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Pulmonary > Ingrid's Review > Flashcards

Ingrid's Review Flashcards

1
Q

Trachea

A

composed of 16-20 C-shaped cartilage rings

-posterior (open) part of ring accommodates the esophagus during swallowing

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2
Q

Carina

A

location of high concentration of cough receptors

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3
Q

Mainstem Bronchi

A

Right Bronchi

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4
Q

Right Bronchi

A

More apt to receive foreign objects aspirated into the trachea or to be “tube” during endotracheal intubation due to being shorter and wider

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5
Q

Bronchioles

A

transitional airways

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6
Q

Terminal Bronchioles - functions

A

heat, humidify, and conduct inspired air

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7
Q

Mucous Blanket

A

mucocilliary escalator

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8
Q

Mucocilliary escalator

A

submucosal glands and cilia

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9
Q

Submucosal glands

A

composition of normal mucous - 95% water

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10
Q

Cilia

A

paralyzed by nicotine

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11
Q

Major muscles of inspiration

A

diaphragm, sternocleidomastoid, scalene, pectoral minor

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12
Q

Diaphragm

A
  • principle inspiratory muscle
  • most important muscle of inspiration
  • –contributes to 70% of increase in thoracic expansion
  • innervation of left and right phrenic never
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13
Q

Poiseuille’s Law

A
  • flow is decreased by a factor of 4

- responses to bronchodilators (albuterol nebulizer therapy)

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14
Q

LaPlace’s Law

A

failure of this law = atelectasis

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15
Q

Dalton’s Law

A

total pressure exerted by a mixture of gases to sum of pressures exerted by each gas

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16
Q

Henry’s Law

A

when a gas is in contact with a liquid, the gas will dissolve in the liquid in proportion to its partial pressure

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17
Q

Boyle’s Law

A

decrease in oxygen tension (pressure) results in an increase in the volume

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18
Q

Limbic system - Anxiety

A

increase in rate and depth of respiration

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19
Q

Temperature

A

decreased body temperature decreases respiration

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20
Q

Pain

A
  • sudden severe pain brings on apnea

- prolonged pain increases respiratory rate

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21
Q

High altitude

A
  • decrease oxygen tension

- increase in volume (Boyle’s Law)

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22
Q

Irritation of Airways

A

immediate cessation of breathing followed by coughing or sneezing

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23
Q

Shift to the Left

A

Increased Hgb affinity for oxygen

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24
Q

Increased Hgb affinity for oxygen

A
  • alkalosis
  • hypocarbia
  • hypothermia
  • decreased 2,3-DPG
  • fetal hemoglobin
  • carboxyhemoglobin
  • methemoglobin
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25
Q

Shift to the Right

A

decreased Hgb affinity for oxygen

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26
Q

Decreased Hgb affinity for oxygen

A
  • acidosis
  • hypercarbia
  • hyperthermia
  • increased 2,3 - DPG
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27
Q

Carboxyhemoglobin - Pathophysiology

A
  • hemoglobin has a 200 to 250 times greater affinity for CO than O2
  • progressive shift to the left
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28
Q

Carboxyhemoglobin - Management

A

Hyperbaric oxygen therapy aka: dive chamber

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29
Q

Methemoglobin - Pathophysiology

A
  • +2 ferrous to a +3 ferric state

- shift to the left

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30
Q

Methemoglobin - Causes

A
  • nitrates and nitrites

- local anesthetics

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31
Q

Methemoglobin - Managment

A

methylene blue administration

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32
Q

Fetal Hemoglobin - Pathophysiology

A
  • two beta chains are absent and two gamma chains are present
  • shifts to the left
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33
Q

Hypoxia

A

state of tissue oxygen deficiency

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34
Q

Hypoxemic

A
  • most common type
  • decreased PaO2
  • COPD, pneumo
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35
Q

Anemic

A
  • decreased hgb availability

- anemia, carboxy/methemoglobin

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36
Q

Circulatory

A
  • stagnant (slow flow) vs AV shunting (no flow)

