Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PPC2 Exam 3 > Pulmonary 1 > Flashcards

Pulmonary 1 Flashcards

1
Q

Fluoroscopy

A

Evaluation of stridor and abnormal movement of the diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Contrast studies

A

Useful for patients with recurrent pneumonia, persistent cough, tracheal ring, or suspected fistulas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Bronchograms

A

useful in delineating the smaller airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pulmonary arteriograms

A

evaluation of the pulmonary vasculature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Radionuclide studies

A

evaluation of the pulmonary capillary bed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Asthma Bronchoconstriction pathophys

A

Bronchial smooth muscle contraction that quickly narrows the airways in response to exposure to a variety of stimuli, including allergens or irritants.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Asthma pathophysiology (

A
  1. Bronchoconstriction
  2. Airway hyperresponsiveness - Exaggerated bronchoconstriction response to stimuli
  3. Airway edema—As the disease becomes more persistent and inflammation becomes more progressive, edema, mucus hypersecretion, and formation of inspissated mucus plugs further limit airflow.
  4. Remodeling of the airways may occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bronchial Asthma (what it is and 2 types)

A

Chronic inflammatory disorder of the airways resulting in contraction of bronchial muscle

Types

  1. Extrinsic (atopic, allergic)
    - Allergens: food, pollen, dust, etc.
  2. Intrinsic (non-atopic)
    - Initiated by infections, drugs, pollutants, chemical irritants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Asthma etiology (3)

A
  1. Gene-by-environment interactions are important to the expression of asthma.
  2. Atopy, the genetic predisposition for the development of an immunoglobulin E (IgE)-mediated response to common aeroallergens, is the strongest identifiable predisposing factor for developing asthma.
  3. Viral respiratory infections are one of the most important causes of asthma exacerbation and may also contribute to the development of asthma.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Asthma atopic triangle

A
  1. Asthma (at top of triangle)
  2. Allergic rhinitis
  3. Atopic dermatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Predicting Asthma in Young Frequent “Wheezers” (2 major criteria, 3 minor criteria)

A

Children less than 3 years of age with >3 episodes of wheezing per year and at least 1 major or 2 minor criteria:

Major Criteria:

  1. Parental asthma
  2. Eczema

Minor Criteria:

  1. Allergic rhinitis
  2. Wheezing apart from colds
  3. Eosinophilia >4%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Characteristics of Asthma (3)

A
  1. Airway Inflammation
  2. Airway Obstruction (reversible)
  3. Hyperresponsiveness (irritability of airways)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Four components of asthma management

A
  1. Measures of Asthma Assessment and Monitoring
  2. Education for a Partnership in Asthma Care
  3. Control of Environmental Factors and Comorbid Conditions that Affect Asthma
  4. Pharmacologic Therapy: The medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

To establish a diagnosis of asthma the clinician should determine…? (3)

A
  1. Episodic symptoms of airflow obstruction or airway hyperresponsiveness are present.
  2. Airflow obstruction is at least partially reversible.
  3. Alternative diagnoses are excluded.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Recommended methods to establish the diagnosis of asthma (4)

A
  1. Detailed medical history.
  2. Physical exam focusing on the upper respiratory tract, chest, and skin.
  3. Spirometry to demonstrate obstruction and assess reversibility, including in children 5 years of age or older.
  4. Additional studies to exclude alternate diagnoses
    - Sweat test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Key Questions to Ask the Child and Parent (6)

A
  1. Which medicines is your child currently taking? How often?
  2. Who is responsible for administering the child’s medicine?
  3. Please show me how the child takes the medicine.
  4. How many times a week does the child miss taking the medication?
  5. What problems have you/your child had taking the medicine (cost, time, lack of perceived need)?
  6. What concerns do you have about your asthma medicines?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Key Indicators: Diagnosis of Asthma (4)

A
  1. Wheezing – high-pitched whistling sounds when breathing out.
  2. History of (any):
    a. Cough, worse particularly at night
    b. Recurrent wheeze
    c. Recurrent difficulty in breathing
    d. Recurrent chest tightness
  3. Symptoms occur or worsen in the presence of known triggers.
  4. Symptoms occur or worsen at night awakening patient.
18
Q

Red Flags for Vocal Cord Dysfunction (6)

A
  1. Not responding to standard asthma therapy
  2. Very acute onset and resolution of Sx
  3. Onset of symptoms in teenage years
  4. Never symptomatic during sleep
  5. Negative family history
  6. Negative allergic history
19
Q

Questionnaires on QOL with Asthma (4)

A

a. Asthma Control Test (ACT)
b. Childhood Asthma Control Test
c. Asthma Control Questionnaire
d. Asthma Therapy Assessment Questionnaire (ATAQ) control index.

