Pulmonary

Question 1

Pulmonary Embolism Symptoms

Answer 1

An older adult complains of sudden onset of dyspnea and coughing. Cough may be productive of pink-tinged frothy sputum. Other symptoms are tachycardia, pallor, and feelings of impending doom

Question 2

PE patients have a history of…

Answer 2

atrial fibrillation, estrogen therapy, smoking, surgery, cancer, pregnancy, long bone fractures, and prolonged inactivity.

Question 3

Asthmatic exacerbation (impending respiratory failure) symptoms

Answer 3

tachypnea (>20 breaths/min), tachycardia or bradycardia, cyanosis, and anxiety; appears exhausted, fatigued, diaphoretic, and uses accessory muscles to help with breathing. Physical exam reveals cyanosis and “quiet” lungs with no wheezing or breath sounds audible. When speaking, the patient may speak only one to two words (cannot form complete sentence because needs to breathe).

Question 4

Treatment for asthma exacerbation (respiratory failure)

Answer 4

Adrenaline (epi) stat, call 911, oxygen, nebulizer, parenteral steroid, antihistamine or H2 blocker.

Question 5

Where are vesicular lung sounds heard?

Answer 5

Lower lobes (soft and low)

Question 6

Where are bronchial breath sounds heard?

Answer 6

Upper lobes (louder)

Question 7

Which disease are OBSTRUCTING airflow?

Answer 7

Asthma, COPD, bronchiectasis

Question 8

Which disease are RESTRICTING airflow?

Answer 8

pulmonary fibrosis, pleural disease, diaphragm obstruction

Question 9

Percussion of lungs and Tympany (or hyperresonance)

Answer 9

Occurs with chronic obstructive pulmonary disease (COPD), emphysema (overinflating). If empty, the stomach area may be tympanic.

Question 10

Percussion of lungs and Dull tone is heard

Answer 10

Bacterial pneumonia with lobar consolidation, pleural effusion (fluid or tumor). A solid organ, such as the liver, sounds dull.

Question 11

Whisper pectoriloquy test

Answer 11

“99” or “one, two, three.” Compare both lungs. If there is lung consolidation, the whispered words are easily heard on the lower lobes of the lungs.

Question 12

Normal whisper pectoriloquy test would…

Answer 12

Voice louder and easy to understand in the upper lobes. Voice sounds are muffled on the lower lobes.

Question 13

Abnormal pectoriloquy test would…

Answer 13

Clear voice sounds in the lower lobes or muffled sounds on the upper lobes.

Question 14

What is tactile fremitus?

Answer 14

You are palpating over the lungs as the patient says “99” or “one, two, three” feeling for vibrations

Question 15

Normal tactile fremitus =

Answer 15

Stronger vibrations are palpable on the upper lobes and softer vibrations on lower lobes

Question 16

Abnormal tactile fremitus =

Answer 16

Can palpate stronger vibrations on one lower lobe (which would be consolidation); asymmetrical findings are always abnormal

Question 17

What is egophony?

Answer 17

Abnormal: you hear “bah”
Normal: you hear “eee” sound is louder over the large bronchi; lower lobes are softer but still hear the “eee”

Question 18

COPD

Answer 18

Characterized by loss of elastic recoil in lungs and alveolar (damage over years)

Question 19

With COPD, long term use of steroids puts patient at risk for?

Answer 19

Pneumonia (treat against strep pneumonia- gram negative therapy)

Question 20

COPD 1st line treatment

Answer 20

SABA or short acting anti-cholinergic (atrovent)

Question 21

Short acting meds are not helping the patient, what do you do next?

Answer 21

Add LABA or LAMA (keep SABA for rescue and PRN)
LABA (salmeterol or formoterol)
LAMA (tiotropium)

Question 22

What are the only drugs you use for rescue in both asthma and copd?

Answer 22

SABA (short acting beta agoinst) - albuterol

Question 23

Emphysema risk factors:

Answer 23

Cigarette smoking, alpha 1 trypsin deficiency, occupational exposure (coal, etc)

Question 24

Objective findings with emphysema…

Answer 24

Increased anterior-posterior diameter, decreased breath and heart sounds, use of accessory muscles, pursed-lip breathing, and weight loss, hyperresonance
Tactile fremitus and egophony is decreased

CXR: Flattened diaphragms with hyperinflation; bullae sometimes present

Question 25

COPD tx with Anticholinergics (Atrovent, Spiriva) / contraindications to think about:

Answer 25

Avoid with narrow-angle glaucoma, BPH, or bladder neck obstruction

Question 26

Important safety/ education for COPD patients:

Answer 26

Stop smoking, pneumococcal and flu vaccines necessary, physical activity

Question 27

Chronic bronchitis

Answer 27

coughing with excessive mucus production for at least 3 or more months for a minimum of 2 or more consecutive years