Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CPR Money > Hubbard Clin Med DSAs > Flashcards

Hubbard Clin Med DSAs Flashcards

1
Q

What defines an acute, subacute, and chronic cough?

A

acute < 3 weeks subacute = 3-8 weeks chronic > 8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the MRC dyspnea scale?

A
  1. not troubled by breathlessness except on strenuous exercise
  2. SOB when hurrying on level or walking up a slight hill
  3. walks slower than most ppl, stops after a mile or after 15 min at own pace
  4. stops for breath after 100 yds
  5. too breathless to leave house, or breathless when undressing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where does the sensation of dyspnea arise?

A

sensory input from resp muscles and lungs –> cerebral cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When should someone w/ dyspnea be transferred to acute care?

A

w/ significant tachypnea, accessory m use, or conversational dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the diagnoses of exclusion for acute dyspnea?

A

panic disorder and hyperventilation syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the primary initial diagnostic tool for dyspnea?

A

chest x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does presence of a basal opacity w/ a meniscus on CXR represent?

A

pleural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is dyspnea considered chronic?

A

when sx persit longer than 1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should the HPI include for dyspnea?

A

quality

precipitating events

associated features

risk factors for cardiac and pulmonary dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do ppl w/ CHF describe their dyspnea?

What about asthmatics?

A

chf = air hunger

asthma = chest tightness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When do you cardiopulm exercise testing and how is it done?

A

pt w/ dyspne whose hx, exam, and initial workup are unrevealing

pt exercises on treatmill or stationary bike w/ continuous oximetry and ECG and measurement of exhaled gases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most reliable indicator of the degree of dyspnea?

A

Pt self-report

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the most common causes of ARDS?

A

pulmonary and nonpulmonary sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the timing requirement for diagnosis of ARDS?

A

w/in 7 days of precipitating cause or onset of new/worsening resp sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the chest imaging requirement for diagnosis of ARDS?

A

bilateral airspace opacities

cannot be explained otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the definitions of mild, moderate, and severe oxygenation deficits?

A

mild PaO2 = 300

moderate = 200

severe = 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the 5 most common direct lung injury causes of ARDS?

A

pneumonia

gastric aspiration

chest trauma/lung contusion

inhalation injury

near-drowning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 5 most common indirect lung injury causes of ARDS?

A

nonpul sepsis

acute pancreatitis

severe nonchest trauma

blood transfusions

surface burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What auscultation sound is typical of ARDS?

A

rales

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What sx dominate the exudative phase of ARDS?

A

shunting and hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What occurs in the proliferative stage of ARDS?

A

type II pneumocytes begin to regenerate to replace surfactant and type I cells rebuild epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the typical length of the proliferative stage and why is it sometimes longer?

A

days 7-21

longer sometimes as procollagen III is deposited in interstitial space –> fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the best predictor of outcome of ARDS?

A

degree of hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the significance of time to recovery in ARDS?

A

pts who don’t get lower O2 requirements by day 7 are worse off

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is ECMO?

A

extracorporeal membrane oxygenation

supports hypoxemia w/out ventilator injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is HFOV

A

advanced ventilator with high resp rates but very small tidal volumes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the benefit of ventilation in ARDS?

A

prone vent at least 16 hrs a day decreases 28 ant 90 day mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the effect of corticosteroids in ARDS management?

A

no benefit

can see neuromyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the mortality rate of ARDS?

A

35 to 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What causes the hypoxemia in ARDS?

A

edema in alveoli –> V/Q mismatching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What type of ventilation can help ARDS pts w/ refractory hypoxemia?

A

high-frequency oscillatory ventilation (HFOV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Where is nasopharyngeal cancer more commonly seen?

A

in mediterranean countries and far east

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the most significant risks for head and neck cancer?

A

alcohol and tobacco

*act synergistically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What viruses are associated w/ head and neck cancer?

A

EBV - esp med and far east

HPV 16 and 18 - good outcome in young pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What type of head and neck cancer is frequently associated w/ EBV?

A

nonkeratinizing and undifferentiated carcinoma (lymphoepithelioma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the premalignant lesions of head and neck cancer?

A

erythroplakia or leukoplakia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

At what age do most tobacco-related head and neck cancers occur?

A

after age 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What sex gets head and neck cancer more?

