Pulm UW Flashcards
for every uncompensated 10mmhg increase in PaCO2, pH decreases…
.08 dec pH for every 10mmhg uncompensated inc PaCO2
how long for kidneys to compensate for respiratory acidosis
48 hours
rapid worsening of respiratory symptoms in COPDEer think…
spontaneous pneumothorax from ruptured bleb
bronchiectasis
signs and symptoms
pathophys
cough, mucopurulent sputum, rhinosinusitis, dyspnea, hemmoptysis, crackles, wheezing
infectious insult with impaired bacterial clearance (immunodeficiency, structural airway defect)
TF
24yo w bronchiectasis could be from CF
T
7% of CF presents after age 18…
how does lung exam for bronchiectasis hint at CF as the cause
Upper lobe involvement (crackles, infiltrate) suggests CF rather than another cause
TF
pt with bronchiectasis may have impaired neutrophil migration
F
more like too many neutrophils with excessive elastase production causing airway structural damage
shoulder pain with horner syndrome with smoking history think
Pancoast tumor
Superior Pulmonary Sulcus Tumor
5 presenting symptoms of Pancoast Tumor
shoulder pain
horner syndrome
C8-T2 neuro atrophy/pain of forearm and hand
supraclavicular lymphadenopathy
weight loss
Pancoast tumor aka
Superior Pulmonary Sulcus Tumor
SPS tumor
usually SCC or Adenocarcinoma
how does pancoast tumor produce shoulder pain
brachial plexus invasion
how does pancoast tumor produce horner syndrome
paravertebral sympathetic chain and inferior cervical ganglion invasion
edrophonium testing is used to diagnose
myasthenia gravis muscle weakness/fatigue
PaCO2, Bicarb, and Chloride levels in OSA with OHS (obstructive sleep apnea with obesity hypoventilation syndrome)
PaO2 up because excess weight on chest hypoventilating
Bicarb up to neutralize respiratory acidosis
Cl- down because intercalated cells of distal nephron exchange for bicarb resorption
Do patients with OSA and OHS (obstructive sleep apnea and obesity hypoventilation syndrome) have high or low PaCO2?
high
hypoventilating
TF
pts with OSA and OHS have low PaCO2 because they are hyperventilating from low oxygen
F
high PaCO2 from hypOventilation because so much weight on chest
patient with fever, respiratory distress, hypoxemia and bilateral lung opacities on FiO2 70% and 5cmH2O PEEP… with PaO2 55%…
increase FiO2 or PEEP?
pt has ARDS with low oxygenation
2 ways to increase oxygenation with vent – FiO2 and PEEP
increase PEEP preferred here when FiO2 is already high and peep under barotrauma limit so far – will improve oxygen transport and open up atelectasis, and avoid pulmonary oxygen toxicity (free radical inflammation) from excessive FiO2
FiO2 - generally want to wean to v60% asap to limit pulmonary oxygen toxicity, so adjust PEEP if possible if FiO2 already running high (^60%)
describe pleural effusion from PE
- size
- etiology
- transudate/exudate?
- painful?
small
due to hemorrhage or inflammation
exudative or bloody
pleuritic pian
asthma med ladder
1 SABA
2 low dose ICS
3 low ICS and LABA or med ICS
4 med ICS and LABA
5 high ICS and LABA maybe Omalizumab for allergies
6 high ICS and LABA and Oral Corticosteroid maybe Omalizumab for allergies
asthma severity and treatment
intermittent v2days/wk 2nights/mo
-SABA
mild persist ^2days/wk 3-4nights/mo
-low ICS
mod persist daily weekly
-med ICS or low ICS and LABA
sev persist thru daily multiple nights/wk
-med ICS and LABA or high ICS LABA maybe Oral Steroid maybe Omalizumab
acid base disturbance in renal failure
ABG
metablic acidosis
due to inadequate excretion of metabolic acids
low pCO2 low Bicarb
