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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
Q

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

A

Klebsiella pneumonia

K = Kill - higher mortality especially in <1yr and >60yo

26
Q

What is a key clinical feature of K. pneumoniae-associated pneumoniae?

A

Thick blood-tinged sputum sometimes called currant jelly sputum

27
Q

S&S of atypical pneumoniae

A

Constitutional symptoms (not respiratory)
Fever, malaise, HA
Non-productive cough
No findings of consolidation

28
Q

MC causative organism of atypical pneumonia

A

Mycoplasma pneumonia

29
Q

What is a key clinical feature of atypical pneumonia?

A

Maculopapular rash (may be diagnostic)

30
Q

What is the CURB-65? What are the 6 criteria?

A 
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
Q

What CRB-65 score would indicate an individual should be hospitalized?

A

> 1 = should consider hospitalization

3 or 4 = urgent hospitalization

32
Q

S&S TB

A

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
Q

What is TB of the spine called?

A

Potts disease

34
Q

3 causes of venous thrombi

A
  1. Venous stasis (immobilization)
  2. Endothelial damage to veins (trauma/infection)
  3. Hypercoagulation (genetic, physiologic, pharmacologic)
35
Q

3 MC locations of thrombi?

A

Calf
Thigh
Pelvis

36
Q

Describe the pathogenesis of pulmonary embolism

A
  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
Q

s/s of pulmonary embolism

A

chest pain, wheezing, pain/swelling in one or both legs, shortness of breath, cough/anxiety

38
Q

How are pulmonary embolisms treated?

A

Manage respiratory distress
Anticoagulative meds (heparin/coumadin)
Thromboysis (streptokinase)
Surgery if large (embolectomy)

39
Q

5 MC sources of mets in the lung

A 
Kidney
Breast
Colon
Cervix
Skin (Melanoma)
40
Q

S&S lung cancer

A
  • 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
Q

DDX clubbing fingers

A 
Cardiovascular dx
Lung dx (incl lung cancer)
42
Q

What stage of tumour is considered not surgically resectable?

A

T4 - have invaded mediastinum (involve heart great vessels, trachea, or esophagus)

43
Q

In which type of lung cancer do 95% of cases have mets at the time of dx?

A

Small cell carcinoma

44
Q

Where is small cell carcinoma MC located in the lung?

A

Centrally - extensive mediastinal node involvement

45
Q

Prognosis for small cell carcinoma

A

5-10% 5yr survival

46
Q

Tx for small cell carcinoma

A

usually just chemo due to early & rapid spread

47
Q

What are the 3 types of non-small cell lung cancer?

A
  1. Squamous cell
  2. Adenocarcinoma
  3. Large cell
48
Q

Which is MC associated with smoking: small cell or non-small cell lung cancer?

A

Non-small cell - smoking increses risk by 4-120x

49
Q

7 non-smoking risk factors for developing non-small cell carcinoma

A 
Exposure to: 
- asbestos
- toxic agents (arsenic, nickel, chromium, chloromethyl ether)
- uranium, radon
History of:
- Interstitial lung disease
- Lung cancer
- COPD
- HIV infection
50
Q

MC non-small cell carcinoma

A

Adenocarcinoma (50% of all bronchogenic carcinomas)

Also MC cell type seen in women and nonsmokers

51
Q

What does adenocarcinoma secrete?

A

Mucin

52
Q

Compare S&S of small cell vs non small cell carcinoma

A 
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
Q

What is the typical pattern of involvement of NSCC?

A

Coin lesion (easier to resect)

54
Q

What is SVC syndrome?

A 
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
Q

Which type of lung cancer is a pancoast tumour?

A

Squamous cell

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

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