Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PANRE > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Tactile Fremitus is?
Incr in what?
Decr in what?

A

Palpable vibrations transmitted through
bronchopulmonary tree to chest wall when patient speaks (i.e. “99”)
- Incr with pneumonia
- Decr w/ COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Percussion of chest wall

A
  • Resonant —>generally healthy lung
  • Flat or dull —> lobar pneumonia or pleural effusion
  • Hyperresonant (low, loud, booming sound) —> COPD or pneumothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

FEV1/FVC Ratio is ? Nl is ?

A

volume exhaled in 1 sec / total volume exhaled after maximal exhalation
nl is 75-85%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ABGs: CO2 acts how in the body?

Does what to pH?

A

CO2 acts as an acid in the body (Opposite!)
• As CO2 incr = incr acid = decr pH (respiratory acidosis)
• As CO2 decr = decr acid = incr pH (respiratory alkalosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ABGs: HCO3 acts how in the body?

Does what to pH?

A

HCO3 acts as a base in the body (SAME!)
• As HCO3 incr = incr base = incr pH (metabolic alkalosis)
• As HCO3 decr = decr base = decr pH (metabolic acidosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Normal ABG Values?

A 
pH 7.35-7.45
pO2 80-100 mmHg
pCO2 35-45 mmHg
HCO3 22-26 mEq
SaO2 97-100%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Causes of Respiratory Acidosis

A

Caused by any process which decr ability of lungs to exchange CO2 for O2.
• Ex. COPD, asthma, heart failure, pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of Respiratory Alkalosis

A

Caused by any process which incr respiratory rate

• Ex. fever, anxiety, mechanical overventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of Metabolic Acidosis

A

Caused by any process that incr accumulation of acids or decr amount of bicarbonate
• Ex. diabetic ketoacidosis, renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of Metabolic Alkalosis

A

Caused by any process that decr acid or incr bicarbonate

• Ex. prolonged vomiting / nasogastric suction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Intermittent Asthma

A

Daytime Sxs: /= 80% predicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mild Persistent Asthma

A

Daytime Sxs: >2 x wk but not daily
Nocturnal Sxs: > 2 x mo
FEV1 or PEF: >80% predicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Moderate Persistent Asthma

A

Daytime Sxs: daily B-agonist use (exacer 2 or more / wk)
Nocturnal Sxs: > 1 x a mo
FEV1 or PEF: >60% to

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Severe Persistent Asthma

A

Daytime Sxs: continual
Nocturnal Sxs: frequent
FEV1 or PEF: = 60% predicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Asthma: S/S of impending airway failure

A
  • Decreased wheezing or breath sounds
  • Fatigue
  • Diminished respiratory effort/bradypnea
  • Cyanosis
  • Inability to speak full word sentences
  • Increased accessory muscle use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diagnostic criteria for Airway Obstruction using spirometry (for Asthma w/u)?

A

• Airway obstruction = reduced FEV1/FVC (

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diagnostic criteria for “reversibility” using spirometry (for Asthma w/u)?

A

Reversibility is defined by an increase of >/=12% and 200mL in FEV1 or >/=15% and 200mL in FVC after administration of a
short-acting bronchodilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Diagnostic eval for asthma (in stable patient).

A
  1. Spirometry: looking for both obstruction and reversibility (necessary for Dx)
  2. bronchoprovacation test (methocholine challenge) if spirometry nondiagnostic and high clinical suspicion.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diagnostic eval for asthma (in unstable patient).

A
  1. Peak Flow (measures trends in asthma control, not used to diagnose asthma).
  2. O2 Saturation
  3. ABGs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q 
Asthma Tx (Rx)
Rescue Meds:
A
  1. Inhaled B-agonists (albuterol): relax smooth muscle

2. Inhaled anticholinergics (Ipratropium): reverse vegally-mediated bronchospasm. Most useful in severe exacerbations (

21
Q 
Asthma Tx (Rx)
Maintenance Meds
A
  1. Inhaled corticosteroids (ICS): Mainstay for persistent asthma. takes 1-2 wks (why needs oral after exacerbation). rinse & spit
  2. Long Acting Beta Adrenergics (LABA): salmeterol or formoterol. black box for monotherapy. LABA commonly mixed with ICS in same inhaler (i.e. advair)
  3. Leukotiene Modifiers (montelukast): more effective in pts with allergen-related asthma
22
Q

