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Pulmonary 1 Flashcards

1
Q

MC cause of acute bronchitis

A

viral

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2
Q

MC bacterial causes of acute bronchitis

A

S. pneumoniae
H. influenzae
M. catarrhalis

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3
Q

hallmark sx of acute bronchitis

A

cough > 5 days - initially nonproductive then becomes productive
can last 1-3 weeks

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4
Q

what sx is rare in acute bronchitis

A

fever

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5
Q

PE acute bronchitis

A

often normal but wheezing and rhonchi may be auscultated on PE
rhonchi usually clear w coughing

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6
Q

dx acute bronchitis

A

clinical; acute onset of persistent cough + no findings suggestive of pneumonia (fever, tachypnea, rales, hypoxia, dullness to percussion, decreased or bronchial breath sounds, rales, ego phony)

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7
Q

when is CXR needed for acute bronchitis

A

if you need to distinguish btwn acute bronchitis and pneumonia

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8
Q

tx acute bronchitis

A

self-limited
cough relief - dextromethorphan, guaifenesin if > 2 years
avoid abx in otherwise healthy

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9
Q

what is asthma

A

reversible, often intermittent, obstructive disease of the small airways

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10
Q

3 components to asthma

A

airways inflammation, airway hyperreactivity (hyperresponsiveness) - type 1 , bronchoconstriction

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11
Q

what is the most common type of asthma

A

allergic asthma - begins in childhood and is associated with eczema, allergic rhinitis, and food allergy (atopic triad)

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12
Q

what is the strongest risk factor for asthma

A

atopy

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13
Q

symptom triad for asthma

A

episodic dyspnea
wheezing
cough (especially at night)

may have chest tightness or fatigue

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14
Q

PE for asthma

A

may be normal between exacerbations

wheezing and/or prolonged expiratory phase during normal breathing due to the presence of airflow obstruction, hyper resonance to percussion, decreased breath sounds, tachycardia, tachypnea, use of accessory muscles (due to increased work of breathing)

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15
Q

what should clue you in that the acute asthma flare is an EMERGENCY

A

lack of wheezing!

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16
Q

describe severe asthma and status asthmaticus

A

inability to speak in full sentences, tripod positioning, silent chest, altered mental status, pulsus paradoxes (inspiratory blood pressure drop > 10 mm Hg

PEFR < 40% predicted

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17
Q

dx asthma

A

pulmonary function tests - pre- and post-bronchidilator to identify reversible airflow obstruction

airflow obstruction - decreased FEV1, decreased FEV1/FVC < 0.7, increased lung volumes due to hyperinflation: increased residual volume (RV), total lung capacity (TLC), and RV/TLC

significant reversibility - defined by an increased of 12% or more and 200 mL in FEV1 or FVC after inhaling a short-acting bronchodilator

bronchial provocation with methacholine or histamine challenge - a decrease in FEV1 20% or greater after exposure; reserved for use when asthma is suspected but baseline spirometry is normal or non diagnostic

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18
Q

intermittent asthma

A

symptoms </= 2 days/week
no interference w daily activities

nighttime sx </= 2 times/month

use of rescue inhaler < 2 days/week

lung function - PEV1 > 80% predicted, FEV1/FVC normal

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19
Q

tx for intermittent asthma

A

SABA as needed

albuterol, levalbuterol, terbutaline, epinephrine

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20
Q

mild persistent asthma

A

sx > 2 days/week but not daily
minor limitation in daily activities

nighttime sx 3-4 times/month

use of rescue inhaler > 2 days/week but not daily and not more than once on any day

lung function - FEV1 > 80% predicted, FEV1/FVC normal

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21
Q

tx mild persistent asthma

A

Low-dose ICS daily with SABA as needed
or
Low-dose ICS plus SABA, concomitantly administered as needed

lose dose ICS - beclomethasone, flunisolide, triamcinolone
SABA - albuterol, levalbuterol, epinephrine, terbutaline

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22
Q

moderate persistent asthma

A

daily sx
some limitation in daily activity

nighttime sx > 1 time/week but not nightly

use of rescue inhaler daily

lung function - FEV1 > 60% but < 80% predicted, FEV1/FVC reduced 5%

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23
Q

tx moderate persistent asthma

A

combination low dose ICS and LABA min a single inhaler daily and 1 to 2 inhalations as needed

low dose ICS - triamcinolone, beclomethasone, flunisolide
LABA - salmeterol, formoterol

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24
Q

severe persistent asthma

A

continual sx
extremely limited physical activities

nighttime sx often 7x/week

use of rescue inhaler several times/day

lung function - FEV1 < 60% predicted, FEV1/FVC reduced > 5%

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25
tx severe persistent asthma
medium to high dose ICS + LABA can add LAMA daily SABA as needed ICS - beclomethasone, flunisolide, triamcinolone LABA - formoterol, salmeterol SABA - albuterol, levalbuterol, terbutaline, epinephrine LAMA - aclidium, darotropium, tiotropium, glyccopyronium, umeclidinium
26
tx of acute asthma exacerbaton
SABA - for all inhaled muscarinic antagonist - moderate to severe systemic glucocorticoids IV mag sulfate - if life-threatening may need mechanical ventilation (intubation) and noninvasive positive pressure ventilation if unresponsive to above
27
what is chronic bronchitis
a type of COPD defined as chronic productive cough for at least 3 months a year for 2 consecutive years
28
pathophys of chronic bronchitis
chronic inflammation leads to mucous gland hyperplasia, goblet cell mucus production, mucus hypersecretion, dysfunctional and damaged cilia, and infiltration of neutrophils and CD8+ T cells
29
3 cardinal sx of chronic bronchitis
chronic cough (MC and earliest) sputum productive dyspnea, especially on exertion
30
PE for chronic bronchitis
crackles (rales) coarse rhonchi wheezing signs of Cor pulmonate - enlarged tender liver, JVD, peripheral edema cyanosis peripheral edema obesity "blue bloaters"
31
dx chronic bronchitis
PFT: obstruction - decreased FEV1, normal or decreased FVC, postbronchodilator decreased FEV1/FVC < 70% predicted hyperinflation - increased volumes (RV, TLC, RV/TLC, FRC) roughly normal diffusing capacity of the lungs for carbon monoxide (DLCO) CXR EKG for cor pulmonale CBC - increased hemoglobin and hematocrit ABG - respiratory acidosis
32
what will CXR show for chronic bronchitis
pulmonary HTN - enlarged right heart border, increased AP diameter, vascular markings normal diaphragms
33
conservative tx COPD
smoking cessation - greatest impact vaccines - flu and pneumococcal home oxygen - resting hypoxia (PaO2 < /= 55 mm Hg or oxygen sat
34
tx acute exacerbations chronic bronchitis
abx amoxicillin doxycycline clarithromycin cephalosporins
35
Category A COPD
mild or infrequent sx 0-1 exacerbations in the last year without associated hospitalization FEV1 >/= 80% predicted
36
tx category A COPD
SABA as needed SABA - albuterol, epinephrine, terbutaline, levalbuterol
37
Category B COPD
moderate to severe sx (ie, the patient has to walk more slowly than others of the same age due to breathlessness, has to stop to catch breath when walking on level ground at own pace, or has more severe breathlessness) 0 or 1 exacerbations in the past year without associated hospitalization 50% ≤ FEV1 <80% predicted
38
tx Category B COPD
add a LABA or LAMA LABA - Salmeterol, Formoterol LAMA - aclidium, darotropium, tiotropium, glyccopyronium, umeclidinium, ipratropium
39
Category C COPD
Mild or infrequent symptoms (ie, breathless with strenuous exercise or when hurrying on level ground or walking up a slight hill) ≥2 exacerbations per year with one or more leading to hospitalization 30% ≤ FEV1 <50% predicted
40
tx category C COPD
regular treatment with a LAMA LAMA - aclidium, darotropium, tiotropium, glyccopyronium, umeclidinium, ipratropium
41
category D COPD
Moderate to severe symptoms (ie, the patient has to walk slower than others of the same age due to breathlessness, has to stop to catch breath when walking on level ground at own pace, or has more severe breathlessness) ≥2 exacerbations per year with one or more leading to hospitalization FEV1 <30% predicted
42
tx category D COPD
regular tx with LAMA severe breathlessnesss - LABA + LAMA can add inhaled glucocorticoid
43
what surgery can you do in COPD
lung reduction surgery lung transplant
44
what is emphysema
