Pulmonary Flashcards by Becca Scott

What is the time period for an acute cough and what are some typical causes?

< 3 weeks

post-infection, viral

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What is the time period for a subacute cough and what are some typical causes?

3 - 8 weeks

pertussis, eosinophilic bronchitis

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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

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What are the most common causes of cough?

upper airway cough syndrome (PND)
asthma
GERD
laryngopharyngeal reflux

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What are some social history factors you would be especially concerned about for chronic cough?

smoking history
employment exposure
incarceration

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What is the typical clinical picture of a patient with a spontaneous pneumothorax? (risk factors)

tall, lean males
FHx
> 40 yo unlikely

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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

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What are some things you would find on PE of a spontaneous pneumothorax?

diminished breath sounds

hyperresonance to percussion

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What would you see on a CXR of a patient with a spontaneous pneumothorax?

visceral pleural line

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What is the treatment for spontaneous pneumothorax?

supplemental O2 x 6 hours

aspiration of air with chest tube or needle decompression

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What is commonly the cause of tension pneumothorax?

trauma, MVC

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what are signs and symptoms that are more common to see in a tension pneumothorax rather than spontaneous?

hypotension and hypoxia

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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

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What would you see on CXR of a patient with tension pneumothorax?

mediastinal shift to contralateral side

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Treatment of tension pneumothorax:

needle decompression 2nd ICS, 14 - 16” cath

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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?

1. O2 2. SABA (3 tx every 20 - 30 min with ipratropium if severe) 3. systemic corticosteroids 4. consider IV MgSO4 or heliox

What is the stepwise treatment approach for asthma patients?

1. SABA 2. low dose ICS 3. low dose ICS + LABA 4. medium dose ICS + LABA 5. high dose ICS + LABA 6. 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)