initial test for sarcoidosis
CXR: bilateral hilar lymphadenopathy
65
PFT for sarcoidosis
restrictive; normal or increased ratio.
nml or decreased FVC,
decreased FEV1
66
noncaeating granulomas
sarcoidosis
67
labs for sarcoidosis
increased ACE levels, high calcium
68
first line tx for sarcoidosis
oral corticosteroids
69
increased ACE levels, high calcium
sarcoidosis
70
nonprod cough, fine, dry bibasilar inspiratory crackles, poss clubbing
pulm fibrosis
71
CXR: basal predominant reticular opacities(honeycombing)
CT: reticular honeycombing, focal ground glass opacification
pulm fibrosis
72
PFT in pulm fibrosis
restrictive; normal or increased ratio, nml or decreased FVC
decreased lung volumes
73
what is honeycombing
large cystic airspaces from cystic fibrotic alveolitis
74
what is pirfenidone and nintedanib
anti-fibrotic agents to slow progression
75
alpha 1 antitrypsin deficiency leads to what 3 diseases
pancinar emphysema, hepatomegaly, cirrhosis
76
alpha 1 antitrypsin deficiency pft
obstructive
77
alpha 1 antitrypsin deficiency, liver biopsy
PAS positive globules in hepatocytes
78
hemoptysis 2 most common causes
acute bronchitis and bronchogenic carcinoma
79
acute bronchitis s/s
hallmark is cough, poss productive, at least 5 days, lasts 1-3 weeks.
dyspnea, wheezing, uri, low fever
80
acute bronchitis exam
nml but maybe wheezing and rhonchi
81
gm neg coccobacillus
bordetella pertussis
82
pertussis age occurence
children under 2 years old
83
pertussis incubation period
7-10 days
84
URI symptoms 1-2 weeks. most contagious during this phase
pertussis catarrhal phase. 1st phase
85
severe paroxysmal coughs with ___ whooping sounds. poss post coughing emesis. lasts 2-4 weeks
inspiratory. 2nd phase: paroxysmal
86
how long does the convalescent phase of pertussis
up to 6 weeks.
87
order what for pertussis
both throat culture and PCR.
lymphocytosis common
88
throat culture for pertussis most sensitive when
first 2 weeks
89
PCR for pertussis most sensitive when
up to 4 weeks
90
drug of choice for pertussis
macrolide.
bactrim 2nd line
91
booster dose of pertussis vaccine given when
between ages 11-18 y/o
92
pertussis(D tap) recommended when ___ ___ ___ months,
____ to 18 months, and _____ years
2, 4, 6 months, 15-18 months, 4-6 years
93
bronchiolitis most common cause and common ages
RSV. 2 months to 2 years of age most common.
94
bronchiolitis s/s
viral prodrome(fever, uri) for 1-2 days then respiratory distress
95
bronchiolitis dx tests
cxr nonspecific, nasal washings using monoclonal antibody testing, pulse ox best predictor
96
bronchiolitis supportive tx
avoid what
humidified O2, IV fluids, nebulized saline
avoid corticosteroids
97
palivizumab
prevention of bronchiolitis in high risk
98
bronchiolitis seasons
autumn and winter
99
epiglottitis organisms
if immunized, strep group A, strep pneumo
h flu used to the most common until vacc came
100
epiglottitis 3 Ds
drooling, dysphagia, distress
101
thumbprint sign
epiglottitis
102
tripod position
epiglottitis
103
definitive dx for epiglottitis
avoid what
laryngoscopy, cherry red
avoid tongue depressor
104
epiglottitis main tx
maintain airway, intubate in OR
105
adult rf for epiglottitis
dm
106
antibiotics for epiglottitis
2nd and 3rd gen cephalosporins: ceftriaxone or cefotaxime, PCN, ampicillin or antistaph coverage
107
what to give close contacts for epiglottitis pts
rifampin
108
epiglottitis ages, gender, season
3 months to 6 years, males, any season
109
croup vs epiglottis, which is life threatening
epiglottitis
110
croup ages, season
6 months to 6 years. fall/winter
111
croup etio
parainfluenza virus most common. RSV 2nd. adenovirus and rhinovirus
112
parainfluenza virus and
streptococcal species
parainfluenza virus: croup
streptococcal species: epiglottitis
113
seal like barking cough
croup
114
croup sx worse when
at night
115
croup involves which airway
upper
116
steeple sign
frontal cervical: croup
117
croup tx mild
no stridor, supportive, dexmethasone
118
croup tx moderate and severe
moderate: stridor at rest, dexmethasone, neb epinephrine
severe: all above plus hospitalization
119
