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Pulm Review > Lipschik Review + Jeopardy > Flashcards

Lipschik Review + Jeopardy Flashcards

1
Q

Effusion with low glucose DDx

A

TB, RA, infection, cancer

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2
Q

DDx effusion very high WBC

A

empyema

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3
Q

Bloody effusion

A

trauma, asbestos

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4
Q

Low pH effusion

A

incipient infection

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5
Q

high LDH effusion

A

complicated parapneumonic

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6
Q

High TG (chylous) effusion DDx

A

lymphoma, trauma

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7
Q

Transudate effusion Lx DDx

A

LDH ratio <.5

Adelectasis, dialysis, mixidema, nephrotic syndrome, CHF

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8
Q

Exudate effusion Lx DDx

A

LDH ratio >0.6
TP ratio >0.5
-Lots of things: cancer, pneumonia, empyema, TB

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9
Q

DDx diffuse interstitial disease

A
  • IPF with UIP (lower)
  • CVD (scleroderma)
  • drugs (amiodarone, bleomycin)
  • sarcoidosis (upper/middle)
  • hypersensitivity pneumonitis
  • lymphagitic spread
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10
Q

Restrictive PFTs

A

-FEV1 and FVC dec, but ratio preserved or increased
TLC and RV down
DLco down

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11
Q

Restrictive PFTs with PRESERVED RV and normal (corrected) DLco

A
  • NM disease
  • obesity
  • poor effort
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12
Q

Why do we ventilate?

A
  • Decreased work of breathing, unload muscles, relieve dyspnea
  • not necessarily a terrible blood gas, can be more about how pt looks
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13
Q

What kind of ventilation is used in resp distress?

A

Volume-cycled, positive pressure

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14
Q

Effects of PPV on CO

A
  • decreased by numerous mechanisms (hypotension)
  • Decreased venous return (L and R), decreased distensibility (L and R), septal displacement (R->L), Increased vascular resistance (R)
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15
Q

Tx for PPV-induced hypotension

A

-fluid initially, then inotropes

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16
Q

fluffy alveolar infiltrates with air bronchograms on CXR

A
  • pulm edema (ARDS, CHF)

- aspiration, diffuse pneumonia, DAH, adenocarcenoma in situ

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17
Q

small cell (location, staging, Tx, prognosis)

A
  • central
  • localized vs disseminated
  • chemo or chemo+rad
  • rarely curable. usually responds/recurs
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18
Q

non-small cell (subtypes, location, staging, Tx, Px)

A
  • adeno, squamos, large cell
  • central or peripheral
  • TNM
  • Surg, rad for palliation
  • curable, depending on stage
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19
Q

hypoxemia that barely improves or doesn’t with fiO2

A

shunt

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20
Q

diuretics for pulmonary edema and starling equation

A

decreases hydrostatic pressure!

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21
Q

Tx ARDS, adelectasis and RDS

A

PEEP/CPAP

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22
Q

PEEP/CPAP vs BIPAP

A

PEEP/CPAP do not provide ventilatory support

BIPAP is PEEP+PPV via NIV does provide ventilatory support. used for OHS and severe COPD flares

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23
Q

monitoring pts on MV

A
  • clinical (secretions, MS, CXR, udnerlying)
  • ABGs
  • Mechanics: Cstat = dV/(Pplat-PEEP)
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24
Q

distinguishing causes of respiratory distress on MV pts

A
  • Ppeak - Pplat reflect airflow only (not passive compliance)
  • if the stay the same, then it’s parenchymal problem (edma, embolus, pneumonia, PTX, anxiety, pain, auto-PEEP
  • if widened, airway problem (ETT problems, tubing kinked, secretions, bronchospasm (NB!)
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25
Q

OSA vs OHS

A

OSA: obstructive apnea, decreased cognition, HTN, CVA, arrhythmias, naps, transient hypoxia asleep, eucapnic while awake. dx: PSG (high AHI), rx: wt loss, CPAP

OHS: obst/central apnea, chronic fatigue, morning h/a, cor pulmonale, hypoxia and hypercanpia asleep and awake, dx: PSG, daytime hypercapnia. tx: wt loss, BIPAP (because needs ventilatory support), trach, bariatric surgery

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26
Q

Answer to Question #1

A

A

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27
Q

form alveolar pressure

A

Pel + Ppl

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28
Q

alveolar air equation and shortcuts

A 
PAO2 = fiO2 x (BP - WVP) - PaCO2/RQ + F
BP - barometric
WVP - water vapor
RQ - resp quotient (.8)
shortcut: 713 x FiO2 - 1.2 x PaCO2
on RA: 147 - 1.2 x PaCO2
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29
Q

form AaDO2

A

PAO2 (RA or 100%) - PaO2

30
Q

determinant of PACO2

A

-given metabolic CO2 production, ventilation is inverse to PACO2

31
Q

rate of gas diffusion across membrane

A

Vgas = A/T x D x dP

non-membrane components: capillary volume, O2-hemoglobin interaction time (theta)

32
Q

form minute ventilation

A

Ve = Va + Vd = Vt xf

33
Q

form compliance

A

dV/dP and 1/E

34
Q

form Cstat on MV

A

dV/dP

Vt / (Pplat- PEEP)

