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cardio and pulm > pulm(chapter 4) > Flashcards

pulm(chapter 4) Flashcards

1
Q

hemothorax

A

bleeding into pleural space

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2
Q

pleural effusion clinical features

A

dull to flat percussion with reduced or absent breath sounds, friction rub, fremitus. mediastinum will be shifted in large effusion

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3
Q

Standard test for pleural effusion

A

u/s guided thoracentesis gold standard.send fluid for culture, wbc, cell counts, protein, LDH, pH, glucose, cytology, gm stain culture & sensitivity

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4
Q

xray findings for pleural effusion

A

blunting of costophrenic angle, loss of sharp demarcation of diaphragm and heart. lateral decubitus differentiates free flowing vs loculated fluid

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5
Q

CT findings in pleural effusion

A

separates parenchymal and pleural densities

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6
Q

Lights criteria for exudate pleural effusion

A
  1. pleural fluid protein to serum protein ratio>.5;
  2. pleural fluid LDH to serum LDH ratio >.6; or
  3. pleural fluid LDH >2/3upper limit of normal of serum LDH
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7
Q

tx for transudate pleural effusion

A

resolve underlying cause

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8
Q

tx for malignant effusion

and common irritants

A

drainage and pleurodesis. common irritants are doxycycline and talc.

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9
Q

tx of emphyema

A

drainage and antibiotic therapy

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10
Q

pneumothorax sx

A

increased unilateral chest expansion, decreased tactile fremitus, hyperresonance, diminished breath sounds, JVD secondary to compression of the SVC

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11
Q

pneumothorax labs/xray

A

CXR shows presence of pleural air, visceral pleural line is evidence. ABG analysis shows hypoxemia.

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12
Q
  • virchows triad

* polycythemia

A

hypercoagulable state, venous stasis, vascular intimal inflammation/injury
*hyperviscosity

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13
Q

3rd leading cause of deaths in hospitalized pts

A

DVT

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14
Q

PE pt sx

A

sudden pleuritic chest pain, dyspnea, low fever, apprehension, cough, hemoptysis(rare), diaphoresis

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15
Q

PE exam findings

A

accentuation of pulmonary component of 2nd heart sound, tachypnea, tachycardia, crackles,low fever

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16
Q

ABG finding in PE

A

acute respiratory alkalosis secondary to hyperventilation

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17
Q

PE test to order

A

*pulmonary angiography(invasive); do spiral CT first

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18
Q

EKG shows S1Q3T3

A

cor pulmonale seen in 20% of pt with symptomatic PE

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19
Q

what is pulmonary HTN?

A

pulmonary arterial pressure that rises to a level inappropriate for a cardiac output. it is self perpetuating.

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20
Q

what is primary pulm HTN? occurs in who

A

idiopathic, rare, and fatal; young females

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21
Q

what is secondary pulm HTN?

A

develop d/t obliteration and obstruction of pulmonary arterial tree (anything that causes increases in vascular resistance); COPD, PE, polycythemia, Mitral stenosis

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22
Q

what is the potent stimulus for pulmonary arterial vasoconstriction?

A

hypoxia! also acidosis and veno-occlusive conditions

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23
Q

symptoms of pulm HTN

A

ascites, cyanosis, syncope, dyspnea, angina like retrosternal chest pain, weakness, fatigue, edema

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24
Q

narrow splitting and accentuation of the second heart sound with an ejection click

A

pulm HTN

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25
Q

what tests do you order for pulm htn?

A

ekg will show right ventricular hypertrophy and strain, and atrial hypertrophy. CXR will show enlarged pulm arteries. *rt hrt cath offers more precise hemodynamic monitoring

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26
Q

CT shows diffuse, patchy fibrosis with pleural base honeycombing

A

idiopathic fibrosing interstitial pneumonia/pulm fibrosis

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27
Q

PFT shows FEV1/FVC ratio nml and decreased lung volume

A

restrictive. idiopathic pulm fibrosis

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28
Q

asbestosis from what

A

insulation, demolition, construction

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29
Q

silicosis from what

A

mining, sand blasting, quarry work, stone work

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30
Q

CXR has irregular parenchymal LINEAR opacities at bases and pleural plaques

A

asbestosis

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31
Q

mesothelioma from what

A

asbestosis

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32
Q

CXR has small nodular opacities at upper lung fields; eggshell calcifications

A

coal workers pneumoconiosis

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33
Q

CXR shows diffuse infiltrates and hilar adenopathy

A

berryliosis

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34
Q

simple vs complicated sx of pnemoconioses

A

simple is asymptomatic. complicated has dyspnea, inspiratory crackles, clubbing, and cyanosis.

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35
Q

PFT shows restrictive dysfunction and reduced diffusing capacity

A

pneumoconioses

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36
Q

pneumoconioses tx

A

supportive(O2 and vaccinations), corticosteroids in silicosis, smoking cessation

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37
Q

noncaseating granulomatous inflammation in affected organs

A

sarcoidosis

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38
Q

sarcoidosis mostly affects which organ, s/s

A

lungs, DRY cough, dyspnea, RALES

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39
Q

races affected by sarcoidosis and how symptomatic

A

north america black woman and north european whites

50% asymptomatic

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40
Q

extrapulmonary sx for sarcoidosis

A

hilar nodes, paratracheal

skin: eryathema nodosum and LUPUS PERNIO, maculopapular rash (most common), parotid gland enlargement

eyes: anterior uveititis
cardiac: restrictive CM, arrthymias, heart blocks
rheu: hepatosplenomegaly, fever, malaise, wt loss, arthralgias
neuro: CN palsies especially facial nn 7, diabetes insipidus
LOFGREN syndrome: triad EN, bilateral hilar LAD, polyarthralgias wth fever

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41
Q

lab findings for sarcoidosis

A

screening test: angiotensin converting enzyme elevated in 40-80% of pts

leukopenia, eosinophilia, elevated erythrocyte sed rate, hypercalcemia, hypercalciuria;

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42
Q

CXR shows symmetric bilateral hilar and right paratracheal adenopathy, and bilateral diffuse reticular infiltrates

A

sarcoidosis

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43
Q

what test confirms sarcoidosis

A

transbonchial bx-noncaseating granulomas

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44
Q

sarcoidosis tx

A

corticosteroids

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45
Q

what is ARDS?

A

increased permability of the alveolar capillary membranes, which leads to development of protein rich pulm edema; the lung tissue is severely inflammed that is impairs gas exchange secondary to the acute injury

** hypoxemia without hypercarbia

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46
Q

3 clinical settings for ARDS

A

sepsis syndrome!, severe multiple trauma, aspiration of gastric contents, critically ill, gram neg sepsis, severe pancreatitis, near drowning

47
Q

S/S of ARDS

A

acute dyspnea and hypoxemia. multi organ failure if severe

rapid onset profound dyspnea 12-24 after precipitating event, tachypnea, frothy pink or red sputum, diffuse crackles; many pts are cyanotic with increasing severe hypoxemia that does not respond to O2

48
Q

CXR of ards

A

bil. diffuse pulmonary infiltrates(similar to CHF)t; infiltrates tend to be peripheral(**spares costophrenic angles) with air bronchograms in 80%

49
Q

tx for ards

A

O2 via ET intubation with positive pressure ventilation and low levels of positive end expiratory pressure(PEEP); low tidal volume

50
Q

xray for aspiration of FB shows what

A

expiratory xray shows regional hyperinflation caused by a check valve effect

51
Q

tx for FB aspiration

A

bronchoscopy

52
Q

what is hyaline membrane disease

A

resp. d/s in preterm infant with deficiency of surfactant

53
Q

what is a exudative pleural effusion

A

“leaky capillaries”, examples: infection, malignancy, trauma, PE, collagen vascular d/s, pancreatitis

54
Q

what is a transudative pleural effusion

A

“intact capillaries”, assoc with increased hydrostatic or decreased oncotic pressure; examples: CHF, atelectasis, renal/liver disease

55
Q

who is at greatest risk of a pneumothorax

A

tall, thin males between 10-30; like a basketball player

56
Q

3 types of pneumothorax

A

1) primary has no underlying cause(smoking is a risk factor)
2) secondary is a complication of underlying lung disease (COPD, asthma, CF, TB)
3) traumatic

57
Q

tension pneumothorax symptoms

A

resp distress, tracheal deviation, hemodynamic instability

58
Q

CXR in a pneumothorax

A

visceral pleural line on expiratory film is diagnostic; pleural air; contralateral mediastinal shift in tension pneumothorax

59
Q

visceral pleural line on expiratory film

A

pneumothorax

60
Q

pneumonic for presentation of pneumothorax

A 
P-THORAX
pleuritic CP
tracheal deviation
hyperresonances
onset sudden
reduced breath sounds(and dyspnea)
absent tactile fremitus(asymmetric chest wall)
xray shows collapse
61
Q

exudative fluid think what

A

pneumonia or malignancy

62
Q

transudative fluid think what

A

CHF

63
Q

bx shows non caseating granulomas

A

sarcoidosis

64
Q

signs of pulm HTN

A

narrow splitting and accentuation of the second heart sound with an ejection click

65
Q

CXR/CT, EKG, and echo in pulm HTN

what is gold standard?

A

CXR/CT: enlarged pulm arteries
EKG: RVH, RAH, rt vent strain
echo: pulm arterial pressure but should do a rt hrt cath** for more precise hemodynamic monitoring

66
Q

tx for primary and secondary pulm HTN

A

primary: chronic oral anticoagulants, CCB( to lower systemic arterial pressure), prostacyclin(potent pulm vasodilator), diuretics with salt restriction, O2; heart/lung transplant usually needed
seondary: treat underlying cause

67
Q

prostayclin

A

potent pulm vasodilator

68
Q

what is cor pulmonale

A

right sided hrt failure secondary to severe pulm disease

69
Q

causes of cor pulmonale

A

ARDS, PE, COPD, severe asthma, sarcoidosis, lung trauma, surgery

70
Q

causes of pulm HTN

A

left heart failure, mitral valve disease, increased resistance in pulm veins(hypoxia and vasoconstriction)

71
Q

rt axis deviation on EKG

A

lead 1 has neg QRS and avF has a positive QRS

72
Q

PE tx

A

acute: bolus heparin then LMWH
chronic: anticoagulate 3-6 months

73
Q

westermark sign, hampton hump, atelectasis

A

PE

74
Q

idiopathic fibrosing interstitial pneumonia sx and exam

A

insidious dry cough, exertional dyspnea, constitutional symptoms;
exam shows clubbing and INSPIRATORY crackles

75
Q

idiopathic fibrosing interstitial pneumonia tx

A

prednisone may help. give O2, maybe lung transplant

76
Q

pneumoconioses PFT

A

PFT shows restrictive dysfunction and reduced diffusing capacity

77
Q

inspiratory rales/ FEV1, FVC, and lung volumes reduced

A

pneumoconioses

78
Q

berylliosis from what

A

high tech fields

79
Q

CXR of asbestosis

A

irregular parenchymal LINEAR opacities at bases and pleural plaques; bx shows asbestos bodies

80
Q

CXR of coal worker’s pneumoconiosis

A

small nodular opacities at upper lung fields; eggshell calcifications

81
Q

CXR of silicosis

A

2.5 mm nodular opacities at upper and middle lung fields; hilar lymph nodes may be calcified; eggshell calcifications

82
Q

CXR of berylliosis

A

diffuse infiltrates and hilar adenopathy

83
Q

complication of asbestosis

A

increased risk of lung cancer and mesothelioma

84
Q

complication of silicosis

A

increased risk of TB; progressive massive fibrosis

85
Q

complication of coal worker’s pneumoconiosis

A

progressive massive fibrosis

86
Q

complication of berylliosis

A

requires chronic steroids

87
Q

2.5 mm nodular opacities at upper and middle lung fields; hilar lymph nodes may be calcified; eggshell calcifications

A

CXR of silicosis

88
Q

what is sarcoidosis?

A
  • idiopathic inflammatory disease characterized by granulomas throughout the body
89
Q

sarcoidosis sx

A

dry cough, dyspnea of insiduous onset, and chest discomfort

90
Q

leukopenia, eosinophilia, elevated erythrocyte sed rate, hypercalcemia, hypercalciuria;
angiotensin converting enzyme elevated in 40-80% of pts

A

sarcoidosis labs

91
Q

sarcoidosis CXR

A

symmetric bilateral hilar and right paratracheal adenopathy, and bilateral diffuse reticular infiltrates

92
Q

eryathema nodosum, enlargement of parotid glands, lymph nodes, liver, spleen

A

sarcoidosis extrapulmonary sx

93
Q

dry cough, dyspnea of insiduous onset, and chest discomfort

A

think sarcoidosis

94
Q

how serious is ards

A

90% will die without treatment; 1/3 of deaths occur within 3 days of onset of symptoms. The remaining deaths occur within 2 weeks of diagnosis and are caused by infection

95
Q

shock, toxic inhalation, near drowning, multiple transfusions, burns, pancreatitis, DIC, TTP, pneumonia, miliary TB, lung contusion, high altitude exposure

A

other causes of ards

96
Q

rapid onset profound dyspnea 12-24 after precipitating event, tachypnea, frothy pink or red sputum, diffuse crackles; many pts are cyanotic with increasing severe hypoxemia that does not respond to O2

A

ards

97
Q 
ards:
heart size
upper lung venous engorgement
pleural effusion
pulm capillary wedge pressure
organ failure
A 
normal heart size
uncommon upper lung venous engorgement
small to absent pleural effusion
normal pulm capillary wedge pressure
multiple organ failure
98
Q

amiodarone, nitrofurantoin, bleomycin, radiations, and long term O2 concentration

A

can cause or contribute to interstitial lung disease

99
Q

hypoxemia, dec lung compliance, pulm edema, PaCO2/FiO2 ratio under 300.

A

ards

100
Q

acid base changes in ards

A

starts off poss resp alkalosis then ends with resp acidosis

101
Q

criteria for ards dx

A

1) acute onset (under 1 wk) of resp distress
2) Pa02/FiO2 ratio under 300 with PEEP/CPAP over 5 cm H20
3) bilateral pulmonary infiltrates on CXR
4) resp failure not completely explained by heart failure

102
Q

goal oxygenation in ards

A

Pa02 under 55 or Sa02 under 88%

103
Q

CXR in hyaline membrane disease

A

air bronchograms, diffuse bilateral atelectasis causing ground glass appearance, doming of diaphram

104
Q

Tx in hyaline membrane disease

A

synchronized and intermittent mandatory ventilation. administer exogenous surfactants; steroids if there is a risk of delivery before 34 weeks gestation

105
Q

air bronchograms, diffuse bilateral atelectasis causing ground glass appearance, doming of diaphram

A

CXR in hyaline membrane disease

106
Q

tall peaked T waves

A

rt atrial hypertrophy

107
Q
  • why is there a high mortality rate with ARDS
A

due to acute hypoxemic respiratory and organ failure

108
Q

CXR of interstitial lung disease

A

reticular opacities and ground glass appearance

109
Q

reticular opacities and ground glass appearance

A

CXR of interstitial lung disease

110
Q

4 stages of sarcoidosis

A
  1. BHL (no sx or mild pulm sx)
  2. BHL + ILD (moderate pulm sx)
  3. ILD only
  4. fibrosis (restrictive ds)
111
Q

lupus pernio

A

raised purple lesions at tip of nose or cheeks. sarcoidoisis

112
Q

PFT of sarcoidosis

A

restrictive pattern: nml or increased ration, normal or decreased FVC, decreased FEV1

decreased lung volumes

113
Q

sarcoidosis labs

A

increased ACE levels, hypercalcuria, hypercalcemia, increased vit d.

114
Q
A

cardio and pulm (22 decks)

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