MKSAP - Respiratory Flashcards
Hydropneumothorax pathogenesis?
Imaging findings?
Bleb rupture causes lung to collapse toward hilum.
Bleeding from rupture produces flat-line junction between the air and fluid at the base of hemithorax
Signs that respiratory failure is due to neuromuscular problem?
- Increased RV/TLC ratio (also seen in obstructive disorders)
- Normal FEV1/FVC ratio
- Low maximal respiratory pressures
- Normal DLCO
Tuberculosis effusion – typical duration of symptoms? Type of effusion? WBCs in effusion? Diagnose by?
Subacute duration of symptoms (weeks to months); exudative with lymphocytes; diagnose with pleural biopsy
Nebulizer therapy for asthma reserved for which patients?
Patients who cannot use a metered dose inhaler appropriately
Treatment of the patient with COPD exacerbation?
- Oral or intravenous corticosteroids
- Albuterol/ipratropium (Short acting bronchodilators)
- Supplemental oxygen
- Levofloxacin or macrolide + ceftriaxone
Suitable candidates for noninvasive positive-pressure ventilation? Contraindications?
Respiration rate >25
PH under 7.35
PCO2 over 45
Contraindications: impending respiratory arrest, cardiovascular instability, altered mental status, I aspiration risk, extreme obesity
Patient with COPD – goal oxygen saturation?
90%
COPD – consider lung volume reduction surgery when? transplantation when?
- Predominantly upper lobe disease with limited exercise performance after rehabilitation
- FEV1 between 20% to 35%
- DLCO greater than 20
- PCO2 >50
- Both FEV1 and DCLO <20
Complications of untreated obstructive sleep apnea?
Pulmonary artery hypertension, a true fibrillation, heart failure, treatment resistant hypertension
Findings and Cushing’s syndrome?
Hypertension, muscle weakness, bruises, diabetes, osteoporosis
Findings in drug-induced long toxicity? Well known cause?
Fatigue, fever, cough, eosinophilia. Amiodarone
Acute eosinophilic pneumonitis?
Rapidly progressive illness associated with
- fever
- sputum production
- eosinophilia
- peripherally distributed lung infiltrate
Patient with suspected PE (Well’s score > 4) – test?
- CT angiogram
2. In patient with elevated creatinine: ventilation/perfusion scan
Patient with previously well-controlled asthma who experiences unstable asthma after respiratory infection – treatment?
If unstable asthma persists?
Short course of oral steroids
Long acting beta agonist
Causes of low DLCO?
- Barriers to diffusion (Edema, infiltrates, fibrosis)
2. Loss of lung tissue (emphysema)
Exam Signs of pulmonary artery hypertension?
- loud P2
- Fixed split S2
- Tricuspid regurgitation
- JVD
Physical exam findings in atrial septal defect?
- Fixed split of S2
2. Right ventricular Heave
Symptoms of vocal cord dysfunction? Test?
- Wheezing, Strider
- No response to asthma therapy. 3. Decreased lung volumes
- normal unsaturation
Laryngoscopy
Pulmonary function tests in PAH? Early diagnostic test?
isolated decreased DLCO with normal airflow and lung volumes
Echo to r/o heart problems
When is chest tube drainage needed for pleural effusion?
- Loculated
- PH under 7.2
- Glucose under 60
- LDH over 1000
Indications for video assisted thorascopic surgery?
Empyema not drained soon enough leading to loculations that need to be surgically removed
Consider chylothorax if effusion studies show?
Triglycerides >110
Signs of respiratory failure?
Pulse ox < 75
Respiration rate >30
heart rate > 120
Adjust criteria for home oxygen patients with COPD with these comorbidities?
Cor pulmonale, pulmonary hypertension, right heart failure
