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cardio and pulm > pulm(chapter 3-flashcard machine) > Flashcards

pulm(chapter 3-flashcard machine)

1
Q

reason for hospitalization of pneumonia

A

neutropenia, more than one lobe affected, poor host, Over 50 with co-morbidities

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2
Q

pneumocystis manisfestations

A

immunosuppression, slow onset, hypoxemic, interstitial infiltrates, increased lactate dehydronase

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3
Q

noscomial pneumonia tx

A

cefepime, ticarcillin/clavulanic, pipercillan/tazobactum, meropenem.

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4
Q

lung cancer labs

A

cytologic exam of sputum and PET

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5
Q

infectious granulomas from old/active TB(or fungal inf, FB inf)

A

solitary pulmonary nodule. 40% malignant

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6
Q

SPHERE(lung cancer complications)

A

SVC syndrome, pancoasts tumor, horners syndrome, endocrine, recurrent laryngeal nn, effusions

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7
Q

SVC syndrome

A

plethora(excess blood), HA, mental status change

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8
Q

Pancoasts tumor

A

Lung apex tumor, causes horners syndrome, shoulder pain,

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9
Q

horners syndrome

A

unilateral facial anhidrosis(lack of sweating), ptosis(droopy eyelid), miosis(constriction of pupil)

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10
Q

carcinoid syndrome

A

flushing, diarrhea, telangiectasias(small blood vessels), wheezing, hypoTN

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11
Q

carcinoid tumors common sx

A

usually asymptomatic;can have hemoptysis, cough, focal wheezing, recurrent pneumonia, obstruction

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12
Q

bronchoscopy reveals pink or purple central lesion that is well vascularized. may be pedunculated or sessile

A

carcinoid tumor, do a CT and octreotide scintigraphy to localize. no radiation or chemo, do surgical excision

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13
Q

stongest predisposing factor to asthma

A

atopy(triad is wheeze, excema, seasonal rhinitis)

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14
Q

Pa02 <60mmHg and PaCO2 >40mmHg.

A

asthma

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15
Q

methocholine challenge

A

bronchial provocation test, FEV1 decrease >20% is diagnostic(do when PFT nml and asthma is expected)

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16
Q

What is bronchiectasis?

A

abnormal permanent dilatation from bronchi causing destruction of bronchial walls. usually congenital(CF), recurrent infections, obstruction(tumor), or injury

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17
Q

bronchiectasis sx, PE, labs, tx

A

sx: chr purulent sputum(yellow/green/fowl smell), hemoptysis, chr cough, recur.pneumona;
PE: rales, wheeze, localized crackles and clubbing;
DX: **high resolution CT(definitive test: shows dilated tortuous airways), abn CXR(tram lines, honeycombing, atelectasis, crowded bronchial markings, & basal cystic spaces)
bronchoscopy for eval of hemoptysis, remove secretions, rule out obstructing lesions;
tx is antibx, bronchodilators(acute exacerbations), chest physiotherapy, surgery/transplant if necessary

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18
Q

CXR shows crowded bronchial markings and basal cystic spaces, tram track lung markings, honeycombing, atelectasis

A

bronchiectasis

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19
Q

bronchiectasis antibx tx

A

10-14 days. amox, augmentin, bactrim, Cipro

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20
Q

pink puffers clinical findings

A

emphysema; exertional dyspnea, thin, no peripheral edema, *barrel chested, hyperventilation, wasted appearance with pursed lips, minimal cough

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21
Q

pink puffer CXR

A

parenchymal bullae and subpleural blebs!! decreased lung markings, hyperinflation, decreased lung markings at apices, small thin heart, flattened diaphrams

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22
Q

blue bloaters clinical findings

A

bronchits; overweight, chr prod cough, peripheral edema, *pursed lip breathing, noisy lungs

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23
Q

blue bloaters CXR

A

increased interstitial markings at bases, diaphrams not flattened

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24
Q

What is emphysema?

A

enlarged air spaces due to destruction of alveolar septae; may be secondary to smoking; pink puffer

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25
Q

parenchymal bullae and blebs

A

emphysema; pink puffer

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26
Q

What is chr bronchits/COPD?

A

chr cough prod of phlem for most of 3 months for 2 years; blue bloater

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27
Q

Rhonchi on exam; breathing raspy and loud; rhonchi definition

A

chr bronchitis; rhonchi(secretions in airways)

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28
Q

CBC shows polycythemia(caused by chr hypoxemia); FEV1/FVC is decreased

A

COPD

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29
Q

sweat chloride test(>60) on 2 days

A

CF

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30
Q

clubbing, chronic cough, increased AP diameter, apical crackles, nasal polyposis, hemoptysis

A

CF

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31
Q

CF ABG

A

hypoxemia and advanced d/s has chronic compensated resp acidosis

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32
Q

pneumothorax sx

A

increased unilateral chest expansion, decreased tactile fremitus, hyperresonance, diminished breath sounds

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33
Q

pneumothorax labs/xray

A

CXR shows presence of pleural air, visceral pleural line is evidence. ABG analysis shows hypoxemia.

