Pulmonary Flashcards
(119 cards)
1
Q
normal vs restrictive vs obstructive values for pulmonary function tests: FVC
A
normal FVC: 5 L
restrictive: lower
obstructive: normal or lower
2
Q
normal vs restrictive vs obstructive values for pulmonary function tests: FEV1
A
normal: 3.75 L
restrictive: lower
obstructive: much lower
3
Q
A
3
Q
normal vs restrictive vs obstructive values for pulmonary function tests: FEV1/FVC
A
normal: 70-75%
restrictive: higher
obstructive: lower
4
Q
which blood has a higher hemoglobin saturation and thus higher Po2; venous or arterial blood?
A
arterial
5
Q
explain the following lung imaging finding:
border between same density organ is lost
A
silhouette sign; usually caused by a pneumonia
6
Q
explain the following lung imaging finding:
dark markings on abnormal white lung
A
alveoli are fluid filled; air in bronchi visible on xray
7
Q
at what cardiac size is imaging positive for enlarged cardiac silhouette?
A
if the size of the heart is greater than half the width of the chest
8
Q
explain the following lung imaging finding:
fundus of stomach appears as a fluid density or air fluid level behind the heart
A
hiatal hernia
9
Q
explain the following lung imaging finding:
jagged edges at the lateral aspect of the image
A
rib fracture; watch for pneumothorax
10
Q
explain the following lung imaging finding:
“fluffy” multiple white lines
A
diffuse interstitial pneumonia
11
Q
explain the following lung imaging finding:
blunt costophrenic angles
A
pleural effusion
12
Q
causes of lungs appearing too white on xray
A
pneumonia
TB
atelectasis
lung cavity, nodule, or mass
pleural effusion
congestive hearrt failure
chronic interstitial disease (confined to a particular area)
13
Q
more common causes of diffuse interstitial pneumonia
A
viral agents or mycoplasma
14
Q
primary and secondary TB infection lung findings
A
primary infxn seen in upper lobes with pleural effusion and hilar lymph node enlargement
secondary infxn xray is normal or shows small calcifications in lungs and lymph nodes
15
Q
causes of lungs to appear too black on xray
A
pneumothroax (air b/w pleura rising to highest point in chest; black w dec number of vessels)
PE (blood supply to lungs cut off)
16
Q
____ collects at the highest point in the chest, as opposed to ____ which collects at the lowest point
A
air = highest
fluid = lowest
17
Q
image of choice for lung / chest masses
A
CT to avoid motion artifact from breathing
18
Q
NON sedating H1 receptor antagonists names and doses
A
fexofenadine (allegra): 30, 60, 180 mg
loratadine (claritin) : 5-10 mg
certirizine (zyrtec): 5 and 10 mg
19
Q
NON sedating H1 antagonist AE and CI
A
loratadine & fexofenadine:
CI with use of erythromycin, ketoconazole, or itraconazole due to fatal arrythmias
avoid in severe renal impairment
no grapefruit/OJ/apple for 4 hours
certirizine:
avoid alcohol, sedative, tranquilizers > CNS depression
20
Q
diphenhydramine medication class and uses
A
sedating h1 receptor antagonists
used for allergic rxns from type 1 allergies and insomnia
21
Q
diphenhydramine AE and CI
A
AE: seizures, sedation, n/v, dry mouth, epigastric distress, thrombocytopenia, agranulocytosis
CI with CNS depressants and MAO inhibitors
22
Q
diphenhydramine dosage
A
12.5, 25, 50 mg
23
Q
epinephrine MOA and uses
A
anaphylactic shock; vasodilation of B2 receptors (and vasoconstriction a1)
24
epinephrine AE
cerebral hemorrhage, CVA, HTN, tachycardia, v fib, shock, n/v, HA, drowsiness
25
oxymetazoline MOA and uses
nasal spray or eye drop; a1 receptor stimulant; vasoconstriction
used for congestion
26
oxymetazoline AE/CI
arrythmia, anaphylaxis, asthmatic episodes, HA
do not use with MAO inhibitors or severe HTN
27
albuterol MOA and uses
short acting b2 adrenergic agonists that causes bronchodilation; acute ashtma; acts in <15 mins, lasts 3-4 hours
28
medications for short term asthma management