20
Q

Comorbid Conditions (8)

A
  1. NSAID hypersensitivity
  2. GERD
  3. Obesity
  4. Obstructive Sleep apnea
  5. Rhinitis/sinusitis
  6. Chronic stress
  7. Depression
  8. Allergic bronchopulmonary aspergillosis
    a. Sickle cell makes you more prone to respiratory infection
    b. IgE will be high very here
    c. Will need long-term steroids as the treatment
21
Q

Key Differences – Assessing/Monitoring Control (3)

A
  1. Periodic assessment of asthma control is emphasized.
  2. A stronger distinction between classifying asthma severity and assessing asthma control.
  3. EPR-3 clarifies the issue:
    a. For initiating treatment, asthma severity should be classified, and the initial treatment should correspond to the appropriate severity category.
    b. Once treatment is established, the emphasis is on assessing asthma control to determine if the goals for therapy have been met and if adjustments in therapy (step up or step down) would be appropriate.
22
Q

Reducing Impairment – Asthma Control (5 Goals of Therapy)

A
  1. Prevent chronic and troublesome symptoms.
  2. Prevent frequent use (< 2 days /wk) of inhaled SABA for symptoms.
  3. Maintain (near) “normal” pulmonary function.
  4. Maintain normal activity levels (including exercise & other physical activity & attendance at work or school).
  5. Meet patients’ and families’ expectations of and satisfaction with asthma care.
23
Q

Asthma Allergen Principles (5)

A
  1. Reduce, if possible, exposure to allergens they are sensitized and exposed to.
  2. Understand effective allergen avoidance is multifaceted and individual steps alone are ineffective.
  3. Avoid exertion outdoors when levels of air pollution are high.
  4. Avoid use of nonselective beta-blockers.
  5. Avoid sulfite-containing and other known food sensitivity Consider allergen immunotherapy.
24
Q

Asthma Control of Environmental Factors (8)

A
  1. Exposure to irritants and allergens increase asthma

Evaluate for allergic triggers in persistent asthma

  1. Avoid offending allergies
  2. Avoid exertion outdoors when air pollution is high
  3. Avoid use of non select beta blockers
  4. Consider immunotherapy
  5. Stronger emphasis on avoiding offending allergens
  6. Formaldehyde and volatile organic compounds as a potential risk factor for asthma/wheezing
  7. Influenza vaccine may not reduce wheezing in flu season
25
Q

Controller medications

A
  1. Corticosteroids
  2. Long Acting Beta Agonists (LABA’s)
  3. Leukotriene modifiers (LTRA)
  4. Cromolyn and Nedocromil
  5. Methylxanthines: (Sustained-release theophylline)
26
Q

Quick Relief Medications (3)

A
  1. Short acting bronchodilators (SABA’s)
  2. Systemic corticosteroids

  3. Anticholinergics
27
Q

Approach to 0-4 year old (4)

A
  1. A therapeutic trial with asthma controller medications
  2. No clear response to medication within 4 to 6 weeks, discontinue therapy
  3. Alternative therapy or diagnosis should be considered.
  4. If the patient experiences a clear and positive response for at least 3 months, step down therapy if possible
28
Q

Treatments approved by the FDA for Asthma Control in Young Children (6)

A
  1. Budesonide [inhaled corticosteroid] nebulizer suspension (approved for children aged 1 to 8 years)
  2. Fluticasone [inhaled corticosteroid] dry-powder inhalation (approved for children aged 4 years and older)
  3. Combined salmeterol/fluticasone dry-powder inhalation or HFA MDI (approved for children aged 4 years and older)
  4. Montelukast [leukotriene receptor antagonist] (based on safety data rather than efficacy data) 4 mg chewable tablet (approved for children aged 2 to 6 years)
  5. Montelukast [leukotriene receptor antagonist] (based on safety data rather than efficacy data) 4 mg granules (approved to children aged 1 year and older)
  6. Cromolyn nebulizer (approved for children aged 2 years and older)
29
Q

Peak expiratory Flow Rate (5)

A
  1. Short term monitoring
  2. Useful in patients with poor perception of sxs
  3. Must establish “personal best”
  4. Early AM (lowest) and evening (highest)
  5. 5-10 min after inhaled bronchodilator
30
Q

PEFR Indices (3)

A
  1. Green = 80-100% = good
  2. Yellow = 50-80% = caution
  3. Red = <50% = danger
31
Q

Managing Exacerbations (3)