A

males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How does cancer of the nasopharynx present?

A

typically no early sx

can cause unilateral serous otitis media

advanced –> neuropathies of cranial nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How does oral cancer typically present?

A

nonhealing ulcers, changes in fit of dentures, or painful lesions

if at tongue base - alterations in speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How to HPV-related tumors frequently present?

A

neck lympadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When would you do a CT scan of the chest for workup of head and neck cancer?

A

for a heavy smoker to rule out a second lung primary tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are T1-T3 tumors of the head and neck?

A

primary tumors w/out metastasis

1 = 2 cm

2 = 2-4 cm

3 > 4 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are stage 4a and 4b tumors of head and neck?

A

4a = invades another structure

4b = invades skull base and or encases carotid A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How are pts with head and neck cancer grossly divided?

A

those w/ localized dz

those w/ locally or regionally advanced dz

those w/ recurrent and/or metastatic dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How are pts w/ localized head and neck cancer treated?

A

surgery or radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How are pts w/ locally adv head and neck cancer treated?

metastatic?

A

local: combined surgery, radiation, and chemo –> 50% 5 yr survival
metastatic: palliative care, regional radiation for pain control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the median survival time for pts w/ metastatic or recurrent head and neck cancer?

A

8-10 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What new txs have improved survival for pts w/ advanced head and neck cancer?

A

monoclonal Ab w/ standard chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the best way to prevent lung cancer?

A

don’t smoke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What screening strategy for lung cancer is est to reduce lung cancer mortality by 14-16%?

A

low dose CT scans to screen for early stage lung cancer in smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What features characterize benign pulm nodules?

A

no growth in 2 yrs

calcification in a diffuse, central, or laminar pattern

less than 2 cm w/ round edges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is bisphosphonate therapy used for in lung cancer?

A

decreases skeletal complications in pts w/ bony metastases

also can use RANK ligand inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the main tx for small cell lung cancer?

A

combo chemo w/ platinum agent and etoposide + radiation

improves survival, but most pts still relapse and die

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What virus is associated w/ nasopharyngeal cancer?

oropharyngeal?

A

EBV = nose

HPV = mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Who should be screened for early lung cancer?

A

current and former smokers aged 55-85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are the 5 Ddxs for COPD?

A

asthma

bronchiectasis

CF

bronchiolitis

alpha1-antitrypsin deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What criteria are most supportive of COPD?

A

self-reported history of COPD

>40 pack year hx

max laryngeal height = 4 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What does cor pulmonale sound and look like?

A

increased intensity of pulmonic sound

persistently split S2

parasternal lift due to R ventricular hypertrophy

neck V distention, edema, enlarged liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What spirometry results confirm COPD?

A

postbronchodilator FEV1 < 80% of predicted

FEV1/FVC ration <70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the BODE system used for?

A

evaluating the risk for hospitalization and long-term prognosis in COPD pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

When should a nebulizer be used?

A

when pt cannot use MDI or inhaler bc of severe sx or coordination issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What are the txs of COPD based on GOLD criteria?

A

I: short acting bronchodilater as needed

II: regular tx w/ one or more long-acting bronchodilators; add pulm rehab

III: add inhaled corticosteriods

IV: add long-term O2 therapy if chronic resp failure; consider surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How often do you take LABAs?

A

every 12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What are the most common side effects of beta-agonists?

A

increased HR and tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

When do you use inhaled anticholinergics for COPD?

A

comine w/ SABA or LABA and/or theophylline

dont combine tiotropium w/ short-acting anticholinergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the most common side effect of inhaled anticholinergics?

who do you use them with in caution?

A

dry mouth

watch out for pts w/ urinary obstruction and narrow-angle glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How does theophylline work and why is it controversial?

What can you use instead?

A

nonspec PDE inhibitor

narrow therapeutic index

roflumilast is an oral PDE-4 inh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

When do you add oxygen therapy in COPD?

A

PO2 < 55 mm Hg or O2 sat < 88%

or < 59 and < 89 if pulm htn or r-sided hf

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

How do you use inhaled glucocorticoids in COPD?

A

never alone

combine w/ bronchodilator w/ recurrent exacerbations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

How do you treat COPD exacerbations?

A

SABA + anticholinergic if no response to SABA

systemic steroids in hospital tx of severe exacerbations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What defines a severe exacerbation of COPD?

A

loss of alertness or 2 of the following:

dyspnea at rest

resp rate > 25/min

pulse rate > 110/min

use of accessory resp muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Can you use antibiotics for tx of COPD?

What are std meds?

A

yes, benefit for mod or severe exacerbations

3rd gen cephalosporin w/ macrolide or monotherapy w/ fluoroquinolone

74
Q

What are the 2 types of ventilation for COPD and when do you use them?

A

noninvasive intermittent: alleviates resp acidosis and decr respiration rate and other sx

use invasive mechanical vent for pts who are severe and can’t tolerate noninvasive

75
Q

If pt has low PaCO2, what else can indicate tx w/ O2?

A

hematocrit > 55%

R heart failure

O2 sat < 88

76
Q

What is the most effective way to slow progression of COPD?

A

smoking cessation

77
Q

What interstitial lung dz should be suspected based on female gender?

A

lymphangioleimyomatosis (LAM)

78
Q

What ILD should be suspected if pt has uveitis/conjuctivitis also?

A

sarcoidosis

connective tissue dz

79
Q

What ILDs are basal predominant?

A

IPF

asbestosis

NSIP

80
Q

What ILDs are upper-lobe predominant?

A

hypersensitivity pneumonitis

sarcoidosis

silicosis

81
Q

What ILDs are peripheral predominant?

A

IPF

chronic eosinophilid pneumo

COP

82
Q

What ILDs are central predominant?

A

sarcoidosis pulmonary alveolar proteinosis

83
Q

What drugs are a common cause of lung dz?

A

amiodarone

methotrexate

nitrofurantoin

84
Q

What ILD is very closely associated with smoking?

A

langerhaan cell histiocytosis

85
Q

What diagnostic reading is most helpful for diagnosing ILD?

A

decreased diffusing capacity

86
Q

What are common sx of obstructive sleep apnea?

A

impaired daytime attention and memory

daytime sleepiness

disruptive snoring

witnessed apnea

erectile dysfunction

mood changes

night sweats

87
Q

What are complications of untreated sleep apnea?

A

secondary hypertension

secondary erythocytosis

increased heart O2 demand and HF

stroke

88
Q

What is the most impt risk factor for OSA?

A

obesity

89
Q

What is an AHI?

A

apnea-hypopnea index

>5 confirms OSA

90
Q

What is required for diagnosis of OSA?

A

polysomnography

91
Q

What is the general tx plan for OSA?

A

lifestyle changes (weight loss, sleep on side, avoid alcohol and sedatives before bed)

CPAP

can try mandibular advancement devices if CPAP is not working, but only in mild cases

surgery

92
Q

Who typically get primary pneumothorax?

A

tall, thin males ages 10-30

93
Q

What 2 things are considered risk factors for dev of pneumothorax?

A

aerosolized pentamidine

prior hx of pneumocystis pneumonia

94
Q

WHo should get a chest tube?

A

secondary pneumothorax

large pneumothorax

tension pneumothorax

severe symptoms

95
Q

Why should ppl stop smoking after a pneumothorax?

A

recurrence is 50% if you’re a smoker

96
Q

What are indications for an thoracoscopy or open thoracotomy?

A

recurrences of pneumothorax

bilateral

failure of tube thoracostomy

97
Q

What are sx of a pneumothorax?

A

chest pain

sx usually begin during rest and resolve w/in 24 hours even if the pneumothorax persists

may present w/ resp failure if underlying cOPD or asthma is present

98
Q

What is the prognosis of a pneumothorax?

A

30% of spontaneous will recur

recurrence after surgery is less likely

99
Q

What does a massive pleural effusion suggest?

A

underlying cancer of lung or pleura

100
Q

What is assoc w/ bilateral transudative effusions?

A

heart or liver failure

101
Q

What do bilateral exudative effusions suggest?

A

malignancy or SLE and other collagen vascular dzs

102
Q

What signs suggest an empyema?

A

loculated effusion on upright and decubitus chest XR

103
Q

What dzs have exudative effusions?

A

infection

cancer

collagen vascular dz

intra-abdominal processes

hypothyroidism

104
Q

Why type of pleural effusion is caused by venous thromboembolic dz?

A

exudative or less commonly transudative

105
Q

What is the pleural fluid like in cancer or TB-related pleural effusion?

A

lymphocyte-predominant

106
Q

When should you remove fluid in a pleural effusion?

A

mediastinal shift –> 2.0 L or more can be removed

in other cases don’t remove more than 1.5 L to min risk of reexpansion pulm edema

107
Q

What defines the anterior mediastinum?

A

sternum ant to pericardium and brachiocephalic vessels posterioly

thymus gland

ant mediastinal LNS

internal mammary As and Vs

108
Q

What defines the middle mediastinum and its contents?

A

heart

ascending and transverse arches of the aorta

Vena cavae

brachiocephalic As and Vs

phrenic Ns

Pulmonary As and Vs

109
Q

What is contained in the posterior mediastinum?

A

descending thoracic aorta

esophagus

thoracic duct

azygos and hemiazygos Vs

posterior LNs

110
Q

What are the common lesions in the anterior mediastinum?

A

thymomas

lymphomas

teratomas

thyroid tumors

111
Q

What are the most common masses in the middle mediastinum?

A

vascular masses

LN enlargement

pleurpericardial and bronchogenic cysts

112
Q

What are the common lesions in the posterior mediastinum?

A

neurogenic tumors

GI cysts

esophageal diverticula

113
Q

What typically causes acute mediastinitis?

A

esophageal perforation or after median sternotomy for heart surgery

114
Q

What typically causes chronic mediastinitis?

A

histoplasmosis or TB

(sarcoidosis, silicosis and other fungi are possible)

115
Q

What is pneumomediastinum?

A

air in interstices of mediastinum; 3 causes:

alveolar rupture

perforation of esophagus, trachea, or main bronchi

dissection of air from neck or abdomen into mediastinum

116
Q

What is hamman’s sign?

A

crunching or clicking noise synchronous w/ heartbeat

best hear in left lat decubitus pos

heard in pneumomediastinum

117
Q

How much fluid is needed to blunt the costophrenic angle on plain CXR?

A

250 ml

this creates a meniscus sign

118
Q

What imaging sign is indicative of adequate pleural fluid to perform thoracentesis?

A

1-cm distance from pleural fluid line to the chest wall

119
Q

What two lab findings can distinguish btw transudative and exudative pleural fluid?

A

levels of LDH and protein

120
Q

What cause of pneumonia is acquired hematogenously?

A

staphylococcus

121
Q

Who gets pneumonia from gram negative bacteria?

A

those w/ comorbidities and in extended care facilities

122
Q

Who is more likely to get pseudomonas pneumonia?

A

pts w/ structural lung dz

after recent antibiotic therapy or hospitalization

123
Q

What are the risk factors for pneumonia?

A

alterations in anatomic barriers

impairment of humoral or cell-mediated immunity or phagocyte function

124
Q

How effective is the flu vaccine in preventing pneumonia?

A

reduces pneumonia-related mortality during flu season 27-50%

125
Q

Who should get the flu shot?

Antiviral for flu?

A

all persons 6 mos or older

oseltamivir or zanamivir in unvaccinated high-risk persons during epidemic

126
Q

What versions of the pneumococcal vaccine are available and who/when should get them?

A

23-valent polysaccharide PPSV23 –> all adults 65 and over and those under 65 in long-term care or who are immunocompromised

13-valent conjugate vaccine PCV13 –> one-time adults 65 and over or those immunocompromised, asplenia, CSF leak, or cochlear implants

127
Q

In what sequence are the pneumococcal vaccines given?

A

PCV13 given first –> PPSV23 at least 8 weeks later

if 23 already given –> 13 given 1 yr after

128
Q

What is the CURB-65?

A

criteria to ID high-risk pts for pneumo

Confusion

Urea nitrogen > 19.6

Respiration rate 30 or above

BP <90 systolic or <60 diastolic

>65 yrs old

*meet at least 2 –> admitted to hospital*

*meet at least 3 –> ICU*

129
Q

What tests should you run for pneumonia in an uncomplicated outpt setting?

A

CXR and pulse oximetry

130
Q

What tests should your run for a pneumonia pt in the hospital?

A

CXR

2 sets of blood cultures

routine metabolic panel

pulse ox

CBC

131
Q

When should you do sputum culture in suspected pneumonia?

A

pts at risk for resistant or unusual pathogens

those w/ severe pneumonia

132
Q

When should you consider unusual pathogens as the cause of pneumonia?

A

if they dont respond to empiric therapy w/in 48-72 hrs

133
Q

What is the definition of respiratory failure?

A

inability to maintain o2 sat >90 on max mask oxygen or the presence of hypercarbia

134
Q

How to treat outpt pneumonia uncomplicated and w/ heart dz or modifying factors?

A

macrolide or doxycycline

w/ comorbidity: beta-lactam and macrolide or doxycycline

135
Q

How to tx hospitalized pts w/ pneumonia?

A

O2, don’t delay antibiotics –> IV

repiratory quinolone or combo of B-lactom and a macrolide or doxy

if aspiration expected –> clindamycin or beta-lactam

136
Q

How do you tx a lung abscess secondary to aspiration?

A

w/ clindamycin and consider surgery

137
Q

How long do you tx pts w/ mild-to-moderate community-acquire pneumonia?

A

7 days or less if there is agood response, no fever for 48-72 hrs, no sign of other infection

138
Q

How long do you tx someone w/ legionella?

A

5-10 days w/ quinolone

139
Q

How long do you tx pneumo caused by Pseudomonas or S. aureus?

A

10 days or more

4-6 weeks if bacteremic staph

140
Q

How can supportive measures improve pneumonia recovery?

A

use of beta-agonist nebulizer, physical therapy, and OMM –> 25% shorter recovery period

141
Q

What is HCAP?

A

heathcare-acquired pneumonia

develops at least 48 hrs after hospitalization

includes VAP, non-vent associated, and post-op

142
Q

What is the most common cause of HCAP?

A

microaspiration of bacteria that colonize the oropharynx and upper airways

endotracheal intubation = greatest risk

143
Q

What antibiotics should be given to someone w/ suspected HCAP?

A

no risk factors –> ceftriaxone or levofloxacin

risk factors –> antipseudomonal and vancomycin

144
Q

What defines pulmonary HTN?

A

elevation of mean pulm a pressure of 25 mm hg or greater during rest

145
Q

What is idiopathic pulmonary arterial htn and how do you treat it?

A

uncommon, 2:1 female to male

management focused on vasodilator therapy

146
Q

What causes most cases of pulm htn?

A

conditions causing elevation of left-sided heart filling pressures

pulmonary dz

147
Q

What might you find on PE of a person w pumonary htn?

A

augmented jugular A wave

pulmonic component of S2 or single S2

tricuspid regurg or pulmonic insufficiency

r ventricular S3 or S4 gallops

148
Q

How is PHtn confirmed?

A

only by R heart catheterization and direct measurement of MPAP

149
Q

How are 6-min walk studies helpful in PHtn?

A

functional assessment

checking progression and response to therapy

150
Q

What is group I PHtn?

A

idiopathic

heritable

drug and toxin-induced

assoc w/ connective tissue dz, HIV, congenital heart dz, anemia, etc.

151
Q

What is group 2 PHtn?

A

Left heart disease

systolic disfunction

diastolic dysfunction

valvular disease

152
Q

What is group 3 PHtn?

A

secondary to lung disease/ hypoxia

COPD, ILD, other pulm dzs

sleep-disordered breathing

chronic exposure to high altitude

153
Q

What is group 4 PHtn?

A

chronic thromboembolic pulm htn

154
Q

What is group 5 PHtn?

A

secondary unclear or multifactorial causes

systemic, metabolic, hematologic , tumor obstruction, kidney failure

155
Q

What is group 1’ PHtn?

A

pulmonary veno-occlusive and/or pulmonary capillary hemangiomatosis

156
Q

How is a positive TST defined?

A

by the diameter of the indurated area, not the size of the erythema

157
Q

How long can it take for TST test to become positive after exposure?

A

12 weeks

can do retesting 7-21 days after first

158
Q

What is an alternative to skin TB testing?

A

IGRA - assesses T-cell response to spec M. tuberculosis antigens

more expensive and not available in all areas, but can do single blood draw; no false-positives in vaccinated ppl

159
Q

How do you tell if there is active TB?

A

positive TST

hx and physical + chest xray

160
Q

What does reactivation TB look like on imaging?