short acting beta agonists
anticholinergics
systemic corticosteroids
magnesium sulfate (IV) - emergency
29
long term asthma control medications
inhaled corticosteroids
long acting beta agonists
leukotriene modifiers
mast cell stabilizers
biologics (immune; for severe asthma)
30
albuterol AE /CI
nervousness, tremor, tachycardia, HA, palpitations, n/v, bronchospasm
avoid use with CNS stimulants
31
ipratropium med class and uses
anticholinergic bronchodilator (parasympathoLYTIC); asthma/COPD bronchospasm relief in combo with SABAs; esp in emergency settings
32
fluticasone/budesonide med type, asthma use, dosage
inhaled corticosteroids; dec inflammation in airways
used daily
33
salmeterol med type, asthma use, dosage
long acting beta 2 agonist; used with ICS for long term control, not for acute sx
1-2 inhalations daily; 1.5 hours before exercise for exercise induced
34
montelukast med type, asthma use, dosage
leukotriene modifier, dec inflammation/bronchoconstriction, taken daily PO
35
cromolyn med type, asthma use, dosage
mast cell stabilizer, prevents degranulation of inflammatory mediators from mast cells
usually inhaled/nasal/opti - dosed frequently
prophylaxis only
36
guaifenesin med class, MOA, uses
mucolytic; decreases viscosity of secretions, expectorant (does NOT suppress cough)
37
acetylcysteine med class, MOA, uses
reduces viscocity of respiratory tract fluid; mucolytic at high doses
used for pneumonia, bronchitis, TB, CF, emphysema, etc
antidote for acetominophen overdose
38
acetylcysteine SE/cautions
rhinorrhea, stomatitis, n/v, bronchospasm
activated charcoal dec effectiveness
39
glucocorticoid AE/caution
water retention and CV problems
long term: osteoporosis, peptic ulcer
inhaled steroids less systemically absorbed
40
steroid drug suffixes
-sone
-zone
-onide
41
cromolyn AE/caution
throat irritation
do not use during acute asthma attacks
42
ipratropium bromide AE/CI
arrythmias
not for single use in acute attack bc no sympathetic activity
43
rescue/acute inhalers versus maintenance inhalers
**rescue/acute**:
- **sympathomimetics only**: epinephrine, albuterol, metoproterenol
maintenance inhalers:
- steroids, advair, intal, atrovent
44
black box warning for long acting beta 2 agonists
inc risk of asthma related death; works very well at managing sx, not treating cause of asthma so person is just as asthmatic - sudden rebound attack when meds leave system (usually happening with missed doses)
ex of med: salmeterol
45
a-adrenergic agonists names and MOA/uses
psuedoephedrine (sudafed) -
phenylephrine (sudafed PE) - less eff/AEs
decongestants; stimulates a1 receptors > vasoconstriction
46
phenylephrine AE/CI
arrythmia, anaphylaxis, asthmatic episodes, HA
DO NOT USE W MAO INHIBITORS or severe HTN
47
pseudoephedrine HCl AE/CI
anxiety, nervousness, palpitatinos, HA, insomnia
DO NOT USE WITH MAO INHIBITORS
48
a-adrenergic agonists (pheynephrine, psuedoephedrine) AE
exacerbation HF, pulmonary HTN, renal toxicity, visceral ischemia
49
antitussives
opiates: codine/hydrocodone; dec central respiratory drive
dextromethorphan (robitussin): cough suppressant, acute coughs/flu
benzonatate: non narcotic, local anesthetic, acute/coughs/flu
50
benzonatate (tesselon pearles) AE/CI
ester or PABA allergy, use with other anesthetics
51
cough duration classifications
acute: 0-3 weeks
subacute: 3-8 weeks
chronic: >8 weeks
52
acute cough algorithm
life threatening (pneumonia, severe asthma/COPD exacerbation, PE, HF)
non life threatening:
- infections (URI, LRI)
- exacerbations (asthma, bronchiectasis, UACS/post nasal drip, COPD)
- environmental/occupational
53
subacute cough algorithm
- postinfectious (pneumonia, pertussis, bronchitis, new onset/exacerbation UACS, ashtma, GERD, bronchitis)
- non-post infectious: chronic cough workup
54
chronic cough algorithm
chest xray if hasn't been done!
