Muthiah's questions Flashcards
Most common cause of hypoxemia
V/Q mismatch
As ventillation increases CO2…..
Decreases
As ventillation decreases CO2
Increases
Anything that causes a decrease in ventillation area would cause what?
A shunt
Know the hemeglobin oxygen dissociation curve
ok
Nocturnal asthma is due to
decrease of catecholamines/cortisol at night, thus decreased beta 2 activity leads to nocturnal bronchiol constriction
The Haldane effect
CO2 increases upon giving supplemental oxygen because if you are hypoxemic, hemoglobin binds CO2 with increased affinity and as O2 is restored, the CO2 is displaced and appears in the blood
Hypoxemia of interstitial lung disease is due to what?
V/Q mismatch
What happens to Type II pneumocytes in interstitial lung disease
They increase
What does ILD look like of cxr
ground glass
Asthma due to aspergillus exposure is what type of immune respone
IgE mediated reaction and TYPE 3 IgE mediated response
What are the criteria needed to diagnose ABPA
- poorly controlled
- Eosinophilia (Positive skin antigen test for A fumigatus, IgG antibody
- IgE over 1,000ng/ml
-proximal bronchiectasis, fleeting chest infiltrates, peripheral eosinophilia with chest infiltrates
Major cytokines and antibodies in asthma
IgE, IL-5, PAF, Histamine, Eosinophils
What does Westermark’s sign show
A complete lack of vasculature in one of the lungs. It means that there is a pulmonary embolism and the vessel has collapsed down stream. Only seen in 2% of pts though. Most ppl with a PE have a normal chest x-ray
What are the features of malignancy on a chest x-ray
- spiculated nodules
- non-calcified nodules
- associated mediastinal or lymph node masses
- Cavitation
- Large nodules
Types of benign calcification
Popcorn, Lamellar, Dense
What are the features of benignity
well defined nodules, calcified, no associated lymph or mediastinal mass, no satellite lesions
What are the features of benignity
well defined nodules, calcified, no associated lymph or mediastinal mass, no satellite lesions
Management of stable COPD includes all of the following except?
Oral gluccocorticoids for mil COPD
Long term management with oxygen therapy is most helpful for COPD
24 hrs is better than 16.
Centrilobular emphysema
smoking. MOST COMMON
panlubular
Alpha 1 AT
Major site of airflow limitation in COPD
Small conducting airways
CD4 lymphocytes predominate in ?
ASTHMA
CD8 lymphocytes predominate in?
COPD
Definition of clinical bronchitis
Productive sputum for 3 months in 2 consecutive years. THE OPPOSITE OF MJs number
DLCO (diffusion capacity) is limited in EMphysema but is normal in….
Chronic Bronchitis and Asthma,,,,the other two obstructive diseases.
Increases in cardiac output increase DO2 linerally
true
Restrictive lung diseases involving the parenchyma of the lung
Interstitial lung disease
Resection of the lung
Hallmarks of ILD
Reduced total lung capacity, reducd vital capacity, reduced diffusion capacity
Normal bronchioalveolar lavage
90% macrophages, 10% lymphocytes, 1% PMNs
Clubbing is a sign of lung fibrosis
truw
ARDS is characterized by
Acute decrease in lung compliance
Decreasing tidal volume is significant in ARDS because it prevents the lungs from expanding so much which reduces injury
true…decreases mortality
How do you improve oxygenation in ARDS
increase the PEEP…PEEP allows you to break the shunt
SIRS criteria
temp over 38 or under 36, HR over 90, RR over 20, WBC above 12,000 or under 4,000 or more than 10% bands
Afebrile sepsis can be related to
Extremem age, kidney disease, steroid use, Tylenol Use, Diabetes, etc…
each hour delay in antibiotics increases mortality by
6-7%
Goals of sepsis treatment
central venous pressure 8-12
mean arterial pressure over 65
urine output over .5 ml/kg/ hr
Aspiration pneumonia
Generally bacteria
Inhalation pneumonia
generally viral
Bronchial breath sounds are a sign of
consolidation
What determines outcome in pts with pneumonia
host response
Resolution of pneumonia is usually clinical before its radiologic.
You will see a decrease in respiration rate before you see resolution on cxr
If pt deteriorates quickly, its probably MRSA
treatment for MRSA is streptomycin
What pathognomonic EKG is pressent in a minority of DVT patients
S1Q3T3
What is the significance of a factor V Leiden Mutation
Factor V Leiden activates protein C, which is a natural anticoagulant. Withough factor V, protein C cannot be activated and coagulation occurs
