CM pulmonary

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  1. Sputum cytology
    • Can diagnose or monitor disease
    • Test early in morning
  2. FVC
    • Forced Vital Capacity
    • Low: obstructive
  3. FEV1
    • Forced Expiratory Volume in 1 second
    • Low: obstructive
    • Both FEV1 and FVC low: restrictive
  4. FEV1%
    • Percentage of air exhaled in first second
    • Ration of FEV1 to FVC (FEV1/FVC)
  5. PEFR
    • Peak Expiratory Flow Rate
    • Max flow rate during forced vital capacity
    • If low --> evaluate for obstructive
    • Useful to see if treatment working
  6. FEF
    • Forced Expiratory Flow
    • Divided into quartiles
  7. TLC
    • Total Lung Capacity
    • Can't measure by spirometry because of Residual Volume
    • TLC = FVC + RV
  8. Staging of lung disease (not cancer)
    • Normal: > 85% predicted
    • Mild: >65% < 85%
    • Moderate: >50% <65%
    • Severe: <50%
  9. Interpret PFTs
    • 1) Check FVC
    • 2) Check FVC1
    • 3) If both normal --> test is normal
    • 4) FVC and/or FEV1 low --> likely disease
    • 5) If disease, then go to % for FEV1/FVC
    • FEV1/FVC > 88-90% --> restrictive
    • FEV1/FVC <69% --> obstructive
  10. Cough DDx
    • Post nasal drip
    • Asthma
    • GERD
    • Chronic bronchitis
    • Bronchiectasis
    • Eosinophilic bronchitis
    • ACE inhibitor
    • Cancer
    • Sarcoidosis
    • Aspiration
    • Psychogenic
  11. Ventilation/perfusion ratio (V/Q)
    • Normal: 4:5 (0.8)
    • Measures effectiveness of exchange of CO2 for O2
    • Can be mismatched from
    • Shunting (reduces VQ): O2 not getting to part of lung (shunt or obstruction), more CO2 then O2 and it goes back into circulation
    • Dead space (increases VQ): blood running around with more oxygen, can't get to a damaged part of lung so doesn't exchange for CO2
  12. Acute bronchitis

    DDx:
    Bronchialitis: acute inflammation of small airways
    Bronchiectasis: permanent dilation of bronchi
    Chronic bronchitis: > 3 mos year, at least 2 yrs
    • Viral or bacterial
    • Sx: Sputum, fever, malaise, wheezing, dypsnea

    Tx: Ipratropium bromide, B2 agonists, Macrolide, Cipro, Amoxicillin, Corticosteroids, chest physiotherapy
  13. Acute bronchiolitis

    DDx: pneumonia, chronic lung disease, aspiration, asthma, reactive airway, heart failure
    Sx: constrictive, s/p viral infection, excessive mucus, edema, sloughed epithelial cells in terminal airways causing obstruction and atelectasis, expiratory wheeze, prolonged expiration, accessory muscles, in immunocompromised

    Tx: unresponsive to corticosteroids, respiratory support, ventilator if needed, fluid, antivirals if comorbidities, antibiotics (by sputum) empirically (Amoxicillin, Ampicillin, Tetracyclin or Bactrim)
  14. Acute epiglottitis
    Sx: abrupt onset, rapid progression, fever, sore throat, dysphagia, drooling, hot potato voice, severe obstruction

    Tx: maintain airway, empirical antibiotics (Oxacillin, Nafcillin, Cefazolin, Clindamycin)
  15. Croup

    DDX: bacterial tracheitis, acute epiglottis, peritonsillar or retropharyngeal abscesses, spasmodic croup, angioneurotic edema, upper airway anomalies
    Sx: barking cough, narrowing of trachea in sublottic region, "steeple sign" on x-ray, insiratory stridor, hoarseness

    Tx: corticosteroids, nebulized mist treatment, mist treatments not effective but are comforting, watch for emergent situation with pulse ox or cyanosis
  16. pertussis
Author
ID
108423
Card Set
CM pulmonary
Description
Pulmonary objectives
Updated
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