Pulmonary Flashcards
s/s PE
sudden onset of SOB and cough. + productive ( pink) sputum, tachy, impending doom. Most common cause is a DVT emboli
what type of reaction is a anaphalxisis
type 1 igE-mediated
how many lobes does the L and R lung have
R = 3 L= 2
What does the normal resp drive respond too?
changes in the aterial C02 ( hypercapnia)
Norm base/lower lung sounds
vesicular
norm bronchi/upper airways sounds
bronchial or bronchovesciular
normal sound with percussion?
reasonance
When you hear dull percussion on lungs?
lobar pnuemonia , blood fluid, tumor
over ribs/bone, liver and heart
when do you hear hyperreasonace/tympany?
“too much air in heart” = emphysema
Do upper or lower lobes have more fremitus?
upper have more vibration
Increased fremitus on one lower lobe indicates what?
lobar pnuemonia
decreased fremitus indicates?
emphysema/copd
What is egophony?
when pt says “ee” but it sounds like ‘aa”, if that is true = positive = lobar pnuemonia over affected lobe ( consolidation)
What is the diagnostic test for COPD
PFT’s with a FEV1/FVC ration
what will a CXR look like with a pt with COPD?
hyperinflation/hyperexpansion with increased chest size and flattened diaphram
What is COPD? what is the #1 risk factor?
irreversible loss of elastic recoil of the lungs and aveolar damage
smoking
what is chronic bronchitis?
chronic cough w/ increased mucus on most days for at least 3 months per year for at least two consecutive years.
what is emphysema? on physcial exam?
increased AP diameter, decreased breath and heart sounds , expiratory phase prolonged, pursed lip breathing
what would you see on PE for emphysema?
- percussion
- fremitus
- egophony
Hyperresonance
decreased tactile fremitus
decreased egophony
What would you see on spirometry for dx of COPD?
FEV 1 <80%
O2 < 92%
examples of ICS:
Fluticansone, budesonide
examples of SABA
Albuterol
examples of SAMA
short-acting anticholingeric atrovent (iprtropium)
examples of LABA
formeterol
examples of LAMA
tiotropium / sprivia
GOLD A and B are based on two things?
exacerabation in the last 12 months and hospitalization
other options for COPD
Oxygen only 2-3 liters - dont go above 92%
pulmonary rehab
flu and pnuemococcal vaccine
what pathogen is responsible for a secondary bacterial infection ? s/s ? tx?
H. influenza pneumonia
acute onset fever, + purulent sputum, wheezing
Bactrim, doxy or ceftin BID for 10 days
who should get the pnuemonia vaccine? which one?
anyone over 65
get PCV 13 then a year later PPSV23
if you give it prior to 65 you want to give again in 5 years
who is considered high risk for getting pnuemonia
no spleen / damaged spleen, scc, HIV/AIDS, chronic heart or lung dx, chemo, people on steroids, cochlear inplant , renal failure
CAP s/s and PE
acute onset fever/chills, w/ productive cough and pluertic chest pain
cough productive of yellow, green - rusty colored phelgm
rusty/blood tinged sputum = strep. pneumoniae
PE if consolidation present:
- positve tactile fremitus, egophany and whispered petroliguy
- dullness on precussion
what is the gold standard for dx the CAP
Chest xray showing infiltrates or lobar consolidation w/ CLINICIAL SYMPTOMS
you should repeat CXR after tx expecially w/ high risk pt
What labs would see on CAP
increased WBC
elevated nuetrophils > 70 %
shift to the left
increase in bands if bacterial
What is the CURB65 criteria
indicates if out pt tx or inpatient tx is needed to tx CAP
A score GREATER than 1 = inpt tx
Confusion Urea (BUN >19 ) Resp rate >30/min BP <60 or <90 Age 65 or older
What are the top two pathogens for CAP
Strep. pnuemoniae ( alcoholics
H. influenza ( more common in copd and smokers
CAP pathogen in young adults?
