Respiratory System

Collection of Q&A flashcards covering acute asthma, COPD, COPD management, CAP, TB, pertussis, pneumonia, COVID-19, PE, and related chest imaging and management guidelines from the notes.

What are the hallmark signs of an acute asthma exacerbation?

Tachypnea (>20 breaths/min), tachycardia or bradycardia, cyanosis, anxiety; exhaustion and diaphoresis with accessory muscle use; lungs may be quiet with little to no audible wheeze.

What late sign may appear in an acute asthma exacerbation?

Cyanosis (late sign).

How can mild-to-moderate acute carbon monoxide poisoning present?

Headache (most common), may have nausea, malaise, dizziness; can resemble URI; sometimes cherry-red skin/lips; severe toxicity causes seizures, syncope, or coma.

How is CO poisoning diagnosed?

Elevated carboxyhemoglobin level measured by co-oximetry of an arterial blood gas; venous samples can be used but are less accurate.

What are common Covid-19 symptoms and the typical incubation period?

Symptoms appear 2–14 days after exposure and may include fever, chills, headache, myalgia, cough, dyspnea, fatigue, diarrhea, nausea, vomiting; loss of taste/smell in some; cold-like symptoms can occur.

Which patients are at higher risk for serious Covid-19 complications?

People with underlying heart or lung disease or diabetes, among other comorbidities.

What are typical signs of lung cancer at presentation and the most common type?

Advanced disease is common; cough in 50%–75% of smokers; hemoptysis, dyspnea, chest pain, weight loss, fatigue, fever; Horner syndrome may occur (pitosis, miosis, anhydrosis on 1 side of face); NSCLC is most common (~85%).

What screening is recommended for lung cancer in high-risk adults?

Annual low-dose CT (LDCT) for adults aged 50–80 with a 20-pack-year smoking history who currently smoke or have quit in the past 15 years.

What is Horner syndrome and its relevance to lung cancer?

Pupil constriction with ptosis; can indicate tumor involvement and prompts urgent MRI.

What is a pulmonary embolism (PE) and its classic presentation?

Obstruction of the pulmonary artery or branches by thrombus/tumor/air/fat; sudden dyspnea and cough; may have pink-tinged sputum, tachycardia, pallor, and a feeling of impending doom.

What are key normal lung examination findings you should know?

Breath sounds: Vesicular (soft, low-pitched, bilaterally); Bronchial (loud, lower trachea); Bronchovesicular (intermediate, mid-chest); Tracheal (high-pitched, neck). Tachypnea and egophony/fremitus tests as described in notes.

What is the normal respiratory rate for adults and how can PaCO2 influence it?

12–20 breaths/min; higher in women; small PaCO2 rise alters rate, but very high PaCO2 (>70–80 mmHg) can depress respiration.

What findings indicate respiratory failure in assessment tips?

Tachypnea, disappearance or lack of wheezing, accessory muscle use, diaphoresis, exhaustion.

What is egophony and what does an abnormal egophony suggest?

Normal: “eee” heard; abnormal: “bah” heard, suggesting consolidation or fluid in the lungs.

What is tactile fremitus and how do you interpret abnormal findings?

Vibrations felt while pt says “99” or “one, two, three”; Normal: stronger at upper lobes, softer at lower; Abnormal: reversed or asymmetric, suggesting consolidation.

What is whispered pectoriloquy and how is it assessed?

Ask patient to whisper “99” or “one, two, three”; normal: distant/muffled; abnormal: whisper clearly heard over lung bases with consolidation.

What does percussion tell you about lung tissue?

Normal resonance; Hyperresonance with COPD/emphysema; Tympanic suggests pneumothorax or chest air; Dull tone with pneumonia or pleural effusion or a solid organ.

What are the main pulmonary function tests and their significance?

FEV1 (forced exhale in 1 sec), FVC (total exhaled air), FEV1/FVC ratio; used to distinguish obstructive vs restrictive dysfunction (obstructive common in asthma/COPD; restrictive with fibrosis, pleural disease, diaphragm issues).

How is asthma defined and what is atopy?

Chronic airway inflammation with symptoms that vary over time (wheezing, SOB, chest tightness, cough) and variable expiratory airflow limitation; atopy is genetic predisposition with allergies (eczema, allergic rhinitis).

Name common triggers for asthma exacerbations.

Viral URIs, airborne allergens (dust mites, mold, cockroaches, pets, pollens), foods/allergies (sulfites, dyes), irritants (cold air, fumes, smoke), exercise, GERD, NSAIDs/ACE inhibitors, beta-blockers; emotional stress and genetics atopy also play a role.

What are the differences between SABA and LABA in asthma treatment?

SABA provides quick relief; LABA provides long-acting bronchodilation and should be combined with ICS; LABA alone increases risk and should not be used as rescue therapy; ICS-LABA combos can be used for maintenance and rescue per guidelines.

What are first-line medications for asthma control and their purpose?

Inhaled corticosteroids (ICS) to treat airway inflammation and improve control; spacer use improves delivery and reduces oral thrush; LABAs are not rescue meds and should not be used alone.

What is the role of spacers or chambers in inhaler therapy?

Increase aerosol delivery to the lungs and minimize oral thrush from inhaled steroids.

What is the HAS mnemonic used for peak expiratory flow (PEF) estimation?

Height, Age, and Sex influence predicted PEF values (HAS).

What are the NAEPP and GINA classifications and their guiding principles?

NAEPP (2020) uses severity via symptoms, impairment, and risks with spirometry/peak flow; GINA (2020) uses treatment level needed to control symptoms and exacerbations; both guide initial therapy.

What is the asthma action plan and what should it include?

A written plan to review inhaler technique, rescue and controller meds, triggers, and steps to take during worsening symptoms; include allergen exposure control and spirometry monitoring.

What is Exercise-Induced Bronchoconstriction (EIB) and its management?

Acute bronchoconstriction during/after exercise; up to 90% of asthmatics affected; leukotrienes, histamine, ILs increased; premedicate 5–20 minutes before exercise with two puffs of a SABA; effect lasts ~4 hours.

What are the emergency management steps for an asthmatic exacerbation?

Tachypnea, accessory muscle use, PEF <40%; give nebulized albuterol up to three doses every 20 minutes; MDI with spacer 4–8 puffs every 20 minutes for up to 3 doses; short course of oral steroids may be needed; add ipratropium and consider magnesium sulfate for moderate-severe cases; refer to ED for poor response.

What constitutes a good response after nebulizer treatment in asthma?

Listening for both inspiratory and expiratory wheeze indicates airway opening; lack of breath sounds or wheeze suggests poor response and possible respiratory arrest.

What is the role of prednisone in asthma exacerbations?

Oral glucocorticoids (e.g., prednisone 40–60 mg daily for 5–7 days) for moderate-to-severe exacerbations; taper not required for short courses (<3 weeks) if ICS already used.

What is the safety caution with LABA use in asthma?

LABAs should not be used alone; they are safer when combined with ICS.

What are common long-term controller medications for asthma?

ICS (inhaled corticosteroids); LABA in combos (not alone); LAMA and other agents in certain regimens; leukotriene receptor antagonists; biologics (anti-IgE, anti-Il-5, etc.).

What are the main COPD categories and what do ACOS and overlap imply?

Chronic bronchitis and emphysema; ACOS = asthma-COPD overlap; important to recognize overlap for management; COPD often presents with dyspnea and productive cough; pulmonary hypertension can develop.

What are the classic COPD physical findings and chest X-ray features?

Hyperinflation, flattened diaphragms, reduced breath sounds, use of accessory muscles; chest X-ray may show hyperinflation, bullae, and flattened diaphragms; in emphysema there is increased anteroposterior diameter.

Describe the COPD GOLD grouping and general treatment approach (Groups A, B, E).

Group A: mild symptoms/low exacerbation risk → short- or long-acting bronchodilator; Group B: more symptoms/low risk → LAMA/LABA combination; Group E: high exacerbation risk → LAMA/LABA (consider ICS if eosinophils ≥300 cells/μL).

What are the main COPD pharmacologic options and safety considerations?

SABA for relief; SABA/SAMA combinations; LABA; LAMA; ICS with LABA; roflumilast (PDE-4 inhibitor) for severe COPD; long-term oxygen therapy for chronic hypoxemia; monitor tachycardia with beta-agonists; caution with glaucoma/BPH for anticholinergics; avoid long-term oral steroids as monotherapy.

What is roflumilast and when is it used?

A PDE-4 inhibitor used to reduce COPD exacerbations in severe COPD; not a bronchodilator; has psychiatric adverse effects.

When is long-term oxygen therapy indicated in COPD?

In chronic hypoxemia: PaO2 ≤55 mmHg or SaO2 ≤88%; titrate to maintain SaO2 between 88% and 92%.

What are common radiographic signs of COPD on chest imaging?

Hyperinflation, flattened diaphragms, barrel chest; reduced diaphragmatic excursion; bullae may be present.

What are typical exam findings of asthma as it worsens?

Wheezing with prolonged expiratory phase; as bronchoconstriction worsens, wheezing may be present on inspiration and expiration; breath sounds can become faint or inaudible.

What is CAP and its most common organism?

Community-acquired pneumonia; most common bacterial cause is Streptococcus pneumoniae; others include H. influenzae and atypicals (Mycoplasma pneumoniae) and respiratory viruses.

What is CURB-65 and how is it used?

A severity score for CAP: Confusion, Urea >19.6 mg/dL, Respiratory rate >30, Blood pressure <90/60, Age ≥65; 0–1 low risk, 2 moderate, 3–5 high risk.

What are first-line outpatient treatments for CAP in otherwise healthy adults?

Amoxicillin 1 g PO TID for 5–7 days; or doxycycline 100 mg PO BID for 5–7 days; or a macrolide if local macrolide resistance <25% (e.g., azithromycin or clarithromycin).

How is CAP treated in patients with comorbidities or high resistance risk?

Combination therapy such as amoxicillin–clavulanate or high-dose amoxicillin plus a macrolide or doxycycline; or a respiratory fluoroquinolone (levofloxacin, moxifloxacin, or gemifloxacin) monotherapy.

What vaccines are recommended for pneumococcal disease?

PCV13/PCV15/PCV20 for certain children and adults with comorbidities; PPSV23 for adults ≥65 or certain adults 19–64 with conditions; PCV20 may replace prior PCV13/PPSV23 in some schedules; timing depends on prior vaccines.

What are typical features of atypical pneumonia and its common causative organisms?

Gradual onset with interstitial or patchy infiltrates; common pathogens include Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella species; Legionella often associated with moisture/air conditioning and may require urinary antigen testing.

What is the preferred initial antibiotic for suspected Legionella that travels or severe symptoms?

Doxycycline or a macrolide; Legionella testing with Legionella urinary antigen may be ordered if suspected.

What is Pertussis (whooping cough) and its stages?

Caused by Bordetella pertussis; three stages: catarrhal (1–2 weeks), paroxysmal (2–4 weeks), convalescent (1–2 weeks); macrolides are first-line; post-exposure prophylaxis recommended; vaccination scheduling varies (Tdap).

How is Pertussis diagnosed and treated in different age groups?

Nasopharyngeal culture and PCR; macrolides (azithromycin, clarithromycin) are preferred; for infants under 1 month monitor for IHPS; trimethoprim-sulfamethoxazole as alternative after 2 months.

What distinguishes latent TB infection (LTBI) from TB disease?

