Exam Flashcards

1
Q

Tidal volume (TV/VT)

A

Volume of air inspired and expired during normal quiet breathing

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2
Q

INSPIRATORY RESERVE VOLUME (IRV)

A

The maximum amount of air that can be inhaled after a normal tidal volume inspiration

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3
Q

EXPIRATORY RESERVE VOLUME

A

Maximum amount of air that can be exhaled from the resting expiratory

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4
Q

RESIDUAL VOLUME

A

Volume of air remaining in the lungs at the end of maximum expiration; indirectly measured

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5
Q

TOTAL LUNG CAPACITY

A

Volume of air in the lungs after a maximum inspiration

TLC = IRV + TV + ERV + RV or VC + RV

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6
Q

FUNCTIONAL RESIDUAL CAPACITY

A

Volume of air remaining in the lungs at the end of a TV expiration
The elastic force of the chest wall is exactly balanced by the elastic force of the lungs
FRC = ERV + RV

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7
Q

VITAL CAPACITY

A

Volume of air that can be exhaled from the lungs after a maximum inspiration
VC = IRV + TV + ERV

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8
Q

INSPIRATORY CAPACITY

A

Maximum amount of air that can be inhaled from the end of a tidal volume
IC = IRV + TV

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9
Q

best values spirometry measures

A

Forced expiratory volume in one second (FEV1)
Forced vital capacity (FVC)
FEV1/FVC%

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10
Q

Obstructive pattern on PFT

A

DECREASED FEV1,
DECREASED FEF 25-75
Decreased FEV1/FVC - <70% predicted

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11
Q

DDx for obstructive lung dz

A

asthma

COPD (chronic bronchitis, emphysema)

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12
Q

Restrictive pattern on PFT

A

Decreased TLC, FVC

Normal or increased: FEV1/FVC ratio

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13
Q

significant bronchodilator response value

A

FEV1 increase by 12% AND >200ml

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14
Q

bronchodilator response

A

documents reversible airflow obstruction

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15
Q

what does spirogram measure

A

forced inspiratory and expiratory flow rate
gold standard
evaluate upper respiratory obstruction

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16
Q

lung volume patterns in obstructive dz*

A

TLC >120% PREDICTED

RV >120% PREDICTED

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17
Q

lung volume patterns in restrictive dz*

A

TLC <80% PREDICTED

RV <80% PREDICTED

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18
Q

DLCO (Carbon Monoxide Diffusing Capacity)

A

pt breathe in carbon monoxide, measure how much of it exhaled
measures gas exchange at alveolar-cap membrane

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19
Q

what is diagnostic of asthma in bronchoprovocation test?

A

greater or equal 20% increase in FEV1

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20
Q

What value is used to follow disease severity in COPD patients?*

A

FEV1

marker for obstructive lung dz

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21
Q

Biggest risk for COPD

A

80-90% TOBACCO SMOKE

VERY HIGH RISK if >40ppy

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22
Q

Causes of COPD

A

Asthma; 10-30 fold increase risk
childhood respiratory infection
alpha 1-trypsin deficiency

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23
Q

Pathophysiology of COPD

A
chronic irritation
airflow limitation/air trapping
gas exchange abnormalities
mucus hypersecretion
pulm vascular scarring from chronic inflammation --> pulm HTN --> R HF
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24
Q

2 types of COPD

A

emphysema
chronic bronchitis
(often coexist)

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25
Q

how to diagnose chronic bronchitis

A

productive cough lasting at least 3 months in 2 consecutive years (exclude other causes)
IRREVERSIBLE

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26
Q

Chronic Bronchitis

A

increase mucus and inflammation from hyperplasia/hypertrophy of goblet cells/mucus glands
affecting terminal bronchioles

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27
Q

Biggest symptoms of Chronic Bronchitis

A

excessive mucus –> cough

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28
Q

what can happen eventually with chronic bronchitis?

