Pulm Flashcards
XR hint to diaphragmatic rupture
NG tube in the thorax
XR hint to diaphragmatic rupture
NG tube in the thorax
what occurs with large areas of atelectasis
large ventilation perfusion mist match. hyperventilation to compensate for hypoxemia leading to respiratory alkalosis and decreased PaCO2
how does the body compensate for severe COPD causing acidosis
renal retention HCO3
apical lung tumor signs and Sx
horner syndrome if compress sympathetic trunk
brachial plexus affected with pancoast tumor
right recurrent laryngeal compression causes hoarse voice
superior vena cava syndrome
high Right atrial P and high pulm artery pressure but with normal PCWP
PE
risk for RDS in newborn
prematurity
DM, male, perinatal asphyxia and C section without labor
CXR for RDS
diffuse reticulogranular pattern (ground glass) with air bronchograms
horners
ptosis miosis anhidrosis
how to Dx pancoast tumor or superior sulcus
CXR
Hypertrophic pulmonary osteoarthropathy
clubbing and arthropathy of fingers and wrists due to lunderlying lung disease like lung cancer, TB, bronchiectasis or emphysema
hypoxemia post MVA is worsened with fluid challenge
pulmonary contusion
theophylline toxicity
CNS stimulation like HA, insomnia and seizures
GI nausea and vomiting
cardiac toxicity causing arrhythmia
PE can cause what arrhythmias
AFib
Dx PE
CTA
most common causes of secondary clubbing
lung malignancies, CF and right to left cardiac shunts
hypertrophic osteoarthropathy
digital clubbing with painful joint enlargement, periostosis of bones and synovial effusions
at what Saturation O2 is home O2 warranted for cOPD
at what Saturation O2 is home O2 warranted for cOPD
what occurs with large areas of atelectasis
large ventilation perfusion mist match. hyperventilation to compensate for hypoxemia leading to respiratory alkalosis and decreased PaCO2
how does the body compensate for severe COPD causing acidosis
renal retention HCO3
apical lung tumor signs and Sx
horner syndrome if compress sympathetic trunk
brachial plexus affected with pancoast tumor
right recurrent laryngeal compression causes hoarse voice
superior vena cava syndrome
high Right atrial P and high pulm artery pressure but with normal PCWP
PE
what happens when lay penumonia side down
increase physiologic shunting
CXR for RDS
diffuse reticulogranular pattern (ground glass) with air bronchograms
horners
ptosis miosis anhidrosis
how to Dx pancoast tumor or superior sulcus
CXR
Hypertrophic pulmonary osteoarthropathy
clubbing and arthropathy of fingers and wrists due to lunderlying lung disease like lung cancer, TB, bronchiectasis or emphysema
hypoxemia post MVA is worsened with fluid challenge
pulmonary contusion
theophylline toxicity
CNS stimulation like HA, insomnia and seizures
GI nausea and vomiting
cardiac toxicity causing arrhythmia
PE can cause what arrhythmias
AFib
Dx PE
CTA
most common causes of secondary clubbing
lung malignancies, CF and right to left cardiac shunts
hypertrophic osteoarthropathy
digital clubbing with painful joint enlargement, periostosis of bones and synovial effusions
does COPD cause clubbing
no
at what Saturation O2 is home O2 warranted for cOPD
what are the anti cholinergics used in COPD
ipratropium and tiotropium
signs of wegeners
blood sputum or nasal discharge, oral ulcers, sinusitis, dyspnea, cough and hemoptysis
renal insufficiency, microscopic hematuria and RBC casts
CXR in wegeners
nodular densities and alveolar or pleural opacities
what does flattening of diaphragm in COPD do
increase work of breathing
normal DLCO but has obstructive pattern
chronic bronchitis
what happens when lay penumonia side down
increase physiologic shunting
what happens to A-a gradient in idiopathic pulmonary fibrosis
increased
what to check in middle aged person with recurrent sinusitis and gastroenteritis
Quantitative measurement of serum Ig levels
how does chlorpheniramine work
decrease nasal secretions
H1 R blocker
what bacteria cause empyema
step pneumo
staph aureus
klebsiella
what do you need to exclude when suspect ARDS in someone without risk factors
echo to rule out hydrostatic pulmonary edema
how to differentiate asthma and cOPD