A
  1. Early treatment of asthma exacerbations is the best strategy for management.
  2. Patient education includes a written asthma action plan to guide patient self‐management of exacerbations.
    * Especially for patients who have moderate or severe persistent asthma and any patient who has a history of severe exacerbations.
  3. A peak‐flow‐based plan for patients who have difficulty perceiving airflow obstruction and worsening asthma.
32
Q

Management of a child 0-4 (4)

A
  1. If there is a history of one or more exacerbations
  2. Review adherence to medications and control of
    environmental exposures
  3. Review the patient’s written asthma action plan to confirm that it includes oral prednisone for patients who have histories of severe exacerbations
  4. Consider stepping up therapy to the next level
33
Q

Management of Exacerbations in Locations (4)

A
  1. Adds levalbuterol as a SABA treatment for asthma exacerbations.
  2. For home management of exacerbations, no longer recommends doubling the dose of ICSs.
  3. For prehospital management (e.g., emergency transport), encourages standing orders for albuterol and—for prolonged transport—repeated treatments and protocols to allow consideration of ipratropium and oral corticosteroids.
  4. For ED management, reduces dose and frequency of oral corticosteroids in severe exacerbations, adds consideration of magnesium sulfate or heliox for severe exacerbations, and adds consideration of initiating an ICS upon discharge.
34
Q

Exacerbations Defined (3)

A
  1. Are acute or subacute episodes of progressively worsening shortness of breath, cough, wheezing, and chest tightness — or some combination of these symptoms.
  2. Are characterized by decreases in expiratory airflow that can be documented and quantified by spirometry or peak expiratory flow.
  3. These objective measures more reliably indicate the severity of an exacerbation than does the severity of symptoms.
35
Q

Mild Asthma Exacerbation: Signs and Symptoms, PEF and Clinical Course

A

Signs and Symptoms: Dyspnea only with activity (assess tachypnea in young children)

PEF: PEF >/= 70% predicted or personal best

Clinical Course: Usually cared for at home, prompt relief with inhaled SABA, possible short course of oral systemic corticosteroids

36
Q

Moderate Asthma Exacerbation: Signs and Symptoms, PEF and Clinical Course

A

Signs and Symptoms: Dyspnea interferes with or limits usual activity

PEF: PEF 40-69% predicted or personal best

Clinical Course: usually requires office or ED visit; relief from frequent inhaled SABA; oral systemic corticosteroids; some symptoms last 1-2 days after treatment has begun

37
Q

Severe Asthma Exacerbation: Signs and Symptoms, PEF and Clinical Course

A

Signs and Symptoms: dyspnea at rest; interferes with conversation

PEF: PEF <40% predicted or personal best

Clinical Course: usually requires ED visit and likely hospitalization; partial relief from frequent inhaled SABA; PO systemic corticosteroids; some symptoms last >3 days after treatment is begun; adjunctive therapies are helpful

38
Q

Life Threatening Asthma Exacerbation: Signs and Symptoms, PEF and Clinical Course

A

Signs and Symptoms: too dyspneic to speak; perspiring

PEF: <25% predicted or personal best

Clinical Course: requires ED/hospitalization and possible ICU; minimal or no relief with frequent inhaled SABA; intravenous corticosteroids; adjunctive therapies are helpful

39
Q

What the EPR-3 does NOT recommend (3)

A
  1. Drinking large volumes of liquids or breathing warm, moist air (e.g., the mist from a hot shower).
  2. Using over-the-counter products such as antihistamines or cold remedies.
  3. Although pursed-lip and other forms of controlled breathing may help to maintain calm during respiratory distress, these methods do not bring about improvement in lung function.
40
Q

New TB Guidelines: Recommendations for Latent TB Testing (2)

A
  1. Interferon-γ release assay (IGRA) rather than a tuberculin skin test (TST) in individuals 5 years or older who meet the following criteria:
    a. Are likely to be infected with Mtb,
    b. Have a low or intermediate risk of disease progression,
    c. It has been decided that testing for LTBI is warranted,
    d. Either have a history of BCG vaccination or are unlikely to return to have their TST read (strong recommendation, moderate-quality evidence)
  2. Tuberculin Skin Testing (TST) is an acceptable alternative in settings where an IGRA is unavailable, too costly, or too burdensome.
    a. Or if the child is less than 5 years old
41
Q

Latent TB: Guidelines (2)

A
  1. Performing a TST rather than an IGRA in healthy children < 5 years
  2. A chest X-ray must be done to look for active disease if either are positive
    * Airspace opacities, pleural effusions, cavities, or changes on serial radiographs

PPC2 Exam 3 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions