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83 Cards in this Set
- Front
- Back
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What are the 4 etiologies of obstructive pulmonary disease? |
- Asthma - Bronchiectasis - COPD (& CF) - Obstruction |
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What do obstructive pulmonary diseases have in common? (3) |
- Airway narrowing - Movement of air is restricted - Air can be trapped |
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What is asthma? |
Reversible airway obstruction secondary to bronchial hyper-reactivity |
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What are Sx of asthma? (4) |
- Cough - Episodic Wheezing (at night) - Prolonged expirator duration - Accessory muscle use |
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How is asthma Dxed? (4) |
- ABGs show mild hypoxia and respiratory alkalosis - Spirometry/PFTs show decreased FEV1/FVC - CBC may show eosinophilia - Methacholine challenge shows bronchial hyperresponsiveness |
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How is asthma Txed? (2) |
- Avoidance of triggers - Management with asthma medication |
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Name two beta-agonists used for mild asthma? |
- Albuterol - Salmeterol |
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What are 2 specific steroids Tx for mild asthma? |
- Beclomethasone - Prednisone |
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Name a muscarinic antagonist used for moderate asthma. |
- Ipatropium |
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Name a methylxanthine used for moderate asthma. |
Theophylline |
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Name a vasoactive mediator of mast cells that is effective only as an asthma prophylaxis. |
Cromolyn |
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Name 3 anti-leukotrienes used for severe asthma. |
- Zileuton - Montelukast - Zafirlukast |
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What asthma medications are indicated for mild asthma? (3) |
- Ipratropim - Systemic corticosteroids - Albuterol |
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What is bronchiectasis? |
Permanent dilation of bronchi, fibrosis, and remodeling of bronchioles due to infection and inflammation |
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What are Sx of bronchiectasis? (4) |
- Chronic cough - Yellow/green sputum - Dyspnea - Hemoptysis/halitosis |
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How is bronchiectasis Dxed? (3) |
- CXR shows increased bronchovascular markings - High-resolution CT shows dilated airways - Spirometry shows decreased FEV1/FVC ratio |
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How is bronchiectasis Txed? (3) |
- Antibiotics - Corticosteroids - Lobectomy or lung transplant if severe |
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How does chronic bronchitis differ from emphysema? |
Chronic bronchitis is productive cough for >3 months per year for 2 consecutive years while Emphysema is terminal airway destruction and dilation secondary to smoking |
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What terminal airway destruction disease is panlobular? centrilobular? |
Panlobular = alpha-1-antitrypsin Centrilobular = emphysema |
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What are Sx of emphysema? (3) |
Dyspnea, pursed lips, minimal cough (pink puffer) |
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What are Sx of chronic bronchitis? (2) |
Cyanosis with mild dyspnea, and productive cough (blue bloater) |
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What is seen on CXR of a patient with terminal airway destruction? |
Hyperinflated lungs |
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What are seen on PFTs of a patient with terminal airway destruction? |
Decreased FEV1/FVC |
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What is seen on ABGs of a patient with terminal airway destruction? (2) |
Hypoxemia with respiratory acidosis |
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How are acute exacerbations of terminal airway destruction Txed? (5) |
- Oxygen - Inhaled beta-agonists - Inhaled corticosteroids - Antibiotics - BiPAP |
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How is chronic terminal airway destruction Txed? (3) |
- Smoking cessation - Supplemental oxygen - Vaccination |
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What are 4 etiologies of restrictive lung disease? |
- Alveolar filling - Interstitial lung disease - Neuromuscular problems - Thoracic wall problems |
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What is interstitial lung disease? |
Inflammation and/or fibrosis of the interalveolar septa |
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What are Sx of restrictive lung disease? (7) |
- Shallow, rapid breathing - Extertional dyspnea - Non-productive cough - Cyanosis - Crackles/wheezes - Clubbing - RHF |
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What antiarrhythmic can cause interstitial lung disease? Which antibiotic? |
Amiodarone Nitrofurantoin |
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What is seen on CXR/CT in a patient with restrictive pulmonary dz? |
Honeycombing
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What is seen on PFTs for a patient with restrictive lung dz? (4)
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- Decreased total lung capacity - Decreased FVC - Decreased diffusion capacity for carbon monoxide - A normal FEV1/FVC ratio |
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What can confirm a Dx of IPF? |
Lung biopsy |
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What is Tx for restrictive lung dz? (3) |
- Supportive - Corticosteroids - Lung Transplant |
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What is seen on biopsy of tissue from a patient with sarcoidosis? |
Noncaseating granulomas |
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What are Sx of sarcoidosis? (6) |
- Fever - Cough - Malaise - Arthritis - Gottron papules - Erythema nodosum |
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What is seen on CXR/CT of a patient with sarcoidosis? (2) |
- Lymphadenopathy and nodules |
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What do PFTs show in a patient with sarcoidosis? |
Decreased diffusion capacity |
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What is seen on labs of a patient with sarcoidosis? (3) |
