Term
| What is defined as air hunger resulting in altered breathing caused by insufficient oxygenation of the blood? |
|
Definition
| *dyspnea*: *not the same thing as sob* generally caused by increased co2 |
|
|
Term
| How are dyspnea types differentiated? |
|
Definition
| differentiate by onset timing, relation to activity, others? |
|
|
Term
| Is the manifestation of lung disease proportional to the severity of illness or airflow limitation and respiratory drive? |
|
Definition
|
|
Term
| What is a natural defense of forceful expiratory effort with the accessory mm of expiration creating expelation noise to aid w/mucus/particle clearing? |
|
Definition
|
|
Term
| COPD is one of the few diseases where incidences of death are increasing. What demographic is increasing the most quickly? |
|
Definition
| majority risk category 15-24 y/o african american male |
|
|
Term
| What is the 4th leading cause of death? |
|
Definition
|
|
Term
|
Definition
| the national asthma education and prevention program- put together guidelines |
|
|
Term
| What are 2 classifications of cough? |
|
Definition
| voluntary v. involuntary. acute, subacute, or chronic |
|
|
Term
| What is the relation of character/timing/forcefulness of cough or presence/absence of sputum to etiology? |
|
Definition
|
|
Term
| What is defined as coughing up blood originating from the respiratory tract below the larynx? |
|
Definition
|
|
Term
| what are some common abnormalities |
|
Definition
| more pronounced heart border, more pronounced pulmonary vessels |
|
|
Term
| When inspecting on a pulmonary physical exam, what findings are you examining in respiration? |
|
Definition
|
|
Term
| What are 5 findings in the inspection phase of a pulmonary physical examination |
|
Definition
| respiratory rate, rhythm, depth. length of inspiration/expiration. accessory muscle use/trachial deviation. alterations: rate variation, *kussmaul respirations, cheyne-stokes respirations, apnea, tachypnea, hyperventilation* |
|
|
Term
| What are alterations of rate variation in the inspection phase of a pulmonary physical examination |
|
Definition
| *kussmaul respirations, cheyne-stokes respirations, apnea, tachypnea, hyperventilation* |
|
|
Term
| what is the timing of subacute cough |
|
Definition
| 3-8 weeks: *ask if they are on any new meds, esp ace inhibitors* |
|
|
Term
| what is the timing of acute cough? |
|
Definition
|
|
Term
| what is the timing for chronic cough? |
|
Definition
|
|
Term
| what is the sensitivity and specificity of percussion/palpation on a pulmonary physical exam? |
|
Definition
| low sensitivity/high specificity |
|
|
Term
| inspiratory to expiratory ration- what is normal? |
|
Definition
| 2:3 inspiration:expiration |
|
|
Term
| What are normal sounds on ascultation in a pulmonary pe? |
|
Definition
| trachial/bronchial/vesicular |
|
|
Term
| What are 3 adventitious sounds in a pulmonary pe? |
|
Definition
|
|
Term
| what's the definition of apnea? |
|
Definition
|
|
Term
| what are kussmaul respirations? |
|
Definition
| rapid, deep, respirations, found w/ketoacidosis, often consistent |
|
|
Term
| What are cheyne-stokes respirations? |
|
Definition
| from 10-60 sec's breathing stops, then gasp, shallow respiration, bad o2 exchange, underlying pathology, high risk of head injury, toxicosis, late chf |
|
|
Term
|
Definition
| increased rate, tidal volume decreased, o2 intake decreased |
|
|
Term
| How frequently do most people sigh? |
|
Definition
| every 90 breaths- fights atelectasis-prevents alveolar collapse |
|
|
Term
| What is a continuous musical sound caused by narrowing of the lumen of a respiratory passageway? |
|
Definition
|
|
Term
| What sounds like velcro or a straw accordian opening and closing? |
|
Definition
|
|
Term
| What sounds like the crinkling of plastic wrap? |
|
Definition
|
|
Term
| What are adventitious breath sounds heard due to air passage through partial obstruction, often due to secretions, mucosal swelling, abnormal collapsibility or tumor tissue? |
|
Definition
| rhonchi, typically in lg airways |
|
|
Term
| What is a discontinusous, brief, nonmusical breath sound w/possible pop sound, typically fine or coarse, due to air passing over retained airway secretions or the sudden opening of collapsed airways? |
|
Definition
| crackle (rales) coarse v. fine |
|
|
Term
| What are peripheral findings of a pulmonary pe- often more chronic diseases? |
|
Definition
| digital clubbing, cyanosis, edema, signs of chronic steroid use (look for chronic steroid signs- mm wasting, anemia, skin thinning, buffalo hump- chronic lung disease pt) |
|
|
Term
| What percent of the adult population in the us has asthm? |
|
Definition
|
|
Term
| Anytime there's a barometric pressure change greater than 20 pts/day, temperature change greater than 30 degrees a day, factories release pollutants, who comes in to er? |
|
Definition
|
|
Term
| There are about 470,000 hospitalizations and more than 5,000 deaths per year due to what illness? |
|
Definition
|
|
Term
| less than what percent of asthma pts are receiving the appropriate therapies as directed by the epr2? |
|
Definition
|
|
Term
| How is the prevalence of asthma and its morbidity and mortality contiue to change? |
|
Definition
|
|
Term
| What is the goal of asthma tx? |
|
Definition
| prevent inflammation acutely to prevent collagen deposition w/early remodeling in long term |
|
|
Term
| In asthma, do bronchial membranes constrict? *we will be asked this question again* |
|
Definition
| no. smooth mm around membranes constrict |
|
|
Term
| Which stage of asthma involves stimulation of mast and macrophage cells w/in 30 min of exposure leading to decreased fev1? |
|
Definition
| first stage (acute stage) |
|
|
Term
| In what stage of asthma do histamine, cytokines, tcells and bcells trigger the "concert master," the *eosinophil*, which directs the inflammation that results in *airway hyperresponsiveness, bronchoconstriction, reversible variable airflow obstruction* and sx? |
|
Definition
| second stage (chronic stage) |
|
|
Term
| are antihistamines a mainstay of tx for asthma? |
|
Definition
| no. they're a great adjunctive tx. |
|
|
Term
| What is the concert master that directs inflammation in asthma? |
|
Definition
|
|
Term
| What does the eosinophil direct in asthma? |
|
Definition
| inflammation that results in *airway hyperresponsiveness, bronchoconstriction, reversible variable airflow obstruction* and sx? |
|
|
Term
| What is the reversible airway obstruction deterrent that helps to open airways in asthma? |
|
Definition
| albuterol- beta agonists, short acting. this doesn't help unless you also tx inflammation (steroids). |
|
|
Term
| Where is the key for asthma? |
|
Definition
|
|
Term
| What is happening in the lung with asthma regarding: smooth mm? |
|
Definition
| hypertrophy or smooth mm and mucus glands which plugs airways |
|
|
Term
| Do you have to find the trigger for every asthma episode? |
|
Definition
| no. focus on inflammation and eosinophils |
|
|
Term
| Does sputum necessarily mean infection? |
|
Definition
|
|
Term
| What time of day are airways most sensitive? |
|
Definition
|
|
Term
| If you know it's an asthmatic and you think they're having an exacerbation and they're not wheezing, should you be concerned? |
|
Definition
| their airways are totally constricted- very concerning |
|
|
Term
| In asthma, what happens in the airway epithelium? |
|
Definition
| denudation of airway epithelium |
|
|
Term
| What is deposited with asthma? |
|
Definition
|
|
Term
| Can you dx asthma w/ a pt in and out of the er? |
|
Definition
| no you have to have a pft- spirometry |
|
|
Term
| Where does edema occur w/asthma? |
|
Definition
|
|
Term
| What infiltrates occur w/asthma? |
|
Definition
| inflammatory cell infiltrates |
|
|
Term
