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Shelves > Pulm > Flashcards

Pulm Flashcards

1
Q

SOB + non productive cough + wheezing

A

Bronchospasm
Caused by reversible inflammation
Triggers can be cold, exercise

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2
Q

Intubated pt with Hypoxia, dullness to percussion, complete opacification of one lung

A

Airway obstruction causing complete atelectasis
Vent -> decreased mucociliary motility -> mucus plug formation
Tx - bronchoscopy

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3
Q

How do you bx a pt that has a centrally located lung mass suspcious for cancer?

A

Bronchoscopy

Peripheral masses - thoracoscopic or needle bx

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4
Q

Decreased diffusion capacity of the lung for CO

A

emphysema

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5
Q

Tx for primary PHTN

A

Prostacyclins, endothelin receptor antagonists or PDE-5 inhibitors
Goal is to vasodilate
Warfarin for all d/t increased risk of DVT/PE
IF they respond to vasodilation - CCB for long term management

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6
Q

Pt gets bronchospasms with NSAID use. Why?

A

Causes a shunting effect and increases production of leukotrienes (potent bronchoconstricotrs)

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7
Q

Silicosis increases the risk of?

A

TB
30x increase
All pts should receive a PPD

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8
Q

Best prognostic indicator in COPD?

A

FEV1

Determines degree of obstruction and monitors progression of dz

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9
Q

FEV1/FVC < 70%

NL DLCO

A

Chronic bronchitis

Asthma

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10
Q

FEV1/FVC <70%

Low DLCO

A

Emphysema

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11
Q

FEV1/FVC 70-80%

low DLCO

A

Interstitial lung dz

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12
Q

Management of acute exacerbation of COPD

A

Bronchodilators, glucocorticoids, abx
If failed -> Non invasive positive-pressure ventilation (NPPV) - PEEP via facemask
If failed -> intubate

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13
Q

What two criteria determine ventilation for a intubated pt?

A

rr x TV
Hyperventilation -> respalkalosis (PO2>100)
Good to start by decreasing the rr

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14
Q

How do you estimate tidal volume for a vent?

A

6mL/kg of ideal body weight

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15
Q

Which test is most sensitive for new onset orthostatic hypotension?

A

Decreased urine sodium (FENa <1%)
Usually caused by underlying hypovolemia
Hypovolemia -> low renal perfusion -> activates RAAS (aldosterone) -> avid uptake of salt and water into the circulation

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16
Q

How is orthostatic defined

A

Drop >20mmHg in SBP

Drop >10mmHg in DBP

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17
Q

sudden onset dyspnea, tachy, tachypnea

A

Pulm embolism
Pleuritic pain, hemoptysis
look for recent travel hx

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18
Q

Most positive impact on survivial in a COPD pt?

A

Long term home oxygen

Proven to prolong survivial

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19
Q

Night time cough -> think?

A

Gerd
Add a PPI
(-prazole)

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20
Q

What is a goal FiO2 while on a vent?

A

<60%, goal is to wean a pt below this to avoid Oxygen toxicity

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21
Q

How does mechanical ventilation improve oxygenation?

A

Increased FiO2

PEEP (decreases dead space)

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22
Q

3 most common causes of chronic cough

A

Upper-aireway cough syndrome (postnasal drip)
Asthma
GERD

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23
Q

Tx for upper-airway cough syndrome (post nasal drip)

A

Chlorpheniramine (1st gen antihistamine, H1 receptor blocker)
Decreases nasal secretions
RF’s - allergies, vasomotos rhinitis, sinusitis

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24
Q

Initial management of PE pt with renal failure

A

Unfractionated heparin

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25
Q

PNA pt has sudden hypoxia and CXR b/l alveolar infiltrates

A

ARDS
Causes impaired gas exchange (V/Q mismatch), lung compliance (stiff lungs d/t loss of surfactant and increased recoil), pulm HTN (d/t hypoxic vasoconstriction

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26
Q

Why does PNA cause hypoxia?

A

V/Q mismatch, intrapulmonary shunting

Difficult to correct hypoxia in the absence of alveolar ventilation

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27
Q

Thoracentesis reveals pleural fluid with glucose < 60 and LDH >60

A

Empyema

Exudative effusion with low glucose d/t the high metabolic activity of WBCs and bacteria

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28
Q

COPD pt has sudden dyspnea and severe R sided chest pain
Tactile fremitus and decreased breath sounds on R
trace ankle edema

A

Secondary spontaneous PTX s/t rupture of alveolar blebs

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29
Q

SOB + dullness to percussion, incerased intensity of breath sounds, increased tactile fremitis

A

Lung consolidation

Usually s/t lobar PNA

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30
Q

Causes of transudative pleural effusion

A 
CHF
Cirrhosis
Nephrotic syndrome
Periotneal dialysis
Effusion can be b/l or unilateral, pH 7.4-7.55,
31
Q

Causes of exudative pleural effusion

A 
Infection
Malignancy
Connective tissue dz
Inflammatory disorders
Movement of fluid from abdomen to pleural space
CABG
PEm
Caused by inflammation so pH tends to be lower (7.3-7.45)
32
Q

New onset shoulder pain

unilateral ptosis, miosis, enophtalmosis, anhidrosis

A

Pancoast tumore (superior pulmonary sulcus (SPS)
Usually caused by malignant lung neoplasm
Presents with shoulder pain (referred), Horners syndrome (ipsi ptosis etc), and brachial plexus numbness/tingling

33
Q

Horners occurs d/t tumor invasion into the?

A

inferior cervical ganglion

Get CXR for a lung mass

34
Q

Former smoker
Feels well
Pulmonary nodule 2cm, completely surrounded by lung parenchyma
No LN

A

Solitary pulmonary nodule
>2cm = High malignancy risk -> surgically excise
Also age over 60 and smoking cessation <5yrs increases risk

35
Q

Most common causes of clubbing

A

Lung malignancy
Cystic fibrosis
R to L cardiac shunts
If you see clubbing look for malignancy

36
Q

COPD pt has an exacerbation and given supplemental O2. He then has a seizure. Why?

A

O2 supplementation in COPD worsens hypercapnia d/t: 1. increased dead space perfusion, V/P mismatch, and 2. Decreased affinity of oxyhemoglobin for CO2, and 3. Reduced alveolar ventilation
goal saturation is 90-93%

37
Q

Definition of COPD

A

chronic productive cough >3 mo in 2 successive years most likely d/t smoking

38
Q

dyspnea
dry cough
fine crackles
ages 50-70

A 
Idiopathic pulmonary fibrosis
Restrictive process
Reduced DLCO
TLC reduced
FEV1/FVC NL
39
Q

Asthma pt has elevated CO2 on ABG despite SABA, ipratropium, systemic steroids. Now what?

A

Intubate

OFten failign due to respiratory m. fatigue

40
Q

BMI > 30
PaCO2 >45 (hyper)
Exertional dyspnia

A

Obesity hypoventilation syndrome
Causes alveolar hypoventilation
Restrictive pattern
ABG - hypercapnia, hypoxia, resp acidosis
Tx - CPAP, weight loss, no sedatives, acetazolamide if severe

41
Q

Reversible airway obstruction (>12% increase in FEV1) w/ bronchodilators
NL DlCO

A

Asthma

42
Q

FEV1/FVC in Obstructive

A

<70%

Restrictive >70%

43
Q

How can you determine between asthma and COPD?

A

Asthma - reversible w/ bronchodilators

COPD - partially reversible/nonreversible, late stage nonreversible

44
Q

Steroids cause a leukocytosis by?

A

Mobilization of PMN’s into the circulation

Also see increased bands from PMN’s leaving the bone marrow

45
Q

What changes are expected in OSA?

A

Hypoxia
Hypercapnia w/ compensated metabolic alkalosis
Erythrocytosis
PHTN
Cor pulmonale
OSA can be found alone or with obesity hypoventilation syndrome (OHS)

46
Q

Sudden onset of SOB and dysphagia

A

Think laryngeal edema (anaphylaxis)
Fixed upper airway obstruction
Decreases airflow on insp and exp
See flattening on top and bottom of flow-volume loop
Tx - ephinephrin, steroids systemic, antihistamines

47
Q

asthma syx > 2days/wk or 3-4 nightly awakenings/mo

A

Mild persistant asthma

Need a daily controller med (INH corticosteroid) + a rescue SABA (albuterol)

48
Q

Asthma syx <2/days week, < 2 nighttime awakenings/mo

A

Intermittent asthma

INH SABA prn (albuterol)

49
Q

Asthma syx w/ SABA use daily, night time awakenings >1/wk but not nightly

A

Low dose INH corticosteroid + LABA

OR medium dose ICS

50
Q

Asthma syx using SABA throughout the day, nighttime awakenings 4-7x/wk

A

Medium dose INH corticosteroid + LABA
OR
High dose INH corticosteroid + LABA AND consider omalizumab if pt has allergies

51
Q

INpt CAP tx

A

Fluoroquinolone (moxifloxacin) or beta lactam + macrolide (ceftriaxone + azithro)

52
Q

How do you decide to admit a PNA pt?

A 
CURB-65
Confusion 
BUN > 20
Respiration > 30
BP < 90/60
Age > 65
>3 -> definite inpt
53
Q

Dyspnea

ECG - irrgular RR intervals, no definite P waves, narrow QRS

A

Pulm embolism

54
Q

Small cell lung cancer causes which metabolic abn?

A

SIADH (hyponatremia)

Fluid restriction in asymptomatic pts

55
Q

Most common malignancy in those exposed to asbestos?

A

Bronchogenic carcinoma
CXR - atelectasis and b/l pleural plaques over the diaphragm
CT - reticular opacities of the lower lung fields, multiple pleural plaques, and a round 6 cm cavitary mass in the RLL

56
Q

Asbestos exposure

CXR - unilateral pleural abnormalaity w/ large pleural effusion

A

Pleural mesothelioma

57
Q 
Young pt (<45) w/ COPD w minimal smoking hx
atypical features (basilar dominant dz)
A

Alpha-1 antitrypsin deficiency

Dx - measure serum AAT levels

58
Q

Pt 20 yrs s/p chemo and radiation for Hodgkin lymphoma

presents with SOB, mass on CXR

A

Secondary malignancy

Hodgkin lymphoma tx with chemo radiation is high risk for secondary solid tumors (lung, breast, thyroid, bone, GI)

59
Q

Decreased breath sounds
decreased tactile fremitus
dullness to percussion

A

Pleural effusion

60
Q

Frequent URI’s

Glomerulonephritis

A

Granulomatosis with polyangiitis
Vasculitis affecting small and medium vessels
Dx - Antineutrophil cytoplasmic Ab (ANCA) + and tissue bx

61
Q

COPD pt presents with palpitations, HA, insomnia, vomiting

EKG - multifocal atrial tachycardia and PVC’s

A

Check serum theophylline levels
Toxicity presents as CNS stimulation, GI disturbance, Cardiac arrhythmia’s.
Cytochrome oxidase inhibitors (medications, diet, dz) can alter the therapeutic window

62
Q

Pancreatitis pt develops ARDS. What is important to remember on ventilation?

A

Prevent alveolar distention by using a Low tidal volume

63
Q

Immigrant w/ distant hx of TB develops 3 months of weight loss, cough, hemoptysis, fatigue
apical cavitary lesion on CT

A

Chronic pulmonary aspergillosis
B syx in a pt with hx of lung dz or immunocompromised
Tx - itraconazole

64
Q

New onset SOB in a pt with significant cardiac hx

A

CHF

65
Q

Male pt w/ large anterior mediastinal mass

Elevated BhCH and AFP

A

Nonseminomatous germ cell tumor

66
Q

Pt gets episodes of fever, malaise, chills, breathlessness, dry cough
CXR - general haziness of both lung fields
NL PFTs
Bird breeder

A

Hypersensitivity pneumonitis

Avoid exposure to birds

67
Q

PNA pt drops O2saturation when lying on the affected side. Why?

A

Intrapulmonary shunting
Positional changes that make consolidation more gravity depends worsen V/Q mismatch, increase intrapulmonary shunting and lead to worsened hypoxemia

68
Q

Immunocompromised

CT - pulmonary nodules w/ surrounding ground-glass opacities “halo sign”

A

Invasive aspergillosis

Tx - voriconazole and echinocandin (caspofungin)

69
Q

RHF d/t PHTN

A

Cor pulmonale
d/t COPD
JVD, loud S@, RV heave, hepatomegaly, dependent sitting edema, possible ascites

70
Q

Immigrant
orthopnea
a fib

A

Mitral valve stenosis d/t rheumatic heart dz

71
Q

Best way to dx pleural effusion?

A

thoracentesis

72
Q

Bronchospasam, nasal congestion after taking ASA

A

Aspirin-exacerbated respirator dz
non IgE mediated
d/t ASA induced protaglandin/leukotriene misbalance.
See in pts with hx of asthma, chronic rinhositis w/ nasal polyposis. Tx - avoid NSAIDs, desensitize, use mentelukate (leukotriene receptor antagonists)

73
Q

pt has lung inflammation hours after aspiration during surgery

A

Aspiration pneumonitis
Acute lung injury d/t chemical burn from gastric content
Aspiration PNA takes days to present vs. hours

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