pulmonology Flashcards
3 components of asthma
1.obstruction of airflow
2.bronchial hyperreactivity
3.inflammation
It is a disease of chronic inflammation leading to airway narrowing and increased mucous prod
Strongest predisposing factor to asthma
atopy
atopy tirad= wheeze, eczema, seasonal rhinitis
Stage 1 of asthma- mild intermittent
Daytime asthma sxs occur 2 or fewer days/week
2 or fewer nocturnal awakening/month
use SABA fear then 2x/week
no interference w/ normal activity
FEV1>80%
FEV1/FVC is normal
use only oral steroids 1 time or less/year
TX-SABA (albuterol)-PRN
Stage 2- mild persistent
Daytime sx >2x a week 3-4 nocturnal awakenings/month use SABA >2x/ week minor limitation in activity FeV1>80% FEV1/FVC is normal 2 or more oral uses
TX-
SABA
either inhaled steroid (low dose) OR cromolyn/nedocromil or can do leukotriene inhibitor
Stage 3 moderate persistent
Daily sxs nocturnal awakenings at least once a week daily need of saba some limitation of activity FEV1 is between 60-80% FEV1/FVC-reduced by 5% same for oral steroids
TX-
SABA (albuterol) prn
either Inhaled steroid (med dose) OR inhaled steroid (low-med dose) AND long acting Beta agonist
if needed can use inhaled steroid (med-high) dose AND long acting beta agonist
4- severe persistent
asthma sxs throughout day nocturnal awakenings nightly SABA several times a day limited physical activity FEV1 5%
TX-
SABA
Inhaled steroid (high dose) AND long acting beta agonist AND oral steroids
Bronchiectasis definition
abnormal, permanent dilation of the bronchi and destruction of bronchial walls. can be congenital (cystic fibrosis) or acquired from recurrent infxns or tumor
results from bronchial injury subsequent to severe infxn and/or inflammation
cystic fibrosis causes 50% of cases
sxs of bronchiectasis
foul smelling sputum, hemoptysis, chronic cough, and recurrent pneumonia
chest crackles and clubbing
comparison of emphysema and bronchitis
Emphesema bronchitis
exertional dyspnea mild dyspnea
cough is rare chronic prod cough
quiet lungs noisy lungs (wheeze and rhochi)
no peipheral edema edema
thin; weight loss overweight; cyanotic
emphysema
airspaces enlarged as a consequence of destruction of alveolar septae
bronchitis
characterized by a chronic cough that is productive of phlegm occurring most days for 3 months of the year for 2 or more consecutive years w/out otherwise acute cause
idiopathic pulmonary fibrosis
most common diagnosis among pts w/ interstitial lung disease
sxs- dry cough, exertional dyspnea, fatigue, malaise, clubbing, crackles
sarcoidosis
multi organ disease of idiopathic cause. characterized by noncaseating granulomatous inflammation in affected organs.
90% have lung involvement
sxs- cough, dyspnea (insidious onset), chest discomfort, may present w/ fever, malaise
Tx- steroids
ARDS
underlying problem is increased permeability o fthe alveolar capillary membranes, which leads to development of protein rich pulmonary edema
clinical fxs- rapid onset of dyspnea, tachypnea, frothy pink or red sputum, crackles, cyanotic
denotes acute hyperemic respiratory failure following a systemic or pulmonary insult w/out evidence of heart failure.
pulmonary func test
Increases in TLC, FRC, and RV may occur as a result of obstructive disease
Reduction in VC, TLC, FRC, and RV result from restrictive disease
5 causes of hypoxemia
high altitude alterations in diffusion hypoventilation shunting V/Q mismatch
A-a gradient
Helps to determine if there are problems on either side of the basement membrane in the pulmonary circulation
ARDS characterized by
bilateral, widespread pulmonary infiltrates, normal pulmonary capillary wedge pressure
rapid onset of profound dyspnea that occurs 12-24 hours after initiating event. labored breathing, tacypnea, crackles are noted
“Restriction” in lung disorders always means a decrease in lung volume (FVC)
true
interstitial lung disease
insidious onset of progressive dyspnea and nonproductive chronic cough
septal thickening
tachypnea, small lung volume, bibasilar rales, and right heart failure w/ adnaved disease
most common lung cancer spreads
breast, colon, prostate, bladder
lung cancer is most common death from a cancer
true
clinical presentation of cancer
centrally located lesions (cough, hemoptysis, wheezing, atalectasis)
peripheral located lesions- (pain due to pleural or chest wall invasion)
with metastasis- bone pain, back pain, difficulty breathing , HA, seizures, mental changes, weight loss, fevers,
90% of lung cancer spread to lungs
true
most common comp of lung cancer
dysphagia, hoarsness, horners syndrome, pleural effusion, tapanade, svc syndrome, pancoast syndrome
pancoast
shoulder pain radiating down arm ulnar distribution
work up of cancer pt
history and physical
cxr
labs-cbc,cmp
biopsy
