IM Pulm - Rd 2 Flashcards
Pt that has rheumatologic condition that presents w/cough, fever, hemoptysis, and Hg drop has what?
Often assoc w/what?
Diffuse alveolar hemorrhage
Drugs
What are the PE findings of pts w/Cor pulmonale?
Peripheral edema Inc JVP Loud S2 Pulsatile liver from congestion TR
Exudative pleural effusions occur d/t what physiology?
Increase capillary permeability d/t cytokines release during inflammation
What can cause a small pleural effusion in a pt with sudden onset chest pain, dyspnea, and tachycardia?
PE
PCP in HIV pts can cause what additional problem?
SIADH
What can cause abrupt increases in RA pressure to > 10 mmHg and PA pressure to > 40 mmHg?
Can lead to what?
Massive PE
Dec CO, HoTN, Obstructive shock
According to uWorld, when should long-term supplemental home oxygen be given?
PaO2 = 55 or SaO2 = 88% on room air
OR
PaO2 = 59 or SaO2 = 89% in pts w/Cor pulmonale, RHF or Hct > 55%
Lung biopsy in a pt w/pulmonary arterial HTN demonstrates what?
Arterial intimal hyperplasia
What makes the Dx for chronic pulmonary aspergillosis?
Who is at increased risk?
> 3 months of B sx
Cavitary lesion
+ aspergillus IgG serology
Immunocompromised pt —> had TB in the past
How much should the TV be in pt when setting the ventilation controls?
6 mL/kg of IBW
What is ASA-exacerbated respiratory disease?
Presents in whom?
Presents how?
Pseudoallergic reaction to NSAIDs, NOT IgE mediated
Pts w/asthma, chronic rhinosinutitis w/nasal polyps
Bronchospasm and nasal congestion following ASA ingestion
JVD and RBBB on EKG indicate what?
Right heart strain
How is the DLCO effected in interstitial fibrosis?
Decreased capacity
How are the following effected in pleural effusion?
Breath sounds?
Tactile fremitus?
Percussion?
Dec (fluid insulates sounds and vibrations originating in the lung, making it quiet)
Dec
Dull
What things cause a high A-a gradient?
V/Q mismatch (PE)
R—>L shunt
Pulmonary fibrosis
Pt that has PNA in the left lobe and lies on left side, what will happen physiologically?
Why?
R—>L intrapulmonary shunting and V/Q mismatch
Gravity increases blood flow to left lung, but there is markedly decrease V d/t alveolar consolidation —> worse V/Q shunt
Diphragmatic flattening in COPD is d/t what?
Increased work of breathing
What improves mortality in ARDS pts?
Preventing alveolar overdistention
Aspergillosis appears in what settings?
TB, sarcoidosis, bronchial cyst, neoplasm
CT scan that shows pulmonary nodules w/surrounding ground-glass opacities is what?
Seen in what?
Halo sign
Invasive aspergillosis
What is CREST syndrome?
Calcinosis Raynaud’s Esophageal dysmotility Sclerodactyly Telangiectasia
Normal diffusion capacity of the lung (DLCO) is seen in what obstructive diseases?
Restrictive?
Chronic bronchitis, asthma
MSK deformity, Neuromuscular disease
What lung infection presents w/subacute fever, chills, malaise, HA, myalgia, dry cough with CXR showing Hilary LAD w/focal, reticulonodular infiltrates?
Biopsy shows what?
Histoplasmosis
Granulomas w/narrow-based budding yeasts
Pt that comes in with RECURRENT episodes of LARGE amounts of productive sputum production with hemoptysis and dyspnea, what is the most likely Dx?
Dx how?
Bronchiectasis
High Res CT
What tumor presents w/elevated bHCG and AFP?
Nonseminomatous germ cell tumor
Wedge shaped infarct is called what?
Seen in what condition?
Hampton hump
PE
Pt that may be developing ARDS, what is the goal PaO2?
This corresponds to what O2 Sat?
What should the FiO2 be immediately following intubation?
Prolonged FiO2 can cause what?
55-80
88-95%
> 60% then weaned down
Oxygen toxicity d/t O2 free radicals
What features help diagnose a pulmonary contusion?
Rales/dec breath sounds
CXR shows patchy, alveolar infiltrate
ABG shows hypoxia, hypocapnia, and respiratory alkalosis indicates what pathology?
CHF
Panacinar emphysema seen in what condition?
Centriacinar?
A1AT
Smoking (Senter - Smoking)
Why do COPD pts have relatively normal pH in their blood and not more acidosis?
Renal tubular compensation via increased bicarbonate retention
What do the PFTs look like in a pt w/Ankylosing spondylitis?
Dec VC and dec TLC
Normal FEV1/FVC
FRC 110% of predicted d/t fixation of the rib cage in an inspiratory position
