Pulmonary Flashcards
1
Q
What are the characteristics of intermittent asthma? (2; +TX)
A
- Symptoms <2 days/wk, brief exacerbations, nighttime symptoms <2 nights/month
- TX =only when sx occur, quick reliever med = SABA (albuterol), systemic oral steroids if needed during exacerbation
2
Q
What are the characteristics of mild persistent asthma? (define and tx)
A
- Sx >2x/week but <1x/day, exacerbations affect activity, nighttime sx >2x/mo
- Tx: low dose inhalers steroid daily, ex. Flovent
Alternative = cromolyn, singulair, theophylline, +SABA for acute exacerbations (Albuterol)
3
Q
What are the characteristics of moderate persistent asthma (define and tx)
A
- Daily sx, exacerbations are long and severely affect activity level, sx >1x wk at night
- TX = medium dose inhaled steroid and long-acting B2 agonist, alt=singulair or theophylline +SABA (albuterol) for acute sx + systemic steroids if needed
4
Q
What are the characteristics of severe persistent asthma? (define and tx)
A
- Continuous sx, uses SABA multiple times per day, frequent exacerbations, limited physical activity
- TX = high dose ICS+long acting B2 agonist for systemic steroids if needed, SABA for acute sx
5
Q
Describe dyskinetic cilia syndrome (3)
A
- causes bronchiesctatsis and chronic sinusitis
- associated with male infertility
- If seen with situs inversus, look for Kartagener syndrome
6
Q
What are steroids and when are they used?
4; physiology, inhaled, systemic, SE
A
- Reverses regulation of B receptors, prevents migration of inflammatory cells, prevents cytokine and histamine production
- Inhaled = fluticasone, use for long term prevention of sx
- Systemic = prednisone, use in short bursts or to prevent sx in severe asthmatics
- Side effects = cough, thrush, growth suppression etc
7
Q
What is a B agonist and when is it used?
4; physiology, short-acting, long-acting, SE
A
- Stimulates B2 receptors causing bronchodilation, stabilize mast cells
- Short-acting: albuterol, epi used to stop sx of asthma
- Long-acting: formoterol/salmeterol, used to px symptoms, long term
- SE = tachycardia, palpitations, tremors, dizzy, HA, Nausea, decrease in K, increase glucose
8
Q
What are mast cells stabilizers and when are they used? (4 physiology, types, use, SE)
A
- inhibits degranulation of mast cells and mediator release from eosinophils, neutrophils, macros, and monos, do not dilate bronchioles
- cromolyn/nedocromil
- Can be used before exercise to prevent E/A or as an additional alt TX for asthma
- SE = bad taste, dry mouth, pharyngitis, cough, N, Heacache
9
Q
What are leukotriene modifiers and when are they used? (4; define, types, use, SE)
A
- Block leukotriene synthesis to prevent allergy response, broncho constriction, and mucous production
- Montelukast/zafirlukast/zileuton (singulair)
- used to prevent allergic rhinitis/persistent asthma
- SE = headaches, n, abdopain, infection, dyspepsia, increase ALT
10
Q
Describe the clinical course and TX for bronchiolitis
(6) Define, common age, sx, tx, x-ray
A
- Bronchiole inflammation caused by viral infection RSV
- Common in children <2years, increase risk in premies, neonates, underlying disease
- sx = rhinitis, cough, development of respiratory distress (tachypnea, use of accessory muscles, noisy/raspy breathing, wheezes, fever)
- Supportive care and hospitalize if needed
- Synagis to px RSV in high risk infants
- Hyperinflation on X-ray
11
Q
What are the clinical characteristics of bronchitis? (5)
Define, viral, bacterial, s/s, tx
A
- Inflammation of the lower airways, can be acute or chronic
- VIRAL = rhino, RSV, parainfluenza
- BACTERIAL = mycoplasma, pneumo, chamydiophilia pneumo, pseudomonas (in kids with CF)
- s/s = dry cough, substernal discomfort, SOB, possible reproductive cough, low or no fever, URI symptoms, fine/moist rales/rhonchi
- TX = supportive, antibiotics if bacterial
12
Q
What are the characteristics of croup? (4)
A
- Acute upper resp airway inflammation and obstruction
- 6-36 months, peak incidence age 2
- Barking cough, URI sx, fever, stridor, sx worse at night, possible dyspnea
- symptomatic relief: cold,steam, humidity
13
Q
What is the tx of croup? (3)
What is radiologic sign (1)
A
- Corticosteroids: dexamethasone 1-2mg/kg/day
- bronchodilator
- hospitalize if severe
- steeple sign
14
Q
What are the causes of pneumonia?
