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First AId 2CK > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Systemic Sarcoidosis

A
  • multi-system dx of unknown etiology with NONCASEATING GRANULOMAS
  • often found in African-American females and North European Caucasians
  • often arises in 3rd or 4th decade of life
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2
Q

Systemic Sarcoidosis: Hx and PE

A

can present with fever, cough, malaise, weight loss, dyspnea, and arthritis

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3
Q

Systemic Sarcoidosis: Dx

A

CXR/CT: lymphadenopathy and nodules used to stage disease
Biopsy: lymph node biopsy or T-VATS lung biopsy shows noncaseating granulomas
PFTS: show restrictive/obstructive patter and decr. diffused capacity
- increased serum ACE levels, hypercalcemia, increased alk phos, lymphopneia, CN defcitic, arrhythmias

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4
Q

Systemic Sarcoidosis: Tx

A

Systemic corticosteroids indicared for deteriorating respiratory fxn, constitutional sx, hypercalcemia, or extrathoracic organ involvement

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5
Q

Obstructive Lung Disease

A
  • characteried by airway narrowing

- OLD restricts aire movement and cause air trapping

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6
Q

Etiology of Obstructive Lung Disease

A 
ABCT
Asthma
Bronchiectasis
Cystic fibrosis/ COPD
Tracheal or bronchial obstruction
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7
Q

Asthma

A
  • reversible airway obstruction secondary to bronchial hyperactivity, airway inflammation, mucous plugging and smooth muscle hypertrophy
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8
Q

Asthma: Hx and PE

A
  • persists with cough, episodic wheezing, dyspnea and/or chest tightness
  • exam shows wheezing, prolonged expiratory duration (decr. I/E ration), accessory muscle use
  • decreased breath sounds and decreased SpO2 are late signs
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9
Q

Asthma: Dx

A
  • ABGs: mild hypoxia and respiratory alkalosis
  • Spirometry: decreased FEV1/FVC
  • increased residual volume and total lung capacity
  • CBC: possible eosinophilia
  • CXR: hyperinflation
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10
Q

Methacholine challenged

A
  • tests for bronchial hyperresponsive

- useful when PFTs are normal but still suspect asthma

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11
Q

Asthma: Tx

A

Avoid triggers (allergens, URIs, cold air, exercise, drugs, and stress)

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12
Q

Tx of acute asthma

A
  • Oxygen
  • Bronchodilating agents (inhaled B2 agonists - first line therapy)
  • Ipatropium (never used alone for asthma)
  • Systemic corticosteroids, magnesium for severe exacerbations
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13
Q

Tx for chronic asthma

A
  • administer long acting bronchodilators and/or inhaled corticosteroids
  • can also use systemic corticosteroids, cromolyn or rarely theophylline
  • Montelukas and other leukotriene antagonist s are oral adjuncts to inhalant therapy
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14
Q

B-2 agonists

A

albuterol or salmeterol

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15
Q

Albuterol

A
  • short acting B-2 agonists

- relaxes bronchial smooth muscle (B 2 adrenoreceptors)

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16
Q

Salmeterol

A
  • long acting B-2 agonist for prophylaxis
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17
Q

Inhaled corticosteroids

A
  • first line treatment for long term control of asthma
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18
Q

Beclomethasone, prednisone

A

inhibit synthesis of virtually all cytokines

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19
Q

Muscarinic antagonists

A

(e. g. ipratroprium)

- competitively blocks muscarinic receptors, preventing bronchospasm

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20
Q

Methylxanthines

A

(e. g. theophylline)
- likely causes bronchodilation by inhibiting phosphodiesterae, thereby decreasing cAMP hydrolysis and increasing cAMP levels
- limited use b/c of narrow therapeutic-toxic index (cardiotoxcity, neurotoxicity)

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21
Q

Cromolyn

A
  • prevents release of vasoactive mediators from mast cells
  • useful for exercise induced bronchospasm
  • EFFECTIVE FOR PROPHYLAXIS OF ASTHMA
  • not effective during acute asthma attack
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22
Q

Antileukotrienes

A

(e.g. zileuton, monteleukast, zafirlukast)

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23
Q

Zileuton

A

5- lipoxygenase pathway inhibitor. Blocks conversion of arachodonic acid to leukotriens

24
Q

Monteleukast, zafirleukast

A
  • block leukotriene receptors
25
Q

Meds for ASTHMA exacerbation

A 
ASTHMA
Albuterol
Salmeterol
Theophylline (rare)
Humidified oxygen
Magnesium (for severe exacerbations)
Anticholingerics
26
Q

10 yr old with hx of asthma on daily fluticasone has been using an albuterol inhaler once a day for several weeks. What changes should be made to current regimen?

