Pulm Flashcards
Risk factors for DVT
Stasis, endothelial injury, hypercoagulability - Virchowβs triad
Criteria for exudative effusion
Pleural/serum protein >0.5
Pleural/serum LDH>0.6
PLeural fluid LDH >2/3 upper limit of nromal serum LDH
Causes exudative effusion
Leaky capillaries
-Malignancy, TB, bacterial or viral infection, PE with infarct, pancreatitis
THink inflammation
Causes transudative effusion
Intact capillaries
-CHF, liver or kidney disease, protein losing enteropathy
think changes in hydrostatic and oncotic P
Normalizing PCO2 in pt having an asthma exacerbation may indicate
Fatigue and impending respiratory failure
Sarcoidosis
Dyspnea Lateral hilar LNopathy on CXR noncaseating granulomas Inc ACE Hypercalcemia
PFT obstructive disease
Dec FEV1/FVC (<80)
PFT restrictive disease
Inc FEV1/FVC, dec TLC (>110)
Honeycomb on CXR
Tx
Diffuse interstitial pulm fibrosis
Supportive care and steroids
Tx SVC syndrome
Rads
Tx mild persistent asthma
Inhaled beta agonists and inhaled corticosteroids
Tx COPD exacerbation
O2, bronchoD, abx, corticosteroids with taper, smoking cessation
Tx chronic COPD
Smoking cessation, home O2, Beta agonist, antichol, systemic or inhaled corticosteroids, flu and pneumo vaccines
Acid base disorder in PE
Resp alkalosis with hypoxia and hypocarbia
Non Small cel lung cancer associated with hypercalcemia
SCC
Lung cancer w/ SIADH
Small cell lung cancer
Lung cancer related to cigarette
Small cell lung cancer
Tall caucasion man witha cute SOB
Dx
Tx
Spontaneous pneumothorax
Spontaneous regression, supplemental O2 may help
Tx tension pneumo
Immediate needle thoracostaomy
Characteristics favoring carcinoma in isolated pulm nodule
Age >45-50
Lesions new ot larger compared to old films
Absence calcification or irregular calcification
Size >2 cm
Irregular margins
ARDS
Hypoxemia and pulm edema with normal PCWP
Resp alkalosis
Sequelae asbestos exposure
Pulmonary fibrosisβ>pleural plaquesβ>bronchogenic carcinoma (mass in lung field)β>mesothelioma (pleural mass
Inc risk of what infection with silicosis
TB
Causes hypoxemia
Right to left shunt Hypoventilation Low inspired O2 Diffusion defect V/Q mismatch
Classic CXR findings for pulm edema
Cardiomegaly, prominent pulm vessels, Kerley B lines, batβs wing appearance of hilar shadows, perivascular and peribronchial cuffing
Westermarkβs sign and Hamptomβs hump
CXR findings suggesting PE
Etiologies of obstructive disease
ABCT Asthma Bronchiectasis CF/COPD Tracheal or bronchial obstruction
Reversible airway obstruction 2/2 bronchial hyperreactivity, airway inflammation, mucous plugging, smooth mm hypertrophy
Asthma
pH imbalance asthma
Resp alkalosis with mild hypoxia
Dx asthma
Dec FEV1/FVC
Methacholine challenge- tests for bronchial hyper responsiveness
Meds for asthma exacerbations
ASTHMA Albuterol Steroids Theophylline Humidified O2 Magnesium - severe Antichol
Example long and short acting beta 2 agonist
albuterol - short
Salmeterol- long
Function corticosteroids in asthma
Inhibit cytokine synthesis - beclomethasone/prednisone
Fcn muscarinic antagonist in asthma
block muscarinic receptors = prevent bronchoC
Ipratroprium
Fcn methylxanthines asthma
BronchoD by inhibiting PDE = inc cAMP levels
Theophylline- narrow therapeutic window (Cardio and neurotoxic)
Cromlyn fcn
Prevents release vasoactive mediators from mast cell
Use exercise induced bronchospasm = only good for prophy
AntiLT fcn
Zileuton: 5-lipoxygenase pathway inhibitor, blocks conversion of arachnidonic aci to LT
Montelukast, Zafirlukast: block LT receptors
Mild intermittent asthma
Howo often
Fev1
Tx
=80%
PRN short acting bronchoD
Mild persistent asthma
How often
FEV1
Tx
> 2/wk but 2 night/month
=80%
Daily low dose corticosteroid, PRN short acting bronchoD
Moderate persistent asthma
How often
FEV1
Tx
Daily
>1 night/wk
60-80%
Low to medium dose corticosteroid + long acting beta 2 and PRN short bronchoD
Severe persistent
How often
FEV1
Tx
Continual, frequent
<=60
High dose inhaled corticosteroid _ long acting beta 2; PO corticosteroid; PRN short acting bronchoD
Permanent dilation of bronchii 2/2 cycles of infection and inflammation
Chronic cough, yellow/green sputum, dysponea, hemoptysis, halitosis
CXR: inc bronchovascular marking and TRAM LINES (outline dilated bronchi)
CT: dilated airway and ballooned cyst
Spiro: dec FEV1/FVC
Bronchiectasis
If chronic hypercapnea, what can O2 do?
Suppress hypoxic respiratory drive
Chronic bronchitis - time criteria
productive cough >3 months in 2 consecutive yrs
Terminal airway destruction and dilation
Emphysema
Emphysema vs bronchitis S?S
E: pink puffer - dyspnea, pursed lips, minimal cough; thin appearance, late hypercarbia/hypoxia
B: blue bloater - cyanosis with mild dyspnea, productive cough, overweight, edema, rhonchi, early signs hypoxia
CXR of COPD
Hyperinflated lung, flat diaphragm, thin heart and mediastinum; bullae or blebs
pH status COPD
acute or chronic resp acidosis (inc pCO2) with hypoxemia
TX COPD
COPD Corticosteroids Oxygen if PaO2 <=89% Prevention - smoking, pneumo and flu vaccines Dilators: Beta 2 ag and antichol
Inflammation or fibrosis of interalveolar septum
Honey combing
Shallow rapid breathing, DOE, nonproductive cough, fine crackles, RHF
Interstitial lung disease
PFT for interstitial lung dis
Dec TLC, FCV, DLCO
normal FEV1/FVC
Meds cause interstitial lung disease
AMIODARONE BLM busulfan Nitrofurantoin Rads
Sarcoid S/S
GRUELING Granulomas aRthritis Uveitis Erythema nodosum LNopathy Interstitial fibrosis Negative TB Gammaglobulinemia
Labs: Inc ACE, hyperCa, hypercalciuria, inc ALP
Sarcoid most common in
Afr Am females
Alveolar thickening and granulomas 2/2 environmental exposure
Acute within 4-6 hrs
Chronic - progressive dyspnea and rales
Hypersensitivity pneumonitis
Inhalation small inorganic dust particles
Pneumoconiosis
Manufacture tile or brake linings, insulation, construction, demolition, shipbuilding
Can see fibers on pleural biopsy
15-20 yrs after initial exposure
CXR shows/multinodular opacities and interstitial fibrosis; calcified pleural plaques, CT shows linear fibrosis
Complications?
Asbestosis
Complication: inc risk mesothelioma and other lung cancers
Coal mines
CXR small nodular opacities in upper lung
Spiro shows restrictive dis
Complicationn?
Coal miners disease
Progressive massive fibrosis
Work in mines or quarries with glass, pottery or silica, sandblasting, cutting granite
CXR: small nodular opacities in upper lung zones, EGGSHELL CALCIFICATIONS, hilar adenopathy
Spiro: restrictive disease
Complication?
Silicosis
Increased risk TB, need annual TB test; progressive massive fibrosis
Work in high technology fields = aerospace, nuclear, electronic plants
Ceramics, foundries, plating facilities, dental material sites, dye manufacturing
CXR: diffuse infiltrates and BILATERAL hilar adenoathy, granulomas
Complications
Berylliosis
Requires chronic corticosteroids
Diverse group w/ eosinophilic pulm infiltrate and eosinophilia
Eosinophilic pulmonary syndromes
Decreased PO2
Hypoxemia
Tx hypercapnic pts
Inc ventilation to inc CO2 exchange
How to increase oxygenation on mechanical ventilator
Inc FiO2 or PEEP
How to increase ventilationon mechanical ventilator
Inc RR or Inc TV
Dx ARDS
Acute onset
Ratio PaO2/FiO2 <18
Hypoxemia, dec lung compliance, pulm edema
4 phases ARDS
- acute injury - normal PE and possible resp alkalosis
- 6-48 hrs: hyperventilation, hypocapnia, widening A-a gradient
- ARF, tachypnea, dyspnea, dec lung compliance, scattered rales, diffuse chest opacity on CXR
- Severe hypoxemia unresponsive to Tx, inc intrapulm shunting, metabolic and resp acidosis
Goal oxygenation ARDS
PaO2 > 60
SaO2>90% on FiO2 <=0.6