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Pulmonology > Pulmonology Basics > Flashcards

Pulmonology Basics Flashcards

1
Q

Lung Mechanics

A
  • Initiation of breathing: Diaphragm contracts downwards causing more - intrathoracic pressure relative to the atmosphere, allowing air into chest
  • Exhalation is passive during tidal breathing as the lungs and chest wall move toward their equilibrium positions
  • During forceful breathing & hyperventilation, abdominal muscles help force air out of the lungs
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2
Q

Compliance

A
  • The change in volume for a given change in pressure of a system
  • Compliance of the lung changes with lung volume
  • As lung volume increases, lung compliance decreases
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3
Q

Resistance

A
  • An important determinant of airflow
  • Total airway resistance is in part a function of lung volume
  • At lower volumes, small airways tend to collapse and total resistance is higher
  • At higher lung volumes, small airways are pulled open
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4
Q

Ventilation-Perfusion Relationships

A
  • The balance between ventilation (V) and perfusion (Q) in the lung is critical in determining the final oxygen content of the blood that returns to the left side of the heart from the lungs
  • -Ventilation is regulated by respiratory control centers in the pons/medulla (peripheral chemoreceptors –> lungs)
  • -Disorders of V are not always caused by primary lung pathology
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5
Q

Pulmonary Blood Flow

A
  • Pulmonary vasculature constricts in areas of low oxygen tension, resulting in less blood flow to areas with little-no ventilation
  • Works to improve overall V/Q matching
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6
Q

Lungs: Fetal/Perinatal

A
  • Fetus: Lungs are filled with fluid-respiratory exchanges occur via the placenta
  • After birth, alveoli inflate & start functioning in gas exchange (fully @ 2 wks.)–this relies on surfactant
  • RR in newborns = 40-80 breaths/min.
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7
Q

Lungs: Infancy - 1 year

A
  • Airways shorter, narrower, less stable & easily obstructed
  • Lung tissue is fragile & prone to barotrauma
  • Fewer alveoli w/ decreased collateral ventilation
  • Accessory muscles immature, susceptible to early fatigue
  • Chest wall less rigid
  • Diaphragmatic breathing
  • Rapid RR = ~30/min. (leads to rapid heat & fluid loss)

*Pulmonary disease accounts for 50% of deaths in children < 1 year

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8
Q

Lungs: 1-5 years

A
  • Terminal airways continue to branch
  • Alveoli increase in number
  • RR @ 5 years = ~25/min.
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9
Q

Lungs: Children to Adolescents

A
  • Lungs mature throughout childhood, with more alveoli forming until young adulthood
  • If smoking is initiated during this period, the lungs may never fully develop

*Pulmonary disease accounts for 20% of hospitalizations in children < 15 years

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10
Q

Lungs: 20-60 years

A 
**RR = 16-20/min.
(20-40 years)
- Develop lifelong habits & routines
- Optimal physical performance
(41-60 years)
- Body still functioning at high level with varying degrees of degradation
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11
Q

Lungs: > 60 years

A
  • RR depends on physical and health status
  • Changes in mouth, nose, and lungs
  • Metabolic changes lead to decreased lung functioning
  • Muscular changes
  • Diffusion through alveoli diminishes
  • Lung capacity diminishes
  • Coughing becomes ineffective
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12
Q

Respiratory Symptoms

A

Primary:
- Cough
^ Acute cough = cough lasting < 3 weeks
^ Chronic cough = cough lasting > 8 weeks
- Dyspnea
- Hemoptysis–Cough with expectoration of bloody sputum or blood
^ Scant (mild) = < 20 mL in 24 hours - blood streaks w/ expectorated phlegm
^ Submassive (moderate) = 20-250 mL (less than 1 cup) in 24 hours
^ Massive (severe) = > 250 mL (more than a cup) in 24 hours - life threatening (admit)

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13
Q

Prevalence of Disease Causing Coughing

A 
Chronic allergic rhinitis or PND - 41%
Asthma - 24%
GERD - 21%
COPD & chronic bronchitis - 5%
Bronchiectasis - 4%
Lung Cancer - < 2%
Medication-induced - 5-25%
Idiopathic/Psychological - < 5 %
(Others, such as CHF)
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14
Q

Alarming Pulmonary Symptoms

A
  • Hemoptysis
  • Fever + purulent sputum production
  • Wheezing + dyspnea
  • Chest pain
  • Excessive chronic sputum
  • Unintentional weight loss
  • Dyspnea + lower extremity edema
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15
Q

Causes of Hemoptysis

A

Serious:

  • Lung cancer
  • Tuberculosis
  • Pulmonary embolism
  • Pneumonia
  • Alveolar hemorrhage syndrome
  • Lung abscess (MC)

Benign:

  • Acute viral or bacterial bronchitis
  • COPD exacerbation
  • Bronchiectasis

MCCs: Acute or chronic bronchitis, pneumonia, tuberculosis, lung cancer

Others: bronchiectasis, PE, trauma, fungal infection, foreign bodies, rheumatologic disease

