Term
| Normal lung sounds heard over the suprasternal notch |
|
Definition
|
|
Term
| Normal lunch sounds heart at lung periphery |
|
Definition
|
|
Term
| High-pitched, musical with a distinct whistling quality |
|
Definition
|
|
Term
| Low-pitched, sonorous and may have a gurgling quality. |
|
Definition
|
|
Term
| Discontinuous, brief, discreet, non-musical sounds with a popping quality. |
|
Definition
|
|
Term
| Low-pitched, fluid filled quality lung sound, |
|
Definition
|
|
Term
| Acute vs Chronic cough? symptoms? |
|
Definition
Acute <3wks, chronic >8wks
3-8wks subacute
Sx: dyspnea, fever, congestion |
|
|
Term
| Acute vs Chronic bronchitis |
|
Definition
Acute: cough lasting <3wks, either viral or bacterial
Chronic: >3wks |
|
|
Term
| 85% of acute bronchitis is ___________ in origin. |
|
Definition
|
|
Term
| The major cause of chronic bronchitis. |
|
Definition
|
|
Term
| T or F: Most patients that come in with bronchitis have a normal physical exam and CXR. |
|
Definition
|
|
Term
|
Definition
-Symptomatic: bronchodilators, NSAIDs, nasal sprays, smoking cessation, anti-tussives
-Viral, so no antibiotics |
|
|
Term
| Tx for chronic bronchitis? |
|
Definition
| *Smoking cessation, O2 therapy, bronchodilators, antibiotic therapy |
|
|
Term
| How do you tell that acute bronchitis is bacterial not viral? |
|
Definition
-Persistent symptoms >1wk
-No improvement with systematic tx
-New symptoms: fever, increased purulent sputum production, & chest pain w/ bacterial |
|
|
Term
| 2 usual pathogens responsible for bronchiolitis? |
|
Definition
| Respiratory syncytial virus (RSV), adenovirus |
|
|
Term
| 2 classifications of bronchiolitis? |
|
Definition
Constrictive: chronic inflammation
Proliferative: intraluminal exudate, leading to obstruction & pneumonia |
|
|
Term
|
Definition
| -Treat underling disease: transplantation, connective tissue disease, hypersensitivity pneumonitis |
|
|
Term
| What influenza strain is most likely to cause a pandemic? |
|
Definition
|
|
Term
|
Definition
Fever, malaise, chills, headache, myalgias, nasal congestion, nausea
Less common: coryza, non-prod cough, sore throat, conjunctival redness. |
|
|
Term
| Common lab tests for influenza? |
|
Definition
| *Nasal swab test (rapid), leukopenia |
|
|
Term
| Who needs to be vaccinated against influenza? |
|
Definition
| >50, children >6mo, nursing homes, COPD, pregnant, HC workers |
|
|
Term
|
Definition
-Symptomatic
-Relenza, Tamiflu |
|
|
Term
| Possible complications of influenza? |
|
Definition
| Co-morbid illness, viral pneumonia, CHF, diabetes, renal failure, heart/pulm disease, |
|
|
Term
| Test that measures the lung's ability to transfer gas via the alveolar-capillary exchange system to detect the type and extent of pulmonary disease. |
|
Definition
| Pulmonary Function Test (PFT) |
|
|
Term
| Who would you NOT order a PFT on? |
|
Definition
| Acute severe asthma, respiratory distress, pneumothorax, ongoing hemoptysis, active TB |
|
|
Term
| 3 major patterns of PFTs? |
|
Definition
Normal
Obstructive- Longer time to reach max expiratory volume
Restrictive- lowered expiratory volume |
|
|
Term
| Most common cause of cancer deaths worldwide |
|
Definition
|
|
Term
| 90% of lung cancers are caused by: |
|
Definition
|
|
Term
| What is the most common form of lung cancer? |
|
Definition
|
|
Term
| Large, central lung tumor. Sometimes paraneoplastic (PTH). |
|
Definition
|
|
Term
| Lung tumor with large amounts of mucoid secretions. Female, non-smoker or radon exposure. |
|
Definition
|
|
Term
| Lung cancer of neuroendocrine cells, metastasizes early, paraneoplastic (ACTH, SIADH), variable primary tumor. |
|
Definition
|
|
Term
| Dilated neck veins, facial edema, prominent veins in arms & torso. More common in SCLC than NSCLC. |
|
Definition
Superior vena cava syndrome
(Tumor is sqeezing SVC) |
|
|
Term
| Tumor located in the superior sulcus, more common in NSCLC, shoulder/arm pain→neuropathy, Horner's syndrome. |
|
Definition
| Pancoast tumor (location is most important!) |
|
|
Term
| Lung cancers most often metastisize to: |
|
Definition
| Live, bone, adrenals, brain |
|
|
Term
| What are some paraneoplastic syndromes that may be associated with lung cancers? |
|
Definition
| Hypercalcemia (PTHrP), SIADH, Cushing syndrome, Anemia, Hypercoaguable state |
|
|
Term
| What must be obtained to make a diagnosis of lung cancer? |
|
Definition
|
|
Term
|
Definition
| Surgery if possible, chemo ineffective |
|
|
Term
|
Definition
Chem, but often metastatic at time of dx, only gets pt a few more months.
