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Z - M2 Pulmonary > M2 Pulmonary Week 2 - Key Facts > Flashcards

M2 Pulmonary Week 2 - Key Facts Flashcards

1
Q

Meta-Relative Risk - Interpretations (3) + Calculation

A

Interpretation
1 = No Difference Between Groups
> 1 = Event more likely to occur in the experimental group (e.g. drug causes risk increase)
< 1 = Event less likely to occur in the experimental group (e.g. drug causes risk reduction)
Key = What is the outcome measure - If you are looking at readmission you want it to be less in experimental

% of Events in Experiemental
/
% of Events in the Control

E.g. 5 of 100 have relapse in experimental vs. 10 of 100 in control
0.05 / 0.1 = Relative Risk Reduction of 50%

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2
Q

Absolute Risk Reduction

A

% Events in Experimental - % Events in Control

E.g. 5 of 100 have relapse in experimental vs. 10 of 100 in control
0.05 - 0.1 = Absolute Risk Reduction of 5%

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3
Q

Number Needed to Treat

A

Number needed to treat to help one person

1 / ARR
E.g. 5 of 100 have relapse in experimental vs. 10 of 100 in control
ARR = 5% ///// NNT = 20

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4
Q

Indoor Exposures Increasing Risk of Asthma Development - Causal (1) + Association (1)

A

Causal - Dust Mites

Association - Second Hand Smoke

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5
Q

Indoor Exposures Increasing Risk of Asthma Exacerbation - Causal (4) + Association (4)

A

Causal

1) Cat
2) Cockroach
3) Dust Mite
4) Second Hand Smoke

Association

1) Dog
2) Fungus
3) Rhinovirus
3) NO2

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6
Q

Ozone in Asthma

A

Ozone Increases Asthma

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7
Q

Dust Mite Management in Asthma - Key Points ()

A

Removal not found to be clinically significant but largely influenced by one large study that was to short and poorly controled

Forest Plot = Key

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8
Q

Funnel Plot - Definition + Example (2)

A

A funnel plot is a graph used designed to check for the existence of publication bias; funnel plots are commonly used in systematic reviews and meta-analyses. In the absence of publication bias, it assumes that the largest studies will be plotted near the average, and smaller studies will be spread evenly on both sides of the average, creating a roughly funnel-shaped distribution. Deviation from this shape can indicate publication bias.

Largest Study (Biggest y) should be closest to the middle (average) while smaller studies are more likely to be scattered 
Large Studies = Pyramid Tip

Big Bite in one Bottom Corner = Missing studies that show one effect - pushes the mean the other way
Missing Most of the Bottom = Low Methodological Quality of small studies = smaller bias vs. leaving studies out

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9
Q

Methods of Pneumonia Acquisition (4)

A

1) Inhalation
2) Aspiration
3) Hematogenous Spread
4) Spread from a contiguous Foci

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10
Q

Factors that Impair Respiratory Immune Defense (2) + Causes (5)

A

Impaired Cough Reflex

1) EtOH
2) Drugs
3) Neuro-Muscular Disease

Impaired Mucociliary Escalator

1) COPD
2) Influenza

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11
Q

3 Major Ways to Organize Pneumonia

A

1) Community (S. Pneumoniae) vs. Nosicomial (Gram Negative)
2) Rapid Onset (Bacterial) vs. Slow Onset (Fungi/TB/Anaerobic)
3) Lobar vs. Bronciolar (Scattered Patch Infiltrates Around Bronchioles) vs. Interstitial (Atypical/Walking)

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12
Q

Major Bronchopneumonia Pathogens (5)

A

1) S. Aureus
2) H. Influenzae
3) Pseudomnas Aeruginosa
4) Moraxella Calarrhalis
5) Legionella

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13
Q

Major Atypical Pneumonia Pathogens (6)

A

1) Mycoplasma Pneumoniae
2) Chlamydia Pneumoniae
3) RSV
4) CMV
5) Influenza
6) Coxiella burnetti

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14
Q

Consolidation Exam Findings (4) + Differential for Bronchial Breath Sounds + Crackles/Rales + Wheezing (1)

A

Consolidation

1) Dullness on Percusion
2) Egophany (E-A)
3) Bronchial Breath Sounds
4) Decreased Tactile Fremitous

DDx - Bronchial
1) Obstructive + Pleural Effusion + Pneumonia

DDx - Crackles/Rales
1) Pneumonia + CHF + Pulmonary Fibrosis

DDx - Wheezing (Expiratory)
1) Asthma

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15
Q

Viral Pneumonia - Keys (3)

A

Causes - Influenza (Main) + CMV (Immunocompromised)
Type - Atypical
Sympomts - Dry Cough + Dyspna + Unremarkable Exam

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16
Q

Streptococcus Pneumoniae - Bacteria + Key Features (2)

A

Gram + Diplocci - Lancet Shaped + Alpha Hemolytic

Most Common Cause of Pneumonia 
Stages (4)
1) Congesiton
2 Red Hepatization
3) Gray Hepatazation
4) Resolution
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17
Q

Streptococcus Pneumoniae - Signs/Symptoms (6) + Risk Factors (4)

A

Signs/Symptoms

1) Acute
2) High Fever
3) Pleuritic Chest Pain
4) Shacking Rigor
5) Rusty Color Sputum
6) Lobar Examination Findings

Risk Factors

1) Asplenia
2) Post-Influenza
3) Arthritis (Septic Joints)
4) Smoking/EtOH

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18
Q

Hemophilius Influenzae - Bacteria + Key Facts (2) + Risk Factors (2)

A

Gram (-) Coccobaccilus

Key Facts

1) Community Acquired
2) Hard to differentiate vs. chronic bronchitis - look for changes in cough/fever

Risk Factors

1) COPD
2) Infants

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19
Q

Staph Aureus - Bacteria + Key Facts (2) + Risk Factors (3)

A

Gram (+) Cocci in Clusters

Key Facts

1) Purulent yellow sputum
2) High risk of necrosis, cavitation and abscess

Risk Factors

1) Rare Community
2) High Nosocomial
3) High Post Influenza

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20
Q

Nosocomial/Rare Bacterial Pneumonia (3) + Key Facts (2-3-3)

A

Klebsiella - Gram Negative Rod

1) Lobar Aspiration in Alcoholoic + Diabetes
2) Currant Jam Sputum

Legionella - Gram Negative Rod with Silver Stain

1) Water sources
2) Hyponatremia from renal disease
3) Atypical

Pseudomonas Aeurginosa - Aerobic Gram (-) Rod

1) Most common CF
2) Coagulative Necrosis with vessel invasion
3) Green Sputum

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21
Q

Rhinopharyngitis - Definition + Causes

A

Common Cold - Communicable with Nasal Stuffiness

Causes

1) Rhinovirus
2) Coronavirus
3) Parainfluenza Virus

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22
Q

Rhinopharyngitis - Pathophysiology + Signs/Symptoms (3)

A

Patho - Inoculation - Epithelial cells infected + spreads to respiratory mucous - Submucosal Edema = Increased Risk for Bacterial Suprainfection

Signs

1) Nasal Discharge
2) Sore Throat
3) Worse in Infants

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23
Q

Tonsillophyaryngitis - Definition + Causes (5)

A

Inflammation of the mucous membranes of the throat without nasal signs/symptoms

Causes

1) Group A Beta Hemolytic Strep (Strep. Pyrogens)
2) Adenovirus
3) Parainfluenza
4) EBV
5) Enterovirus (Summer)

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24
Q

Tonsillophyaryngitis - Signs/Symptoms (6)

A

1) Petechia in Throat
2) Inflamed Uvula/Tonsils
3) Fever
4) Sore Throat
5) Abdominal Pain (Worse in Kids)
6) Tender Anterior Cervical Nodes
7) Can Cause Acute Rheumatic Fever + Scarlet Fever

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25
Q

Laryngotracheobronchitis - Definition + Causes (5) + Key Features

A

Croup - Uniquely Pediatric - Respiratory illness characterized by hoarse voice, dry barking cough, and inspiratory stridor

Causes - Parainfluenza Type 1 - Influenza + RSV + Adenovirus + Rhinovirus

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26
Q

Laryngotracheobronchitis - Pathophysiology

A

Diffuse tracheal inflammation with erythema + edema - Leads to narrowing + ciliary inhibition - Impaired vocal cords + steeple sign (narrow trachea on CXR)

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27
Q

Sinusitis - Description + Causes (2)

A

Purulent infection of the mucosal linings of the paranasal sinuses - Usually secondary to upper respiratory infection

Ca sues - Haemophilus (Not Type B) + Pneumococcus

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28
Q

Sinusitis - Signs/Symptoms (5) + High Risk Complications (3)

A

Signs

1) Fever
2) Cough
3) Facial Pain/Pressure
4) Potts Puff Tumor - Periostium erodes
5) Purulent Nasal Discharge

Complications

1) Meningitis
2) Abscess
3) Orbital Damage (Children)

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29
Q

Atypical Pneumonia (3) - Bacteria + Key Facts

A

Mycoplasma Pneumoniae - Not seen on gram stain - cold agglutinate

1) Walking Pneumonia (terrible X-Ray but feel okay)
2) Elder Patients
3) Dry Hacking Cough

Legionella - Gram Negative Rod with Silver Stain

1) Water sources
2) Hyponatremia from renal disease
3) Atypical

Chlamydia Pneumonia

1) Atypical
2) Young Adults + Military Recruits
3) High Risk of Reactive Arthritis

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30
Q

Acidemia - 2 Causes

Alkalosis - 2 Causes

A

Acidemia
High PCO2 or Low Bicarb

Alkalosis
Low PCO2 or High Bicarb

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31
Q

Anion Gap - Calculation + Use

A

Anion Gap = Na - (Cl + Bicarb)

Normal = 7-16
Use in Metabolic Acidosis to Help Determine Type

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32
Q

Delta - Delta - Calculation + Use

A

Change in AG (AG - 10 ) vs. Change in Bicarb (24 - Bicarb) - Should be approx 0

Ratio > 0 = AG Change is Greater Suggest AG Metabolic Acidosis + Metabolic Alkalosis

Ratio < 0 = Bicarb Change is Greater than Suggested = AG Metabolic Acidosis + Non-AG Metabolic Acidosis

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33
Q

Respiratory Compensation Equations (4)

A

Acute Resp. Acidosis - Up 1 for 10 (Bicarb up 1 for 10 CO2 Rise)

Chronic Resp. Acidosis - Up 4 for 10 (Bicarb up 4 for 10 CO2 Rise)

Acute Resp. Alkalosis - Down 2 for 10 (Bicarb down 2 for 10 CO2 Drop)

Chronic Resp Alkalosis - Down 5 for 10 (Bicarb down 5 for 10 CO2 Drop)

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34
Q

Primary Causes of Respiratory Acidosis - Acute (4) + Chronic (2)

A

Acute - Reduced Ventilation

1) Sedatives
2) Airway Obstruction
3) Mechanical Ventilation
4) Muskuloskeletal

Chronic - Obstructive Disease

1) COPD
2) Asthma

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35
Q

Primary Causes of Respiratory Alkalosis - Acute (4)

A

Hyperventilation

1) High Altitude
2) Pneumonia- V/Q Mismatch leads to poor oxygenation - Response = Hyperventilation
3) PE - V/Q Mismatch leads to poor oxygenation - Response = Hyperventilation
4) Panic Attack

36
Q

Metabolic Compensation Equations - Acidosis + Alkalosis

A

Acidosis - PCO2 = 1.5 * Bicarb + 8 +/- 2
Met. Acidosis = Hyperventilation to blow off all the CO2 and try to get back to normal

Alkalosis - PCO2 = 0.7 * Bicarb + 20 +/- 5
Met Alkalosis = Hypoventilatlion to save all the acidic CO2 and try to get back to normal

37
Q

Causes of Metabolic Acidosis - With AG (3) + Without AG (2)

A

With AG = Lactic Acidosis + Ketoacidosis + Intoxication (EtOH or Aspirin)

Without AG = Diarrhea or Renal Tubular Acidosis

38
Q

Hypoventilation/Hyperventilation - Acid Base Impacts

A

Hypo = Not blowing off enough CO2 = Saving Acid = Causes acidosis (and responds to metabolic alkalosis)

Hyper = Blowing off to much CO2 = Wasting acid = Causes alkalosis (and responds to metabolic acidosis)

39
Q

Causes of Metabolic Alkalosis (2)

A

Vomiting

Thiazide/Loop Diuretics

40
Q

Causes of Lactic Acidosis (3)

A

1) Exercise
2) CHF = Hypoperfusion
3) MI = Hypoperfusion

41
Q

Major Types of Pulmonary Embolism (3) + Signs and Symptoms

A

1) Fat Emboli - Long Bone Fractures
Latency Period –> Followed by ARDS picture - Supportive therapy = key

2) Amniotic Fluid Emboli - Premature rupture of the amniotic sac causes lipoprotein based pulmonary artery occlusion
Allergic Reaction to the amniotic fluid with CV collapse

3) PE == Most likely lower lobe + Infarction with a peripheral wedge

42
Q

Pathophysiology of PE - 5 Changes + Associated Symptoms

A

1) Hypoxemia - V/Q Mismatch to the blocked region - Increased A-a Gradient with cyanosis

2) Atelectasis - Decreased surfactant due to Type II Pneumocyte death
S/Sx = Dyspnea + Rales

3) Increased Pulm. Arterial Pressure - Flow Back-UP
S/Sx = Increases the P2 Heart Sound (Wide Splitting)

4) Increased Alveolar Ventilation (in an effort to try and fix the hypoxemia via hyperventilation) - Increased Physiological Dead Space (ventilation)
S/Sx - Mismatch causes overcompensation + tachypnea + Resp. Alkalosis

5) Embolism without Infarction - Tachycardia due to increased Strain

5B) Embolism with Infarction - Pleuritc Pain + Breathlessness + Pleural Friction Rub

43
Q

Classic PE Presentation (4)

A

1) Dyspnea (Rapid Onset)
2) Pleuritc Chest Pain
3) Tachycardia
4) Hemoptysis

44
Q

Steps in DVT Evaluation (3)

A

1) Clinical/Lab Evaluation
2) Apply Well’s Score
3) Diagnostic Radiology

45
Q

Venous Duplex - Findings (2)

A

1) No DVT = Compressible

2) DVT = Non-compressible

46
Q

Pulmonary Arterial HTN - Definition + Classic Presentation

A 
Definition = Pulm Pressure > 25 mmHg
Classic = Exertional Dyspnea + Right HF
47
Q

Secondary Causes of Pulmonary HTN (4)

A

1) Left HF (#1 Cause)
2) Lung Disease/Hypoxemia (V/Q Mismatch)
3) Embolic Disease
4) Disease - Pneumonia Sarcoidosis

48
Q

Primary Pulmonary HTN - Key Points (3)

A

1) Idiopathic (Must Rule Out Secondary)
2) BMPR2 Gene - Inactivated = Increased Pulmonary Smooth Muscle Hypertrophy
3) Most Common Equal Female 20-40 Years of Age

49
Q

Lung Disease Causing Pulm. HTN (3) + Pathophysiology

A

1) Obstructive Sleep Apnea
2) COPD
3) Tissue DIseae

Destruction of the lung parenchyma increases pulmonary resistance and hypoxic vasoconstriction - pathological over use of normal physiological shunting

50
Q

Risk Factors for Obstructive Sleep Apnea (7)

A

1) Male Gender
2) Age
3) Race
4) EtOH/Smoking
5) Neck Circumference
6) BMI > 30
7) Menopausal Women

51
Q

Night Time OSA Symptoms (6)

A

1) Snoring
2) Excessive Sweating
3) Twisting/Turning
4) Heartburn
5) Enuresis (Kids)
6) Nocturia (Kids)

52
Q

Daytime OSA Symptoms (6)

A

1) Excessive Somnolence
2) Decreased Libido
3) Morning Headaches (High CO2 On Waking)
4) Hyperactivity (Kids)
5) Depression