mycoplasma pnumoniae
TX for CAP out pt? comormidities or not
No commormidities : Macrolides Azithromycin x 5 days
Doxy if allergic to macrolides
Comordities ( renal, lung, heart , asplenia, DM, Alcoholics)
Fluoroquinolones : Moxifloxacin QD 5-7 days, Levofloxacin 750 mg X 5 days
Adverse effects of Fluoroquinolones? Name 3
Hypo/hyperglycemia, QTc prolongation, confusion, achiles tendon rupture, nueropathy, AKI
Cipro, anything ending in floxin, levaquin)
What type of bacteria causes Atypical Pnuemonia? TX
Mycoplasma pnuemoniae and Chlamydia
TX: doxycline
Viral URI
acute onset of sneezing, runny nose, sore throat, nasal congestion
resololves on own
can use dextromethropan for cough
pseaudophedrine for nasal congeston
guiafenesin ( mucoltic )
ACEI / ARB cough
new cough, dry
stop ACE and try ARB if not better switch classes
Acute Bronchitis s/s, organism, tx
Recent history of a cold but longer duration x 2 weeks
may have chest wall pain
organisms ( viruses and chlamydia )
TX: no antibiotics
- antitissuves ( honey, dextromethorpan, tessalon) - cough
- Wheezes - albuterol
- mucolytic - increased fluids and guiafenesin
What is asthma?
chronic airway inflammation results in hyperresponsive airways and bronco-contriction ( which is reversible)
presentation of asthma and PE
history of a “bad cold” or acute bronchitis, increase use of inhaler, w/ no relief. Complains of chest tightness especially at night
PE: inspiritory and expiriotry wheezes or heard to hear lung sounds
what is the rescue drug for asthma ?
SABA PRN - albuterol to treat wheezing
what are asthma controller agents?
Inhaled corticosteriod ( ICS) flovent 2 puff BID * first line*
can also use
- singulair
- LABA ( advair diskus) which is a combo of a LABA and ICS
What concerns to we have with theophylline ?
Blood levels and drug interactions
safety concerns with ICS
osteoporosis, cateracts, gluacoma
thrush ( rinse mouth with water after use)
safety concerns with LABA
increase risk of death and pneumonia
safety concerns with albuterol
arrythmias, MI, angina
What are the variables that are used to figure out someones PEF ( volume lung can hold)
H eight
A ge
G ender / sex
Step 1 asthma ( called, symptoms, nighttime awakenings, PEF)
intermittent
( everything less than two) (symptoms less than 2 week, using SABA less than 2 x month
N : < 2 a month
>80 PEF
Step 2 asthma ( called, symptoms, nighttime awakenings, PEF)
mild persistent
> two days a week, > SABA use 2 days a week ( not daily)
N: 3/4 a month
> or equal to 80%
Step 3 asthma ( called, symptoms, nighttime awakenings, PEF)
MODERATE persistent ***
Daily attacks, SABA use daily
N : > night a week ( but not daily)
60-80 percent
Step 4 asthma ( called, symptoms, nighttime awakenings, PEF)
Severe Persistent
daily attacks markedly imparied function and activity
N: nightly
<60 %
What type of asthmatics should use an ICS
all BUT step one ( intermittent)
all should be using albulterol
What is the tx for Exerisce-Induced bronchospams?
pre-tx before excerise : 5-15 min with SABA
Education: use a mask/scarf for cold-induced EIB. Warm up period encouraged
Emergency care for asthma
- assess severity ( check PEF, s/s, resp distress, check o2
- tx with continuous SABA with inhaled ipratripium
- monitor response
- if PEF is less than 50 % of expected or <91 % send to ED`
What does it mean if you cant hear lung sounds in an asthmatic
severe bronchoconstriction
What is a PFT
pulmonary function test : measure of severity of obstructive and restrictive pulmonary dysfunction
what are examples of obstructuve diseases
reduction in airflow rates
COPD, Asthma
what are examples of restrictive diseases
reduction in lung volumes
pulmonary fibrosis, plerual dx, diaphram obstuction