ACEis, smoking, cancer, UACS, GERD, asthma
55
ashtma signs/sx
wheezing, dyspnea, cough, nocturnal sx
bilateral wheezing, hyperresonance to percussion, PFTs normal/abnormal
56
conditions that can mimic asthma
CHF
PE
GERD
foreign body aspiration
upper airway obstruction > stridor (tumors, tracheal stenosis)
57
how do NSAIDs cause asthma exacerbation?
NSAIDS only block COX pathway, so all arachadonate goes through lipoxygenase pathway > leukotrienes
58
exercise induced asthma usually occurs when during exercise?
5-10 mins after starting
59
what drugs can induce/exacerbate asthma?
ASA
NSAIDs
beta blockers
histamine
60
asthma four step classification
(higher step = more chance of death = more medication)
1: mild intermittent (<2/week) - short acting rescue inhaler
2: mild persistent (>2/week, <1/day)
3: moderate persistent (daily)
4: severe persistent (constant)
61
pneumothorax vs
atelectasis
pneumothorax: lung being collapsed by area, trachea deviates AWAY from lesion
atelectasis: lung losing body and collapsing in on itself; trachea deviates TOWARD lesion
62
types of pleural effusion
**transudate** (CHF; starling forces)
**exudate** (infectious; immune proteins)
empyema (walled off infxn)
hemorrhagic (PE)
chyliform (lymph fluid)
63
pleural effusion vs pneumothorax lung sounds
pneumo: dec lung sounds
pleual effusion: inc breath sounds
64
bronchiolitis
dangerous in infants and elderly; usually viral in nature
xray shows hyperinflation and peribronchial infiltrates
65
acute bronchitis common causes
acute inflammation trachea/bronchi usually due to: influenza, RSV, coxsackie, adenovirus, rhinovirus
often follows or is associated with acute sinusitis or pharyngitis
bacteria less common: strep pneumo, h flu, morazella catarrhalis
66
consolidated/lobar pneumonia etiology
**strep pneumo**, h flu, gram neg bacteria, moraxella catarrhalis, staph aureus
**klebsiella pneumo in chronic alcoholics, e coli in diabetics**
67
atypical/"walking" pneumonia etiology
mycoplasma, chlamydia pneumoniae
viral pneumonias
68
what lung pathology should be considered in ddx of altered mental status in the elderly?
pneumonia; elderly pts often have fewer/less severe sx or atypical presentations
69
most common causes of hospital acquired pneumonia
gram negative bacilli
70
lung abscess etiology, signs/sx
mostly bacterial;
50% due to aspiration of bacteria when pt is recumbant (coma, anesthesia, substance use, stroke), or those with problems swallowing or coughing
sx: fever, chills, pain, weakness, wt loss, foul/musty smelling sputum mixed w blood (**rusty sputum**)
71
TB patho
acid-fast intracellular parasitic mycobacteria
usually starting in upper lobes; primary infxn becomes walled off, lesions shrink and heal, leaving behind **caseating granulomas**
72
testing/dx TB
tuberculin skin test; bacteriologic culture is dx
airborne transmission
often asx
reactivation = upper lobe infiltrates on CXR
73
aspergillosis transmission, dx
fungal infection caused by soil pathogens; airborne transmission (construction)
XR: solitary lesions, round intracavitary mass, + sputum culture and ab
74
cryptococcal pneumonia transmission, dx
encapsulated yeast in pigeon droppings; portal of entry in lung but often causes meningitis
asx, XR shows large solitary nodule, pneumonitis
dx biopsy and culture; LP to r/o meningitis
75
cryptococcal pneumonia tx
amphotericin B
76
histoplasmosis dx/transmission
most common US mycosis; midwest/south central US
asx or atypical pnuemonia; patchy ilfiltrates on XR with hilar/medistinal adenopathy, flu like sx
XR: apical lung lesions, cavitation, fibrosis
dx: sputum culture/biopsy
77
coccidiomycosis/valley fever etiology
"valley fever"
infectious fungal lung; arthospores become airborne from fungal mycelia in soil
common in deserts after rainstorms
78
coccidiomycosis/valley fever signs/sx/dx
incubation up to 4 weeks: fever, malaise, dry cough, chest pain, night sweats, anorexia
NO hemoptysis
fine macular, urticarial rash, **erythema nodosum** (good prognosis)
tx: antifungal
79
first two ddx to consider with hemoptysis
TB
lung cancer
80
general description of chronic obstructive lung disease
airflow limitation from obstruction that is not fully reversible; lungs fill with air behind obstruction and become over inflated. difficult to breathe overcoming that resistance
lung tissue destroyed from chronic infection
81
interstitial (restrictive) lung dz general description
infiltration of inflammation and scarring of lung parenchyma > wide spread lung fibrosis > inc elastic recoil, dec compliance
lung is smaller in volume, patient has to work harder to breath against decreased compliance (lungs more like rubber)
82
two major lower respiratory diseases/COPD dx
emphysema "pink puffers" - normal pCO2 due to **reactive polycythemia** adjusting to new normal (RF: cig smoking, def serum 1 alpha protease inh)
chronic bronchitis "blue bloaters" - increased pCO2 bc episodic
83
why would you give a bronchitis patient antibiotics if acute bronchitis is usually viral?
if they have an acute exacerbation with chronic bronchitis it is likely bacterial superinfection
84
acute onset of dyspnea or hypoxemia with normal chest XR first ddx
PE until proven otherwise
85
PE dx and tx
V/Q scan, CT angio
anticoagulation, preventing recurrence
86
cystic fibrosis etiology and patho
AR disorder of exocrine glands
dx: >80 adult, >60 kids sweat chloride. pancreatic insufficiency, esp in kids
chronic pseudomonas aeruginosa or staph aureus bronchitis and beconhiectasis with recurrent exacerbation
87
what is bronchiectasis
irreversible dilatation of bronchial tree; obtruction can arise from tumor, foreign bodies, impacted mucus, external compression
congenital form rare, cystic fibrosis most common form
88
signs/sx bronchiectasis
prurlent sputum, or dry cough
rales and clubbing
recurrent pulmonary infxn
hemoptysis
loss of lung volume and honeycombing and cystic spaces
89
collagen vascular disease etiology/patho
common in SLE, scleroderma
2/3 pts with CVD will have clinical pulmonary dz; pleural dz in all CVD except poly/dermatomyosis
pulmonary nodules can occur in RA
90
ddx hemoptysis and hematuria
goodpastures
dx IgG deposits in glomeruli and presence of antiglomeruli BM ab in serum
91
silicosis etiologic agent & mechanism of lung injury