| What 3 signs are caused by inflammation in asthma? |
|
Definition
| airway hsn, airflow inhibition, respiratory sx |
|
|
Term
| What is ms'd by peak flow? |
|
Definition
| peak flow ms's force and volume in an instant, not pev1. |
|
|
Term
| epsiodic wheezing, difficulty breathing. chest tightness. cough. sx w/circadian variability. nasal findings. associated eczema. intercostal retractions. nasal flaring. airflow lmtations w/o wheezing *beware* |
|
Definition
|
|
Term
| What is exercise challenge testing? |
|
Definition
| have the pt walk around the building, wait 15 min, see if they have an attack. no done very frequently |
|
|
Term
| When might you do cxr for asthma dx? |
|
Definition
| only if you suspect another lung problem causing the asthma |
|
|
Term
| What are asthma triggers? |
|
Definition
| common aeroallergens, exercise, uri, post-nasal drainage, gi reflux, weather changes, uncompensated chf, medications |
|
|
Term
| What are asthma triggers? |
|
Definition
| common aeroallergens, exercise, uri/rhinitis/sinusitis, post-nasal drainage, gi reflux, weather changes/**barometric pressure/temp, uncompensated chf, medications |
|
|
Term
| What class of asthma triggers involves dust mites, cockroaches, cats, seasonal molds, pollens, tobacco smoke environmental air particles/dust/ozone? |
|
Definition
|
|
Term
| What is the amt of air you can expel after a full inspiration? |
|
Definition
|
|
Term
| What is the amt of air you can expel after fvc? |
|
Definition
|
|
Term
| What spirometry measurements are needed for assessment of obstructive pulmonary disorders? |
|
Definition
| fev1/fvc ratio- should be 80%. decreased in asthma |
|
|
Term
| What class of asthma triggers involves ASA, NSAIDS, certain dyes, others-beta blockers? |
|
Definition
|
|
Term
| What is the GOLD STD for asthma dx? |
|
Definition
| spirometry, before and after administration of bronchodilator |
|
|
Term
| What are normal breaths in pft? |
|
Definition
|
|
Term
|
Definition
| amt of air in your lung at any given time |
|
|
Term
| How does tlc change w/copd? |
|
Definition
|
|
Term
| For what purpose is a peak expiratory flow used in asthma dx? |
|
Definition
| peak expiratory flow- monitoring tool, NOT diagnostic, helpful to determine severity and variability |
|
|
Term
| What is diffusing capacity msmt? |
|
Definition
| ability to diffuse o2 and co2 back and forth across membrane |
|
|
Term
| What is bronchial provocation testing? |
|
Definition
|
|
Term
| What are 4 stages of pulmonary function testing/spirometry? |
|
Definition
| 1. ASSESS the nature and severity of lung disease. 2. QUANTIFIES the progression of disease and the response to tx. 3. MS'S airflow rates, lung volues, and the ability of the lung to transfer gases- the diffusing capacity. 4. ASSESSES the presence and severity of obstructive and restrictive pulmonary disfunction. |
|
|
Term
| Why is pft/spirometry necessary? |
|
Definition
| **necessary for *accurate* dx of chronic lung disease |
|
|
Term
| Pt c/o albuterol inhaler no longer work. Why might this be? |
|
Definition
| 60 acuations in an albuterol inhaler. it doesn't tell you when it's empty. |
|
|
Term
| What is bronchial provocation testing? |
|
Definition
| "Bronchial Provocation Test: The bronchial provocation test evaluates how sensitive the airways in your lungs are. A spirometry breathing test is done before and after you inhale a spray such as methacholine. The spirometry results are compared before and after you inhale the spray to see what changes there are in your breathing."- pft done before and after allergen |
|
|
Term
| What are 6 tests to help dx asthma? |
|
Definition
| *gold std* spirometry, before and after administration of bronchodilator; pef; bronchial provocation testing, exercise challenge testing; abg; cxr; rule out other etiologies |
|
|
Term
| What is the amt of air you can expel after full inspiration? What if you expel forcefully? |
