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Clinical Medicine II > "Other" Pulmonary Disorders > Flashcards

"Other" Pulmonary Disorders Flashcards

1
Q

Life threatening acute hypoxemia respiratory failure (organ failure from prolonged hypoxemia). Most commonly develops in critically-ill patients.

A

Acute respiratory distress syndrome (ARDS)

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2
Q

What is the hallmark of ARDS?

A

Severe refractory hypoxemia NOT responsive to 100% O2

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3
Q

What 3 things can help to identify ARDS?

A
  1. Severe refractory hypoxemia
  2. Bilateral pulmonary infiltrates on CXR
  3. Absence of cariogenic pulmonary edema (Pulmonary capillary wedge pressure
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4
Q

Inflammatory lung injury due to proinflammatory cytokines leads to diffuse alveolar damage which increases the permeability of the capillary barrier which causes pulmonary edema and alveolar fluid influx, loss of surfactant, and vascular endothial damage. This decreases blood oxygenation.

A

ARDS

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5
Q

What are the clinical manifestations of ARDS?

A

Acute dyspnea, hypoxemia, and multi-organ failure if severe

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6
Q

PaO2/FIO2 ratio 200-300mmHg + PEEP or CPAP > 5cm H20

A

Mild ARDS

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7
Q

PaO2/FIO2 ratio 100-200mmHg + PEEP >5cm H20

A

Moderate ARDS

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8
Q

PaO2/FIO2 ratio 5cm H20

A

Severe ARDS

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9
Q

What should you expect to see on a CXR in a patient with ARDS?

A

Diffuse bilateral pulmonary infiltrates –> white out pattern (CXR resembles CHF)

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10
Q

What does ARDS typically spare in a CXR?

A

Costophrenic angles

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11
Q

How do you tell the difference between ARDS and pulmonary edema?

A

PWCP

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12
Q

What is a normal PWCP?

A

12-18mmHg
(Low normal PWCP in ARDS)
(High normal PWCP in Pulmonary Edema)

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13
Q

How do you manage ARDS?

A

Noninvasive or mechanical ventilation

CPAP with full face mask, PEEP

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14
Q

Prevents airway collapse at end of expiration, increases FRC, decreases shunting and expands alveoli for increased diffusion

A

PEEP

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15
Q

PE shows tachypnea, frothy pink or red sputum, and diffuse crackles

A

ARDS

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16
Q

What are the three clinical settings that account for 75% of ARDS cases?

A

Sepsis syndrome
Severe multiple trauma
Aspiration of gastric contents

17
Q

Most common cause of respiratory disease in the preterm infant, usually within the 1st month of life?

A

Hyaline membrane disease

18
Q

What causes hyaline membrane disease?

A

Deficiency of surfactant

19
Q

When does surfactant production begin?

A

24-28 weeks

20
Q

When is enough surfactant produced for a baby to survive?

A

35 weeks

21
Q

Caucasian, males, C-section delivery, prenatal infections, multiple births (esp. premature), and maternal diabetes are all risk factors for which disease?

A

Hyaline membrane disease

22
Q

Presents shortly post partum with respiratory distress: Tachypnea, nasal flaring, cyanosis, chest wall retractions. May develop respiratory failure and apnea.

A

Clinical manifestations of hyaline membrane disease

23
Q

CXR of infant shows bilateral diffuse reticular ground-glass opacities and air bronchograms*; poor expansion and domed diaphragms

A

Hyaline membrane disease

24
Q

How do you manage hyaline membrane disease?

A

Exogenous surfactant given to open alveoli via endotracheal tube; CPAP, IV fluids

25
Q

How do you prevent hyaline membrane disease?

A

Steroids given to mature fetal lungs if premature delivery is suspected between 24-36 weeks

26
Q

What can you administer in the delivery room as a prophylaxis or rescue in established hyaline membrane disease?

A

Exogenous surfactants

27
Q

What are some common foreign bodies that can be aspirated?

A

Gastric contents
Inert material
Toxic material
Poorly chewed food

28
Q

In aspiration of foreign bodies, the degree of injury depends on ______

A

The substance aspirated

29
Q

An epodes of choking and coughing or unexplained wheezing or hemoptysis should raise the suspicion of ?

A

Foreign body aspiration

30
Q

What may result from the aspiration of obstructing material?

A

Asphyxia

31
Q

What could develop secondary to the aspiration of toxic materials?

A

Pneumonia

32
Q

What is one of the most common causes of ARDS?

A

Aspiration of gastric contents

33
Q

What can you use to establish a diagnosis of foreign body aspiration and can also be used to help remove the foreign body?

A

Bronchoscopy

34
Q

What is the treatment of choice when removing an aspirated foreign body?

A

Bronchoscopy

35
Q

What do you do if you suspect post-obstructive pneumonia in a patient who has aspirated a foreign body?

A

Culture

36
Q

Expiratory radiography may reveal ____ ____ in a patient who aspirated a foreign body?

A

Regional hyperinflation caused by a check valve effect

Clinical Medicine II (10 decks)

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