Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IPAP > Pulm Block 2 > Flashcards

Pulm Block 2 Flashcards

1
Q

What is the trifecta of issues smoke inhalation has on the body?

Why is this type of injury so deadly?

What type of injury affects the whole airway

A

Thermal to upper airway
Impaired tissue oxygenation
Chemical to lower airway

CO binds to Hgb 250x easier than O2, leading cause of poisoning death worldwide

Steam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Smoke inhalation that causes thermal injury to the respirator tract can create ? sound to be heard during PE due to what characteristic injuries

How long can it take for these complications to show and why?

Cyanide poisoning inhibits ? enzyme causing Pts to present w/ ? Sxs

A

Inspiratory stridor due to bronchospasm/bronchorrhea

18-24hrs later
Neutrophilic inflammation causing edemal/ulceration

Cytochrome- shock, lactic acidosis, coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What finding would be indicative PT has cyanide poisoning?

How are PTs w/ thermal injury smoke inhalation injuries Tx?

What secondary illnesses are present at specific times after the initial injury?

A

Inc venous O2 saturation

High humidity O2
Elevate head to 30*
ABG/PO2 monitoring
Topical Epi- reduces edema/
Suction, gentle

ARDS: 1-2 days
Pneumonia: 5-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What Tx/management step is added to PTs w/ chemical injury to their airways from gases/products of combustion?

What two Tx types are avoided in these PTs?

A

PEEP for bronchiolar edema
Daily sputum Gram stains

CCS
ABX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Even if PTs w/ severe body burns and smoke inhalation survive, they need constant f/u monitoring for the development of ? which appears as ?

A

Bronchiolitis Obliterans

CT shows ground glass, bronchial wall thickening and honey comb appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define Pneumoconioses

How do these PTs present?

How are they Tx?

A

Chronic fibrotic lung Dzs from inhalation of inorganic dusts

ASx w/ diffuse nodular opacities on CXR

Life shortening Dz w/ supportive Tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What causes coal dust to be absorbed and turned into Black Lung Dz

What are the growths seen on CXR called?

A

Alveolar macrophages ingest dust and consolidate in upper lung areas

Coal macules: 2-5mm in upper fields

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the difference between Simple and Complicated Coal Worker’s Dz?

Complicated Dz complications are similar and seen in ? other pneumoconiosis Dz?

A

Simple: ASx
Complicated: massive fibrosis w/ irregular masses >1cm w/ upper lung contractions

Complicated silicosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What causes Silicosis lung dz?

How does this Dz on CXR?

A

Quarries/mines of quartz, granite, sandstone

Small round opacities
Calcification of hilar lymph nodes- eggshell calcifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does Simple Silicosis present?

How does Complicated Silicosis present?

A

ASx
Normal PFTs

Irregular masses >1cm
Inc upper lung densities
Obstruct/Restrictive PFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Silicosis PTs have an increased risk of contracting ? lung infection

Why is there this increased risk?

A

Infections requiring macrophage defenses: Fungi Atypical mycobacteria TB

Silica is cytotoxic to alveolar macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

All silicosis PTs need to have updated/on records results of ? 2 things?

How does asbestosis present?

A

TB skin test
CXR

Dyspnea
Inspiratory crackles
Clubbing/cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does Asbestosis appear on CXRs?

What CXR finding holds the best Dx value?

A

Linear streaks in lower fields
Various size opacities
Honey comb changes if advanced Dz

Pleural calcifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What image modality has the best imaging ability of asbestosis?

What does this imaging allow providers to see?

A

High Res CT

Parenchyma fibrosis
Pleural plaques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What would be seen on PFT in a PT w/ asbestos

What is done for these PTs as Tx?

A

Restrictive pattern
Reduced FVC and FEV1
Normal/Inc FEV1/FVC ratio
Reduced DLCO

O2 for SoB
Resp PT to remove secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hypersensitivity Pneumonitis is AKA ?

What type of d/o is this?

A

Extrinsic Allergic Alveolitis

Inflammatory d/o involving alveolar walls and terminal airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What causes Hypersensitivity Pneumonitis

What causes Bagassosis

A

Exposure to inhaled organic agent leading to an acute illness

Moldy sugar cane fiber

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What causes Sequoiosis

What causes Suberosis

What causes Detergent Worker’s lung

A

Moldy redwood saw dust

Moldy cork dust

Enzyme additives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does acute Hypersensitivity Pneumonitis present?

What will be seen on PE?

What would be seen on lab results?

What will be seen on CXR

What would be seen on PFTs?

A

Sudden F/C/N
Dyspnea

Crackles, Tachy/Tachy

Neutrophilia/L shift
Inc ESR/CRP

Nodular densities except in Apex/Bases

Restrictive dysfunction
Reduced DLCO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does Subacute Hypersensitive Pneumonitis present

What is seen on CXRs

How is if definitively Dx?

A

Wks-Mon of:
Chronic cough
Dyspnea, Anorexia/Wt loss

Fibrosis/honey comb

Lung biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is Hypersensitive Pneumonitis Tx

What are the 3 types of obstructive airway d/os?

A

Acute- self limiting/recovery
Severe/protracted: PO CCS w/ 4-6wk taper

Byssiniosis
Industrial bronchitis
Occupational asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Define Industrial Bronchitis

This respiratory Dz rarely ?

A

Chronic bronchitis seen in coal miners, exposure to cotton, flax or hemp

Leads to chronic disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Define Byssinosis

How does it present?

What happens if exposure is not d/c?

A

Asthma like d/o in textile workers from inhalation of cotton dust

Tight chest, Cough, Dyspnea- worse on 1st day back to work, better later in week

Chronic bronchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Define Silo-Fillers Dz

What is a common finding late in this Dz

A

Toxic lung injury causing pulmonary edema due to inhalation of N-dioxide

Bronchiolitis obliterans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is Silo Filler’s related bronchiolitis obliterans prevented?

What happens if exposure is not d/c’d?

A

CCS

Fatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What causes Popcorn Lung

What is one of the MC causes of ARDS

A

Inhalation of diacetyl (butter flavoring) leading to bronchiolitis obliterans

Acute aspiration of gastric contents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the S/Sxs of acute aspiration of gastric contents

What is seen on labs?

What is seen on CXR?

A

Cough Wheeze Fever Tachypnea w/ base crackles
Fever even w/out infection

Hypoxemia Leukocytosis

Patches of alveolar opacities in dependent lung fields

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How are PTs w/ acute aspiration of gastric contents managed?

What is the secondary infection risk for these PTs?

A

Intubate/ventilate
Fluids- HOTN management
No ABX/CCS

25% of PTs 2-3 days later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What can cause Chronic Aspiration of Gastric contents

What habits can cause relaxation of the LES which can lead to this d/o?

A

Primary d/o of larynx/esophagus

Smoking
Theophylline
ETOH
Caffeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What pulmonary d/os are linked to GERD and chronic aspiration?

What causes Hydrocarbon pneumonitis

How are PTs w/ hydrocarbon pneumonitis Tx?

A

Bronchiectasis
Cough
Asthma
Pulmonary fibrosis

Aspiration of ingested petroleum distillates

Support/protection: cuffed ET tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How does acute radiation pneumonitis present?

What will be seen on CXR?

How is this Tx?

A

Acute onset: 2-3mon after radiation completion
Insidious dyspnea, dry cough, angina, weakness, fever

Alveolar/nodular opacities in the irradiated areas

Prednisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What can radiation pneumonitis progress to?

How does this present?

What would be seen on imaging?

A

Pulmonary Radiation Fibrosis

Slow onset dyspnea

Reduced volumes
Opacities
Obliterated lung markings
Tented diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Obesity Hypoventilation Syndrome is AKA ?

What causes this syndrome?

A

Pickwickian Syndrome

Blunted ventilatory drive
Inc mechanical load on chest due to obesity- leads to alveolar hypoventilation, hypoxemia, elevated PaCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How is Pickwickian Syndrome Tx

A

Weight loss- improves hypercapnia, hypoxemia

NPPV

Stimulants: Theophylline, Acetazolamide, Medroxyprogesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Define OSA

What are the risk factors for developing this?

A

Upper airway obstruction due to loss of pharyngeal muscle tone allowing for passive collapse during inspiration

Tonsillar hypertrophy
Obesity
Micrognathia- small jaw
Macroglossia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are additional/non-anatomical risk factors for developing OSA?

What PT population is OSA MC in?

A

Testosterone supplementation
Smoking
Hypothyroidism

Obese, middle age men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

When is OSA a considered Dx during a PE?

What is the first S/Sx that may be reported?

What Mallampati score is common for this Dx?

A

Refractory HTN

Personality changes

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What labs are ordered when suspecting OSA?

How is OSA severity classified?

A

CBC- common erythrocytosis
TSH/fT4

Apnea Hypopnea Index: number of apnea/hypopnea events per hour of sleep
Normal= 0-4
Mild= 5-14
Moderate= 15-29
Severe= +30 or O2 sat <90 for >20% of study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What will be seen in a AHI of 5-14

What may be noticed in moderate score PTs?

What may be seen in PTs w/ AHI scores of +30

A

No impairment on life, noticed by family
Noticed by PT when energy inc due to weight loss/cessation of ETOH

Daytime sleepiness
HTN

Daytime sleepiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

PTs w/ AHI scores above 30 are 3x more likely to develop ? Dzs

How is OSA Tx?

A

CAD HTN Arrythmias DM2

Weight loss
Avoid ETOH/Sedatives
Mild: oral devices
Mod/Sev: nightly nasal CPAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When surgery is considered for OSA, what is the procedure?

What procedure is saved for a last resort in PTs w/ arrhythmias and failed conservative Tx?

A

UPPP- uvulopalatopharyngoplasty
Resection of soft tissues
Nasal septoplasty

Trachoestomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is NOT used during OSA Tx and why

What is the #3 MC cause of death in hospitalized PTs?

A

O2- dec desaturation, lengthens apneas

PEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What “things” can embolize into pulmonary circulation?

What is the MC ‘thing’?

A 
Foreign bodies
Fat
Rumor cells
Air
Parasite eggs
Septic emboli

Thrombus from deep veins of LE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What blood issues can create a hyperviscosity state for DVTs

What can cause increased central venous pressures?

A

Polycythemia

Pregnancy
CHF/low CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are examples of inherited states of hypercoagulability

A

Factor V Leiden mutation

Deficient/dysfuntion of Antithrombin 3, Prothrombin, Protein C/S

Antiphospholipid syndrome- Lupus, anticardiolipin Ab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are two immediate effects when a PE becomes lodged?

What are two effects that can become systemic after this obstruction occurs?

A

Obstructed vascular bed
Reflex constriction= wheeze and inc work to breathe

Inc dead space
Hypoxemia (R to L shunt, dec CO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

A massive thrombus can possibly be the cause of ?

What Sxs can PTs w/ a PE present with?

A

R ventricle failure

Dyspnea
Pain w/ inspiration
Cough
Hemoptysis
Wheeze
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What signs can PTs w/ PEs present w/?

What are the top 3 presenting S/Sxs

A

Tachypnea
Crackles
S4
Homans sign

Dyspnea
Pain w/ inspiration
Tachypnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

PTs w/ a massive PE may present w/ ? issue

What is the MC EKG sign?

A

Syncope

Sinus tach
ST and T wave changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Define McGinn White Sign

What would an ABG result show in a PT w/ a PE?

A

S1Q3T3 on EKG for PE and Cor Pulmonale

Respiratory alkalosis due to hyperventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Define a D-Dimer test

What other hematological findings are not Dx but useful for Dx PEs?

A

Degradation production of cross linked fibrin that i elevated w/ thrombus

Troponin I, T, B and BNP: carrelate w/ poor outcome due to R heart strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What CXR finding is most suggestive of a PE?

What are the MC findings?

A

Hypoxia w/ normal CXR

Atelectasis
Pleural effusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are two rare/less common CXR findings during a PE?

What is the study of choice for suspected PEs?

A

Westermark sign: proximal central pulmonary artery w/ local oligemia
Hampton hump: wedge shaped opacity representing intraparenchymal hemorrhage

2 Helical CT pulmonary angiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How does a V/Q scan work?

These scans are usually done in conjunction w/ ? other study?

A

Radiolableled albumin into circulation to detect low blood flow

Ventilation scan- Xenon gas, distribution is measured q15 sec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What V/Q scan results are highly suggestive of PEs

70% of PTs w/ PE have a ?
but only 50% of these have a PE on angio

A

Perfusion defect w/out ventilation defect

DVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the TOC for proximal DVTs

What used to be the gold standard but is now called the reference standard?

A

Venous ultrasonography
Dx= inability to compress femoral/popliteal veins

Pulmonary angiography- catheter through vein in groin to heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

When is pulmonary angiography warranted?

What is the MC used algorithm for Dx PEs?

A

All other studies are inconclusive
Dx must be established
Helical CT unavail or c/i

Rapid D-dimer
Helical CT PA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Wells Criteria

A 
DAHMN BC
DVT Sxs- 3 
Alternatives unexplained- 3
HR >100bpm- 1.5
Mobility reduced- 1.5
Nown Hx of DVT- 1.5
Bloody Cough- 1
CA (active or last 6mon)- 1
>6= high <2= low
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How are PEs Tx

A

Anticoagulation- stops thrombus formations, NO dissolving ability
Allows endogenous fibrinolytic lyses

Heparin then PO Warfarin

INR goal: 2-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are the anticoagulants used for PE Tx?

A

LMWH: SQ Enoxaparin
IV UFH
Fondaparinux: Factor Xa inhibitor

All but Fonda 5-7 day combo w/ Warfarin overlap or until INR 2-3 for 24hrs
D/c Heparin/Lovenox on day 5 or 6 after INR is in range x 24hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the new Factor Xa inhibitors that are used for PE Tx that don’t require Warfarin over lap

What are the benefits of using these meds?

What are the risks though?

A

Apixaban Rivaroxaban Edoxaban

No INR monitoring
Andexxa- reverses Riva/Apixa

No way to track/monitor compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Pregnant PTs w/ DVT risk are managed w/ ? anticoagulant?

What meds are used to break up a PE?

A

LMWH

Thrombolytics: Streptokinase, Urokinase, rt-PA Alteplase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How do thromblytic therapies work?

What are the absolute c/i to using these?

What are the major c/i?

A

Lysis of thrombin to increase plasmin levels but no inc of mortalitiy than heparin/warfarin

Active internal bleeding
Stroke in past 2mon

Uncontrolled HTN
Surgery/trauma past wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

When are IVC filters installed?

A

Recurrent embolisms despite adequate anticoagulation therapy
Chronic emboli w/ PHTN
PTs w/ c/i to anticoagulation therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How are PTs that are low/med/high risk for VTE formation positioned for prevention?

A

Low: young admitted for <24hrs, early ambulation

Mod/high: low UFH/LMWH/Fondaparinux

Mod/High w/ bleeding risk: compression stockings/foot pumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Define Interstitial Lung Dzs

How do they present?

A

Group of d/os causing pulmonary inflammation and fibrosis

Dyspnea, Crackles
Septal thickening
Reticular changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What location is the issue of ILDz?

Because of this location, what issues arise from it’s position?

A

Distal, below bronchioles

Obliterated capillaries and fibrosis

68
Q

What is the pathophysiologic reason behind ILDz?

What are the 3 MC etiologies?

There is a strong correlation to ?

A

Injury Repair Fibroblast Proliferation Fibrosis Honeycomb PHTN

Meds
Dusts, in/organic
Radiation

CT dz

69
Q

What is the major consequence of ILDz?

What is the MC classification?

A

Impaired gas exchange

idiopathic interstitial pneumonia: Idiopathic pulmonary fibrosis

70
Q

What Dzs are found in x-rays in the upper lobes

What Dzs would be seen in the middle/lower lobes?

A

Sarcoidosis
Silicosis

Idiopathic pulmonary fibrosis
Subacute eosinophilic pneumonia
Asbestosis

71
Q

Hilar and mediastinal adenopathys are not common to ILD but are seen in ? 3 Dzs

What would be seen on x-ray of chronic eosinophilic pneumonia

A

Sarcoid
Berylliosis
Silicosis

Peripheral located infiltrates in uppler/middle lobes w/ clear hilar/central zones

72
Q

What are 4 radiographic features on HRCT typical w/ idiopathic fibrosis

Define idiopathic pulmonary fibrosis

A

Dec lung volume
Honeycomb change
Peripheral reticular change
Lower lobe predominence

Intersitial pneumonia w/out a cause (MC of these, 25% of ILDz)

73
Q

? type of sample is often required for definitive Dx of Idiopathic Interstitial Pneumonias

Define Pulmonary Fibrosis

A

Lung biopsy

Scarring of the lung

74
Q

Define Usual Interstitial Pneumonias (UIP)

When is a Dx of Idiopathic Pulmonary Fibrosis given

A

Lung injury characterized by collagen fibrosis w/ scarring in peripheral/pleural w/ honeycomb changes

If cause/trigger of UIP is unknown
MC form of ILD

75
Q

What would be seen on x-ray of UIP

What type of PFT is seen w/ IPF

A

Dec lung volume/fibrosis
Uneven diaphragm
Honeycomb

Restrictive defect

76
Q

How is IPF Tx?

What is the average survivability from onset age to death

What is the 2nd MC ILDz?

A

Prednisone
Nintedanib/Pirfenidone
O2 if <89%
Only definitive: transplant

Onset: 5th-6th decade
2-5yrs

Sarcoidosis

77
Q

Define Sarcoidosis

What PT population is usually affected?

What age range does it usually present at?

A

Systematic granulomatosis Dz of unknown etiology

AfAm/European

3-4th decade

78
Q

What are the presenting Sxs of Sarcoidosis

What will be seen on CXR

What is an uncommon finding on PE

A

Cough, Dyspnea, Fatigue, Fever, Weight loss

Hilar adenopathy
Paratracheal lymphadenopathy

Crackles

79
Q

Define Lofgren Syndrome

Why is this important for Dx and PT comfort

How is it Tx

A

Sarcoidosis Triad:
Bilateral hilar lymphadenopathy
Erythema nodosum
Migratory polyarthralgia

95% specific for Dx, no need for biopsy

NSAIDs
Low dose CCS
Colchicine
Hydroxychloroquine

80
Q

What is a rare presentation of Sarcoidosis

What is the trifecta

A

Uveoparotid Fever

Fever Uveitis Parotitis w/ or w/out CN7 palsy

81
Q

Uveoparotid Fever can progress to ? Sxs and mimic?

What lab findings may be seen?

A 
Sicca Sxs (Latin for eyes/mouth)
Sjogren's syndrome

Inc ACE levels
Hyper Calcemia/uria
Leukopenia
Inc ESR

82
Q

What will be sen on PFTs in sarcoidosis?

How is the Dz staging accomplished?

A

Restrictive pattern
Dec volume and diffusing capacity

CXRs

83
Q

What lab result is Dx for Sarcoidosis

What 3 Dx have to be r/o

A

Biopsy of lymph node, skin lesion or salivary gland showing Noncaseating granulomas

Lymphoma, Fungal, TB

84
Q

How is Sarcoidosis Tx

Pts w/ ? Sx/finding have the best prognosis

What type of f/u or tracking is done for these PTs?

A

PO CCS
Methotrexate if intolerant/poor response to CCS

Only hilar adenopathy

Opto
CXR
CMP
Annual physical
PFTs
EKG
85
Q

Define Pulmonary Alveolar Protein

What are the usual presenting Sxs

A

Phospholipids in alveolar spaces from 1* (idiopathic) or 2* causes

Progressive dyspnea/cough

86
Q

What did Dr T find unique or interesting about Pulmonary Alveolar Proteinosis

What are the defining characteristics of Eosinophilic Pulmonary Syndromes

A

Spontaneous remission

Constitutional Sxs
Lung tissue eosinophilia
Inc eosiniphils in lavage fluids
Peripheral blood eosinophilia

87
Q

What can cause Eosinophilic Pulmonary Syndrome

What is often associated w/ acute eosinophilic pneumonia

A

Meds: Nirto Phenytoin Ampicillin Acetominophen Ranitidine
Helminth infection

Initiation/resuming smoking

88
Q

How is acute eosinophilic pulmonary pneumonia Tx

What is the difference in presentation of this dz in chronic form?

A

PO CCS

More common in women and non-smokers
Asthma

89
Q

Granulomatosis w/ polyangiitis used to be called ?

This idiopathic Dz is characterized by ?

A

Wegener’s granulomatosis

Glomerulonephritis
Necrotizing granulomatous vasculitis
Small vessels vasculitis

90
Q

What are two unique presenting Sxs of Granulomatosis w/ Polyangiitis

What characteristic CXR finding is unique

What external findings may be seen on PE

A

Sinusitis, Ottitis

Nodular pulmonary infiltrates w/ cavitation

Saddle nose
Tracheal stenosis
Strawberry gums

91
Q

What Dx test is done for Granulomatosis w/ Polyangiitis

Eosinophilic granulomatosis w/ Polyangitis used to be ? syndrome

A

Serologic (C-ANCA) and lung/sinus/kidney biopsy shows necrotizing granulomatous vasculitis

Churg Strauss syndrome

92
Q

What PT population does Eosinophilic granulomatosis w/ Polyangitis affect most

This Dz has what transient CXR findings

A

PTs w/ asthma involving skin and lungs

Opacities of multiple nodules

93
Q

How is Granulomatosis w/ Polyangiitis Tx

How is Eosinophilic granulomatosis w/ Polyangitis Tx

A

Cyclophosphamide
PO Prednisone
Rituximab- antineoplastic monoclonal Ab
Bactrim

CCS
Mepolizumab- interlukin 5 antagonist
Cyclophosphamide

94
Q

? is AKA Goodpasture Syndrome

Define this Dz

A

Anti-Glomerular Basement Membrane Dz

Alveolar hemorrhage
Glomerulonephritis
Anti-GBM Abs

95
Q

How is Anti-Glomerular Basement Membrane Dz Dx

How is it Tx

A

IgG immunofluorescence and antiGBM Abs

CCS
Cyclophosphmide
Plasmaphoresis

96
Q

What is the bimodal distribution pattern of Anti-Glomerular Basement Membrane Dz

What are the presenting Sxs

A

Men: 30-40
Women: >60

Hemoptysis
Anemia
Hypoxemia

97
Q

What Dz would have microscopic hematuria on its results?

How does Idiopathic Pulmonary Hemosiderosis

A

Anti-Glomerular Basement Membrane Dz

Young adult/Peds w/ recurrent pulmonary hemorrhage w/ hemosiderin macrophages in lavage fluids

98
Q

How can you differentiate Idiopathic hemosiderosis from Anti-Glomerular Basement Membrane Dz

What finding is typical in this Dz

How is it Tx

A

Idopathic hemosiderosis has no renal/anti-GBM involvement

Fe deficiency

CCS

99
Q

How does Histoplasmosis present

Because of these Sxs, what incidental findings may lead to a past Dx

A

ASx/mild flu Sxs after inhalation fungal spores from dirt/cave in Ohio/MS valley

Pulmonary/Splenic calcification

100
Q

What microbes are found in SW US, South, O/M Valley, East and New England regions of the US

What microbe is from Northern Mexico?

A 
SW: Coccidio
South: Blastomycosis
O/M Valley: Histo
East: RMSF
NE: Lyme/Babesiosis

Mexico: Paracoccidio

101
Q

What PT presentation would indicate Histo instead of atypical/CAP?

What two unique PT population are more susceptible to this Dz

A

No response to ABX

HIV w/ CD4 <100
PTs on TNF blocking agents

102
Q

What is the classic CXR finding of Histoplasmosis

How can this be Dx

A

Diffuse nodular infiltrates

Urine/Serum Ag
Broncho lavage
Blood/Marrow culture

103
Q

What meds are used for Histo Tx

How do Coccidio infections present

A

Mild: Itraconazole
Sev: IV Amphotericin B

Inhalation of spores from dirt w/ most infections being ASx
Very common opportunistic in HIV and endemic areas

104
Q

What is a unique presenting Sx of Coccidio

What is the MC presentation

Half of the time, what does it look like on CXR

A

Back ache/pain

CAP in endemic areas

Unilateral hilar adenopathy

105
Q

How is Coccidio Dx

What PT populations are more likely to have this

A

Serologic tests for IgM/IgG
Possible eosinophils, no dx value

Phillipino Black Pregnant

106
Q

How does disseminated Coccidio infection present

What CXR finding is seen?

A

More pronounced pulmonary involvement:
Lung abscess
Meningitis
Wart like skin lesions

Diffuse miliary pattern

107
Q

How are mod/severe Coccidio infections tx

Define Blastomycosis

A

Fluconazole
Itraconazole
Amphotericin B- only for severe PTs

Midwest/Canada outdoor man from inhaled spores

108
Q

Blastomycosis is ASx unless it’s disseminated then it presents as ?

How is this Dx

A

Skin/Bone lesions
Prostatitis/Epididymitis

CXR- cavitary lesions
Sputum culture
BALavage
Calcofluorfluorescent staining of sputum

109
Q

How is Blastomycosis Tx

Which fungal infection is ubiquitous in nature?

A

Mild: Azole anti-fungals (Itracon/Ketoconazole)
Mod/Sev: Amphotericin B

Aspergillosis

110
Q

Aspergillosis is usually ASx unless it’s in an ImmSupp PT, then it presents as ?

This is the MC ? presenting in ? 3 forms

A

Transplant PTs w/ neutropenia

Pulmonary infection: Allergic, Invasive, Aspergilloma

111
Q

Since Aspergillosis is a hard Dx to make, what facts can help aid w/ the Dx

What other presentation is unique and can help?

A

PT w/ Asthma Hx who has worse Sxs, Infiltrates on CXR w/ high Eosinophils/IgE in blood

Wax/wane of Sxs

112
Q

What med can be used for acute exacerbations of allergic bronchopulmonary Aspergillosis

How are Aspergillomas w/ cavitary masses Tx

A

PO Prednisone
Bronchodilators

Surgical ressection

113
Q

How does PCP present

What is seen on CXR

How is it Tx

A

ImmComp PTs w/ CD4 <200

Pneumothorax/consolidations on CXR

Bactrim

114
Q

Define Acute Respiratory Failure

Normal pH, PCO2 and HCO3 levels

ABG gives you what 3 pieces of info

A

Respiratory dysfunction leading to poor oxygenation/ventilation

pH: 7.35-7.45
PCO2: 35-45
HCO3: 22-28

pH PaCO2 PaO2

115
Q

Although ABG criteria for respiratory failure is not absolute, what two criteria are observed for class

S/Sxs of respiratory failure include those of the underlying Dz and what 2?

A

PaO2 <60mm= SaO2 <90%
PaCO2 >45mm

Hypercapnia
Hypoxemia

116
Q

What is the main/chief sign of hypoxemia and hypercapnia

What other signs may be present of hypoxemia

What other signs of hypercapnia may be present

A

Dyspnea
Dyspnea + HA

Tachy Restless Anxiety Confusion Tremor

Conjunctival hyperemia
HTN Asterixis Tachy

117
Q

If there is suspicion of respiratory failure, what test needs to be ordered?

Define Non-ventilatory

Define Ventilatory

A

ABG

Ensures oxygenation of vital organs w/ O2 administration

Maintains patency of airway and ensured adequate ventilation

118
Q

What is the goal of non-ventilatory respiratory support

Enough O2 is given to PTs to maintain O2 sat at ? level

A

Oxygenate vital organs

Lowest amount to maintain SPO2 of 90% or higher

119
Q

How is NPPV delivered to PTs?

When is this the first line therapy?

A

Full face mask or nasal mask

COPD w/ hypercapnic failure as long as they can:
Protect airway
Manage secretions
Tolerate mask apparatus

120
Q

What is the benefit of using NPPV in COPD PTs

What is the next step if PTs can’t handle this Tx or decompensate

A

Dec need for intubation, length of hospitalization and mortality

Intubation

121
Q

What are the seven indications for tracheal intubation

A

Hypoxemia even w/ O2
Upper airway obstruction
No airway protection

Severe hypoxemia
Apnea
Inability to clear secretions
Decompensation

122
Q

After intubation, why is a CXR needed

What are the 2 modes of positive pressure ventilation

A

Verify tip is at aortic arch, 5cm above charina

Controlled mechanical vent
Synchronized intermittent mandatory vent- vent delivers minimum number of breaths at a specific tidal volume each minute

123
Q

What are the 3 alternate modes on mechanical ventilators

Define Tube migration

What will be seen to signify this has occurred?

A

Pressure support
Pressure control
Continuous pos pressure

Tip of ET tube moves into main bronchus

Atelectasis of contralateral lung and over distension of intubated lung

124
Q

What are the S/Sxs of barotrauma induced ventilator complications?

This adverse effect is why PTs on ventilators are set at ? setting?

A

SubQ emphysema
Pneumomediastinum
Subpleural air cysts

Deliberate hypoventilation

125
Q

Over ventilation of a PT will lead to respiratory ?

Under ventilation will result in respiratory ?

A

Resp alkalosis

Resp acidosis

126
Q

What are the effects on the body of HOTN induced ventilation

Why is carb heavy nutrition avoided in PTs that are on ventilators

A

Elevated intrathoracic pressure= dec venous return

Inc CO2 production

127
Q

Why do E+ need to be monitored in PTs on ventilators

What is given to reduce the stress of the PTs Gi system?

Since these PTs are immobile what anticoag therapy are they on?

A

HypoK and hypoPO4 which worsen hypoventilation

PPIs

LMWH w/ compression devices

128
Q

What are the prognosis for PTs on ventilators due to sedative/opioid OD, COPD w/out intubation or ARDS associated sepsis

Define ARDS

A

Excellent
Good
Poor

Non-cardiogenic form of pulmonary edema leading to hypoxemia respiratory failure

129
Q

How is the severity of ARDS determined

A

PaO2/FIO2 ratios
Mild: 200-300mmHg
Mod: 100-200mmHg
Sev: <100mmHg

FIO2- fraction of inhales O2, amount of O2 given to PT

130
Q

Regardless of the mechanism of injury, what lung injuries are common w/ ARDS

Why are these injuries important

A

Cappilary endothelial and alveolar epithelial cells

Inc permeability and
Dec surfactant production= pulmonary edema, atelectasis, hypoxemia

131
Q

How does ARDS present

In addition to labored breathing, tachy and crackles, what will most PTs present w/ ?

A

12-48hs post event w/ hypoxemia refractory to O2

Multiples organ failure

132
Q

CXR of ARDS shows bilateral infiltrates that are not seen ?

What normal findings will be noted

A

Costophrenic angles

Normal heart size
Small/no effusions

133
Q

How is ARDS Tx

ARDS + ? Dx has a 90% mortality rate

A

Broad ABC
Intubate/ventilate w/ lowest PEEP and tidal volume
Maintain SaO2>88%

Sepsis causing organ failure

134
Q

Respiratory distress Syndrome is AKA ?

When is this MC seen

A

Hyaline membrane Dz

Preterm infant <28wks due to surfactant deficiency

135
Q

When does surfactant development begin?

The lack of this in a baby causes ? reactions

A

20th week

Neutrophil accumulation
Pulmonary edema

136
Q

What happens if infant w/ respiratory distress syndrome develops atelectasis

What steps are taken to prevent respiratory distress syndrome?

A

Cytokine mediated inflammatory response

Surfactant therapy via ET tube
Antenatal CCS in all PTs 23-34wks pregnant
PEEP prevents atelectasis

137
Q

What is the definition of persistent severe respiratory distress in PT w/ RDS

Define Pleuritis and it’s cause

A

Reqs FiO2 +0.40 to maintain 90% O2 sats
Apeneic

Inflammation of parietal pleura causing pain
URI, Pneumonia, Autoimmune

138
Q

What will be seen on PE of pleuritis

If a radiating Sx is seen, what is the etiology

A

Pain w/ inc resp effort
Ipsilateral shoulder pain
Friction rub

Central diaphragmatic parieteal pleura irritation (CN10)

139
Q

What is the anatomical reason for pleuritis pain

How is this condition Tx

A

Parietal pleura: + nerves
Visceral pleura: - nerve

NSAIDs
Indomethacin
Codeine

140
Q

How is pleura fluid absorbed out of the pleural space

How much is normally present

A

Lymphatics

5-15mL

141
Q

What are 4 etiology’s of pleural effusions

A

Hemothorax: bleeding

Empyema: infection in space

Exudate*: inc production from abnormal capillary permeability/dec lymph clearance

Transudate*: inc production due to inc hydrostatic/dec oncotic press

142
Q

Define Hydrostatic Pressure

Define Oncotic Pressure

How do these two work in relation to each other

A

Press exerted by particular fluid

Proteins in blood that displace water, make appearance of less fluid in blood stream
Opposite of each other

143
Q

What are the S/Sxs of a pleural effusion

What may be seen on PE of a larger effusion

How are they Dx

A

Dyspnea Cough Respirophasic pain

Dullness to percussion (hyporesonance)
Dec breath sounds

Thoracentesis

144
Q

What would different appearing pleural effusions be caused by

A

Empyema: clear over white cells

Chylous: always turbid w/ chylomicrons, inc TG levels

Hemorrhagic: blood and effusion mixture

Hemothorax: pleural fluid hct >0.5

145
Q

What are the 3 things a pleural effusion sample is tested for?

What are the 3 criteria an ‘exudate’ must meet

A 
pH
Microbiology: gram, culture
Cytology
Protein Glucose LD
WBC

One of:
Protein >0.5
Pleural LD/serum LD ratio >0.6
Pleural fluid LD >2/3 of upper limit of normal serum LD

146
Q

What is the MC cause of transudate pleural effusion

What is the cause of an exudative effusion to have high amylase

A

Heart failure

Esophageal rupture/pancreatitis
Usually a L sided effusion

147
Q

What would a rheumatoid caused effusion look like

What would it look like if it was caused by TB

A

Empyema
Cholesterol crystals
Low complement

Inc protein

148
Q

What are the 2 MC types of malignancys to cause exudative effusion?

Since CXRs are the first images ordered for effusions, how much fluid must be present to be seen on certain views?

A

Lung Breast

Upright lateral: 75-100mL
Upright frontal: 175-200mL

149
Q

How much effusion must be present to perform a blind thoracentesis

CTs are able to pick up and ID how much effusion fluid

A

1cm of fluid on decubitus view

10mL and the etiology

150
Q

How are pleural effusions Tx

A

Transudative: Tx underlying issue

Malignant: chemo/rad, thoracentesis can be therapeutic

Hemothorax: large bore tube thoracostomy

151
Q

Define parapneumonic pleural effusion

How are these Tx if they’re un/complicated

A

Bacterial pneumonia w/ effusion:

Unomplicated: ABX

Complicated: low pH, low glucose, Neg gram stain/culture
Tx w/ ABX and tube thoracostomy if glucose is <60 or pH <7.2

152
Q

What type of lab results doe empyema pleural effusions have and how are they Tx?

A

Purulent appearance
Low pH
+ Gram stain

Tx: ABX and tube thoracostomy

153
Q

Spot Pneumos can be life threatening if there are underlying ? issues

How will the PT present if it’s a small/large pneumo?

A

Asthma
COPD

Small: mild tachy
Large: dec sounds, fremitus and unilateral hyper resonance

154
Q

How are pneumothorax’s usually revealed on imaging?

How are small ones defined and Tx?

A

Visceral pleural line on CXR

<15%
Observe and O2
D/c if no progression seen on repeat CXRs

155
Q

When are chest tubes placed for Spot Pneumos

A

Severe Sxs
On ventilation
Large
Secondary

Tube placed under waters seal drainage and suction
Respond in 3 days

156
Q

After needle decompression, what is the definitive care step done for tension pneumos

After Tx, PTs need to avoid ? 3 things

A

Tube thoracostomy

Smoking
High altitudes
Scuba diving

157
Q

How are spot pneumos that have blebs and pleurodesis Tx

What spirometry result is most consistent with a restrictive pulmonary Dz?

A

Open thoracotomy w/ resection

Reduced expansion of lung parenchyma
Asthma/COPD= obstruction

158
Q

? type of pneumoconioses is an obstructive lung Dz?

Insterstitial syndromes of the lung include ? Dz

A

Byssinosis

SHIT FACEDD
Sarcoidosis Histiocytosis IPF Tumor Failure Asbestosis Ceolagen d/o Environmental Dust Drugs

159
Q

What is the physiological reason for hypoventilation in abesity hypoventilation?

What abnormal corrective mechanism seen in this Dz is unique and not found in other lung Dzs

A

Blunted ventilatory drive
Inc mechanical load

Voluntary hyperventilation

160
Q

What is the Dx criteria for obesity hypoventilation

Why do these PTs in surgery cause concern

A

BMI +30
Arterial partial pressure of CO2 +45mm
Exclusion of other causes

Higher risk of respiratory/cardiac failure, intubation

161
Q

What is the most serious secondary consequence of hypoxemia

Why are PTs that drown in winter more likely to be saved?

A

Anoxic brain injury

Dec brain temp by 10*C= dec ATP demand x 50%

162
Q

What type of thermal inhalation injury is not isolated to the upper airway?

Smoke inhalation PTs present with Sxs 18-24hrs later due to ? reaction

A

Steam affects whole airway tract

Neutrophil inflammation causing mucosal edema/ulcerations

163
Q

Thermal airway injuries present as ? issue

Inhalation injuries manifest primarily with ? 2 things

A

Laryngeal edema

Bronhcospasm
Bronchorrhea

164
Q

What test is conducted serially in inhalation injury PTs

Define Reactive Airway Dysfunction Syndrome

A

CXRs

Impaired pulmonary function after inhalation injuries manifesting as airway hyper responsiveness

165
Q

What is the leading cause of death from poisoning worldwide?

If CO poisoned PT is placed in hyperbaric chamber, how many atmospheres are they palced at to displace CO from Hgb?

A

Carbon monoxide

2.5-3 atm

166
Q

What enzyme is inhibited by cyanide

These PTs present with ? 3 common findings

What’s the quickest result that would indicate PT has cyanide poisoning

A

Cytochrome, prevents cellular respiration

Coma
Lactic acidosis
Shock

Inc venous oxygen saturation

IPAP (212 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions