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Clinical Prep > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Wheezing

A

high pitched whistle
Usually louder in Expiration

Obstructive dz: asthma, COPD, lung CA, sleep apnea, CHF, GERD, Fb

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2
Q

Ronchi

A

continuous, low pitched rumble

may clear with Cough or suction

d/t increased secretions or obstruction in bronchial airway

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3
Q

Crackles/Rales

A

discontinuous
high pitched

during Inspiration

not changed by cough
d/t popping open of collapsed alveoli

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4
Q

Crackles/Rales are seen with

A 
PNA
Atelectasis
Bronchitis
Pulm edema
Pulm fibrosis
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5
Q

Stridor

A

loudest over anterior neck d/t narrowing of larynx of anywhere over trachea

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6
Q

COPD includes:

A

Emphysema

Chronic Bronchitis

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7
Q

COPD is

A

largely irreversible airflow obstruction

Chronic bronchitis: episodic

Emphysema: steady decline

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8
Q

Risk factors for COPD

A

Cig smoking
A1 antitrypsin def
Occupation exposure
Recent airway infection

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9
Q

Emphysema

loss of elastic recoil

A

Permanent enlargement of terminal airspace- distal to the bronchioles

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10
Q

Pathophys of Emphysema

A

decreased protective enzymes and increased damaging enzymes –>

Alveolar capillary and Wall damage
–>

Expiration is now active process
Increased airway trapping

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11
Q

Hallmark of Emphysema

A

simply Dyspnea: hard to breath and chronic cough (wet or dry)

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12
Q

PE of Emphysema

A

“Pink puffers”
Dec breath sounds
BARREL CHEST
Hyperresonance on percussion

Severe dz: pursed lip expiration

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13
Q

Gold standard to dx both Emphysema and Chronic Bronchitis

A

PFT: pulmonary function test

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14
Q

PFT results of COPD

A

Decreased FEV1

Ratio of FEV1/FVC <70%

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15
Q

What will you see on CXR in both types of COPD?

A

Increased AP diameter

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16
Q

CXR of Emphysema specifically

A

Flattened diaphragms

Bullae

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17
Q

Chronic Bronchitis (a sub category of COPD)

A

WET cough for at least 3 months per year, 2 years in a row

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18
Q

Pathophys of Chronic Bronchitis

A

Mucous gland hyperplasia

increased risk of infection!!! (S.PNA and H.Flu)

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19
Q

Cardinal sx of Chronic Bronchitis

A

Dyspnea and WET cough

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20
Q

PE of Chronic Bronchitis

A

Crackles/Rales
Wheezing

Cor pulmonale
Enlarged, tender LIVER (RUQ)
JVD
Periph edema

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21
Q

Cyanosis and Obesity

“Blue bloaters”

A

Chronic Bronchitis

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22
Q

EKG of Chronic Bronchitis (a subcategory of COPD) may show

A

Cor pulmonale- RVH, right atrial enlargement, RAD

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23
Q

CBC of Chronic bronchitis pt may show

A

Increased Hgb and Hematocrit- chronic hypoxia causes this

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24
Q

ABG of Chronic bronchitis pt may show

A

Respiratory acidosis

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25
Q

Cor pulmonale

A

alteration of RIGHT ventricle as a result of a Respiratory problem

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26
Q

Peripheral edema and Cyanosis go with what category of COPD

A

Chronic Bronchitis

the resp affects are starting to affect the Right side of heart

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27
Q

Which type of COPD has a severe V/Q mismatch?

A

Chronic Bronchitis

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28
Q

Hypercapnia (too much CO2) is assoc w what type of COPD

A

Chronic Bronchitis

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29
Q

CXR shows flattened diaphragms, DEC vascular markings, and BULLAE (dark circles signify airspace loss)

A

Emphysema

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30
Q

CXR shows INCreased vascular markings, Right heart enlargement

A

Chronic Bronchitis

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31
Q

4 types of Obstructive airway dz

A

Asthma
Emphysema, Chronic Bronchitis (COPD)
Cystic Fibrosis
Bronchiectasis

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32
Q

Order of airway breakdown

A

Trachea (windpipe)
Bronchi
Bronchioles
Alveoli

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33
Q

What is Bronchiectasis?

A

Irreversible DILATION of bronchial airways and impairment of mucociliary escalator

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34
Q

If someone has Bronchiectasis, what’s the big deal?

