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Clin Med > Exam 6 > Flashcards

Exam 6 Flashcards

1
Q

Emphysema definition

A

Airspace destruction
Loss of elasticity
Enlargement of airspaces distal to terminal bronchiole

Blebs/bullae

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2
Q

Chronic bronchitis definition

A

Hypertrophy of mucous glands, more secretions

Lots of inflammation

Excess mucus, daily productive cough for 3+ months per year x2 consecutive years

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3
Q

COPD and liver disease

A

A1 antitrypsin deficiency, may see cirrhosis and/or hepatocellular CA or emphysema in 3rd/4th decade of life

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4
Q

What decade of life do you see COPD?

A

Usually 5th-6th decade

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5
Q

Early presentation and late presentation

A

Early- dyspnea, productive cough

Late- pneumonia, pulmonary HTN, cor pulmonale, chronic respiratory failure

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6
Q

Exacerbations of COPD description

A

Increased cough, dyspnea, sputum production

Often requires change in therapy

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7
Q

Pink puffers

A

Emphysema

Barrel chest, hyperventilation, weight loss

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8
Q

Blue bloaters

A

Bronchitis

Cyanosis, cor pulmonale, obesity

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9
Q

Emphysema physical exam

A

Quiet breath sounds

Barrel chest

Accessory muscles (tripod, pursed lip, intercostals)

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10
Q

Chronic bronchitis exam

A

Cyanotic, coarse breath sounds, comfortable at rest

Ronchi and or wheezes

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11
Q

When do you perform a bullectomy?

A

If a single bulla occupies 30% or more of hemithorax

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12
Q

Asthma definition

A

Clinical syndrome of 3 components:

  1. Recurrent episodes of airway obstruction that resolve spontaneously or with treatment
  2. Exaggerated bronchoconstriction in response to stimuli, “airway hyperresponsiveness”
  3. Inflammation of the airways
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13
Q

Pathology of asthma

A

Edema and hyperemia of bronchial mucosa

Bronchoconstriction

Infiltration of inflammatory cells and chemokines

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14
Q

4 mediators in acute asthma

A

Acetylcholine
Histamine
Leukotrienes
Nitric oxide

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15
Q

Atopic triad

A

Asthma, allergic rhinitis, atopic dermatitis

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16
Q

Samter triad

A

Asthma, nasal polyps, aspirin sensitivity

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17
Q

Clinical findings of asthma

A 
Episodic wheezing
Difficulty breathing
Chest tightness
Cough with excess sputum
Common attacks at night
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18
Q

Exam findings of asthma

A 
Wheezing
Hyperresonance to percussion
Tachycardia/tachypnea
Hypoxia
Accessory muscles
Nasal secretions, polyps, swelling
Atopic dermatitis
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19
Q

Complications of asthma

A 
Exhaustion
Dehydration
Airway infection
Fainting from cough
Pneumo
Hypercapnia and hypoxia
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20
Q

PEFR suggesting severe obstruction

A

<200 L/min

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21
Q

Sarcoidosis is characterized by…

A

Noncaseating granulomatous inflammation

Involvement of lungs, lumps, eyes, skin, liver, spleen, heart, nervous system

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22
Q

Which races is sarcoidosis most common in?

A

North american black and northern european whites

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23
Q

Symptoms of sarcoidosis

A 
Asymptomatic
Malaise, fever
Cough
Dyspnea
Chest discomfort
Other organ involvement
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24
Q

Signs of sarcoidosis

A 
Skin changes
Lungs (wheezing or normal)
Parotid gland enlargement
Lymphadenopathy
HSM
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25
Q

How often is cutaneous involvement seen in sarcoidosis?

A

~25% of the time as an early finding

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26
Q

Lofgren syndrome

A

Erythema nodosum
Polyarthritis
Hilar adenopathy
Fever

95% specificity for sarcoidosis

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27
Q

Which imaging choice is central to evaluation of sarcoidosis? What do you find?

A

CXR

Symmetric bilateral hilar LAD
Diffuse reticular infiltrates

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28
Q

What three elements need to be present to make the diagnosis of sarcoidosis?

