Respiratory Disease

Front 1

What is the course of asthma

Back 1

Fluctuating course

Front 2

What are the symptoms of asthma

Back 2

Wheeze

Cough

Chest tightness

Dyspnea

Front 3

What causes exacerbations

Back 3

1. Allergen (LMW penicillin, Organic Dander)

2. Non specific stimuli (cold air)

3. No identifiable source

Front 4

Which mediators cause bronchoconstriction

Back 4

1. Histamine

2. Methacholine

Front 5

Which drugs cause bronchoconstriction

Back 5

1. Beta antagonists (propranolol, metoprolol is Beta 1 selective but is still contraindicated)

2. NSAIDs (ASA)

Front 6

Which physicochemical agents cause bronchoconstriction

Back 6

Exercise

Sulfer Dioxide

Nitrogen Dioxide

Front 7

What kind of response does an allergen cause

Back 7

Cytokine/inflammatory mediator release causing mucus hypersecretion

Front 8

Is asthma predictable of unpredictable

Back 8

Unpredictable disease

Front 9

Which immunoglobulin is formed in an allergic reaction of asthma

Back 9

IgE

Front 10

What is the early response in asthma

Back 10

Within 10-15 minutes of exposure

Front 11

What is the late response in asthma

Back 11

6-10 hours after exposure by "late formed" mediators

Front 12

What time of the day are the symptoms of asthma bad

Back 12

Night time

Front 13

Why does a wheeze occur in asthma

Back 13

Intrathoracic pressure > intra-airway pressure (worth with forced attempts)

Front 14

What causes the dyspnea

Back 14

early = greater muscle effort

later = hypoxemic effect from chemoreceptor

Front 15

What causes chest tightness

Back 15

Increased muscle effort and bronchocontriction

Front 16

What are the clinical signs of asthma

Back 16

1. Tachycardia

2. Tachypnea

3. Pulsus Parodoxus (not common)(drop in systolic blood pressure in inspiration of greater than 10 mmHg)

4. Hypoxemia (V/Q mismatch)

5. Decreased PCO2

6. Decreased FEV1; FEV1/FVC;peak flow (common to obstructive defects)

7. Bronchial Hyper-responsiveness (greater than normal drop in FEV1 with methacholine test)

Front 17

What does a rising PC02 in asthma suggest

Back 17

Decompensating asthma

Front 18

What are the Ddx for asthma

Back 18

1. COPD

2. CHF

3. GERD

4. Pneumonia

5. Pneumothorax

Front 19

What is the outpatient treatment of asthma

Back 19

Step 1: beta 2 agonist prn

Step 2: add daily ICS

Step 3: Add long acting beta 2 agonist and leukotriene agonist

Step 4: Add sustained released theophylline and oral corticosteroid

Front 20

What is the Emergency department treatment for Asthma

Back 20

First: assess ABC (any concern get MD)

Consider assessing with spiro as treatment begins

Oxygen

Salbutamol

Ipratropium amount empiric but often 3 doses

IV or oral corticosteroids

Consider antibiotic (if infection), aminophlline, magnesium

Front 21

Which patient with Asthma do you admit

Back 21

FEV1 < 40%; post treatment FEV1 < 60%

They just don't look well

Front 22

Does a normal O2 saturation mean the asthmatic patient is stable

Back 22

NO

Front 23

What are some things you should keep tract of an asthmatic patient that means things are going wrong

Back 23

1. Normal or elevating PCO2

2. Not working as hard

3. No more wheezing

4. Dont mist pneumonia

5. Premature discharge

6. Do not under treat asthma

7. Be careful of beta blocker and NSAID/ASA

Front 24

What analogy can you use to describe ventolin

Back 24

Fire extinguisher

Front 25

What is the most common cause of COPD

Back 25

Smoking

Front 26

What happens in COPD

Back 26

1. Persistent inflammation of airway

2. Parenchymal destruction (less support of small air ways)

3. Expiratory airway collapse and air trapping (because of the destruction of the surrounding tissue i.d. parenchyma)

4. Hyperinflation

5. Increased lung compliance

Front 27

When is the cross sectional area the greatest and smallest in the bronchioles

Back 27

Greatest = inspiration

Smallest = expiration (lumen gets supper small)

