Midterm Flashcards
1
Q
Asthma early-phase response
A
- peaks 30-60 minutes after exposure
- subsides 30-90 minutes later
- primary cause is bronchospasm
2
Q
asthma late-phase response
A
- primary cause is inflammation
- histamine and other mediators set up self sustaining cycle
- air trapping and lung hyperinflation occurs
3
Q
asthma signs and symptoms
A
- episodic wheezing
- dyspnea (most common)
- chest tightness
- cough
- frequently worse at night
4
Q
asthma physical exam red flags
A
- fatigue
- diaphoresis
- cyanosis
- no wheezing
5
Q
Intermittent asthma
A
- symptoms: less than or equal to 2 days/week
- night awakenings: less than or equal to 2/month
- use of SABA: less than or equal to 2 days/week
- ADL interference: none
- FEV1: >80% predicted
- FEV1/FVC: normal
- treatment: step 1
6
Q
mild persistent asthma
A
- symptoms: >2 days/week but not daily
- night awakenings: 3-4/month
- SABA use: >2/week but not daily and no more than 1/day
- ADL interference: minor
- FEV1: >80% predicted
- FEV1/FVC: normal
- treatment: step 2
7
Q
moderate persistent asthma
A
- symptoms: daily
- night awakenings: >1/week, but not nightly
- SABA use: daily
- ADL interference: some limitation
- FEV1: >60% but <80% predicted
- FEV1/FVC: reduced 5%
- treatment: step 3
8
Q
severe persistent asthma
A
- symptoms: throughout the day
- night awakenings: often 7/week
- SABA use: several times per day
- ADL interference: extreme limitation
- FEV1: <60% predicted
- FEV1/FVC: reduced >5%
- treatment: step 4 or 5
9
Q
obstructive lung disease examples
A
COPD
asthma
bronchiectasis
cystic fibrosis
10
Q
restrictive lung disease examples
A
interstitial lung disease
chest wall abnormalities
obesity
ALS
11
Q
obstructive PFT
A
- FEV1: reduced
- TLC: normal or increased
- FEV1/FVC: reduced
12
Q
restrictive PFT
A
FEV1: normal or reduced
TLC: reduced
FEV1/FVC: normal or increased
13
Q
inspiratory capacity
A
inspiratory reserve volume and tidal volume
14
Q
functional residual capacity
A
expiratory reserve volume and residual volume
15
Q
vital capacity
A
inspiratory reserve volume, tidal volume, and expiratory reserve volume
16
Q
PFT reversible obstruction definition
A
increase of 12% or more and 200mL increase in FEV1 or FVC
17
Q
bronchoprovocation
A
- methacholine challenge
- mannitol challenge
- exercise testing
- not recommended if FEV1 is <70% predicted
18
Q
5 components of asthma management
A
- assess control and severity
- severe versus uncontrolled
- appropriate pharmacology
- address modifiable risk factors and environmental concerns
- self management and education
19
Q
LABA
A
- indicated for bronchodilation maintenance
- helps with nocturnal symptoms
20
Q
short acting anticholinergic
A
- reduces vagal tone of the airway
- useful for severe exacerbation when combined with SABA
21
Q
long acting muscarinic agent
A
- reduces vagal tone of the airway
- works well in COPD
- slow onset of action 60-90 minutes
22
Q
inhaled corticosteroids
A
- suppress acute and chronic airway inflammation
- inhibit inflammatory cell migration
- block late phase reaction
- first line maintenance therapy for persistent asthma
23
Q
leukotriene receptor antagonist
A
- decreases airway smooth muscle activity
- decreases mucus production
- used in long term control but with variable effect
- alternative to ICS in mild persistent
24
Q
mast cell stabilizers
A
- prevent bronchoconstriction
- for prevention and maintenance
- trial of 6-8 weeks needed before effectiveness known
25
methylxanthines
- causes bronchodilation
- suppresses response of airway to stimuli
- 2nd/3rd line treatment for moderate to severe
- can cause toxicity and drug interactions
26
step 1 treatment
SABA
27
step 2 treatment
- low dose ICS
| - SABA
28
step 3 treatment
-low dose ICS and LABA combo
29
step 4 treatment
-medium dose ICS and LABA
30
step 5 treatment
medium to high dose ICS/LABA and LAMA
31
asthma exacerbation treatment
BIOMES
```
Beta agonists
Ipratropium (and IV access)
Oxygen
Mag
Epinephrine
Steroids
```
32
emphysema
- permanent enlargement of airspace due to alveolar destruction
- increased CO2 retention
- pursed lip breathing
- thin with barrel chest
- accessory muscle use
33
chronic bronchitis
- extensive bronchial mucus
- daily productive cough for 3 consecutive months
- cyanotic/dusky
- hypoxic
- digital clubbing
- exertional dyspnea
- accessory muscle use
34
COPD causes
- smoking #1
- occupational dust/chemicals
- air pollution
- genetic factors
- Hx allergies and recurrent bronchitis
- alpha1 antitrypsin deficiency
35
pack year
(# packs/day) x (# years)
36
COPD GOLD 1
- mild
| - FEV1 greater than or equal to 80% predicted
37
COPD GOLD 2
-moderate
| FEV1: 50-80% predicted
38
COPD GOLD 3
-severe
| FEV1 30-50% predicted
39
COPD GOLD 4
-very severe
| FEV1: <30% predicted
40
COPD group A treatment
- 0-1 moderate exacerbation but no admission
- mMRC 0-1
- CAT <10
bronchodilator
41
COPD group B treatment
- 0-1 moderate exacerbation but no admission
- mMRC 2 or more
- CAT 10 or more
LABA or LAMA
42
COPD group C treatment
- 2 or more moderate exacerbation or 1 or more exacerbation with admission
- mMRC 0-1
- CAT <10
LAMA
43
COPD group D treatment
- 2 or more moderate exacerbation or 1 or more exacerbation with admission
- mMRC 2 or more
- CAT 10 or more
LAMA
LAMA + LABA (highly symptomatic CAT>20)
ICS + LABA (eos >300)
44
COPD treatment steroids
- inhaled reduce exacerbation frequency in combination with LABA
- not responsive to oral steroids but a subset of steroid responsive may warrant a trial
45
COPD treatment antibiotics
- azithromycin as prophylaxis for exacerbation and anti-inflammatory
- macrolide (azithromycin)
- amoxicillin clavulanate
- trimethoprim sulfamethoxazole
- fluoroquinolones (ciprofloxacin)
- doxycycline
46
COPD treatment when hospitalized
- oxygen
- broad spectrum antibiotics (levofloxacin, ceftriaxone, piperacillin tazobactam)
- usually nebulizers/IV steroids
47
community acquired pneumonia
- streptococcus pneumonia most common cause
- right middle lobe most common site
- x-ray gold standard for diagnosis
48
atypical pneumonia
- mycoplasma pneumoniae most common (walking pneumonia) with CXR bilateral patchy infiltrate
- pneumocystis jiroveci in HIV positive
49
tools to admit pneumonia patient
- PORT score to assess outpatient CAP Tx
| - CURB score for admission decision
50
hospital acquired pneumonia
develops 48 hours after admission
51
ventilator associated pneumonia
develops 48 hours after intubation
52
viral pneumonia
- flu like
- patchy infiltrates on CXR
- most common in kids
53
strep pneumonia
- red-brown rusty sputum
- lobar
- gram + diplococci
54
H influenzae pneumonia
- COPD patients
| - small gram - rods
55
klebsiella pneumonia
- alcoholics, aspiration
- currant jelly sputum
- encapsulated gram - rod
56
staph pneumonia
- pink salmon colored sputum
- often nosocomial
- gram + cocci in cluster
57
mycoplasma pneumonia
- young adults
| - CXR looks worse than patient
58
pseudomonas pneumonia
ICU
immunocompromised
CF patients
59
legionella pneumonia
- air conditioners
| - GI and CNS symptoms that start later
60
pneumocystitis jiroveci
- HIV patients
- white out CXR
- Tx with bactrim
61
TB pneumonia
fever, night sweats, weight loss, bloody sputum
62
pH normal
7.35 - 7.45
63
PaCO2 normal
35 - 45
64
HCO3 normal
22 - 26
65
PaO2 normal
>80
66
SaO2 normal
>95
67
acidosis causes
increased CO2
| decreased HCO3
68
alkalosis causes
decreased CO2
| increased HCO3
69
respiratory acidosis
decreased pH
| increased pCO2
70
respiratory acidosis with compensation
decreased pH
| increased HCO3
71
metabolic acidosis
decreased pH
| decreased HCO3
72
metabolic acidosis with compensation
decreased pH
| decreased pCO2
73
respiratory alkalosis
increased pH
| decreased pCO2
74
respiratory alkalosis with compensation
increased pH
| decreased HCO3
75
metabolic alkalosis
increased pH
| increased HCO3
76
metabolic alkalosis with compensation
increased pH
| increased pCO2
77
anion gap calculation
Na - (HCO3 + Cl)
78
decreased anion gap Dx
hypoalbumenemia
hyponatremia
monoclonal protein
79
elevated anion gap Dx
MUDPILERS
```
methanol
uremia
DKA
propylene glycol
isoniazid intoxication
lactic acidosis
ethanol
rhabdo
salicylates
```
80
respiratory acidosis causes
- head trauma
- airway obstruction
- pneumonia
- decreased surface area
81
respiratory alkalosis causes
- hyperventilation
| - ascent to high altitude
82
acute bronchitis
- self limiting inflammation of the tracheobronchial tree due to upper airway infection
- lots of coughing that can last 5 days to 2 weeks (8 weeks not unheard of)
83
acute bronchitis symptoms
- coughing
- fever is unusual
- wheezing may occur secondary
- 50% have purulent sputum
- important to rule out pneumonia
84
acute bronchitis cause
- 85% are caused by a virus
| - influenza, coronavirus, rhinovirus, RSV
85
acute bronchitis with bacterial cause
- can occur in patients with tracheostomy or intubated
- mycoplasma pneumoniae
- chlamydia sp.