|
Definition
|
|
Term
| What does abg assess in pft/analysis? |
|
Definition
| assessment of o2, co2, a/b levels |
|
|
Term
| What is the goal of asthma tx? |
|
Definition
| lower the no of agents, lower side effects, keep asthma control: based on prevention and long term control "control of asthma w/the fewest adverse effects, lowest no of agents, and good pt compliance" |
|
|
Term
| What are the 5 rights of asthma? |
|
Definition
| right dx. right classification. right medications, how they work, how you give it. right timing. right use. |
|
|
Term
| What is bronchoscopy for tx asthma? |
|
Definition
| Look- you might find a foreign body |
|
|
Term
| As soon as you move from step 1 to anything else, what do you add to asthma tx? |
|
Definition
| inhaled corticosteroid- dose goes up as disease progresses |
|
|
Term
| What 2 factors need to be balanced w/asthma pharmacotherapy? |
|
Definition
| agents of *quick relief* vs agents for *long term control* |
|
|
Term
| What is the most important consideration when using corticosteroids for asthma tx? |
|
Definition
| the faster you give steroid for tx of asthma, the better the results |
|
|
Term
| How do beta-adrenergic agonists work for asthma pharmacotherapy? |
|
Definition
| relax airway smooth mm, increasing airflow through bronchodilators |
|
|
Term
| What is a major side effect of albuterol? |
|
Definition
|
|
Term
| The following are brand names of what type of agent to tx asthma: albuterol (proventil, ventolin), pirbuterol (maxair), terbutaline (brethine), levabuterol (xopenex)? |
|
Definition
| nebulized vs. mdi, vs. liquid beta-adrenergic agonist |
|
|
Term
| How do you dose prednisone in general? |
|
Definition
|
|
Term
| What are side effects of beta-adrenergic agonists? |
|
Definition
| tachycardia, increased bp, anxiety**, cough |
|
|
Term
| What did optima/smart trial results find? |
|
Definition
| if you use long acting beta-agonists as mono-therapy, risk of sudden death from asthma skyrockets, add to other agents to form advair- this is helpful for asthma |
|
|
Term
| How do anticholinergic agents (ipratropium bromide (atrovent), tiotroprium (spiriva)) act for asthma tx/? |
|
Definition
| reduce vagally-mediated bronchospasm, and *decrease hypersecretion* |
|
|
Term
| How do long acting bronchodilators (cromolyn (intal), nedocromil (tilade)) act? |
|
Definition
| modulate mast cell mediator release and eosinophil recruitment of allergen adn exercise-induced bronchospasm |
|
|
Term
| How do phosphodiesterase inhibitors work for asthma? |
|
Definition
| bronchodilation, mild anti-inflam., increased mucociliary clearance and diaphragm contractility |
|
|
Term
|
Definition
| phosphodiesterase inhibitor w/narrow therapeutic range, many interactions, many side effects |
|
|
Term
|
Definition
| Asthma, allergic rhinitis (Hayfever), and atopic dermatitis (eczema) |
|
|
Term
| What is the no. one way to stop severe asthma rxn? |
|
Definition
|
|
Term
| What medications are used for both pts w/asthma and those w/horrible allergies? |
|
Definition
|
|
Term
|
Definition
| IgE, extremely expensive, injection |
|
|
Term
| How do leukotrienes work? |
|
Definition
| increase airway obstruction, contract smooth mm, increase vascular permeability and attract airway inflammatory cells |
|
|
Term
|
Definition
|
|
Term
| How does magnesium tx asthma? |
|
Definition
| decreases ca2+ available to smooth mm contractile apparatus, transiently improving flow rates |
|
|
Term
| What are some other agents that are useful in tx copd? |
|
Definition
| Mg, oral antihistamines, mucolytics, antimicrobials, general anesthesia |
|
|
Term
| How is general anesthesia useful for tx asthma? |
|
Definition
| direct bronchial smooth mm relation and inhibit reflex bronchospasm |
|
|
Term
| What is the relationship w/pts w/asthma and copd? |
|
Definition
|
|
Term
| What lung disease can be tx by desensitization? |