A

Moderate persistent asthma w/ daily symptoms

- may benefit from long acting B-2 agonist (salmeterol) for prevention of symptoms

27
Q

Mild intermittent asthma

A 
< 2 days/ week
< 2 nights/month
FEV > 80%
- no daily meds
- prn short acting bronchodilator (albuterol)
28
Q

Mild persistent asthma

A 
> 2 / weeks but < 1/ day
> 2 nights/ month
FEV > 80 %
- daily low dose inhaled corticosteroids
- prn short acting B2 agonist
29
Q

Moderate persistent asthma

A 
Daily
> 1 night/ week
FEV 60 - 80%
low to medium dose inhaled corticosteroids + long acting inhaled B2 agonist
prn short-acting bronchodilator
30
Q

Severe persistent asthma

A 
Continual, frequent
FEV < 60 %
High dose inhaled corticosteroids + long acting B2 agonists
- possible PO corticosteroids
PRN short-acting bronchodilator
31
Q

Bronchiectasis

A
  • disease caused by cycles of infection and inflammation in the bronchi/bronchioles that lead to fibrosis, remodeling and PERMANENT DILATION OF BRONCHI
32
Q

Bronchiectasis: Hx and PE

A
  • presents with chronic cough accompanied by frequent bouts of yellow or green sputum production, dyspnea, and possible hemoptysis and halitosis
  • exam reveals rales, wheezes, rhonchi, purulent mucous and occasional hemoptysis
33
Q

Conditions associated with bronchiectasis

A
  • Pulmonary infxns
  • Hypersensitivity
  • Cystic fibrosis
  • Immunodeficiency
  • Localized airway obstruction
34
Q

Bronchiectasis: Dx

A

CXR: shows increased bronchovascular marking and tram lines (parallel lines outlinting dilating bronchi )
CT: Dilated airways and balloon cysts are seen at end of bronchus (mostly lower lobes)

35
Q

Bronchiectasis: Tx

A
  • Abx for bacterial infections
  • maintain bronchopulmonary hygiene (cough control, postural drainage)
  • consider lobectomy for localized disease or lung transplantation
36
Q

Chronic Obstructive Pulmonary Disease (COPD)

A
  • disease with decreased lung fxn associated with airflow obstruction
  • secondary to chronic bronchitis or emphysema
37
Q

Chronic Bronchitis

A
  • productive cough for > 3 months per year for 2 consecutive years
38
Q

Emphysema

A

terminal airway destruction and destruction that may be secondary to smoking (centrilobular) or to alpha-1 antitrypsin deficient (panlobular)

39
Q

Emphysema: Hx and PE

A

“Pink puffer”: dyspnea, pursed lips, minimal cough, decreased breath sounds

  • late hypercarbia/hypoxia
  • tend to have thin wasted apperance
  • few exacerbations in between episodes
40
Q

Chronic bronchitis

A

“Blue bloater”: Cyanosis with mild dyspnea, productive cough

- often overweight with peripheral edema, rhonchi and early signs of hypercarbia/hypoxia

41
Q

COPD: Dx

A

CXR: Hyperinflated lungs: decreased lung markings with flat diaphragms and thin heart/mediastiunum
- parenchymal bullae or subpleural blebs
ABGS: hypoxemia with acute or chronic respiratory acidosis
- consider gram stain or sputum culture if pt has fecer or productive cough

42
Q

COPD: PFTs

A

Decreased FEV1/FVC

  • normal or decreased FVC
  • increased TLC (emphysema, asthma)
  • decreased DLco (emphysema)
43
Q

Acute COPD exacerbation Treatment

A
  • Oxygen
  • Inhaled B2 agonists
  • Anticholingerics (ipatropium, tiotroprium)
  • IV and/or inhaled corticosteroids
  • Abx
    • Severe cases may need BiPap**
44
Q

Chronic COPD exacerbation treatment

A
  • Smoking cessation, inhaled B2 agonists, anticholingerics (tiotroprium), systemic/inhaled corticosteroids
  • Supplemental oxygen if resting PaO2 < 55 mm Hg or SaO2 < 80% or has cor pulmonale, pulm HTN, or hematocrit < 35%
  • Give pneumococcal and flu vaccines
45
Q

COPD Treatment

A 
COPD
Corticosteroids
Oxygen
Prevention (stop smoking/ flu + pneumoccocal  vaccines)
Dilators (B2 agonists, anticholinergic)
46
Q

Restrictive Lung Disease

A
  • loss of lung compliance

- result in increased lung stffness and decreased lung expansion

47
Q

Causes of atypical pneumonia

A
  • Mycoplasma
  • Legionella
  • Chlamydia
48
Q

Causes of nosocomial pneumonia

A
  • GNRs
  • Staphylcoccus
  • Anaerobes
49
Q

Causes of immunocompromised pneumonia

A
  • Staphylcoccocus
  • Gram positive rods
  • Fungi (e.g. aspergillous)
  • P. jiroveci (esp with HIV)
  • Mycobacteria
50
Q

Causes of aspiration pneumonia

A

Anaerobes

51
Q

Causes of pneumonia in alcoholics/IV drug users

A

S. pneumoniae
Klebsuella
Staphylococcus

52
Q

Causes of cystic fibrosis pneumonia

A

Pseudomonas
Burkholderia
S. aureus
Mycobacteria

53
Q

Causes of pneumonia in COPD

A

H. influenzae
Moraxella catarrhalis
S. pneumoniae

54
Q

Causes of post-viral pneumonia

A

S. pneumonoia
Staphylococcus
H. influenzae

55
Q

Causes of pneumonia in neonates

A

Group B Strep

E. coli

56
Q

Causes of recurrent pneumnoa

A 
Obstruction
Bronchogenic carcinoma
Lymphoma
Wegener's granulomatosis
Immunodeficiency
Unusual organisms (e.g. Nocardia, Coxiella burnetti, Aspergillus, Pseudomona

First AId 2CK (22 decks)

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