A

thickening of airways –> fibrosis –> pulm HTN

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29
Q

Acute Bronchitis

A

affects LARGE bronchi

from virus/bacteria

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30
Q

Emphysema

A

permanent destruction of alveolar sac –> enlarged air spaces

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31
Q

pathophysiology of emphysema

A
loss of lung elasticity
destruction of lung parenchyma
enlargement of air spaces
PERMANENT
inadequate gas exchange
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32
Q

Classic COPD Symptoms

A

chronic cough
sputum (purulent w/exacerbation)
breathlessness + fatigue, DOE
(and wheezing, chest tightness)

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33
Q

population affected with COPD

A

> 40 yo w/risk factors

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34
Q

What should you consider if pt has COPD AND Clubbing of fingers

A

lung cancer

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35
Q

Late dz presentation of COPD

A
muscle wasting, weakness
pursed lip breathing*
R HF Sx: JVC, Peripheral edema, hepatomegaly
depression, anxiety
osteoporosis
polycythemia (inc epo from hypoxia)
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36
Q

how to Dx COPD

A

Risk factors and confirm w/spirometry

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37
Q

Spirometry findings for COPD

A

FEV1/FVC <0.7

reduced expiratory flow

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38
Q

What spirometry value is used to stage COPD and determine treatment?

A

FEV1

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39
Q

Class IV COPD

A

FE1 <30% predicted

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40
Q

how to distinguish asthma from COPD?

A

Do Pre/Post bronchodilator spirometry

asthma will have post bronchodilator change, but NOT COPD

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41
Q

COPD treatment

A

prevent progression, exacerbation, infections
maintain at least 88% oxygenation
short acting, long acting bronchodilators
STEP UP and CUMULATIVE Tx

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42
Q

What do ALL COPD patients need?

A

flu and pneumococcal vaccine!

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43
Q

When are inhaled glucocorticoids used in COPD?

A

Severe cases
helps airway inflammation
s/e: oral thrush, increase risk infection in immunocomp
eg fluticasone

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44
Q

What is the only thing that improves survival for COPD?

A

Smoking prevention/cessation

O2 therapy

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45
Q

What is the mainstay treatment at EVERY stage of COPD?

A

Inhaled bronchodilators (BA or anti-cholingeric)

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46
Q

Examples of short acting bronchodilators

A

Beta agonist: albuterol
Anti-cholinergic: ipratropium
used for sx relief

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47
Q

Examples of long acting bronchodilators

A

LABA: salmeterol
LAMA: Tiotropium (anti-cholinergic)
used for prevention

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48
Q

When do you recommend pulmonary rehab for COPD patients?

A
symptomatic pts w/FEV1 <50% predicted
class II to IV
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49
Q

When do you prescribe O2 therapy?

A

PaO2 <55 mmHg

O2 <88%

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50
Q

Signs of COPD exacerbations

A

inc cough freq/severity
inc sputum/change in sputum - purulent
inc dyspnea

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51
Q

Tx for COPD Exacerbation

A

sputum culture but start empirical abiotic first
Antibiotics (50% from bacterial infection) - azithro
bronchodilator, systemic corticosteroids (prednisone), O2

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52
Q

Most common chronic illness in children

A

asthma

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53
Q

Asthma pathophysiology

A

inflammation and constriction of lumen in small airways (thickened)
obstructive dz - reversible!

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54
Q

Symptoms of Asthma

A

coughing
wheezing
breathlessness
chest tightness

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55
Q

Causes of asthma

A

hereditary + environ
RSV as infant
allergen, air quality, tobacco

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56
Q

Triggers of asthma

A

allergen, virus, exercise, cold air, emotions –> causing bronchial hyperresponsiveness (constriction)

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57
Q

What happens if asthma is chronic and uncontrolled?

