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cardio and pulm > LA Pulm 1 > Flashcards

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

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2
Q

What is forced respiratory capacity?

A

ERV and TV

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3
Q

What is inspiratory capacity?

A

TV and IRV

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4
Q

what sound is louder during expiration?

A

wheezing

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5
Q

what sound is heard best with inspiration?

describe reason for sound

A

crackles/rales; popping alveoli

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6
Q

what sound is low pitched and sounds like snoring?

how to clear

A

rhonci, may clear with cough

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7
Q

ratio for obstructive d/o

A

decreased and <70-80%

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8
Q

pink puffer explanation

A

emphysema

pursed lip, non cyanotic. hyperinflation

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9
Q

blue bloater explanation

A

chronic bronchitis;
obese and cyanotic

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10
Q

hallmark for emphysema

A

dyspnea, mild cough

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11
Q

3 cardinal symptoms for chr bronchitis

A

chronic cough, sputum production, and dyspnea.

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12
Q

CXR: flattened diaphragms, increased AP diameter, decreased vascular markings, bullae

A

emphysema

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13
Q

CXR: pulm HTN, enlarged right heart border, increased AP diameter and vascular markings

A

chronic bronchitis

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14
Q

ABG in COPD

A

chronic bronchitis: respiratory acidosis!!

emphysema: poss resp acidosis if severe.

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15
Q

CO2 in COPD

A

chronic bronchitis: hypercapnia

emphysema: CO2 often nml initially.

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16
Q

hypoxemia in COPD

A

chronic bronchitis: severe!

emphysema: mild to moderate

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17
Q

signs of cor pulmonale

A

enlarged tender liver, JVD, peripheral edema. think chronic bronchitis

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18
Q

COPD in pt under 40 yo

A

think alpha 1 antitrypsin deficiency

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19
Q

most common kind of emphysema

A

centrilobar (proximal acinar)/ smoking

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20
Q

mucous gland hyperplasia, goblet cell mucus production, dysfunctional cilia, and infiltration of neutrophils and CD8 cells

A

chronic bronchitis

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21
Q

oxygen therapy for which copd pts

A

paO2 <55 or air saturation <88%, or cor pulmonale

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22
Q

antibiotics for chronic brochitis

A

macrolides, cephalosporins, augmentin, FQ

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23
Q

what is tiotropium?

A

bronchodilator; LAMA, long acting, anticholinergic(antimuscarinic)

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24
Q

anticholinergic SE:

A

dry mouth, thirst, blurred vision, urinary retention, diff swallowing

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25
Q

what is ipratropium

A

bronchodilator; short acting, SAMA. anticholinergic

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26
Q

what is salmeterol and formoterol?

A

LABA; beta 2 agonist

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27
Q

tx for minimally symptomatic COPD

A

SABA or SAMA as needed

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28
Q

tx for more symptomatic COPD (category B)

A

add LAMA or LABA to the (SAMA or SABA prn)

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29
Q

tx for minimally symptomatic day to day COPD(category C)

A

LAMA and/or LABA

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30
Q

tx for highly symptomatic COPD

A

LAMA plus inhaled glucocorticoid(fluticasone)

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31
Q

CF common in what race and describe genetics

A

autosome recessive; whites and north europeans

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32
Q

CF: abnormal ___ and water transport across ___ glands throughout body leading thick, viscous secretions of the lungs, ____, sinuses, intestines, ____, genitourinary tract

A

chloride; exocrine, pancreas, liver

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33
Q

meconium ileus, diarrhea from malabsorption

may lead to what

A

CF, may lead to rectal prolapse

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34
Q

most common cause of bronchiectasis in US

A

CF

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35
Q

fat soluable vitamins

A

ADEK

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36
Q

infertility due to what in CF

A

azoospermia

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37
Q

dx CF

A

sweat chloride test 60 or greater on 2 occasions after pilocarpine administration(cholinergic that induces sweating)

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38
Q

PFT in CF

A

obstructive

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39
Q

If CF is pseudomonas aeruginosa, tx?

