Respiratory MDT Flashcards
Episodic or chronic symptoms of wheezing, dyspnea, or cough
Symptoms frequently worse at night or early morning
Prolonged expiration and diffuse wheezes on physical exam
Asthma
Chronic disorder of the airways characterized by variable airway obstruction, airway hyperresponsiveness, and airway inflammation
Asthma
Plays a central role in the pathogenesis of allergic asthma
IgE
Important in promoting eosinophilic inflammation
Interleukin-5
Most common type of asthma, usually begins in childhood and is associated with other allergic diseases such as eczema, allergic rhinitis, or food allergy.
Allergic asthma
Late asthmatic response
Symptoms 4-6 hours after allergen exposure
Selected individuals may experience asthma symptoms after exposure to aspirin
Aspirin-exacerbated respiratory disease
Triggered by various agents in the workplace and may occur weeks to years after initial exposure and sensitization
Occupational asthma
Women may experience asthma symptoms at predictable times during their menstrual cycle
Catamenial asthma
Begins during exercise or within 3 minutes after its end, peaks within 10-15 minutes, and then resolves by 60 minutes
Exercise-induced bronchoconstriction
This phenomenon is thought to be a consequence of the airways’ warming and humidifying an increased volume of expired air during exercise
Exercise-induced bronchoconstriction
Wheezing precipitated by pulmonary edema in the setting of decompensated heart failure
Cardiac asthma
Cough instead of wheezing as the predominant symptom of bronchial hyperreactivity
Cough-variant asthma
Signs and symptoms:
Episodic wheezing, shortness of breath, chest tightness, and cough.
Symptoms vary over time and in intensity and are often worse at night or early in the morning.
Asthma
Physical findings found in patients with allergic asthma
Mucosal swelling, increased secretions, polyps, eczema, atopic dermatitis, or other skin disorders
Asthma patient:
Arterial blood gas may be normal, but what lab will show an increased result?
Respiratory alkalosis and alveolar-arterial oxygen difference
Asthma:
The combination of an increased PaCO2 and respiratory acidosis may indicate:
Impending respiratory failure and the need for mechanical ventilation
Asthma:
Test used before and after administration of a bronchodilator
Spirometry
1) Assessing asthma control and severity
2) Distinguishing between severe and uncontrolled asthma
3) Personalized pharmacologic therapy for asthma
4) Treatment of modifiable risk factors and control of environmental factors
5) Guided self-management education and skills training
Five important aspect of chronic asthma management; from the Global Strategy for Asthma Management and Prevention
Asthma:
Medication therapy reserved for patients who are acutely ill and those who cannot use inhalers because of difficulties with coordination, understanding, or cooperation.
Nebulizer therapy
Most effective bronchodilator during exacerbations and provide immediate relief of symptoms
SABAs
Most effective in achieving prompt control of asthma during acute exacerbations
Systemic corticosteroids
Asthma medication:
Reverse vagally mediated bronchospasm but not allergen or exercise-induced bronchospasm
Anticholinergics
Potent mediators that contribute to airway obstruction and asthma symptoms by contracting airway smooth muscle, increasing vascular permeability and mucous secretion, and attracting and activating airway inflammatory cells
Leukotriene modifiers
Provides mild bronchodilation in asthmatic patients. It also has anti-inflammatory and immunomodulatory properties, enhances mucociliary clearance, and strengthens diaphragmatic contractility
Phosphodiesterase inhibitor (Theophylline)
Long-term control medications that prevent asthma symptoms and improve airway function in patients with mild persistent or exercise-induced asthma
Mediatory inhibitors (Cromolyn sodium and Nedocromil)
Patients who require monoclonal antibody therapies should be evaluated by a:
Pulmonologist or allergist experienced in their use
Vaccines:
Adult patients aged 19-64 with asthma should receive the:
23-valent pneumococcal polysaccharide vaccine (Pneumovax 23)
Annual Influenza
Common cause of asthma deaths
Asphyxia
(administer oxygen immediately)
When would you refer an asthmatic patient:
After how many courses of oral prednisone therapy in the past 12 months?
More than 2 courses of oral prednisolone
Sudden onset of asthma-like symptoms following high-level exposure to a corrosive gas, vapor, or fumes
Reactive airway dysfunction syndrome (RADS)
Symptoms:
-Acute single event with exposure to a chemical/irritant
-Mucus membrane irritation of the upper airway
-Dyspnea
-Cough
-Possible wheezing
-Possible hypoxia
Reactive airway dysfunction syndrome (RADS)
RADS is less responsive to:
Beta2 Agonists
Hallmark signs:
Acute exacerbation of symptoms beyond day-to-day variation including increased dyspnea, increased frequency or severity of cough, increased sputum volume or character
COPD
Emphysema
Chronic bronchitis
Chronic obstructive asthma
COPD Subtypes
Airflow limitation that is not reversible
COPD
Usually presents in the 5th or 6th decade of life with symptoms often present for 10 years
COPD
Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles that is accompanied by destruction of the airspace walls, without obvious fibrosis
Emphysema
Physical exam:
Over distention of the lungs in the stable state, decreased intensity of breath and heart sounds, and prolonged expiratory phase
Emphysema
“Pink Puffer”
Emphysema predominant
“Blue Bloater”
Bronchitis predominant
Chronic productive cough for three months in each of two successive years in a patient and other causes of chronic cough have been excluded
Chronic bronchitis
Major complaint of dyspnea
Usually presents after age 50
Cough is rare
Patients are thin
Accessory muscle use
Chest is quiet without adventitious lung sounds
Emphysema
Major complaint is productive cough with mucopurulent sputum
Frequent exacerbations due to chest infections
Often present in their 30’s and 40’s
Mild dyspnea
Chronic bronchitis
How many times will you test peak expiratory flow rate?
Three times total
Imaging:
Identifies and can quantify the emphysema phenotype associated with loss of tissue, can detect airway narrowing and wall thickening characteristic of a bronchitis phenotype
CT
Predisposition to venous thrombosis, especially in the legs
Acute onset of dyspnea, pleuritic chest pain, tachypnea, and tachycardia
Elevated rapid D-dimer, characteristic defects on imaging
Pulmonary embolism
Air embolization occurs most commonly after:
Penetrating trauma
Clots that form pulmonary emboli are most commonly from the:
Femoral or pelvic venous beds
Patients with DVT are how likely to develop PE?
50-60%
Venous Stasis
Injury to the vessel wall
Hypercoagulability
Virchow’s Triad (PE/DVT)
Massive embolization causes:
Acute pulmonary hypertension
Right Heart Strain
Systemic hypotension
Shock
Standard for PE diagnosis
Pulmonary Angiography
Fever, cough, along with other symptoms of the lower respiratory tract
Smoking history
Nasopharyngeal or GI Bleed
Hemoptysis
Expectoration of blood can range from blood-streaking of sputum to the presence of gross blood from below the vocal cords or within the lungs.
Hemoptysis
> 500 mL of expectorated blood over a 24-hour period or bleeding at a rate of >100 mL/hour
Massive hemoptysis
Hemoptysis patient, evaluate for:
Tachycardia
Hypotension
Decreased oxygen saturation
Inspect nose and oropharynx
How would you assess the bleeding magnitude in a hemoptysis patient?
Hemoglobin and hematocrit levels, white blood cell count and differential for possible infection
Most important study for hemoptysis patients
Chest CT
Treatment for Hemoptysis
Position the patient - good lung on top
Establish a patent airway
Clear rhinorrhea, hyposmia, and nasal congestion
Malaise, headache, and cough
Erythematous, engorged nasal mucosa on exam
Symptoms last less than 4 weeks and typically less than 10 days
Upper respiratory infection
Most frequent acute illness
Upper respiratory infection
Refers to a mild upper respiratory viral infection involving, to variable degrees, nasal congestion and discharge, sneezing, sore throat, cough, low grade fever, headache, and malaise
“Common Cold”
Colds typically last longer in what kinds of patients?
Smokers