Pulmonology Flashcards
1
Q
peak expiratory flow and pulmonary function tests
A
- if <350L/min, perform PFTs to screen for obstruction
- PFT:
- FEV1: amount of air that can be forced out of the lungs in 1 second
- Airway obstruction dx by: normal/increased TLC w/ decreased FEV1 (FEV1/FVC <0.7)
- Tiffeneau index (FEV1/FVC x 100): % of FVC expired in 1 second
- FET = forced expiratory time
- FEV1: amount of air that can be forced out of the lungs in 1 second
- Obstructive vs restrictive: BASED ON TLC, NOT VITAL CAPACITY
2
Q
obstructive vs restrictive dz
A
3
Q
Tidal volume, residual volume, insp reserve, exp reserve, vital capacity, total lung capacity, insp capacity, funcitonal residual capacity
A
4
Q
DLCO
A
- diffusing capacity of the lung for carbon monoxide
- DLCO = CO into lungs - CO out of lungs
- use carbon monoxide bc we can maximize diffusion bc of the affinitiy of Hgb for it - Volume = area/thickness x (P1 - P2) x constant
- In emphysema, tissue is destroyed, reducing surface area for diffusion - decreased surface area causes volume to decrease
- In sarcoidosis and fibrosis, lung thickness increases, also driving volume to decrease
5
Q
Acute/Chronic bronchitis
A
- etiology: viruses (most), cannot distinguish acute bronchitis from URTI in first few days
- sxs: cough >5d (+/- sputum), lasts 2-3wks
- chest discomfort
- SOB
- +/- fever
- dx: labs not indicated, unless pneumonia suspected (HR >100, RR >24, T >38C, rales, hypoxemia, mental confusion, or systemic illness)
- CXR
- Tx: abx not recommended since most viral
- sxs based tx: NSAIDs, ASA, tylenol, and/or ipratropium
- abx and cough suppressants not indicated
- cough suppressants: codeine-containing cough meds
- bronchodilators (albuterol)
- abx and cough suppressants not indicated
6
Q
Asthma
A
- characteristics: airway inflammation, airway hyperresponsiveness, reversible airflow obstruction, may begin at any age, dyspnea common when rapid changes in temp or humidity
- extrinsic: Atopic: produce IgE dt enviro triggers (eczema, hay fever), become asthmatic young
- intrinsic: not related to atopy of enviro factors
- want to see increased FEV1 >12% with albuterol
- can also see decrease in FEV1 >20% with methacholine or histamine challenge
- increase in diffusion capacity of lung for DLCO
7
Q
Asthma characteristics, signs, sxs
A
- Triggers: pollens, house dust, molds, cockroaches, cats, dogs, cold air, viral infxns, tobacco smoke, meds (BB, ASA), exercise
- sxs: SOB, wheezing, chest tightness, cough (occurs in 30 mins to exposure to triggers, sxs worse at night)
- signs: wheezing (inspiration and expiration) is the MC finding
8
Q
Asthma dx and tx
A
- Dx: CXR for first time wheezers, PFTs required to dx, spirometry before and after bronchodilators - increase in FEV1 ro FVC by 12%
- Tx 1:
- SABA for acute attacks (onset 2-5 min, lasts 4-6h
- LABA (salmeterol) for nighttime asthma and exercise induced
- ICS: moderate to severe asthma, use reg to decrease airway hyperresp.
- Tx 2:
- Montekukast: proph for mild exercised induced and control of mild-moderate, allows for reduction in steroid and B2
- Cromolyn sodium: proph before exercise
- Avoid BB in asthmatics
9
Q
Acute asthma exacerbation
A
- sxs: sweating, wheezing, speaking incomplete sentences, tachypnea, paradoxical mvmt of abdomen, use of accessory mm.
- dx: PEFR: low, severe <60
- ABG: increased A-a gradient
- CXR: ro pneumonia, pneumothorax
- tx 1: nebulizer (SABA) or MDI, IV or oral steroids, IV magnesium (prevent bronchospasm)
- complications:
- status asthmaticus: doesnt respond to standard meds
- ARDS: resp mm fatigue
- pneumothorax, atelectasis, pneumomediastinum
10
Q
Asthma classification
A
- Intermittent, mild persistent, moderate persistent, severe persistent
11
Q
COPD
A
- 4th leading cause of death in the United States
- Coexisting bronchitis and emphysema, rarely one or the other by itself
- Leads to chronic respiratoyr acidosis with metabolic alkalosis as compensation
- risk factors and causes:
- Smoking (tobacco), alpha antitrypsin deficiency, enviro factors (second hand smoke), chronic asthma
- MCC acute exacerbation: infxn, noncompliance, cardiac dz
- secondary polycythemia (response to chronic hypoxemia
12
Q
Chronic Bronchitis
A
- excess mucous narrows airways (productive cough), scarring and inflamm -> enlarged glands -> smooth m hyperplasia = obstruction
- sxs: cough, sputum, dyspnea (on exert or rest)
- signs: prolonged forced exp time, exp wheezes, dec. breath sounds, insp crackles, tachypnea, tachycardia, cyanosis, accessory mm use, hyperresonance, signs of cor pulmonale
- dx: chronic cough and sputum >3 mo, at least 2 consec years
- CXR, alpha antitryp levels, ABG
13
Q
emphysema etiology and types
A
- elastase (protease) excess and overinflation (elastase released from WBCs ingesting lung tissue, normally inhib by alpha antitryp.; tobacco smoke increases WBCs, inhibits antitryp, increases oxidative stress)
- types:
- centrilobular: MC, smokers, destruction of bronchioles in upper lungs
- Panlobular: pts with alpha antityrp def.; destruction of prox and distal acini (lung bases)
14
Q
emphysema sxs, dx
A
- sxs: productive cough or chest tightness, worse in morning, clear to white sputum, 50yo typical
- dyspnea MC presents at 60yo, wheezing
- signs: tachypnea, DOE, cyanosis, JVD, atrophy of limb musculature, peripheral edema, Barrel chest (2:1 A:P), diffuse or focal wheezing, diminished breath sounds, hyperresonance
- dx: permanent enlargement of airspaces distal to terminal bronchioles dt destruction . of alveolar walls
- decreased DLCO
- PFTs (spirometry): FEV1/FVC <0.75, FEV1 decreased, TLC, residual volume, FRC increased
- Vital capacity decreased: extra air coming in is not useful - becomes dead space
- CXR
15
Q
chronic bronchitis tx
A
- smoking cessation (most important)
- albuterol (long term salmeterol for requent use of SABA)
- anticholinergics (ipratropium)
- combo of B agonist and anticholinergics
- Inhaled corticosteroids (O2 tx): long term hypoxemia leads to HTN and cor pulmonale
- pulmonary rehab: improves exercise tolerance
- IMZ: flue and strep q1y pneumo q5-6y
- surgery: lung resection vs transplant
16
Q
emphysema tx
A
- smoking cessation and home O2 are the only interventions shown to lower mortality
-
steroids and abx for acute exacerbations: increased sputum produciton or change in character or worsening SOB
- not responsive to bronchodilators, IV methylprednisolone if hosp., azithro or levo, O2>90% nasal cannula, NPPV (BiPAP or CPAP), can lead to ARDS
- Criteria for O2: PaO2 55mm Hg, O2 sat <88% (pulse ox) at rest or exercise, PaO2 55-59 + polycythemia or cor pulmonale
- look for nocturnal hypoxemia, give CPAP or O2 as needed