- cardiogenic vs septic shock

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37
Q

Methemoglobin - Clinical Manifestations

A

reddish brown blood, cyanosis (blue people)

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38
Q

Histotoxic

A
  • inability of tissue to use oxygen

- seen in cyanide poisoning (sodium nitroprusside toxicity)

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39
Q

normal pH

A

7.35 to 7.45

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40
Q

normal pCO2

A

35 to 45

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41
Q

normal HCO3

A

22 to 26

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42
Q

ROME

A

respiratory opposite direction and metabolic equal direction

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43
Q

Respiratory Acidosis

A

can’t breathe = impaired lung mechanics

-do not correct with sodium bicarbonate

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44
Q

Respiratory Alkalosis

A

CHAMPS Hyperventilate

  • CNS disease
  • Hypoxia
  • Anxiety
  • Mechanical ventilation
  • Progesterone or pregnancy
  • Salicylates or Sepsis
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45
Q

Metabolic Acidosis

A

MUDPILE CATS

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46
Q

MUDPILE CATS

A 
Methanol, metformin 
Uremia
Diabetic ketoacidosis
Paraldehyde, pregnancy 
Isoniazid (INH) and iron
Lactic acidosis 
Ethylene glycol
Carbamazepine
Alcoholic ketoacidosis
Toluene 
Salicylates, starvation ketoacidosis
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47
Q

Metabolic Alkalosis

A

CLEVER PD

  • Contraction
  • Licorice
  • Endocrine excesses
  • Vomiting
  • Excess alkali
  • Refeeding alkalosis
  • Post - hypercapnia
  • Diuretics
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48
Q

Cardiogenic pulmonary edema

A
  • part of overall problem related to CHF

- cardiomegaly

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49
Q

Non-cardiogenic pulmonary edema

A

damage to the alveoli or capillary without elevation of the pulmonary capillary wedge pressure

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50
Q

High altitude pulmonary edema

A

most common cause of death from high altitude illness

-treatment = get them down

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51
Q

Neurogenic pulmonary edema

A

subarachnoid hemorrhage or head trauma

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52
Q

Reperfusion pulmonary edema

A

after removal of blood clot

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53
Q

Re-Expansion pulmonary edema

A

occurs unilaterally status post rapid expansion of collapsed lung in pneumothorax

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54
Q

Opioid Overdose

A
  • particularly seen in heroin overdose

- treatment = naloxone (narcan)

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55
Q

Salicylate toxicity

A
  • generally occurs in elderly patients from chronic salicylate toxicity
  • treatment = sodium bicarbonate
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56
Q

Inhalants

A
  • chlorine gas

- ammonia

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57
Q

Pulmonary embolism - causes

A

Virchow’s triad

  • vascular intimal trauma
  • venous stasis
  • hyper-coagulable state
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58
Q

Pulmonary embolism - clinical manifestations

A
  • dyspnea

- tachypnea

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59
Q

Pulmonary embolism - ECG

A

sinus tachycardia

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60
Q

Pulmonary embolism - diagnostic gold standard

A

pulmonary angiography

—CTA or V/Q

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61
Q

WHO classification of pulmonary hypertension

A
  • pulmonary arterial hypertension
  • left heart disease
  • lung disease and/or chronic hypoxemia
  • chronic thromboembolic disease
  • miscellaneous
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62
Q

Pulmonary arterial hypertension

A

-idiopathic, women, poor prognosis

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63
Q

Lung disease/and or chronic hypoxemia

A

causes include ILD, OSA, COPD and any other cause of chronic hypoxemia

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64
Q

Chronic thromboembolic disease

A

recurrent PE

65
Q

Miscellaneous

A

tumor

66
Q

Pathophysiology of pulmonary hypertension

A
  • passive resistance of pulmonary venous system
  • hyperkinetic
  • obstruction
  • pulmonary vasoconstriction
67
Q