A

inhaled tobramycin 28 days

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40
Q

PFT in obstructive and restrictive disorders

A

obstructive will have reduced ratio; FEV and FVC are decreased

restrictive will be normal or increased; FEV decreased.

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41
Q

lung volumes in hyperinflation

A

increased TLC, RV, FRC

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42
Q

decreased lung volume TLC…

A

decreased TLC, TV, FRC

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43
Q

name main obstructive disorders

ABBCCC

A

asthma,
brochiolitis, bronchiectasis
CF, COPD, cancer

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44
Q

sarcoidosis, pneumoconiosis, idiopathic pulm fibrosis, mesothelioma, scoliosis

A

restrictive disorders

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45
Q

coal workers pneumoconiosis is what patttern

A

obstructive

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46
Q

is bronchiectasis reversible?

A

no, it is permanent

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47
Q

organisms in bronchiectasis

A

pseudomonas aeruginosa most common cause due to CF;

h. influenza is the most common cause IF NOT due to CF

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48
Q

impairment of what in bronchiectasis leads to repeat infections

A

mucociliary escalator

49
Q

bronchiectasis leads to increased risk for what 3 organisms

A

pseudomonas, aspergillus, mycobacterium avium complex

50
Q

symptoms of bronchiectasis

A

persistant productive cough with thick sputum, dyspnea, and pleuritic CP. Hemoptysis if from brochial artery erosion.

51
Q

PE in bronchiectasis

A

nonspecific, crackles most common. wheezing, rhonchi

52
Q

imaging of choice for bronchiectasis

gold standard

A

high resolution CT, tram track sign, signet ring sign

gold standard: PFT, obstructive pattern.

53
Q

what is the signet ring sign

A

increased airway diameter is > adjacent vessel diameter

bronchiectasis

54
Q

name main restrictive disorders

MAI2 POSE (2 no E)

A

mesothelioma,

ARDS
interstitial lung ds,idiopathic pulm fibrosis
obesity, occupation related
pneumonia, pneumoconiosis
sarcoidosis, silicosis
effusion

55
Q

idiopathic, chronic multisystem inflammatory granulomatous disease

A

sarcoidosis

56
Q

population for sarcoidosis

A

female, black, northern europeans

57
Q

what % of sarcoidosis are asymptomatic

A

50%

58
Q

dry cough, dyspnea, rales, CP

hilar lymphadenopathy

A

sarcoidosis

59
Q

sarcoidosis classic s/s

A

erythema nodosum and lupus pernio

60
Q

lofgren syndrome

A

triad of erythema nodosum, bilateral hilar LAD, and polyarthralgias with fever

61
Q

triad of erythema nodosum, bilateral hilar LAD, and polyarthralgias with fever

A

lofgren syndrom, sarcoidosis

62
Q

erythema nodosum and lupus pernio

A

sarcoidosis

63
Q

purple lesions on face, neck

A

lupus pernio, sarcoidosis

64
Q

best initial test for sarcoidosis

A

CXR: bilateral hilar lymphadenopathy

65
Q

PFT for sarcoidosis

A

restrictive; normal or increased ratio.

nml or decreased FVC,

decreased FEV1

66
Q

noncaeating granulomas

A

sarcoidosis

67
Q

labs for sarcoidosis

A

increased ACE levels, high calcium

68
Q

first line tx for sarcoidosis

A

oral corticosteroids

69
Q

increased ACE levels, high calcium

A

sarcoidosis

70
Q

nonprod cough, fine, dry bibasilar inspiratory crackles, poss clubbing

A

pulm fibrosis

71
Q

CXR: basal predominant reticular opacities(honeycombing)

CT: reticular honeycombing, focal ground glass opacification

A

pulm fibrosis

72
Q

PFT in pulm fibrosis

A

restrictive; normal or increased ratio, nml or decreased FVC

decreased lung volumes

73
Q

what is honeycombing

A

large cystic airspaces from cystic fibrotic alveolitis

74
Q

what is pirfenidone and nintedanib

A

anti-fibrotic agents to slow progression

75
Q

alpha 1 antitrypsin deficiency leads to what 3 diseases

A

pancinar emphysema, hepatomegaly, cirrhosis

76
Q

alpha 1 antitrypsin deficiency pft

A

obstructive

77
Q

alpha 1 antitrypsin deficiency, liver biopsy

A

PAS positive globules in hepatocytes

78
Q

hemoptysis 2 most common causes

A

acute bronchitis and bronchogenic carcinoma

79
Q

acute bronchitis s/s

A

hallmark is cough, poss productive, at least 5 days, lasts 1-3 weeks.

