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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
Q

what conditions cause exudative vs transudative pleural effusion?

A

exudative- infection or neoplasm (pleural disease). transudative- imbalance between oncotic and hydrostatic pressures, like in CHF

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26
Q

Patient presents with dyspnea and PAIN with INspiration. Upon PE, there is DULLNESS to percussion and decreased breath sounds. suspect..

A

pleural effusion

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27
Q

diagnosis of pleural effusion

A

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

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28
Q

how much fluid on decubitus CXR or US is significant in pleural effusion

A

1 cm

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29
Q

tx pleural effusion

A

therapeutic thoracentesis- drain no more than 1-1.5 L

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30
Q

consider bleeding in cough according to vessels

A

bronchial or pulmonary vessels

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31
Q

Emergent bleeding in sputum/cough results from..

A

bleeding from the bronchial vessels 90% of the time

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32
Q

mild, moderate, severe hemoptysis

A

mild- less than 20 ml in 24 hours. moderate is 20-600mL in 24 hours. Severe- more than 600mL in 24 hours

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33
Q

chronic, productive, blood streaked cough in patient

A

chronic bronchitis, bronchiectasis, CF, TB, neoplasm

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34
Q

hemoptysis, night sweats, fever, weight loss

A

TB

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35
Q

clustering cases of hemoptysis with fever, cough, chest pain, and fulminate course

A

plague

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36
Q

abrupt onset of bloody, purulent sputum

A

pneumonia or bronchitis

37
Q

life threatning hemoptysis treatment

A

intubation with large ET tube, 2 large bore IV’s, pulse ox, type and crossmatch, CXR, CBC, PT, PTT

38
Q

acute bronchitis caused by

A

usually viral- influenza A and B, parainfluenza, RSV

39
Q

common cold caused by

A

rhinovirus, coronavirus, adenovirus

40
Q

SARS (severe acute resp syndrom) caused by

A

coronavirus

41
Q

diagnostic testing in acute bronchitis and URI

A

not indicated in absence of rales and egophony on chest exam. Exception= elderly with cough- get chest xray

42
Q

5 criteria suggestive of pneumonia. if present, get CXR. if all 5 absent, no need for CXR

A
  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
Q

influenza tx

A

give antivirals within 48 hours of symptom onset

44
Q

bronchitis tx

A

no need for abx, antitussives, inhaled bronchodilators

45
Q

PNA tx

A

empiric antibiotics, bronchodilators. steroids in severe cases

46
Q

pus in the plerual space

A

empyema

47
Q

localized supparative necrotizing process in the lung parenchyma

A

lung abscess

48
Q

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

A

empyema

49
Q

diagnosis of empyema

A

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
Q

3 stages of empyema

A

exudative (easiest to treat), fibrinopurulent (loculations), and organizational (pleural peel)

51
Q

empyema tx

A

pain control, tx of underlying condition (abx if PNA), if early- chest tube drainage. if late- VATS

52
Q

lung abscess commonly caused by….

A

aspiration pneumonia, happens 7-14 days after aspiration

53
Q

lung abscess caused by anaerobic vs. aerobic bacteria

A

anaerobic- immunocompetent. aerobic- immunocompromised

54
Q

lung abscess presentation

A

cough for several weeks, putrid sputum, hemoptysis, fever, weight loss, night sweats, pleuritic chest pain

55
Q

CXR shows air-fluid level and cavitating lesion in the lower lobes. CT shows smaller abscesses in consolidations. diagnosis:

A

lung abscess

56
Q

tx of lung abscess

A

clindamycin and metronidazole. drainage usaully occurs spontaneously. surgical- percutaneous drainage or thoracotomy and resection.

57
Q

what type of bacteria is mycobacterium TB

A

slow growing aerobic rod, acid fast bacilli

58
Q

CXR shows cavitating lesions in UPPER lobe, caseation necrosis, gohn complexes. Sputum for AFB positive. dx?

A

TB

59
Q

diagnostic tests for TB

A

sputum for AFB (60%), culture for M. Tuberculosis takes 4-8 weeks, CXR showing gohn complexes and cavitating lesions. and TB skin test

60
Q

TB tx

A

four drug (INH, RIF, PZA, EMB) for 8 weeks, followed by 2 drug for 18-31 weeks

61
Q

risk factors for spontaneous pneumothorax

A

marfan body habitus, smoking, male, asthma, COPD, Tb, AIDS, CF

62
Q

spontaneous pneumothorax result from

A

bullae rupture

63
Q

Patient presents with dyspnea, hypoxemia, pleuritic chest pain, decreased breath sounds, decreased fremitus, hyperresonance. EKG shows ST changes and T wave inversion,

A

pneumothorax

64
Q

tx for pneumothorax

A

oxygen. catheter aspiration for small (heimlich valve). Tube thoracostomy for large (Pleurivac)

65
Q

clinical hallmarks of tension pneumothorax

A

tracheal deviation, hypotension, and hyperresonance of affected side

66
Q

how is tension pneumothorax managed?

A

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
Q

ribs broken in 2 places on the same rib

A

flail chest

68
Q

problematic issue in flail chest

A

pulmonary contusion more than rib fractures

69
Q

tx in flail chest

A

pain control, oxygenation. chest tube if pneumothorax or hemothorax

70
Q

tx of sucking chest would

A

cover would with occlusive dressing on 3 sides, creating a valve

71
Q

is wheezing pathognomonic in asthma

A

NO

72
Q

asthma classification

A

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
Q

asthma diagnosis

A

history of asthma, pulse ox, peak flow, cxr to r/o pneumonia, ABG- respiratory acidosis. cardiac workup if dx not certain

74
Q

inflammation of the bronchioles causing bronchoconstriction, increased mucous secretion

A

asthma

75
Q

tx of mild asthma

A

nebulizers, follow up outpatient

76
Q

tx of moderate asthma

A

nebulizerse (albuterol- beta agnosit and ipratropium-anticholinergic) and prednisome, ADMIT

77
Q

tx of severe asthma

A

nebulizerse (albuterol- beta agnosit and ipratropium-anticholinergic) and prednisome, ADMIT. IV steroids, IV magnesium. Intubation and mechanical ventilation if ARF

78
Q

chronic productive cough for 3 months in the year for 2 consecutive years when all other causes of chronic cough have been excluded

A

chronic bronchitis

79
Q

COPD main causes

A

smoking, alpha 1-antitrypsin deficiency, other respiratory irritants (coal, silica)

80
Q

patient presents with wheezing, dypsnea, chest tightness, anxiety. Hypoxia, barrel chested, and clubbing. Has smoking history for last 20 years. suspect

A

COPD (exacerbation)

81
Q

diagnosis of COPD exacerbation

A

pulse ox, cardiac monitoring, CXR, ABG, cardiac workup if indicated

82
Q

mild COPD exacerbation tx

A

smoking cessation counsel, nebulizers, abx if bacterial infection, OP F/U

83
Q

moderate COPD exacerbation

A

smoking cessation counsel, albuterol, ipratropium, prednisone, zithromax

84
Q

severe COPD exacerbation

A

smoking cessation counsel, albuterol, IV steroids. intubation and mechanical ventilation if indicated

85
Q

common causes of PE

A

smoking, BCP, pregnancy, clotting disorder, previous DVT/PE, recent surgery

86
Q

patient presents with tachycardia, tachypnea, hypoxia. may have fever. automatically think—

A

PE

87
Q

PE labs

A

CBC, d-dimer, troponin, EKG

88
Q

Diagnosis of PE

A

CT angiogram, VQ scan, wells criteria

Surgery/ER Fall 2013 (11 decks)

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