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Clin Med I- PULMONARY > Pulm Intro > Flashcards

Pulm Intro Flashcards

1
Q

Early inspiratory and expiratory crackles are hallmark for…

A

Chronic bronchitis

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2
Q

When do you hear late inspiratory crackles

A

Pneumonia, CHF

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3
Q

When would you hear crackles?

A

Associated with lung abnormalities- pneumonia (fluid in lungs), fibrosis. Or in airway disease like bronchitis or bronchiectasis.

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4
Q

What do wheezes suggest and when do you hear them?

A

Narrowed airways- asthma, COPD, bronchitis,

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5
Q

Rub- when do you hear these?

A

Dry crackling, grating, low pitched sound heard in pleurisy when 2 inflamed surfaces slide by one another

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6
Q

What sounds discontinuous, intermittent, nonmusical, and brief?

A

Crackles- fine are brief and discontinuous, coarse are louder, last longer, and lower in pitch

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7
Q

What sounds continuous, muscal, and prolonged?

A

wheezes and rhonchi. Wheezes are high-pitched, rhonchi are low-pitched with snoring quality.

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8
Q

What do rhonchi suggest?

A

Secretions in large airways. Heard in the chest wall where bronchi are, not over any alveoli.

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9
Q

What would egophony tell you?

A

If sounds like “ay” then, lobar consolidation like in pneumonia or fibrosis. If absent, pneumothorax.

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10
Q

Decreased tactile fremitus

A

Emphysema

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11
Q

Increased tactile fremitus

A

Pneumonia

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12
Q

Types of PFT

A

clinical assessment, spirometry, lung volume measurements, maximal respiratory pressure measurements, DLCO

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13
Q

When would a 6 min walk test show abnormal results?

A

When SaO2 decrease more than 4%- further testing needed

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14
Q

When would post-bronchodilator show good response?

A

If FEV1 increases by more than 12%- means patient responding well to that treatment

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15
Q

Is spirometry good for diagnosing or monitoring asthma?

A

monitoring because mild asthmatics have normal spirometry between acute exacerbations

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16
Q

What is the gold standard for lung volume measurement?

A

Body plethysmography

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17
Q

What does plethysmography measure

A

RV, TLC, FRC (functional residual capacity)

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18
Q

RV and TLC would be ___ in emphysema

A

increased because of air trapping and hyperinflated lungs

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19
Q

RV and TLC ___ in chronic bronchitis

A

RV is increased because of air trapping- so more than normal amount of air is still left in lungs after exhalation. TLC is the same.

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20
Q

What does maximal respiratory pressure measurement measure?

A

respiratory muscle WEAKNESS. Maybe that’s why having a hard time breathing.Also helps to figure out why there are decreases in vital capacity.

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21
Q

Maximal and expiratory pressures are achieved by using what device?

A

Blocked mouthpiece

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22
Q

What is DLCO helpful to diagnose in?

A

Restrictive and obstructive lung disease

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23
Q

Procedure of DLCO

A

Inhale deep breath of 0.3% CO and 10% helium. Hold breath for 10 seconds, then exhale quickly. Alveolar sample of exhaled gas is analyzed- see how much CO diffused from alveoli to RBC.

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24
Q

DLCO increased and decreased in…

A

Increased in asthma, decreased in COPD, PE, CF, pulmonary vascular disease, anemia

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25
Q

Tests that can be done to assess lung function/analysis

A

PFT, ABG, Radiologic Imaging, measures of oxygenation

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26
Q

Indications for ABG’s

A

Assess breathing difficulties, monitor treatment response, monitor ventilation, and assess acid-base status

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27
Q

What is the most common initial screening tool for pulmonary disorders?

A

CXR

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28
Q

CT scans with IV contrast benefits

A

Provide further detail, used to evaluate chest pain, dyspnea, tumor, trauma, pneumothorax

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29
Q

What is a subset of CT scan w/contrast where the contrast is timed to be present in the vascular system

A

CT angiography

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30
Q

Non contrast CT scans

A

COPD, ILD, bronchiectasis,

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31
Q

What is normal for resting SaO2?

A

Greater than or equal to 95%

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32
Q

A-a oxygen gradient

A

Difference between the amount of oxygen in the alveoli and the amount of oxygen dissolved in plasma.

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33
Q

What does a high A-a oxygen gradient show

A

PE

34
Q

Normal PaO2/FiO2 ratio

A

300-500 mmHg

35
Q

When is oxygenation index used?

A

In neonates with persistent pulmonary HTN of the newborn

36
Q

Causes of hypoxemia

A

V/Q mismatch (PE), hypoventilation, right to left shunt, diffusion impairment, high elevations

37
Q

Nasal cannula administers oxygen rates between…

A

1-6L/min

38
Q

Types of masks

A

Simple, air entrapment masks (Venturi), partial rebreathing, and nonbreathing systems

39
Q

What is a Venturi?

A

Air entrapment mask-more controlled. Not as much exchange between room air and oxygen.

40
Q

Supplemental oxygen devices

A

Nasal cannula, masks, enclosure systems (hoods or tents)

41
Q

What supplemental oxygen device would you use for infants?