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34
Q

virchows triad

A

hypercoagulable state, venous stasis, vascular intimal inflammation/injury

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35
Q

3rd leading cause of deaths in hospitalized pts

A

DVT

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36
Q

PE pt sx

A

pleuritic chest pain, dyspnea, apprehension, cough, hemoptysis, diaphoresis

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37
Q

PE exam findings

A

accentuation of pulmonary component of 2nd heart sound, tachypnea, tachycardia, crackles,low fever

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38
Q

ABG finding in PE

A

acute respiratory alkalosis secondary to hyperventilation

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39
Q

PE test to order

A

*pulmonary angiography(invasive); do spiral CT first

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40
Q

EKG shows S1Q3T3

A

cor pulmonale seen in 20% of pt with symptomatic PE

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41
Q

PFT shows FEV1/FVC ratio nml and decreased lung volume

A

restrictive. idiopathic pulm fibrosis

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42
Q

4 appropriate meds for CAP

A

doxy, emycin, macrolide, FQ

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43
Q

interstitial infiltrates

A

pneumocystis

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44
Q

legionella comes from what

A

exposure to contaminated water droplets from cooling and ventilation systems

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45
Q

segmental unilateral lower lung zone infiltrates or diffuse infiltrates

A

atypical CAP

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46
Q

what is a neuramididase inhibitor

A

antiviral for atypical CAP; inhaled zanamivir or oral oseltamivir

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47
Q

diffuse or perihilar infiltrates on CXR

A

HIV pneumo

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48
Q

pneumocystis sx

A

fever, non prod cough, tachypnea, dyspnea

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49
Q

post tussive rales

A

TB

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50
Q

hilar/paratracheal lymph node enlargement, segmental atelectasis

A

primary TB

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51
Q

fibrocavitary apical disease(upper lung lobes)

A

reactivation TB

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52
Q

ghon complexes

A

calcified primary focus(TB)

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53
Q

ranke complexes

A

calcified primary focus and calcified hilar lymph nodes (TB)

54
Q

definitive diagnosis for TB

A

from cultures, DNA or RNA amplification techniques. bx shows noncaseating granulomas

55
Q

bx shows noncaseating granulomas

A

TB histologic hallmark

56
Q

bacille calmette-guerin

A

vaccine for TB neg people with high risk.

57
Q

expiratory rhonchi or wheeze; neg CXR

A

acute bronchitis

58
Q

tx for acute exacerbations of chronic bronchitis

A

1st line: second gen ceph; 2nd line is macrolide or bactrim

59
Q

sx of resp distress in brochiolitis

A

nasal flaring, tachypnea, retractrions

60
Q

CXR in bronchiolitits

A

nml but can show air trapping and peribronchial thickening

61
Q

what has reduced epiglotitits

A

H influenza vaccacine(HIB)

62
Q

high fever, severe dysphagia, drooling

A

epiglotitits

63
Q

viral laryngotracheobronchitis is also called what

64
Q

what can help aid in dx bronchogenic carcinoma

A

positron emission tomography

65
Q

solitary pulmonary lesion with low probability of malignancy tx

A

CT every 3 months for a year, if stable then every 6 months for 2 yrs

66
Q

solitary pulmonary lesion with high probability of malignancy tx

A

resection ASAP!

67
Q

solitary pulmonary lesion with intermediate probability of malignancy tx

A

transthoracic needle bx or bronchoscopy if perpheral. **high resolution CT or PET can help.

68
Q

malignancy of solitary pulmonary nodule

A

40% malignant and represent carcinoma, hamartoma, mets(multiple) as well as bronchial adenoma(95% carcinoid tumors); malignancy rare under 30 y/o and high risk in smokers

69
Q

benign/malignancy criteria of solitary pulmonary nodule

A

benign if it hasn’t enlarged in 2 years; malignant are symptomatic, age over 45, over 2cm, indistinct margins, rapid progression

70
Q

carcinoid tumors common where

71
Q

asthma definition and 3 components

A

def: chr inflammation leading to airway narrowing and inc mucus production
1) obs of airflow
2) bronchial hyperactivity
3) inflammation of airway

72
Q

asthma sx(5) and when are the sx worse

A

dry cough, episodic wheeze, chest tightness, wheezing(only 1/3 of pts), prolonged EXPIRATION with wheeze, sx worse at night

