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PCM 3 final > Lung > Flashcards

Lung Flashcards

1
Q

Chapman Point: Parasternal, between 2nd & 3rd intercostal space

A

Esophagus, bronchus

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2
Q

Posterior Chapman point T2

A

Esophagus, bronchus

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3
Q

Parasternal, between 3rd & 4th intercostal space Chapman point

A

Upper lung

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4
Q

Chapman point T3

A

Upper lung

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5
Q

Chapman point Parasternal, between 4th & 5th intercostal space

A

lower lung

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6
Q

posterior chapman point T4

A

lower lung

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7
Q
  • Cough lasting 1 - 3 weeks
  • Cough may or may not be productive
  • Constitutional symptoms
  • May be preceded by mild URI symptoms which resolve leaving the cough as the primary symptom.
  • Physical exam may include rhonchi with or without wheezing. Rhonchi clears with coughing.

NO EVIDENCE OF PNEUMONIA OR COPD

A

Acute Bronchitis

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8
Q

What is most common cause of acute bronchitis?

A

Most often caused by viral infections:

  • influenza,
  • rhinovirus,
  • coronavirus 1-3,
  • parainfluenza,
  • human metapneumovirus and RSV.

Occasionally B. pertussis, M. pneumonia and Chlamydophila pneumonia.

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9
Q

What is tx of acute bronchitis?

A

Reassurance and symptomatic relief

  • if needed acetaminophen, NSAIDs, cough drops
  • AVOID ABX
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10
Q

What are the 3 phases of pertussis

A
  1. Catarrhal phase
  2. Paroxysmal phase
  3. Convalescent phase
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11
Q

What pertussis phase lasts 1-2 weeks, characterized by nonspecific symptoms including generalized malaise, rhinorrhea, and mild cough. May have low grade fever. Hallmarks include excessive lacrimation and conjunctival injection.

A

Catarrhal phase

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12
Q

What pertussis phase starts during the second week of illness with a
-series of severe, vigorous coughs that occur during a single expiration (paroxysmal cough).

  • May be followed by a characteristic vigorous inspiration that has a distinctive ‘whooping’ sound.
  • Post-tussive syncope or emesis can also occur. Patient often feel otherwise well with few symptoms between cough paroxysms.
A

Paroxysmal phase

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13
Q

How long does paroxysmal phase last untreated?

A

2-3 months

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14
Q

What phase of pertussis general reduction in the frequency and severity of cough. Duration may last up to three months.

A

Convalescent

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15
Q

How should you treat pertussis

A

Abx within 3 weeks of cough onset - macrocodes drug of choice

  • avoid opioid based cough suppressants
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16
Q

Clinical presentation of
- Fever, cough (may or may not be productive)

  • Tachypnea,
  • Dyspnea
  • Rales (75-80% of cases)

+ Infiltrates on chest x-ray (PA & lateral)—may be negative early in the disease or with dehydration.

A

Pneumonia

17
Q

What are PE pneumonia findings?

A
  1. Tachypnea >20 bpm
  2. dullness to percussion
  3. tactile fremitus or egophony

4.Both fine and coarse rales, and wheezing may be present.

18
Q

What pathogen accounts for the majority of pneumonia cases?

A

S. Pneumonia

19
Q

How is severity of pneumonia assessed?

A

CRB-65 table

20
Q

What is CURB/CRB criteria?

A
  1. New onset confusion
  2. Severe Tachypnea
  3. Hypotension
  4. age>65
21
Q

When should you hospitalize based on CURB/B?

A

1 or more

  1. New onset confusion
  2. Severe Tachypnea
  3. Hypotension
  4. age>65
22
Q

What is clinical presentation of COPD?

A
  1. Productive cough featuring sputum production for ≥3 months for 2 consecutive years.
  2. Chronic Dyspnea
  3. FEV1/FVC < 0.7 on spirometry confirms the diagnosis of COPD; patients should receive annual spirometry to monitor disease and/or progression
23
Q

What is risk of COPD/emphysema?

A
  1. Cigarette Smoking is the largest risk factor and is associated with more severe emphysema
  2. Can also be caused by occupational exposures (firefighters, welders)
  3. α 1-antitripsinase deficiency
24
Q
  • increased AP diameter of the chest (barrel chest)
  • prolonged expiration on auscultation
  • hyper-resonance with percussion of the chest wall
  • Patient may display pursed-lip breathing in effect creating positive end expiratory pressure to support ventilation/oxygenation
A

COPD

25
Q

When should you order a 2 view cxr?

A

concern of pneumonia

not for bronchitis or COPD

26
Q

When should you used PFT/spirometry

A

annually for COPD (not for bronchitis or pneumonia)

27
Q

How do you treat cough for pneumonia?

A

Setromethorphan or guaifensesin

28
Q
  • Episodic or chronic symptoms of wheezing, dyspnea, or cough.
  • 􏰀 Symptoms frequently worse at night or in the early morning.
A

Asthma

29
Q

PE for asthma?

A
  • prolonged expiration and diffuse wheeze

- 􏰀 Obstructive pattern that is reversible following bronchodilator therapy

30
Q

How long is pertussis vax protector

A

5-10 years

31
Q

What is clinical presentation of pertussis?

A
  1. paroxysms of cough followed by mild URI sx
  2. Worse at night
  3. Post-tussive emesis is best predictor in adults
  4. Patients feel well between coughing bouts

PE is unremarkable

32
Q

When should you do nasopharyngeal PCR and culture

A

Pertussis

Cough week 1-2: culture and PCR

cough week 2-4: PCR>culture

beyond week 4 only serology

33
Q

How do you manage pertussis cough?

A

Dextromethorphan avoid opioid cough suppressants

34
Q

How do you treat asthma cough?

A

ICS or ICS+LABA

35
Q

What is asthma green zone?

A

> 80% personal best, continue meds

36
Q

What is asthma yellow zone?

A

50-79% personal best

-increase and retest in 20-30 min

37
Q

What is Red zone

A

<50% personal best - emergency!

38
Q

What is first line therapy in COPD?

A

Noninvasive positive pressure ventilation (NIPPV

  • this is also ofter first therapy in Acute respiratory failure
39
Q

What is NIPPV

A

is a full face mask or nasal mask that delivers oxygen under pressure.

It is appropriate in patients that can manage their own secretions, can protect and maintain the patency of their own airway

PCM 3 final (3 decks)

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