Pulmonary Cards

Question 1

What S/Sxs might indicate bronchitis over pneumonia?

Answer 1

Rhonchi, coarse crackles, vesicular breath sounds, prolonged expirations
coughing induces chest pain
Lower temp, rare dyspnea, less sputum
hemoptysis less likely
no XRAY infiltrates

Question 2

What S/Sxs might indicate pneumonia over bronchitis?

Answer 2

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

Question 3

What do vesicular breath sounds sound like?

Answer 3

soft, low pitch, normal over most lung fields I>E

Question 4

What do bronchovesicular breath sounds sound like?

Answer 4

medium intensity and pitch, normal over main-stem bronchi

Question 5

What do tracheal breath sounds sound like?

Answer 5

loud, high pitch, normally heard over trachea E>I

Question 6

What neurotransmitter imbalances may be associated with HTN?

Answer 6

increased NE

Decreased SAMe

Question 7

What neurotransmitter imbalances may be associated with Asthma?

Answer 7

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

Question 8

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?

Answer 8

Fibrinogen 250-300
Bleeding time 8-12 mins

Monitor monthly

Question 9

What are some S/Sxs of RCHF?

Answer 9

JVD >3cm
Kussmauls sign (air hunger- think carboveg)
Hepatojugular reflex, Tender liver, ascites, pitting edema, anasarca

Question 10

What lab findings might you see in RCHF? (Bloodwork and CXR)

Answer 10

increased SGOT, AlkPhos
Increased PT
ELEVATED BNP (>100)
CXR: Cardiomegaly, chamber enlargement

Question 11

What symptoms might you see in LCHF?

Answer 11

Dyspnea, orthopnea, Cheyne-stokes breathing, acute PE, pallid, clammy, tachypnea, coughing, wheezing, HTN, crackles, S3, S2 split, PMI >3cm, pulses alternans

Question 12

What bloodwork and EKG findings might you see in LCHF?

Answer 12

ELEVATED BNP

EKG: LA enlargement

Question 13

What CXR findings might you see in LCHF?

Answer 13

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

Question 14

Compare/Contrast Systolic versus Diastolic heart failure

Answer 14

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

Question 15

What are some causes of RCHF?

Answer 15

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, ....

Question 16

What are some causes of LCHF?

Answer 16

Obstruction of LA emptying: Mitral stenosis, LA myxoma, LA thrombus, …..
Constrictive do (tamponade, pericarditis, cardiomyopathies
….
pressure overload: HTN, stenosis, IHSS

Question 17

What are the 3 Ls of conventional treatment for CHF?

Answer 17

Lasix
Lanoxin
Lying down

Best ND preload/afterload reducers? HYDROTHERAPY

Question 18

What is Cor pulmonale?

Answer 18

RCHF from chronic lung disease

Question 19

What are some etiologies of cor pulmonale?

Answer 19

vascular obstruction: PE, thrombus, etc
Vascular pulmonary disease: scleroderma, arteriosclerosis, DM, pHTN, eg
Lung disease: COPD, eg
Ventilation/Perfusion mismatch

Question 20

How might you administer oxygen to a patient with COPD?

Answer 20

2L/min via nasal cannula (blue bloaters respond well)

Question 21

What is FVC?

Answer 21

forced vital capacity: total volume of air forcibly expired in one breath

Question 22

What is FEV1?

Answer 22

forced expiratory volume in 1 second

Question 23

FEV3 normally comprises what percent of FVC?

Answer 23

95%

Question 24

What spirometry findings would you see in restrictive lung disease?

Answer 24

FEV1 0.7

general lung volumes diminished with FEV1 normal or high, SHORTENED EXPIRATION

Question 25

What spirometry findings might you see in obstructive lung disease?

Answer 25

(eg. Asthma, COPD, CF, Lung Ca, TB, Bronchitis…)

FEV1 DECREASED

Question 26

What upper respiratory consequence could results from extensive antibiotic use?

Answer 26

secondary fungal infections

Question 27

What treatments could be useful in an acute asthma attack?

Answer 27

Lobelia, Ephedra, Capsicum tincture
local hot compresses
mustard/ginger compress
Heimlich maneuver
B12 injection
Epipen
Prednisone, Albuterol, Flonase, Theophylline

Question 28

How might you describe a pink puffer?

Answer 28

predominance of emphysema
alveoli well ventilated, poorly perfused
lots of dead lung space

Question 29

How might you describe a blue bloater?

Answer 29

predominance of chronic bronchitis
low ventilation
arterial hypoxia

Question 30

What are some signs of lung disease with low arterial oxygen

Answer 30

pHTN, rCHF, cor pulmonale, tachypnea, clubbing of digits, cyanosis, high hematocrit