35
Q

hyperinflation on CXR

A
  • lots of ribs
  • flattened diaphragm
  • COPD (chronic) or asthma (acute)
36
Q

asthma PFTs

A
  • obstructive (FEV1/FVC)
  • might have hyperinflation/gas trapping
  • normal DLco
  • *FEV1 improves >12% w/ bronchodilators
37
Q

causes obstructive PFTs w/ normal DLco

A
  • chronic bronchitis
  • bronchiectasis
  • asthma
38
Q

restrictive PFTs

A

-TLC low and preserved FEV1/FVC

39
Q

mixed defect PFTs

A

-FEV1/FVC and TLC low

40
Q

-hyperinflation and air trapping PFTs

A
  • TLC high = hyperinflation

- RV high = air trapping

41
Q

nml PFTs with nml DLco

A

-PV disorders (PAH, PE)

42
Q

restrictive PFTs by DLco

A
  • nml (adjusted) DLco: CW and NM disorders, also obesity and low effort
  • low DLco: ILD, pneumonitis
43
Q

obstructive PFTs by DLco

A
  • nml DLco: astma, CB

- low DLco: emphysema

44
Q

F-V loops

A
  • obstructive: pushed left and expiratory shape distorted
  • restriction: pushed right and shape preserved
  • variable extra-thoracic UA obstruction: flattened inspiration
  • variable intra-thoracic UA obstruction: flattened expiration
45
Q

causes of dyspnea in COPD

A
  • hyperinflation –> loss of mechanical advantage
  • loss of elasticity
  • hypoxia/hypercapnia (more in CB)
  • airway obstruction (loss of tethering, effective of active expiration, bronchiolostenosis, airway inflammation/secretions (in CB)
46
Q

causes of hypercapnia in COPD

A
  • high WOB (resp muscles, airway obst, active expiration)
  • decreased sensitivity to CO2
  • V/Q mismatch
47
Q

general pathogenesis COPD

A
  • protease-antiprotease imbalance
  • alpha-1-anti-trypsin def
  • protease excess (smoking)
  • both
48
Q

Respiratory alkalosis (compensation formula and causes)

A
  • 2/5 bicarb per 10 PCO2
  • fever, pain, anxiety
  • hypoxia
  • pregnancy, liver disease, aspirin
49
Q

Respiratory acidosis (compensation formula and causes)

A
  • 1/3.5 bicarb per 10 PCO2
  • drugs (opiates/benzos)
  • severe LD (COPD)
  • NM, CW diseases
50
Q

shunt

A
  • low V/q
  • increase V to neighboring segments
  • hypoxic vasoconstriction
  • predominant hypoxia
  • not/less responsive to fiO2
51
Q

dead space

A
  • high V/Q
  • ventilation to diseased segment wasted
  • perfusion to nearby segments increased
  • predominant hypercarbia (and hypoxia)
52
Q

types of hypoventilation

A
  • generalized: normal AaDO2 and elevated PCO2, improves with fiO2
  • net aka dead space aka V/Q mismatch: widened AaDO2, elevated PCO2, improves with fiO2
53
Q

pseudo-normalization of ABG

A
  • pts with alveolar hypoventilation (asthma)
  • fatiguing –> ABGs normalize on their way to acidemia
  • that’s why you give parenteral roids and consider MV with acute asthma attacks
54
Q

Rising PaCO2 with O2 in CRF

A
  • hypoventilation (loss of hypoxic drive)
  • worsening V/Q
  • haldane effect
55
Q

Tx Emphysema

A
  • anti-cholinergic + SABA
  • LABA, inhaled steroids, theo?
  • O2 (if they are hypoxic)
  • Abx, IV steroids for flares
  • rehab, surgery
56
Q

Tx Asthma

A
  • SABA + inhaled steroids
  • LABA, LP antagonists
  • systemic steroids/O2 for flares
57
Q

ambulatory pathogens

A
  • Myscoplasma (atypical, close contact, URIs),
  • Strep (most common acute)
  • RSV (kids)
  • chlamydia (atypical, young and elderly, URI)
58
Q

wards pathogens

A
  • Strep

- RSV (kids)

59
Q

ICU pathogens

A
  • Strep

- Legionella (water, high mortality, outbreaks, hard to culture, urine for Dx

60
Q

Staph aureaus pneumonia

A

-hospitalized pts, post-flu, MRSA

61
Q

anaerobe infection

A

-aspiration, poor MS, dental dz, abcess

62
Q

causes of viral CAP

A

-influenza, paraflu, adeno, RSV

63
Q

life-prolonging measures in severe COPD

A
  • LTOT (if indicated)

- smoking cessation

64
Q

Tx acute COPD flare

A

-Abx, O2, steroids, SABA (anticholinergic)

65
Q

DDx granulomas, restrictive PFTs, UL predominance, interstitial infiltrates

A

Sarcoid, berylliosis, HP

66
Q

Tx CO poisoning

A

-hyperbaric O2

67
Q

effects of lung reduction surgery

A

-improved diaphragmatic contour, decreased hyperinflation, healthy segments able to expand

68
Q

Rusty sputum + lobar + chills + gram positive diplococci

A

-strep pneumo

69
Q

Tx pneumocystis pneumonia

A

-steroids, not antifungals

70
Q

unexplained recurrent PE

A
  • Factor V Leiden (most ocmmon)
  • cancer
  • OCPs
71
Q

location of (putative) resp pacemaker

A

pre-Botzinger area

72
Q

PFT criterion for obstructive disease

A

FEV1/FVC!

-NB restrictive can have decreased FEV1 and FVC as well, only the ratio helps you distinguish.

Pulm Review (1 decks)

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