|
Definition
|
|
Term
| What class of asthma pharmacotherapeutics do the following belong to: zileuton (zyflo), zafirlukast (accolate) ** montelukast (singulair)? |
|
Definition
|
|
Term
| What leukotriene modifier decreases leukotriene production? |
|
Definition
|
|
Term
| What leukotriene modifier acts on leukotriene receptor antagonists? |
|
Definition
|
|
Term
| W/what disease might a cxr show an enlongated heart border, decreased diaphragm arch, show more ribs? |
|
Definition
|
|
Term
| Perfect test ? what xray findings occur w/chronic bronchitis |
|
Definition
| flattened diaphragms, sm appearing heart, peribronchial puffing (see sm circles around bronchioles) |
|
|
Term
|
Definition
| increase in ap diameter of chest |
|
|
Term
|
Definition
| spirometry: lower fev1/fvc ratio |
|
|
Term
|
Definition
| 1. monitoring and prevention. 2. clinic and pt assessment. 3. WRITTEN ACTION PLAN. 4. peak flow monitoring. 5. sx recgnition. 6. pneumonia and flu vaccination. 7. allergy tx. 8. proper medication usage |
|
|
Term
| What is the only thing that has been shown to decrease progression of copd? |
|
Definition
|
|
Term
| What disease occurs in 14 million americans, w/an equal no expected to be undx? |
|
Definition
|
|
Term
| As of 2000, women exceed men in no. f deaths attributable to what disease? |
|
Definition
|
|
Term
| What is the primary risk factor for copd? |
|
Definition
|
|
Term
| You have a chronic copd w/pulsox of 90 and no current complaints. How do you tx? |
|
Definition
|
|
Term
| Besides the primary factor of smoking, what are other factors that contribute ot copd? |
|
Definition
| air pollution, second-hand smoke, hx childhood respiratory infection, heredity, occupational exposure to pollutants |
|
|
Term
| What is the cost for the nation for copd? |
|
Definition
|
|
Term
| Any copd pt needs to be evaluated for what? |
|
Definition
|
|
Term
| Emphysema involves a gradual onset of what? |
|
Definition
| irreversible destruction of air sacs (alveoli) due to influx of pns (*neutrophils* NOT EOSINOPHILS) affecting elastin, causing decresaed elasticity, decresaed oxygen transfer, and incresed size of air spaces distal to terminal bronchiole |
|
|
Term
| On what is alveolar destruction dependent w/copd pts? |
|
Definition
| *dose* and *duration*dependent |
|
|
Term
| In what pts do arterial oxygenation remain relatively preserved? |
|
Definition
| "pink puffers" (emphysema) |
|
|
Term
| What is the usual age of emphysema? |
|
Definition
|
|
Term
| What is the hallmark of emphysema? |
|
Definition
|
|
Term
| **Progressive dyspnea is a clinical feature of what disease? |
|
Definition
|
|
Term
| The following are clinical features of what disease: age 50-60's. progressive dyspnea. excessive, chronic cough. +/- sputum production, +/- barrel chest, use of accessory mm, hyperresonance, decreased breath sounds, crackles/wheezing during inspiration. prolonged expiratory phase. distant heart sounds. sings of pulmonary htn/r heart faiolure/cor pulmonale in advanced disease. hallmark *frequent exacerbations*? |
|
Definition
|
|
Term
| What disease involves inflammation and eventual scarring of the lining of bronchial tubes w/pulmonary vascular remodeling? |
|
Definition
|
|
Term
| Do you use abx more frequently in copd or asthma pts? |
|
Definition
|
|
Term
| What disease involves excessive mucus production due to inflammation, increased likelihood of infection? |
|
Definition
|
|
Term
| Chronic bronchitis involves daily productive cough for how long? |
|
Definition
| daily for 3 mos or more in at least 2 consecutive years |
|
|
Term
| Should you start a pt on chronic o2 therapy based on peripheral findings? |
|
Definition
| never start pt on chronic o2 tx based purely on peripheral findings |
|
|
Term
| BQ: do copd pts most commonly present w/copd or emphysema? |
|
Definition
| most commonly pts have pathologic evidence of bo disorders |
|
|
