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CD 3305 (mod 11/12) > Respiratory 2 > Flashcards

Respiratory 2 Flashcards

1
Q

What is the MC presenting complaint of emphysema?

A

Dyspnea (cough rare)

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2
Q

Compare and contrast the physical exam findings of chronic bronchitis and emphysema

A

Tactile fremitus: normal with chronic bronchitis, descreased with emphysema
Percussion: resonant with CB, hyperresonant with E
Breath sounds: normal with CB (may have prolonged expiration, wheeze, or crackles), decreased/absent with E

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3
Q

Asthma is a key ddx for COPD. How can you tell the difference?

A

Onset: COPD in mid-life, asthma in early life
Symptom progression: COPD slowly progressive, Asthma varies day-to-day but worse at night/early morning
History: COPD smoker, Asthma allergy/rhinitis/eczema
Airflow limitation: irreversible in COPD, reversible in asthma

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4
Q

Name 9 common asthma triggers

A 
Allergens
Viruses
Air pollution
Foods/additives
Drugs
Occupational factors
Emotional stress
Cold air
Exercise
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5
Q

True or false: inflammation associated with asthma is episodic

A

False - asthma attacks are episodic but airway inflammation in chronically present

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6
Q

What are the typical spirometry findings associated with asthma?

A

FVC is normal but FEV1 is reduced

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7
Q

DDX for URTI

A

Viral rhinitis

Sinusitis

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8
Q

What 6 viruses are associated with the “common cold”? Which is MC?

A 
MC: Rhinovirus
Coronaviruses
Influenza C
Parainfluenza virus
Adenoviruses
RSV
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9
Q

How long is the incubation period of the common cold?

A

2-4days

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10
Q

True or false: fever is a common feature of the common cold

A

Flase

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11
Q

Which OTC supplement has been shown to reduce the duration of subjective symptoms of the common cold?

A

Zinc lozenges

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12
Q

2 MC causative organisms of sinusitis

A

H. Influenzae

Strep pneumoniae

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13
Q

What are the 3 types of sinusitis?

A

Maxillary
Frontal
Ethmoid

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14
Q

What are 2 key history features of sinusitis

A

Yellow-green purulent discharge

Bending over makes symptoms worse

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15
Q

How can you check for sinusitis in the physical exam?

A

Transillumination

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16
Q

For how long is an individual contageous with influenza?

A

24 hours before to 7 days after symptoms began

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17
Q

S&S of influenza

A 
High Fever (up to 104F)/chills 2-5d
Marked fatigue
Muscle aching - Malaise especially in back and legs
Headache
Dry cough
Sore throat
Headaches
Children may have vomiting or diarrhea
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18
Q

What is a possible complication of influenza which is suspected if fever, cough, and respiratory symptoms last for >5d?

A

Bacterial infection

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19
Q

4 at-risk populations for severe disease

A
  1. Chronic pulmonary diseases
  2. Heart disease
  3. Prenant women in 3rd trimester
  4. Elderly/young/bed-ridden
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20
Q

What 2 medications can help shorted the duration of influenza and may be prescribed in at-risk popualtions?

A

Zanamivir

Tamiflu

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21
Q

True or false: headache is a common feature of the common cold but uncommon with the flu

A

False - other way around

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22
Q

S&S of pneumonia

A

fever/chills, green mucous, shortness of breath, (sharp/plueritic) chest pain, headache, crackling, dullness to percussion, enhanced voice sounds on ausculation, egophony, whispered pectroiloquy

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23
Q

MC causative organism of bacterial pneumonia

A

S. Pneumonia

24
Q

MC causative organism of bacterial pneumonia in children

A

H. influenza

25
Which causative organism tends to cause a more aggressive form of bacterial pneumonia and is associated with destructive changes in the lungs and rapid onset
Klebsiella pneumonia | K = Kill - higher mortality especially in <1yr and >60yo
26
What is a key clinical feature of K. pneumoniae-associated pneumoniae?
Thick blood-tinged sputum sometimes called currant jelly sputum
27
S&S of atypical pneumoniae
Constitutional symptoms (not respiratory) Fever, malaise, HA Non-productive cough No findings of consolidation
28
MC causative organism of atypical pneumonia
Mycoplasma pneumonia
29
What is a key clinical feature of atypical pneumonia?
Maculopapular rash (may be diagnostic)
30
What is the CURB-65? What are the 6 criteria?
``` Prognositc tool to assess whether or no to hospitalize patients with CAP. 1. Confusion 2. BUN >19mg/dL 3. RR >30bpm 4. SBP <90mmHg 5. DBP <60mmHg Age >65yo ```
31
What CRB-65 score would indicate an individual should be hospitalized?
>1 = should consider hospitalization | 3 or 4 = urgent hospitalization
32
S&S TB
su asymptomatic - primary symptom: chronic productive cough - fever w/ night sweats - anorexia/weight loss - malaise, fatigue - cough, hemoptysis - dyspnea, pleuritic chest pain w/ inspiration - calcification - positive sputum culture
33
What is TB of the spine called?
Potts disease
34
3 causes of venous thrombi
1. Venous stasis (immobilization) 2. Endothelial damage to veins (trauma/infection) 3. Hypercoagulation (genetic, physiologic, pharmacologic)
35
3 MC locations of thrombi?
Calf Thigh Pelvis
36
Describe the pathogenesis of pulmonary embolism
1. Embolus dislodges from thrombus 2. Once in lung, clot releases vasoactive substances producing vasoconstruction & bronchoconstriction 3. Decreased surfactant produced --> atelectasis 4. Increased pulmonary resistance leads to right-sided heart failure
37
s/s of pulmonary embolism
chest pain, wheezing, pain/swelling in one or both legs, shortness of breath, cough/anxiety
38
How are pulmonary embolisms treated?
Manage respiratory distress Anticoagulative meds (heparin/coumadin) Thromboysis (streptokinase) Surgery if large (embolectomy)
39
5 MC sources of mets in the lung
``` Kidney Breast Colon Cervix Skin (Melanoma) ```
40
S&S lung cancer
- dry hacking cough - hoarseness/dysphagia - dyspnea - hemoptysis/rust colored sputum - pain in chest area - diminished breath sounds/wheezing - constitutional: loss of appetite, tiredness, general discomfort - weight loss - pneumonia/fever
41
DDX clubbing fingers
``` Cardiovascular dx Lung dx (incl lung cancer) ```
42
What stage of tumour is considered not surgically resectable?
T4 - have invaded mediastinum (involve heart great vessels, trachea, or esophagus)
43
In which type of lung cancer do 95% of cases have mets at the time of dx?
Small cell carcinoma
44
Where is small cell carcinoma MC located in the lung?
Centrally - extensive mediastinal node involvement
45
Prognosis for small cell carcinoma
5-10% 5yr survival
46
Tx for small cell carcinoma
usually just chemo due to early & rapid spread
47
What are the 3 types of non-small cell lung cancer?
1. Squamous cell 2. Adenocarcinoma 3. Large cell
48
Which is MC associated with smoking: small cell or non-small cell lung cancer?
Non-small cell - smoking increses risk by 4-120x
49
7 non-smoking risk factors for developing non-small cell carcinoma
``` Exposure to: - asbestos - toxic agents (arsenic, nickel, chromium, chloromethyl ether) - uranium, radon History of: - Interstitial lung disease - Lung cancer - COPD - HIV infection ```
50
MC non-small cell carcinoma
Adenocarcinoma (50% of all bronchogenic carcinomas) | Also MC cell type seen in women and nonsmokers
51
What does adenocarcinoma secrete?
Mucin
52
Compare S&S of small cell vs non small cell carcinoma
``` SCC: - cough uncommon - sputum, - wheezing - atelectasis, tracheal shift - infection with fever, pain, and weight loss - pleural effusion - SVC syndrome - dyspnea from intrapulmonary spread NSCC: - cough - bloody, purulent sputum - stridor/wheezing/dyspnea - atelectasis, tracheal shift - infection with fever, pain, and weight loss ```
53
What is the typical pattern of involvement of NSCC?
Coin lesion (easier to resect)
54
What is SVC syndrome?
``` obstruction of blood flow through the SVC Causes the following symptoms: - dyspnea (MC) - trunk/UL extremity swelling - facial swelling - cough - orthopnea - HA - nasal stuffiness - light-headedness/dizziness/stupor - swollen jugular veins/venous system of upper chest/shoulders/neck - visual disturbances ```
55
Which type of lung cancer is a pancoast tumour?
Squamous cell

CD 3305 (mod 11/12) (8 decks)

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