Surgery only if small, localized |
|
|
Term
| Most common primary lung neoplasm in children (late teens) |
|
Definition
| Pulmonary carcinoid tumor |
|
|
Term
| Most pulmonary carcinoid tumors arise in the ____________. |
|
Definition
| Proximal bronchi (presents with cough, obstruction or hemoptysis, recurrent infections) |
|
|
Term
| What is carcinoid syndrome? |
|
Definition
| Flushing, wheezing, diarrhea, may result in R-sided heart disease. |
|
|
Term
|
Definition
| solitary pulmonary nodule, asses risk of malignancy |
|
|
Term
| Pneumonia is the ____ leading cause of death in the US and _____ out of 1000 hospitalizations result in nosocomial pneumonia. |
|
Definition
|
|
Term
| What are some risk factors for pneumonia? |
|
Definition
Age
alcoholism
alt mental status
co-morbid medical problems: CF, COPD, smoking
inc respiratory rate (>30/min)
hypotension (<90/<60)
BUN >30 |
|
|
Term
| Infiltrate vs Consolidation |
|
Definition
Infiltrate: infection has invaded an area of tissue
Consolidation: infiextion has filled an area of tissue |
|
|
Term
| Community vs Nosocomial pneumonia |
|
Definition
Community: outside hospital or <48h of admission
Nosocomial: >48h after admission, excludes any infx present at admission |
|
|
Term
| "Typical Pneumonia" organisms |
|
Definition
| Strep pneumoniae, Pneumococcus, Haemophilus, Staphylococcus |
|
|
Term
| "Atypical pneumonia" organisms |
|
Definition
Most common: Mycoplasma
Rare: legionella, chlamydia |
|
|
Term
| Most common pneumonia organisms in a young healthy adult? Elderly? Debilitated? Hospitalized? Among all pops? |
|
Definition
YHA: S. pneumonia, H. influenzae, Mycoplasma pneumoniae
Elderly: S. pneumoniae, H. Influenzae, S. aureus
Debilitated: H. influenzae, S. pneumoniae, Anaerobes
Hosp: Pseudomonas aeruginosa, E. coli, S. aureus
All: Strep pneumoniae |
|
|
Term
| Why does atypical pneumonia effect multiple lung lobes? |
|
Definition
| -Immune-mediated, so can spread across the lung boundaries |
|
|
Term
| What is the most common reason for nosocomial pneumonia? |
|
Definition
|
|
Term
| What are some s/sx of pneumonia? |
|
Definition
| Fever, cough, sweats, rigors, chills, myalgias, headache, abdominal pain, chest pain |
|
|
Term
| What lab tests should be ordered for suspected pneumonia? |
|
Definition
-Sputum gram stain, w/ Culture & Sensitivity (C&S)
- Blood cultures (if admit & sm children)
-CBC (↑WBCs: neutrophils, bands, L-shift)
-BMP: *renal BUN/Creat, electrolytes
-Hepatic fx panel (AST/ALT)
-If HIV: CD4 & viral load
-Cardiac enzymes (+/-) |
|
|
Term
| What would you look for on the CXR for viral pneumonia? |
|
Definition
|
|
Term
| What would you look for to dx mycoplasma pneumonia? |
|
Definition
-Signs of bullous myringitis
-Young, healthy adult
-Summer/fall
-Hemolytic anemia, rashes |
|
|
Term
| What would you look for to dx tuberculosis? |
|
Definition
-Hx: exposure, drug use, HIV
-Sx: Fever, chills, *unexplained weight loss, *night sweats
-Positive PPD
-CXR- apical infiltrates, *cavitary lesions |
|
|
Term
| CXR- apical infiltrates, cavitary lesions |
|
Definition
|
|
Term
| What would you look for to dx fungal pneumonia? |
|
Definition
-Immunocompromised/HIV
-Geographic location (SW, Ohio Valley)
90% YHA heal w/o tx
70% mortality in HIV+/AIDS
-Cryptococcus, coccoides, histoplasmosis |
|
|
Term
| What is the purpose of the Pneumonia Patient Outcomes Research Team (PORT)? |
|
Definition
-19 clinical variables to determine if pt admission is necessary based on risk and mortality.
