Lipschik Review + Jeopardy Flashcards
1
Q
Effusion with low glucose DDx
A
TB, RA, infection, cancer
2
Q
DDx effusion very high WBC
A
empyema
3
Q
Bloody effusion
A
trauma, asbestos
4
Q
Low pH effusion
A
incipient infection
5
Q
high LDH effusion
A
complicated parapneumonic
6
Q
High TG (chylous) effusion DDx
A
lymphoma, trauma
7
Q
Transudate effusion Lx DDx
A
LDH ratio <.5
Adelectasis, dialysis, mixidema, nephrotic syndrome, CHF
8
Q
Exudate effusion Lx DDx
A
LDH ratio >0.6
TP ratio >0.5
-Lots of things: cancer, pneumonia, empyema, TB
9
Q
DDx diffuse interstitial disease
A
- IPF with UIP (lower)
- CVD (scleroderma)
- drugs (amiodarone, bleomycin)
- sarcoidosis (upper/middle)
- hypersensitivity pneumonitis
- lymphagitic spread
10
Q
Restrictive PFTs
A
-FEV1 and FVC dec, but ratio preserved or increased
TLC and RV down
DLco down
11
Q
Restrictive PFTs with PRESERVED RV and normal (corrected) DLco
A
- NM disease
- obesity
- poor effort
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
13
Q
What kind of ventilation is used in resp distress?
A
Volume-cycled, positive pressure
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)
15
Q
Tx for PPV-induced hypotension
A
-fluid initially, then inotropes
16
Q
fluffy alveolar infiltrates with air bronchograms on CXR
A
- pulm edema (ARDS, CHF)
- aspiration, diffuse pneumonia, DAH, adenocarcenoma in situ
17
Q
small cell (location, staging, Tx, prognosis)
A
- central
- localized vs disseminated
- chemo or chemo+rad
- rarely curable. usually responds/recurs
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
19
Q
hypoxemia that barely improves or doesn’t with fiO2
A
shunt
20
Q
diuretics for pulmonary edema and starling equation
A
decreases hydrostatic pressure!
21
Q
Tx ARDS, adelectasis and RDS
A
PEEP/CPAP
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
23
Q
monitoring pts on MV
A
- clinical (secretions, MS, CXR, udnerlying)
- ABGs
- Mechanics: Cstat = dV/(Pplat-PEEP)
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!)
25
OSA vs OHS
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
26
Answer to Question #1
A
27
form alveolar pressure
Pel + Ppl
28
alveolar air equation and shortcuts
```
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
```
29
form AaDO2
PAO2 (RA or 100%) - PaO2
30
determinant of PACO2
-given metabolic CO2 production, ventilation is inverse to PACO2
31
rate of gas diffusion across membrane
Vgas = A/T x D x dP
| non-membrane components: capillary volume, O2-hemoglobin interaction time (theta)
32
form minute ventilation
Ve = Va + Vd = Vt xf
33
form compliance
dV/dP and 1/E
34
form Cstat on MV
dV/dP
| Vt / (Pplat- PEEP)
35
hyperinflation on CXR
- lots of ribs
- flattened diaphragm
- COPD (chronic) or asthma (acute)
36
asthma PFTs
- obstructive (FEV1/FVC)
- might have hyperinflation/gas trapping
- normal DLco
* *FEV1 improves >12% w/ bronchodilators
37
causes obstructive PFTs w/ normal DLco
- chronic bronchitis
- bronchiectasis
- asthma
38
restrictive PFTs
-TLC low and preserved FEV1/FVC
39
mixed defect PFTs
-FEV1/FVC and TLC low
40
-hyperinflation and air trapping PFTs
- TLC high = hyperinflation
| - RV high = air trapping
41
nml PFTs with nml DLco
-PV disorders (PAH, PE)
42
restrictive PFTs by DLco
- nml (adjusted) DLco: CW and NM disorders, also obesity and low effort
- low DLco: ILD, pneumonitis
43
obstructive PFTs by DLco
- nml DLco: astma, CB
| - low DLco: emphysema
44
F-V loops
- 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
causes of dyspnea in COPD
- 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
causes of hypercapnia in COPD
- high WOB (resp muscles, airway obst, active expiration)
- decreased sensitivity to CO2
- V/Q mismatch
47
general pathogenesis COPD
- protease-antiprotease imbalance
- alpha-1-anti-trypsin def
- protease excess (smoking)
- both
48
Respiratory alkalosis (compensation formula and causes)
- 2/5 bicarb per 10 PCO2
- fever, pain, anxiety
- hypoxia
- pregnancy, liver disease, aspirin
49
Respiratory acidosis (compensation formula and causes)
- 1/3.5 bicarb per 10 PCO2
- drugs (opiates/benzos)
- severe LD (COPD)
- NM, CW diseases
50
shunt
- low V/q
- increase V to neighboring segments
- hypoxic vasoconstriction
- predominant hypoxia
- not/less responsive to fiO2
51
dead space
- high V/Q
- ventilation to diseased segment wasted
- perfusion to nearby segments increased
- predominant hypercarbia (and hypoxia)
52
types of hypoventilation
- 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
pseudo-normalization of ABG
- 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
Rising PaCO2 with O2 in CRF
- hypoventilation (loss of hypoxic drive)
- worsening V/Q
- haldane effect
55
Tx Emphysema
- anti-cholinergic + SABA
- LABA, inhaled steroids, theo?
- O2 (if they are hypoxic)
- Abx, IV steroids for flares
- rehab, surgery
56
Tx Asthma
- SABA + inhaled steroids
- LABA, LP antagonists
- systemic steroids/O2 for flares
57
ambulatory pathogens
- Myscoplasma (atypical, close contact, URIs),
- Strep (most common acute)
- RSV (kids)
- chlamydia (atypical, young and elderly, URI)
58
wards pathogens
- Strep
| - RSV (kids)
59
ICU pathogens
- Strep
| - Legionella (water, high mortality, outbreaks, hard to culture, urine for Dx
60
Staph aureaus pneumonia
-hospitalized pts, post-flu, MRSA
61
anaerobe infection
-aspiration, poor MS, dental dz, abcess
62
causes of viral CAP
-influenza, paraflu, adeno, RSV
63
life-prolonging measures in severe COPD
- LTOT (if indicated)
| - smoking cessation
64
Tx acute COPD flare
-Abx, O2, steroids, SABA (anticholinergic)
65
DDx granulomas, restrictive PFTs, UL predominance, interstitial infiltrates
Sarcoid, berylliosis, HP
66
Tx CO poisoning
-hyperbaric O2
67
effects of lung reduction surgery
-improved diaphragmatic contour, decreased hyperinflation, healthy segments able to expand
68
Rusty sputum + lobar + chills + gram positive diplococci
-strep pneumo
69
Tx pneumocystis pneumonia
-steroids, not antifungals
70
unexplained recurrent PE
- Factor V Leiden (most ocmmon)
- cancer
- OCPs
71
location of (putative) resp pacemaker
pre-Botzinger area
72
PFT criterion for obstructive disease
FEV1/FVC!
| -NB restrictive can have decreased FEV1 and FVC as well, only the ratio helps you distinguish.
