Pulm Flashcards
1
Q
spirometry
A
Measures flow rate and volume in inhalation and exhalation
Measures respiratory capacity
2
Q
FEV1 baries based on
A
gender, age, height, ethnicity
3
Q
sx asthma
A
vary, seasonal/allergies, wheezing, cough, breathlessness, chest tightness/discomfort
allergies and nasal polyps, accessory muscle use, hyperexpansion of chest and hunched shoulders, tachycardic, pulsus paradoxus, wheezing, long expiration
4
Q
asthma
A
Spirometry will show obstructive pattern with bronchodilator (BD) response (witches hat)
Allergy testing, chest xray and bronchial provocation
5
Q
intermittent asthma meds
A
No daily meds just SABA PRN
6
Q
mild persistent asthma meds
A
Low dose inhaled steroid. If that does not work, then use a leukotriene modifier such as theophylline
7
Q
moderate persistent asthma meds
A
Low dose inhaled steroid and LABA or medium dose inhaled steroid. If that does not work, give low dose inhaled steroid and leukotriene modifier such as theophylline
8
Q
severe persistent asthma meds
A
High dose inhaled steroid and LABA
9
Q
acute management asthma meds
A
immediate SABA (albuterol). If no complete response within 20 minutes, five 3 more SABA trmts in within 1 hour. If still no response, give oral or IV corticosteroids. If it is still not working, admit pt
10
Q
emerency asthma meds
A
give Epi
11
Q
what vassines should asthma pts get
A
influenza, pertussis, and pneumonia
12
Q
copd?
A
Chronic bronchitis + emphysema that leads to a fixed airway obstruction
13
Q
copd complications
A
Resp. Infections (bronchitis and pneumonia)
Heart failure (hard to get air in lungs? Hard to get blood too)
Cardiac ischemia
14
Q
ss copd
A
Daily productive cough 3 months or more for at least 2 yrs, high HgB, rhonchi, wheezing, peripheral edema, CXR hyperinflation and flat diaphragm, ABG and SpO2 are lower, Inc CO2 leads to respiratory acidosis and they compensate by metabolic alkalosis
15
Q
dx copd
A
Spirometry- concave witches hat pattern
Peak expiratory flow is NOT a criteria like asthma
DLCO
CXR- hyperinflated and flat diaphragm on emphysema
CBC
Oximetry
ABG
Serum alpha 1 antitrypsin in pts under 45
16
Q
trmt copd
A
Inhaled ipratropium (SAMA) with or without albuterol (SABA)
LABA or LAMA
Oral theophylline if not responsive to other meds
Lung transplant, lung reduction volume, bullectomy
17
Q
copd exacerbation
A
IV ATB such as macrolides (azithromycin) in patient
18
Q
emergency copd
A
breathing trmt with SAMA/SABA like albuterol and ipratropium, CPAP, BiPAP, intubation, vent support
19
Q
copd vaccines?
A
Get flu and pneumonia vaccines
20
Q
CF triad sx
A
COPD
Pancreatic exocrine insufficiency
High sweat electrolyte concentrations
21
Q
Bacterial pneumonia caused by staph aureus then pseudomonas aeruginosa (not in many other conditions). Pseudomonas aeruginosa is impossible to get rid of
A
cf
22
Q
dx cf
A
sweat chloride test
if ng get dna test- 7q
23
Q
cf trmt
A
Minimize airway reactivity and infections
24
Q
MC bacteria in bronchiectasis sputum are
A
H influenzae, pseudomonas aeruginosa, and strep pneumoniae
25
Sx bronchiectasis
dyspnea, wheezing, chest pain, crackles, productive cough
26
dx bronchiectasis
XCR- dilated airways and mucus plugging
| CT- airway changes
27
MC of the interstitial lung diseases
Idiopathic pulmonary fibrosis/ Idiopathic interstitial pneumonia
28
Idiopathic pulmonary fibrosis/ Idiopathic interstitial pneumonia is a dx of____
exclusion
29
Idiopathic pulmonary fibrosis/ Idiopathic interstitial pneumonia sx
Hypoxemia, inspiratory crackles, tachypnea
30
Idiopathic pulmonary fibrosis/ Idiopathic interstitial pneumonia dx
1st a Physical exam
2nd High resolution thin cut (HRTC) CT chest shows interstitial reticular linear changes and possible honeycombing
3rd Bloodwork to r/o rheum markers
4th Special studies
Bronchoalveolar lavage- r/o infections and malignancies
Transbronchial biopsy- r/o sarcoidosis, malignancy, TB
Surgical open lung biopsy- gold standard, but it’s riskier
31
Idiopathic pulmonary fibrosis/ Idiopathic interstitial pneumonia trmt
high dose steroids
32
UIP- usual interstitial pneumonia (a type of IPF)
progressive scarring of the lungs
33
UIP- usual interstitial pneumonia (a type of IPF) trmt
steroids, Antifibrotic and immunosuppressive modulators Not responsive
Only definitive trmt is a long transplant
34
Idiopathic pulmonary fibrosis/ Idiopathic interstitial pneumonia can be caused by this medicine
amiodarone
35
pts taking amiodarone should get this frequently
pft
36
Pneumoconiosis sx
Sx: weak, pale, cyanotic, rhonchi, wheezing, crackles/rales (heard on inspiration), pleural friction rub
37
Pneumoconiosis dx
PFT- restrictive
DLCO- reduced diffusion
CXR- linear/reticular interstitial marlins in the lower and mid lung fields and calcified thickening along the chest wall/diaphragm, ground glass appearance
Note: lung biopsy not needed
38
Pneumoconiosis trmt
supplemental O2
39
Lung cancer and mesothelioma are huge concerns!
pneumonicosis
40
sarcoidosis?
Inflammatory disease with noncaseating granulomas
41
sarcoidosis cause
Unknown cause possibly propionibacter acnes
42
Mc in nordic population
sarcoidosis
43
sarcoidosis sx
Multisystem- need 2+ organs to dx
44
sarcoidosis dx
XCR- shows micronodular interstitial densities and nodular granulomatous changes
Chest CT- nodules and mediastinal hilar adenopathy
45
sarcoidosis trmt
Single organ: topical therapy
| Multi-organ: oral steroids
46
sarcoidosis pts must have this test done
ophthalmic
47
pe ss
Ss: Sudden onset dyspnea, hypoxemia, tachycardia, light headed
48
pe dx
CXR normal
Chest CT with contrast (angio/spiral ct) shows small arterial emboli
VQ scan- old standard before CT, used only if pt has dye allergy
Serum D dimer should be positive
Ekg should be normal, but if you see S1Q3T3, it's most likely PE
49
pe trmt with rhf and hypotension
thrombolysis or thrombectomy
50
pe trmt with normal r ventricle function
anticoagulation
Heparin drip
Anticoagulation for 6 months (or 3 if only DVT)
51
sx pulm htn
Sx: dyspnea, chest pain, fatigue, peripheral edema, syncope
52
dx pulm htn
Measure right heart pressure by echocardiogram, swann-ganz catheter, right heart catheterization (gold std)
53
Classification of pulmonary HTN
WHO group 1- idiopathic, younger pts, more females than males
WHO group 2- from left heart disease
WHO group 3- from lung disease or hypoxemia
WHO group 4- secondary to chronic thromboembolism
WHO group 5- from blood disorders, systemic disorders, and metabolic disorders, miscellaneous
54
WHO group 1 pulm htn trmt
PDE 5 inhibitor (phosphodiesterase) (sildenafil)
Endothelin receptor antagonists (bosentan, ambrisentan)
cGMP stimulator/vasodilator
Prostaglandin- relax arterial smooth muscles
55
cor pulmonale
RV systolic and diastolic failure from lung disease or pulmonary CV disease
56
MCC from tobacco and exposure to heating/cooking fuel
cor pulmonale
57
cor pulmonale ss
Lower extremity edema, inc abdominal girth, dyspnea on exertion, inspiratory crackles, pulsatile liver with ascites, JVD, high serum Cr, abnormal liver function, albuminuria, paracentesis (clear straw colored fluid, a transudate), tachycardia with RAD (enlarged right heart), worsening renal failure
58
dx cor pulmonale
EKG shows: RVH, RV and RA dilated, tricuspid regurgitation, RVSP 100 mmHg normal is 12-25)
59
trmt cor pulmonale
IV diuretics, supplemental O2, Digoxin (inotrope)
60
Meniscus sign on CXR
pleural effusion
61
milky pleural effusion that clears with spinning
cells
62
milky pleural effusion that does not clear with spinning
lipids- chylothorax
63
pleural effusion: Hematocrit > 50%
hemothorax
64
pleural effusion Hematocrit 1- 50%
cancer
65
richard lights criteria is for
pleural effusion
66
trmt open pneumothorax
cover it mechanically
67
sx pneumothorax
Hypotension, tachycardia, rise in airway pressure, no breath sounds on affected side, percussion on affected side, trachea deviation, hyperexpanded chest
68
small asymptomatic < 15% pneumothorax trmt
observe it to see if it can resolve itself
69
large but <30% width pneumothorax trmt
thoracentesis or pleural catheter
70
large >30% width pneumothorax trmt
tube thoracostomy
71
after 2nd pneumo trmt
pleurodesis
72
pneumo trmt in field
needle throacostomy
73
pneumo trmt in hospital
chest tube
74
Fleischners society criteria- interprets
pulmonary nodules
75
Pulmonary nodules dx
MUST get chest CT +/- PET scan
76
Acute respiratory distress syndrome ARDS?
Fluid builds up in the alveoli/parenchyma of the lungs from leaky vessels
Alveoli collapse and impair O2 exchange
77
causes Acute respiratory distress syndrome ARDS ?
sepsis, toxic inhalation, severe pneumonia, head/chest trauma
78
sx Acute respiratory distress syndrome ARDS
Worsening SOB and resp failure; looks like heart failure but involves the periphery many times; lag from when it occurs until when you develop sx
Labored rapid breathing, low bp, fatigue, hypoxia
General criteria:
Resp sx within 1 wk of incident
CXR shows Bilateral opacities/fluid (pulm edema)
Resp failure not explained by CHF or fluid overload
Oxygenation impairment
79
dx ards
CXR shows Bilateral opacities/fluid (pulm edema)
80
Hyaline membrane disease (HMD) or neonatal respiratory distress syndrome (RDS) is due to
not enough surfactant in babies lungs
81
Will worsen in the first 48-72 hours, but improves with trmt
HMD
82
epiglottitis cause
HiB (MC), streptococci, staph aureus
83
risk factors Croup/ Laryngotracheobronchitis
Recurrent URI
Upper abnormalities such as stenosis and strictures
GERD
Intubation issues
84
MCC Croup/ Laryngotracheobronchitis
Parainfluenza virus 1 is the MCC
85
____ can occur secondarily in Croup/ Laryngotracheobronchitis
bacterial infection
86
sx Croup/ Laryngotracheobronchitis
Gradual, nasal irritation, congestion, fever, hoarseness, barking/seal cough, striador
87
dx Croup/ Laryngotracheobronchitis
```
Neck x ray- Steeple sign
CBC if you think a bacteria caused it
Westly croup severity scoring system- determines trmt
Mild- 2 or less
Moderate- 3 to 7
Severe- 8+
```
88
trmt Croup/ Laryngotracheobronchitis
Mild: home, supportive, hydration, humidity
Moderate: support, ER, steroids, bronchodilators, admit to hospital
Severe: ER, admit, aggressive
89
Excessive lacrimation and conjunctival injection are important early clinical findings
catarrhal phase of pertussis
90
Hallmark sx- paroxysmal cough
paroxysmal phase pertussis
91
dx pertussis
```
Cough less than 2 wks?
Culture and PCR
Cough 2-4 wks?
PCR only (bc culture sensitivity declines)
Cough 4+ wks?
Only serology
```
92
trmt pertussis
Most ppl fight this off without ATB (azithromycin/zithromax) within 6 wks
Catarrhal phase- ATB (azithromycin/zithromax) can decrease duration and cough, but it’s hard to catch in this phase
You can treat with ATB later, but it will only prevent the infection from spreading to others
Hydration, mucolytics, control airway
93
9th MC illness in outpt
acute bronchitis
94
MCC acute bronchitis
flu
95
sx acute bronchitis
Last 5-7 days
Productive or nonproductive cough that lasts over 5 days
Infection may go aways, but inflammation does not so the cough won't go away
96
trmt acute bronchitis
Cough suppressants, antipyretics, SABA, steroids, atb if sputum is present
Treat the inflammation to treat the disease. You’ll need more than 1 medication to do so or else the disease will “bounce back”. If you don't treat the disease, pts think they have the worst cold ever or a bad case of bronchitis
97
bronchiolitis?