before and after bronchodilator Tx on spirometry
high PaCO2 and low PaO2 suggest what
alveolar hypoventilation
Aa gradient with hypoventilation
normal with respiratory acidosis
why not use Positive pressure mechanical ventilation in someone with hypovolemic shock
it will acutely increase the intrathoracic pressure and so increase right atrial pressure and decrease systemic venous return– can cause circulatory collapse
what happens to Aa and V/q with pneumonia
Aa increases and there is a V/Q mistmatch
solitary pulmonary nodule, management
high risk malignancy- resect
mod risk- further imaging and studies
VC in COPD
decreased from air trapping
what are the anti cholinergics used in COPD
ipratropium and tiotropium
Rx used for acute pulmonary thromboembolism
unfractionated heparin
exudative fluid
fluid protein/ serum protein is >0.5
fluid LDH/serum LDH >0.6
what cause exudative pleural effusions
infection, autoimmune, neoplasm
what mechanism causes the exudate in pleural effusions
increased capillary permeability
transudative mechanism
increased hydrostatic pressure or decreased capillary oncotic pressure
what causes cough in ACEI Tx
increased kinin
how to Dx CF
positive screening
increased sweat Cl test on 2+ occasions (quantitative pilocarpine iontophoresis)
identification of 2 CF mutations
Bruton tyrosine kinase gene mutation
X linked agamma globulinemia
what do we measure exhaled nasal nitric oxide for
primary ciliary dyskinesia
best way to prevent post op pneumonia
incentive spirometry
what are the complications of PEEP
alveolar damage, tension pneumo, hypotension
Tx tension pneumo
needle insertion 2nd ICS MCL
recurrent pneumonias in adult in same anatomic region every time
do CT to evaluate for potential obstructions
what causes a increase in plateau pressure or (compliance)
pneumothorax PE pneumonia atelectasis right mainstem intubation
what happens to Aa and V/q with pneumonia
Aa increases and there is a V/Q mistmatch
exudative fluid
fluid protein/serum protein >0.5
LDH fluid/serum LDH >0.6
pleural fluid LDH >2/3 uper limit normal serum LDH
pleural effusion fluid with glucose
rheumatoid pleurisy, parapneumonic effusion or empyeme, malignant effusion, TB pleurisy, lupus pleuritis, esophageal rupture
where do bronchogenic cysts occur
middle mediastinum
complication bronchilitis in infant
apnea
what cause V/Q mismatch
obstrucive lung disease, atelectasis, pulmonary edema and pneumonia
what is Aa gradient in V/Q mistmatch
increased
what type of lung pathology does not correct with supp O2
shunt
what causes increased tactile fremitus
consolidation lobar or pneumonia
what cause decreased tactile fremitus
pleural effusion COPD and pneumothorax
what is mainstay ventilation settings for ARDS
low tidal volumes and PEEP
ARDS is from what underlying physiologic process
pulmonary edema from leaky alveolar capillaries
COPD excacerbation not improving with medicaitons. next step
Noninvasive positive pressure ventilation
what are Sx for someone requiring albuterol and corticosteroids
mild persistent asthma (more than 2x a week and 3-4x night awakenings a month)
next step in pleural effusion management once diagnosed by CXR
thoracocentesis to find cause. transudate or exudate
in newborn with polyhydramnios nasal flaring, barrel chest, breath sounds absent on left and heart sounds loudest at right. abdomen is scaphoid
congenital diaphragmatic hernia pushing everything to the right
recurrent pneumonias in adult in same anatomic region every time
do CT to evaluate for potential obstructions
location of adenocarcinoma of lung
peripheral. most common lung CA
Tx for non allergic rhinitis
intranasal antihistamines or glucocorticoids
effects of squamous cell carcinoma of lung
hypercalcemia
what can small cell carcinoma of lung cause
cushing, SIADH, lambert eaton
where does large cell carcinoma in lung occur
peripheral and can cause gynecomastia and galactorrhea
intial management of PE
anticoagualte if no contraindicaitons
what lung pathogen can cause lytic bone lesions
blastomycosis
what lba test is most helpful indetermining need for chest tube in papapneumonic effusion
pH lower than 7.2 indicates empyema
spontaneous pneumothorax usually caused by
