pulm exam 1

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pulm exam 1
2013-09-10 22:15:02
pulm exam

pulm exam 1
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  1. what evaluates respiratory capacity and the ability for a pt to get air out; also used to evaluate obstructive or restrictive disease
    pulmonary function test
  2. what is used to monitor asthmatics, the pt is to blow as hard and fast as the can out
    peak flow monitors
  3. which device is used to diagnose obstructive/restrictive disease
  4. what are some indications for the use of spirometry
    • to determine presence, location and severity of dz
    • etiology
    • reversibility¬†
    • operability
    • disability
    • progression and prognosis
  5. the amount of air contained in the fully expanded lung is known as what
    total lung capacity (everything but the residual volume)
  6. the maximum amount of air that can be exhaled is known as what
    vital capacity (80% of air blown out in 1 sec and tested for 6 seconds)
  7. spirometry measures ______ volumes of _____ involved in ventilation

  8. the volume of air that enters the lung during a normal breath is known as what
    tidal volume
  9. the amount of air remaining after maximum expiration is known as what
    residual volume
  10. what indicates the degree of lung and chest expansion, is a good indicator of patient effort, and measures volume
    forced vital capacity
  11. what measures the total amount of air that a patient can blow out as rapidly as possible after inhaling as deeply as possible
    forced vital capacity
  12. what indicates patency of large airways, indicates both large and small airway function, and measures volume
    forced expiratory volume 1 (FEV1)
  13. what measures the amount of air forcefully blown out during the first second of the effort
    forced expiratory volume 1 (FEV1)
  14. a reduced FEV1/FVC ratio may imply what
    airway obstruction
  15. FEV1/FVC ration is directly affected by what
    height and age
  16. the percentage of FVC that occurs in the 1st second of the effort is known as what
    FEV1/FVC ratio
  17. what indicates patency of small airways, measures flow generated during the mid-portion of the forced expiratory maneuver, is least effort dependent and measures FLOW
    FEF25-75 (maximal mid-expiratory flow rates MMEF)--- midblows
  18. what indicates large airway patency, measures the highest flow that can be generated by the pt forcefully blowing after fully inflating the lungs, IT IS VERY EFFORT DEPENDENT, and measures FLOW
    peak expiratory flow (PEF)
  19. this can be used to diagnose lung disease
  20. this type of lung disease is when there is a decrease in vital capacity (lung volume) but no decrease in the FEV1:FVC ratio
  21. this type of lung disease has a marked decrease in FEV1:FVC ratio, the vital capacity may be normal or decreased
  22. definition: FEV1 or FVC increases >200cc or 12% after given a bronchodilator
  23. what are some restrictive D/O's
    • neurologic D/O (ie Guillan Barre, ALS etc)
    • tumors (space occupying lesions)
    • cavitations
    • pneumonia
    • fibrosis (sarcoidosis)
  24. if the FEV1/FVC is greater than 80, and the FVC is decreased this is consistent with what type of pattern
  25. what are some examples of obstructive D/O's
    • asthma
    • emphysema
    • chronic bronchitis
    • cystic fibrosis
  26. if the FEV1/FVC is lower than 80, this is consistent with what type of pattern
  27. which test reflects the ability of the lung to transfer gas across the alveolar/capillary interface
    single breath carbon monoxide
  28. when would the diffusing capacity DLCO be increased and why
    • pulmonary hemorrhage
    • CHF
    • asthma

