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Natalie IGEP > Pulm in Elderly > Flashcards

Pulm in Elderly Flashcards

1
Q

how many cases of lung cancer are attributed to tobacco smoke?

A

85-90% wtf people! lay off the cancer sticks!

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2
Q

Besides tobacco, what are some other risk exposures that contribute to lung cancer?

A 
occupational exposure
arsenic
asbestos
nickle
uranim
chromium
silica
beryllium
diesel feul
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3
Q

If someone smokes AND has been exposed to tobacco smoke, how much greater is their risk of getting lung cancer?

A

80-90 fold higher

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4
Q

what form of screening provides greater reduction in risk of dying from lung cancer: CT or CXR?

A

CT. 20% lower risk

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5
Q

How many pack years should tip you off to go more aggressive with screening?

A

30 pack years

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6
Q

What is the recommendation for lung cancer screening in people aged 55-80?

A

If 30 pack year or more: annual low dose CT

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7
Q

If you’re screening for lung cancer in people aged 55-80, but they have quit, long long ago should they have quit to decrease the need to do yearly screenings?

A

30 pack year history indicates screening, but if they have quit greater than 15 years ago, don’t need to screen anymore

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8
Q

Other than quitting greater than 15 years ago, what else would stop the need for annual lung cancer screening via CT?

A

developing a health problem that significantly limits life expectancy

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9
Q

Does the clinical presentation of lung cancer vary?

A

yes

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10
Q

There are 4 types of lung cancer presentations, what are they?

A

local
intrathoracic spread
extrathoracic spread
paraneoplastic

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11
Q

S/S of LOCAL lung cancer

A

cough
chest pain
dyspnea
hemoptysis

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12
Q

What should you think if someone presents with hemoptysis?

A

lung cancer until proven otherwise

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13
Q

S/S of INTRA-THORACIC spread of lung cancer

A

Chest wall pain (TTP is likely not cardiac)
Dyshpagia
Hoarseness
Pleural Effusion
SVC obstruction by tumor (Superior Vena Cava)

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14
Q

What does the symptom of dyspnea indicate?

A

Local lung cancer

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15
Q

What does the symptom of dysphagia indicate?

A

Intra-thoracic spread of cancer

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16
Q

What does the symptom of hoarseness indicate?

A

Intra-thoracic spread of cancer

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17
Q

If superior vena cava is obstructed by tumor, how far has lung cancer spread?

A

intra-thoracic spread

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18
Q

S/S of EXTRA-THORACIC spread

A 
Abdominal Pain
Bone Pain
Jaundice
Lymphadeopathy
Paralysis
Seizures
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19
Q

S/S of PARA-NEOPLASTIC spread

A 
clubbing
Cushing syndrome
Hypercalcemia
Hypertrophic osteoarthropathy
Lambert-Eaton Syndrome
SIADH
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20
Q

Excess of what causes Cushing syndrome?

A

Cortisol

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21
Q

What is the hallmark of paraneoplastic syndrome?

A

Hypercalcemia

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22
Q

What is Lambert-Eaton Syndrome?

A

Immune system attacks own neuromuscular connections

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23
Q

What does Lambert-Eaton syndrome typically present with?

A

Leg weakness

Eye and facial muscle weakness

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24
Q

What does SIADH stand for?

A

Syndrome of Inapropropriate Anti-duretic Hormone

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25
Q

What secretes ADH?

A

Pituitary

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26
Q

What are some clinical signs of cushings?

A

Striae
Moon Facies
Buffalo Hump

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27
Q

What is the difference between dementia and delirium?

A

Dementia: chronic decline

Delirium: acute and caused by something organic. reversible.

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28
Q

When pneumonia presents in older adult, will there typically be greater or fewer symptoms?

A

Fewer.

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29
Q

What is one symptom pneumonia may present with?

A

Delirium

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30
Q

Admitting older adults to the hospital for treatment of pneumonia is aways a good idea! Right?

A

Nope. most will have long standing loss of some degree so think twice about admitting.

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31
Q

Pneumonia is among the top 10 causes of death.

A

Yup. This wasn’t a question, just know it’s bad.

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32
Q

Do more people get pneumonia in nursing facilities or at home?

A

rate of occurance is highest in nursing facilities

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33
Q

Risk factors for pneumonia in elderly (Diseases-5)

A 
Dementia
Seizures
CHF
Cerebrovascular Ds
COPD
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34
Q

Level of activity that is risk factor for pneumonia

A

inactivity

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35
Q

How does swallowing affect risk of pneumonia?

A

Increases

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36
Q

Does surgery or hospitalization affect risk of pneumonia?

A

yup. increases

37
Q

Etiology of Community Acquired Pneumonia

A

exposure through contact with pathogen via normal living activities in non-special needs community

38
Q

Etiology of Hospital/Nosocomial acquired pneumonia

A

exposure to pathogen while hospitalized

39
Q

Etiology of pneumonia acquired in nursing home

A

exposure to pathogen while hospitalized

40
Q

Do all geriatric patients present with typical fever, cough, malaise when they have pneumonia?

A

Nope, may just “not seem right”

41
Q

What are some non-pulm symptoms of pneumonia in elderly?

A 
N/V/D
Mayalgia
Arthralgia
Confusion
Falls
General decline in over-all health
Fatigue
42
Q

What is the most common extra-pulmonary symptom of pneumonia in elderly?

A

fatigue

43
Q

Pulmonary symptoms of pneumonia in elderly

A

cough
SOB
Sputum production
Hemoptysis

44
Q

What is the most common pulmonary symptom of pneumonia in elderly?

A

cough

45
Q

PE findings for pneumonia? what are you expecting to find?

A

crackles
wheezes
dullness to percussion
egophony

46
Q

What does increase RR indicate in elderly

A

it’s the most sensitive presentation of pneumonia in elderly

47
Q

How long should you count to get an accurate RR?

A

30-60 seconds

48
Q

Is RR valid if you count for 15 seconds?

A

No, only accurate if you count for 1 minute

49
Q

What RR indicates severe pneumonia?

A

> 28

50
Q

What will most people report or present with in pneumonia?

A

fatigue

51
Q

How much of the >75 yo population has COPD?

A

10%

52
Q

Is COPD adequately diagnosed and treated?

A

no, under dx and tx

53
Q

What will SPO2 be doing in COPD?

A

it will be low. Might be first indication that something is wrong.

54
Q

Areas that are affected by aging in respiratory function

A

structure, function, control

55
Q

What happens to elastic recoil in aging?

A

goes down

56
Q

Bronchiolar diameters ____ and alveolar ducts _____ (size)

A

Bronchiolar diameters diminish. Alveolar ducts enlarge

57
Q

What does the change in bronchioles and alveoli result in?

A

decreased expiratory flow and decreased surface area for gas exchange

58
Q

Advancing age = airways in dependent portions of lungs to close at higher volumes.

A

no idea what this means, but it’s in the ppt.

59
Q

What happens to costochondra cartilages?

A

they become calcified.

60
Q

What does calcified constochondral cartilage lead to?

A

less lung expansion because the intercostal muscles shorten

61
Q

Which parts of the immune system are dysregulated in aging?

A

adaptive and innate

62
Q

What happens to cytokine production in aging?

A

increases

63
Q

What disease process do cytokines play an integral role in?

A

COPD

64
Q

The immune system response triggers a cascade of constant inflammation. COPD is though by some to be an autoimmune condition

A

This is in her ppt, but I think it’s more food for thought than anything else.

65
Q

How do you diagnose COPD in the older adult?

A

spirometry and history of exposure to noxious agents

66
Q

Everyone being hospitalized for respiratory issues should have what?

A

CXR

67
Q

If you suspect pneumonia, as a general rule for elderly patients, what blood tests should you order?

A

CBC and BMP.

Look at electrolytes

68
Q

What’s with the tongue?

A

look to see if it’s dry

69
Q

Is CT or CXR more sensitive for finding pneumonia?

A

CT

70
Q

How does COPD present in the older adult?

A

Complicatedly. Might have SOB, fatigue, cough.

OR

Might have few or no respiratory complaints if they have other comorbidities

71
Q

What happens to coughing as someone ages?

A

becomes less vigorous

72
Q

Aging itself is though too be what kind of state?

A

inflammation. This adds to the difficulty of maintaining healthy lung function

73
Q

What does spirometry measure?

A

lung function. measures volume and rate of air on inhalation and expiration

74
Q

What could impact the validity of spirometry tests?

A

cognitive deficits or comorbidities that limit the patient’s ability to perform the test or understand the instructions

75
Q

What is the most commonly used PFT?

A

spirometry

76
Q

What is the normal FEV1 value?

A

80-120%

77
Q

What is the normal FVC value?

A

80-120%

78
Q

How close should the FEV1/FVC ratio be to predicted ratio to be considered normal?

A

with in 5%

79
Q

What is the TLC (total lung capacity) normal value?

A

80-120%

80
Q

What is the normal FRC (functional residual capacity)?

A

75-120%

81
Q

What does FVC stand for?

A

Forced vital capacity

82
Q

How is spirometry performed?

A

Patient inhales maximally then exhales as rapidly and as completely as possible

83
Q

How much of their volume can normal lungs expire in 6 seconds?

A

80%

84
Q

Based on oximetry, when should you order O2?

A

if O2 Sat is

85
Q

Arterial Blood Gas will show the arterial oxygen pressure (paO2). If it’s below ___ patients should be given oxygen

A

60mmHg

86
Q

Red flags during pulmonary exam in older patients (5)

A 
crackles in base of lungs
Cyanosis
Markedly decreased exercise tolerance
Severe fatigue
"dad's just not himself"
87
Q

What should you ALWAYS consider as a possible cause of respiratory symptoms?

A

cardiac pathology

88
Q

What should you consider as a possible cause of delirium?

A

O2

Natalie IGEP (13 decks)

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