A

It leads to

  • Repeat infections
  • Airway obstruction
  • Peribronchial fibrosis
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35
Q

Sx of Bronchiectasis

A

Persistent wet cough
SOB
Pleuritic CP
Hemoptysis (BLOOD, d/t bronchial artery erosion)

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36
Q

PE of Bronchiectasis is non specific

A

Crackles usually
Wheezing
Rhonchi

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37
Q

Preferred imaging of choice to diagnose Bronchiectasis (but not the gold standard)

A

High resolution CT

thick bronchial walls, airway dilation, tram-track appearance, signet ring sign

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38
Q

Gold standard to dx Bronchiectasis

A

PFT: pulmonary fx test showing Obstructive pattern

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39
Q

Tx for Bronchiectasis

A

Conservative: chest physiotherapy, mucolytics, bronchodilators

Abx often needed: Macrolides, Ceph, Augmentin, FluoroQ

Surgery if severe/refractory

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40
Q

“Tram track” on CXR

A

Bronchiectasis

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41
Q

Signet ring sign

a pulmonary artery coupled with dilated bronchus

A

Bronchiectasis

42
Q

Abx for Acute exac of COPD

A

Macrolide (Azithromycin, “Z pack)
Ceph
Augmentin
FluoroQ

43
Q

Category A COPD tx

A

SABA (Albuterol) or

SAMA (Ipratropium)

44
Q

Category B COPD tx

A

LAMA

Lama: Tiotroprium (inhaled powder)

45
Q

Category C COPD tx

A 
LAMA (Tiotropium) + LABA (Salmeterol)
or
LAMA (Tiotropium)
or 
LABA (Salmeterol) + Glucocorticoid (Fluticasone)
46
Q

When to use Oxygen in COPD?

it reduces mortality and improves QOL in severe COPD

A

if Cor pulmonale (R heart changes)
O2 sat < 88%
PaO2 <55 mmHg

47
Q

Asthma 3 components

A

Airway hyperreactive
Bronchoconstriction
Inflammation

48
Q

IgE response in Asthma

A

increased IgE binds to mast cells –> inflammatory response –> increased Leukotrienes

49
Q

Samter’s Triad

Aspirin exacerbated

A

Asthma + Chronic runny nose + Nasal polyps + sensitive to ASA or NSAIDs

50
Q

Atopic Triad

A

Asthma
Allergic rhinitis
Eczema (atopic dermatitis)

51
Q

Classic triad of Asthma

A

SOB
Wheezing
Cough
(esp at NIGHT)

maybe chest tightness and fatigue

52
Q

Clues to severity of Asthma

A

Previous intubation, hospital admission, ICU visit

53
Q

PE shows wheezing, hyperresonance, dec breath sounds, tachycardia, tachypnea, use of Acessory muscles

54
Q

Dx of Asthma in office

A

PFT test
Methacoline challenge
Bronchodilator challenge

55
Q

Dx of Asthma in acute exacerbation

A

Peak expiratory flow rate

in order to d/c pt, the PEFR must be >70% or improved by 15% from 1st attempt

56
Q

CXR of asthma

A

generally not helpful

used to r/o other conditions

57
Q

normal BUN level

“teenager years”

58
Q

normal Cr

59
Q

normal Bicarb level

“the twenties”, when many people come out as Bi

60
Q

Normal K (potassium) level

61
Q

Normal Na (sodium) level

62
Q

Asthma:

Sx 1x per week
SABA use 1x per week
Nighttime awaken <2 x per MONTH
No limit to daily actvitiy

A

Intermittent Asthma

Tx: SABA prn

63
Q

Asthma:

Sx 3-4 per week
SABA use a fewx per week
Nighttime awaken a fewx per Month
Minor limit to normal activity

A

Mild Pers Asthma

Tx: Inhaled corticosteroid (and SABA prn)

64
Q

Asthma

Sx daily
SABA use daily
Nighttime awakening a fewx per WEEK, but not nightly
Some limit to normal activity
FEV1 60-80% of predicted
A

MODERATE pers Asthma
when you see the word “daily”

Tx: Low dose Inhaled corticosteroid + LABA
OR
just Med dose Inhaled corticosteroid

can add LTRA (Montelukast)

65
Q

Asthma

Sx throughout day
SABA use throughout day
Awaken nightly
Activity very limited
FEV1 <60% of predicted
A

Severe pers Asthma

Tx: High dose ICS + LABA

can add Omalizumab if severe and uncontrolled

66
Q

Tx for Asthma exacerbation

A

SABA- Albuterol
Steroid- Prednisone
Anticholinergic/SAMA- Ipratropium

67
Q

SABA and

LABA

A

Albuterol

Salmeterol, Formeterol

68
Q

SAMA and

LAMA

A

Ipratropium

Tiotropium

69
Q

LTRA

A

Montelukast

70
Q

Mast cell stab

71
Q

Preferred tx, Step up therapy in Asthma

A

1: SABA prn
2: Low dose ICS
3: Low dose ICS + LABA
4: Med dose ICS + LABA
5: High dose ICS + LABA
6: High dose ICS + LABA + steroid

72
Q

Note, anytime you see LABA (Salmeterol, Formeterol) you can substitute with

A

LTRA (Montelukast) as an alternate

73
Q

When can you consider stepping down therapy?

