Pulmonology Flashcards
Is pulmonology what is considered a shunt?
An area of lung that is perfused but has no ventilation
What is cor pulmonale?
Right heart failure due to pulmonary hypertension
*pulmonary htn is usually caused by chronic local hypoxic vasoconstriction due to dz like asthma or chronic bronchitis
Physiologic V:Q mismatch
Low V:Q in lung bases
High V:Q in lung apices
Pathologic V:Q mismatch
Low: asthma, chronic bronchitis, pulmonary edema
High: emphysema, PE, foreign body
Control of respiration
Central receptors in the medulla or peripheral receptors in the carotid bodies and aortic bodies detect increased PaCO2
Phrenic nerve stimulation increases rate and depth of respiration
*peripheral receptors are sensitive to low PaO2 but only if hypoxia is significant
Samter’s triad
Asthma
Nasal polyps
ASA/NSAID allergy
Lung exam findings in asthma
Prolonged expiration with wheezing, decreased breath sounds, and hyperresonance to percussion
Signs of status asthmaticus
Inability to speak in full sentences
AMS
pulsus paradoxus
Cyanosis
Tripod positioning
Silent chest
Tachycardia/tachypenea
Pulsus paradoxus
SBP decreases >10 mmHg with inspiration
Best way to assess asthma exacerbation/severity and monitor asthma
Peak expiratory flow rate (PEFR)
Asthma management in ED
Nebulized SABA q20min x3 then reassess
dc on short course (3-5d) oral corticosteroids
SE of SABAs
Tachycardia, tremor, CNS stimulation, and hypokalemia
SE of antimuscarinics
Thirst dry mouth blurred vision urinary retention dysphasia acute glaucoma BPH
SE of steroids
Immunosuppression Hyperglycemia Fluid retention Osteoporosis Growth delay Psychosis Thinning skin
Thrush-inhaled
DOC long term persistent asthma
Inhaled corticosteroids
MOA cromolyn and nedcromil
Inhibits mast cell and leukotriene mediated degranulation
*helps limit acute response to cold air and exercise
Omalizumab
Anti-IgE antibody
Used in severe uncontrolled asthma
Classification of intermittent asthma
Sx <2x week and <2x a month at night
Treatment of intermittent asthma
SABA prn
Classification of mild persistent asthma
Sx >2d/wk and night sx >2x month
Treatment of mild persistent asthma
Low dose ICS
SABA prn
Classification of moderate persistent asthma
Daily sx and nightly sx >1xweek
Treatment of moderate persistent asthma
Low dose ICS with LABA(especially if night sx are worse)
OR
Increase ICS dose
OR
Add LTRA (especially if allergic or asa induced)
SABA prn
Classification of severe persistent asthma
Sx throughout the day and usually nightly