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Pulmonology > Lectures 9-10 > Flashcards

Lectures 9-10 Flashcards

1
Q

What is problem oriented approach

A
  1. Get data- history, PE, tests
  2. Problem prioritization
  3. Plans- diagnostic, therapeutic, client education
  4. Follow up
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2
Q

What are some “big picture” things to look at during your physical exam

A

Rate
Effort
Patient position and attitude
Audible or auscultable sounds

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3
Q

What are some details to look for during physical exam

A

Inspiration vs expiration (timing, effort, sounds)

Body wall movements

Auscult full lung fields and large airways

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4
Q 
Define:
Eupnea
Tachypnea
Bradypnea
Hyperpnea
Hypopnea
Apnea
Dyspnea
A
  1. Normal breathing
  2. Increased rate/frequency (hyperventilation)
  3. Decreased rate/frequency (hypoventilation)
  4. Increased depth/airflow (hyperventilation)
  5. Decreased depth/airflow (hypoventilation)
  6. Cessation of breathing
  7. Difficult/labored breathing (need to further describe besides just “dyspnea”)
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5
Q

What is orthopnea

A

Dyspnea while lying down but is corrected when upright

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6
Q

What is ataxic/agonal

A

Continuous irregular shifts of hyperventilation, hypoventilation, and apnea

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7
Q

What is paradoxic breathing

A

Abdomen and thorax moving in opposite directions

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8
Q

What is flail chest

A

One segment of chest wall moves differently

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9
Q

What are bronchial sounds

A

Normal, airflow through trachea (mid height, mid width of chest)

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10
Q

What are vesicular sounds

A

Normal airflow through large airways

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11
Q

What is stertor and what does it mean

A

Snoring sounds produced by partial obstruction of upper airway

Means a problem somewhere between nose or nasopharynx

Abnormal

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12
Q

What is stridor and what does it mean

A

High pitched, harsh, vibratory sound caused by partial upper airway obstruction

Usually means problem in the larynx

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13
Q

What are crackles and what causes it

A

Discontinuous bubbling/popping sounds caused by air passing through fluid or when air forces collapsed airway/alveolar walls open

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14
Q

What are wheezes and what causes it

A

Continuous whistling sounds caused by air turbulence in narrowed lower airwars

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15
Q

What does an end expiratory grunt indicate

A

Bronchoconstriction or air trapping

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16
Q

What does a pleural rub indicate

A

Irregular pleural surface

Similar to crackles but is very focal (same place and time in breath)

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17
Q

What does it mean if you can hear lung sounds dorsally but not ventrally

A

Fluid line usually means pleural space disease or consolidation

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18
Q

what are signs the problem is nose/nasopharynx specific

A

Nasal discharge, epistaxis, sneezing

Nasal passage occlusion, stertor, mouth breathing, facial asymmetry or deformity, ocular signs, anorexia (cats)

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19
Q

What are signs the problem is upper airway below the nose?

A

Stridor, coughing, altered breathing pattern (posture, I>E, paradoxic breathing), exercise intolerance, hyperthermia, tachypnea, panting, dyspnea, distress

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20
Q

What are signs the problem is lower airways

A

Couging, wheezing, altered breathing (I

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21
Q

What are signs the problem is pleural space?

A

Altered breathing (I>E), tachypnea, dyspnea, distress, exercise intolerance, decreased lung sounds on auscultation

22
Q

What are other things that can determine your differential diagnoses

A

Cats vs dogs
Breed specifics
Age

23
Q

What are important things to gather in your history

A 
Confirm and characterize principal clinical signs
Preventative care protocol
Prior treatment, response to treatment
Other concurrent signs or diseases
Environment
24
Q

What is coughing?

Where are cough receptors located?

A

A symptom, NOT a disease

Receptors are located in upper respiratory tract and large airways

25
Q

Basic approach for nasal disease

A

Start with less invasive tests- blood work, infectious disease screening, cytology

Next step is imaging- oropharyngeal exam, nasal rads, dental rads, CT/MRI, rhinoscopy

Next step is more invasive tests- nasal flush, biopsy

26
Q

What type of information does imaging give you about nasal disease

A

Give you information of localization, but generally doesn’t give you definitive diagnose UNLESS it’s:

  • foreign body
  • tooth root abscess
  • mites
  • anatomic/structural abnormalities
27
Q

Which diagnostic test will provide the highest diagnostic yield?

A

Blind nasal biopsies. Don’t technically need imaging so it can be done for clients with low budgets

28
Q

Basic approach for upper airway problems?

A

Still start with less invasive tests (blood work, infectious disease screening, cytology, imaging)

Next visualization and imaging (oropharyngeal exam, CT/MRI, endoscopy)

More invasive tests (brush cytology, biopsies)

29
Q

What will imaging tell you about upper airway problems

A

Can localize, but will not provide definitive diagnoses UNLESS it is:

  • laryngeal paralysis
  • cervical tracheal collapse
  • foreign body
  • other anatomic/structural abnormalities
30
Q

Basic approach for lower airway/ lung problems

A

Less invasive tests (infectious disease screening, blood gas analysis, cytology, imaging)

More invasive tests (transthoracic FNA, airway washes, biopsies)

31
Q

Fecal testing for parasites- when should you do it? What test should you do if looking for resp parasites?

A

Do this diagnostic for all patients with cough!

Baermann is resp parasite check, but in practice you should also do float and sediment

32
Q

What signs clue you in to a lower airway/lung problem

A

Cough, tachypnea, expiratory distress

33
Q

What signs clue you in to upper airway problems?

A

Stridor, tachypnea, inspiratory distress, cough

34
Q

What signs clue you in to nasal problems?

A

Stertor, discharge, sneezing, open mouth breathing

35
Q

What can the blood gas help you determine?

A

Severity
Differentiate between pulmonary disease from hypoventilation
Monitor response to treatment

36
Q

What does pulse oximetry tell you

A

Measure saturation of hemoglobin, NOT the total content

*need to make sure the number fits with HR, RR, and breathing effort

37
Q

What is the FIO2: PIO2 ratio

A

Percentage of oxygen patient is breathing in to percentage of oxygen in their blood

Expect it to be 400 or more

Can’t use this for oxygen cages or nasal cannulas

38
Q

What is the hemoglobin dissociation curve

A

Sigmoid shape with a plateau at higher PaO2

39
Q

What does imaging tell you about lower airway/lung problems

A

Only definitive diagnosis unless it is tracheal/bronchial collapse, foreign bodies, anatomic/structural abnormalities

40
Q

What are differentials for alveolar pulmonary patterns

A

Fluid or tissue within alveolar spaces

Pneumonia, effusion, neoplasia

41
Q

What are differentials for interstitial pulmonary pattern

A

Increased tissue in interstitium

Fibrosis, neoplasia, inflammatory infiltrates

42
Q

What are differentials for bronchial pulmonary pattern

A

Bronchitis, asthma

43
Q

What would you use a trans-thoracic aspiration for?

What are complications?

A

Cytology and/or culture- mainly in patients with mass lesions or diffuse disease

Most patients will get a pneumothorax

44
Q

What are other very specific tests for lower airway/lung problems

A

Pulmonary function testing
Angiography
Scintigraphy

45
Q

What is a tracheal wash

A

Sample for large airways
Two main techniques- TTW and endotracheal lavage
Doesn’t require anesthesia
Limited use in cases of interstitial or focal disease

46
Q

What is a bronchoalveolar lavage

A

Two main techniques- bronchoscopy guided and endotracheal
Sample from small airways and alveoli
Limited use in cases of interstitial disease
Anesthesia required

47
Q

What should all airway washing techniques do?

What may they result in?

A

Bypass normal flora/debris from oral and pharyngeal cavities

May cause transient hypoxemia and crackles

48
Q

What cells should predominate in normal secretions

A

Large mononuclear cells

49
Q

What signs clue you in to a pleural space problem?

A

Tachypnea, inspiratory distress

50
Q

What diagnostics are available for pleural disease?

A

Imaging (rads, CT)
Thoracocentesis
Thoracoscopy/thoracotomy

51
Q

If a dog is coughing, what two thing do you need to differentiate between?

A

Heart disease or resp disease

*no murmur and no tachycardia prob means coughing is not cardiac related

52
Q

What are components of adequate oxygen delivery

A 
Oxygen in air
Enough air getting to lungs
Air can move from inside lung to blood
Blood is able to hold enough oxygen
Blood can get to tissues

Pulmonology (10 decks)

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