A

If sx have been controlled for >3 months

74
Q

Corticosteroids (for acute Asthma exacerbation)

A

Prednisone
Methylprednisolone
Prednisolone

75
Q

Inhaled Corticosteroids (for maintenance therapy of Asthma)

A

Triamcinolone

Beclomethasone

76
Q

LABAs are added in Asthma tx starting in step 3, what is a LABA?

A

Long acting beta agonist

Formoterol
Salmeterol

77
Q

Pt has daily SABA use, daily sx
and a few PM wakenings per week

What is the treatment?

A

This person has MODERATE persistent asthma

Tx: Low dose ICS + LABA

78
Q

This person has sx and uses SABA throughout the day, awakens nightly, and <60% FEV1

What is the treatment?

A

This person has SEVERE persistent asthma

Tx: Med/High dose ICS + LABA

can add Omalizumab

79
Q

This person has sx and SABA use 1-2x per week
1-2 nighttime wakening per MONTH

What is the tx?

A

This person has only INTERMITTENT asthma

Tx: SABA prn

80
Q

This person has 3-4 sx and SABA use per week
3-4 nighttime wakenings per MONTH

What is the tx?

A

This person has MILD persistent asthma

Tx: Low ICS

81
Q

When do you start adding the LABA (Formoterol, Salmeterol) to the ICS?

A

in step 3, MODERATE persistent

when stuff is “DAILY”

82
Q

Acute Bronchitis

A

Usually VIRAL-

Adenovirus, Infleunza, Corona, Coxsackie

83
Q

Acute Bronchitis if bacterial (rare), what are the causative organisms?

A

S. PNA
M. cat
H. flu

the “SMH” pathogens

84
Q

Clinical sx of Acute Bronchitis

A

Cough for at least 5 days, often 1-3 weeks!
productive

Malaise, SOB, wheezing, low grade fever, malaise

MAYBE HEMOPTYSIS

85
Q

2 most common causes of Hemoptysis (bloody cough)

A

Acute Bronchitis

Bronchogenic carcinoma

86
Q

PE and CXR of Acute Bronchitis

A

PE often normal, with maybe wheezing/ronchi
CXR not needed! Imaging not needed usually

If CXR obtained, will be normal or nonspecific

87
Q

Tx for Acute Bronchitis

A

Supportive (fluids, antitussive, antipyretic, analgesics)

Abx not usually needed

88
Q

Pertussis

“whooping cough”

A

Bacteria: Bordetella pertussis
Transmission: resp droplets during coughing fits

Catarrhal: URI sx 1-2 weeks. most contagious!!
Paroxysmal: Severe cough fit, posttussive emesis, 2-4 wks
Convalescent: resolution, cough may last up to 6 wks

89
Q

Tx of Pertussis

“whooping cough”

A

Supportive

Abx to decreases contagiousness: Macrolide (Azithromycin “Z pack”)

90
Q

2nd line Abx tx for Pertussis “whooping cough”

Azithromycin “Z pack” is 1st line

A

Bactrim is 2nd line

91
Q

Complications of Pertussis “whooping cough”

A

PNA, Encephalopathy, Ear infection, Seizure

in infants, deaths often d/t Apnea/ cerebral HYPOXIA d/t coughing fits

92
Q

Pertussis Vaccine (5 doses!!! + booster later)

A

DTaP
2,4,6, 15 mo and 4-6 YO

then booster 11-18 YO

93
Q

Bronchiolitis

infection AND inflammation of bronchioles

A

RSV most common!!!

2 mo-2 yo

94
Q

Acute Bronchiolitis- RSV

A

Viral prodrome- fever and URI for 1-2 days

THEN

Respiratory distress- wheezing, tachypnea, nasal flaring, cyanosis, retractions, rales

95
Q

Tx for RSV Bronchiolitis

A

Mostly supportive: oxygen, antipyretic- Acetaminophen, fluids

Meds limited role: beta agonist, epi

96
Q

If RSV Bronchiolitis pt has severe Lung or Heart dz or is Immunocompromised, what should you consider giving them?

97
Q

Prevention of RSV Bronchiolitis in high risk patients

Premature <29 wks
Chronic lung dz 
Cong Heart dz
Neuromusc difficulties
Immunodef
A

Palivizumab

and

WASH HANDS

98
Q

Triple D’s: drooling, dysphagia, distress

Stridor
Thumb sign on CXR

Tx is to maintain airway, maybe intubate, and Ceftriaxone (Rocephin)

A

Acute Epiglottitis!!!

99
Q

How can we prevent Acute Epglottitis

A

Hib vaccine

Rifampin given to close contacts

100
Q

Barking seal cough
“Steeple sign”

inflammation of Larynx and subglottic airway

Tx is based on severity
1. supportive, o2, air mist, fluids, and dexamethasone
GO HOME

  1. dexamethasone and nebulized Epi
    STAY FOR 3-4 HOURS
  2. dexamethasone + nebulized Epi + ADMIT
A

Croup!

Laryngotrachetiits

Clinical Prep (41 decks)

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