A

Compatible clinical and radiographic manifestations

Exclusion of other diseases that may present similarly

Histopathologic detection of noncaseating granulomas

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29
Q

Stage 1 sarcoidosis

A

Bilateral hilar adenopathy, right paratracheal node enlargement

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30
Q

Stage II sarcoidosis

A

Bilateral hilar adenopathy & reticular opacities

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31
Q

Stage III sarcoidosis

A

Increased reticular opacities

Shrinking hilar nodes

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32
Q

Stage IV sarcoidosis

A

Reticular opacities with evidence of volume loss in lung

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33
Q

Pleuritis definition

A

Chest wall pain due to acute pleural inflammation caused by irritation to the parietal pleura

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34
Q

Pleuritic pain

A

Localized
Sharp
Fleeting
Worse with sneezing, coughing, deep breathing, movement

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35
Q

Pleural effusion definition

A

Accumulation of fluid between parietal and visceral pleura

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36
Q

Classifications of pleural effusion

A

Exudative
Transudative
Empyema
Hemothorax

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37
Q

Exudative effusions

A

Leaky capillaries, often from infection, malignancy, or PE

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38
Q

Chylothorax

A

Disruption or obstruction of thoracic duct resulting in leakage of chyle into the pleural space

White, milky

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39
Q

Transudative effusion

A

Increased hydrostatic pressure or decreased oncotic pressure

Intact capillaries

CHF >90% of cases

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40
Q

Physical exam pleural effusion

A

Decreased tactile fremitus
Dullness to percussion
Absent/diminished breath sounds
Shift of trachea and heart away

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41
Q

Which CXR view is most sensitive for pleural effusion?

A

Lateral decubitus

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42
Q

Gold standard to diagnose pleural effusion?

A

Thoracentesis

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43
Q

Grossly purulent fluid

A

Empyema

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44
Q

Light’s criteria

A

Pleural fluid protein : serum protein >0.5

Pleural fluid LDH : serum LDH >0.6

Pleural fluid LDH > 2/3 ULN for serum LDH

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45
Q

Solitary pulmonary nodule

A

3 cm or smaller in diameter

Rounded opacity

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46
Q

Calcification patterns on CXR that are benign

A

Diffuse
Central
Popcorn
Laminated

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47
Q

Calcification patterns on CXR that are potentially malignant

A

Stipples
Eccentric

Spiculated

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48
Q

Histoplasmosis

A

Bird dung
Infection
Flu like symptoms or asymptomatic

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49
Q

Blastomycosis

A

Fungus in soil
Asymptomatic or flu like
Infection
Rarely calcify or caseate the lungs

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50
Q

Coccidioidomycosis

A

Fungus in soil
60% asymptomatic
Moderate flu like symptoms
Severe in HIV patients

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51
Q

Squamous cell carcinoma

A

Bronchial epithelium
Centrally located
Hemoptysis
Spread locally, hilar LAD and mediastinal widening

**best prognosis

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52
Q

Adenoarcinoma

A

Peripheral nodules or masses
Metastasize earlier than squamous cell
Better prognosis in bronchioloalveloar cell

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53
Q

Large cell carcinoma

A

Rapid doubling times

Central or peripheral masses

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54
Q

Small cell carcinoma

A

Centrally located, bronchial origin
Regional lymph node involvement
Aggressive

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55
Q

Lung cancer clinical findings

A 
Anorexia
Dyspnea
Weight loss
NEW cough or CHANGE in cough
Hemoptysis
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56
Q

T1, T2, T3, T4

A

T1: <3 cm

T2: 3-7 cm

T3: >7 cm

T4: invasion of organs/vertebrae/carina/tumor nodules in same lobe

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57
Q

N0, N1, N2, N3

A

N0: no lymph involvement

N1: ipsilateral bronchopulmonary/hilar

N2: ipsilateral mediastinal/subcarinal

N3: contralateral hilar/mediastinal, supraclavicular

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58
Q

M0, M1

A

M0: no metastasis

m1: bilateral lesions

Distant metastasis, malignant pleural effusion

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59
Q

Hypersensitivity pneumonitis

A

Inflammation in the alveoli secondary to hypersensitivity to organic inhaled dusts

Acute reaction, can become chronic

Microbes, animal proteins, or LMW chemical

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60
Q

Acute findings of hypersensitivity pneumonitis

A

Malaise, chills, fever, cough, dyspnea

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61
Q

Chronic hypersensitivity pneumonitis findings

A

Muscle wasting, weight loss

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62
Q

Byssinosis

A

Inhalation of cotton fiber dust

Typically occuring when patients return to work after weekend or vacation

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63
Q

Cyanide inhalation

A

Antidote- hydroxocobalamin

Headache, weak pulse, vertigo, abnormal heartbeat, vomiting, death

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64
Q

Carbon monoxide exposure

A

Colorless, odorless, tasteless gas

Headache, light headed, flu like symptoms, central nervous system toxicity

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65
Q

Physical exam finding on CO inhalation

A

Cherry red skin (actually pallor is more common from the lack of oxygen)