-Also consider compliance, social status, and subjective look of the pt |
|
|
Term
| What are some complications of pneumonia? |
|
Definition
-Endobronchial obstruction
-Empyema: "pus pocket" consolidation
-Pericarditis: pneumococcus
-Pleural effusion |
|
|
Term
| Abnormal collection of fluid in the pleural space |
|
Definition
|
|
Term
| 5 causes of pleural effusion |
|
Definition
1. Inc hydrostatic or dec oncotic pressures (transudates)
2. Abnormal capillary permeability
3. Dec lymphatic clearance
4. Infx of pleural space
5. Bleeding into the pleural space |
|
|
Term
| Most common cause of transudate pleural effusions? |
|
Definition
| Heart failure & cirrhosis |
|
|
Term
| Most common cause of pleural effusions (overall: transudate and exudate)? |
|
Definition
| Heart failure, pneumonia, cancer, pulm emboli, virus |
|
|
Term
|
Definition
Dyspnea, cough, respirophasic chest pain
Small effusions are normally asymptomatic |
|
|
Term
| What are some physical exam findings with larger pleural effusions? Massive? |
|
Definition
Dull percussion, dec/absent breath sounds, bronchial breath sounds, egophony
Massive: Tracheal shift |
|
|
Term
| What is the first thing you ask yourself when a pleural effusion is suspected? |
|
Definition
| Does the pt have heart failure? |
|
|
Term
| What tests need to be done in a pleural fluid analysis if a pleural effusion is suspected? |
|
Definition
-Appearance change: bloody, turbid, serous, purulent
-WBC & RBC counts
-Glucose
Exudates ONLY, not in transudates |
|
|
Term
| How much fluid must be present to see a pleural effusion on a standard upright CXR? |
|
Definition
|
|
Term
| How are transudate and exudate pleural effusions treated? |
|
Definition
Transudate: treat underlying cause or therapeutic thoracentesis
Exudate:
-treat underlying cause:CA, infx, trauma, --
-empyema-surgery
-thoracentesis
-chest tube
-pleurodesis for prevention |
|
|
Term
| What is the most common cause of exudative pleural effusions? |
|
Definition
| Pneumonia, but is often hiding lung cancer (40-80%) |
|
|
Term
| Spontaneous or traumatic accumulation of air in the pleural space. |
|
Definition
|
|
Term
| Primary vs Secondary spontaneous pneumothorax |
|
Definition
Primary: no underlying disease; ex. young 18-25, tall, thin male or smoker or family history
Secondary: Complication of pre-existing lung disease; COPD, CF, TB, pneumocystis pneumonia |
|
|
Term
|
Definition
S: respiratory distress, tachycardia, tachypnea
Sx: Chest pain, dyspnea, palpitations
*some pts have none & some have all |
|
|
Term
| Test of choice for a suspected pneumothorax? |
|
Definition
|
|
Term
| A complete collapse of the lung. It occurs when air enters, but does not leave, the space around the lung (pleural space). |
|
Definition
Tension pneumothorax
EMERGENCY! |
|
|
Term
| How is a pneumothorax treated? ___% may have a recurrence. |
|
Definition
Small: Watchful waiting
Large: Chest tube w/ water seal vacuum, VATS, thoracostomy, or open thoracotomy
30%
|
|
|
Term
| Pulmonary HTN w/ elevated pulmonary vascular resistance due to narrowing of the vessels. Etiology? Initial presentation? |
|
Definition
Primary pulmonary HTN (congenital), has no underlying cause.
Young women
Pres: Right sided heart failure |
|
|
Term
| Reasons for pulmonary HTN? |
|
Definition
|
|
Term
| How is pulmonary HTN usually treated? |
|
Definition
| Anticoagulation therapy, diuretics, supplemental O2, Ca2+ channel blockers, |
|
|
Term
| Right-ventricular hypertrophy (RVH) resulting from pulmonary disease? |
|
Definition
|
|
Term
| Most common cause of Cor Pulmonale? |
|
Definition
|
|
Term
|
Definition
Sx: chronic cough, dyspnea on exertion, wheezing, fatigue
S: Cyanosis, clubbing, JVD, RV heave/gallop, hepatomegaly, edema |
|
|
Term
| Tests for Cor Pulmonale dx? |
|
Definition
EKG: R axis deviation, peaked P-waves, Deep S-waves, RVH
PFT: to det underlying cause
Echo: RV fx |
|
|
Term
| Third leading cause of death in hospitalized patients? |
|
Definition
|
|
Term
| Etiology of a Pulmonary Embolism? |
|
Definition
| Air, amniotic fluid, long-bone fat, foreign bodies, renal cell tumor, septic emboli, parasite eggs, genetic clotting deficiency (Proteins C&S, Factor V) |
|
|
Term
| What is the most common embolus? |
|
Definition
Thrombus, esp from iliacs
50% will have DVT |
|
|
Term
| Most common symptoms of pulmonary embolism? |
|
Definition
| Tachypnea (>50% of pts), tachycardia, hypoxia |
|
|
Term
| Tests to Dx pulmonary emboli (PE)? Results? |
|
Definition
Pulmonary Arteriogram: "Gold Standard" for PE detection
CT: Initial test of choice for PE detection
EKG: 70% are abnormal, tachycardia or ST/T wave abn
ABG: acute respiratory alkylosis
CXR: Usually normal
D-dimer: used to rule out PE, but not diagnose
V/Q lung scan: ventilation to perfusion scan, determines probability of PE based on dispersion of inhaled contrast media |
|
|
Term
| What are some CXR findings that can occur in pts w/ a pulmonary embolism (PE)? |
|
Definition
Westermark sign: prominent central pulmonary artery
Hampton Bump: pleural base w/ inc marking, interparenchymal hemorrhage |
|
|
Term
| How are pulmonary emboli treated? |
|
Definition
-*Heparin: target aPTT 1.5-2.5x N
-Anticoagulation therapy to prevent emboli growth: warfarin/Coumadin (INR ~2.5), LMW heparin
-Thrombolytic therapy
|
|
|
Term
| What are some major disadvantages and contraindications of pulmonary embolism therapy? |
|
Definition
-Inc risk of intracranial hemorrhage
CI: stroke in past 2mo, active internal bleeding, uncrontrolled HTN, surgery/trauma in past 6wks, Coumadin: pregnancy X |
|
|
Term
| 4th leading cause of death in the US |
|
Definition
|
|
Term
| Population at greatest risk for COPD |
|
Definition
| 15-24yo African American males |
|
|
Term
| Air hunger resulting in altered breathing caused by insufficient oxygenation of the blood |
|
Definition
Dyspnea
*Not proportionate to severity of illness or air flow limitation and is affected by respiratory drive |
|
|
Term
| A natural defense of forceful expiratory effort with the accessory muscles of expiration creating expelation noise to aid with mucus/particle clearing. |
|
Definition
Cough
*No relation of character/timing/forcefulness of cough or presence/absence of sputum to etiology |
|
|
Term
| Acute v. subacute v. chronic cough |
|
Definition
| Acute <3wks, Subacute 3-8wks, Chronic >8wks |
|
|
Term
| Coughing up of blood originating from the respiratory tract below the larynx. |
|
Definition
|
|
Term
| Ratio of inspiratory to expiratory breathing rate |
|
Definition
| 2:3 inspiratory : expiratory |
|
|
Term
| Why do we sigh every ~90 seconds? |
|
Definition
| To fight alveolar collapse |
|
|
Term
| Continuous musical sound caused by narrowing of the lumen of a respiratory passageway. |
|
Definition
|
|
Term
| Adventitious breath sounds heard due to air passage through partial obstruction, often due to secretions, mucosal swelling, abn collapsibility or tumor tissue. |
|
Definition
|
|
Term
| A discontinuous, brief, non-musical breath sound with possible pop sound, typically fine or coarse, due to air passing over retained airway secretions or the sudden opening of collapsed airways. |
|
Definition
|
|
Term
| What cell type is responsible for the asthma reaction? |
|
Definition
|
|
Term
| Acute vs Chronic stage asthma |
|
Definition
Acute: stimulation of mast and macrophage cells within 30min or exposure to dec FEV1
Chronic: Histamine, cytokines, T&Bcells trigger the eosinophils, causing inflammation resulting in airway hyper-responsiveness, bronchioconstriction, reversible airflow obstruction and symptoms |
|
|
Term
| What is the gold standard for asthma diagnosis? |
|
Definition
| SPIROMETRY (PFT), before and after administration of bronchodilator |
|
|
Term
| Amount of air forcefully expelled after a full inspiration |
|
Definition
| Forced vital capacity (FVC) |
|
|
Term
|
Definition
PREVENTION and LONG-TERM control
-w/ fewest adverse effects, lowest number of agents and good patient compliance |
|
|
Term
| What are the "5 rights" of asthma therapy? |
|
Definition
| Diagnosis, classification, medications, timing, use |
|
|
Term
| Tx of acute stage asthma? |
|
Definition
-Beta-adrenergic agonists (beta2 selective) to relax sm mm to inc airflow via bronchodilaiton
-Albuterol, pirbuterol, terbtaline, Levalbuterol |
|
|
Term
| SE of beta-adrenergic agonists for asthma? |
|
Definition
| Tachycardia, inc BP, anxiety, cough |
|
|
Term
| Rx for asthma prevention? |
|
Definition
Corticosteriods- dec inflammation, inc airflow, dec hyperresponsiveness, dec exacerbations, dec remodeling
-Inhaled preferred over oral |
|
|
Term
| Asthma tx that provides prolonged bronchodilation, long-term prevention of asthma symptoms |
|
Definition
| Long-acting beta- agonsists |
|
|
Term
| Asthma tx that modulates mast cell mediator release and eosinophil recruitment of allergen and exercise-induced bronchospasm. |
|
Definition
| Long-acting bronchodilators |
|
|
Term
| Asthma tx that reverses vagally mediated brpnchospasm and may decrease hypersecretion |
|
Definition
|
|
Term
| Asthma tx for bronchodilation, mild anti-inflam, inc mucociliary clearance and diaphragm contractability |
|
Definition
| Phosphodiesterase inhibitors |
|
|
Term
| Asthma tx mediators that inc airway obstruction, contract smooth muscle, inc vascular permeability and attract airway inflammatory cells. |
|
Definition
|
|
Term
| Why might magnesium be given to a pt having an acute asthma attack? |
|
Definition
| Dec Ca available to smooth muscle contractile apparatus, transiently improving flow rates |
|
|
Term
| #1 way to stop acute asthma exacerbation? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Gradual onset of irreversible destruction of air sacs due to influx of PMNs, affecting elastin, causing decreased elasticity, dec O2 transfer, and inc size of air spaces distal to the terminal bronchiole. |
|
Definition
|
|
Term
| What is the hallmark of emphysema and chronic bronchitis? |
|
Definition
|
|
Term
| What does an CXR of a pt with chronic bronchitis show? |
|
Definition
| PERICARDIAL CUFFING, flattened diaphragm, small-appearing heart, non-specific markings |
|
|
Term
| What test is used to diagnose COPD? |
|
Definition
Spirometry
see notes for findings |
|
|
Term
|
Definition
STOP SMOKING- will decrease progression
-pulmonary rehab
-Oxygen
-lung transplant |
|
|
Term
| What is the goal of pharmacotherapy for COPD? |
|
Definition
| Provide relief of symptoms and prevent complications and/or progression of the disease with minimum side effects |
|
|
Term
| Because COPD is associate with more of a cholinergic tine than the other airway diseases, what is the best pharmacologic tx? |
|
Definition
| Inhaled anticholinergics for bronchodilation |
|
|