Virus infects bronchiolar epithelial cells on small bronchi and bronchioles. These infected cells secrete mucus and swell which cause the airways to obstruct and may collapse
Starts as an URI then infects the LRT
98
risk factors bronchiolitis?
Children less than 2 yo
| Toxic fumes, viral infections, transplant, CT disease
99
mcc bronchiolitis?
RSV
100
sx bronchiolitis?
Cough, dyspnea, wheezing or crackles, inflammation in airways less than 2mm in diameter
Clinical course
1- viral URI symptoms
2- increased respiratory effort such as nasal flaring, sternal retractions, SOB, tachypnea, wheezing
If severe, you may see, hypoxemia, apnea, acute respiratory failure
101
dx bronchiolitis?
Clinical but you'll see…
PFT- airflow obstruction
CXR- normal
102
trmt bronchiolitis?
Healthy: self limited, support
Sick: hydration, ventilation, mucolytics, suctioning, bronchodilators
103
MCC lower respiratory infections in kids less than 1
RSV
104
MCC medical admissions in kids under 5
RSV
105
Almost all kids have been infected by age 2
RSV
106
Dx RSV
Isolate virus in HEp-2 cells- ID plaques with syncytium formation
Rapid assay-
nasal swabbing
107
trmt RSV
Support
Inhaled bronchodilators- use in kids with asthma or RAD, but NOT routinely
Corticosteroids- use in older children and adults but NOT infants
Ribavirin- can give to infants but not routinely
108
MC mechanism is upper airway colonization by aspirated organisms
pneumonia
109
pneumonia?
Infection of the parenchyma dt bacteria, viruses, fungi, and parasites
110
cause Community acquired/typical pneumonia?
MCC is streptococcus pneumoniae/pneumococcus but H flu and moraxella can also cause it
111
sx Community acquired/typical pneumonia?
Rust colored sputum, fever, chills, shaking,
112
dx Community acquired/typical pneumonia?
CXR- lobar infiltrates
113
trmt Community acquired/typical pneumonia?
In healthy: Macrolide (clarithromycin or azithromycin) or fluoroquinolone (levofloxacin, moxifloxacin)
If hospitalized and not in the ICU: IV beta lactam (cefuroxime, cefotaxime, ceftriaxone, ampicillin-sulbactam) and IV macrolide (erythromycin or azithromycin)
Follow up 3-4 days later. If no response to therapy, get a CXR to r/o bronchogenic carcinoma
114
atypical pneumonia cause
Mycoplasma pneumoniae, chlamydia pneumoniae, legionella pneumophila
115
atypical pneumonia dx
CXR- bilateral diffuse wispy infiltrates
116
atypical pneumonia trmt
beta lactam + antipseudomonal fluoroquinolone or aminoglycoside
117
Hospital acquired/nosocomial pneumonia risk factors
Intubation, nasogastric tube feeding, pre existing lung disease, multisystem failure
118
Hospital acquired/nosocomial pneumonia causes
Aerobic gram - bacteria like pseudomonas, klebsiella, acinetobacter
Aerobic gram + cocci like staph aureus
119
pneumonia sx
Productive cough, fever, pleuritic chest pain, dyspnea, fever, tachycardia, reduced oxygen saturation, rhonchi or rales, dullness to percussion (pulmonary effusion), egophony (from lung consolidation)
120
elderly may have this as their only sx of pneumonia
change in mental status
121
if you have diarrhea with your pneumonia, you prob have been infected by this organism
leigonella
122
common cause of post influenza pneumonia
staph aureus
123
complications pneumonia
Bacteremia, parapneumonic pleural effusion, empyema
124
sx active tb
Sx: cough * 3 wks, chest pain, hemoptysis, fatigue, weight loss, anorexia, fever, night sweats
125
dx active tb
+PPD (purified protein derivative)
CXR- abnormal
Sputum culture- positive
126
trmt tb
Long term ATB months - years (don't need to know specific meds)
127
Determine if tb is latent or active via
sputum culture