A

airway remodeling (fibrosis, inc mucus, hypertrophy, injury, angiogenesis)

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58
Q

Dz progression of asthma

A

increase airway edema and mucus hyper secretion

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59
Q

Key of asthma

A

CONTROL

control the allergy –> control the asthma!

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60
Q

Most bronchoconstriction is what?

A

IgE-mediated

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61
Q

Strongest predisposing factor to asthma

A

atopy –> propensity for IgE response

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62
Q

Characteristics of Asthma*

A

airflow obstruction
bronchial hyper-responsiveness
underlying inflammation
(attacks of impaired breathing)

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63
Q

What should be included in DDx with unexplained dyspnea/cough

A

asthma

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64
Q

Asthma cough characteristics

A

non-productive (dry)
episodic
worst at night*

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65
Q

What can you find on PE of asthma

A

end expiratory wheezing*

inc nasal drainage, mucosal swelling, nasal polyps

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66
Q

What is the gold standard diagnostic tool for asthma

A

spirometry before and after SABA

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67
Q

How to objectively diagnose asthma?*

A

FEV1 increase 12% from baseline after SABA (reversibility)

atleast 20% decrease in FEV1 after methacholine (bronchoprovocation test)

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68
Q

How to determine tx for asthma

A

assess severity (for initial Tx) and control (changes in tx) of symptoms

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69
Q

When is systemic corticosteroids used in asthma?

A

> or equal 3 wheezing/yr

or 2 eps/6mon

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70
Q

What should everyone with asthma get?

A

SABA - rescue inhaler - for acute bronchospasm

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71
Q

What is the preferred long term control for all age groups for asthma?

A

Inhaled corticosteroids - prevent exacerbations, most effective for persistent asthma

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72
Q

When to step down treatment for asthma?

A

asthma controlled for 3 months

start high and step down once control achieved, maintain lowest effective dose

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73
Q

Tx for severe asthma exacerbation

A

oral corticosteroids

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74
Q

How is LABA used?

A

ONLY in combo w/ICS, NOT monotherapy
only for Step 3 and above and greater than 5 yo
(can increase asthma related death in young children)

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75
Q

Sampter’s Triad

A

(ASA exacerbated asthma)
ASA sensitivity
Asthma
Nasal Polyps

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76
Q

How do you confirm pleural effusion?*

A

CXR - PA and Lateral view

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77
Q

What is pleural effusion associated with

A

infection (eg bacterial pneumonia)
malignancy
HF
Trauma

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78
Q

Biggest PE finding in Pleural Effusion

A

dullness w/percussion

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79
Q

What is the most useful test and treatment for pleural effusion?*

A

thoracentesis, both Dx and Tx

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80
Q

Function of pleural fluid

A

lubricant to minimize friction during breathing
surface tension - allows alveoli to inflate maximally
reabsorbed by lymphatics

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81
Q

Types of pleural effusions

A

transudative

exudative

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82
Q

Transudative pleural effusion

A

due to increased hydrostatic pressure or low plasma oncotic pressure
causes: HF, cirrhosis, nephrotic syndrome, PE

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83
Q

Exudative pleural effusion

A

due to inflammation and increased capillary permeability

causes: pneumonia, cancer, TB, viral infection, PE

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84
Q

Lab differences between transudative and exudative fluid*

A

Transudative fluid: low in protein and LDH

Exudative: high in protein and LDH

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85
Q

Causes of exudative pleural effusion

A
malignancy
infection
PE
Chylothorax
Hemothorax
GI dz
Collagen dz
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86
Q

Causes of transudative pleural effusion

A

90% CHF
cirrhosis
kidney failure: nephrotic syndrome
(rarely need intervention)

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87
Q

Light’s Criteria for exudative pleural effusion

A
  1. pleural fluid protein/serum protein >0.5
  2. or pleural fluid LDH/serum LDH >0.6
  3. or pleural fluid LDH >2/3 normal upper limit of serum LDH
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88
Q

Symptoms of pleural effusion

A
SOB*
Pleuritic pain*
Cough*
DOE, orthopnea
25% asymp
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89
Q

Pleural effusion on PE

A
DULLNESS TO PERCUSSION
decreased/absent tactile fremitus
dec breath sounds
egophony
friction rub
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90
Q

Mediastinal shift in unilateral pleural effusion

A

AWAY

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91
Q

What do do if suspect malignancy in pleural effusion?