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66
Q

Silo fillers. Disease

A

Toxic pulmonary edema from acute inhalation of nitrogen dioxide in recently filled silos

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67
Q

Pneumoconiosis

A

Chronic, fibrotic lung diseases secondary to hazardous inhalation

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68
Q

Coal workers pneumoconiosis

A

Chronic exposure to coal >10 years causing interstitial lung disease

CXR shows diffuse small opacities especially in upper lung fields

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69
Q

Silicosis

A

Fibrosing interstitial lung disease from inhaling fine particles of silica

Eggshell calcification

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70
Q

Asbestosis

A

Fibrosing interstitial lung disease from exposure to mineral asbestos

Pleural plaques, lower lung involvement, calcified plaques

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71
Q

What causes mesothelioma?

A

Asbestos

72
Q

Mesothelioma

A

Primary tumor arising from surface lining of the pleura or peritoneum

73
Q

Berylliosis

A

IARC group 1 carcinogen

Aerospace and fiber optics workers

Non caseating granulomas

74
Q

Radiation lung disease

A

Complication of therapy

Fibrosis or pneumonitis

75
Q

Bronchiectasis

A

Disease of large bronchi

Permanent dilation and destruction of bronchial wall

Recurrent infection or inflammation

76
Q

Causes of bronchiectasis

A

Cystic fibrosis commonly

Infection
Obstruction
Immunodeficiency

77
Q

Bronchiectasis symptoms

A 
Chronic cough
Copious purulent sputum
Hemoptysis
Rhinosinusitis
Weight loss, anemia, fatigue
78
Q

Signs/exam bronchiectasis

A

Crackles at lung base

Clubbing

Foul smelling, copious purulent sputum

79
Q

CXR findings in bronchiectasis

A

Atelectasis

Tram lines, ring shadows

80
Q

CT findings in bronchiectasis

A

Tree in bud opacities

81
Q

Cystic fibrosis

A

Most common cause of severe chronic lung disease in young adults

Altered CL and H20 transport across epithelial cells

Thickened mucus, obstructing airway, GI

82
Q

Signs of CF

A 
Pancreatitis
Infertility
Chronic lung dz
Steatorrhea
Cough
83
Q

Exam of CF

A 
Malnourished
Clubbing
Barrel chest
Apical crackles 
Gallstones
84
Q

CF diagnosis

A

Sweat chloride test

85
Q

Obstructive sleep apnea

A

Blockage of airway during sleep, resulting in periods of no breathing

86
Q

Risk factors of OSA

A

Age
Gender male
Obesity
Upper airway abnormality

87
Q

Pickwickian syndrome

A

Decreased ventilatory drive from obesity

88
Q

OSA has ______ ventilatory effort during apnea

A

Increased

89
Q

Manifestations of OSA

A 
Snoring
Waking up gasping or choking
Excessive daytime sleepiness
Thick neck
Large tonsils
90
Q

Common OSA screening tool

A

STOP- bang

91
Q

Atelectasis

A

Collapse or loss of lung volume/alveolar space

92
Q

Resorptive atelectasis

A

Alveolar space filling, commonly pneumonia

Chest wall pain is common with this type

93
Q

Compressive atelectasis

A

Pressure from mass effects in chest

94
Q

Exam with atelectasis

A

Minimal findings

Maybe decreased breath sounds, crackles, dullness to percussion

95
Q

5 w’s of atelectasis and post op fever

A 
Wind 
Water
Wound
Wonder drugs
Walking
96
Q

Acute respiratory failure

A

Dysfunction of respiratory system

Abnormal gas exchange, potentially life threatening, threatens end organs

97
Q

Acute respiratory distress syndrome

A

Abrupt onset of diffuse lung injury

Severe hypoxemia

Generalized infiltrates

Bilateral infiltrates with pulmonary edema without clinical HF

98
Q

A common cause of ARDS

A

Sepsis about 1/3 of the cases

99
Q

Clinical findings of acute respiratory distress syndrome

A

Rapid onset of profound dyspnea

Hypoxemia, tachypnea, accessory muscle usage

Diffuse or patchy bilateral infiltrates

100
Q

Pneumomediastinum

A

Consider bronchial or esophogeal perforation

101
Q

Idiopathic interstitial pneumonia

A

Acute or chronic

Restrictive pattern on PFT

102
Q

Cryptogenic organizing pneumonia

A

Previously known as BOOP

Follows flu like illness

DOE

Inflammatory debris in the alveoli

Usually responds to steroids

103
Q

Goodpastures syndrome

A

Glomerulonephritis

Pulmonary hemorrhage

Antiglomerular basement membrane antibodies

104
Q

Granulomatosis with polyangiitis

A

Classic triad of upper and lower respiratory tract disease and glomerulonephritis

105
Q

Unusual sign of granulomatosis with polyangiitis

A

Saddle nose deformity

106
Q

Church strauss syndrome

A

Allergic angiitis and granulomatosis

Skin and lung disease

Peripheral eosinophilia

107
Q

Inspiratory stridor is a sign of….

A

Upper airway obstruction

108
Q

Expiratory wheezing is a sign of…

A

Lower airway obstruction

109
Q

Acute bronchitis

A

Self limited inflammation of bronchi due to an upper airway infection

Usually a virus

110
Q

Typical presentation of acute bronchitis

A

Cough >5days

Sputum

Wheezing, mild dyspnea

111
Q

Physical exam in acute bronchitis

A

Rhonchi that clear with coughing

Wheezing

NO signs of parenchyma consolidation

112
Q

What are the criteria to order a CXR with a cough?

A

Abnormal vital signs

Persistent rales or other signs of consolidation

Special populations

113
Q

Bronchiolitis

A

Varied inflammatory processes that effect the bronchioles

114
Q

What is the most common cause of bronchiolitis in children?

A

RSV

115
Q

Clinical presentation of bronchiolitis

A

Viral upper respiratory prodrome followed by increased respiratory effort and wheezing usually 3-6 days after onset of illness

116
Q

Lung exam in bronchiolitis

A 
Retractions
Expiratory wheezing
Hyperexpanded chest
Hyperresonant to percussion
Crackles, rales, rhonchi
117
Q

Respiratory syncytial virus

A

Causes acute respiratory tract illness in persons of all ages

4-6 day incubation

Infects small bronchiolitis epithelium- necrosis of epithelial cells, proliferation of bronchiolitis epithelium, release of cytokines and chemokines

118
Q

Presentation of RSV

A

Airway obstruction, air trapping, increased airway resistance

Low grade fever, tachypnea, wheezing, cough, rhinorrhea, conjunctivitis

119
Q

Signs of RSV

A

Hyperinflated lungs, decreased gas exchange, increased respiratory effort

120
Q

Epiglottitis i

A

Inflammation and cellulitis of the epiglottis and adjacent supraglottic structures

Medical emergency

121
Q

Presentation of epiglottitis

A

Appears toxic with difficulty breathing

Muffled speech, hot potato voice

Tripod, doesn’t want to lie down

Hoarseness, cough, stridor

122
Q

X-ray findings of epiglottitis

A

Thumb sign

123
Q

Croup

A

Acute respiratory illness that leads to inflammation in the larynx and subglottic airway

Barry cough, stridor

124
Q

Anatomic hallmark of croup

A

Narrowing of the trachea in the subglottic region

125
Q

Westley croup scores mild moderate and severe

A

Mild is less than or equal to 2

Moderate is 3-7

Severe is 8 or greater

126
Q

Ap XR in croup

A

Steeple sign

127
Q

Bacterial tracheitis

A

Exudative bacterial infection of the soft tissue of the trachea

Staph aureus is almost all the cases

128
Q

Primary and secondary presentation of bacterial tracheitis

A

Primary- fulminant onset, progression of acute respiratory distress <24hrs after onset of minor symptoms

Secondary- viral respiratory tract infection prodrome 1-3 days prior to onset of severe symptomatology

129
Q

Signs and symptoms of bacterial tracheitis

A 
Fever
Stridor
Cough
Prefer to lie flat
Hoarseness
Wheezing
130
Q

Definitive diagnosis of bacterial tracheitis

A

Direct visualization of inflamed, exudative covered trachea

131
Q

What is the #1 infectious cause of death in the US?

A

Pneumonia

132
Q

What are the three normal defense mechanisms that are at risk in pneumonia?