73
Q

exacerbation factors of asthma (7)

A

NSAIDs, aspirin, post-nasal drip, GERD, ACE, cold air, stress

74
Q

atopy triad

A

atopy(triad is wheeze, excema, seasonal rhinitis)

75
Q

dry cough, episodic wheeze, chest tightness, wheezing(only 1/3 of pts), prolonged EXPIRATION, sx worse at night or early morning

76
Q

test for asthma

A

PFT: gold standard in making the diagnosis. reversible obstruction (decreased FEV1, decreased FEV1/FVC ratio, increased RV, TLC, and RV/TLC)

77
Q

when to do an ABG in asthma

A

if pt is ill; severe asthma will show hypoxemia, hypercapnia, Pa02 <60; PaCO2 >40; acute respiratory alkalosis.

78
Q

asthma tx pneumonic

A

albuterol, steroids, theophylline(rare), humidified O2, Mg, anticholinergics

79
Q

FEV1 < FVC

A

obstructive

80
Q

obstructive FEV1–FVC ratio

A

FEV1 < FVC

81
Q

FEV1 > FVC

A

restrictive

82
Q

restrictive FEV1–FVC ratio

A

FEV1 > FVC

83
Q

TLC in obstructive vs restrictive

A

obs: nml to elevated; res: decreased

84
Q

FEF 25%-75% in obstructive vs restrictive

A

obs: <80% and res: nml to elevated

85
Q

FEV1/FVC in obstructive vs restrictive

A

obs: <80% and res: nml to elevated

86
Q 
ASTHMA SYMPTOM OCCURANCE DAY/NIGHT
intermittent
mild persistant
moderate persistant
severe persistant
A
  • intermittent: 1-2 days/wk; 1-2 nights/month; nml activities fine
  • mild persistant: over 2 days/wk(not daily); 3-4 nights/month; minor limitation
  • moderate persistant: daily; over 1 night/wk; some limitation
  • severe persistant: continual; often 7 nights a wk; extreme limitation
87
Q 
USE OF RESCUE ASTHMA MEDICATION
intermittent
mild persistant
moderate persistant
severe persistant
A

intermittent: under 2 days/wk
mild persistant: over 2 days/wk
moderate persistant: daily
severe persistant: several times a day

88
Q 
FEV1 in types of asthma
intermittent
mild persistant
moderate persistant
severe persistant
A

intermittent: under 80%
mild persistant: over 80%
moderate persistant: 60-80%
severe persistant: under 60%

89
Q 
FEV1/FVC ratio in asthma
intermittent
mild persistant
moderate persistant
severe persistant
A

intermittent: nml
mild persistant: nml
moderate persistant: reduced 5%
severe persistant: reduced over 5%

90
Q

medications for asthma
intermittent
mild persistant

A

-all short acting prn bronchodilator
intermittent: no daily med
mild persistant: daily low dose inh CCS

91
Q

medications for asthma
moderate persistant
severe persistant

A
  • all short acting prn bronchodilator
  • moderate persistant: low to medium inh CCS plus long actiing inh B2 agonists
  • severe persistant: high dose inh CCS plus long acting inh B2 agonists; poss po CCS
92
Q

B2 agonists

A
  • albuterol: short acting; relaxes bronchial smooth mm

- salmeterol: long acting for prophylaxis

93
Q

muscarinic antagonists

A

ipratropium: competively blocks muscarinic receptors therefore preventing bronchoconstriction.
* never use alone for asthma

94
Q

corticosteroids for asthma

A
  • inh CCS 1st line for long term control

- becomethasone, prednisone: inhibit synthese of cytokines

95
Q

methylxanthines

A

theophylline: bronchodilation. careful due to narrow therapeutic-toxic index. (cardio and neurotoxicity)

96
Q

cromolyn

A

prevents release of vasoactive mediators from mast cells. good for exercise induced bronchospasm. *only for prophylaxis- not during an attack

97
Q

antileukotrines

A

montelukast and zafirlukast: blocks leukotrine receptors

98
Q

tram lines

A

bronchiectasis

99
Q

crowded bronchial markings with basal cystic spaces

A

bronchiectasis

100
Q

CT shows dilated tortuous airways

A

bronchiectasis

101
Q

chronic purulent sputum, recurrent pneumonia, chr cough, hemoptysis

A

bronchiectasis

102
Q

CF sx

A

clubbing, chronic cough, increased AP diameter, apical crackles, nasal polyposis, hemoptysis, bronchiectasis

103
Q

hyperresonance to percussion; nasal polyposis

104
Q

def of CF

A

autosomal RECESSIVE d/p caused by mutation on chromosome 7 resulting in abn production of mucos by ALL exocrine glands, causing obs of those glands and ducts

105
Q

most common severe genetic disease in US

106
Q

CF frequently occurs in what race

107
Q

CF has increased risks of what

A

malignancies in GI tract, osteopenia, arthropathies

108
Q

CF usually seen when

A

newborn screening due to obs of distal ileum due to abnormally thick meconium

109
Q

Why is there FTT in CF in babies

A

due to pancreatic insufficiency

110
Q

pancreatic insufficiency sx(8)

A

greasy stools, flatulence, pancreatitis, rectal prolapse, HYPOproteinuria, biliary cirrhosis, jaundice, esophageal varieces

111
Q

abnormal sx in CF (4)

A

type 2 DM, salty tasting skin, male infertility(ageosis of vas def), unexplained hyponatremia

112
Q

malabsorption in CF

A

fat soluble vitamin deficiency: A, D, E, K; look for night blindness, rickets, neuropathy, coagulopathy

113
Q

greasy stools, flatulence, pancreatitis, rectal prolapse, HYPOproteinuria, biliary cirrhosis, jaundice, esophageal varieces

A

pancreatic insufficiency sx

114
Q

how to confirm CF besides sweat chloride test

A

genetic DNA testing

115
Q

PFT in CF

A

mixed obs/rest pattern

116
Q

CXR in CF

A

hyperinflation, peribronchial cuffing, mucous plugging, bronchietasis(thin cut CT shows too), inc intersitial markings, small round peripheral opacities, focal atelectasis, pneumothorax

117
Q

hyperinflation, peribronchial cuffing, mucous plugging, bronchietasis, inc intersitial markings, small round peripheral opacities, focal atelectasis, pneumothorax

118
Q

tx in CF

A

1) manage pulm manisfestations, chest PT, bronchodilators, CCS, antibx for pseudomonas, DNase
2) maybe give pancreatic enzymes or fat soluble vitamins
3) high calorie and high protein diet
4) ?transplant

119
Q

parenchymal bullae and subpleural blebs!! decreased lung markings, hyperinflation, decreased lung markings at apices, small thin heart, flattened diaphrams

A

emphysema; pink puffer

120
Q

*barrel chested, hyperventilation, wasted appearance with pursed lips

A

emphysema; pink puffer

121
Q 
emphysema and chr bronchitis:
dyspnea
cough
lungs
peripheral edema
weight
A 
emphysema and chr bronchitis:
dyspnea: exertional/mild
cough: rare/chr productive
lungs: quiet/noisy with rhonchi and wheeze
peripheral edema: none/yes
weight: thin; overweight and cyanotic'
122
Q

emphysema and chr bronchitis CXR

1) lung markings
2) diaphrams

A

1) emphysema has dec lung markings at apices and flattened diaphrams
2) chr bronchitis CXR has inc interstitial markings at bases and diagphrams not flattened

123
Q

emphysema and chr bronchitis CXR:

acid-base status

A

1) emphysema has late hypercarbia/hypoxia- hence pink 2) chr bronchitis has early hypercarbia/hypoxia- hence blue

124
Q

pollutants, recurrent URIs, eosinophilia, bronchial hyperresponsiveness, alpha 1 antitrypsin deficiency

A

other causes of COPD

125
Q

percussion, auscultation, and wheezing in COPD

A
  • percussion yields resonance
  • auscultation reveals dec breath sounds and early inspiratory crackles; long prolonged expiration
  • wheezing not present at rest but can be provoked with forced expiration or exertion
126
Q

COPD tx

A

anticholinergic inh(…tropiums) for bronchodilation, short acting BD for acute exacerbations, oral antibiotics, supplemental oxygen(pts with resting hypoxemia of PaO2 <55% or SaO2 <88%)

127
Q

Pa02 < what; PaCO2 > what in asthma

A

Pa02 <60; PaCO2 >40

128
Q
  • PE of asthma
A

hyperresonance to percussion, decreased breath sounds, tachycardia, tachypnea, use of accessory muscles

129
Q
  • PE of severe asthma
A

inability to speak in full sentences, tripod position, silent chest(no air movement), altered mental status, pulsus paradoxus(inspiratory blood pressure > 10mmhg), PEFR<40% predicted.

130
Q
  • bronchoprovocation for asthma
A

methacholine challenge (>20% decreased in FEV1) followed by brochodilator challenge (increase of FEV1 >12% expected)

131
Q
  • how to do a dx of an acute asthma exacerbation
A
  • peak expiratory flow rate, discharge criteria: PEFR>70% or PEFR>15% initial attempt, subjective improvement.
    *pulse ox: Sa02 <90% indicative of resp distress
    *ABG not usually ordered. Respiratory alkalosis expected(from tachypnea).
    *CXR nml

cardio and pulm (24 decks)

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