Pulm

Question 1

CP of obesity hypoventilation syndrome (OHS)

Answer 1

• chronic fatigue
• dyspnea
• difficulty concentrating
• INC partial pressure of CO2 (PaCO2)
• setting of obesity
• nml alveolar to arterial gradient
  
  • along w/: neuromuscular d/o and high altitude (low inspired fraction of oxygen)

Question 2

OSA vs. OHS vs. narcolepsy

Answer 2

• OSA:
  
  • PP: relaxed pharyngeal mu=AW closure
  • CP: loud snoring with periods of apnea
  • s/s:
    
    • daytime somnolence, non-restorative sleep w/ freq awakenings, morning HA, affective and cognitive s/s
  • sequelae: systemic HTN, pulm HTN+RHF
• Narcolepsy:
  
  • poorly regulated REM
  • xs daytime sleepiness
  • cataplexy, sleep attacks, hypnagogic/hypnopompic hallucinations, sleep paralysis
• OHS:
  
  • restricted CW expansion d/t severe obesity
  • hypoventilation with chronically elevated PCO2 and reduced PO2

Question 3

CF vs. Kartagener syndrome (primary ciliary dyskinesia)

Answer 3

• CF:
  
  • mc GI d/o: pancreatic insufficiency
    
    • thick, viscous secretions in pancreas lumens=obstruction, inflamm, friboris
    • CP: steatorrhea, FTT, deficiency of fat soluble vitamins
  • can have MISSING VAS DEFERENS=infertility in men

Question 4

CF of CF

Answer 4

• RESPIRATORY
  
  • obstructive lung dz–>bronchiectasis
  • recurrent pneumonia
  • chronic rhinosinusitis
• GI
  
  • obstruction
    
    • meconium ileus
    • distal intestinal obstruction syndrome
  • pancreatic dz
    
    • exocrine pancreatic insufficiency
    • CF-related diabetes
  • biliary cirrhosis
• REPRO
  
  • infertility…MISSING VAS DEFERENS
• MUSCULOSKELETAL
  
  • osteopenia–>fractures
  • kyphoscoliosis
  • digital clubbing

Question 5

pulm hemorrhage syndromes termed

Answer 5

• who are they??:
  
  • anti-GBM Ab dz
  • vasculitis-associated hemorrhage
  • idiopathic pulmonary hemosiderosis
• what do we see??
  
  • focal. necrosis. of. alveolar walls. with associated. intra-alveolar. hemorrhage

Question 6

neutrophil-RICH alveolar EX-udate termed

Answer 6

early histologic manifestation of acute bacterial or aspiration pneumonia

Question 7

mono-nuclear interstitial pulmonary infiltrates termed

Answer 7

early in the course of a variety of interstitial lung diseases

Question 8

fat embolism triad

Answer 8

• setting: pt with severe long bone and/or pelvic fractures
• acute-onset euro abnormalities
• hypoxemia
• petechial rash

Question 9

pulm embolism

Answer 9

• CP: (sudden onset) tachnypnea, tachycardia, cough, PLEURITIC CHEST PAIN
• pts at risk: hospitalized and postop (**ortho)
  
  • RF: immobilization causes venous stasis
  • RF: recent sx causes inflamm which induces a hypercoaguable state
• hypoxemia (low PaO2) develops in pts with PE d/t ventilation/perfusion
• thrombi originate in deep veins of pelvis and lower extremities before embolizing to lungs

Question 10

ship between thrombotic occlusion and V/Q

Answer 10

• thrombotic occlusion of pulm circulation leads to INC blood flow to remainder of the lung=V/Q mismatch
• ischemic injury causes inflamm=surfactant deficiency and atelectasis in surrounding lung regions

Question 11

what are the main causes of INC A-a gradient hypoxemia (DEC PaO2)

Answer 11

• V/Q mismatch (pulm embolism)
• diffusion impairment (less common, occurs in pts with end-stage interstitial lung dzL pulm fibrosis, hyaline membrane dz)
• R-to-L shunt (high vol of deoxy blood traverses poorly ventilated lung regions)

Question 12

atelectasis chest xray

Answer 12

• atelectasis=diminished air vol in pt of the lung
  
  • most commonly d/t obstruction of corresponding bronchus or bronchiole
• chest xray: opacification (collapse) of corresponding lobe/lobule

Question 13

decompensated LV failure CXR

Answer 13

• cardiomegaly (heart > 1 hemi-thorax in size)
• pulm edema
• pleural effusion
• enlarged pulm vessels

Question 14

COPD CXR

Answer 14

• lung HYPER-inflation w/ diaphragmatic flattening

Question 15

pulm HTN CXR

Answer 15

• enlargement of pulm arteries (circular blobs on left and right) and RV

Question 16

pulm fibrosis CXR

Answer 16

• CP: gradually progressive dyspnea and bilat reticulonodular opacities
• PFT: restrictive pattern
• lung bx: patchy interstitial lymphocytic inflamm and fibrosis of the alveolar walls

Question 17

Cheyne-Stokes vs. Kussmaul breathing

Answer 17

• CS: cyclic breathing
  
  • apnea followed by gradually INC then DEC total volumes until next apneic period
  • seen in setting of advanced CHF
• Kussmau: deep and labored pattern
  
  • assoc with severe metabolic acidosis (espec DKA**)
    
    • also dt: uremia, sepsis, salicylates, methanol, aldehydes, LA
• in obstructive sleep apnea breathing there is thoracic/abdo mvmt but intersperesed absence of airflow

Question 18

ABPA (allergic bronchopulmonary aspergillosis)

Answer 18

• who? pts with asthma or CF
• CP: recurrent asthma exacerbations
  
  • also: fever, maliase, expectoration of brown mucus plugs
• CXR: infiltrates or evidence of proximal bronchiectasis

Question 19

HOT cheese up front..jk HOT T-BONE st..EAK

Answer 19

• IL1: fever (HOT)
• IL2: stimulates T cells
• IL3: stimulates BONE marrow
• IL4: stimulates IgE production
• IL5: stimulates IgA production
• IL6: stimulated aKute-phase protein production and fever

also: IL-8=major chemotactic factor for neutrophils