A

Cough reflex

Mucociliary clearance system

Immune responses

133
Q

Mycplasma pneumoniae

A

Walking pneumonia, young adults

134
Q

Legionella pneumophila

A

Contaminated water sources
Older, sickly men
GI symptoms and abnormal LFTs

135
Q

Pneumonia history

A 
Fever, chills, rigors, malaise
Cough
Sputum
Chest pain
SOB
136
Q

Physical exam pneumonia

A

Bronchial breath sounds
Egophony
Dullness to percussion
Increased tactile fremitus

137
Q

Lobar pneumonia

A

Bacterial

138
Q

Interstitial pneumonia

A

Viral or mycoplasma

139
Q

Nodular pneumonia

A

Fungal

140
Q

Patients with CAP should be treated for a minimum of..

A

5 days

141
Q

3 categories of nosocomial pneumonia

A

Hospital acquired

Ventilator associated

Health care associated

142
Q

Problems with nosocomial pneumonia

A

Different pathogens
Different antibiotic susceptibility patterns
Impaired defense mechanisms

143
Q

High risk pathogens in nosocomial pneumonia

A

Pseudomonas

MRSA

Acinetobacter

144
Q

True aspiration pneumonia…

A

Infection caused by less virulent bacteria, primarily anaerobes

145
Q

Where does anaerobic pneumonia usually develop in the lungs?

A

Dependent lung zones

146
Q

Presentation of anaerobic pneumonia

A

Constitutional symptoms
Cough
Foul smelling purulent sputum

147
Q

Pulmonary embolism

A

Obstruction of the pulmonary artery or one of its branches by something that originated elsewhere within the deep venous circulation

148
Q

What is the 3rd leading cause of death in hospitalized patients?

A

PE

149
Q

How often does a PE develop if you have a DVT?

A

50-60% of the time

150
Q

3 acute classifications of PE

A

Massive

Submissive

Saddle PE

151
Q

How many PEs result from a DVT?

A

95% of PE’s

152
Q

Virchow’s triad

A

Stasis
Injury
Hypercoagulability

153
Q

Additional risk factors of PE in women

A

Obesity
Heavy cigarette smoking >25 a day
HTN

154
Q

Acute clinical manifestations of PE

A 
Sudden dyspnea onset
Plueritic chest pain
Cough
>2 pillow orthopnea
Calf or thigh pain or swelling
Wheezing
155
Q

PE physical exam

A

Tachypnea (most common)
Tachycardia
Hypoxia
Low grade fever

Late findings: HOTN, hemodynamically unstable

156
Q

EKG findings

A

Tachycardia
NSSTTchanges

S1Q3T3 changes

157
Q

CXR findings of PE

A

Atelectasis
Westermark sign
Hampton hump
Pleural effusion

158
Q

What is the imaging diagnostic study of choice for PE?

A

Helical CT with contrast

159
Q

What wells criteria values are highly likely for PE?

A

6 or greater

160
Q

Ventilation perfusion scan for PE

A

Identifies mismatch between areas that are ventilated by not perfumed

161
Q

What is the gold standard test for PE?

A

Pulmonary angiography

162
Q

What pharmacologic meaure is started ASAP with PE?

A

Empiric anticoagulation

163
Q

Low and high risk 30 day mortality

A

1%

11%

164
Q

Which situations with PE indicate indefinite anticoagulation?

A

Unprovoked PE

>2 or equal to 2 episodes

165
Q

Pulmonary HTN definition

A

Elevated pulmonary arterial pressure and secondary RV failure

Mean PA pressure >25mmHg at rest

166
Q

Pathophysiology of pulmonary HTN

A

Low pressure, hypoxemia causes PA vasoconstriction, PA pressure rises to an inappropriate level for the CO

167
Q

Idiopathic pulmonary HTN

A

Young, middle aged females

Absence of other lung or cardiac diseases

168
Q

Group 1 PH

A

Idiopathic, diseases of small pulmonary muscular arterioles, drugs nad toxins

169
Q

Group 2 PH

A

Left heart disease

170
Q

Group 3 PH

A

Lung diseases or hypoxemia

171
Q

Group 4 PH

A

Chronic thromboembolic HG

172
Q

Group 5 PH

A

Unclear, multifactorial mechanisms

173
Q

Clinical presentation of PH

A

Dyspnea
Fatigue
Chest pain

174
Q

Signs of PH

A

Narrow splitting of 2nd heart sound, large pulmonary component

Systolic ejection click

175
Q

What diagnostic study is needed to confirm diagnosis of HTN?

A

Right heart catheterization

Clin Med (7 decks)

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