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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
risks for transient tachypnea of newborn
``` males c section perinatal asphyxia umbilical cord prolapse depressed newborn (sedation) ```
26
presentation of transient tachypnea of newborn
CXR for diagnosis develop minutes after delivery and resolve by 12-48 hrs treatment-supportive (oxygen and nasal cPAP)
27
respiratory distress syndrome
``` surfactant deficiency (begins at 24 but 35 for adequate) leads to membrane formation (hyaline) impaired gas exchange ```
28
risk factors respiratory distress syndrome
``` prematurity caucasian and male previous baby with RDS perinatal asphyxia/cold stress perinatal infection multiple gestation infant of diabetic mother patent ductus arteriosus ```
29
presentation of respiratory distress syndrome
develop distress hours after delivery worsen for first 3 days adequate surfactant by 7 days of life
30
treatment of RDS
natural surfactant from porcine or bovine artifical lack functional proteins nasal cPAP/mechanical ventilation
31
congenital pneumonia
symptoms in first 24 hours of life isolated to pulmonary system only 10% have positive blood culture
32
sources of congenital pneumonia
infectious-e. coli, GBS, u. urealyticum | non-infectious-aspiration of blood or meconium
33
risk factors for congenital pneumonia
prolonged rupture of membranes (<12 hours) maternal fever uterine tenderness foul smelling amniotic fluid
34
treatment for congenital pneumonia
antibiotics (amp and gent) oxygen nasal cPAP/mechanical ventilation
35
spontaneous pneumothorax
related to alveoli with defective formation during development
36
risk factors for spontaneous pneumothorax
difficult deliveries/birth trauma large for gestational age-infants of diabetic mothers positive pressure ventilation during resuscitation connective tissue diseases
37
treatment for pneumothorax
avoid positive pressure needle the chest half require placement of chest tube usually resolves in 3-4 days
38
congential diaphragmatic hernia
related to abnormal diaphragm formation during development
39
treatment for congenital diaphragmatic hernia
mechanical ventilation, replogle to LIS | surgery is potentially curative
40
chest x-rays in asthma
flattened diaphgram | hyperexpansion of lungs due to air trapping
41
Curschmann spirals
twisted mucous plugs mixed with sloughed epithelium | seen in asthma
42
Charcot-Leyden crystals
hexagonal bipyramidal crystals of eosinophil membrane proteins seen in asthma
43
symptoms of acute sinusitis
``` URI facial pain, pressure or fullness purulent rhinorrhea maxillary toothache nasal obstruction ```
44
etiology of acute sinusitis
viral-rhino, adeno, influenza, parainfluenza | bacterial-strep pneumo, H flu, staph, moraxella
45
indications for antibiotics in acute sinusitis
``` dont resolve within 7 days or worsen moderate to severe pain temp of 101 periorbital swelling erythema and facial pain immunocompromised patients ```
46
signs of acute bronchitis
cough nasal congestion rhinorrhea can persist for 3 weeks regardless of antibiotics
47
most common etiology of acute bronchitis
viral
48
treatment of acute bronchitis
antibiotics should not be given | symptom management with antitussive medications
49
procalcitonin level
marker of bacterial infection when deciding on antibiotic in acute bronchitis
50
signs of strep pharyngitis
``` sore throat fever tonsillar exudates cervical lymphadenopathy absence of cough ```
51
diagnostic tests for strep pharyngitis
rapid antigen detection test throat culture (gold standard) antibody titres should not be used routinely
52
suppurative complications of strep pyo
``` bacteremia cervical lymphadenitis endocarditis mastoiditis meningitis otitis media peri-tonsillar abscess pneumonia ```
53
non-supprative complications of strep pyo
post strep pharyngitis | rheumatic fever
54
DOC strep pyo
penicillin | erythro in allergy
55
air bronchogram
fluid fills alveoli-bronchus becomes visible | sign of airspace disease
56
solid spheres on CT
homogeneous from one side to another blood vessels and masses can be met nodules, AVM
57
hollow tubes on CT
lower density in center bronchi and cavities can be CF, bronchiectasis, TB
58
alveolar disease characteristics
``` air bronchogram fluffy and indistinct confluent and homogeneous may have segmental or lobar distribution seen in pneumonia and pulmonary edema ```
59
interstitial lung disease characteristics
discrete inhomogeneous no air bronchogram made up of lines (reticular), dots (nodular), both (reticulo-nodular)
60
atelectasis
opacified hemi-thorax from volume loss | shift of heart and mediastinal toward opacified hemi-thorax
61
pleural effusion
opacified hemi-thorax from large fluid | shift of heart and mediastinal structures away from side of opacified hemi-thorax
62
congestive heart failure
kerley B lines pleural effusions fluid in fissure peri-bronchial cuffing
63
pneumothorax
visceral pleural white lines absence of lung markings peripherally tension-shift away from pneumothroax
64
carcinoma characteristics on CXR
thick wall | nodular
65
TB characteristics on CXR
thin wall | smooth margin
66
abscess on CXR
thick wall smooth margin air fluid level
67
most common cause of CAP
strep pneumo
68
viral pneumonia on CXR
bilateral infiltrates
69
CXR findings for pulmonary embolism
Hampton's hump (hemidiaphragm elevated) | Westermark sign from enlargement of PA
70
causes of transudate effusions
CHF nephrosis liver cirrhosis hypoalbuminemia
71
causes of exudative effusions
infections malignancy inflammatory disorders
72
benign asbestos related pleural effusions
develop after 15 years
73
pleural plaques from asbestos
circumscribed areas of pleural lining along ribs and diaphgram benign in etiology
74
asbestosis as interstitial lung disease
progressive pulmonary fibrosis caused by inhalation of fibers
75
mesothelioma
from surface of pleural cavity | rare neoplasm
76
silicosis
crystalline silica from mining 10 years of exposure before x-ray changes progressive nature progressive fibrosis on CXR
77
systems approach to CXR
``` airway bones and soft tissue cardiac and mediastinum diaphgragm and gastric bubble effusions fields ```
78
pathophysiology of pneumothroax
gas within the pleural space gases follow pressure gradient and flow into pleural space tension pneumothorax is a medical emergency
79
possible treatment of pneumothorax
watchful waiting with or without supplemental oxygen simple aspiration tube drainage with or without pleurodesis
80
measurements from British Thoracic Society and US for pneumothorax
from outer edge at level of hilum >2cm large | US from apex >3cm large
81
characteristics of strep pneumo
extensive infiltrate usually abutting pleural space prominent air bronchograms (ddx from staph) predilection for lower lobes
82
characteristics of staph pneumo
patchy bronchopneumonia of segmental distribution, frequently bilateral may be associated with atelectasis since airways are filled pleural effusion in 50%
83
characteristics of mycoplasma pneumo
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
characteristics of aspiration pneumo
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
pathophysiology of pleural effusion
imbalance between fluid production and fluid removal in pleural space
86
exudate
local factors | protein and LDH rich
87
transudate
systemic factors | low protein and low LDH
88
solitary pulmonary nodule
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
nodular mimics
nipple shadows skin moles prominent costochondral junction
90
guidelines for low risk
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
guidelines for high risk
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
CXR for TB
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
bronchiectasis
dilation of medium sized airways
94
triad of bronchiectasis
chronic cough excess sputum production repeated infection
95
pathophysiology of asbestosis
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
mechanism of clearance of asbestos fibers
lymphatic drainage and pleural cavities
97
silicosis pathophysiology
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
imaging of silicosis
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
guidelines for AAA
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
stage 1 CHF | redistribution
redistribution cardiomegaly broad vascular pedicle 13-18mmHg
101
stage 2 CHF | interstitial edema
``` Kerley lines peribronchial cuffing hazy contour of vessels thickened interlobar fissure 18-25mmHg ```
102
stage 3 CHF | alveolar edema
``` consolidation air bronchogram cottonwool appearance pleural effusion >25mmHg ```
103
most common cause of cough
post infectious
104
upper respiratory infection
viral
105
nonpulmonary causes for dyspnea
cardiac problems anemia neuromuscular disorders
106
most common cause of hemoptysis
bronchitis
107
other causes of hemoptysis
lung cancer pulmonary vascular disorders (Goodpasture, Wegener) coagulopathy or thrombocytopenia (still need source of bleeding)
108
sudden chest pain
pneumothorax
109
do not cause chest pain
chronic lung diseases
110
other causes of chest pain
pneumonia abscess pulmonary embolism neoplasm
111
cause of rhonchi
airway obstruction | usually mucus secretions
112
cause of wheeze
airway obstruction
113
crackles
fluid in parenchyma
114
fine dry crackles
scarring and interstitial
115
common spontaneous pneumothorax
tall thin patients | COPD
116
pneumonia with hyperresonance
pleural effusion
117
pulmonary nodules
common can be associated with connective tissue diseases can be sign of lung malignancy
118
mets to lungs
testicular thyroid kidney
119
sound of edema
rales
120
sound of interstitial disease
fine crackles
121
sound of secretion in airway
rhonchi
122
sound of airway swelling
wheezing
123
COPD as umbrella term
includes emphysema, chronic bronchitis, adult asthma
124
definition of chronic bronchitis
chronic productive cough for at least 3 months in 2 successive years most are smokers more mucous production
125
emphysema
abnormal enlargement of air sacs of terminal bronchioles, accompanied by destruction of air space results in air trapping and hyperinflation
126
COPD mixture
chronic bronchtiis asthma emphysema
127
asthma
chronic obstructive lung disorder with reversible and intermittent airway obstruction
128
interstitial disease
involves inflammation and secondary fibrosis of pulmonary interstitium frequently coexists with obstructive disease
129
characteristics of chronic bronchitis
mucus gland hypertrophy increased neutrophilic infiltrates increased airway reactivity increased sputum production
130
physical exam chronic bronchitis
wheezing rhonchi prolongation of expiratory phase
131
provocation of asthma attacks
cold allergens irritants respiratory illness
132
inflammatory profiles COPD
PMNs CD8
133
inflammatory profiles asthma
IL4 IL5 CD4
134
severe asthma
may have bronchiolitis rather than pure asthma | requires treatment with corticosteroids
135
physical exam interstitial disease
fine dry crackles no wheezing digital clubbing may be present cough and dyspnea
136
acute respiratory failure
drop in pH suggests decompensation
137
increased pCO2 in asthmatic
v bad
138
dd of COPD exacerbations
CHF pneumonia pulmonary embolism
139
treatment for COPD and asthma
``` bronchodilators inhaled steroids oral steroids anti-leukotriene agents theophylline ```
140
risk from chronic steroid use
osteoporosis
141
vaccinations for obstructive lung disease patients
influenza | pneumococcal vaccinations
142
causes blebbing
coalescing air sacs | emphysema
143
emphysema and cirrhosis
A1AT deficiency
144
most consistent exacerbation of asthma
viral infection

DT3 Exam 2 (5 decks)

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