LTBI is asymptomatic and noninfectious with latent bacteria; TB disease shows symptoms and is contagious; active TB may require multiple drugs and longer treatment.

What is MDR-TB and XDR-TB?

MDR-TB: resistance to isoniazid and rifampin; XDR-TB: resistance to isoniazid, rifampin, a fluoroquinolone, and at least one second-line injectable or resistance to bedaquiline or linezolid.

What is the booster phenomenon in TB testing and how is it identified?

Two-step TST: if the initial test is negative, repeat in 1–4 weeks on the opposite arm; a boosted reaction suggests prior exposure; follow with CXR and assess LTBI prophylaxis if no symptoms.

What are the diagnostic steps for TB (Mantoux, IGRA, and sputum testing)?

Mantoux TST: intradermal 5 TU PPD; measure induration width; IGRA tests (QuantiFERON-TB Gold in-tube, T-SPOT TB) measure gamma-interferon; Sputum NAAT, culture and sensitivity, and AFB smear; collect multiple samples (early morning) for active TB.

What are the key radiographic features of TB on chest X-ray?

Upper-lobe cavitation with possible adenopathy and granulomas; miliary TB shows millet-seed nodules; healed TB may show nodules and fibrotic scars.

What are common signs and symptoms of CAP on physical exam and labs?

Fever, tachypnea, tachycardia; crackles; dullness to percussion over affected area; increased tactile fremitus and egophony; CBC with leukocytosis and left shift possible; CXR shows lobar consolidation.

What is the standard approach to antibiotic therapy for CAP?

Treat based on ATS/IDSA guidelines: for healthy outpatients, amoxicillin or doxycycline or macrolide; for comorbidities or resistance risk, combination therapy (beta-lactam plus macrolide/doxycycline) or respiratory fluoroquinolone monotherapy.

What is the role of influenza and pneumococcal vaccination in CAP prevention?

Influenza vaccine for all >50 or those at risk; pneumococcal vaccines PCV13/PCV15/PCV20 and PPSV23 recommended for various age groups and conditions to reduce CAP risk.

What are the common complications of pertussis?

Sinusitis, otitis media, pneumonia, rib fractures; severe coughing in paroxysms and vomiting post-tussive.

What are the common COVID-19 management principles for non-hospitalized patients?

Supportive care; antivirals (nirmatrelvir-ritonavir within 5 days of onset preferred for high-risk) or remdesivir; corticosteroids not recommended for non-hospitalized patients not requiring oxygen; vaccination remains key; monitor for warning signs.

What are major risk factors for acute severe illness in COVID-19?

Age ≥65, comorbidities (diabetes, heart or lung disease, chronic kidney/liver disease), immunosuppression, and high BMI, among others.

What is the Pneumonia Severity Index (PSI) and CURB-65 used for?

Tools to assess severity and guide site of care decisions in pneumonia; CURB-65 uses confusion, BUN, RR, BP, age 65+; PSI uses a broader set of variables.

What is a key characteristic of blue bloater vs pink puffer in COPD?

Blue bloater = chronic bronchitis with blue-tinged skin due to hypoxemia; pink puffer = emphysema with pink skin, thin, tachypneic, accessory muscle use, often barrel-chested.

What should be considered in COPD exacerbation management regarding antibiotics and imaging?

Assess oxygen saturation; chest X-ray to exclude pneumonia; early inhaled bronchodilators; consider antibiotics if signs of infection; sputum testing as indicated.

What vaccination strategies are recommended for adults with COPD to prevent exacerbations?

Influenza vaccination annually; pneumococcal vaccines per schedule; COVID-19 vaccination as available; smoking cessation and vaccination status should be reviewed.

What are common imaging signs suggesting COPD on chest X-ray or CT?

Hyperinflation, flattened diaphragms, possible bullae; decreased lung markings; in advanced disease, signs of emphysema.

What is the significance of LDCT screening in lung cancer?

Low-dose CT scanning reduces mortality in high-risk individuals (50–80 years, 20 pack-year history) by detecting cancer earlier.

How is the classic CAP pathogen rust-colored sputum clinically suggestive?

Rust-colored sputum is classically associated with Streptococcus pneumoniae.

What differentiates typical vs atypical pneumonia on presentation?

Typical pneumonia often presents with productive cough, high fever, lobar consolidation; atypical pneumonia (e.g., Mycoplasma) may have gradual onset, interstitial/patchy infiltrates, nonproductive cough.

What is the purpose of post-treatment CXR in CAP management?

To ensure clearing of infection and document resolution since imaging can lag behind clinical improvement.

What is the booster phenomenon and how does it affect TB testing strategy?

Two-step TST to detect boosting in someone tested long ago; if second test is positive, LTBI prophylaxis may be indicated depending on risk and symptoms.

What are the common adverse effects of inhaled corticosteroids (ICS) and how can they be mitigated?

Oral thrush; mitigate with spacer use and mouth rinse or hydration after inhalation.

What are common GI or systemic adverse effects of COPD medications like roflumilast or bronchodilators?

Roflumilast may cause psychiatric symptoms (insomnia, depression); bronchodilators can cause tachycardia/palpitations; monitor for interactions and cautions with hypertension and arrhythmias.

What is the role of direct-acting antivirals for severe COVID-19?

Nirmatrelvir-ritonavir (PAXLOVID) within 5 days of symptoms for high-risk outpatients; alternative is remdesivir; corticosteroids for non-hospitalized patients not routinely recommended.

How does oxygen therapy impact survival in COPD?

Long-term oxygen therapy improves survival in chronic hypoxemia compared with nocturnal oxygen use; titrate to target saturations 88–92%.

What is the 'silhouette sign' in chest radiographs?

Displacement of the normal chest silhouette, such as para-aortic line, which may indicate a mass, aneurysm, or other pathology.

What key radiographic sign is typical for upper-lobe TB on PA film in healed disease?

Pulmonary nodules and/or cavitations (round black holes) in the upper lobes with or without fibrotic scars.

What is the management approach for acute bronchitis?

Symptomatic treatment; avoid routine antibiotics; hydration, rest, antitussives (dextromethorphan, tessalon), guaifenesin, bronchodilators for wheezing; short course of steroids if severe wheezing.

What are the typical components of the CAP treatment plan for otherwise healthy adults?

Outpatient monotherapy with amoxicillin, doxycycline, or macrolide depending on local resistance; ensureCx; adjust for comorbidities as needed.

What is the role of vaccination in CAP prevention for adults?

Influenza vaccine annually; pneumococcal vaccines (PCV13/PCV15/PCV20 and PPSV23) per age/condition guidelines; COVID-19 vaccination.

What are the common features of “walking pneumonia” and its causative agents?

Atypical pneumonia with gradual onset and milder symptoms; often caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae; Legionella can cause severe forms with extrapulmonary symptoms.

What is DVT/PE risk in COPD exacerbations and the preventive approach?

Hospitalized COPD patients have higher DVT/PE risk; thromboprophylaxis is advised; manage with standard COPD exacerbation care including oxygen and bronchodilators.

What constitutes a severe asthma exacerbation requiring ED or ICU involvement?

Very low PEF (<40% predicted), cyanosis, altered mental status, poor response to bronchodilators, impending respiratory arrest; escalate to emergency care.

What are the Gina guidelines?

GINA guidelines are based on occurrence of troublesome symptoms. Step 1 involves infrequent asthma symptoms (less than 2 × /week); Step 2 involves asthma symptoms or need for reliever inhaler more than 2 × /week; and Step 4 involves severely uncontrolled asthma with three or more of the following: daytime asthma symptoms more than 2 × /week, nocturnal awakening due to asthma, reliever needed for symptoms more than 2 × /week, or activity limitation due to asthma.

What are the NAEPP guidlines?

CAT scoring for COPD with treatment