Two types of COPD and sxs of each

A

1) Pink puffers (emphysema) –>mostly dyspnea
• Cough rare, scant clear sputum, breath sounds quiet
2) Blue bloaters (chronic bronchitis) –> chronic cough /purulent sputum / ↑ pulmonary infections
• Dyspnea mild, rhonchi variable, wheezes common
• May appear cyanotic

23
Q

Tx for COPD: General Measures

A
  1. Education (COPD + Smoking Cessation)
  2. Pneumococcal and yearly influenza vaccines
  3. Stress consistent and proper inhaler use
  4. Pulmonary Rehab
24
Q

Tx for COPD:

A

Bronchodilators = mainstay of therapy

  1. Short-acting Inhaled “Rescue” Agents (all patients)
    - β2-agonist plus anticholinergic (generally) (i.e. Albuterol plus Ipratropium)
  2. Long-Acting Inhaled “Maintenance” Agents –> advanced patients
    • Long-acting anticholinergics (ex. tiotropium, aklidinium)
    • Long-acting β2-agonists (LABAs) (ex. salmeterol, formoterol, indacaterol)
  3. Inhaled corticosteroids (ICS): generally for all stage III-IV with >/= 3 exacerbations per year
25
Q

Roflumilast (Daliresp®) is used for? indication?

A

COPD (new 2011): Modestly improved lung function & reduced frequency of moderate to severe exacerbations in patients with severe COPD associated with bronchitis

26
Q

Bronchiectasis is ?

A

Disorder of large bronchi characterized by
permanent dilation / destruction of bronchial
walls

27
Q

Who to screen for lung cancer?

A

Recommended for:

- pts 55-74 yrs who have smoked ≥30pk-yrs - who either continue to smoke or have quit within past 15 yrs

28
Q

Location of Lung Tumors?

A

HASSLE:

  1. peripheral (A and L): Adenocarcinoma and Large cell
  2. central (SS): Squamous cell carcinoma and Small cell carcinoma
29
Q

Most common sites for lung CA metastasis?

A
  1. Bones (pain, pathologic Fx)
  2. Liver (poor prognosis)
  3. Brain (HA, N/V, seizure, focal neuro change) - lung CA (adeno and small cell) account for 70% of symptomatic brain tumors
30
Q

Paraneoplastic Syndromes

A

Hypercalcemia - SCC

SIADH - SCLC

31
Q

Acute Bronchitis clinical manifestations

A

cough, usually with sputum production (50%), & evidence of concurrent URI (ex. nasal symptoms)
• Fever is a relatively unusual sign in acute bronchitis (when present consider influenza or pneumonia)
- Note: Purulent sputum doesn’t predict bacterial involvement
- Acute bronchitis cannot be distinguished
from URIs in 1st few days
• Acute bronchitis is suggested by persistence of cough for >5d
• Acute bronchitis cough typically lasts 10-20
days

32
Q

Indications for CXR in patients with an acute cough syndrome? Purpose?

A

1) Abnormal vital signs (P >100/min, RR >24, or T >38 ºC)
2) Pulmonary exam findings
Purpose: exclude pneumonia

33
Q

Acute Exacerbation of COPD (AE-COPD):

Dx and Tx

A

Dx: (70-80% infectious)
• Sputum gram stain / culture (?)
• Viral Studies (nasopharyngeal swab) (?)
• CXR –> R/O pneumonia (if fever +/- hypoxia)
Tx: Supplemental O2 is critical
• Bronchodilators
- Albuterol + ipratropium (may be nebulized)
• Systemic steroids–>taper over 5-10 days
• Antibiotic Therapy
- Uncomplicated exacerbation:
Doxycycline, cefuroxime, TMP-SMX, azithromycin(?)
- Complicated exacerbation:
Amoxicillin / clavulanate or levofloxacin

34
Q

Acute Exacerbation of COPD (AE-COPD):

Clinical Manifestations

A
  • ↑ volume or change in character of sputum
  • ↑ frequency & severity of cough
  • ↑ dyspnea / respiratory rate
35
Q

Community-Acquired Pneumonia: Clinical Manifestations

A

Often present with >/= 1 of following:
• Fever or hypothermia
• Rigors & sweats
• New cough +/- sputum production
• Dyspnea
• Constitutional symptoms (fatigue, myalgias,
abdominal pain, anorexia, or headache) common

