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