Block 54, 55: Lung Flashcards
Causes of hypoxemia?
- reduced inspired oxygen tension
- hypoventilation
- diffusion limitation
- shunt
- V/Q mismatch
what is hypoventilation associated
- respiratory acidosis
- normal A-a gradient
what is normal A-a gradiant
less than 15
equation for A-a gradient
PAO2 - PaO2
PAO2 = 170 - (CO2/.8)
what should you worry about a COPD patient given supplemntal oxygen
improves hypoxia but causes CO2 retention
hypercapnea causes what in the brain
reflex cerebral vasodilation
what clinical feature makes pericarditis feel better for aptient
leaning forward
flow-volume curve for fixed upper-airway obstruction
flattening the top and bottom of curve
how might an immunocompetent patient get aspergilus
history of pulmonary disease
what does CT show for aspergilloma
- cavitary lesion
- pulmonary nodules with surrounding ground-glass opacities (“halo sign”)
equation for ventilaiton
respiratory rate times tidal volume
what metabolic disturbance causes hyperventilation
respiratory alkalosis
when do you use incentive spirometry
prevent atelectasis in bed-bound patients
most common acid-base disturbance in pulmonary embolism? why?
respiratory alkalosis
- because patient hyperventilates due to decrease O2 and the V/Q mismatch
Asbestos exposure increases the risk of what
pulmonary fibrosis and malignancy
most common cause of malignancy diagnosed in patients with exposed to asbestos
Bronchogenic carcinoma
occupations related to asbestosis exposure
plumber electrician carpenter pipefitters insulation workers
PE exam for asbestosis
bibasilar, end-inspiratory crackles
fingernail clubbing
X-ray for asbestosis
babasilar reticulonodular infiltrates
honeycombing
bilateral pleural thickening
CT of asbestosis
subplerual linear densities
parenchymal fibrosis
- Plreural plaques are key for asbestosis
pulmonary fibrosis does what to forced expiratory volume in 1 second/ forced vital capacity ratio
preserved for increased
first-line treatment for exercise-induced bronchoconstriction if only required few times a week?
exercise daily?
short-acting beta-adrenergic agonist
10-20 min before exercise
Daily exercise: inhaled corticosteriods or antileukotriene agents
all patients with acute exacerbation of COPD should receive
- inhaled bronchodialater ( B2 agonist and anticholinergic)
- systemic glucocorticoids
what is the diffusion capacity of the lung for carbon monoxide in interstitial lung disease?
decreased but normal in extrinsic causes of restrictive pulmonary physiology
what are side effects of beta-2 agonists
- hypokalemia ( muscle weakness, arrhthymias, EGK abnormalities)
- tremor
- palpitations
- headache
Diagnose asthma in an adult
- reversible airway obstruction ( 12% or more increase in FEV1)
- normal diffusion capacity for CO
complications of positive pressure ventillation
- alveolar damage
- pneumothorax
- hypotension
best step in management for hyponatermia due to SIADH
Fluid restriction
common complication of small cell lung cancer
hyponetremia due to SIADH
what lung cancer is the most common cause of SAIDH
small cell lung cancer
lung compliance
ability to expand.
are there pulmonary symptoms in wilson diesase
NO
young patient with chronic dyspnea on exertion, decreased breath sounds, slight liver function test abnormalities, and a family history of cirrhosis has
alpha-1 antitrypsin deficiency
why are impaired consciousness, advanced dementia, and other neurologic paitents predisposed to aspiration pneumonia
- impaired swallowing and cough reflex
what happened during endotrachial intubation when there is overinflation of right lung, underventilation of left lung, and asymmetric chest expansion
right mainstem bronchus intubation
when is needle thoracostomy performed
emergency procedure, for life-threatening tension pneumothorax
test of choice in clinically stable patients in whom PE is likely
CT angiography
patient with chronic shortness of breath, productive cough, and evidence of destruction of the lower lung lobes has
alpha-1 antitrypsin deficiency
panacinar eymphysema
usually due to alpha1 antitrypsin defieicny
- destruction of lower lobes
Centriacinar emphysema
smoking induced
- upper lobe of lung destruction
what is considered young age for COPD
less than 45
triad for asperigillosis
fever
pleuritic chest pain
hemoptysis
Chest X-ray of sarcoidosis? histology of it?
bilateral hilar adenopathy
- noncaseating granulomas on tissue biopsy
loss of elastin in lung matrix occurs in what
alpha-1-antitrypsin deficiency
necrotizing pulmonary vasculitis occurs in
granulomatosis with polyangiitis
- Wegener granulomatosis
Chronic low back pain in an otherwise young healthy man, pain at night, improvement of pain with activity, and elevated erythrocyte sedimentation rate suggests
ankylosing spondylitis
how does ankylosing spondylitis imipact lungs
limits lungs expansion due to diminished chest wall and spinal mobility
- mild restrictive pattern
- reduce VC, TLC
- normal FEV1/FVC
- normal or increase FRC, RV
PFT for pulmonary fibrosis vs just restrictive disease
FRC, TLC and RV are also reduced in pulmonary fibrosis
define massive PE
- most likely postoperative pt
- PE complicated by hypotension and/or acute right heart strain
- jugular venous distension
patient with significant smoking history, hypercalcemia, and a hilar mass
squamous cell carcinoma of lungs
what anticoagulation therapy is sued for severe renal insufficiency
unfractionated heparin
what GFR rate indicates severe renal insufficiency
less than 30 mL/min/1.73 m^2
Transudative effusion caused by
- decreased intrapleural or plasma oncotic pressures
- elevated hydrostatic pressure
exudative effusions caused by
- increased capillary or pleural membrane permeability
- disruptions to lymphatic outflow
pleural fluid shows moderate lymphocytosis, very elevated protein, elevated LDH. what does the patient have
tuberculous effusion
what indicates severe asthma exacerbation with signs of impending respiratory failure? what should you do?
elevated or normal PaCO2
- endotracheal intubation
- mechanical ventilation
what should you give during severe asthma exacerbation
- inhaled short-acting Beta agonist
- inhaled ipratropium
- systemic corticosteroids
how does hypoxemia occur in alveolar consolidation
right-to-left intrapulmonary shunting
define dead space
ventilation of areas of lung that are not perfused with blood
a patient who can fall back asleep quickly after experiencing choking sensation, most likely has what
obstructive sleep apnea
atelectasis
alveolar collapse
- can be due to obstruction
pneumothorax
air in pleural space