Viral vs. Bacterial (ages)
A
- VIRAL = RSV, CMV, influ, rhino = ALL AGES
2. Bacterial = group B strep, gram - neonates = group b strep, listeria 1-3mo = strep pneumo, chlamydia, staph 4mo-5yr = strep pneumo, HIB, M. pneumo >5 years = mycoplasma pneumo, chlamydophilia pneumo and S. Pneumo Mycoplasma is usually mild
15
Q
What are the s/s of pneumonia? (11)
A
- cough
- wheeze
- URI sx
- chest pain
- high fever (bacterial)
- GI sx
- tachypnea
- crackles, pleural effusion
- dullness
- retractions,
- nasal flaring
16
Q
What are the clinical characteristics of cystic fibrosis?
( define, leads to…11)
A
- Autosomal recessive, dysregulation of chloride channels, dehydrated/viscous secretions in the airways, bile ducts, pancreas, intestines, vas deferens, sweat glands
- Leads to chronic pulmonary disease, nasal polyps, malnutrition, steatorrhea, biliary cirrhosis, male infertility, increased sweat production, pancreatitis, poor growth, diabetes, rectal prolapse
17
Q
How is CF diagnosed and tx? (2)
A
- DX with sweat test (could be from newborn screen), fam hx, and mutation detection
- Refer to CF center, antibiotics to cover pseudomonas (Ciprofloxin+aerosolized tobramycin), chest PT, pancreatic enzymes, nut support
18
Q
Describe hyaline membrane disease/respiratory distress syndrome (5; define, s/s, xray, tx)
A
- deficiency of surfactant = poor lung compliancy
- s/s tachypnea, grunting, nasal flaring, chest retractions, cyanosis
- ground glass appearance
- tx = oxygen, CPAP, surfactant
- Most common resp illness of newborn
19
Q
Describe transient tachypnea of newborn (4)
A
- Results from incomplete evacuation of fetal lung fluid in FT infants
- Common in C-sections, no “big squeeze”
- Tachypnea, grunting, retractions, rare cyanosis
- Tx with oxygen, will resolve in 24-48 hours
20
Q
What are the clinical characteristics of BPD?
4; define, incidence, s/s, tx
A
- Infant require o2 at 36 wks or greater with radiographic changes = chronic lung disease
- increase incidence in LBW infants, caused by multifactoral (lung immaturity, barotrauma)
- Respiratory distress (cough/wheeze), poor growth/feeding, cyanotic episodes, fluid overloading
- Tx = supplemental O2, supplemental nutrition/fluids, bronchodilators, diuretics, immunize, synagis, decrease risk environment
21
Q
What are the clinical characteristics of meconium aspiration syndrome? (4)
A
- Meconium is aspirated in utero or with first breath
- Term or PT at highest risk due to placental insufficiency
- Tachypnea, retractions, grunting, cyanosis
- Supportive care and management of respiratory distress
22
Q
What are the clinical signs of a foreign body aspiration? (2)
A
- rapid onset of gagging, coughing, choking with subsequent stridor, wheezing, cyanosis, can be asymptomatic if object is small and non-obstructive but will cause secondary infections/symptoms
- Chronic recurrent pneumonia is retained in the lung
23
Q
Tracheal Breath Sounds (2)
A
- Heard over trachea
2. Harsh, sounds like blowing through a pipe
24
Q
Bronchial Breath sounds (3)
A
- Over anterior chest, near 2nd and 3rd ICS
- Loud and high in pitch with short pause between inspiration and expiration
- Exploratory phase > Inspiratory phase
25
Bronchovesicular Breath Sounds (4)
1. Heard in posterior chest between scapula and center part of anterior chest
2. Softer than bronchial sounds, have tubular quality
3. Inspiration = Expiration
4. Difference in pitch and intensity is more equally detected in expiration
26
Vesicular Breath Sounds (3)
1. Soft, blowing or rustling sound over most lung fields
2. Normally heard throughout inspiration and continues without pause through expiration but fades 1/3 into expiration
3. Inspiration > expiration
27
Fine crackles/Rales (3)
1. Short, rattling sounds best heard on mild to late inspiration and occasionally on expiration
2. Unaffected by cough
3. Pneumonia and intersitial lung disease
28
Coarse crackles (3)
1. Short, explosive heard early inspiration and throughout expiration; intermittent bubbling or brief popping that lasts longer than fine crackles
2. Affected by cough
3. Indicates intermittent airway opening; may be related to secretions