dyspnea, wheezing, uri, low fever

80
Q

acute bronchitis exam

A

nml but maybe wheezing and rhonchi

81
Q

gm neg coccobacillus

A

bordetella pertussis

82
Q

pertussis age occurence

A

children under 2 years old

83
Q

pertussis incubation period

A

7-10 days

84
Q

URI symptoms 1-2 weeks. most contagious during this phase

A

pertussis catarrhal phase. 1st phase

85
Q

severe paroxysmal coughs with ___ whooping sounds. poss post coughing emesis. lasts 2-4 weeks

A

inspiratory. 2nd phase: paroxysmal

86
Q

how long does the convalescent phase of pertussis

A

up to 6 weeks.

87
Q

order what for pertussis

A

both throat culture and PCR.

lymphocytosis common

88
Q

throat culture for pertussis most sensitive when

A

first 2 weeks

89
Q

PCR for pertussis most sensitive when

A

up to 4 weeks

90
Q

drug of choice for pertussis

A

macrolide.

bactrim 2nd line

91
Q

booster dose of pertussis vaccine given when

A

between ages 11-18 y/o

92
Q

pertussis(D tap) recommended when ___ ___ ___ months,
____ to 18 months, and _____ years

A

2, 4, 6 months, 15-18 months, 4-6 years

93
Q

bronchiolitis most common cause and common ages

A

RSV. 2 months to 2 years of age most common.

94
Q

bronchiolitis s/s

A

viral prodrome(fever, uri) for 1-2 days then respiratory distress

95
Q

bronchiolitis dx tests

A

cxr nonspecific, nasal washings using monoclonal antibody testing, pulse ox best predictor

96
Q

bronchiolitis supportive tx

avoid what

A

humidified O2, IV fluids, nebulized saline

avoid corticosteroids

97
Q

palivizumab

A

prevention of bronchiolitis in high risk

98
Q

bronchiolitis seasons

A

autumn and winter

99
Q

epiglottitis organisms

A

if immunized, strep group A, strep pneumo

h flu used to the most common until vacc came

100
Q

epiglottitis 3 Ds

A

drooling, dysphagia, distress

101
Q

thumbprint sign

A

epiglottitis

102
Q

tripod position

A

epiglottitis

103
Q

definitive dx for epiglottitis

avoid what

A

laryngoscopy, cherry red

avoid tongue depressor

104
Q

epiglottitis main tx

A

maintain airway, intubate in OR

105
Q

adult rf for epiglottitis

A

dm

106
Q

antibiotics for epiglottitis

A

2nd and 3rd gen cephalosporins: ceftriaxone or cefotaxime, PCN, ampicillin or antistaph coverage

107
Q

what to give close contacts for epiglottitis pts

A

rifampin

108
Q

epiglottitis ages, gender, season

A

3 months to 6 years, males, any season

109
Q

croup vs epiglottis, which is life threatening

A

epiglottitis

110
Q

croup ages, season

A

6 months to 6 years. fall/winter

111
Q

croup etio

A

parainfluenza virus most common. RSV 2nd. adenovirus and rhinovirus

112
Q

parainfluenza virus and

streptococcal species

A

parainfluenza virus: croup

streptococcal species: epiglottitis

113
Q

seal like barking cough

A

croup

114
Q

croup sx worse when

A

at night

115
Q

croup involves which airway

A

upper

116
Q

steeple sign

A

frontal cervical: croup

117
Q

croup tx mild

A

no stridor, supportive, dexmethasone

118
Q

croup tx moderate and severe

A

moderate: stridor at rest, dexmethasone, neb epinephrine

severe: all above plus hospitalization

119
Q
A

cardio and pulm (22 decks)

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