crystalline silicon dioxide via inhalation; alveoli filled with eosinophilic debris
sandblasting, mining, tunnerling, quarrying, stonecutting, polishing
92
asbestosis etiologic agent & mechanism of lung injury
strength/flexiblity/resistance
pulmonary fibrosis with asbestos bodies; pleural collagen plaques, pleural effusion
inc risk bronchogenic carcinoma and mesothelioma
93
most common cause of death due to cancer in the US for men and women
bronchogenic carcinoma
94
adenocarcinoma radiologic findings & 5 year survival rate
most common
peripheral mass, solitary nodules
27%
95
squamous cell bronchiogenic carcinoma radiologic findings & 5 year survival rate
common
hilar mass, atelectasis, post obstructive pn, hypercalcemia
37%
96
large cell bronchiogenic carcinoma radiologic findings & 5 year survival rate
large peripheral mass
27%
97
small cell bronchiogenic carcinoma radiologic findings & 5 year survival rate
hilar mass central location, adenopathy, sx SiADH
<1%
98
central vs obstructive apnea
central- cessation of air flow, no movemnt of rib cage or abdomen
obstructive - paradoxical motion of rib cage and abdomen without air flow
can also be a mixed type. all typed have fall in O2 sat
99
ARDS etiology/path
life threatening condition in which inflammation in the lungs and accumulation of fluid in the air sacs (alveoli) leads to low blood oxygen levels
common causes: pneumonia, septic shock, trauma, aspiration of vomit, chemical inhalation
100
ARDS signs/sx
SOB
labored, rapid breathing
low BP/shock
so sick theyre unable to complain of sx
101
acute pulmonary edema is usually associated with what pathology?
usually associated with CHF; may appear suddenly with chronic heart failure or be first manifestation of cardiac dz
102
acute pulmonary edema signs/sx
severe dyspnea, worse with lying supine
productive frothy pink sputum
diaphoresis
tachycardia
cyanosis
wheezing
rales
CXR: blurred vascular outline, inc heart size and interstitial markings
103
cheyne stokes respiration is often seen when?
advanced CHF and neuro dz
alternating tachypnea and apnea
104
cough classification by duration
acute: 0-3 weeks (CXR if u believe consolidation)
subacute: 3-8 weeks (CXR if u believe consolidation)
chronic: >8 weeks; get CXR
105
hemoptysis is _ until proven otherwise
lung cancer or TB
106
acute onset dyspnea or hypoxemia with normal CXR is _ until proven otherwise. what would next steps be?
PE
+Homans sign
order pulmonary angiography
107
what are the non-small cell lung carcinomas?
squamous cell carcinoma
adenocarcinoma
large cell carcinoma
108
are non small cell or small cell lung CA more common?
non-small cell
109
pancoast tumor presentation
superior sulcus tumor at apex of lung
110
mesothelioma presentation
malignancy of pleura associated with asbestosis
hemorrhagic pleural effusion (exudative), pleural thickening
111
blastomycosis presentation, dx, tx
fungal infxn with wart like skin lesions
chest pain, cough, fever, night sweats, pink papules, veg plaques w verrucous arciform borders
dx: sputum microscopy, CXR
tx: itraconazole
112
emphysema presentation
pink puffers: barrel chest, pursed lips, slow forced expiration
perm dilation of acinus with eventual destruction of alveolar walls
normal pCO2 = reactive polycythemia
113
chronic bronchitis preentation
blue bloaters: persistent cough with sputum for at least 3 months in at least 2 consecutive years
obese, cor pulmonale, cyanotic, can have acute exacerbatinos (bacterial superinfections)
114
pleuritis/pleurisy presentation, workup
causes include viral resp ifxn or pneumonia
pain localized, sharp, and inc with cough/sneeze/deep breath
friction rubs with auscultation, "leathery squeak" component
115
workup pneumonia
CXR, sputum culture
116
tx pulmonary edema
furosemide
morphine
nitroglycerin
oxygen
pos airway pressure
117
pulmonary fibrosis presentation, dx
lung dz of chronic alveolitis and interstitial inflammation
common w smoking
dry inspiratory crackles, clubbing, medial survivial rate 3 years
dec FVC, dec TLC
dx requires HRCT (**honeycombing, ground glass appearance**, interstitial pneumonia pattern)
118
sarcoidosis
non caseating granulomas