A

lesions in apical posterior segments of upper lung and superior segments of the lower lung

161
Q

What defines multidrug-resistant TB?

extensively drug resisant?

A

resistant to at least isoniazid and rifampin

extensive: also resistant to fluoroquinolones and at least kanamycin, amikacin, or capreomycin

162
Q

What does the term fat embolism syndrome mean?

A

clinical syndrome that follows fat embolism

classic triad: hypoxemia, neurologic abnormalities, patechial rash

163
Q

What typically causes fat embolism from fracture and who gets them?

A

long bone and pelvic fractures

more frequent in closed fractures

more common in men aged 10-40

rarely surgical trauma

164
Q

What are the two theories of the pathogenesis of fat embolism?

A

mechanical theory: fat globules directly enter bloodstream

biochemical: inflammation results from the production of toxic intermediates of circulating fat

165
Q

How many people have hypoxemia in fat embolism and how many people have patechial rash?

A

hypoxemia = 96%

rash = 20-50%

166
Q

What is seen on imaging of fat embolism?

A

CXR normal in most ppl, sometimes see air space dz or edema

CT of lung normal or bilateral ground glass opacities or ill-defined centrilobular nodules

Ventilation-perfusion - look for PE, mottled pattern of subsegmental perfusion defects

MRI brain: starfield pattern

167
Q

What is the only treatment of FES?

What are preventatitve measures?

A

Tx: supportive

Prevention: ealry immobilization of fractures, intraosseous pressure limitation, prophylactic systemic steroids (controversial)

168
Q

Why is the pharyngeal airway susceptible to collapse?

A

doesn’t have rigid structures supporting it unlike oral and nasal cavities

169
Q

How does upper and lower airway obstruction present?

A

sx after obstruction has been there for a while

airway diameter 8 mm –> sob on exertion

airway 5 mm or less –> sob at rest

170
Q

What characterizes stridor?

A

occurs during inspiration and is loudest in the neck

can be confused w/ asthma, but stridor is heard higher up

171
Q

What is the imaging technique of choice for the upper airway?

A

thoracic CT

(trachea usually well visualized on PA XRay, but study showed a ton of tumors were missed this way –> CT now prefered)

172
Q

How is the Wells criteria for DVT used?

A

score of 0 or lower –> DVT unlikely –> d-dimer testing –> if positive, U/S, if negative, nothing

score of 1-2 –> moderate risk –> high-sensitivity d-dimer –> if positive do U/S

score of 3 or more –> DVT likely, do U/S

173
Q

How long should heparin and warfarin overlap when transitioning to warfarin?

How long should someone be on anticoagulants after a DVT?

A

min of 5 days

min of 3 mos

174
Q

When should you screen for PE or DVT?

A

only in symptomatic pts

noninvasive diagnostic tests are insensitive and not assoc w/ improved outcomes

175
Q

What is d-dimer testing used for?

A

to rule out PE or DVT in symptomatic pts

(if high risk, don’t use d-dimer and go ahead and tx)

176
Q

What initial testing should be done for PE?

A

contrast-enhanced CT (very specific, but kidney issues w/ contrast and might not visualize small subsegmental emboli)

or ventilation-perfusion scanning (less kidney issues, doesn’t provide direct image of clot, less affected by obesity)

177
Q

When is thromboembolytic therapy appropriate for a PE pt?

A

may be effective for:

pts w/ circulatory shock

pts w/ acute embolism and PH or R vent dysfunction but without arterial hypotension or shock

178
Q

What is a westermark sign?

hamptom hump?

A

westermark: lack of vascularity distal to PE
hamptom: peripheral wedge-shaped density above diaphragm

(both can be seen in PE)

179
Q

What do you use to tx pneumonia if aspiration is suspected in a hospitalized pt?

A

clindamycin or a beta-lactam/lactamase inhibitor

180
Q

How do you tx latent TB?

A

isoniazid daily for 9 mos

or rifampin daily for 4 months

or combo of rifampin and isoniazid once weekly for 3 mos

181
Q

What defines MDR TB and extensively drug-resistant TB?

A

MDR: resistant to at least isoniazid and rifampin

XDR: also resistant to fluoroquinolones and at least to kanamycin amikacin, or capreomycin

CPR Money (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions