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Pulmonary
COPD & Asthma
| Question | Answer |
|---|---|
| Approach to CXR | Name, Exposure, Rotation, Expiration, Bones(8 ribs or more), accessory structures, soft tissue, Lungs |
| Helical(sprial) CT | Scans entire lung in one-two breath holds; detects nodules(malagnancies), PE |
| High Resolution(HRCT) | Thin sections of 1mm seperated by 1-4 cm sections; detects bronchioecstasis, infiltrates, solitary pulmonary nodules |
| ABG | PO2 - 75-100 PCo2 - 35-45 pH - 7.35 - 7.45 SaO2 - 94% to 100% HCO3 22-26 |
| COPD(prevelance, etiology) | Prevel: 64 million, another 14 million undiagnosed, 17 million office visits; combined with asthma 4th most common cause of death for men and women smokers; Etio: decreased lung F(x)' |
| COPD(risk factors, clinical features) | Risks: smokers make up 60% of COPD, 80% of smokers get COPD, dust exposure, chemical, air pollution, genetics(alpha1-antiprotease(trypsin) deficiency, Clinical features: reducing expiratory flow rate, excessive cough, sputum in the am, SOB, DOE, DAR |
| COPD findings(Physiologically) | Early - nothing; Progresses - ronchi, dec. intensity of breath sounds, prolonged expiration, dec. Dia. Excur., cyanosis, clubing |
| COPD findings(Testing) | PFT - dec. FEV, ^ TLC; ABGs: progressive change; EKG: RA deviation from Dia. excur.; CXR: dia will be lower, hyperinflation, small vertical heart; SpiralCT: r/o malig |
| COPD Treatment | Stop smoking(wellbutrin); anticholinergic(atrovert); beta agonist(albuterol); mixed(combavent); 2nd line(predinisone,theothelym(3rd LTVD) o2; pulmonary rehab; lung resection or tplant |
| Asthma | intermittent, reversible airway obstruct sensitive to stimuli, mucous accum due to inflame; AA Men 15-24yo; Contributing factors: allergies, enviro, air, excercise, stress, GERD, sinuisitis, rhinitis, smoke |
| Asthma - mild | symptoms >= 2 days/week, nite awakes 3-4x/mo |
| Asthma - intermittent | symptoms <= 2 days/week, nite awakes < 2x/mo |
| Asthma - Moderate | Daily symptoms, nite awakes > 1x/wk but not nitely |
| Asthma - severe | throuhg the day symptoms, nite awakes every night |
| Asthma - SS, diagnostics | episodic wheezing, chest tightness, nite awakes, cough + sputum; PFTs: FEV1>80%predict, ratio normal(inter+mild); 60%<FEV1<80%, ratio reduced 5%(moderate); severe: FEV1<60%, ratio reduced 5%; CXR: hyperinflation |
| Asthma - treatment | 1st: bronchodilators(spacers); 2nd: mast cell stabilizer, leukotriene modifers; 3rd: steroids(palliative) |
| CF - prev, etio | Prev: 1/3200 caucs 1/25 carriers; etio: chormosome 7 defective protein CFTR, cl channels overactive |
| CF - SS | chronic or recurrent cough; sputum; dyspnea+wheezing; dec. exercise tolerance; recurr. hemopt; abd pain(steato); delayed sex dev.; clubbing cyanosis; DM symptons |
| CF - Diagnostics | Quantitative sweat test: cl->60meq, 2 seperate + tests; genetics; CXR: hyperinflation; inc. interstitial markings, some cases of pneumo; Advanced: fecal fat; PFTS and ABG |
| CF - Management | early recognition; 4 components: break up mucous(dec. airway obstructs, mucolytics, chest physiotherapy); nutritional interventions(dec. pancrea insuff, hydrate; ABs when infected; corticos to control airway inflame; conseling; Lung tplant |
| ALI | A syndrome of acute and persistent lung inflammation with increased vascular perm; acut eonset, bilateral radio infiltrates; Pao2/FIo2 201-300 mm hg regardless of PEEP; PCPW is <18mmhg |
| ARDS | Severe ALI, same as ALI; Pao2/FIo2 < 200; hypoxemia is arbitrary |
Created by:
bmg4