Term
| What can percussion reveal? |
|
Definition
| consolidation or loss of lung volume |
|
|
Term
| What is the medical term for SOB? |
|
Definition
|
|
Term
| What is the medical term for difficulty breathing when lying down? |
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Definition
|
|
Term
| In what timeframe is a cough considered acute? |
|
Definition
|
|
Term
| In what timeframe is a cough considered chronic? |
|
Definition
|
|
Term
| In what timeframe is a cough considered subacute? |
|
Definition
|
|
Term
| What are 3 important symptoms that may accompany a coug? |
|
Definition
| dyspnea, fever, congestion |
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|
Term
| If a pt wakes at night SOB, what condition do they have? |
|
Definition
| paroxysmal nocturnal dyspnea |
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Term
| If a pt experiences SOB after walking up the stairs, what condition do they have? |
|
Definition
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|
Term
| If a pt coughs up blood, what condition do they have? |
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Definition
|
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Term
| What are 3 pulmonary findings found while inspecting the pt in physical exam? |
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Definition
| rate and work of breathing (kussmaul, cheyne-stokes). use of accessory mm (tripod). digital clubbing. |
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|
Term
| What type of hx is key when evaluating a pt for cough? |
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Definition
| social history, smoking, exposures, environmental, etc. |
|
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Term
| A pt c/o hemoptysis. What questions should you ask? |
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Definition
| Is it mixed w/sputum? How much blood? |
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Term
| While inspecting for rate and work of breathing, for what abnormalities should you be looking? |
|
Definition
|
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Term
| "A physical exam may show that a pt's neck veins stick out, suggesting increased blood pressure in the area." What sign does this indicate? |
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Definition
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Term
| What is "an abnormal pattern of breathing characterized by oscillation of ventilation between apnea and tachypnea with a crescendo-decrescendo pattern in the depth of respirations, to compensate for changing serum partial pressures of oxygen and carbon dioxide." |
|
Definition
| cheyne-stokes respirations |
|
|
Term
| What physical change in breathing is associated w/tripod position? |
|
Definition
|
|
Term
| What are 5 things for which you look when palpating in a pulmonary pe? |
|
Definition
| trachea. rib contour. fremitus (palpable vibration). subcutaneous emphysema. asymmetrical expansion. |
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Term
| When ascultating in a pulmonary pe, what are 6 problems for which you are looking? |
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Definition
| all lung fields. bronchial and vesicular. wheeze. rhonchi. crackles. rales. |
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Term
| What is the cause of the vast majority of acute bronchitis cases? |
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Definition
| a great majority are *viral* (>85%) (this is very impt; Thibideau wanted to stress this) |
|
|
Term
| For how long does acute bronchitis persist? |
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Definition
|
|
Term
| What are 2 causes of acute bronchitis? |
|
Definition
| *viral* (great majority) or bacterial |
|
|
Term
| What are some dx studies when evaluating cough? |
|
Definition
|
|
Term
| By what will pulmonary tests to evaluate a cough be determined? |
|
Definition
|
|
Term
| What is a mneumonic for determining possible etiologies of cough? |
|
Definition
|
|
Term
| Toward what should tx of a cough be geared? |
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Definition
| toward underlying cause. in some instances, there may be more than one etiology causing a cough. |
|
|
Term
| How many ddx can you come up with for acute cough? |
|
Definition
| asthma. aspiration. atypical mycobacterial. bacterial tracheitis. bronchiectasis. bronchogenic cyst. bronchopulmonary dysplasia. cf. gerd. influenza. smoking exposure. rsv in children. sinusitis. tracheomalacis. pertussis. inhalation pneumonia. rhinovirus infection. uri. tb. |
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|
Term
| How many ddx can you come up with for chronic cough? |
|
Definition
| asthma. allergic rhinitis. asbestosis. bronchiectasis. bronchopulmonary dysplasia. copd. chf. cf. gerd. meds (ace inhibitors, beta blockers). pulmonary embolus. sarcoidosis. reflux tracheitis. retained foreign body. smoking exposure. tb. |
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|
Term
| How will the exam on most pts w/acute uncomplicated bronchitis appear? |
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Definition
| normal. we do the exam to be sure it's bronchitis and not something else. |
|
|
Term
| What medications might cause chronic cough? |
|
Definition
| ace inhibitors, beta blockers |
|
|
Term
| What is the major reason for bronchitis? |
|
Definition
|
|
Term
| In what timeframe is bronchitis considered chronic? |
|
Definition
|
|
Term
| What are other considerations when evaluating for bronchitis? |
|
Definition
| gerd. asthma. post-nasal drip. mass |
|
|
Term
| What are 8 symptoms of bronchitis? |
|
Definition
| symptoms include: fever. sob. chills. chest pain. sore throat. malaise. body aches. rhinorrhea. |
|
|
Term
| How must you assess for other causes for cough in an h&p? |
|
Definition
| hx of uri symptoms. possible irritants (fumes, dust, molds, aerosols). aspiration (children, alcoholics, elderly). any change in the pts hx of lifestyle, work, seasonal, meds). smoking hx. |
|
|
Term
| What are possible irritants that might cause cough? |
|
Definition
| fumes, dust, molds, aerosols |
|
|
Term
| What populations are at risk for aspiration? |
|
Definition
| children, alcoholic, elderly |
|
|
Term
| When performing a pe for bronchitis, what areas should you include? |
|
Definition
| skin. eyes. ears. nose. throat. neck. lung sounds. cardiac. extremities. |
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|
Term
|
Definition
| acute: symptomatic tx. usually a viral illness. avoid the use of abx. controversy concerning atypical bacteria. (we tx the symptoms. 85% it's viral. the virus has to run its course and go away. you have to explain this to pt b/c they'll want Abx.) |
|
|
Term
| What are medications that can be rx for bronchitis? |
|
Definition
| bronchodilators (albuterol). anti-inflammatory agents (ibuprofen). nasal sprays (afrin, astelin, flonase). anti-tussives (guifenasen). consider combination w/pain meds. smoking cessation. |
|
|
Term
| What is the #1 way you tx bronchitis? |
|
Definition
| #1: if you smoke, stop. no way around it. |
|
|
Term
| When are bronchodilators (albuterol) indicated for bronchitis? |
|
Definition
| If you have a bit of wheeze. otherwise, it is not indicated. |
|
|
Term
| When are nasal sprays indicated for bronchitis? |
|
Definition
| rhinitis, difficulty breathing. first line is afrin, astelin. very bad cases get flonase. anti-inflammatory nasal sprays help reduce inflammation in nasal turbinates. |
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|
Term
| When are anti-tussives (guifenasen) indicated? |
|
Definition
| help with cough, in some cases for individuals (esp bad smokers w/hacky irritating cough) you can use combination pain reliever/cough suppresant to help with pain and cough. (lortab elixer, etc) |
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|
Term
| How is chronic bronchitis tx? |
|
Definition
| #1: smoking cessation. 2 o2 tx. 3. bronchodilators. 4. Abx tx |
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|
Term
| When is o2 therapy indicated for chronic bronchitis? |
|
Definition
| acutely hypoxic from an acute exacerbation of chronic bronchitis. then respiratory system fails chronically: chronic o2 tx. they have to meet crieria- they have to be around abg w/po2 <55% |
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|
Term
| When are bronchodilators indicated for chronic bronchitis? |
|
Definition
|
|
Term
| When is abx tx indicated for chronic bronchitis? |
|
Definition
| repeat exacerbations of chronic bronchitis state. |
|
|
Term
| What may suggest bacterial illness w/bronchitis? |
|
Definition
| persistent symptoms greater than 1 week may suggest bacterial illness |
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|
Term
| If you have no improvement w/bronchodilators and anti-inflammatories, and purulent sputum production- what might be causing bronchitis? |
|
Definition
|
|
Term
| Bronchitis w/new symptoms: fever, increased purulent sputum production, chest pain. What might this indicate? |
|
Definition
| supportive ms aren't working; may need to tx bacterial bronchitis w/abx |
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|
Term
| In what populations is bronchiolitis common? (most common) |
|
Definition
|
|
Term
| What are the usual pathogens of bronchiolitis? |
|
Definition
| rsv (respiratory syncytial virus) and adenovirus |
|
|
Term
| What are 2 classifications of bronchiolitis? |
|
Definition
| constrictive (aka obliterative)- chronic inflammation, concentric scarring, and smooth mm hypertrophy. proliferative- intraluminal exudate, obstructing the lumen leading to pneuumonia (cryptogenic organizing pneumonitis) |
|
|
Term
| Which classification of bronchiolitis involves chronic inflammation, concentric scarring, and smooth mm hypertrophy? |
|
Definition
| constrictive (aka obliterative) |
|
|
Term
| What classification of bronchiolitis involves intraluminal exudate, obstructing the lumen, leading to pneumonia (cryptogenic organizing pneumonitis)? |
|
Definition
| proliferative bronchiolitis |
|
|
Term
| How are adult cases of bronchiolitis? |
|
Definition
| cases are approached depending on underlying disease (transplantation, connective tissue disease, hsn pneumonitis) |
|
|
Term
| What are some underlying diseases that must be considered with bronchiolitis? |
|
Definition
| transplantation, connective tissue disease, hsn pneumonitis |
|
|
Term
| What is known as inflammation of bronchioles? |
|
Definition
|
|
Term
| What is known as obliterative bronchiolitis? |
|
Definition
|
|
Term
| What are the typical ages for adult bronchiolitis? |
|
Definition
|
|
Term
| What are s/s for bronchiolitis in adults? |
|
Definition
| dry cough, dyspnea, and constitutional symptoms for weeks to mos |
|
|
Term
| How are most bronchiolitis cases tx in children? |
|
Definition
| respiratory rate up to 40's and 50's and they're sent home w/supportive ms (fluids, analgesics, antipyretics). viral illness- must run its course. watch them a little closer to make sure respiratory ms are intact. |
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|
Term
|
Definition
| nasal washing for rsv culture. kids hate it. |
|
|
Term
| On what does prognosis of bronchiolitis depend? |
|
Definition
|
|
Term
| How easily spread is the influenza virus? |
|
Definition
|
|
Term
| What are the influenza strains? |
|
Definition
|
|
Term
| Which 2 influenza strains have similar characteristics? |
|
Definition
|
|
Term
| Which influenza strain has a very short lived duration? |
|
Definition
|
|
Term
| How is tx geared for bronchiolitis in adults? |
|
Definition
| tx geared toward underlying disease |
|
|
Term
| When palpating the trachea during pe, for what abnormalities are you evaluating? |
|
Definition
| midline, no deviation, air movmt |
|
|
Term
| When evaluating the thorax in pe, for what abnormalities in the rib contour are you palpating? |
|
Definition
|
|
Term
| What might abnormal fremitus indicate on a thoracic pe? |
|
Definition
|
|
Term
| What illnesses might be revealed in a family hx regarding a cough? |
|
Definition
|
|
Term
| What illness contributing to bronchitis occurs frequently in infants and children? |
|
Definition
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|
Term
| What notable medical emergency occured in 1918? |
|
Definition
|
|
Term
| What is the most likely strain to lead to a flu pandemic? |
|
Definition
|
|
Term
| In the 1918 flu pandemic, how many deaths occured in the US? Most deaths occured in which month? |
|
Definition
| over 1 million, most in october. |
|
|
Term
| In the 1918 flu pandemic, how many deaths occured worldwide? |
|
Definition
| over 50 million deaths worldwide |
|
|
Term
| Why is the H5N1 Avian Flu a concern for researchers? |
|
Definition
|
|
Term
| Why is influenza a cause for concern? |
|
Definition
| it mutates into other forms. invluenz virus is thought and the cause of all other related influenza outbreaks in the 1900's and 2000's. no other form has been so virulent since then |
|
|
Term
|
Definition
| Hemagglutinin type 5 neuramindase Type1: surface Ag's on the virus structure |
|
|
Term
| What is the recent news regarding H1N1? |
|
Definition
| now declared pandemic. same features as other influenza strains. can lead to death. |
|
|
Term
| What are s/s of influenza? |
|
Definition
| fever. malaise. chills. ha (general). myalgias. nasal congestion. nausea. other symptoms: coryza. non-productive cough. sore throat. conjunctival redness. |
|
|
Term
| What influenza pandemic occured in 1855? |
|
Definition
| norfolk yellow fever pandemic 1855 |
|
|
Term
| What lab findings indicate influenza? |
|
Definition
| leukopenia (common). nasal swab influenza A&B test (rapid). some places have throat swabs. |
|
|
Term
| What is the hallmark for influenza care? |
|
Definition
|
|
Term
| Who do you vaccinate for influenza? |
|
Definition
| pts age >50. children over 6 mos. nursing home pts. chronic lung disease. pregnant in 2nd or 3rd trimester. health care workers. proper hand washing and reduce the exposure, esp in schools. |
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|
Term
|
Definition
| bed rest. fluids. analgesia (acetominophen, ibuprofen). anti-tussives. zanamifir (relenza) 2, 5mg inhalations qd x 5 days. oseltamivier (tamilflu) 75 mg bid x 5 days. |
|
|
Term
| How expensive are zanamifir (relenza) and oseltamivir (tamiflu)? |
|
Definition
|
|
Term
| How effective are zanamifir (relenza) and oseltamivir (tamiflu)? |
|
Definition
| both can rapidly reduce the severity and length of symptoms and illness |
|
|
Term
| When must zanamifir (relenza) and oseltamivir (tamiflu) be given? |
|
Definition
