Pulmonary Flashcards
What is the time period for an acute cough and what are some typical causes?
< 3 weeks
post-infection, viral
What is the time period for a subacute cough and what are some typical causes?
3 - 8 weeks
pertussis, eosinophilic bronchitis
What is the time period for chronic cough and what are some typical causes?
> 8 weeks
bronchitis, asthma, COPD, GERD, TB, ACEI, allergic rhinitis, fibrosis, lung CA
What are the most common causes of cough?
upper airway cough syndrome (PND)
asthma
GERD
laryngopharyngeal reflux
What are some social history factors you would be especially concerned about for chronic cough?
smoking history
employment exposure
incarceration
What is the typical clinical picture of a patient with a spontaneous pneumothorax? (risk factors)
tall, lean males
FHx
> 40 yo unlikely
What are some signs and symptoms for a spontaneous pneumothorax?
SOB at rest
acute dyspnea
ipsilateral pleuritic CP
tachycardia and hypotension are common but not always present
What are some things you would find on PE of a spontaneous pneumothorax?
diminished breath sounds
hyperresonance to percussion
What would you see on a CXR of a patient with a spontaneous pneumothorax?
visceral pleural line
What is the treatment for spontaneous pneumothorax?
supplemental O2 x 6 hours
aspiration of air with chest tube or needle decompression
What is commonly the cause of tension pneumothorax?
trauma, MVC
what are signs and symptoms that are more common to see in a tension pneumothorax rather than spontaneous?
hypotension and hypoxia
What are some things you would find on exam of a patient with tension pneumothorax?
absent breath sounds on ipsilateral side
tracheal deviation
hyperresonance to percussion
JVD, tachy
What would you see on CXR of a patient with tension pneumothorax?
mediastinal shift to contralateral side
Treatment of tension pneumothorax:
needle decompression 2nd ICS, 14 - 16” cath
What is the #1 complication of COPD?
upper airway infection
What is the technical diagnosis for COPD?
emphysema + chronic bronchitis, cough and sputum production for at least 3 months in each of 2 consecutive years
Risk Factors: 80% of COPD patients are _______.
smokers
How might Hgb and Hct values differ in a patient with COPD?
elevated Hgb and Hct (chronic hypoxia)
What is the GOLD guideline diagnostic for COPD?
FEV1/FVC < 0.7
What are the FEV1 values (% predicted) for GOLD criteria?
Gold 1: FEV1 >= 80
Gold 2: FEV1 50 - 79
Gold 3: FEV1 30 - 49
Gold 4: FEV < 30
What is the recommended first choice for pharmacologic therapy for a patient with COPD in category A (low risk, less symptoms)?
SABA (albuterol sulfate)
or
SAMA (ipratropium)
What is the recommended first choice for pharmacologic therapy for a patient with COPD in category B (low risk, more symptoms)?
LABA (salmeterol/formoterol)
or
LAMA (tiotropium)
What is the recommended first choice for pharmacologic therapy for a patient with COPD in category C (high risk, less symptoms)?
ICS (beclomethasone, fluticasone, mometasone) + LABA or LAMA
What is the recommended first choice for pharmacologic therapy for a patient with COPD in category D (high risk, more symptoms)?
ICS + LABA and/or LAMA
What is the gold standard for evaluating a patient with asthma?
peak flow expiratory rate
FEV1/FVC < 80% or + > 12% increase of FEV1 with bronchodilator
What are the rules of two for asthma patients? (if yes to any of these, Rx adjustment)
quick relief inhaler > 2x/week
awake at night > 2x/month
refill quick-relief inhaler > 2x/year
How are asthma exacerbations managed?
- O2
- SABA (3 tx every 20 - 30 min with ipratropium if severe)
- systemic corticosteroids
- consider IV MgSO4 or heliox
What is the stepwise treatment approach for asthma patients?
- SABA
- low dose ICS
- low dose ICS + LABA
- medium dose ICS + LABA
- high dose ICS + LABA
- high dose ICS + LABA + oral corticosteroids
What is the CURB-65 Score for PNA?
score gives you a suggested site-of-care for PNA patients
C = confusion U = blood urea nitrogen >= 20 mg/dL R = RR >= 30 B = systolic BP < 90 or diastolic BP <= 60 65 = age >= 65
0 - 1 = outpatient
2 = short inpatient / supervised outpatient
3 = inpatient
4 - 5 = inpatient / ICU
How should you treat PNA in patients that were previously healthy with no risk factors for drug-resistant S. pneumoniae ?
macrolide
How should you treat PNA in the presence of comorbidities (chronic heart, lung, liver, renal dz, DM, alcoholism, etc.)
or in a PNA patient with the use of antimicrobials within the previous 3 months
or other risk factors for drug-resistant S. pneumoniae?
macrolide + beta lactam
or
respiratory FQ (levofloxacin)
