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131 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Labored or difficult breathing
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Dyspnea
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Noise heard on breathing when the trachea or larynx is obstructed (louder/harsher than wheezes)
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Stridor
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Abnomal breathing sound (whistling/squeaking) resulting from narrowed airways
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Wheeze
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Expectoration of blood that originates below the vocal cords
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Hemoptysis
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Structural changes at the base of the nail that includes softening of the nail bed and loss of the normal 150 degree angle bn the nail and cuticle
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Digital clubbing
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Blue or blue-gray discoloration of the skin and mucus membranes caused by increased amounts of unsaturated hemoglobin in capillary blood
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Cyanosis
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Palpable vibrations transmitted through the bronchopulmonary tree to the chest wall when the patient speaks
("99") |
Tactile fremitus
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When "ee" is heard as "ay," an E-to-A change is present (quality sounds nasal)
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Ecophony
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When whispered sounds are heard louder/clearer
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Whispered Pectoriloquy
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Sternum is displaced anteriorly (increased AP diameter)
Pigeon chest |
Pectus Carinatum
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Lower portion of sternum is depressed
Funnel chest |
Pectus Excavatum
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Decreased O2 in the tissues
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Hypoxia
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Decreased O2 in the arterial blood
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Hypoxemia
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PaO2 <= 55 mmHg or <= 85% oxygen saturation
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Abnormally increased CO2 in the blood
Symptoms include SOB, N/V, confusion, lethargy, HA, increased RR |
Hypercapnia or Hypercarbia
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Failure of part of the lung to expand
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Atelectasis
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Tactile fremitus increased
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Pneumonia
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Tactile fremitus decreased
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COPD
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Percussion is flat or dull (2)
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Lobar pneumonia
PE |
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Percussion is normal (2)
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Healthy lung
Bronchitis |
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Hyperresonant Percussion
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Emphysema
Pneumothorax |
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When are breath sounds decreased?
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When normal lung is displaced by air or fluid (3)
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Emphysema
Pneumothorax PE |
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When do breath sounds shift from vesicluar to bronchial?
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Fluid in the lung parenchyma
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Pneumonia
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High-pitched, discontinuous sounds caused by air passing through moisture in the alveoli or bronchioles
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Crackles (rales) (3)
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Bronchitis
Pneumonia PE |
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High-pitched, musical sounds from air squeezing through narrowed airways
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Wheezes
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Bronchospasm
PE RSV |
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Snoring or gurgling sounds from fluid or obstructions in large airways
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Rhonchi (2)
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Chronic bronchitis
Pneumonia |
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Rough, grating, scratching sounds caused by inflamed surfaces of the pleura rubbing together (pain on deep inspiration common)
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Pleural Friction Rubs (4)
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Pleurisy
TB Pneumonia Lung cancer |
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Measures airflow rates and vital capacity
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Spirometry
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Measure gas exchange
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PFTs
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Reflect net effect on gas exchange of abnormalities in pulmonary function
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ABGs
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Total volume of air exhaled after maximal inspiration
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Forced Vital Capacity
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Total volume exhaled in one second
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Forced Expiratory Volume and 1 second
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Maximum rate of flow with forced, maximal effort during exhalation
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Peak Expiratory Flow Rate
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Caused by any process which decreases the ability of the lungs to exchange CO2 for O2
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Respiratory Acidosis (4)
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COPD
Asthma CHF Pneumonia |
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Caused by any process which increases respiratory rate
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Respiratory Alkalosis (3)
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Fever
Anxiety Mechanical overventilation |
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Caused by any process that increases the accumulation of acids or decreases the amount of bicarbonate
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Metabolic Acidosis (2)
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DKA
Renal Failure |
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Caused by any process that decreases acid or increases bicarbonate
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Metabolic Alkalosis (2)
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Prolonged vomitting
NG suction |
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Low pH
Elevated CO2 |
Respiratory Acidosis
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Low pH
Normal or low CO2 |
Metabolic acidosis
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High pH
Low CO2 |
Respiratory alkalosis
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High pH
Normal or high CO2 |
Metabolic alkalosis
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Low pH
High CO2 High HCO3 |
Partial compensated respiratory acidosis
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Low pH
Low CO2 Low HCO3 |
Partially compensated metabolic acidosis
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High pH
High CO2 High HCO3 |
Partially compensated metabolic alkalosis
