Clinical Flashcards
What are the 4 things on XRay that will be seen in a to with pulmonary hypertension
1) Peripheral hypovascularity
2) Prominent central pulmonary artery
3) Right ventricular enlargement
4) Right descending pulmonary artery
What is the cause of Pulmonary Hypertension group 1
Idiopathic and chronic tissue diseases (SLE or RA)
What is the cause of Pulmonary Hypertension group 2
Heart issues
What is the cause of Pulmonary Hypertension group 3
Lung issues
What is the cause of Pulmonary Hypertension group 4
Emboli and thrombi
What is the cause of Pulmonary Hypertension group 5
Everything else
Similarities between pulmonary hypertension and ischemic heart disease
- Exertional dyspnea
- Lack of associated symptoms
- Elevation of BNP
Which condition is indicated with an elevated P2 during auscultation
Pulmonary hypertension
What are the patient history clues that can lead to diagnosis of sleep apnea
- Motor vehicle accidents
- Difficulty with memory
- Obesity with depression
- Snoring
- Witnessing apnea
- Large neck circumference
- Nasal obstruction (nasal polyps)
- Enlarged tonsils
People with obstructive sleep apnea are at increased risk for which conditions
- Cancer (2.5x)
- Cerebral vascular aneurysm (4x)
How does a CPAP work
Increases the intraluminal airway pressure and FRC to keep the airways open
What is the pockeickian syndrome
Aka obesity hypoventilation syndrome, where being overweight leads to appearance of COPD and other issues such as CHF and CAD
*Most have restrictive rather than obstructive lung issues
What is the responsiveness to carbon dioxide in the pink puffer and the blue bloater
Blue bloater is unresponsive to carbon dioxide
Pink puffer is responsive to carbon dioxide, so makes the hyperventilate to breathe off the excess
What are the indications home supplemental oxygen
-PaO2 <56 or 89% measures twice over 3 week period
-Pa)2 from 56-60 with:
Pulmonary HTN
CHF
Erythrocytosus >55%
If you have a patient with pulmonary fibrosis presenting with low pleural glucose, what is the likely entity
RA
When a patient presents with interstital lung disease with “shrinking lung” where the volumes keep decreasing, what is the underlying entity
SLE
What is the autoantibody seen in scleroderma that will commonly be seen with interstital lung disease
SCL-70
What is the autoantibody present in scleroderma that is predicts a worst prognosis
Antinucleolar
What autoantibody is present in SLE that correlates with nephritis
DsDNA (50-75%)
What is the most common autoantibody seen in SLE
ANA (90-95%)
What is the autoantibody that is present in those patients with drug induced SLE
Histones (>90%)
What are the common drugs that can lead to induced lung disease
- Amioderone (treats cardiac issues)
- Nitrofurantoin (treats UTI)
- Bleomycin (treats germ line tumors such as testicular)
- Busulfan (restrictive lung disease)
What are the drugs that are given/used for a patient with idiopathic pulmonary fibrosis
- Pirfenidone
- Nintedanib
This individuals who enjoy cave diving are known to have inhalation of which chemicals
Silica and bat guano
What conditions of the lung is commonly seen to have a pattern on chest X-ray that is diffuse, symmetrical, and bilateral
Acute interstital pneumonia
What is the combination of symptoms leading to the idea of Sarcoidosis
- Erythema nodosum
- Fever
- Arthralgia
- Hilar adenopathy (on CXR) usually bilaterally
What conditions is lymphangioleiomyomatosis associated with
Tuberous sclerosis
Most patients pediatric emergency arrests are due to which issue
Respiratory
At the door of assessment, what are the ABC’s
Appearance, breathing, circulation
What is a classic sign in a child in respiratory distress
Somnolence or lethargy
Stridor is heard with which portion of breathing
High pitched during inspiration
What is Beck’s triad and what is it indicative for
Beck’s Triad seen in cardiac tamponade:
- JVD
- Muffled cardiac sounds
- Hypotension
If there is a retropharyngela abcess, which was is the uvula pointing
Towards you out of the mouth
When is Croup commonly seen during the year
January to March
What is Croup
Most common cause of infectious airway obstruction in ages 6-26months
What is the common cause of croup
Parainfluenza virus
What is the sound commonly heard with CROUP
Stridor
Epiglottis is commonly seen due to which infectious agent
H. Influenza type B
What condition is indicated by a patient with sickle cell anemia, fever, and a new infiltrate on CXR
Acute chest syndrome
Which type of channel is a CFTR
CAMP regulated chloride channel
What is the location of CFTR gene
Chromosome 7
What is the timeline that bacteria infect a CF patient
- S. Aureus early in life
- Pseudomonas later in life
What is the most common cause of death in a patient with CF
- Respiratory failure
- cor pulmonale
Which nose condition can arise from from CF
Nasal polyps
What are the criteria for diagnosis of CF
- Positive newborn screening test
- elevated sweat chloride concentration on two or more occasions
What is being tested in CF in neonates
-Immunoreactive trypsinogen (IRT)
Which patients are more likely to have squamous cell carcinoma of the UAT
African American males age 60
What are the clinical patient presentations that can indicate squamous cell carcinoma of the upper airways
- Difficulty swallowing or intermittent choking
- Tismus: Inability to open jaw due to compression of the trigeminal nerve
- Ear pain
What is pancoast syndrome
Superior sulcus tumor-a tumor located at the lung apex that compresses or invades the brachial plexus leading to shoulder pain or paresthesias along the C7-T1 dermatome
What is the cause of Horner syndrome as a result of a mediastinal tumor
Growth compresses the stellate ganglion and causes anhydrosis of the face, ptosis of the eyelid, pupillary constriction
What is superior vena cava syndrome
Blockage of the SVC due to neoplasm or something else. This will block the blood from being able to enter the SVC
What is the efficacy of a PET scan for cancer
Higher predictably of the cancer versus just a benign disease
What is the benefit of a fine needle aspiration (FNA)
Done with CT guidance, and is the procedure of choice for the peripheral lung lesions, with an accuracy of about 90%
Which pathogen has the appearance of a friend egg when grown on selective agar
Mycoplasma pneumoniae
What organism grows on chocolate agar
H. Influenza
Neisseria G
Which organism has elementary bodies
Chlymidia (infectious form)
What are the two organisms that have urinary antigens
Legionella and strep pneumonia
What are the blood findings in a patient with mycoplasma pneumoniae
Microcytic anemia
Which drugs can not be given to mycoplasma
Penicillins and cephalosporins because no cell wall to act one
What is the empiric treatment for a patient with community acquired pneumonia
Macrolides, or doxycycline if they can not handle those
Which drug is used when there is a higher chance of restistance to antibiotics, or hospitalized patients (because a higher risk of resistance)
Flouroquinolones
When will procalcitonin levels begin to rise
When there is a bacterial causes pneumonia
Which organism grows on charcoal yeast extract agar
Legionella
What are the characteristics of legionella
Gram negative bacillus, aerobic, flagellated
Which organisms grow on MacConkey agar
Gram negative Lactose fermenters such as klebsiella pneumoniae
What are the characteristics of H influenza
Gram negative coccobacillus
What are the organisms that grow on chocolate agar
H influenza
Neisseria
What organism will have coin lesion on CXR
Histo
Bunyavirus are associated with which carrier
Rodents
What are the symptoms seen with leptospirosis
High fevers, aseptic meningitis, jaundice
*Given through animals, so seen with vets
What is the treatment timing for an active case of TB
6 months of treatment with monitoring via sputum samples
