Pulmonary Cards Flashcards
What S/Sxs might indicate bronchitis over pneumonia?
Rhonchi, coarse crackles, vesicular breath sounds, prolonged expirations coughing induces chest pain Lower temp, rare dyspnea, less sputum hemoptysis less likely no XRAY infiltrates
What S/Sxs might indicate pneumonia over bronchitis?
Increased tactile fremitus
pleural friction rub, abdominal distention, chest pain common
more likely to have dyspnea, higher temp, chills, hemoptysis
May see pleural effusion, infiltrates on CXR
What do vesicular breath sounds sound like?
soft, low pitch, normal over most lung fields I>E
What do bronchovesicular breath sounds sound like?
medium intensity and pitch, normal over main-stem bronchi
What do tracheal breath sounds sound like?
loud, high pitch, normally heard over trachea E>I
What neurotransmitter imbalances may be associated with HTN?
increased NE
Decreased SAMe
What neurotransmitter imbalances may be associated with Asthma?
Dec Tyrosine –> dec dopamine –> dec NE–> dec EPI
inc Tryptophan –> inc serotonin –> inc bronchoconstriction
B6, B12, folate, Vi C, Cal/Mag as cofactor for NT synthesis required
What are the desired fibrinogen and bleeding times for patients on natural or alternative blood thinning therapies? How often do we want to monitor these patients?
Fibrinogen 250-300
Bleeding time 8-12 mins
Monitor monthly
What are some S/Sxs of RCHF?
JVD >3cm
Kussmauls sign (air hunger- think carboveg)
Hepatojugular reflex, Tender liver, ascites, pitting edema, anasarca
What lab findings might you see in RCHF? (Bloodwork and CXR)
increased SGOT, AlkPhos
Increased PT
ELEVATED BNP (>100)
CXR: Cardiomegaly, chamber enlargement
What symptoms might you see in LCHF?
Dyspnea, orthopnea, Cheyne-stokes breathing, acute PE, pallid, clammy, tachypnea, coughing, wheezing, HTN, crackles, S3, S2 split, PMI >3cm, pulses alternans
What bloodwork and EKG findings might you see in LCHF?
ELEVATED BNP
EKG: LA enlargement
What CXR findings might you see in LCHF?
Cephalization: blood flow redistribution from base to apex Hilar "butterfly" rales Kerly B lines Fluid in fissures costophrenic angle blunting "White-out" pattern Septal edema
Compare/Contrast Systolic versus Diastolic heart failure
Systolic (weak): decrease EF, increase EDV and EDP, –> MI, fibrosis, scarred cells
Diastolic (stiff): increase EDP, increased pulmonary venous pressure, SOB, edema, PE, backward failure
What are some causes of RCHF?
pressure overload poor compliance/restriction (pericarditis, cardiomyopathy, hypertrophy) volume overload (regurgitation, shunts) reduced ionotropy (CAD, myocarditis, cardiomyopathies) Obstruction of right atrial emptying (tricuspid stenosis, RA thrombus/myxoma) Chronic lung disease (PE, scleroderma, HTN, COPD, restrictive lung disease, pHTN, ....
What are some causes of LCHF?
Obstruction of LA emptying: Mitral stenosis, LA myxoma, LA thrombus, …..
Constrictive do (tamponade, pericarditis, cardiomyopathies
….
pressure overload: HTN, stenosis, IHSS
What are the 3 Ls of conventional treatment for CHF?
Lasix
Lanoxin
Lying down
Best ND preload/afterload reducers? HYDROTHERAPY
What is Cor pulmonale?
RCHF from chronic lung disease
What are some etiologies of cor pulmonale?
vascular obstruction: PE, thrombus, etc
Vascular pulmonary disease: scleroderma, arteriosclerosis, DM, pHTN, eg
Lung disease: COPD, eg
Ventilation/Perfusion mismatch
How might you administer oxygen to a patient with COPD?
2L/min via nasal cannula (blue bloaters respond well)
What is FVC?
forced vital capacity: total volume of air forcibly expired in one breath
What is FEV1?
forced expiratory volume in 1 second
FEV3 normally comprises what percent of FVC?
95%
What spirometry findings would you see in restrictive lung disease?
FEV1 0.7
general lung volumes diminished with FEV1 normal or high, SHORTENED EXPIRATION