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High pH
Low CO2 Low HCO3 |
Partially compensated respiratory alkalosis
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Characterized by increased responsiveness of the trachea and bronchi to various stimuli
Airway narrowing is reversible |
Asthma
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Normal FEV1/FVC
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> 80
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Relax airway smooth muscle
Increase airflow |
Inhaled B2 andrenergics (1)
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Albuteral
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Reverse vagally mediated bronchospasm (not exercise or allergen-induced)
May decrease mucus production |
Inhaled Anticholinergics (2)
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Ipratropium
Ipratropium/albuteral |
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Used as "burst" therapy
Speed the resolution of airway obstruction |
Systemic Corticosteroids
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Prednisone
Methylprednisone |
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1st line for persistent asthma
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Inhaled Corticosteroids (5)
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Beclomethasone
Budesonide Flunisolide Fluticasone Triamcinolone |
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Provide bronchodilation for up to 12 hours, but have slow onset
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Long-acting inhaled B-adrenergics (2)
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Salmeterol
Fluticasone/salmeterol |
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Modulate mast cell mediator release and eosinophil recruitment
Good for mild persistent asthma or exercise-induced asthma |
Inhaled Mediator Inhibitors (2)
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Cromolyn
Nedocromil |
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Inhibits airway smooth muscle contraction, vascular permeability/mucus secretion, and attraction/activation of inflammatory cells
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Leukotriene modifiers (3)
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Zileuton
Zafirlukast Montelukast |
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Provide mild bronchodilation
may also have anti-inflammatory properties and enhance mucus clearance |
Phosphodiesterase inhibitors
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Theophylline
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Characterized by airflow obstruction due to chronic bronchitis or emphysema
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COPD
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Characterized by increased bronchial secretions with cough > 3 months in at least two consecutive years
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Chronic Bronchitis
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Permanent air space enlargement distal to the terminal bronchiole, with wall destruction and no obvious fibrosis
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Emphysema
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Associated with early development of emphysema (<40 yrs)
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alpha1-antitrypsin deficiency
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Parenchymal bullae or blebs on CXR
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Emphysema
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Only COPD treatment that prolongs survival
Vital for pts with resting hypoxemia |
Oxygen terapy
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COPD drug
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Tiotrpium
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Congenital or acquired disorder of the large bronchi characterized by permanent dilation/destruction of bronchial walls
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Bronchiectasis
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Characterized by chronic cough, abundant production of purulent sputum, hemoptysis, and recurrent pneumonia or sinusitis
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Bronciectasis
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Bronchiectasis Dx
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CT
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Bronchiectasis Tx
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ABX
Chest physiotherapy with postural drainage Inhaled bronchodialators |
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Extrapulmonary manifestions:
Pancreatitis Steatorrhea Men have congenital bilateral absence of the vas deferens with azzospermia |
Cystic Fibrosis
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CF Dx
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Sweat test
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Lesion < 3 cm that is an isolated rounded opacity surrounded by normal lung
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Solitary Pulmonary Nodule
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Most benign solitary pulmonary nodule
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Infectious granulomas
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Evaluation of solitary pulmonary nodule
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CT
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Low pH
High CO2 High HCO3 |
Partial compensated respiratory acidosis
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Low pH
Low CO2 Low HCO3 |
Partially compensated metabolic acidosis
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High pH
High CO2 High HCO3 |
Partially compensated metabolic alkalosis
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High pH
Low CO2 Low HCO3 |
Partially compensated respiratory alkalosis
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Characterized by increased responsiveness of the trachea and bronchi to various stimuli
Airway narrowing is reversible |
Asthma
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Normal FEV1/FVC
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> 80
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Relax airway smooth muscle
Increase airflow |
Inhaled B2 andrenergics (1)
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Albuteral
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Reverse vagally mediated bronchospasm (not exercise or allergen-induced)
May decrease mucus production |
Inhaled Anticholinergics (2)
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Ipratropium
Ipratropium/albuteral |
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Used as "burst" therapy
Speed the resolution of airway obstruction |
Systemic Corticosteroids (2)
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Prednisone
Methylprednisone |
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1st line for persistent asthma
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Inhaled Corticosteroids (5)
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Beclomethasone
Budesonide Flunisolide Fluticasone Triamcinolone |
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Dx of solitary pulmonary nodule
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Biopsy
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Benign neoplasm composed of abnormal mixture of tissues
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Hamartoma
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"Popcorn" lesion on CXR
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Hamartoma
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Leading cause of cancer death in men and women
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Bronchogenic carcinoma
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Weight loss + hemoptysis (2)
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Cancer or TB
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Change in voice
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Involved recurrent laryngeal nerve
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Top of body looks swollen in cancer patient
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SVC syndrome
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Arises from bronchial epithelium
Usually found as a centrally located intraluminal mass Often presents with hemoptysis |
SCC
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Typically arise from mucus glands
Usually present as peripheral masses or nodules Generally asymptomatic |
Adenocarcinoma
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Heterogeneous group of undifferentiated tumors that have large cells
Aggressive course May present as central or peripheral masses |
Large cell carcinoma
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Tumor of bronchial origin that begins centrally, infiltrating to cause bronchial narrowing/obstruction without a discrete luminal mass
Hilar or mediastinal pathology common on CXR |
Small Cell Carcinoma
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Prone to early mets with aggressive clinical course
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Small Cell Carcinoma
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Bronchogenic Carcinoma Dx
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Cytology and tissue examination
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Present with slow-onset of dyspnea, nonpleuritic chest pain, weight loss
May have exudative and hemorrhagic PE Primary tumors predominantly of the pleural surface lining |
Mesothelioma
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Mesothelioma DX
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CT and Open Pleural Biopsy
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Low grade carcinoma seen as pedunculated or sessile growths in the central bronchi
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Carcinoid tumors
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Carcinoid tumor Dx
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Bronchoscopy or CT
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Influenza Dx
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Rapid antigen tests
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Influenza Tx
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Zanamivir or oseltamivir (Influenza A, B)
Amantadine or rimantidine (Influenza A) |
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Inflamation of the airways (trachea, bronchi, bronchioles) usually secondary to an infectious process
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Acute Bronchitis
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Viruses that most commonly cause acute bronchitis
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Rhinovirus
Coronavirus |
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Nonviral causes of acute bronchitis (3)
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M. pneumo
C. pneumo Bordetella pertussis |
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Characterized by cough (with or without sputum, fever, or substernal discomfort) and in the absence of CXR findings of pneumonia
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Acute Bronchitis
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Usually in pt with severe underlying COPD that has chronic cough and sputum production, but something has changed in the nature of either of these symptoms
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Acute bacterial exacerbation of chronic bronchitis
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Acute bacterial exacerbation of chronic bronchitis Tx
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Mild to moderate = doxy, amox, or bactrim
Severe = amoxicillin/clavulanate, cefuroxime, clarithromycin, or resp fluoroquinolone |
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Acute parenchymal lung infection associated with at least some symptoms of acute infection, accompanied by the presence of an actue infiltrate on CXR or auscultatory findings consistent with penumonia (adventitous breath sounds +/- localized rates)
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CAP
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CAP Typicals
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S. pneumo
H. influenzae M. catarrhalis |
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CAP Atypicals (3)
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Legionella
Chlamydia Mycoplasma |
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Induced sputums (2)
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Pneumocystis jiroveci
Mycobacterium tuberculosis |
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CAP Dx
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Chest x-ray is necessary
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Often presents with an acute onset of a single episode of shaking with chills (rigor) and pleurisy
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S. pneumo
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May present with sore throat, hoarseness, and headache as important nonpneumonic symptoms
Cold agglutinins are not elevated |
C. pneumo
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May present with high fever, hyponatremia, and diarrhea
Appear more ill than CXR would predict |
L. pneumophilia
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Most commonly presents with tracheobronchitis (cough that is dry or produces mucoid sputum, associated with low-grade temp)
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M. pneumo
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Bullous myringitis
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M. pneumo
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Cold agglutinins
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M. pneumo
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May present as nonproductive cough, fever, and dyspnea that evolve over several weeks
Hypoxemia Respiratory alkalosis |
P. jiroveci pneumo (PCP)
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Ground glass appearance on CXR
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PCP
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Presents with severe headache, myalgia, and nonspecific respiratory symptoms
Zoonotic atypical pneumonia |
C. psittaci (Psittacosis)
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Horder's spots
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C. psittaci (Psittacosis)
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ETOH + pneumo
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Klebsiella
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"Currant jelly" sputum
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Klebsiella
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Splenectomy + pneumo
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S. pneumo
H. influenzae |
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Leukemia + pneumo
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Aspergillus
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CF + pneumo
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Pseudomonas
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Milk/postparturition products + pneumo
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Coxiella burnetii (Q fever)
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Rabbits + pneumo
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Francesella tularensis
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CAP Tx for patients >50 or pts with comorbidites
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Fluoroquinolones
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CAP Tx for patients <50 w no comorbidities
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Doxy or macrolide
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Inpatient CAP Tx
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Ceftriaxone + macrolide (azithromycin)
Or respiratory fluoroquinolones |
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2 most lethal pneumos
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S. pneumo
L. pneumo |
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