ARDS - Berlin Criteria

A
  • acute onset
  • refractory to O2
  • PCWP <18 mmHg
  • bilateral infiltrates on CXR
68
Q

ARDS - etiologies

A
  • sepsis is most common risk factor

- elderly + UTI + pneumonia

69
Q

ARDS - clinical manifestations

A
  • dyspnea, tachypnea, and tachycardia

- progressive hypoxemia

70
Q

ARDS - Diagnostics

A

ABG = hypoxemia and any ABG possible

-wedge pressure <18

71
Q

ARDS - Management

A
  • oxygenation
  • mechanical ventilation
  • fluid management
  • -avoid volume overload
  • treat underlying cause
72
Q

Transudative

A

CHF (most common)
low protein content, few cells
-occurs due to increased hydrostatic pressure or low plasma oncotic pressure

73
Q

Exudative

A
  • high protein content, may contain some white and red cells
  • occurs due to inflammation and increased capillary permeability
  • pneumonia, cancer, TB
74
Q

evaluated pleural fluid amylase

A

pancreatitis

75
Q

milky, opalescent fluid

A

chylothorax

76
Q

frank, purulent fluid

A

empyema

77
Q

blood effusion

A

malignancy

78
Q

exudative effusions that are primarily lymphocytic

A

tuberculosis

79
Q

ph<7.2

A

parapneumonic

80
Q

Glucose <60

A

RA

81
Q

empyema - etiologies

A

untreated exudative pleural effusion

82
Q

empyema - clinical manifestations

A

pneumonia most common underlying cause

83
Q

empyema - management

A

aggressive drainage of pleura with antibiotic therapy

84
Q

Chylorthorax - etiologies

A

tumors - most common cause
-lymphomas
trauma - 2nd most common cause
-surgery is most common cause of traumatic chylorhorax

85
Q

Chylorthorax - diagnostic findings

A

triglycerides in pleural fluid

86
Q

Chylorthorax - management

A
  • no treatment necessary
  • fat restriction
  • octreotide may be beneficial in some cases
87
Q

Pleurisy

A

history, history, history - commonly mimics a heart attack

88
Q

Pleurisy - etiologies

A

viral (most common) - may lead to epidemic pleurodynia (aka: Bornholm’s disease) viral pleurisy is a diagnosis of exclusion

89
Q

Pleurisy - appropriate management

A

treatment of the underlying etiology

-indomethacin

90
Q

simple/spontaneous pneumothorax - etiologies

A

tall, lean, young men +/- smokers

91
Q

simple/spontaneous pneumothorax - clinical manifestations

A

mediastinal shift toward side of pneumothorax

92
Q

Open pneumothorax

A

penetrating trauma = sucking chest wound

-cover the entry wound with a three-sided occlusive dressing

93
Q

Tension pneumothorax

A

accumulation of air within the pleural space such that the tissues surrounding the opening in the pleural cavity act as valves, allowing aria o enter but not escape
-absent breath sounds

94
Q

tension pneumothorax - CXR or physical exam findings

A

shift of trachea away from the side of pneumothorax

95
Q

tension pneumothorax - treatment

A

chest needle decompression in 2nd or 3rd intercostal space above rib

96
Q

Hemothorax

A
  • blood accumulating in pleural cavity

- tube thoracotomy

97
Q

Fail chest/pulmonary contusion

A
  • two or more ribs broken in two or more place

- severe blunt force trauma

98
Q

Stridor - causes

A

narrowed upper airway

99
Q

cough, congestion, and rhinorrhea

A

viral croup (MC)

100
Q

drooling, trismus, torticolis, inability to extend the neck or uvular deviation

A

peritonsillar abscess

101
Q

“steeple” sign

A

croup

102
Q

“thumbprint” sign

A

epiglottis

103
Q

Neonatal respiratory distress - causes

A

transient tachypnea of the newborn is most common cause

104
Q

Neonatal respiratory distress - clinical findings

A

respiratory distress, tachypnea, grunting, hypoxia, increased work of breathing
-symptoms may begin at birth and lasts up to 24 hours