a type of COPD that has a pathologic definition - abnormal permanent enlargement of the terminal airspaces (distal to the terminal bronchioles) with no obvious fibrosis
45
types of emphysema
centrilobar (proximal acinar) - MC associated w smoking panacinar (pan lobar, diffuse) - associated w alpha-1 anti trypsin deficiency paraseptal (distal acinar) - seen with either of above or spontaneous pneumothorax if isolated
46
pathophysiology of emphysema
chronic inflammation, decreased protective enzymes (A1A), and increased damaged enzymes known as proteinases cause destruction of the alveolar-capillary membrane (destruction of the capillaries + alveolar wall destruction and dilation) loss of elastic recoil and airway collapse makes expiration an active process and increased compliance leads to airway obstruction (air trapping)
47
sx emphysema
dyspnea - hallmark chronic cough - often mild weight loss
48
PE emphysema
hyperinflation - decreased distant breath sounds, increased AP diameter, hyper resonance to percussion obstruction - end-expiratory wheezing and prolonged expiration. accessory muscle use cachectic and non-cyanotic pursed lip expiration
49
CXR for emphysema
hyperinflation - flattened diaphragms, increased AP diameter, decreased vascular markings, bull and/or blebs
50
Dx emphysema
PFT obstruction - normal or decreased FVC, FEV1/FVC < 70% predicted; decreased FEV1 hyperinflation - increased RV, TLC, RV/TLC, FRC (functional residual capacity) Decreased DLCO in emphysema due to destruction of alveolar-capillary pulmonary membrane ABG Normal CBC
51
what is cor pulmonale
right ventricular hypertrophy with eventual RV failure resulting from pulmonary HTN secondary to pulmonary disease
52
in cor pulmonale what is seen in EKG
right axis deviation
53
MC cause of cor pulmonale
COPD
54
what is the gold standard diagnostic test to directly measure pulmonary pressures and assess response to vasodilation meds in cor pulmonale
right heart catheterization
55
tx cor pulmonale
treat underlying dz diuretics are not helpful chest pain usually does not respond to nitrates
56
PE cor pulmonale
Lower extremity edema, neck vein distention, hepatomegaly, parasternal lift, tricuspid/pulmonic insufficiency, loud S2
57
Obesity hypoventilation syndrome (OHS), also known as
Pickwickian syndrome
58
Pickwickian syndrome
condition in which severely overweight people fail to breathe rapidly or deeply enough, resulting in low oxygen levels and high blood carbon dioxide (CO2) levels
59
sx hypoventilation syndrome
sluggish/sleepy during day
60
what can occur secondary to hypoventilation syndrome
pulmonary hypertension, cor pulmonale, secondary erythrocytosis
61
what is idiopathic pulmonary fibrosis
progressive extensive remodeling and scarring of the lungs due to an unknown cause
62
sx idiopathic pulmonary fibrosis
progressive dyspnea nonproductive cough fatigue
63
PE idiopathic pulmonary fibrosis
diffuse, fine, dry, bibasilar end-inspiratory velcro crackles (rales) clubbing of the fingers
64
dx idiopathic pulmonary fibrosis
CXR Chest CT PFT Histopathology
65
what will CXR show for idiopathic pulmonary fibrosis
reticular opacities (honeycombing) most marked at lung bases
66
what will chest CT show for idiopathic pulmonary fibrosis
preferred imaging; reticular honeycombing, focal ground-glass opacification
67
PFTs for idiopathic pulmonary fibrosis
restrictive pattern - normal or increased FEV1/FVC, normal or decreased FVC, decreased lung volumes (VC, RV, FRC, TLC) decreased DLCO
68
histopathology for idiopathic pulmonary fibrosis
usual interstitial pneumonia - abnormal proliferation of mesenchymal cells; patchy temporally and nonuniform distribution of fibrosis. sub pleural cystic airspaces (3-10 mm) honeycomb cysts
69
tx idiopathic pulmonary fibrosis
antifibrotic drugs (pirfenidone or nintedanib), oxygen therapy, and eventually lung transplant (only possible cure)
70
median survival for idiopathic pulmonary fibrosis
Most patients deteriorate and the median survival is about 3 years from diagnosis
71

Internal Med EOR (17 decks)

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