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Surgery/ER Fall 2013 > EM-Pulm > Flashcards

EM-Pulm Flashcards

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1
Q

dyspnea upright

A

platypnea

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2
Q

dyspnea a/w one of several recumbent positions

A

trepopnea

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3
Q

hyperventilation

A

hyperpnea

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4
Q

dyspnea in recumbent position

A

orthopnea

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5
Q

dyspnea that awakens the patient from sleep

A

paroxysmal nocturnal dyspnea

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6
Q

S3 gallop, pulmonary venous congestion on xray, and JVD suggestive of

A

CHF

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7
Q

what signs DO NOT DISCRIMINATE between heart vs. lung problem?

A

wheezing, exertional dyspnea, orthopnea, PND (paroxysmal nocturnal dyspnea), leg edema

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8
Q

BNP less than 80 pgm/ mL can r/o

A

cardiac cause

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9
Q

basic labs for dyspnea

A

pulse ox, ABG, CXR, spirometry, EKG, CBC, BNP

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10
Q

specialized labs for dyspnea

A

cardiac stress testing, echo, pulmonary function testing, CT angiography of chest, and cardiopulmonary exercise testing

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11
Q

dyspnea tx

A

treat cause of dyspnea. administer oxygen, maintain airway- keep paO2 above 60 mmHg, and pulse ox above 90%

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12
Q

acute respiratory failure categories

A

oxygenation (hypoxemia) and removal of carbon dioxide (hypercapnia)

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13
Q

hypoxemia vs. hypoxia

A

hypoxemia- decreased oxygen partial pressure in blood. hypoxia- insufficient delivery of oxygen to organs/tissues

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14
Q

causes of hypoxia

A

low cardiac output, low hemoglobin, and low oxygen saturation

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15
Q

causes of hypoxemia

A

hypoventilation, R to L shunt, V/Q mismatch, diffusion impairment, low inspired oxygen

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16
Q

hypoxemia

A

partial pressure of oxygen in blood less than 60 mmHg. need an ABG to get this value

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17
Q

hypercapnia defined as

A

paCO2 greater than 45 mmHg

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18
Q

hypercapnia caused by__, NOT ___

A

caused by alveolar hypoventilation, not by excessive CO2 production

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19
Q

symptoms of acute hypercapnia

A

increased ICP- headache, confusion, lethargy, seizures, coma (paCO2 over 100 mmHg)

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20
Q

causes of hypercapnia

A

depressed central respiratory drive (drug overdose, brainstem lesions, tetanus), thoracic age disordres (morbid obesity, kyphoscoliosis), neuromuscular impairment (MG, GB), intrinsic lung disease (COPD), and upper airway obstruction

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21
Q

wheezing a/w

A

asthma or COPD

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22
Q

acute vs. subacute vs. chronic cough

A

acute- lasts less than 3 weeks. a/w self limited URI or bronchitis. Subacute cough- more than 3 weeks but less than 8, usually postinfectious. Chronic cough- lasts more than 8 weeks, a/w smoking, upper airway cough syndrome, asthma, GERD, ACE/ARB

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23
Q

central vs. peripheral cyanosis

A

central- cyanosis caused by inadequate pulmonary oxgenation. peripheral- cyanosis peripherally caused by vasoconstriction

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24
Q

management of acute respiratory failure

A

intubation and mechanical ventilation

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25
what conditions cause exudative vs transudative pleural effusion?
exudative- infection or neoplasm (pleural disease). transudative- imbalance between oncotic and hydrostatic pressures, like in CHF
26
Patient presents with dyspnea and PAIN with INspiration. Upon PE, there is DULLNESS to percussion and decreased breath sounds. suspect..
pleural effusion
27
diagnosis of pleural effusion
diagnostic thoracentesis indicated for all cases except if CHF suspected. If CHF, treat for 3-4 days and if effusion does not resolve THEN drain
28
how much fluid on decubitus CXR or US is significant in pleural effusion
1 cm
29
tx pleural effusion
therapeutic thoracentesis- drain no more than 1-1.5 L
30
consider bleeding in cough according to vessels
bronchial or pulmonary vessels
31
Emergent bleeding in sputum/cough results from..
bleeding from the bronchial vessels 90% of the time
32
mild, moderate, severe hemoptysis
mild- less than 20 ml in 24 hours. moderate is 20-600mL in 24 hours. Severe- more than 600mL in 24 hours
33
chronic, productive, blood streaked cough in patient
chronic bronchitis, bronchiectasis, CF, TB, neoplasm
34
hemoptysis, night sweats, fever, weight loss
TB
35
clustering cases of hemoptysis with fever, cough, chest pain, and fulminate course
plague
36
abrupt onset of bloody, purulent sputum
pneumonia or bronchitis
37
life threatning hemoptysis treatment
intubation with large ET tube, 2 large bore IV's, pulse ox, type and crossmatch, CXR, CBC, PT, PTT
38
acute bronchitis caused by
usually viral- influenza A and B, parainfluenza, RSV
39
common cold caused by
rhinovirus, coronavirus, adenovirus
40
SARS (severe acute resp syndrom) caused by
coronavirus
41
diagnostic testing in acute bronchitis and URI
not indicated in absence of rales and egophony on chest exam. Exception= elderly with cough- get chest xray
42
5 criteria suggestive of pneumonia. if present, get CXR. if all 5 absent, no need for CXR
1. HR over 100. 2. RR over 24. 3. temp over 38. 4. age over 64. 5. chest exam findings of egophony or fremitus
43
influenza tx
give antivirals within 48 hours of symptom onset
44
bronchitis tx
no need for abx, antitussives, inhaled bronchodilators
45
PNA tx
empiric antibiotics, bronchodilators. steroids in severe cases
46
pus in the plerual space
empyema
47
localized supparative necrotizing process in the lung parenchyma
lung abscess
48
Patient is on empiric abx for PNA. Symptoms are not resolving though- patient is ill, has weight loss, night sweats, anemia, pain with inspiration. PE shows decreased breath sounds, dullness to percussion, decreased fremitus, friction rub, rales. suspect
empyema
49
diagnosis of empyema
aspiration of grossly purulent fluid on thoracentesis AND at least one of the following: positive gram stain or culture, pleural fluid glucose less than 40 mg/dL, ph less than 7.1, and LDH more than 1000 IU/L
50
3 stages of empyema
exudative (easiest to treat), fibrinopurulent (loculations), and organizational (pleural peel)
51
empyema tx
pain control, tx of underlying condition (abx if PNA), if early- chest tube drainage. if late- VATS
52
lung abscess commonly caused by....
aspiration pneumonia, happens 7-14 days after aspiration
53
lung abscess caused by anaerobic vs. aerobic bacteria
anaerobic- immunocompetent. aerobic- immunocompromised
54
lung abscess presentation
cough for several weeks, putrid sputum, hemoptysis, fever, weight loss, night sweats, pleuritic chest pain
55
CXR shows air-fluid level and cavitating lesion in the lower lobes. CT shows smaller abscesses in consolidations. diagnosis:
lung abscess
56
tx of lung abscess
clindamycin and metronidazole. drainage usaully occurs spontaneously. surgical- percutaneous drainage or thoracotomy and resection.
57
what type of bacteria is mycobacterium TB
slow growing aerobic rod, acid fast bacilli
58
CXR shows cavitating lesions in UPPER lobe, caseation necrosis, gohn complexes. Sputum for AFB positive. dx?
TB
59
diagnostic tests for TB
sputum for AFB (60%), culture for M. Tuberculosis takes 4-8 weeks, CXR showing gohn complexes and cavitating lesions. and TB skin test
60
TB tx
four drug (INH, RIF, PZA, EMB) for 8 weeks, followed by 2 drug for 18-31 weeks
61
risk factors for spontaneous pneumothorax
marfan body habitus, smoking, male, asthma, COPD, Tb, AIDS, CF
62
spontaneous pneumothorax result from
bullae rupture
63
Patient presents with dyspnea, hypoxemia, pleuritic chest pain, decreased breath sounds, decreased fremitus, hyperresonance. EKG shows ST changes and T wave inversion,
pneumothorax
64
tx for pneumothorax
oxygen. catheter aspiration for small (heimlich valve). Tube thoracostomy for large (Pleurivac)
65
clinical hallmarks of tension pneumothorax
tracheal deviation, hypotension, and hyperresonance of affected side
66
how is tension pneumothorax managed?
do NOT wait for chest xray. clinical diagnosis. insert 18G needle into pleural space at mid clavicular line in 2 or 3 intercostal space to decompress, then put in chest tube
67
ribs broken in 2 places on the same rib
flail chest
68
problematic issue in flail chest
pulmonary contusion more than rib fractures
69
tx in flail chest
pain control, oxygenation. chest tube if pneumothorax or hemothorax
70
tx of sucking chest would
cover would with occlusive dressing on 3 sides, creating a valve
71
is wheezing pathognomonic in asthma
NO
72
asthma classification
mild- pulse ox over 92%, peak flow over 80%. moderate- pulse ox over 90%, peak flow 50-80%. severe- pulse ox less than 90%, peak flow less than 50%
73
asthma diagnosis
history of asthma, pulse ox, peak flow, cxr to r/o pneumonia, ABG- respiratory acidosis. cardiac workup if dx not certain
74
inflammation of the bronchioles causing bronchoconstriction, increased mucous secretion
asthma
75
tx of mild asthma
nebulizers, follow up outpatient
76
tx of moderate asthma
nebulizerse (albuterol- beta agnosit and ipratropium-anticholinergic) and prednisome, ADMIT
77
tx of severe asthma
nebulizerse (albuterol- beta agnosit and ipratropium-anticholinergic) and prednisome, ADMIT. IV steroids, IV magnesium. Intubation and mechanical ventilation if ARF
78
chronic productive cough for 3 months in the year for 2 consecutive years when all other causes of chronic cough have been excluded
chronic bronchitis
79
COPD main causes
smoking, alpha 1-antitrypsin deficiency, other respiratory irritants (coal, silica)
80
patient presents with wheezing, dypsnea, chest tightness, anxiety. Hypoxia, barrel chested, and clubbing. Has smoking history for last 20 years. suspect
COPD (exacerbation)
81
diagnosis of COPD exacerbation
pulse ox, cardiac monitoring, CXR, ABG, cardiac workup if indicated
82
mild COPD exacerbation tx
smoking cessation counsel, nebulizers, abx if bacterial infection, OP F/U
83
moderate COPD exacerbation
smoking cessation counsel, albuterol, ipratropium, prednisone, zithromax
84
severe COPD exacerbation
smoking cessation counsel, albuterol, IV steroids. intubation and mechanical ventilation if indicated
85
common causes of PE
smoking, BCP, pregnancy, clotting disorder, previous DVT/PE, recent surgery
86
patient presents with tachycardia, tachypnea, hypoxia. may have fever. automatically think---
PE
87
PE labs
CBC, d-dimer, troponin, EKG
88
Diagnosis of PE
CT angiogram, VQ scan, wells criteria

Surgery/ER Fall 2013 (11 decks)

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