- bordetella pertussis
86
acute bronchitis signs
- pharyngeal erythema
- no parenchymal consolidation
- CXR non specific
87
acute bronchitis treatment
- symptomatic: NSAIDs, tylenol
- OTC cough meds
- Rx cough meds
88
influenza treatment
-antivirals administered if within 48 hours of symptoms onset
89
pertussis
- respiratory tract infection caused by bordetella pertussis
- consider for cough lasting more than 3 weeks
- 50% in <2 years old
- no lasting immunity from vaccine or active infection
90
pertussis catarrhal stage
- 7-10 days
- insidious onset
- mild fever
- hacking cough at night
- coryza
- conjunctivitis
91
pertussis paroxysmal stage
7-28 days
- spasmodic rapid coughing
- followed by inspiratory stridor
92
pertussis convalescent stage
- several months
| - decreasing severity and frequency of symptoms
93
pertussis diagnosis
nasopharyngeal culture swab = gold standard
94
pertussis treatment
-macrolides for all suspected cases
(end in -thromycin)
-prophylaxis for those exposed within 3 weeks
95
bronchiectasis
- disorder of large bronchial with permanent abnormal dilation and destruction of bronchial walls
- congenital or acquired
- local or diffuse
96
bronchiectasis causes
- 50% caused by cystic fibrosis
- lung infections
- RA
- localized airway obstruction
97
bronchiectasis clinical findings
- chronic cough with copious purulent sputum
- hemoptysis
- pleuritic chest pain
- 75% dyspnea/wheezing
- weight loss
- persistent crackles at lung base
- digital clubbing = chronic sign
98
bronchiectasis imaging
-CT is diagnostic study of choice
99
bronchiectasis treatment
Acute
- antibiotics
- chest physiotherapy
- inhaled bronchodilator
cystic fibrosis
-use of aerosolized aminoglycoside
100
RSV
- form of paramyxovirus
- leading cause of hospitalization of children
- highly contagious
101
RSV presentation
```
fever
rapid breathing
cough
possible accessory muscle
runny nose
nasal flaring
```
102
RSV treatment
- O2
- hydration
- treat the fever
- ribavirin in extreme cases
- clear nasal passages
103
bronchiolitis
- generic term for inflammatory processes that affect the bronchioles
- usually caused by RSV
- most common in under 2
- clinical diagnosis
104
bronchiolitis treatment
- majority can be discharged
| - deep nasal suctioning
105
constrictive bronchiolitis
- common after inhalation injury
- airflow obstruction on PFT
- chronic condition
106
croup causes
- parainfluenza most common
- also RSV and flu
- bacterial pneumonia may be secondary
children 3-36 months
107
croup clinical findings
- gradual onset of symptoms
- barking cough
- hoarse voice
- inspiratory stridor
- mild fever
- often at night
108
croup severity
westley croup score
109
croup treatment
- mild: humidified air, antipyretics, fluid
- moderate: single dose dexamethasone, nebulized Epi
- severe: repeated nebulized epi with admission if no improvement
- impending respiratory failure: O2, ICU, scheduled epi, IV steroids
110
epiglottitis
- inflammation of epiglottis and adjacent supraglottic structures
- in children primarily caused by H. influenza type B, strep, and staph
111
epiglottitis clinical findings
- febrile toxic appearing children with rapid onset
- dysphagia
- drooling
- tripoding
- hot potato voice
112
epiglottitis treatment
- defer pharyngeal exam
- stabilize airway
- draw labs before ABX
- empiric ABX cefotaxime or ceftriaxone plus clindamycin or vancomycin