*Must differentiate between true hemoptysis versus bleeding from the upper airway or GI tract

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16
Q

Causes of Fever + Purulent Sputum Production

A

Serious:

  • Pneumonia
  • Lung abscess

Benign:
- Acute sinusitis

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17
Q

Causes of Wheezing + Dyspnea

A

Serious:

  • Asthma
  • COPD exacerbation
  • Heart failure

Benign:
- Acue bronchitis

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18
Q

Causes of Pulmonary Related Chest Pain

A

Serious:

  • Pulmonary embolism
  • Acute coronary syndrome

Benign:
- COPD exacerbation

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19
Q

Causes of Excessive Chronic Sputum

A

Serious:

  • Bronchiectasis
  • Lung abscess
  • Lung cancer

Benign:

  • Chronic bronchitis
  • Chronic sinusitis
20
Q

Causes of Pulmonary Related Unintentional Weight Loss

A

Serious:

  • Lung cancer
  • Tuberculosis
  • Lung abscess
21
Q

Causes of Dyspnea + Lower Extremity Edema

A

Serious:

  • CHF
  • Pulmonary embolism
22
Q

Cough History

A

HPI: Onset, duration, frequency, associated sxs, precipitating and/or alleviating factors, changes over time**

ROS: F/C, weight changes, night sweats, upper/lower respiratory tract (post-nasal drip –> allergic, vasomotor, nonallergic rhinitis), cardiovascular system, digestive tract (heartburn, bitter taste –> GERD)

SH: Smoking (tobacco and other), alcohol (aspiration, increased cancer risk), diet, environmental and occupational exposures

PMH: Current & prior medications (i.e., ACEIs), allergies, asthma, atopic dermatitis, sinusitis (recent respiratory infections), tuberculosis exposures, CAD, esophageal disease

23
Q

Quality of Cough - DDx

A
  • Dry cough –> GERD, irritant cough, post-viral infection, pulmonary fibrosis
  • Clearing throat frequently –> UACS, allergic vasomotor, nonallergic rhinitis
  • Worsening overtime –> bronchitis, asthma, CHF, lung cancer, bronchiectasis
  • Worse w/ particular season –> UACS, asthma
  • Lingered after a recent cold/flu –> post-infectious cough, UACS
24
Q

Associated Sxs - DDx

A
  • Quality/Quantity of sputum (color, amount, consistency, changing?)
  • DOE –> asthma, CHF, COPD
  • Wheezing –> asthma, CHF
  • Hoarseness –> GERD, chronic laryngitis, laryngeal nodules/polyps, UACS
  • Burning in throat at night or early morning –> GERD
  • PND (Post-nasal drip) –> UACS, sinusitis
  • Seasonal –> asthma, UACS, allergic rhinitis
  • Halitosis or sinus pain –> chronic sinusitis
  • Orthopnea or nocturnal dyspnea –> CHF, obstructive sleep apnea, GERD, COPD
25
Q

Cough Modifying Factors - DDx

A
  • During/after exercise or cold exposure –> asthma, UACS, allergic/vasomotor rhinitis
  • Worse in supine –> UACS, GERD, CHF, bronchiectasis, acute bronchitis
  • Worse at night –> asthma, GERD, CHF
  • Triggered by position changes –> bronchiectasis, CHF
  • Improved with OTC antihistamines –> allergic rhinitis, UACS
26
Q

Chronic Cough Causes

A

Often caused by multiple contributing factors
- MCCs:
^ GERD, UACS, & asthma account for 90% of chronic cough in non-smokers
^ Chronic cough occurs in 5-25% of patients taking ACEIs
^ Pt’s with alarm symptoms require prompt evaluation

27
Q

Pulmonary Labs and Tests

A
  • CXR
  • Sinus imaging (CT)
  • Pulmonary function tests
  • Barium esophagography
  • 24-hour esophageal pH monitoring
  • WBC w/ differential
  • Direct laryngoscopy
  • Fiberoptic bronchoscopy
  • Bronchoscopy (if > 40, tobacco hx, cancer hx, hemoptysis lasting > 1 week)
  • Consider referral (i.e., ENT)
28
Q

Dyspnea Terminology

A

Dyspnea–abnormally increased awareness of breathing or sensation of difficulty breathing

Orthopnea–dyspnea when laying flat

Paroxysmal nocturnal dyspnea (PND)–dyspnea that wakes the pt from sleep

Platypnea–dyspnea that improves when the pt lies down

Trepopnea–dyspnea that occurs in the lateral decubitus position on one side, but not the other

29
Q

Dyspnea Causes

A 
Pulmonary 
Cardiac
Hematologic (i.e., anemia)
Chest wall or neuromuscular disease
Metabolic (i.e., acidosis)
Functional (i.e., panic disorders, anxiety)
Deconditioning
30
Q

Cardiovascular Causes of Dyspnea

A

Muscle – cardiomyopathies
Vessels – ischemia, pulmonary HTN
Valves – regurgitation, stenosis, infection