A

Hoods or tents (enclosure systems)- passive so not on face

42
Q

What device would you use on patient who requires airway assistance but not emergent intubation?

A

NPPV- noninvasive positive pressure ventilation- COPD, obesity hypoventilation syndrome

43
Q

Absolute contraindication for NPPV

A

Need for emergent intubation

44
Q

Relative contraindication for NPPV

A

If can’t cooperate, impaired consciousness, facial trauma or surgery, high aspiration risk, anticipated prolonged duration of mechanical ventilation (should go directly to invasive in this case)

45
Q

NPPV types

A

Standard ICU ventilator, portable ventilator. Interfaces include face mask, nasal mask-better tolerated but not as effective, and nasal plugs

46
Q

NPPV modes

A

CPAP and BIPAP more common. Others- assist control, pressure support ventilation, and proportional assist ventilation

47
Q

When to use CPAP vs. BPAP?

A

Use CPAP in more non-urgent conditions, BiPAp in URGENT conditions.

48
Q

CPAP- how does it work?

A

Patient initiates each breath, ventilator provides continuous positive airway pressure to keep airways open

49
Q

How does BiPAP work?

A

Delivers both inspiratory and expiratory positive airway pressure- when patient not able to initiate his/her own breath

50
Q

Assist control

A

Sets the minimal minute ventilation by setting the respiratory rate and tidal volume. patient can still initiate breaths

51
Q

Pressure support ventilation

A

Patient triggers each breath, but can’t go all the way so there is pressure support from the ventilation with each breath

52
Q

Proportional assist ventilation

A

provides automatic synchrony between the patient and the ventilatory cycle-delivers inspiratory pressure that is proportional to patient effort

53
Q

NPPV monitoring

A

Monitor closely in 1st 8 hours of therapy

54
Q

When is NPPV considered successful?

A

Improvement in pH and PaCO2 in 30 min-2hours

55
Q

What if no improvement in alotted time for NPPV or changes in mental status/agitation?

A

ENDOTRACHEAL INTUBATION

56
Q

Benefits of NPPV

A

Improved mortality rates compared to invasive, decreased need to use invasive mechanical ventilation since you have this as an alternative, and decreased incidence of nosocomial infections

57
Q

Disadvantages of NPPV

A

poorly tolerated by patients, esp face mask

58
Q

Invasive positive pressure ventilation indicaions

A

for insufficient oxygenation and/or ventilation

59
Q

Most common pulmonary symptoms seen

A

cough, dyspnea, chest pain, and hemoptysis

60
Q

PE of dyspnea

A

HEENT, neck, chest, heart, lower extremities

61
Q

diagnostic testing of dyspnea

A

CXR, ABG, spirometry, EKG, cardiac workup

62
Q

What will distinguish chest pain from other systems?

A

Pulmonary/pleural problem-pleuritic chest pain vs. regular chest pain with cardiovascualr, musculoskeletal, GI, psychiatric

63
Q

Pleuritic chest pain questions- to differentiate from CV origin

A

Does it get worse when you take a deep breath in, when you cough, when you change positions?

64
Q

PE for chest pain

A

pulmonary, CV, GI, MS

65
Q

DIagnostic tesing for pleuritic chest pain

A

EKG, cardiac markers helpful to evaluate for cardiac etiology. CXR/CT helpful for pulm, esp if associated pulm symptoms

66
Q

Acute cough

A

less than 3 weeks

67
Q

Acute cough cause

A

Viral- most people will have symptoms resolve in less than 3 weeks

68
Q

Cough + dyspnea =

A

More serious illness- evaluate thoroughly. May be chronic lung disease, CHF, or anemia

69
Q

Persistent cough

A

3-8 weeks

70
Q

Chronic cough

A

more than 8 weeks

71
Q

Subacute cough

A

Post-infectious cough that persists for more than 3 weeks

72
Q

Cause of cough

A

postnasal drip, asthma, COPD, GERD, ace inhibitors, pertussis

73
Q

Cough + constitutional symptoms=

A

carcinoma evaluation

74
Q

If history of recurrent cough or complicated infections with

A

consider bronchiectasis (RECURRENT)

75
Q

What are signs of infection?

A

fever, tachycardia, tachypnea, sputum

76
Q

What are signs of consolidation?

A

crackles, decreased breath sounds, fremitus increased, egophony

77
Q

PE for cough

A

evaluate for sings of infection, consolidation, and cardiac disease

78
Q

Diagnostic studies for cough

A

ABG, pulse ox, CXR, CT, spirometry for airflow, testing for specific infections- sputum cultures, PCR for pertussis

79
Q

What is hemoptysis classified as?

A

Trivial, mild, or massive

80
Q

Where can bleeding in hemoptysis originate from?

A

Airways, pulmonary vasculature, or pulmonary parenchyma

81
Q

Diagnostic testing for hemoptysis

A

CBC, UA, BMP, coag studies, D-Dimer, CXR/CT, Bronchoscopy

Clin Med I- PULMONARY (7 decks)

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