Respiratory Flashcards
The most common causes of bronchiolitis in infant
RSV, Parainfluenza….
Most common cause of Croup in child
Parainfluenza 75% then RSV, influenza….
What is the inhaled treatment of choice and dose if need for a croup patient
Could use racemic epi but regular 1:1000 epi (L-epinephrine) 5ml nebulized is just as effective
a coin seen on end in AP view xray suggest what location
Trachea
Round in the Esophagus
Who gets mycoplasma pneumonia
Although mycoplasmal pneumonia is common in all age groups, it is most common in the first 2 decades of life, is rare in children younger than five years, and has the highest rate of infection in individuals aged 5-20 years.
At what age is CF diagnosed
Many variants. Most babies are screened with newborn screening and most diagnosed before 2yrs
Some may not present with symptoms until 20yrs
What is organic dust toxicity syndrome
Organic dust toxic syndrome is a term recently coined to describe a noninfectious, ACUTE febrile illness associated with chills, malaise, myalgia, a dry cough, dyspnea, headache and nausea which occurs after heavy organic dust exposure. EVERYONE THAT IS EXPOSED GETS IT. treat supportively
Farmer’s Lung Dx = Acute Hypersensitivity Pneumonitis which is more rare and an individual with CHRONIC allergic lung dx from repeated exposure to biologic dust. Long term parenchymal changes
Farmer’s lung (hypersensitivity peumomonitis)
Farmer’s lung is a disease caused by an allergy to the mold in certain crops. Farmers are most likely to get it because it’s usually caused by breathing in dust from hay, corn, grass for animal feed, grain, tobacco, or some pesticides. Not everyone gets farmer’s lung after breathing in these things. Treat with oral steroids
T/F Frequent respiratory infections is protective against asthma
True
What are the steps used to interpret results of an in office spirometry test?
The first step is determining the validity of the test by seeing if patient gives a strong enough effort. Next, the determination of an obstructive or restrictive ventilatory pattern is made. If a ventilatory pattern is identified, its severity is graded.
What number is best used to identify Obstructive Lung disease from Spirometry?
FEV1/ FVC ratio—The percentage of the FVC expired in one second.
What 4 lung volumes make up TLC - total lung capacity
expiratory reserve volume, inspiratory reserve volume, residual volume, and tidal volume.
For how many seconds is FVC measured
Up to 6 seconds
What is used to determine if a spirometry test (spirogram) is valid?
at least three acceptable spirograms must be obtained. In each test, patients should exhale for at least six seconds and stop when there is no volume change for one second. The test session is finished when the difference between the two largest FVC measurements and between the two largest FEV1 measurements is within 0.2 L.
If FVC is low, FEV1 low or normal, and absolute FEV1/FVC ratio is >0.7 what is the diagnosis?
restrictive ventilatory impairment may be present- due to restricted Total Lung Capacity
What would you expect to find on spirometry in asthma
A reduced FEV1 and absolute FEV1/FVC ratio < .7 indicates an obstructive ventilatory pattern, and bronchodilator challenge testing is recommended to detect patients with reversible airway obstruction (e.g., asthma).
Always look at FEV1/FVC to see if it is > or < 0.7
To diagnose Obstructive Dx which is always < 0.7
Daily symptoms of asthma puts a patient into what severity classification
Moderate persistent (>1x/wk at night) Severe persistent = throughout the day, almost nightly Mild persistent is more than 2 days per week but not daily. (3-4 x/wk at night)
What is the FEV1 if Mild persistent asthma
> 80% predicted
is FEV1/FVC used to diagnose Obstructive lung disease or to categorize severity
Just to diagnose if Obstructive or Restrictive. Would be <0.7
At what severity level should a patient be started on an inhaled steroid?
Mild Persistent. (Any persistent …)
Rule of 2 categorizing asthma severity
More than 2 times per week or 2 nights per month moves you into “Persistent” asthma
Can leukotriene inhibitors be used as a substitute for inhaled corticosteroids?
Yes in Step 2 but not recommended . They should be used in patients already receiving inhaled steroids. Also add to aspirin sensitive asthma.
at what “step” in therapy can you begin the monoclonal ab medications
5 and 6
May use Zyflo (zileuton) at step ….
4
Should COPD patients receive inhaled steroids to prevent exacerbations
Not any more. Now just a short course in recovery from and acute exacerbation
COPD types A and B
COPD types C and D
Have low, high symptom severity but both have low exacerbation risk
Have low/high symptom severity but both have high exacerbation risk
COPD types A and B
COPD types C and D
Have low, high symptom severity but both have low exacerbation risk
Have low/high symptom severity but both have high exacerbation risk
C and D get inhaled corticosteroids (severe and very severe)
what are the criteria for COPD patient to get home O2
Sats <88% or PO2 < 55 or <59 with evidence of cor pulmonale
What is the goal for number of hours of use of home oxygen for COPD patients to get improved survival
15 hours/day
What is the BODE Index?
Index used for criteria to meet before referral of a COPD patient for lung transplant. BMI, Obstruction,Dyspnea,Exercise
What are the PERC rules
Age ≥50
HR ≥ 100
SaO2 on room air < 95%
Unilateral leg swelling
Hemoptysis
Recent surgery or trauma (≤4 weeks ago requiring treatment with general anesthesia)
Prior PE or DVT
Hormone use (oral contraceptives, hormone replacement, or estrogenic hormones use in males or females)
most common cause of Pulmonary HTN
Left heart failure