31
Q

Pulmonary Causes of Dyspnea

A 
Bronchi -- mass, foreign body
Bronchioles -- asthma, chronic bronchitis
Interstitial lung disease
Alveoli -- emphysema, chronic pneumonia
Vessels -- chronic pulmonary emboli
Pleura -- effusions
Lung cancer
32
Q

Causes of Acute Dyspnea

A
  • Flash pulmonary edema
  • Pulmonary embolism
  • Anaphylaxis
  • Aspiration
  • Cardiac tamponade
  • COPD exacerbation
  • Acute pneumonia
  • Respiratory muscle weakness
  • Spontaneous pneumothorax
  • Metabolic acidosis
33
Q

Alarm Symptoms of Dyspnea

A

Acute onset & rapid progression may lead to respiratory failure

  • Pleuritic CP –> PE, pneumothorax, pneumococcal pneumonia
  • Lip swelling, hives, & wheezing –> anaphylaxis or angioedema
  • Substernal CP –> acute MI or ischemia
  • Pink, frothy sputum –> cardiogenic pulmonary edema
  • Fever + sputum production –> acute pneumonia
  • Fever + signs of infection or shock –> acute respiratory distress syndrome
  • Fever + sore throat, dyspnea, & hoarseness –> epiglottitis
  • Ascending weakness –> Gullain-Barre syndrome
  • Generalized weakness –> Myasthenis gravis
  • Known or suspected DM or CKD –> diabetic ketoacidosis or metabolic acidosis
  • Suicidality or chronic pain –> ASA overdose
34
Q

Dyspnea Risk Factors

A
  • Hx of CHF, MI, CAD, DM, HTN, or hypercholesterolemia
  • Smoking
  • Occupation (toxin, organic material, chemicals)
  • Prolonged immobilization, OCPs
  • Travel
  • Known allergies
  • Medications
35
Q

HPI: Dyspnea

A
  • CP
  • Itching/hives –> anaphylaxis
  • Fever
  • Cough
  • Swelling in legs or abdomen
  • Weight loss
  • Syncope –> primary/secondary pulmonary HTN
  • Joint pain
  • Weakness
  • Numbness in fingers –> panic attack or anxiety disorder
36
Q

HPI: Hemoptysis

A
  • Scant to moderate w/ sputum (i.e., bronchitis)
  • Hoarseness, smoking, cancer history
  • Severe or recurrent pneumonia or TB, chronic massive sputum production (i.e., bronchiectasis)
  • Fever (i.e., pneumonia, lung abscess)
  • Massive sputum for short time (i.e., pneumonia)
  • Cough, fever, dyspnea, arthralgias, or rash (i.e., SLE or other collagen vascular disease)
  • Hematuria
  • Sinusitis
  • Otitis
  • Skin lesion
  • TB or HIV exposure/history
  • Acute CP w/ dyspnea, recent immobilization or surgery (i.e., PE)
37
Q

PMH: Hemoptysis

A

Cancer, DVT, CV disease, liver disease, peptic ulcer disease, CKD, transplantation, HIV, vascular surgeries, tracheotomy, COPD, recent travel, IV drug use, occupational exposure, recent bronchoscopy or pulmonary surgery

38
Q

Normal Function of Mucous & Sweat

A
  • Sweat cools the body
  • Mucous lubricates the respiratory, digestive, & reproductive systems
    • Prevents tissues from drying out
    • Protects against infection
39
Q

Risk Factors for Infectious Respiratory Disease

A
  • Low SES
  • Exposure to secondhand smoke
  • Low birth weight
  • Bottle feeding vs. breast feeding
  • Overcrowding
40
Q

Bronchoscopy

A
  • Technique used to visualize the inside of the airways
  • Can be both diagnostic & therapeutic
  • Typically done to look for suspicious abnormalities (e.g. foreign body, tumor, bleeding)
41
Q

Flutter Valves

A
  • Vibrates the airways (loosens mucus from the airway walls)
  • Intermittently increase endobronchial pressure (helps maintain the patency of the airways during exhalation to prevent mucus trapping as it moves up)
  • Accelerates expiratory airflow (facilitates upward movement of mucus through the airways; enhances clearing)
42
Q

Flutter Valves

A
  • Vibrates the airways (loosens mucus from the airway walls)
  • Intermittently increase endobronchial pressure (helps maintain the patency of the airways during exhalation to prevent mucus trapping as it moves up)
  • Accelerates expiratory airflow (facilitates upward movement of mucus through the airways; enhances clearing)
43
Q

Oscillation Vest

A
  • Uses a compressor to inflate/deflate at timed intervals (high frequency)
  • Thins airway mucus to facilitate its removal by coughing
44
Q

Oscillation Vest

A
  • Uses a compressor to inflate/deflate at timed intervals (high frequency)
  • Thins airway mucus to facilitate its removal by coughing
45
Q

Oscillation Vest

A
  • Uses a compressor to inflate/deflate at timed intervals (high frequency)
  • Thins airway mucus to facilitate its removal by coughing

Pulmonology (8 decks)

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