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First Aid Step 2 > Pulm > Flashcards

Pulm Flashcards

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1
Q

Risk factors for DVT

A

Stasis, endothelial injury, hypercoagulability - Virchow’s triad

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2
Q

Criteria for exudative effusion

A

Pleural/serum protein >0.5
Pleural/serum LDH>0.6
PLeural fluid LDH >2/3 upper limit of nromal serum LDH

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3
Q

Causes exudative effusion

A

Leaky capillaries
-Malignancy, TB, bacterial or viral infection, PE with infarct, pancreatitis

THink inflammation

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4
Q

Causes transudative effusion

A

Intact capillaries
-CHF, liver or kidney disease, protein losing enteropathy

think changes in hydrostatic and oncotic P

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5
Q

Normalizing PCO2 in pt having an asthma exacerbation may indicate

A

Fatigue and impending respiratory failure

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6
Q

Sarcoidosis

A 
Dyspnea
Lateral hilar LNopathy on CXR
noncaseating granulomas
Inc ACE
Hypercalcemia
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7
Q

PFT obstructive disease

A

Dec FEV1/FVC (<80)

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8
Q

PFT restrictive disease

A

Inc FEV1/FVC, dec TLC (>110)

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9
Q

Honeycomb on CXR

Tx

A

Diffuse interstitial pulm fibrosis

Supportive care and steroids

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10
Q

Tx SVC syndrome

A

Rads

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11
Q

Tx mild persistent asthma

A

Inhaled beta agonists and inhaled corticosteroids

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12
Q

Tx COPD exacerbation

A

O2, bronchoD, abx, corticosteroids with taper, smoking cessation

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13
Q

Tx chronic COPD

A

Smoking cessation, home O2, Beta agonist, antichol, systemic or inhaled corticosteroids, flu and pneumo vaccines

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14
Q

Acid base disorder in PE

A

Resp alkalosis with hypoxia and hypocarbia

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15
Q

Non Small cel lung cancer associated with hypercalcemia

A

SCC

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16
Q

Lung cancer w/ SIADH

A

Small cell lung cancer

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17
Q

Lung cancer related to cigarette

A

Small cell lung cancer

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18
Q

Tall caucasion man witha cute SOB
Dx
Tx

A

Spontaneous pneumothorax

Spontaneous regression, supplemental O2 may help

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19
Q

Tx tension pneumo

A

Immediate needle thoracostaomy

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20
Q

Characteristics favoring carcinoma in isolated pulm nodule

A

Age >45-50
Lesions new ot larger compared to old films
Absence calcification or irregular calcification
Size >2 cm
Irregular margins

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21
Q

ARDS

A

Hypoxemia and pulm edema with normal PCWP

Resp alkalosis

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22
Q

Sequelae asbestos exposure

A

Pulmonary fibrosis–>pleural plaques–>bronchogenic carcinoma (mass in lung field)–>mesothelioma (pleural mass

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23
Q

Inc risk of what infection with silicosis

A

TB

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24
Q

Causes hypoxemia

A 
Right to left shunt
Hypoventilation
Low inspired O2
Diffusion defect
V/Q mismatch
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25
Classic CXR findings for pulm edema
Cardiomegaly, prominent pulm vessels, Kerley B lines, bat's wing appearance of hilar shadows, perivascular and peribronchial cuffing
26
Westermark's sign and Hamptom's hump
CXR findings suggesting PE
27
Etiologies of obstructive disease
``` ABCT Asthma Bronchiectasis CF/COPD Tracheal or bronchial obstruction ```
28
Reversible airway obstruction 2/2 bronchial hyperreactivity, airway inflammation, mucous plugging, smooth mm hypertrophy
Asthma
29
pH imbalance asthma
Resp alkalosis with mild hypoxia
30
Dx asthma
Dec FEV1/FVC | Methacholine challenge- tests for bronchial hyper responsiveness
31
Meds for asthma exacerbations
``` ASTHMA Albuterol Steroids Theophylline Humidified O2 Magnesium - severe Antichol ```
32
Example long and short acting beta 2 agonist
albuterol - short | Salmeterol- long
33
Function corticosteroids in asthma
Inhibit cytokine synthesis - beclomethasone/prednisone
34
Fcn muscarinic antagonist in asthma
block muscarinic receptors = prevent bronchoC | Ipratroprium
35
Fcn methylxanthines asthma
BronchoD by inhibiting PDE = inc cAMP levels | Theophylline- narrow therapeutic window (Cardio and neurotoxic)
36
Cromlyn fcn
Prevents release vasoactive mediators from mast cell | Use exercise induced bronchospasm = only good for prophy
37
AntiLT fcn
Zileuton: 5-lipoxygenase pathway inhibitor, blocks conversion of arachnidonic aci to LT Montelukast, Zafirlukast: block LT receptors
38
Mild intermittent asthma Howo often Fev1 Tx
=80% | PRN short acting bronchoD
39
Mild persistent asthma How often FEV1 Tx
>2/wk but 2 night/month >=80% Daily low dose corticosteroid, PRN short acting bronchoD
40
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
41
Severe persistent How often FEV1 Tx
Continual, frequent <=60 High dose inhaled corticosteroid _ long acting beta 2; PO corticosteroid; PRN short acting bronchoD
42
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
43
If chronic hypercapnea, what can O2 do?
Suppress hypoxic respiratory drive
44
Chronic bronchitis - time criteria
productive cough >3 months in 2 consecutive yrs
45
Terminal airway destruction and dilation
Emphysema
46
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
47
CXR of COPD
Hyperinflated lung, flat diaphragm, thin heart and mediastinum; bullae or blebs
48
pH status COPD
acute or chronic resp acidosis (inc pCO2) with hypoxemia
49
TX COPD
``` COPD Corticosteroids Oxygen if PaO2 <=89% Prevention - smoking, pneumo and flu vaccines Dilators: Beta 2 ag and antichol ```
50
Inflammation or fibrosis of interalveolar septum Honey combing Shallow rapid breathing, DOE, nonproductive cough, fine crackles, RHF
Interstitial lung disease
51
PFT for interstitial lung dis
Dec TLC, FCV, DLCO | normal FEV1/FVC
52
Meds cause interstitial lung disease
``` AMIODARONE BLM busulfan Nitrofurantoin Rads ```
53
Sarcoid S/S
``` GRUELING Granulomas aRthritis Uveitis Erythema nodosum LNopathy Interstitial fibrosis Negative TB Gammaglobulinemia ``` Labs: Inc ACE, hyperCa, hypercalciuria, inc ALP
54
Sarcoid most common in
Afr Am females
55
Alveolar thickening and granulomas 2/2 environmental exposure Acute within 4-6 hrs Chronic - progressive dyspnea and rales
Hypersensitivity pneumonitis
56
Inhalation small inorganic dust particles
Pneumoconiosis
57
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
58
Coal mines CXR small nodular opacities in upper lung Spiro shows restrictive dis Complicationn?
Coal miners disease Progressive massive fibrosis
59
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
60
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
61
Diverse group w/ eosinophilic pulm infiltrate and eosinophilia
Eosinophilic pulmonary syndromes
62
Decreased PO2
Hypoxemia
63
Tx hypercapnic pts
Inc ventilation to inc CO2 exchange
64
How to increase oxygenation on mechanical ventilator
Inc FiO2 or PEEP
65
How to increase ventilationon mechanical ventilator
Inc RR or Inc TV
66
Dx ARDS
Acute onset Ratio PaO2/FiO2 <18 Hypoxemia, dec lung compliance, pulm edema
67
4 phases ARDS
1. acute injury - normal PE and possible resp alkalosis 2. 6-48 hrs: hyperventilation, hypocapnia, widening A-a gradient 3. ARF, tachypnea, dyspnea, dec lung compliance, scattered rales, diffuse chest opacity on CXR 4. Severe hypoxemia unresponsive to Tx, inc intrapulm shunting, metabolic and resp acidosis
68
Goal oxygenation ARDS
PaO2 > 60 | SaO2>90% on FiO2 <=0.6
69
Mean pulm arterial P > 25 (normal 15) 5 classifications 1. Arterial pulm Htn 2. inc pulm venous P from L sided heart disease 3. Hypoxic vasoconstriction 2/2 chronic lung dis 4. chronic thromboembolic dis 5. Pulm Htn with unclear multifactorial etiology
Pulm HTN/Cor pulmonale
70
Causes pulm HTn
LHF MV disease Inc resistance pulm VV
71
S/S pulm HTN
``` DOE Fatigue Letharfy Syncope with exertion CP RHF (edema, abdominal distention, JVD)' Loud palpable S2, S4, parasternal heave ```
72
Sudden onset dyspnea, pleuritic CP, low grade fever, cough, tachypnea, tachycardia, resp alkalosis, loud P2, RHF
Pulmonary thromboembolism
73
Most common cause PE
from DVT
74
Dx of PE
``` CXR: normal, possble Hapmtoms hump (wedge shaped infarct) or Westermarks sign (oligemia in affected lung zone) EKG: sinus tach or S1Q3T3 Ct pulm ang with IV contrast - spiral CT VQ scan- mismatch D dimer: sensitive not specific LE venous US: clot ```
75
Lung nodules on CXR - Recent immigrant - SW US - Ohio River Vally
- TB - Cocci - Histoplasmosis
76
Benign vs malignant - age - smoking - films - appearance - margins - size
/ 2cm
77
Highly correlated with cigarette exposure, central location, neuroendocrine origin, paraneoplastic, mets on presentation (brain, liver, bone)
Small cell lung cancer
78
3 types nonsmall cell lung ca
AdenoCA SCC Large cell/neuroendocrine
79
Most common lung CA, peripheral location, broncheoalveolar carcinoma (single nodules, interstitial infiltration, prolific sputum), pleural effusion have increased hyaluronidase NOT ASSOCIATED WITH SMOKING
AdenoCA
80
central location, 98% smokers
SCC
81
least common, poor prognosis, peripheral location, early cavitation
Large cell/neuroendocrine CA
82
Lung cancer mets
``` LABB Liver Adrenals Brain Bone ```
83
Horners | Associated tumor
Miosis, ptosis, anhidrosis | Pancoast tumor at apex
84
Facial swelling and lung Ca
SVC syndrome - supraclavicular engorgement and facial swelling
85
Hoarseness and lung CA
recurrent laryngeal n involvement
86
Examples paraneoplastic syndromes of lung CA
- Endocrine/metabolic - -Cushing - SCLC - -SIADH--SCLC - -Hypercalcemia--SCC - -Gynecomastia--Large cell - Skeletal - -Hypertrophic pulmoary osteoarthyopatyh- non small - -Digital clubbing - non small - Neuromuscular - -Peripheral neuropathy, subacute cerebellar degen, MG (Lambert-Eaton) - SCLC - -Dermatomyositis- All - CV - -Thrombophlebitis or nonbacterial venous endocarditis - Adeno - Heme - -Anemia, DIC, eosinophilia, thrombocytosis-All - -Hypercoagulability- Adeno - Cutaneous- acanthosis nigircans -All
87
Tx SCLC
Unresectable, rads and chemo- low survival rate b/c returns
88
Tx NSCLC
Surgical resection, rads or chemo
89
Dyspnea, pleuritic CP, cough, dullness to percussion, dec breast sounds, possible rub
Pleural effusion
90
Tx pleural effusion
Thoracentesis
91
Acute onset unilat pleuritic CP and dyspnea; tachypnea, diminished or absent breat sounds, hyper resonance, dec tactile fremitus, JCD, decreased chest wall movement
Pneumothorax Tension pneumo: tracheal deviation and hemodynamic instability
92
Primary vs secondary pneumothorax
Primary: 2/2 rupture subpleural apical blebs - tall thin young adulte males Secondary: COPD, trauma, infectious, iatrogenic
93
1 way air valve causing air trapping in pleural space
Tension pneumothorax
94
Presentation of pneumothorax
``` P-THORAX Pleuritic pain Tracheal deviation Hyperresonance Onset sudden Reduced breast sounds and dyspnea Absent fremitus (asymmetric chest wall) Xray shows collapse ```
95
What does DLCO stand for
Diffusing capacity of lungs - ability to transfer gases from alveoli to pulm capillaries
96
Inspiratory V during normal respiration
TV
97
Air V beyond normal tidal V that is filled during maximal inspiration
IRV
98
Total inspiratory air volume considering both TV and IRV
IC
99
Air V beyond TV that can be expired during normal respiration
ERV
100
Remaining air V left in lungs following max expiration
RV
101
RV + ERV = air remaining after expiration of TV
FRC
102
Max air volume that can be expired and inspired IC + ERV
FVC
103
Total air volume of lungs FVC + RV
TLC
104
2 PFT decreased in obstructive, all others are increased
FVC and FEV1
105
Normal A-a gradient
5-15 mmHg Inc: PE, pulm edema, r-l shunt False normal: may be seen in causes of hypoventilation or at high altitudes
106
PAO2-PaO2 gradient
713 x 0.21 -(PaCO2/0.8)-PaO2 0.21 = FiO2 fraction of O2 in inspired air PAo2: alveolar O2 content PaO2 - arterial O2 (90-100)
107
Nasal and throat irritation, sneezing, rhinorrhea, nonproductive cough, fever, no exudative or productive coug
Viral rhinitis/common cold
108
Sore throat, LNopathy, fever, red swollen pharynx, tonsillar exudates Causes?
Pharyngitis Cause: GABS or common cold virus
109
Tx GABS
Penicillin, amoxicillin, etc
110
Complications GABS pharyngitis
PSGN- high antistreptolysin O Rheumatic fever Rheumatic heart disease
111
Cause of tonsillar infections
Strep pharyngitis
112
Arthralgias, myalgias, sore throat, nasal congestion, nonproductive cough, N/V, diarrhea, high fever, LNopathy Rx to shorten course
Viral influenza Oseltamivir
113
Major complication of sinusitis
Meningitis
114
Causes acute sinusitis
Strep pneumo H flu Moraxella catarrhalis
115
Cause chronic sinusitis
Anaerobic
116
DM and sinusitis
Mucormycosis
117
Which sinuses usually affected in sinusitis
Maxillary
118
Rx sinusitis
Amoxicillin
119
Productive cough, sore throat, fever, wheezing tight breath sounds Usual cause
Acute bronchitis Viral If inc risk bacterial infection give fluoroquinolones, tetracycline, erythromycin
120
Infection broncheolaveolar tree by nasopharyngeal bugs--> prod or nonprod cough, dyspnea, chills, night sweats, pleuritic CP, decreased breast sound, dullness to percussion egophony, tachypnea Labs: Inc WBC, positive sputum CXR: lobar consolidation
Pneumonia Bacterial or fungal- broad spectrum abx until cultures return
121
Cough, hemoptysis, dyspnea, weight loss, night sweats, fever, rales Dx?
TB TB is screening for exposure Acid fast stain, culture, bronchoscopy
122
CXR reactived vs primary
Primary- lower lobe Reactivated - apical Also Ghon complexes- calcified granulomas/LN
123
Most common pneumo in kids
Viral
124
Most common pneumo adults
Strep pneumo - higher risk in pts w/ sickle cell PRODUCTIVE COUGH Tx: beta lactams and macrolides
125
Pneumo common in COPD, slower onset than classic pneumo
H flu Tx: Beta lactams or TMP-SNX
126
Nosocomical pneumoa common in immunocompromised pts | Forms abscess
Staph auresu Beta lactams
127
Pneumo in alcoholics with high risk aspiration, currant jelly sputum
Kleb pneumo Cephalosporin, aminoglycosides (gentamicin)
128
Chronically ill and immunocompromised, CF, rapid onset pneumo
Pseudomonas Tx: Fluroquinolones, aminoglycosides, 3rd gen cephalopsoring,
129
Neonates and infants pneumo
GBS Beta lactams
130
Nosomical and elderly pts
Enterobacter | TMP SMX
131
3 types atypical pneumo
Mycoplasma- young adults (college), positive cold agglutinin (macrolides) Legionella: aerosolized water (macrolides, fluoroquinolones) Chalmydophila - young and old (doxycyline and macrolides)
132
Pneumo | Midwest and south central america
Blastomycosis KOH prep Verrucous or ulcerated skin lesions Itraconazole
133
Pneumo caves
Histoplasmosis
134
Immunocompromised Pneumo + GI
PCP - inc LDH (or CMV if koilocytosis) | TMP SMX
135
Paired gram + cocci pneumo
Strep pneumo
136
PPD test positive at 5 mm
HIV, close contacts with TB, signs TB on CXR
137
PPD test positive 10 mm
Homeless, immigrants, IVDU, health care, recent incarceration
138
PPD test positive 15 mm
Always positive
139
Causes ARDS
A- aspiration, acute pancreatitis, air or amniotic embolism R - radiation D- drug OD, diffuse lung disease, DIC, drowning S -shock, sepsis, smoke inhalation
140
Proonged, nonresponsive asthma attack that can be fatal | Tx
Status asthmaticus Agressive bronchoD, corticosteroids, O2, possibly intubation
141
Emphysema vs chronic bronchitis:
DLCO Normal in bronchitis Dec in ephysema (also asbestosis)
142
Alpha 1 antitrypsin def induced emphysema vs not
Alpha 1: panlobular | Not: centrilobular
143
Hoarseness worsens with time, dysphagia, hemoptysis, assocaited tob and alcohol
Laryngeal CA | Tx - remove lesions, rads with surg
144
> 50 yrs, inflammatory lung disease, restrictive, inc PMN on lavage, CXT with honeycomb and CT ground glass
Idiopathic pulm fibrosis Tx: steroids + azothioprine/cyclophosphamide
145
Progressive AI disease of lungs and kidneys 2/2 antiglomerular basement membrane Ab (anit-GBM) S/S: hemoptysis, dyspnea, resp infection Labs: restrictive PFT, UA proteinuria and granular casts, renal biopsy crescenteric GMN and IgG in glomerular capillaries Tx?
Goodpasture Plasmapheresis, steroid and immunosuppressive Rx
146
Granulomatous inflammation and necrosis of lung and other organs 2/2 systemic vasculitis affecting lung and kidneys - noncaseeating granulomas and destruction of lung parenchyma S/S: ulceration of nasopharynx, CNS Sx Lab: + cytoplasmic antineutrophil Ab (c-ANCA) Tx
Granulomatosis with polyangitis -Wegner Cytotoxic Tx - cyclophosphamide and steroids
147
Risk factors PE
``` 7H Hereditary hypercoagulability History- prior DVT or PE Hypomobility Hypovolemia- heydration Hypercoagulability Hormones Hyperhomocysteinemia ```
148
Time line to anticoagulate after PE
3-6 months
149
3 types pneumothorax
Closed - chest wall intact (COPD, spontaneous, TB, blunt trauma) Open- air through opening in chest wall (penetrating trauma, iatrogenic) Tension- air enters but does not leave (trauma)
150
Dyspnea, pleuritic CP, weakness, decreased BS, dullness to percussion, decreased tactile fremitus
Hemothorax
151
Tumor on visceral pleura or peritoneum with poor prognosis | Asbestos (20 yrs later)
Mesothelioma Extrapleural pneumonectomy w/ chemo and rads - Tx
152
Tx central sleep apnea
respiratory stimulants | phrenic n pacemaking
153
Localized alveolar collapse, common after surgery and anesthesia, also asthmatics/FB aspiration/ mass effect CXR: fluffy infiltrates and lobar collapse Preventive Tx?
Atelectasis Incentive spiro, ambulate, PT
154
How to check proper placement of ET tube?
end tidal CO2 - rise following expiration
155
What can be adjusted with mechanical ventilation?
TV RR FiO2 inspirator P PEEP prevent alveolar collapse
156
Predictors of weaning success
Max ins P < 30 cm H2O VC > 10mL/Kg minute vent 200 frequency: TV ratio <100 breaths/min/L
157
Determines and automatically delivers set TV and rate | Pt provides no effort
CMV
158
Determines and automatically devliers set TV and rate | Pt can breathe spontaneously between mechanical breaths
IMV
159
Machines tries to synch rate with pt initiated breaths, automatically delivers TC and rate Pt can breathe spontaneously between mechanical breaths
SIMV
160
Machines senses pt's attempt to breathe and delivers full preset TV, backup rate if no spont breathing Pt driven unless no attempts to breath
AC
161
Acute inflammation of larynx, 3 mo - 5 yrs, barking cough, inspiratory stridor, subglottic narrowing/steeple sign Causes?
Croup | Parainfluenza 1 and 2 (RSV, influenza, rubeola, adenovirus, Myco pneumo)
162
Cause epiglottitis | Major S/S
HiB, strep or the H flu Dysphagia, drooling, muffled voice, high fever, lean forward to breath, THUMBPRINT SIGN (opacified epiglottis obscures airways)
163
Cause bronchiolitis
RSV or parainfluenza 3 (not common) S/S - wheezing and resp distress CXR - hyperinflation lungs Tx- monitor airway
164
Caused by surfactant def; presents within 2 d of birth, inc RR, ABG shows inc CO2, dec O2, ground glass on CXR
RDS of newborn Increased risk of developing asthma
165
complication meconium aspiration
pulm HTN
166
Tx CF
DNase - decrease viscosity of phlegm NSAIDS BRonchD abx
167
Common pulm infection
Pseudomonas | Staph
168
Top 3 causes cough in outpt
Asthma GERD postnasal drip
169
Pneumo in TB and pulm cavitation
Aspergillus
170
Popcorn calcifcations
Granulomas - bening
171
NBulls eye calcifications
Hamartomas- benign
172
Gold standard PE
pulm angiography

First Aid Step 2 (22 decks)

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