36
Q

Clinical presentation Pearls for S. pneumoniae CAP

A
  • Single rigor (often r/t transient bacteremia)

* Pleurisy (pleural effusions common)

37
Q

Clinical presentation Pearls for H. influenzae CAP

A

Common in patients with underlying obstructive lung disease (ex. COPD)

38
Q

“Typical” CAPs and presentations pearls

A
  1. S. Peneumoniae: Single Rigor; Pleurisy
  2. H. influenzae: common in COPD
  3. M. catarrhalis: nothing special
39
Q

“Atypical” CAPs and presentation pearls

A
  1. L. pneumophila
    • May present with high fever, hyponatremia, & diarrhea
    • Appear more ill than their CXR would predict
  2. M. pneumoniae
    • Cough illness presentation common
    • Extrapulmonary symptoms common (ex. bullous myringitis)
    • More common in healthy kids & young adults (“Walking
    Pneumonia”)
  3. C. pneumoniae
    • Similar to M. pneumoniae but often older patients
40
Q

Management of TB (i.e. + TST or IGRA/Quant-Gold)

A

If (+) TST or IGRA–> refer to rule out active TB
prior to treatment for LTBI
1) Evaluate for symptoms (ex. fever, cough, weightloss, etc.) & perform exam

2) CXR
• If (-) –> treat for LTBI
• If (+) –> work-up & treat for active TB
Make sure to check HIV status.

41
Q

Treatment for active TB

A

4 drugs for 2 months then 2 drugs for 4 months “RIPE drugs”
- 4 drugs: Rifampin (RIF), Isoniazid (INH),
Pyrazinamide(PZA), Ethambutol(EMB) x 8 wks
Then:
• 2 drugs (INH & RIF) X 16 wks

42
Q

Treatment of Latent Tuberculosis

A

Isoniazid (INH) X 9 months has most data

43
Q

Sarcoidosis Clinical Manifestations

A

Incr. incidence in North American blacks & northern European whites
1. Pulmonary: >90% present with pulmonary findings (DOE, dry nonproductive cough, BIL perihilar lymphadenopathy)
2. Non-Pulmonary:
• Skin: erythema nodosum, lupus pernio
• Heart: conduction abnormalities
• Ocular: uveitis
• Parotid gland enlargement
3. Biopsy (bronchoscopy or mediastinoscopy) is definitive diagnosis–>
shows noncaseating granulomas

44
Q

Transudate vs Exudate W/U

A
  1. CXR/Chest CT
  2. thoracentesis
  3. protein and LDH (exudate vs transudate)
    • Exudate: >0.5 protein, >0.6 LDH, low glucose
  4. pH, total cell count w/ diff, glucose, cytology, gram stain/Cx
45
Q

“Virchows Triad” is:

describes what?

A

• 1) Hypercoagubility
• 2) Venous stasis
• 3) Endothelial injury
Describes pathophysiology of venous thromboembolism

46
Q

Common acquired ETIOL of venous thromboembolism:

A 
• Major surgery
• Trauma
• Malignancy
• Age (>45yrs)
• OCP or HRT
• Pregnancy /
postpartum
• Medical conditions
(ex. serious infection)
47
Q

Clinical presentation of DVT

A
  • Ipsilateral edema
  • Ipsilateral pain
  • Ipsilateral warmth
  • Palpable cord (reflects a thrombosed vein)
  • Homan’s sign unreliable
48
Q

Clinical presentation of PE

A
  • Sudden / unexplained dyspnea
  • Pleuritic chest pain
  • Cough
  • Tachypnea
  • Tachycardia
49
Q

Dx of PE

A

Nonspecific Measures
1. ECG abnormal (70%)
• S1Q3T3 classic; new-onset sinus tachycardia most common
2. CXR
• Usually reveals atelectasis, parenchymal infiltrates, & pleural effusions
• Historic Findings
- Westermark’s Sign: prominent central pulmonary artery with local oligemia
- Hamptom’s Hump: increased opacity from intraparenchymal hemorrhage

Specific Measures

  1. Helical (Spiral) CT = CT Angiography (CTA = “PE Protocol”
  2. Ventilation / Perfusion Lung Scanning (V/Q Scan)
  3. Pulmonary angiography = gold standard

PANRE (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions