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62 Cards in this Set
- Front
- Back
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what do crackles on ascultation indicate
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fluids or mucus in the airways
heard on inhalation CHF, pulmonary fibrosis/edema, |
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what does ronchi or wheezing indicate
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an obstruction of the airway
continuous sound, but typically heard on exhalation prolonged expiritory phase |
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what is stridor
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high pitched wheezing heard on inspiration
airway obstructions |
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what are plural rubs
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leathery sound from inflammed plura
inspiration or ehpiration indicative of pluritis |
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what is egophony
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E to A sound heard if there is consolidation in the lung
lobar pneumonia compressed lung |
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what are the types of pneumonia
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CAP- community aquired
HCAP- health care VAP- ventilator |
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Hx for pneumonia
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cough, sputum, SOB, wheezing, plural pain (pain on deep breathing or coughing)
thoracic or neck pain fever, leukocytosis malaise, weakness, syncope |
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what Hx do you look for in an elderly patient that might be your only clue that this is pneumonia
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mental status change
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what are the mech for developing pneumonia
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pathogenisis
microaspiration or large volume aspiration aerosolized soil |
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how do you Dx pneumonia
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H&P indicative of pneu
positive lab cultures abnormal Chest CT or x-ray |
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when do you hospitalize someone with pneumonia
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3 or more of the following
-confusion -BUN >19 -Resp rate >30 bpm - sys <90/ dias < 60 - >65 |
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what are the most common micro causes of pneumonia
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Strep pneumoniae
H. influenzae Moraxella |
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what is the treatment of pneumonia
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quinoloen or macrolide puls 3rd gen cephalosporin within 6 hours of dx
non-hospital- oral hospitalized- IV |
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what are the complications of pneumonia
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Pleural effeusions
abscesses empyema pericarditis meningitis |
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what are some predisposing factors for aspiration pneumonia
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altered conciousness
GERD vomitus poor dentition trach tube |
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where do you usually seen an aspiration pneumonia on x-ray
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non-hospital= posterior portion of upper lobes
hospital= lung base |
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what are septic emboli usually caused by
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staph bacterimia
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what is empyema
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pus in the plural space
complication of CAP, Cocci, or aspiration |
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how do you treat empyema
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drain with a chest tube
surgical intervention antibiotics |
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who is most susceptible to Cocci
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elderly
African Americans Native Americans Asians people with chronic lung conditions |
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what are the symptoms of cocci
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rash
wheezing persistant fatigue CXR- cavities, micronodules, adenopathy, |
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what is the treatment for cocci
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mostly self limited
anti-fungals for persistent sympt 4months up to a lifetime surgical removal of cavity |
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histoplasmosis
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aerosolized environmental fungus
chicken farmers of the ohio river valley basin |
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how is TB transmitted
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resp droplet
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TB symptoms
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cough, hemoptosis
weight loss fever night sweats fatigue |
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what are the risk factors for TB
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extreames of age
DM steroid use immunocompramised (HIV=greatest risk factor) chemotherapy agents |
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how do you treat TB
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Isoniazid
Rifampin Ethambutol pyrazinamide |
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what is the origin of a nocardia infection
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decayed organic material
No P2P xmission |
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treatment length for
pneumonia TB Nocardia Cocci |
Pneu: 3 days to 2 weeks
TB: 6 - 18 months nocardia: one year cocci: 4 months to a lifetime |
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how do you diagnose Wegners
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chronic sinus disease
acute or chronic kidney disease lung or renal biopsy positive for c-ANCA |
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what are the causes of asthma
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innate immunity
genetics environmental factors |
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what triggers asthma
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exercise
infections inhaled allergens irritants cold, dry air NSAIDs, b-blockers GERD |
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how do you diagnose asthma
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Sx of recurrent episodes of airflow obstruction via narrowing. reversible with use of albuterol
spirometry |
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What are the NIH treatment guidelines for step 1 asthma. Mild intermittent asthma
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no medications
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What are the NIH treatment guidelines for step 2 asthma. mild persistant asthma
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low dose ICS
or cromyolin for children |
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What are the NIH treatment guidelines for step 3 asthma. moderate persistant asthma
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medium dose ICS
or low dose ICS & long acting B2 agonist |
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What are the NIH treatment guidelines for step 4 asthma. severe persistant
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high dose ICS & LABA & oral corticosteroids
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what are the 3 components of asthma pathophysiology
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SM dysfunction
Airway inflammation airway remodeling |
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what is the diagnostic criteria for UIP (usual interstitial pneu)
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evidence of
normal lung areas active fibrosis areas end-stage honeycomb fibrosis areas |
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what is IPF
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progressive, life threatinging interstitial lung disease of unk etiology
most common and worst prognosis median survival is 2-5 years |
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what are the HRCT findings for IPF
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sup plural fibrosis with honeycombing
traction bronchiectasis basal involvement reticular opacities |
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what treatment of IPF shows the most promise
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pirfenidone
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what is the mortality of a PE without treatment
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30%
8% with |
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what is virchows triad and what does it indicate
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factors that lead to thrombosis
1-hypercoagulability 2- stasis 3- injury |
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what are the syndromes of acute PEs
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infarct of hemorrhage
PE or cor pulmonale unexplained dyspnea/hypoxemia |
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what are normal PCO2 and PO2 levels
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PCO2= 40
PO2= 90 to 100 |
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what happens to ABGs in a PE
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hypocapnia
hypoxia |
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what are some CXR findings for a PE
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westermarks sign- dilation of pulmonary arteries proximal to PE
hamptons hump- wedge shaped opacity line densities |
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how do you treat PEs
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thrombolytisc- t-PA **
anticoags- heparin, warfarin Treat any time there is a high index of suspicion, confirmation or not |
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what are the 2 types of Pulmonary edema
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cardiogenic
non-cardiac |
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what are the common signs of pulmonary edema
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dyspnea
tachypnea cough frothy sputum hypoxemia x-ray chgs |
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what ix the clinical presentation of cardiogenic pulmonary edema
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Hx of CAD
HTN DM CHF |
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what are the signs and sympt of cardiogenic pulmonary edema
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Known LV dysfunction
S3 gallop orthopnea DOE PND cardiomegaly |
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what are the signs and symptoms of non-cardiogenic pulmonary edema
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dyspnea with no hx of cardiac disease
normal LV function hypoxemia and resp alkalosis |
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what do high levels of CO2 in the blood lead to
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lots of carbonic acid = resp acidosis
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what do low levels of CO2 in the blood lead to
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bicarb binds to H+ and ends up making more CO2
resp alkalosis |
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what can NPE lead to
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acute lung injury which leads to
ARDS |
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what is the diff btw ALI and ARDS when looking at PaO2/FiO2
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ALI= >200, <300
ARDS= <200 |
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what are the diagnostic criteria for ARDS
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acute onset
PaO2/FiO2 <200 bilat lung opacities norm cardiac size no evidence of- heart failure, fluid overload, chronic lung disease |
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what is the mech fo NPE
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acute lung injury
alveolar injury cytokine storm redistrobution of pulmonary blood flow |
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what is the difference btw primary and secondary ARDS
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primary- direct injury
secondary- non direct injury (sepsis, shock, pancreatitis) |
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how do you treat ARDS
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treat underlining cause
Oxygen supportive ventilate |