alveolar bleb rupture
hours after gastric secretion aspiration have cough and decreased O2 saturation
pneumonitis from inflammation from the gastric acid
new solitary pulmonary nodule compared to 2 years ago on CX
need a CT to evaluate
management of laryngomalacia in child
reassurance
sometimes supraglottoplasty
diagnosis laryngomalacia
flexible laryngoscopy showing collapse of supraglottic structures with inspiration and omega shaped epiglottis
chronic low back pain in young adult male and also is having trouble breathing, DOE
ankylosing spondylitis that causes restrictive pattern in lungs
what are Sx for someone requiring albuterol and corticosteroids
mild persistent asthma (more than 2x a week and 3-4x night awakenings a month)
when do you give long acting beta 2 agonist
moderate persistent asthma daily Sx, weekly nighttime awakenings, limits on activities, FEV1 60-80% predicted
panacinar empysema from AAT deficiency affects what part of lungs
lower lobes
pH of transudate vs exudate
exudate is usually 7.3-7.45
transudate is usually 7.4-7.55
manifestations of sarcoid
pulmonary: bilateral hilar adenopathy, interstitial infiltrates
opthalmologic: anterior uveitis and posterior uveitis
reticuloendothelial: peripheral lymphadenopathy, hepatomegaly and splenomegaly
MSK: acute polyarthritis, chronic arthritis with periosteal bone resorption
CNS: central DI, hypercalcemia
Lofgren’s syndrome: erythema nodosum, hilar adenopathy, migratory polyarthralgias, fever
Tx for non allergic rhinitis
intranasal antihistamines or glucocorticoids
Tx for bacterial sinusitis
amoxicillin-clavunate
neonate CXR shows bilateral perihilar linear streaking shortly after birth
transient tachypnea of the newborn
if a newborn CXR shows clear lungs with decreased pulm vascularity
persisten pulmonary HTN
primary problem in RDS newborns
surfactant deficiency
massive hemoptysis, next step
secure airway and if bleeding continues do bronchoscopic interventions
what lba test is most helpful indetermining need for chest tube in papapneumonic effusion
pH lower than 7.2 indicates empyema
what to use to rule in or out PE if PE clinically unlikely? clinically likely?
unlikely based on Wells– do D-dimer
likely based on Wells– do CTA
metabolic imbalance from Obstructive sleep apnea
metabolic alkalosis to counteract respiratory acidosis. will have low Cl from bicarb retention
fungal ball on CT
aspergilloma, most common in preexisting lung cavities like old TB lesion
velcro like inspiratory crackles
idiopathic pulm fibrosis
Hypersensitivity pnuemonitis
inhalation of inciting Ag leading to alveolar inflammation
ground glass opacity or haziness of lower lung fields
outpatient Tx CAP
macrolide or doxy
if have comorbidity: fluorquinolone or beta lactam+macrolide
ICU Tx CAP
betalactam + macrolide IV
or
betalactam +fluoroquinolone
non ICU Tx CAP
fluoroquinolone
or
betalactam+ macrolide
CURB-65
for CAP hospitalization Confusion Uremia (BUN>20( Tachypnea >30 hypotension Age>65
2 or more will benefit from inpatient. 4 or more ICU
skin manifestations wegeners.
painful subcut nodules, palpable purpura and pyoderma gangrenosum-like lesions
immunocompromised from chemo and now has pneumonia, pathogen? CXR findings?
P jiroveci
diffuse interstitial infiltrates in perihilar region
PE cause transudate or exudate
both
male has SOB and cough with some hemoptysis. also UA shows dysmorphic RBC
goodpastures
Ab to basement membrane, alpha 3 chain IV collagen, linear IgG deposits
how is recent GI illness risk factor for PE
dehydration and hemoconcentration
wedge shaped pleural opacification in CTA
pulmonary emoblism
signs hyeprcalcemia
anorexia, constipation, increased thirst and easy fatiguability
how does squamous cell carcinoma of lung cause hyperCa
release PTHrp
what is produced by non-seminomatous germ cell tumors
bhCG and AFP
Aa gradient in PE
high
target INR for warfarin in idiopathic DVT patient
2-3 for at least 6 mo
Tx aspergilloma
itraconazole, resectino or bronchial artery embolization
confirm Dx aspergilloma
IgG serology for aspergillus
APGAR stand for
Appearnce(color) Pulse Grimace (reaction) Activity (muscle tone) Respiratory effort
