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DT3 Exam 2 > Clinical > Flashcards

Clinical Flashcards

1
Q

embryonic stage of lung development

A

3rd to 7th week
at 28 days R and L mainstem bronchi are present
44th day PA from 6th aortic arch
initial branching into 5 lobes

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2
Q

failure to complete separation from esophagus

A

TE fistula

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3
Q

pseudoglandular stage

A

glandular appearance
weeks 5-17
rapid branching of pulmonary tree
mucus glands develop by 14th week

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4
Q

canalicular stage

A

16th to 24th week
capillary bed expands and endothelium thins
becomes thin enough to allow gas exchange

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5
Q

acceleration of tissue thinning and surfactant production

A

glucocorticoids

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6
Q

failure of capillary beds to form

A

alveolar capillary dysplasia

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7
Q

saccular stage

A

decrease in mesenchymal tissue

increase in type II maturation and surfactant

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8
Q

factor that decreases surfactant production

A

maternal diabetes

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9
Q

alveolar stage

A

36 weeks to 2-3 years
increased epithelial cells (most are type 2 pneumocytes but type 1 covers most of the alveolar structure)
changes in pulmonary vasculature

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10
Q

failure to change pulmonary vasculature

A

PPHN

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11
Q

VEGF

A

promotes angiogenesis
when blocked increase in alveolar size similar to emphysema
involved in development of BPD and ROP

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12
Q

retinoic acid

A

increase alveolarization

may decrease BPD

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13
Q

estrogen and testosterone

A

estrogen required fr adequate levels of surfactant

testosterone slows lung development

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14
Q

surfactant components

A

dipalmitoylphosphatidylcholine
phospholipids
proteins
cholesterol

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15
Q

surfactant protein A

A

most abundant
recycled by type II pneumocyte
opsonin-important in phagocytosis
deficiency still compatible with life

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16
Q

surfactant protein B

A

small but fusogenic-enhances spread and stability of surfactant mono layer
required for extra-uterine life

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17
Q

surfactant protein C

A

most hydrophobic
must be activated by surfactant protein B
functions to recruit phospholipids to lipid layer
AD deficiency-develop interstitial pneumonitis/emphysema

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18
Q

surfactant protein D

A

largest surfactant protein
not involved in stabilizing or recycling surfactant
found in other organs
main function in innate immunity (e. coli, salmonella, pseudomonas, RSV, adeno, flu A)

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19
Q

increases secretion of surfactant

A

glucocorticoids
estrogen
thyroid hormone

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20
Q

decreased secretion of surfactant

A

insulin

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21
Q

sources of surfactant inactivation

A

aspiration-BM, formula, sterile water
meconium
swallowed blood
pneumonia

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22
Q

betamethasone

A

increases surfactant production
decreases division and bronchial length
worsens body and lung growth if given to the mother
improves lung maturation if given to fetus

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23
Q

signs of respiratory distress

A 
tachypnea 
grunting
nasal flaring
retractions
cyanosis
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24
Q

transient tachypnea of newborn

A

failure for lung fluid to be reabsorbed

hormonal changes from labor cause reversal of Na channels

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25
Q

risks for transient tachypnea of newborn

A 
males
c section
perinatal asphyxia
umbilical cord prolapse
depressed newborn (sedation)
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26
Q

presentation of transient tachypnea of newborn

A

CXR for diagnosis
develop minutes after delivery and resolve by 12-48 hrs
treatment-supportive (oxygen and nasal cPAP)

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27
Q

respiratory distress syndrome

A 
surfactant deficiency (begins at 24 but 35 for adequate)
leads to membrane formation (hyaline)
impaired gas exchange
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28
Q

risk factors respiratory distress syndrome

A 
prematurity
caucasian and male
previous baby with RDS
perinatal asphyxia/cold stress
perinatal infection
multiple gestation
infant of diabetic mother
patent ductus arteriosus
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29
Q

presentation of respiratory distress syndrome

A

develop distress hours after delivery
worsen for first 3 days
adequate surfactant by 7 days of life

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30
Q

treatment of RDS

A

natural surfactant from porcine or bovine
artifical lack functional proteins
nasal cPAP/mechanical ventilation

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31
Q

congenital pneumonia

A

symptoms in first 24 hours of life
isolated to pulmonary system
only 10% have positive blood culture

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32
Q

sources of congenital pneumonia

A

infectious-e. coli, GBS, u. urealyticum

non-infectious-aspiration of blood or meconium

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33
Q

risk factors for congenital pneumonia

A

prolonged rupture of membranes (<12 hours)
maternal fever
uterine tenderness
foul smelling amniotic fluid

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34
Q

treatment for congenital pneumonia

A

antibiotics (amp and gent)
oxygen
nasal cPAP/mechanical ventilation

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35
Q

spontaneous pneumothorax

A

related to alveoli with defective formation during development

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36
Q

risk factors for spontaneous pneumothorax

A

difficult deliveries/birth trauma
large for gestational age-infants of diabetic mothers
positive pressure ventilation during resuscitation
connective tissue diseases

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37
Q

treatment for pneumothorax

A

avoid positive pressure
needle the chest
half require placement of chest tube
usually resolves in 3-4 days

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38
Q

congential diaphragmatic hernia

A

related to abnormal diaphragm formation during development

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39
Q

treatment for congenital diaphragmatic hernia

A

mechanical ventilation, replogle to LIS

surgery is potentially curative

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40
Q

chest x-rays in asthma

A

flattened diaphgram

hyperexpansion of lungs due to air trapping

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41
Q

Curschmann spirals

A

twisted mucous plugs mixed with sloughed epithelium

seen in asthma

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42
Q

Charcot-Leyden crystals

A

hexagonal bipyramidal crystals of eosinophil membrane proteins
seen in asthma

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43
Q

symptoms of acute sinusitis

A 
URI
facial pain, pressure or fullness
purulent rhinorrhea
maxillary toothache 
nasal obstruction
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44
Q

etiology of acute sinusitis

A

viral-rhino, adeno, influenza, parainfluenza

bacterial-strep pneumo, H flu, staph, moraxella

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45
Q

indications for antibiotics in acute sinusitis

A 
dont resolve within 7 days or worsen
moderate to severe pain
temp of 101
periorbital swelling
erythema and facial pain
immunocompromised patients
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46
Q

signs of acute bronchitis

A

cough
nasal congestion
rhinorrhea
can persist for 3 weeks regardless of antibiotics

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47
Q

most common etiology of acute bronchitis

A

viral

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48
Q

treatment of acute bronchitis

A

antibiotics should not be given

symptom management with antitussive medications

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49
Q

procalcitonin level

A

marker of bacterial infection when deciding on antibiotic in acute bronchitis

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50
Q

signs of strep pharyngitis

A 
sore throat
fever
tonsillar exudates
cervical lymphadenopathy
absence of cough
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51
Q

diagnostic tests for strep pharyngitis

A

rapid antigen detection test
throat culture (gold standard)
antibody titres should not be used routinely

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52
Q

suppurative complications of strep pyo

A 
bacteremia
cervical lymphadenitis
endocarditis
mastoiditis
meningitis
otitis media
peri-tonsillar abscess
pneumonia
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53
Q

non-supprative complications of strep pyo

A

post strep pharyngitis

rheumatic fever

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54
Q

DOC strep pyo

A

penicillin

erythro in allergy

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55
Q

air bronchogram

A

fluid fills alveoli-bronchus becomes visible

sign of airspace disease

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56
Q

solid spheres on CT

A

homogeneous from one side to another
blood vessels and masses
can be met nodules, AVM

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57
Q

hollow tubes on CT

A

lower density in center
bronchi and cavities
can be CF, bronchiectasis, TB

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58
Q

alveolar disease characteristics

A 
air bronchogram
fluffy and indistinct
confluent and homogeneous 
may have segmental or lobar distribution
seen in pneumonia and pulmonary edema
59
Q

interstitial lung disease characteristics

A

discrete
inhomogeneous
no air bronchogram
made up of lines (reticular), dots (nodular), both (reticulo-nodular)

60
Q

atelectasis

A

opacified hemi-thorax from volume loss

shift of heart and mediastinal toward opacified hemi-thorax

61
Q

pleural effusion

A

opacified hemi-thorax from large fluid

shift of heart and mediastinal structures away from side of opacified hemi-thorax

62
Q

congestive heart failure

A

kerley B lines
pleural effusions
fluid in fissure
peri-bronchial cuffing

63
Q

pneumothorax

A

visceral pleural white lines
absence of lung markings peripherally
tension-shift away from pneumothroax

64
Q

carcinoma characteristics on CXR

A

thick wall

nodular

65
Q

TB characteristics on CXR

A

thin wall

smooth margin

66
Q

abscess on CXR

A

thick wall
smooth margin
air fluid level

67
Q

most common cause of CAP

A

strep pneumo

68
Q

viral pneumonia on CXR

A

bilateral infiltrates

69
Q

CXR findings for pulmonary embolism

A

Hampton’s hump (hemidiaphragm elevated)

Westermark sign from enlargement of PA

70
Q

causes of transudate effusions

A

CHF
nephrosis
liver cirrhosis
hypoalbuminemia

71
Q

causes of exudative effusions

A

infections
malignancy
inflammatory disorders

72
Q

benign asbestos related pleural effusions

A

develop after 15 years

73
Q

pleural plaques from asbestos

A

circumscribed areas of pleural lining along ribs and diaphgram
benign in etiology

74
Q

asbestosis as interstitial lung disease

A

progressive pulmonary fibrosis caused by inhalation of fibers

75
Q

mesothelioma

A

from surface of pleural cavity

rare neoplasm

76
Q

silicosis

A

crystalline silica from mining
10 years of exposure before x-ray changes
progressive nature
progressive fibrosis on CXR

77
Q

systems approach to CXR

A 
airway
bones and soft tissue
cardiac and mediastinum
diaphgragm and gastric bubble
effusions
fields
78
Q

pathophysiology of pneumothroax

A

gas within the pleural space
gases follow pressure gradient and flow into pleural space
tension pneumothorax is a medical emergency

79
Q

possible treatment of pneumothorax

A

watchful waiting with or without supplemental oxygen
simple aspiration
tube drainage with or without pleurodesis

80
Q

measurements from British Thoracic Society and US for pneumothorax

A

from outer edge at level of hilum >2cm large

US from apex >3cm large

81
Q

characteristics of strep pneumo

A

extensive infiltrate usually abutting pleural space
prominent air bronchograms (ddx from staph)
predilection for lower lobes

82
Q

characteristics of staph pneumo

A

patchy bronchopneumonia of segmental distribution, frequently bilateral
may be associated with atelectasis since airways are filled
pleural effusion in 50%

83
Q

characteristics of mycoplasma pneumo

A

commonest cause of nonbacterial pneumonia
mild course; lasts 2-3 weeks
peak in autumn and winter
acute interstitial infiltrate in lower lobes, alveolar infiltrates usually unilateral

84
Q

characteristics of aspiration pneumo

A

depends on position of patient when aspiration occurred
RLL most common
while standing will have bilateral LL
lying in left lateral decubitus-left sided
RUL from alcoholics who aspirate in prone position

85
Q

pathophysiology of pleural effusion

A

imbalance between fluid production and fluid removal in pleural space

86
Q

exudate

A

local factors

protein and LDH rich

87
Q

transudate

A

systemic factors

low protein and low LDH

88
Q

solitary pulmonary nodule

A

single, well defined lesion, usually rounded or slightly ovoid, surrounded by normal lung tissue
diameter must be 3cm or less (greater is malignant mass)

89
Q

nodular mimics

A

nipple shadows
skin moles
prominent costochondral junction

90
Q

guidelines for low risk

A

less than 4mm no investigation
4-6mm at 12 months
6-8mm at 6-12 and 18-24 months
greater than 8mm scan at 3,9, and 24

91
Q

guidelines for high risk

A

less than 4mm at 12 months
4-6mm at 6-12 and 18-24 months
6-8mm at 3-6, 9-12, and 24 months
greater than 8mm scan at 3,9 and 24

92
Q

CXR for TB

A

hilar and/or mediastinal lymphadenopathy
primary-upper lung filed infiltrate with or without cavitation
reactivation-large unilateral pleural effusion, pericardial effusion, or miliary pattern

93
Q

bronchiectasis

A

dilation of medium sized airways

94
Q

triad of bronchiectasis

A

chronic cough
excess sputum production
repeated infection

95
Q

pathophysiology of asbestosis

A

fibers deposited at alveolar duct bifurcations and cause alveolar macrophage alveolitis
activated macrophages release cytokines (TNF, interleukin 1 beta and oxidant species) leads to fibrosis
mechanical irritation and inflammation initiates pleural scarring
diffuse pleural thickening from confluence of smaller parietal pleural plaques or extension of subpleural interstitial fibrosis

96
Q

mechanism of clearance of asbestos fibers

A

lymphatic drainage and pleural cavities

97
Q

silicosis pathophysiology

A

silica ingested by alveolar macrophages
breakdown of macrophage releases enzymes which produce fibrogenic response
requires 10-20 years of exposure
progressive despite cessation of dust exposure

98
Q

imaging of silicosis

A

multiple small round opacities 1-10mm in size
usually in upper lobes
mostly in apical and posterior regions of upper lobes and apical portion of lower lobes

99
Q

guidelines for AAA

A

repair in symptomatic AAA and in large asymptomatic
monitor infra/juxtarenal measuring 4.0-5.4cm with ultrasound every 6-12 months
AA <4cm ever 2-3 years

100
Q

stage 1 CHF

redistribution

A

redistribution
cardiomegaly
broad vascular pedicle
13-18mmHg

101
Q

stage 2 CHF

interstitial edema

A 
Kerley lines
peribronchial cuffing
hazy contour of vessels
thickened interlobar fissure
18-25mmHg
102
Q

stage 3 CHF

alveolar edema

A 
consolidation
air bronchogram
cottonwool appearance
pleural effusion
>25mmHg
103
Q

most common cause of cough

A

post infectious

104
Q

upper respiratory infection

A

viral

105
Q

nonpulmonary causes for dyspnea

A

cardiac problems
anemia
neuromuscular disorders

106
Q

most common cause of hemoptysis

A

bronchitis

107
Q

other causes of hemoptysis

A

lung cancer
pulmonary vascular disorders (Goodpasture, Wegener)
coagulopathy or thrombocytopenia (still need source of bleeding)

108
Q

sudden chest pain

A

pneumothorax

109
Q

do not cause chest pain

A

chronic lung diseases

110
Q

other causes of chest pain

A

pneumonia
abscess
pulmonary embolism
neoplasm

111
Q

cause of rhonchi

A

airway obstruction

usually mucus secretions

112
Q

cause of wheeze

A

airway obstruction

113
Q

crackles

A

fluid in parenchyma

114
Q

fine dry crackles

A

scarring and interstitial

115
Q

common spontaneous pneumothorax

A

tall thin patients

COPD

116
Q

pneumonia with hyperresonance

A

pleural effusion

117
Q

pulmonary nodules

A

common
can be associated with connective tissue diseases
can be sign of lung malignancy

118
Q

mets to lungs

A

testicular
thyroid
kidney

119
Q

sound of edema

A

rales

120
Q

sound of interstitial disease

A

fine crackles

121
Q

sound of secretion in airway

A

rhonchi

122
Q

sound of airway swelling

A

wheezing

123
Q

COPD as umbrella term

A

includes emphysema, chronic bronchitis, adult asthma

124
Q

definition of chronic bronchitis

A

chronic productive cough for at least 3 months in 2 successive years
most are smokers
more mucous production

125
Q

emphysema

A

abnormal enlargement of air sacs of terminal bronchioles, accompanied by destruction of air space
results in air trapping and hyperinflation

126
Q

COPD mixture

A

chronic bronchtiis
asthma
emphysema

127
Q

asthma

A

chronic obstructive lung disorder with reversible and intermittent airway obstruction

128
Q

interstitial disease

A

involves inflammation and secondary fibrosis of pulmonary interstitium
frequently coexists with obstructive disease

129
Q

characteristics of chronic bronchitis

A

mucus gland hypertrophy
increased neutrophilic infiltrates
increased airway reactivity
increased sputum production

130
Q

physical exam chronic bronchitis

A

wheezing
rhonchi
prolongation of expiratory phase

131
Q

provocation of asthma attacks

A

cold
allergens
irritants
respiratory illness

132
Q

inflammatory profiles COPD

A

PMNs CD8

133
Q

inflammatory profiles asthma

A

IL4
IL5
CD4

134
Q

severe asthma

A

may have bronchiolitis rather than pure asthma

requires treatment with corticosteroids

135
Q

physical exam interstitial disease

A

fine dry crackles
no wheezing
digital clubbing may be present
cough and dyspnea

136
Q

acute respiratory failure

A

drop in pH suggests decompensation

137
Q

increased pCO2 in asthmatic

A

v bad

138
Q

dd of COPD exacerbations

A

CHF
pneumonia
pulmonary embolism

139
Q

treatment for COPD and asthma

A 
bronchodilators
inhaled steroids
oral steroids 
anti-leukotriene agents 
theophylline
140
Q

risk from chronic steroid use

A

osteoporosis

141
Q

vaccinations for obstructive lung disease patients

A

influenza

pneumococcal vaccinations

142
Q

causes blebbing

A

coalescing air sacs

emphysema

143
Q

emphysema and cirrhosis

A

A1AT deficiency

144
Q

most consistent exacerbation of asthma

A

viral infection

DT3 Exam 2 (5 decks)

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