A

take 3 diff samples
cytology
glucose

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92
Q

Color differences between transudative and exudative pleural fluid

A

transudative: very clear
exudative: dark
normal: straw colored

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93
Q

Lab results of pleural effusion w/malignancy

A

pos cytology
glu <60mg/dl
frank red fluid

94
Q

Lab results of pleural effusion w/chylothorax

A

milky fluid

triglyceride >110 mg/dl

95
Q

Purulent pleural fluid

A

empyema

96
Q

Pleural fluid WBC ct >10,000

A

parapneumonic effusion

acute pancreatitis

97
Q

Pleural fluid WBC ct >50,000

A

complicated parapneumonic effusion

empyema

98
Q

Low glucose levels of pleural fluid

A

infections
autoimmune
malignancy

99
Q

What is low pH of pleural fluid and malignancy associated with?

A

poorer prognosis

100
Q

What can you get if you remove too much pleural fluid at once?

A

pulmonary edema

101
Q

When is pleurodesis used

A
recurrent effusions
(chemically adhere visceral and parietal layers; drain fluid beforehand - eg doxycycline)
102
Q

VATS (video assisted thoracoscopic surgery)

A

deflate affected lung –> draw out fluid –> re-inflate lung

low success rate

103
Q

When is thoracotomy used?

A

empyema
lung cancer
(involves decortication or pleurectomy)

104
Q

How is pleural effusion usually diagnosed?

A

History

description of fluid

105
Q

Interstitial lung disease

A

damage to alveolar walls and lung parenchyma from inflammation and resulting fibrosis

106
Q

Hallmarks of interstitial lung disease

A

restrictive pattern on PFT

decrease diffusing capacity for carbon monoxide

107
Q

drugs that cause acute interstitial lung dz

A

amiodarone

methotrexate

108
Q

diseases that can cause interstitial lung dz

A

RA
cancer
sarcoidosis
amyloidosis

109
Q

Most common type of interstitial lung dz*

A

idiopathic interstitial fibrosis

110
Q

Interstitial lung dz affects which population of people generally

A

> 50 yo

111
Q

Most common causes of interstitial lung dz

A
idiopathic pulmonary fibrosis
sarcoidosis
assoc collagen vascular dz
occupation related
drug or toxin related
112
Q

Most common presenting complaint of interstitial lung dz

A
DYSPNEA**
SOB
non-productive cough 
chest tightness/heaviness
weight loss, fatigue, anorexia
113
Q

what is hilar/mediastinal lymphadenopathy associated with in interstitial lung dz?

A

sarcoidosis
silicosis
lymphoma

114
Q

what is pleural effusion/thickening associated with in interstitial lung dz

A

collagen vascular dz
lymphoma
asbestos

115
Q

“ground glass” on CXR

A

amiodarone

Inflammation –> potentially reversible

116
Q

“honey comb” on CXR

A

Fibrosis

VERY POOR PROGNOSIS - IRREVERSIBLE

117
Q

What population is associated with idiopathic pulmonary fibrosis?

A

older, male

BAD prognosis

118
Q

Pathology of idiopathic pulm fibrosis

A

triggering event –> inflammation –> damage alveolar-cap basement membrane –> inc perm –> FIBROSIS

119
Q

End stage of idiopathic pulm fibrosis

A

destruction of alveolar wall

honeycombing on CXR

120
Q

What pulm function is reduced in idiopathic pulm fibrosis

A

DLCO (diffusing capacity) reduced

but normal spirometry ratios

121
Q

characteristic of sarcoidosis

A

multiple uniform non-caseating granulomas (lungs and lymph nodes)

122
Q

most common population with chronic sarcoidosis

A

north american blacks

123
Q

What can you get with sarcoidosis

A

iritis and uveitis

124
Q

large, “fluffy” nodules on CXR

A

Sarcoidosis

125
Q

Sarcoidosis staging*

A

Stage 0: normal
Stage I: Hilar adenopathy only
Stage II: Hilar adenopathy and parenchymal involvement
Stage III: parenchymal involvement alone

126
Q

Tx for sarcoidosis

A

most don’t require treatment

treat if symptomatic, ocular, and other organ involvement (corticosteroids)

127
Q

pneumoconiosis

A

hypersensitivity pneumonitis from inhaled dusts/chemicals (occupational)

128
Q

Hallmark of chronic pneumoconiosis

A

pulmonary fibrosis in upper lobes

129
Q

what cancer can you get with asbestos

A

mesothelioma

130
Q

Pneumothorax

A

collapsed lung from air in potential space

131
Q

Causes of pneumothroax

A

penetrating trauma
blunt trauma
barro trauma
birth

132
Q

Signs of pneumothorax

A

decreased breath sounds - affected side
hyperresonance
tracheal deviation
crepitance - lungs

133
Q

Tracheal deviation of tension pneumothorax*

A

AWAY from side w/decreased breath sounds

134
Q

Tracheal deviation of routine pneumothorax*

A

TOWARD side w/decreased breath sounds

135
Q

empyema

A

purulent fluid in pleural space

136
Q

stages of empyema

A

exudative
fibrinopurulent
organizing

137
Q

empyema causes

A

pneumonia
mediastinal infection
abscess

138
Q

empyema necessitans

A

complication of empyema

goes into chest wall

139
Q

risk factors of lung abscess*

A
alcoholism* - most common
severe gingivodental dz
seizures
CV accidents
anesthesia
140
Q

Which side is more commonly affected w/lung abscess*

A

right side 75%

141
Q

bronchiectasis

A

persistent, abnormal dilation of bronchi

142
Q

which side is more common in bronchiectasis?*

A

left*

143
Q

most common type of bronchiectasis

A

varicose 62%

144
Q

causes of bronchiectasis

A

acquired: viral, bacterial, obstruction, heroin

congenital rare

145
Q

most common symptom of bronchiectasis

A

persistent cough 75%

146
Q

pulmonary HTN

A

elevated pulmonary arterial pressure and secondary right ventricular failure

147
Q

what’s the mean arterial pressure in pulmonary HTN*

A

> 20mmHg at rest

148
Q

How is pulmonary arterial pressure measured?

A

right heart catheterization

149
Q

Group 1 pulmonary HTN

A

pulmonary arterial HTN - RIGHT heart dz

150
Q

Group 2 pulmonary HTN

A

pulmonary venous HTN - LEFT heart dz

151
Q

Group 3 pulmonary HTN

A

associated w/lung dz

152
Q

Group 4 pulmonary HTN

A

associated w/embolitic dz

153
Q

Group 5 pulmonary HTN

A

unclear, multi-factorial

154
Q

Initial complaints of pulmonary HTN

A

Dyspnea on exertion*
fatigue
lethargy

155
Q

PE of pulm HTN*

A

increase pulmonic component of S2 (P2)

156
Q

What diagnostic test should you first order for pulm HTN*

A

2D echo w/doppler flow study

157
Q

Biggest cause of dyspnea in children

A

infections

foreign body aspiration

158
Q

Causes of acute dyspnea in adults

A
(PPOPPA)
PE
Pulm edema
obstructed airway
pneumothorax
pneumonia
asthma/COPD
159
Q

most common airway obstruction in adults*

A

food bolus

160
Q

most common airway obstruction in children*

A

coins

161
Q

What should you think w/dyspnea at rest AND pleuritic chest pain

A

PE

162
Q

What presentation is most severe w/dyspnea

A

orthopnea

163
Q

types of PE

A

acute: immediately after
subacute: days/weeks after
chronic: pulm htn over years

164
Q

pulmonary embolism

A

obstruction of pulmonary arteries/branches by thrombus, air, fat, tumor

165
Q

locations of PE

A

Saddle
Lobar
Segmental and Subsegmental
Clot-in-Transit

166
Q

which locations are the large thrombi

A

saddle: bifurcation of main pulmonary artery
lobar: uni or bilateral

167
Q

Which PE is more likely to cause pulmonary infarct and pleuritis*

A

segmental and subsegmental (branches)*

168
Q

Clot in transit PE*

A

TRAVELS THROUGH HEART

HIGH MORTALITY!!

169
Q

Effects of massive PE

A

Right heart failure
cardiogenic shock (arterial hypotension)
(submassive + low risk PEs: normal BP)

170
Q

most common cause of unexpected death in most age groups

A

PE

171
Q

3rd most common cause of CV death in US

A

PE

172
Q

High population is at high risk for PE?

A

Hospitalized patient

Dx missed 70%!

173
Q

acute PE at high risk for:

A

recurrence
pulmonary HTN
chronic cor pulmonale

174
Q

where do LE thrombi originate from

A

valve cusps/bifurcations

areas of low blood flow!!

175
Q

common causes of fatal PE

A

axillary and subclavian veins
veins in pelvis
indwelling central venous catheter

176
Q

1/2 of PEs are what

A

Asymp!

177
Q

RV thrombus has**

A

double mortality!!

178
Q

cor pulmonale

A

right sided heart failure from pulmonary HTN (from chronic lung disease like COPD, OSA)

179
Q

Symptoms of PE*

A

Dyspnea at rest or w/exertion (73%)

Pleuritic chest pain (66%)

180
Q

Signs of PE*

A

Tachypnea (70%)

rales (51%)

181
Q

Patients without what symptoms are unlikely for PE*

A

Dyspnea, pleuritic chest pain, tachypnea

182
Q

Massive PEs sign

A

systolic BP <90mmHg or drop in atleast 40mmHg from baseline
JVD
only 4% of PEs byt 20-60% mortality

183
Q

what’s the gold standard to Dx DVT

A

contrast venography

184
Q

Labs to order for PE

A

D Dimer: pos

ABG: hypoxemia, resp alkalosis

185
Q

Gold standard to diagnose PE*

A

Pulmonary angiography

186
Q

1st choice to Dx PE (not gold standard)*

A

CT pulmonary angiography (spiral)

187
Q

Well’s criteria

A

assess whether there’s PE

188
Q

PERC rule

A

criteria to rule out PE
for pts w/low Well’s score
need to fulfill all 8 criteria to rule out PE

189
Q

What you may see on CXR w/PE

A

Westermark sign: dilation of pulmonary vessels

190
Q

Tx for PE

A
  1. Assess HD stability
  2. Anticoagulate to prevent progression
  3. Thrombolytic if massive PE/unstable, inject near location
191
Q

preferred anticoagulant for PE

A

DAOAC (Direct acting oral anticoag): eliquis, xarelto

-only HD stable pts

192
Q

when should you prophylax for PE

A

Post-op: esp ortho/pelvic surgery on LE - early ambulation, lovenox, pneumatic compression
planned stasis risks: long flights - ASA

193
Q

what procedure has high mortality in PE

A

embolectomy

194
Q

how is cystic fibrosis inherited?

A

autosomal recessive

195
Q

Pathophysiology of cystic fibrosis

A

defect in CFTR gene –> abnormal Cl transport –> mucus more viscous/sticky to bacteria –> promote infection/inflammation

196
Q

Dx of CF*

A

Dz in one or more organs

>/= 60mmol/L sweat chloride**

197
Q

Atypical CF likely present w/

A

Gi issues
DM infertility
dx >18 yo

198
Q

when is CF typically Dx?

A

1 yo

199
Q

Presentations of CF

A
Respiratory tract involvement
sinus dz
pancreatic dz
meconium ileus
hepatobiliary dz
musculoskeletal dz
reduced/infertility
200
Q

How does CF affect male fertility

A

> 95% infertile bc defects in sperm TRANSPORT

201
Q

What do most patients eventually get w/CF*

A

Pseudomonas respiratory infection

202
Q

pulmonary presentation of CF

A

Dry hacking (non-productive) cough
lung hyperinflation on CXR
Chronic bronchitis

203
Q

Sinus presentation of CF

A

Chronic nasal congestion

10-32% nasal polyps

204
Q

Pancreatic presentation in CF

A

pancreatic insufficiency –> fat malabsorption!
resultant poor weight gain
deficient in fat/protein, fat-sol vitamins

205
Q

Meconium ileus

A

bowel obstruction by meconium (stool produced in utero) in infants
only 10-20% occurence byt 80-90% w/this has CF!

206
Q

Advance dz of CF

A

Distal intestinal obstructive syndrome (DIOS)

clubbing, bronchiectasis

207
Q

Hepatobiliary presentation in CF

A

Focal biliary cirrhosis: inc serum alk phos, lobular hepatomegaly from thickened bile
12% cholelithiasis

208
Q

Musculoskeletal presentation in CF

A

Reduced bone mineral density

rare: hypertrophic osteoarthropathy: abnormal prolif

209
Q

hand in bucket sign of CF

A

Aquagenic wrinkling of palms
white plaques
rare

210
Q

How to dx non-classic CF (sweat chloride normal)

A

nasal potential difference

or DNA analysis

211
Q

Tx goals for CF

A

Maintain lung function
control infections
clear mucus
nutritional

212
Q

Tx for CF exacerbations

A

chest percussion and postural drainage:
bronchodilator 1st
clap on chest/back or vest
loosen mucus

213
Q

CF medication

A
pancreatic enzymes
bronchodilators
vitamin D
mucolytics: dornase alfa
CFTR potentiators
antibiotics
214
Q

Management/follow-up for CF

A

Monitor every 2-3 months

resp culture every visit

215
Q

How to differentiate between chronic bronchitis and emphysema on PFT?

A

emphysema: INC Residual Volume

216
Q

How to differentiate between asthma and emphysema w/DLCO?

A

asthma: inc DLCO
emphysema: dec DLCO
(DLCO unaffected in Chronic bronchitis)

217
Q

TB w/Night sweats, think…

A

HIV

218
Q

Latent TB on CXR

A

Ghon Lesion –> enlarged hilar nodes

or normal

219
Q

Ghon lesion

A

fibrotic, calcified lesion

contain: T cell, macrophage, central necrosis

220
Q

Reactivation risk of TB in HIV pts

A

10% risk every year!

221
Q

How does active TB infection spread?

A

cavitary open into bronchi, spread by cough

222
Q

Where do you first see calcifications in TB?

A

Apices

223
Q

Late sign of TB*

A

Hemoptysis

Rasmussen’s Syndrome

224
Q

What does PPD do?

A

only screens for TB exposure

test only at risk pts!

225
Q

How long do you need to isolate pts w/TB

A

Atleast 2 weeks after Tx or until 3 sequential sputum neg

226
Q

What’s the minimum initial therapy for TB

A

3 drugs minimum initially

227
Q

How long is TB medication taken for ?

A

6-9 months

228
Q

1st line agents for TB*

A

ISONIAZID
RIFAMPIN
ETHAMBUTOL
PYRAZINAMIDE

229
Q

Causes of false negative in PPD

A

Anergy, steroids, HIV, malnutrition

230
Q

Most common causes of community acquired pneumonia

A

s. pneumoniae
H. influenzae
Mycoplasma
viruses