| early in course of illness usually in 1st 1-2 days |
|
|
Term
| How frequently are amantadine and rimantidine used? |
|
Definition
| used to be 1st line tx but no longer used. resistance to drug decreased effectiveness |
|
|
Term
| For which influenza pts should anti-tussives be given? |
|
Definition
| should be reserved for pts who c/o coughing |
|
|
Term
| How many possible complications of influenza can you name? |
|
Definition
| co-morbid illness. viral pneumonia. chf. diabetes. renal failure. heart disease. pulmonary disease. length of illness 1-7 days. prognosis is excellent in young healthy adults. |
|
|
Term
| Do zanamifir and osteltamivir rid the body of the virus? |
|
Definition
| It does not get rid of virus, it just reduces the duration of s/s for 2-3 days (maybe just 1 day if you ask Dr. Lynch). |
|
|
Term
| On what pts do you not order a pft? |
|
Definition
| acute severe asthma. respiratory distress. pneumothorax. ongoing hemoptysis. active tb. |
|
|
Term
|
Definition
| ms the lungs' ability on airflow and transfer of gas via alveolar-capillary exchange system. can detect type and extent of pulmonary disease. |
|
|
Term
| When might you order a pft? |
|
Definition
| when you suspect a pt w/a chronic cough or difficulty breathing or a hx of lung disease |
|
|
Term
| On what values is a pft msed? |
|
Definition
| the test itself is msd on predicated values based on numerous studies of pts. values include: age. gender. height. (lesser considerations: weight, ethnicity) |
|
|
Term
| What is defined as the total amt of gas that exists at the end of a maximal inhalation? |
|
Definition
| tlc (total lung capacity) |
|
|
Term
| What is defined as the amt of gas that can be exhaled after a maximal inhalation? |
|
Definition
|
|
Term
| What is defined as the amt of gas left in lungs after a maximu exhalation? |
|
Definition
|
|
Term
| What is defined as the amt of gas that one can inhaled at the start of a normal breath? |
|
Definition
| ic (inspiratory capacity) |
|
|
Term
| What is defined as the amt of gas that remains at the end of a resting tital breath? |
|
Definition
| frc (functional reserve capacity) |
|
|
Term
| What is defined as the available amt of volume that can be achieved at a full tidal breath? |
|
Definition
| irv (inspiratory reserve volume) |
|
|
Term
| What is defined as the amount of gas that is inhaled and exhaled w/ea breath? |
|
Definition
|
|
Term
| What is defined as the amt of gas remaining that can be exhaled beyond a nml exhalation? |
|
Definition
| erv (expiratory reserve volume) |
|
|
Term
| What test can help determine what kind of pulmonary disease a pt has? |
|
Definition
|
|
Term
| What are 3 patterns for pft results? |
|
Definition
| nml, obstructive, restrictive |
|
|
Term
| Why might you see obstructive abnormalities on a pft? |
|
Definition
|
|
Term
| Book?: When ace inhibitor tx, acute respiratory infection, and abnormal cxr are absent, the most common causes of chronic cough are: |
|
Definition
| postnasal drip, asthma, gerd. empiric tx w/max-strength regimen for 2-4 weeks is recommended approach since their presence does not necessarily mean they are the cause of teh cough illness. multiple contributers in 25% of cases. |
|
|
Term
| Book? How common is dyspnea in pts w/persistent cough? |
|
Definition
| not commonlly reported. requires workup for chronic lung disease, chf, or anemia |
|
|
Term
| Book? How common is dyspnea in pts w/persistent cough? |
|
Definition
| not commonlly reported. requires workup for chronic lung disease, chf, or anemia |
|
|
Term
| Book?: In adults, what are wheezing and rhonchi frequently associated w/? |
|
Definition
| acute bronchitis. do not represent adult-onset asthma in most cases. |
|
|
Term
| Book ?: What should always be suspected when a pt presents w/dyspnea and has a hx of prolonged immobilization or estrogen or when the cause of dyspnea is not apparent tx? |
|
Definition
|
|
Term
| Book ?: What is the cause of pleuritic chest pain in most outpt? |
|
Definition
| acute viral respiratory tract infection |
|
|
Term
| Book ?: Comparing constrictive vs. proliferative bronchiolitis, which is more common, more likely to show restrictive or mixed ventilatory defect, more likely to have abnml cxr and more likely to be responsive to corticosteroids? |
|
Definition
|
|
Term
| Book ?: What is required to make definitive dx of constrictive/proliferative bronchiolitis in majority of cases? |
|
Definition
|
|
Term
| Book ?: What is the most deadly infectious disease in the us and 6th leading cause of death? |
|
Definition
|
|
Term
| Book ?: Which are more commonly id'd as the cause of cap: virus or bacteria? What is the most common pathogen id'd as the cause of cap? |
|
Definition
|
|
Term
| Book ?: What are the s/s of most pts w/cap? |
|
Definition
| acute/subacute onset of fever, cough (w/ or w/o sputum) and dyspnea |
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