    it is due to increased pulmonary capillary blood volume
  29. which test aids in the evaluation of suspected asthma, when spirometer is normal
    methacholine challenge (histamine)
  30. what constitutes a positive bronchial provocation test
    if the FEV1 falls greater than 20%
  31. what can assess lung function by analyzing pH, partial pressure of O2, and partial pressure of CO2
    arterial blood gases
  32. what monitors hemoglobin O2 saturation
    pulse ox
  33. what is a hereditary, congenital bodily predisposition to a disease or metabolic or structural abnormality
  34. what are some complications of a capillary puncture
    • infection
    • excessive bleeding
    • thermal injury
  35. when are capillary punctures not recommended
    • poor peripheral perfusion
    • edematous extremities
    • unstable cardiovascular parameters
  36. a cough duration greater than 8 weeks is known as what type of cough
  37. what type of cough usually has a self-limited origin, is 3 weeks or less, and is usually a viral URI
    acute cough
  38. what is thought to be the most common overall cause of chronic cough
    chronic bronchitis (due to cigarette smoking)
  39. what is the single most common cause of chronic cough in non-smokers
    postnasal drainage
  40. what are some symptoms that accompany PND
    • rhinorrhea
    • nasal congestion
    • sensation of drainage or tickle in oropharynx
    • throat clearing
  41. which type of radiologic view is used to see the sinuses
    waters view
  42. what is characterized by a productive cough on most days for 3 months in 2 consecutive years
    chronic bronchitis
  43. a postinfectious cough is usually caused by what
    • respiratory virus
    • mycoplasma species
    • chlamydia pneumonia
  44. what is important to remember when evaluating and treating a cough
    treatment fails in a significant proportion of nonresponders due to inadequate intensity or duration of treatment
  45. what are the essentials of diagnosis for asthma/acute bronchitis
    • episodic or chronic symptoms of airflow obstruction
    • sx's frequently worse at night or early morning
    • prolonged expiration and diffuse wheezing
    • limitation of airflow on PFT's or a positive bronchial provocation
    • complete or partial reversibility
  46. Definition: a respiratory disease of increased irritability of the tracheobronchial tree, and is a reversible obstructive airway disease
  47. what are the characteristics of asthma
    • airway obstruction
    • airway inflammation
    • airway hyper-responsiveness
  48. what pathogen normally affects pts with DKA
    S. Pneumo; S. Aureus
  49. what pathogen normally affects alcoholics
    Klebsiella; Anaerobes
  50. what pathogens normally affect pts with COPD
    H. flu; Moraxella Catarallis; Legionella
  51. what pathogens normally affect organ transplant pts
    Pneumocystis; CMV; Legionella
  52. what pathogens normally affect sickle cell pts
    S. Pneumo
  53. what pathogens normally affect HIV, CD4 >200
    S. Pneumo; H flu; TB
  54. what pathogens normally affect pts with HIV, CD <200
    Pneumocystis; Histo; Crypto
  55. what is the possible pathogen in air conditioners or hot tubs
    Legionella pneumophila
  56. what is the possible pathogen within travel in the SW USA
    coccidoides immitis
  57. what is the possible pathogen in military training camps
    adenovirus; mycoplasm pneumo
  58. what is the possible pathogen in homeless shelters or jail
    S. Pneumonia or MTB
  59. what is the possible pathogen with exposure to birds
    chlamydia psittaci
  60. what is the possible pathogen with exposure to mice
  61. what is the possible pathogen with parturient animals
    coxiella burnetti
  62. what is the pathogen with bat caves or excavations
    histoplasma capsulatum
  63. what are some patient evaluations (PE) when suspecting pneumonia
    • fever >100.4
    • tachycardia, tachypnea
    • increased breathe sounds, tactile fremitus, consolidation
    • wheezes or rhonci
    • crackles or crepitant rales
    • decreased pulse ox +/-
  64. what are some consolidation signs when evaluating a pt with pneumonia
    • dullness to percussion
    • increased tactile fremitus (increased vibration on 99)
    • egophony (e to a changes)
    • bronchial breathe sounds crackles (rales)
    • whispered pectoriloquy
  65. what is the possible pathogen when a pt has periodontal disease
    anaerobes, polymicrobial
  66. what is the possible pathogen when a pt has a bullous myringitis
    mycoplasma pneumonia
  67. what is the possible pathogen when a pt has an absent gag reflex, altered mental status
    polymicrobial aspiration/ anaerobes
  68. if a pt is in your office what is the diagnostic criteria for pneumonia
    H&P, CXR, sputum, empiric tx
  69. if there is a pt in a nursing home, what is the diagnostic criteria for pneumonia
    H&P, consider CXR, empiric tx
  70. if the pt is in the ER, what is the diagnostic criteria for pneumonia
    H&P, CXR, Labs

    *if prognosis if good, empiric tx as outpt
  71. if you have focal opacity on a CXR, what pathogens can you suspect
    • S. Pneumonia, L. Pneumophilia
    • S. aureus, C. pneumonia
  72. if you have multifocal opacities on a CXR what pathogens can you suspect
    S. Aureus, L. pneumophilia, S. Pneumo
  73. if you have an interstitial pattern on a CXR, what pathogens can you suspect
    viruses, M. pnueumonia, pneumocystis carnii, C. psittaci
  74. what labs should be ordered for a pt in the ER for suspected pneumonia
    • CBC (differential)
    • electrolytes, renal function, liver enzymes
    • O2 saturation (ABG if COPD)
    • consider HIV serology especially ages 15-54

    * if more than 2 pneumo's within 6 months be concerned with their immune system
  75. what should you consider if there is significant effusion in a pt with pneumoniat
  76. which microbial test should be be run on all ICU pts
    urine legionella antigen
  77. in typical pneumonia, what is bacterial pneumonia normally caused by
    streptococcus pneumonia
  78. what are some clinical features in a typical bacterial pneumonia
    • sudden onset of fever
    • chills
    • purulent sputum
    • signs of consolidation
    • leukocytosis
    • CXR with patchy or lobar infiltrates
    • pleuritic chest pain with splinting
  79. what is atypical pneumonia normally caused by
    mycoplasma pneumonia
  80. which type of pathogen normally affects young people in crowds to include school teachers
    mycoplasma pneumonia
  81. what are some clinical features of atypical pneumonia
    • gradual onset
    • dry cough
    • abnormalities on CXR despite minimal PE findings other than rales
    • predominance of extrapulmonary sxs (dry cough, HA, malaise, myalgias, nausea and vomiting, diarrhea)
    • May or may not have pleurisy or appear sick
  82. what is the designations of typical and atypical pneumonias based on
    the ability of the pts defense mechanism and virulence of infecting organism
  83. what is the most common pathogens for outpts without co-morbidities and age <60
    • strep pneumo
    • mycoplasma pneumo, resp viruses, H flu
  84. what is the empirical therapy for outpts without co-morbidities and age <60 for pneumo
    macrolide zithromax or doxy for 10-14 days
  85. what are the most common pathogens for outpts with co-morbidities and age > 60 for pneumo
    streptococcus pneumo, staph aureus, resp viruses, H flu, aerobic gram neg bacilli
  86. what is the empirical therapy for outpts with comorbidities or age >60 with pneumo
    • beta-lactamase inhbitor (augmentin)¬†
    • OR
    • 2nd generation cephalosporin (ceftin) or beta lactam cefuroxime¬†
    • OR
    • IV ceftriaxone (rocefin) 1. give with steril water IM
    • 2. dilute into IV bag
    • 3. mix with lidocaine
    • plus a macrolide or doxy
  87. what is the most common pathogen in hospitalized severely ill CAP
    strep pneumo, legionella, aerobic gram-neg, pseudomonas aeruginosa, resp viruses, mycoplasma
  88. what is the empirical therapy for severely ill pts (hospitalized) CAP
    combination of macrolide and 3rd generation cephalosporin (Fortaz) or other antipseudomonal agent (cipro)
  89. if you get an CXR on a pt and has a consolidation infiltrate and progressing good with no set backs, when must you repeat the CXR
    4-6 weeks
  90. what is the medication that treats influenza At
  91. what are the findings in HAP
    • fever
    • leukocytosis
    • purulent sputum
    • new filtrate on CXR
  92. what labs should be run for HAP
    • blood cultures x 2
    • gram stain and culture of sputum
    • tap fluid for exam
    • check chemistry tests
    • fungal stains and cultures
    • serological tests
  93. in a HAP, which procedure should be used to obtain a good bacteria specimen
    fiberoptic bronchoscopy
  94. if a pt is on a vent and they acquire pneumo what do you want to consider
    • atelectasis
    • pulmonary edema
    • aspiration
    • hemorrhage
    • effusion
    • PE
  95. what is the treatment for a pt on a vent that acquires pneumonia
    broad spectrum and an aminoglycosides
  96. this type of pneumo follows an URI and has a lobar consolidation on a CXR
    strep pneumo
  97. what is the DOC and alternate for strep pneumo
    • zithromax
    • levofloxacin
  98. this type of pneumonia is common in alcoholics, diabetics, and HAP and will show a lobar consolidation on CXR
  99. what is the treatment for klebsiella pneumo
    cefotaxime (claforan)
  100. this type of pneumonia is common in CAP, often hits young adults in the summer and fall, often has an atypical presentation compicated by bullous myringitis with an extensive patchy infiltrate on CXR
    mycoplasma pneumo
  101. what is the DOC for mycoplasma pneumo
  102. this type of pneumo is often seen in the summer or fall with exposure to contaminated construction site, water source, or air conditioner, has a patchy or lobar consolidation on CXR
  103. what is the DOC for legionella pneumonia
    zithromax (macrolide)
  104. this type of pneumo is often seen in preexisting lung disease, elderly, pts on long term high dose corticosteroids or immunosuppressive therapy
    moraxella catarrhalis
  105. what is the preferred and alternative tx for moraxella catarrhalis
    2nd or 3rd generation cephalosporin (rocefin)

    Augmentin- bactrim/septra
  106. which type of pneumo is normally seen in AIDs pts, immunosuppressive or cytotoxic therapy and cancer
    pneumocystis jiroveci
  107. what is the preferred tx for pneumocystis jiroveci
    trimethoprim-sulfamethoxazole or pentamidine plus prednisone
  108. what is the treatment for anaerobic pneumo
  109. in anaerobic pneumonia and lung abscess, what is required for an empyema
    tube thoracostomy