53
Q

General Management of OSA (4)

A

1) Avoid EtOH
2) Sedatives
3) Weight Loss
4) Exercise

54
Q

Advanced OSA Treatment (4)

A

1) Nasal CPAP = Low Compliance
2) Oral Appliance = Mild/Moderate Only
3) Surgery = Uvulopalatopharyngoplasty
4) Tracheostomy = Most Serious

55
Q

Major Physiologic Impacts of OSA (3)

A

1) Increased Endothelian 1
2) Endothylial Dysfunction
3) Increased Symp. Activity

All Cause HTN

56
Q

Major OSA Disease Links (5)

A

1) HTN
2) Pulm. HTN
3) CHF
4) Stroke
5) Arrhythmia

57
Q

Major Pathophysiology Behind Dyspnea (6) - 1 Example Each

A

1) Structural/Mechanical - Airway obstruction
2) Flow Obstruction - Asthma
3) Restriction of Chest Wall Expansion - Intrinsic (Lung Parenchyma) = ARDS
4) Restriction of Chest Wall Expansion - Extrinsic (Blocked) - Obesity
5) Increased Dead Space Ventilation - PE
6) Increased Respiratory Drive - Hypoxmia/Acidosis

58
Q

Dyspnea with Coughing

A

Think Obstructive

59
Q

Dyspnea with Sputum Production

A

Pulm. Edema

60
Q

Dyspnea with PND and Orthopnea

A

CHF

61
Q

Dyspnea Causes - Extrinsic Restrictive (4)

A

1) Obesity
2) Ascites
3) Pregnancy
4) Kyphposcholiosis

62
Q

Dyspnea Causes - Increased Respiratory Drive (4)

A

1) Hypoxemia
2) Acidosis
3) Exercise
4) Reduced CO/Hb

63
Q

Pulmonary Causes of Dyspnea (3)

A

Airflow Obstruction (Restrictive or Obstructive)

2) Mismatch between neuro ventilatory output and achieved ventilation
3) Lung Over-Inflattion

64
Q

Non Cardio-Pulm. Causes of Dyspnea (5)

A

1) DKA
2) Metabolic Anemia
3) Neuromuscular
4) Hypothyroid
5) Psych (Panic Attack)

65
Q

Three Major Classes of Pleural Fluid + Findings on Analysis

A

Exudate = Thick/Protein + Cloudy
+ If Pleural Protein/Serum Protein > 0.5
+ If Pleural LDH/Serum LDH > 0.6
Low pH

2) Transudate = Clear
Ruled out Exudate
High pH

3) Chylotorax - Milky Triglycerides
TAG > 110

66
Q

Exudate - Findings + Common Causes (5)

A

1) Exudate = Thick/Protein + Cloudy
+ If Pleural Protein/Serum Protein > 0.5
+ If Pleural LDH/Serum LDH > 0.6
Low pH

Causes - Microvascular Damage

1) Pulmonary Infarction (PE)
2) Infection (TB, Pneumonia)
3) Malignancy
4) Connective Tissue Disease (SLE/Rheumatoid)
5) Trauma

67
Q

Transudate - Findings + Common Causes (4)

A

Transudate = Clear - Oncotic Disruption - High Hydrostatic or Low Oncotic Pressure
Ruled out Exudate
High pH

Causes

1) CHF (Left)
2) Pulmonary HTN
3) Nephritic Syndrome (Low Fluid Protein)
4) Hepatic Cirrohosis (Ascities + Low Albumin)

68
Q

Chylothorax - Findings + Common Causes (3)

A

Chylotorax - Milky Triglycerides
TAG > 110

Causes

1) Thoracic Duct Trauma
2) Lymphoma

69
Q

Special Cases for Pleural Effusion Diagnostics (4)

A

1) Frankly Purulent (Pus) Fluid = CLosed pus filled infection
2) Putrid Odor - Anaerobic Empyema
3) Low pH = More Severe
4) S/Sx after 300 ml (Normal = 10ml)

70
Q

Pneumothorax Signs/Symptoms (6)

A

1) Unilteral Chest Pain
2) Dypsnea
3) Pleuritc Pain
4) Decreased Tactile Fremitous
5) Hyper-Resonance
6) Diminished Breath Sounds

71
Q

Primary vs. Secondary vs. Tension Pneumonthorax

A 
Primary = Spontaneous = Tall Thin Men + LAMB (Menstral) 
Secondary = Underlying Lung Pathology

Both = Same Side Trachea

Tension = Flap from Trauma = Opposite Side

72
Q

Major Classes of Primary Lung Tumors (4) + Prevalence %

A

1) Small Cell (15%) vs. Non-Small Cell (80%)

Non Small Cell

1) Large Cell (10%)
2) Adenocarcinoma (50%)
3) Squamous Cell (30%)

73
Q

Squamous Cell Carcinoma - Histology + Gross Examination

A

Histo - Keratin Pearls + Desomosmal Intracellular Bridges

Gross - Cavitation + Central

74
Q

Small Cell Carcinoma - Histology + Gross Examination

A

Histo - Small undifferentiated blue cells (like lymphocytes) - Chromagramin (+)

Gross - Central + Hilar Lymp nodes without cavitation

75
Q

Large Cell Carcinoma - Histology + Gross Examination

A

Histo - Poorly differentiad malignant cells with abundant cytoplasm (vs. none in small cell)

Gross - Peripheral + chance of cavitation

76
Q

Adenocarcinoma - Histology + Gross Examination

A

Histo - Glands of mucin cells = key = no keratin pearls

Gross - Peripheral + Metastatic SPread - Pleural Involvement Likely

77
Q

Bronchioalveolar Adenocarcinoma - Histology + Gross Examination

A

Histo - Well differentiated columnar cells (from clara cells)
Looks like Pneumonia but with cancer cells not neutrophils

Gross - Peripheral + Consolidation like a lobar pneumonia - Grows along the bronchioles

78
Q

Carcinoid Tumor - Histology + Gross Examination

A

Histo - Cells in nests - Chromagramin (+)

Gross - Polyp like mass - Benign

79
Q

Squamous Cell Carcinoma - Key Associations (5)

A

1) Hypercalcemia due to increased Parathyroid Hormone (Vit. D)
2) Cavitation
3) Pancost Tumor
4) Atelectiasis
5) Pneumonia

80
Q

Pancost Tumor - Key Associations (6)

A

Apex of the Lung

1) Cervical Sympathetics (Horner’s)
2) Superior Vena Cava Syndrome
3) Brachial Plexus Inhibition
4) Hoarseness (Recurrent Laryngeal)

81
Q

Adenocarcinoma - Key Associations (5)

A

1) Non-Smoking Women
2) Hypertrophic Oseoarthopathy (CLubbing)
3) Peripheral + Pleural Involvement
4) 3 Mutations - EGFR + ALK + KRAS

82
Q

Large Cell Carcinoma - Key Associations (6)

A

1) Possible Cavitation
2) Early Metastasis
3) Associated with Gyncomastia (Man Boobs)

83
Q

Bronchioalveolar Adenocarcinoma - Key Associations (

A

1) Subtype of Adenocarcinoma
2) Arises from Clara Cells
3) Multifocal can look like pneumonia
4) Around the bronchioles
5) Bronchorrea (cups of mucous)

84
Q

Small Cell Carcinoma - Key Associations

A

1) Paraneoplastic - SIADH (Hyponatrermia) + Cushings + Eaton Lambert
2) CXR Show Hilar Mass
3) Poor Prognosis - No Surgery

85
Q

Classic Features of Lung Cancer Presentation (5)

A

1) Weight Loss
2) Dyspnea
3) Cough
4) Hemoptysis (Streaks in Sputum)
5) Vocal Cord/Diaphragm Issues

86
Q

Lung Cancer Diagnostic Tools + Uses

A

1) Fiberoptic Bronchoscopy - Only good for central cancer

2) Percutaneous Needle Biopsy - Good for peripheral but risk of pneumothorax

Z - M2 Pulmonary (5 decks)

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