First Aid Flashcards by Melissa Khalil

Pulmonary hypoplasia

Poorly dev bronchial tree
Abnl histo
Ass w/ congen diaphragmatic hernia, bilat renal agenesis

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Bronchogenic cysts

Abnl budding of foregut
Dilation of terminal or large bronchi
Air-filled densities on CXR
Drain poorly + chronic infections

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3 risk factors + 3 complications of Neonatal respiratory distress sd

RF: prematurity, maternal db, C-section
Compl: metabolic acidosis, PDA, necrotizing enterocolitis

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Ttt + complications of O2 suppl in NRDS

Ttt: maternal steroids before birth, artificial surfactant for infant
Suppl O2: retinopathy of prematurity, intraventricular hge, bronchopulmonary dysplasia

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3 symptoms/signs in Phrenic nerve palsy

Respiratory distress
Diminished breath sounds ipsilat
Elevation of hemidiaphragm

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Ttt of cyanide poisoning

Induced methemoglobinemia (metHg has high affinity for cyanide)
By nitrites then thiosulfate

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Ttt of methemoglobinemia

Methylene blue and Vitamin C

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Ttt of carboxyhemoglobinemia

100% O2 and hyperbaric O2

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Response to high altitude

Respiratory alkalosis
Renal HCO3- excretion to compensate
Hypoxia: high EPO, Hb, 2,3-BPG
Chronic hypoxic pulmonary vasoconstriction: pulm HTN + RVH

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Response to exercise

V/Q more uniform (apex to base)
Low pH in strenuous exercise (lactic acidosis)
No change in PaO2 and PaCO2
High venous CO2 and low venous O2 content

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Microorganisms causing acute Rhinosinusitis

Viral +++

Superimposed bact: S pneumoniae, H influenzae, M catarrhalis

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2 types of epistaxis

Ant: Kiesselbach plexus (ant ethmoidal, sphenopalatine, sup labial)
Post: sphenopalatine art (branch of maxillary art)

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4 risk factors for Head and Neck cancer

Tobacco
Alcohol
HPV-16 (oropharyngeal)
EBV (nasopharyngeal)

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Virchow triad predisposing DVT

Stasis
Hypercoagulability
Endothelial damage

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Prophylaxis + ttt of DVT

Prophylaxis + acute ttt: unfractionated heparin or LMWH (enoxaparin)
Long-term prevention + ttt: oral anticoag (Warfarin, rivaroxaban)
Pregnancy: LMWH (best for mom+baby)

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Ttt of PE

Immediate: heparin, rivaroxaban

Severe PE + unstable ptt: recombinent tPA

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Centriacinar vs panacinar emphysema

CentriA: smoking, upper lobes; macroph+neutro release proteases
PanA: alpha1-antitrypdin def, lower lobes; excess neutro-elastase activity

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Chronic bronchitis vs asthma

CB: hyperplasia of mucus-secreting glands in bronchi
Asthma: smooth muscle hypertrophy

2 types of asthma

Extrinsic: atopic, high IgE, HS I
Intrinsic: non-immune mediated, normal IgE, precipitated by aspirin, cold air, inhaled irritants, stree, exercise, non-selective beta blockers, GERD, NSAIDs

Definition + 5 findings in Bronchiectasis

Chronic necrotizing inf of bronchi
Permanently dilated airways
Purulent sputum
Recurrent inf
Hemoptysis
Digital clubbing

4 conditions ass w/ bronchiectasis

Bronchial obstruction
Poor ciliary motility (smoking, Kartagener)
Cystic fibrosis
Allergic bronchopulmonary aspergillosis

Asbestosis

Ivory white, calcified, supradiaph, pleural plaques
Lower lobes
Asbestos in sputum (Prussian blue stain)
Bronchogenic carcinoma > mesothelioma

Berryliosis

Granulomatous

Upper lobes

Coal worker’s pneumoconiosis

Macrophages laden w/ carbon
Inflammation + fibrosis
Upper lobes
Anthracosis: asympt (urban)

Silicosis

Macrophages release fibrogenic factors Silica disrupt phagolysosomes + macroph: risk of TB Upper lobes Eggshell calcification of hilar lymph nodes

Acute respiratory distress syndrome

Acute resp failure Bilateral lung opacities: diffuse alv damage (protein-rich leakage) No evidence of HF/fluid overload: normal PCWP Sepsis, pancreatitis, pneumonia, aspiration, uremia, trauma, amniotic fluid embolism, shock

Microscopy of ARDS

Intra-alv hyaline membranes Toxic neutro substances Activation of coag cascade Oxygen-derived free radicals

Small cell carcinoma of the lungs

Central; smoking; amplification of myc Very aggressive ACTH, SIADH, Lambert-Eaton sd, Ab against neurons Neopl of neuroendocrine Kultchitsky cells Chromogranin A+, Synaptophysin+, neuron-specific enolase+ Chemotherapy +/- radiation

Adenocarcinoma of the lungs

Peripheral; most common in nonsmokers Activating mutations: KRAS, EGFR, ALK Glandular pattern (mucin+) Bronchioloalveolar subtype: better px, along alveolar septa

Squamous cell carcinoma of the lungs

Central; smoking Cavitation, necrosis, hypercalcemia (PTHrP) Keratin pearls, intercellular bridges

Large cell carcinoma of the lungs

``` Peripheral; highly anaplastic Pleomorphic giant cells Beta-hCG Poor prognosis Surgery ```

Bronchial carcinoid tumor of the lungs

Excellent prognosis Mass effect or carcinoid sd Neuroendocrine cells Chromogranin A+

Indications + adv effects of 1st + 2nd gen of Antihistamines

1st: allergy, motion sickness, sleep aid Adv eff: sedation, antimusc, anti alpha-adren 2nd: allergy Adv eff: far less sedating

Dextromethorphan

``` Antitussive Antagonizes NMDA glutamate recept Synthetic codeine analog Mild opioid if excess, mild abuse Serotonin sd if combined w/ serotoninergic agents If overdose: Naloxone ```

Pseudoephedrine, phenylephrine

Alpha-adren agonists Nasal decongestants Adv eff: HTN, CNS stimulation/anxiety (pseudoephedrine)

Pulmonary HTN drugs

Bosentan: antag endothelin-1 recept Sildenafil: inhib cGMP PDE-5, prolongs eff of NO Epoprostenol, iloprost: PGI2, vasodil pulm+system art, inh platelet aggreg

Methacholine

M3 agonist | Bronchial challenge test: exclude dg of asthma

6 asthma drugs

``` Beta2-agonists Inhaled corticosteroids Muscarinic antagonists Antileukotrienes Anti-IgE monoclonal therapy Methylxanthines ```

3 beta2-agonists

Albuterol: short-acting, acute exacerb | Salmeterol, formeterol: long-acting, prophylaxis

Inhaled corticosteroids

Fluticasone, budesonide Inactivate NFkB 1st line ttt for chronic asthma

Muscarinic antagonists

Ipratropium (short) Prevents bronchoconstriction, blocks tracheobr glands, enhances eff of Beta2+ For COPD Tiotropium (long-act)

Antileukotrienes

Montelukast, Zafirlukast: block leukot recept | Zileuton: 5-lipoxygenase pathw inh, blocks conv of arach acid to leukot

Anti-IgE monoclonal therapy

Omalizumab Binds unbound IgE For allergic asthma w/ high IgE resistant to inh cortico + long-act beta2

Methylxanthines

``` Theophylline Inhib phosphodiesterase: bronchodilation Narrow therapeutic index Metab by CYP450 Blocks adenosine ```