Respiratory Flashcards
What diagnosis are peak flows used to monitor ongoing response?
Asthma
Which diagnosis is most likely to have dry non-productive cough and/or excessive vomiting or regurgitation?
GERD
Which is a multifactorial disease with heterogenous clinical phenotype and complex genetic inheritence?
Asthma
Disease of reversible airway obstruction
Asthma
Abrupt onset of symptoms, history of choking, UNILATERAL monophonic wheeze is most often associated with:
Airway foreign body
The five major steps of “Ask, Advise, Assess, Assist, and Arrange” are used to help the clinician in reducing the progression and burden of chronic lung disease related to?
Smoking
A major predisposing factor for developing asthma as a child.
Atopy
Female sex, family history, atopy, bronchial hyper-responsiveness, obesity, and rhinitis/sinusitis are:
Factors that predict persistence of asthma from childhood to adulthood
Symptoms, night time-awakening, use of rescue inhaler, ability to do normal activities
Parameters defining level of asthma severity/level of asthma control
Wheezing during normal breathing, prolonged phase of forced expiration, hyper-expansion of thorax, use of accessory muscles
Physical findings of asthma exacerbation
Sound heard as air passes through fluid-filled airways
Crackles
Abnormal breath sounds associated with PNA and/or CHF
Crackles
Sound heard secondary to narrowing of the airway d/t asthma or bronchitis
Wheezes
Tone of this sound varies depending on which area of the airway is affected; may be musical (polyphonic) or hoarse (monophonic) in nature
Wheezes
Which age-related population are these considerations for?
Due to shorter stature, upper airway sounds are frequently transmitted to lower airway, making the exam more challenging in this patient.
Peds
Which age-related population are these considerations for?
Diagnostic testing of pulmonary function/lung volumes may need to be delayed in this population.
Peds
Key history/PE findings:
-Mildly ill
-Fever presenting around (less than or =)100F for first few days then resolved
-Lung exam normal or wheezing/rhonchi clearing with cough
Acute bronchitis
Acute bacterial infection of the lower respiratory tract characterized by cough, febrile (>100.6), tachypnea, tachycardia, and crackles on lung exam
PNA
Direct testing designed to detect the volume and capacity of the lungs to determine overall functioning of the respiratory system
Spirometry (PFTs)
Key Findings:
productive cough, dyspnea, nasal congestion, headache, fever, substernal or chest wall pain, cough lasting 2-6 weeks
Acute bronchitis
Key Findings:
prodromal viral URI followed by increased resp effort and wheezing, rhinorrhea, cough, commonly seen in children over adults with AMS, activity level decline, decreased appetite
Bronchiolitis
Key Findings:
chronic cough, dyspnea, sputum production, recurrent lower respiratory infections, chest tightness exacerbated by exercise (exercise intolerance)
COPD
Key Findings:
persistent productive cough, wheezing, dyspnea, tachypnea, hyperinflation of lungs on CXR, PFTs consistent for obstruction, recurrent lung infections, bronchiectasis with impaired mucociliary clearance, OSA; often genetic with the presence of a CFTR gene
Cystic fibrosis
Key Findings:
cough, fever, sore throat, malaise, often seen in the fall/winter
Influenza
Patients with a poorly explained cough, hemoptysis, SOB, CP, unintentional weight loss, hoarseness, bone pain, headaches, vision changes, confusion, nausea, constipation, weakness, and/or clubbing should be screened for…
Lung cancer
Key Findings:
Loud snoring, frequent arousals and disruption of sleep, EKG changes
OSA
Key Findings:
incubation period of 3-5 days, peaks in late summer/early fall, most serious in infants; runny nose, sneezing, mild cough, low-grade fevers, apnea/cyanosis in infants, posttussive vomiting in adults
Pertussis
What is a useful tool to guide treatment of PNA in older adults (>65 y/o)?
CURB-65 PNA severity scale
Key Findings:
cough (can be pink-tinged or hemoptysis), CP, fatigue, weight loss, growth delay in children, chills, anorexia, fever, night sweats, recent travel to high exposure risk areas or living in high-risk congregate settings, immunocompromised
TB
What is an important aspect to assess with respiratory symptoms?
Timing (time of day symptoms occur), habits, recreational/occupational exposures
When is smoking status assessed?
With every patient encounter
What should the inspiration to expiration ratio be?
1:2
