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Internal medicine > Lung > Flashcards

Lung Flashcards

1
Q

What is an pulmonary embolism?

A

The condition one are in, when a thrombus in another region of the body embolizes to the pulmonary vasculature tree via the RV ang pulm. artery

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2
Q

What are the common sources for PE?

A

1) Lower extremity
- most common
- above the knee(iliofemoral) / deep veins of pelvis/ calf vein
2) Upper extremity
- rare, seen in Iv drug abusers

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3
Q

What can be said of DVT + PE in the indication for Tx?

A

They are one continuum of a disease. Dx of either one is indication for Tx.

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4
Q

What are the risk factors for PE?

A
  • Age >60
  • Malignancy
  • Prior history of DVT/PE
  • Hereditary hypercoagulable state: 1) Factor v Leiden, protein C & S def. 2) Antithrombin 3 def.
  • Prolonged immibolozation/long distance travel
  • Cardiac disease
  • Obesity
  • Nephrotic syndrome
  • Major surgery
  • Major trauma
  • Pregnancy, estrogen use
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5
Q

What is the pathophysiology of PE?

A

1) Emboli block pulm. vasculature 2) Increased resistance, increased pulm. artery and RV pressure 3) Dead space leads to hypoxemia + hypocarbia 4) tachypnea/dyspnea

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6
Q

What are the clinical symptoms of PE?

A
  • Dyspnea 73%
  • Pleuritic chest pain 66%
  • Cough 37%
  • Hemoptysis 13%
  • Syncope in large PE
  • Decreased general condition
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7
Q

What are the clinical signs of PE?

A
  • Tachypnea
  • Rales
  • Tachycardia
  • S4
  • Increased P2(?)
  • Shock w/ circulatory collapse
  • Other: lowgrade fever, decreased breath sounds, dullness on percussion
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8
Q

What is “Wells criteria”?

A

A scoring system that takes into account and helps guide the work- up of PE

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9
Q

How do you Dx PE?

A

1) ABG: PaO2 & PaCO2 are decreased, pH is high (resp.alkalosis)
2) CXR: usually normal- used for exclusion, pleural effusion, atelectasis, Hampton hump, Westermark
3) Venous duplex US of lower extremities
4) CTA: good sens & spec. Test of choice!
5) Pulm. angiography: gold standard - excludes
6) D-dimer: if normal, PE is unlikely

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10
Q

How to Tx PE ?

A

1) O2 supplement, may require intubation
2) Acute anticoagulation: bolus of LMWH, do not wait for confirmation of DX! Continous infusion for 5-10 days. Goal aPTT of 1,5-2,5
3) Oral anticoagulants: Warfarin or novel anticoagulant (e.g. rivaroxaban)
4) Thrombolytic: streptokinase, tPA, for massive PE
5) IVC filter placement
6) Surgical thrombectomy: hemodynamically compromised, large proximal thrombus (saddle)

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11
Q

What does pulse oximetry?

A

Measures % of oxygenated Hb. Follows a sigmoid curve in relationship to partial pressure oxygen in the arterial blood.

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12
Q

What is the O2 % established criterion for receiving home oxygen?

A

=/ < 88%

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13
Q

What are the use for pulse oximetry?

A

When pulm. disease is suspected. Assessing patients w/ dyspnea(chronic or acute). Useful as screening test.

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14
Q

What is/does ABG?

A

Measures partial pressures of O2 and CO2 and pH

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15
Q

What are the normal values in ABG?

A 
pH= 7,35-7,45
PaO2= decreases w/ age but 90 is normal in 20y/old
PaCO2= 35-45
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16
Q

In ABG, for every 10mmHg increase/decrease in PaCO2..

A

The pH increase/decrease by 0,08. If change is the same way as PaCO2, the patient have metabolic primary disease. If the opposite direction, disease is respiratory.

17
Q

Explain spirometry

A

Patient exhales as rapidly & forcibly as possible (max inspiration). Spirometer plots the change in lung volume against time.

18
Q

What is the use of spirometry?

A
  • Distinguish obstructive from restrictive disease
  • Assessing degree of functional impairment
  • Monitoring effectiveness of Tx
  • May detect resp. impairment in asymptomatic patient
19
Q

Explain DLco

A

Patient breathes in a small, specific amount of CO, and the amount transferred from alveolar air to pulmonary capillary blood is measured. CO is a diffusion limited gas so other variables are eliminated.

20
Q

What is the use of DLco

A
  • Distinguish btw asthma, emphysema and COPD

- Monitoring sarcoidosis

21
Q

Causes for low DLco

A
  • Emphysema
  • Sarcoidosis
  • Interstitial fibrosis
  • Pulmonary vascular disase (PE)
  • Anemia, due to decreased CO binding to Hb
22
Q

Causes for high DLco

A
  • Asthma
  • Obesity
  • Intracardiac left to right shunt
  • Exercise
  • Pulm. hemorrhage (alveolar RBC bind w/ CO)
23
Q

Explain V/Q scan

A

Compares degree of ventilation to perfusion, exact match is V/Q=1, but normal ratio is 0,8 (physiologic shunting)

24
Q

What are the use of V/Q scan?

A

Dx of PE

25
Q

What does methacholine challenge do?

A

Assess degree of airway hyperactivity. Used for suspected asthma(sensitive in mild form) and COPD.

26
Q

What is interstitial lung disease?

A
  • Inflammatory process involving the alveolar wall
  • Resulting in widespread fibroelastic proliferation and collagen deposits
  • Can lead to irreversible fibrosis, distortion of lung architecture and impaired gas exchange
27
Q

How is ILD classified

A 
Based on pathologic &amp; clinical characteristics
1) Environmental
2) Alveolar filling disease
3) ILD associated w/ granulomas
4) Hypersensitivity lung disease
5) Drug induced
6) Miscellaneous
Over 100 causes have been identified!
28
Q

What are the environmental ILDs?

A
  • Coal workers pneumoconiosis
  • Silicosis
  • Asbestosis
  • Berylliosis
29
Q

What are the ILDs associated w/ granulomas?

A
  • Sarcoidosis
  • Histiocytosis X
  • Wegener granulomatosis
  • Churg-Strauss syndrome
30
Q

What are the alveolar filling diseases? (ILDs)

A
  • Goodpasture syndrome
  • Idiopathic pulm. hemosiderosis
  • Alveolar proteinosis
31
Q

What are the hypersensitivity lung diseases? (ILDs)

A
  • HS pneumonitis

- Eosinophilic pneumonitis

32
Q

What are the drugs that may induce ILDs?

A
  • Amiodarone
  • Nitrofurantoin
  • Bleomycin
  • Phenytoin
  • Illicit drugs
33
Q

What are examples of miscellaneous ILDs?

A
  • Idiopathic pulm. fibrosis
  • Cryptogenic organizing pneumonia (COP)
  • ILDs associated w/ connective tissue disease: RA, scleroderma, SLE, mixed CTD
  • Radiation pneumonitis
34
Q

What are the clinical symptoms and signs of ILD?

A
  • Sypmtoms: dyspnea(exertion at first), nonproductive cough, fatigue, other secondary (CTD)
  • Signs: rales at base, digital clubbing, pulm. HT, cyanosis (advanced)
35
Q

How to Dx ILDs?

A
  • CXR: diffuse changes, reticular, reticunodular, ground glass, honeycombing
  • CT: high resolution!
  • PFT: restrictive pattern FEV1/FVC ratio increase
  • Tissue biopsy
  • Urinalysis ( Goodpasture, Wegener)

Internal medicine (4 decks)

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