COPD
CF
Surprise ;)
Bronchiectasis
Diagnostics
100
COPD is an umbrella term for?
Chronic Bronchitis
Emphysema
100
5 clinical findings of CF in infants regardless of newborn screenings
Meconium ileus
Failure to thrive
Pancreatic insufficiency --> anemia, electrolyte and/or protein imbalance
Hepatobiliary disease
ALWAYS ENCOURAGE NBS
100
What nerves provide sensation to the peripheral diaphragm?
Lower intercostal nerves
100
Abx of choice for PROPHYLAXIS
Azithromycin 500mg PO 3x per week x 6 months
100
Three factors that interfere with chest x-rays
1. Patient unable to take and hold deep breath (dyspnea, severe pain)
2. Scarring
3. Obesity
200
Two presentations of COPD
Pink puffer - emphysema dominance
Blue bloater - chronic bronchitis dominance
(Let's review this)
200
What is a unique finding of CF in adults?
Aquagenic wrinkling (usually on palms of hands)
can be seen in CF patients and those who are carriers
200
What are some reasons you may get a "dry" tap in a thoracentesis?
•Skin indentation or movement
•Poor angle replication (compared to US)
•Patient movement
•Needle blockage
•Lung cannot expand due to pleural pressure
•Needle too short (obesity)
200
What is the diagnostic study of choice for bronchiectasis?
High resolution CT
- confirms dx and shows the cause
200
When is CT contrast used?
Non-contrast?
Contrast is used for cancer staging, pulmonary embolism, and it may mask the appearance of calcifications (if focusing on vascular issues, you may want to do with and without contrast on the same day)
Non-contrast is used for diffuse lung disease or chronic dyspnea
300
Deficiency of what gene is found to play a role in the pathogenesis of EMPHYSEMA
Alpha-1-antitrypsin
(genetics play more of a role in this than COPD)
300
What is the only definitive tx for CF
Lung transplant :/
300
What are the 4 primary lung volumes
1. Tidal volume (VT)
2. Inspiratory reserve volume (IRV)
3. Expiratory reserve volume (ERV)
4. Residual volume (RV)
300
2 high resolution CT findings
Tram tracking
Signet ring sign
300
What is preferred, arterial blood gases or venous blood gases?
Arterial blood gases
- there is poor correlation between venous blood gases and arterial blood gases
400
What are the 1st line bronchodilators for COPD
SABAs (albuterol) and Ipratropium bromide
400
Three findings of PFTs in a patient with cystic fibrosis
1. Mix of obstructive and restrictive - obstructive in earlier stages and restrictive in later stages due to loss of elasticity of lungs and mucus build-up
2. Decrease FVC, TLC, and airflow rates
3. Lots of air trapping
400
Ventilation is movement of air into or out of the lungs. What is the relationship between alveolar ventilation and the alveolar partial pressure of CO2?
Inverse relationship
ex: if ventilation decreases--> less CO2 is pulled out--> more CO2 stays in blood (increased PaCO2)
400
Bacteria most commonly seen in CF pts with bronchiectasis?
Non-CF?
CF - Pseudomonas aeruginosa
H influenzae for non-CF
400
Homogenous uptake of particles filling the entire pulmonary vasculature conclusively rules out pulmonary embolism on Q (perfusion) test only. What does an abnormal ventilation scan with parenchymal disease indicate?
Pulmonary nodular amyloidosis (PNA), pleural effusion, etc.
500
5 diagnostic findings of pink puffers (COPD with emphysema dominance)
Hemoglobin normal
PaO2 normal
CXR shows hyperinflation and flattened diaphragm
PFT shows very small FEV1 with small or increased FVC (increased compliance due to loss of lung elasticity)
V/Q scan shows increased perfusion to poorly ventilated areas
500
What is the diagnostic criteria for CF?
Patients must have at least one of these three: (1) clinical symptoms of CF in at least one organ system, (2) positive newborn screening, (3) have a sibling with CF
And
Patients must also have at least one of these three: (1) elevated sweat chloride test, (2) two disease causing CFTR gene mutations, (3) abnormal nasal potential difference
500
The goal of breathing is to maintain partial pressure of oxygen and partial pressure of carbon dioxide in a normal range. Breathing is both voluntary and involuntary. What are four ways that the brain stem controls the involuntary aspect of breathing?
1. Chemoreceptors for oxygen, carbon dioxide, and H+
2. Mechanoreceptors in lungs and joints
3. Medulla (inspiratory and expiratory centers) and pons (apneustic- abnl breathing w/ prolonged inspiratory gasps and pneumotaxic centers- turns of inspiration (turns off phrenic))
4. Respiratory muscles (directed by medulla and pons)
500
4 chest x-ray findings
Tram tracks - dilated and thickened bronchi
Opacities - mucus plugs
Infitrates - consolidation or atelectasis
Honeycombing!!
500
In a tube thoracostomy, local anesthesia is usually done, but sedation isn't always. when placing the tube where should it be placed in terms of effusions and air?
-effusion- lower or posteriorly
-air- higher or anteriorly