105
Q

Neonatal respiratory distress - Management

A
  • supportive

- oxygen or CPAP may be required

106
Q

Croup - causes

A

parainfluenza virus serotypes

107
Q

Croup - Clinical Findings

A

barking cough, stridor worse with irritation

  • fever usually absent
  • cough with no drooling
108
Q

Croup - CXR

A

steeple sign

109
Q

Croup - mangement

A

Westley criteria to determine severity

  • humidified oxygen
  • steroid
  • racemic epinephrine, nebulizer
110
Q

Epiglottitis - causes

A

Hemophilus influenzae type B

Streptococcus spp.

111
Q

Epiglottitis - clinical findings

A
  • drooling

- tripod positioning or sniff dog positioning

112
Q

Epiglottitis - CXR

A

thumbprint sign

113
Q

Bronchiectasis - causes

A

cystic fibrosis - pseudomonas most common cause

114
Q

Bronchiectasis - clinical findings

A

cough with expectoration of large amounts of purulent ad foul-smelling sputum

  • hemoptysis
  • halitosis - bad breath
115
Q

Bronchiectasis - CT Scan

A

-tram-track appearance

Signet sign

116
Q

Bronchiectasis - Management

A

antibiotics are mainstay of treatment

117
Q

Acute Bronchiolitis

A
  • respiratory syncytial virus (RSV) most common cause

- humidified O@ is mainstay of therapy

118
Q

Bronchiolitis Obliterans

A 
CXR = cuffing
CT = mosaic
119
Q

Cryptogenic Organizing Pneumonia (COP)

A

fibrotic scaring

-no response to antibiotics

120
Q

Cystic fibrosis - causes

A

autosomal recessive disorder

  • meconium ileus and intussusception
  • pancreatic insufficiency and pancreatitis
  • chloride sweat test
121
Q

Cystic fibrosis - management

A 
airway clearance therapies 
-SABA and LABA
-antibiotics
-decongestants
regular exercise and proper nutrition
122
Q

Community acquired pneumonia - causes

A

streptococcus pneumonias

123
Q

Community acquired pneumonia - clinical manifestations

A

fever, cough, tachypnea, elevated WBC with leftward shift

124
Q

Community acquired pneumonia - management

A

empiric antibiotic therapy

-admit all children <3 months

125
Q

Apparent life-threatening

A

event in which infant has episode frightening to observer

  • apnea
  • color change
  • changes in muscle tone
  • choking or gagging
  • breath holding
126
Q

Apparent life-threatening - causes

A

50% - idiopathic

identified causes are related to GI, neurologic, and respiratory systems

127
Q

Apparent life-threatening - clinical manifestations

A

retinal hemorrhages

128
Q

Apparent life -threatening - management

A

hospitalization for patients with unexplained ATLE

-home apnea monitoring

129
Q

Sudden Infant death syndrome - risk factors

A 
Maternal = smoking and bed sharing 
Infant = prone sleep position
130
Q

What do you expect on chest x-ray with asbestos exposure?

A
  • small irregular opacities in lower lung fields
  • pleural plaques
  • blunting of costrophrenic angle
131
Q

presentation of sarcoidosis

A
  • noncaseated granuloma

- required the presence of involvement of 2 or more organ systems

132
Q

What to look for with a person who has worked in coal mines?

A
  • large masses of dust and collagen tissue
  • chronic bronchitis
  • appears about 10 years after exposure
  • inspiratory crackles
  • clubbing
  • cyanosis
133
Q

Presentation of IIP

A

fever, hemoptysis, pleuritic chest pain, bilateral basilar

  • wet quality = alveolar filling
  • dry quality = no alveolar filling = Velcro rales
134
Q

Treatment of IIP

A
  • eliminate further exposure
  • supplemental oxygen
  • glucocorticoids
  • refer to pulmonologist
135
Q

Lofgren’s sign

A

erythema nodosum and Hilar adenopathy

136
Q

Simple fibrosis

A

-fine crackles
-coarse crackles (end inspiration)
CXR = innumerable small rounded opacities in upper lung fields

137
Q

PMF

A

no crackles

-small opacities, gradually enlarge and connect to for larger opacities distributed in the upper and middle lung fields

138
Q

Sings and symptoms of lung cancer

A

cough, dyspnea, hemoptysis, weight loss, anorexia, clubbing, Horner syndrome, superior vena cava obstruction, bone pain

139
Q

American College fo Chest Physicians (ACCP)

A

use 7th edition of TNM (tumor size, nodes, and metastasis) staging system for prognosis and placement into clinical trials

140
Q

U.S Preventative Service Task Force (USPSTF)

A
  • support annual low dose CT to screen for lung cancer in patients 55 to 80 years of age with at least a 30-pack year history who currently smoke or have quit within past 15 years
  • screening every patient for tobacco use and encourage smoking cessation for smokers at every appointment
141
Q

What are some of the characteristic of malignant nodule?

A
  • subsoild nodules: purse ground glass or part solid in nature, non calcified or eccentric calcification
  • irregular or speculated borders
  • double in size from 1 month to 1 year
  • size is >10 mm
142
Q

When would a PET scan be cost effective in assessing a nodule?

A

most cost effective when the clinical pretest probability of malignancy and the results of the CT are discordant

143
Q

Presentation of lung cancer

A

cough, weight loss, dyspnea, chest pain, hemoptysis, bone pain, clubbing, fever, night sweats, weakness, anorexia

144
Q

Diagnostics of lung cancer

A

CXR, Chest CT, PET Scan

145
Q

What would make you consider malignant mesothelioma?

A

asbestos exposure

146
Q

Central Endobronchial Growth of Primary Tumor

A

cough, hemoptysis

dyspnea, wheeze

147
Q

Peripheral Growth of Primary Tumor

A
  • pain from pleura or chest wall involvement
  • dyspnea
  • lung abscess from tumor cavitation
148
Q

Regional Spread of Tumor in Thorax

A
  • tracheal obstruction, esophageal compression
  • laryngeal paralysis - hoarseness
  • Horner’s syndrome = ptosis, enopthalmos, mitosis, and anhidrosis
149
Q

Malignant Pleural Effusion

A

-pain, dyspnea or cough

150
Q

What presentation do you expect with a superior sulcus tumor?

A

Pancoast syndrome - pain that may arise in the shoulder or chest wall or radiate to the neck
Horner’s syndrome - enopthalmos, ptosis, mitosis, and anhidrosis

151
Q

What presentation would key you toward bronchial carcinoid tumor?

A

hemoptysis, cough, focal wheezing, and recurrent pneumonia

152
Q

How does Strep Pneumoniae present?

A

productive cough (rusty)

153
Q

What is atypical CAP?

A

walking pneumonia - mycoplasma pneumoniae

  • fever, dry cough
  • bullous myringitis
  • erythema multiforme
154
Q

What infections do you expect to see in AIDS patient?

A

pneumocystis jiroveci

155
Q

What infections do you expect to see in a smoker?

A
  • acute bronchitis

- C. pneumoniae (most common in smokers)

156
Q

Air conditioning can cause what type of infections?

A

legionella pneumophila

157
Q

What physical features do you expect to see in someone with pneumonia?

A

abrupt onset of fever, cough (w/wo sputum), pleuritic chest pain, dyspnea, fatigue, sweats, chills, rigors, anorexia, myalgia, headaches

158
Q

What is the pathology of bronchitis?

A

most common cause by virus

  • rhinovirus
  • coronavirus
  • RSV
159
Q

Treatment of bronchitis

A 
when lasted longer than 2 weeks
antibiotics indicated for 
-elderly patients
-patients with underlying cardiopulmonary disease
-immunocompromised patients

Pulmonary (12 decks)

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