pulm(chapter 4) Flashcards
1
Q
hemothorax
A
bleeding into pleural space
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
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
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
5
Q
CT findings in pleural effusion
A
separates parenchymal and pleural densities
6
Q
Lights criteria for exudate pleural effusion
A
- pleural fluid protein to serum protein ratio>.5;
- pleural fluid LDH to serum LDH ratio >.6; or
- pleural fluid LDH >2/3upper limit of normal of serum LDH
7
Q
tx for transudate pleural effusion
A
resolve underlying cause
8
Q
tx for malignant effusion
and common irritants
A
drainage and pleurodesis. common irritants are doxycycline and talc.
9
Q
tx of emphyema
A
drainage and antibiotic therapy
10
Q
pneumothorax sx
A
increased unilateral chest expansion, decreased tactile fremitus, hyperresonance, diminished breath sounds, JVD secondary to compression of the SVC
11
Q
pneumothorax labs/xray
A
CXR shows presence of pleural air, visceral pleural line is evidence. ABG analysis shows hypoxemia.
12
Q
- virchows triad
* polycythemia
A
hypercoagulable state, venous stasis, vascular intimal inflammation/injury
*hyperviscosity
13
Q
3rd leading cause of deaths in hospitalized pts
A
DVT
14
Q
PE pt sx
A
sudden pleuritic chest pain, dyspnea, low fever, apprehension, cough, hemoptysis(rare), diaphoresis
15
Q
PE exam findings
A
accentuation of pulmonary component of 2nd heart sound, tachypnea, tachycardia, crackles,low fever
16
Q
ABG finding in PE
A
acute respiratory alkalosis secondary to hyperventilation
17
Q
PE test to order
A
*pulmonary angiography(invasive); do spiral CT first
18
Q
EKG shows S1Q3T3
A
cor pulmonale seen in 20% of pt with symptomatic PE
19
Q
what is pulmonary HTN?
A
pulmonary arterial pressure that rises to a level inappropriate for a cardiac output. it is self perpetuating.
20
Q
what is primary pulm HTN? occurs in who
A
idiopathic, rare, and fatal; young females
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
22
Q
what is the potent stimulus for pulmonary arterial vasoconstriction?
A
hypoxia! also acidosis and veno-occlusive conditions
23
Q
symptoms of pulm HTN
A
ascites, cyanosis, syncope, dyspnea, angina like retrosternal chest pain, weakness, fatigue, edema
24
Q
narrow splitting and accentuation of the second heart sound with an ejection click
A
pulm HTN
25
what tests do you order for pulm htn?
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
26
CT shows diffuse, patchy fibrosis with pleural base honeycombing
idiopathic fibrosing interstitial pneumonia/pulm fibrosis
27
PFT shows FEV1/FVC ratio nml and decreased lung volume
restrictive. idiopathic pulm fibrosis
28
asbestosis from what
insulation, demolition, construction
29
silicosis from what
mining, sand blasting, quarry work, stone work
30
CXR has irregular parenchymal LINEAR opacities at bases and pleural plaques
asbestosis
31
mesothelioma from what
asbestosis
32
CXR has small nodular opacities at upper lung fields; eggshell calcifications
coal workers pneumoconiosis
33
CXR shows diffuse infiltrates and hilar adenopathy
berryliosis
34
simple vs complicated sx of pnemoconioses
simple is asymptomatic. complicated has dyspnea, inspiratory crackles, clubbing, and cyanosis.
35
PFT shows restrictive dysfunction and reduced diffusing capacity
pneumoconioses
36
pneumoconioses tx
supportive(O2 and vaccinations), corticosteroids in silicosis, smoking cessation
37
noncaseating granulomatous inflammation in affected organs
sarcoidosis
38
sarcoidosis mostly affects which organ, s/s
lungs, DRY cough, dyspnea, RALES
39
races affected by sarcoidosis and how symptomatic
north america black woman and north european whites
50% asymptomatic
40
extrapulmonary sx for sarcoidosis
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
41
lab findings for sarcoidosis
screening test: angiotensin converting enzyme elevated in 40-80% of pts
leukopenia, eosinophilia, elevated erythrocyte sed rate, hypercalcemia, hypercalciuria;
42
CXR shows symmetric bilateral hilar and right paratracheal adenopathy, and bilateral diffuse reticular infiltrates
sarcoidosis
43
what test confirms sarcoidosis
transbonchial bx-noncaseating granulomas
44
sarcoidosis tx
corticosteroids
45
what is ARDS?
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
46
3 clinical settings for ARDS
sepsis syndrome!, severe multiple trauma, aspiration of gastric contents, critically ill, gram neg sepsis, severe pancreatitis, near drowning
47
S/S of ARDS
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
CXR of ards
bil. diffuse pulmonary infiltrates(similar to CHF)t; infiltrates tend to be peripheral(**spares costophrenic angles) with air bronchograms in 80%
49
tx for ards
O2 via ET intubation with positive pressure ventilation and low levels of positive end expiratory pressure(PEEP); low tidal volume
50
xray for aspiration of FB shows what
expiratory xray shows regional hyperinflation caused by a check valve effect
51
tx for FB aspiration
bronchoscopy
52
what is hyaline membrane disease
resp. d/s in preterm infant with deficiency of surfactant
53
what is a exudative pleural effusion
"leaky capillaries", examples: infection, malignancy, trauma, PE, collagen vascular d/s, pancreatitis
54
what is a transudative pleural effusion
"intact capillaries", assoc with increased hydrostatic or decreased oncotic pressure; examples: CHF, atelectasis, renal/liver disease
55
who is at greatest risk of a pneumothorax
tall, thin males between 10-30; like a basketball player
56
3 types of pneumothorax
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
tension pneumothorax symptoms
resp distress, tracheal deviation, hemodynamic instability
58
CXR in a pneumothorax
visceral pleural line on expiratory film is diagnostic; pleural air; contralateral mediastinal shift in tension pneumothorax
59
visceral pleural line on expiratory film
pneumothorax
60
pneumonic for presentation of pneumothorax
```
P-THORAX
pleuritic CP
tracheal deviation
hyperresonances
onset sudden
reduced breath sounds(and dyspnea)
absent tactile fremitus(asymmetric chest wall)
xray shows collapse
```
61
exudative fluid think what
pneumonia or malignancy
62
transudative fluid think what
CHF
63
bx shows non caseating granulomas
sarcoidosis
64
signs of pulm HTN
narrow splitting and accentuation of the second heart sound with an ejection click
65
CXR/CT, EKG, and echo in pulm HTN
what is gold standard?
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
tx for primary and secondary pulm HTN
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
prostayclin
potent pulm vasodilator
68
what is cor pulmonale
right sided hrt failure secondary to severe pulm disease
69
causes of cor pulmonale
ARDS, PE, COPD, severe asthma, sarcoidosis, lung trauma, surgery
70
causes of pulm HTN
left heart failure, mitral valve disease, increased resistance in pulm veins(hypoxia and vasoconstriction)
71
rt axis deviation on EKG
lead 1 has neg QRS and avF has a positive QRS
72
PE tx
acute: bolus heparin then LMWH
chronic: anticoagulate 3-6 months
73
westermark sign, hampton hump, atelectasis
PE
74
idiopathic fibrosing interstitial pneumonia sx and exam
insidious dry cough, exertional dyspnea, constitutional symptoms;
exam shows clubbing and INSPIRATORY crackles
75
idiopathic fibrosing interstitial pneumonia tx
prednisone may help. give O2, maybe lung transplant
76
pneumoconioses PFT
PFT shows restrictive dysfunction and reduced diffusing capacity
77
inspiratory rales/ FEV1, FVC, and lung volumes reduced
pneumoconioses
78
berylliosis from what
high tech fields
79
CXR of asbestosis
irregular parenchymal LINEAR opacities at bases and pleural plaques; bx shows asbestos bodies
80
CXR of coal worker's pneumoconiosis
small nodular opacities at upper lung fields; eggshell calcifications
81
CXR of silicosis
2.5 mm nodular opacities at upper and middle lung fields; hilar lymph nodes may be calcified; eggshell calcifications
82
CXR of berylliosis
diffuse infiltrates and hilar adenopathy
83
complication of asbestosis
increased risk of lung cancer and mesothelioma
84
complication of silicosis
increased risk of TB; progressive massive fibrosis
85
complication of coal worker's pneumoconiosis
progressive massive fibrosis
86
complication of berylliosis
requires chronic steroids
87
2.5 mm nodular opacities at upper and middle lung fields; hilar lymph nodes may be calcified; eggshell calcifications
CXR of silicosis
88
what is sarcoidosis?
- idiopathic inflammatory disease characterized by granulomas throughout the body
89
sarcoidosis sx
dry cough, dyspnea of insiduous onset, and chest discomfort
90
leukopenia, eosinophilia, elevated erythrocyte sed rate, hypercalcemia, hypercalciuria;
angiotensin converting enzyme elevated in 40-80% of pts
sarcoidosis labs
91
sarcoidosis CXR
symmetric bilateral hilar and right paratracheal adenopathy, and bilateral diffuse reticular infiltrates
92
eryathema nodosum, enlargement of parotid glands, lymph nodes, liver, spleen
sarcoidosis extrapulmonary sx
93
dry cough, dyspnea of insiduous onset, and chest discomfort
think sarcoidosis
94
how serious is ards
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
shock, toxic inhalation, near drowning, multiple transfusions, burns, pancreatitis, DIC, TTP, pneumonia, miliary TB, lung contusion, high altitude exposure
other causes of ards
96
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
ards
97
```
ards:
heart size
upper lung venous engorgement
pleural effusion
pulm capillary wedge pressure
organ failure
```
```
normal heart size
uncommon upper lung venous engorgement
small to absent pleural effusion
normal pulm capillary wedge pressure
multiple organ failure
```
98
amiodarone, nitrofurantoin, bleomycin, radiations, and long term O2 concentration
can cause or contribute to interstitial lung disease
99
hypoxemia, dec lung compliance, pulm edema, PaCO2/FiO2 ratio under 300.
ards
100
acid base changes in ards
starts off poss resp alkalosis then ends with resp acidosis
101
criteria for ards dx
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
goal oxygenation in ards
Pa02 under 55 or Sa02 under 88%
103
CXR in hyaline membrane disease
air bronchograms, diffuse bilateral atelectasis causing ground glass appearance, doming of diaphram
104
Tx in hyaline membrane disease
synchronized and intermittent mandatory ventilation. administer exogenous surfactants; steroids if there is a risk of delivery before 34 weeks gestation
105
air bronchograms, diffuse bilateral atelectasis causing ground glass appearance, doming of diaphram
CXR in hyaline membrane disease
106
tall peaked T waves
rt atrial hypertrophy
107
* why is there a high mortality rate with ARDS
due to acute hypoxemic respiratory and organ failure
108
CXR of interstitial lung disease
reticular opacities and ground glass appearance
109
reticular opacities and ground glass appearance
CXR of interstitial lung disease
110
4 stages of sarcoidosis
1. BHL (no sx or mild pulm sx)
2. BHL + ILD (moderate pulm sx)
3. ILD only
4. fibrosis (restrictive ds)
111
lupus pernio
raised purple lesions at tip of nose or cheeks. sarcoidoisis
112
PFT of sarcoidosis
restrictive pattern: nml or increased ration, normal or decreased FVC, decreased FEV1
decreased lung volumes
113
sarcoidosis labs
increased ACE levels, hypercalcuria, hypercalcemia, increased vit d.
114