Front 28

What are the results of emphysema

Back 28

1. Decreased alveolar surface area

2. Decreased elastic recoil

3. Increased alveolar gas volume

4. Fewer capillaries

Front 29

What does pursed airway breathing allow

Back 29

Increase intra air way pressure to prevent collapse of the alveoli

Front 30

Which gender is COPD more common in

Back 30

More common in women than men EXCEPT older than 75

Front 31

What are the symptoms of COPD

Back 31

1. Dyspnea

2. Cough

3. Sputum

4. Fever

5. Exercise Tolerance

Front 32

What causes the majority of COPD exacerbations

Back 32

Infection

Front 33

What can cause COPD exacerbation without an infection

Back 33

1. CHF

2. MI

3. PE

4. Pneumothorax

Front 34

What are the clinical signs of COPD exacerbation

Back 34

1. Visible Dyspnic

2. Cough

3. Flaired nasal

4. Pursed lip breathing

5. Accessory muscle use

6. Barrel chest

7. Intercostal withdrawing

8. Hyperresonant to percussion

9. Wheeze

10. Altered LOC

11. ABG: hypoxemic, hypercapnic, acidosis

12. Obstructive pattern pulmonary function test

Front 35

How do you manage COPD

Back 35

1. ABC

2. Consider intubation if unstable

3. Consider BiPAP

4.Oxygen

If hypoxemic DO NOT withhold for fear of CO2 retention (afraid they won't be breathing out CO2 anymore)

Deliver in controlled manner

Front 36

If a patients O2 sat is low should you ever withhold oxygen

Back 36

NO, always give oxygen in an acute setting because no oxygen will kill the patient. You can always titrate the oxygen downward to maintain sats in the low 90's if you are concerned about CO2

Front 37

What is the management of COPD

Back 37

1. Salbutamol Nebulized

2. Ipratroprium Nebulized

3. Antibiotics

4. Systemic steroids

Front 38

In DVT what is Virchows Triad

Back 38

1. Venous stasis (immobile person)

2. Endothelial Disruption (prior DVT's, orthopedic injury)

3. Hypercoagulable state (Drugs, malignancies)

Front 39

Which tests do you consider for DVT

Back 39

1. D-dimer

2. Ultrasound

3. Contrast venogram

Front 40

What is the treatment for DVT

Back 40

Anticoagulant (Wafarin, UFH, LMWH, NOAC)

Front 41

What is in the physical examine for DVT

Back 41

1. Increase temp in limb

2. Increase limb size

3. Low grade fever

4. Calf tenderness

5. Palpable cord

6. Homan's sign

7. Signs of pulmonary embolism

Front 42

What are the Signs and symptoms of Pulmonary Embolism

Back 42

1. Dyspnea

2. Tachypnea

3. Wheezing

4. Tacyhcardia

5. Pleuritic chest pain

6. Hemoptysis

Front 43

Where does pulmonary embolisms arise from

Back 43

DVT (thrombosis embolised into lungs)

Front 44

What is vital in regards to testing in PE

Back 44

Need to rule PE in or out

Front 45

What are the test for PE

Back 45

1. D-dimer (highly sensitive test to rule out PE)(not specific)(therefore can be positive without having a PE)

2. CXR (non sensitive)

3. ECG (non sensitive)

4. ABG (non sensitive)

5. V/Q scan (some what sensitive and specific)

6. CT-PE study (This is the gold standard)(Most sensitive and specific)

Front 46

What is the treatment for PE

Back 46

1. Prevention (get person walking right after surgery)

2. Oxygen

3. Anticoagulation

4. Thrombolytics (only to pt you think my code, or have a high risk)

5. IV filter

Front 47

What is high, moderate, and low probability for wells DVT score

Back 47

3 = high

1-2 = moderate

0 = low

Front 48

What is high, moderate, and low probability for Wells PE criteria

Back 48

High > 6

Moderate 3-6

Low < 2