- Elevated ACE - Hypercalcemia - Elevated Alk Phos |
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What is Tx for sarcoidosis? |
Systemic corticosteroids |
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What pulmonary disease is characterized by alveolar thickening and granulomas secondary to environmental exposure? |
Hypersensitivity pneumonitis
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What are acute Sx of hypersensitivity pneumonitis? (5) |
- Dyspnea - Fever - Malaise - Chills - Cough |
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What is common on CXR/CT among patients with hypersensitivity pneumonitis? |
Upper lobe fibrosis |
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What are Tx for hypersensitivity pneumonitis? (2) |
Corticosteroids and avoidance of noxious agents |
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What is seen on CXR of a patient with asbestosis? |
linear opacities |
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What is seen on CXR of a patient with silicosis? |
eggshell calcifications |
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What are Sx of eosinophilic pulmonary syndrome? (3) |
- Dyspnea - Cough - Fever |
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What are 4 etiologies of hypoxemia? |
- Ventilation-perfusion mismatch - Right-to-left shunt - Hypoventilation - Diffusion impairment |
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What is the classic sign on vitals for hypoxemia? |
Decreased oxygen saturation |
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How are hypercapnic patients Txed? |
Increase ventilation to increase CO2 exchange
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What Sx are seen in acute respiratory distress syndrome? (9) |
- Hypoxemia - Decreased lung compliance - Pulmonary edema |
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What is PaO2 / FiO2 in ARDS? |
<= 200 |
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How is ARDS Txed? (2) |
- Mechanical ventilation - Treat underlying dz |
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What pressure threshold signifies pulmonary hypertension? |
25 mmHg |
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What can be auscultated in a patient with cor pulmonale? |
Loud S2 (often split), flow murmur, or S4 |
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What is seen on CXR of a patient with cor pulmonale? |
Enlargement of central pulmonary arteries |
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How is cor pulmonale Txed? (4) |
- Supplemental oxygen - Anticoagulation - Vasodilators - Diuretics |
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What percentage of PE's are from DVTs? |
95% |
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What are Sx of PE? (5) |
- Sudden-onset dyspnea - Pleuritic chest pain - Low-grade fever - Tachypnea/tachycardia - Cough/hemoptysis (rare) |
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What is seen in ABGs of a patient with a PE? |
Respiratory alkalosis |
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What is Hampton's hump? Westermark's sign? |
Hampton's hump is wedge-shaped infarct Westermark's sign is oligemia of affected lung zone |
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What imaging study is diagnostic for a PE? |
CT pulmonary angiogram with IV contrast |
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What lab is sensitive for PE? |
D-dimer |
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How is PE Txed acutely? Chronic? |
Acutely: LMWH sub-Q Chronically: LMWH or Warfarin for at least 6 months |
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When is thrombolysis indicated for PE? |
When a PE is massive |
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What 2 type of lung cancers occur centrally? |
Small cell and squamous cell carcinomas |
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Which lung carcinoma is most likely to metastasize? |
Small cell carcinoma |
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What is the most common lung carcinoma that forms peripherally? |
Adenocarcinoma |
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Which type of lung carcinoma is most associated with smoking? |
Squamous cell carcinoma |
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What are Sx of lung cancer? (5) |
- B-symptoms - Dyspnea - Hemoptysis - Chest pain - Cough |
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What are Sx of Horner's syndrome? (3) |
- Miosis - Ptosis - Anhidrosis |
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What term refers to facial swelling in a patient with lung cancer? |
SVC syndrome |
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How are peripheral lung lesions biopsied? Central lung lesions? |
Peripheral = FNA Central = bronchoscopy |
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What is the treatment for Small cell lung carcinoma? (2) |
Radiation and chemo |
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What is the treatment for non-small cell lung carcinoma? (3) |
Resection with radiation and chemo |
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What is the cause of transudative pleural effusion? (2) |
Increased pulmonary capillary wedge pressure and decreased oncotic pressure |
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What is the cause of exudative pleural effusion? |
Increased pleural vascular permiability |
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What are Sx of pleural effusion? (3) |
- Dyspnea - Dullness to percussion - Decreased breath sounds |
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How is pleural effusion Txed? (2) |
- Treat underlying cause - Thoracentesis |
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What type of pneumothorax happens in tall, thin young males? |
Spontaneous pneumothorax |
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What is tension pneumothorax? |
Chest wall defect that lets air out of lungs into pleural space but not back in causing air to be trapped |
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What are Sx of pneumothorax? (4) |
- Acute onset unilateral pleuritic chest pain - Dyspnea - Tachypnea - Diminished breath sounds |
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How is tension pneumothorax treated? (2) |
Immediate needle in the second intercostal midclavicular space or chest tube placement if large |
