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IPAP > Pulm w/ Reading > Flashcards

Pulm w/ Reading Flashcards

1
Q

Smoke inhalation affects ? part of the airway?

What type of inhalation burn can impact the entire airway

A

Upper

Steam

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2
Q

Thermal inhalation injuries are usually isolated to ?

Why do PTs w/ inhalation injuries progress and present w/ issues up to 18-24hrs later

A

Mucosa of supraglottic airway

Neutrophilic inflammation- edema and ulcerations

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3
Q

Inhalation injuries tend to present w/ ? two issues

What needs to be conducted on serial repeat in these PTs?

A

Bronchospasm
Bronchorrhea

Serial CXRs

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4
Q

What are the 3 effects of smoke inhalation

PTs that survive burns usually do so w/out issues but impaired pulmonary function may manifest as ? syndrome

? is the leading cause of death from poisoning worldwide

A

Thermal injury, upper airway
Impaired tissue oxygenation
Chemical injury, lower airway

Reactive Airway dysfunction- hyper responsiveness of airway

Carbon monoxide

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5
Q

How are CO poisoning PTs Tx w/ hyperbaric chambers

Cyanide inhibits ? enzyme causing PTs to present w/ ? 3 Sxs

Since it takes so long for lab results to Dx this, what finding is indicative of this type of poisoning

A

2.5-3 atm x 2-3 Tx sessions
One Tx of 2hrs for severe cases

Cytochrome enzyme: lactic acidosis, coma, shock

Inc venous O2 saturation

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6
Q

What two drugs are in the cyanide antidote kit

What is the adverse effect of using this antidote?

How are Thermal inhalation injuries Tx

A

Hydroxocobalamin (B12 precursor)
Sodium thiosulfate

Red skin/urine

HEATS
Humidified O2 
Elevate head 30*
ABG/pulse ox monitoring
Topical Epi
Suction
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7
Q

What are the early and late S/Sxs of chemical inhalation injuries

What injury process makes these PTs at risk for ? two Dzs later

A

Early: bronchorrhea, bronchospasm
Late: dyspnea, cyanosis

Edema/sloughing= atelectasis, hypoxemia
ARDS 1-2 days
Pneumonia 5-7 days

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8
Q

How is smoke inhalation Tx

What two Txs are avoided

PTs that survive need monitoring to detect development of ?

A

PEEP
Daily Gram stains
Fluids
Suction O2 Dilators

CCS, ABX

Bronchiolitis obliterans: ground glass, bronchial thickening

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9
Q

What does ‘ground glass” appearance on a CT mean

What do reticular/linear opacities mean

A

Inc attenuation in lung
Opportunistic infection
Interstitial Dz
Acute alveolar Dz

Pathological involvement of pulmonary interstitium

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10
Q

What is the relationship between silicosis and the development of other Dzs

Define Caplan Syndrome

A

Macrophage dependent defense invasions:
Collagen vascular Dzs- RA
Atypical Mycobacteria
TB

Rheumatoid nodules in lung in PTs w/ pneumoconiosis and RA

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11
Q

What compensatory Dz may be seen in Silicosis

What will be seen on CXRs

What is seen in complicated silicosis PTs?

A

Lower lobe emphysema

Egg shell calcifications of mediastinal lymph nodes

Masses in upper lobes
Dyspnea
Obstructive Restrictive PFT

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12
Q

What type of asbestosis has more/less effect on the lung

What are the first initial appearances of asbestos exposure

What finding is a marker of exposure but seen in all exposed PTs

A

More- chrysotile
Less- amphiboles

Linear calcified opacities over hemidiaphragm and cardiac border

Pleural plaques

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13
Q

What is the “Comet Sign” and where is it seen

What type of Dz is Asbestosis

A

Thickened pleura due to rounded atelectasis from asbestos

Restrictive

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14
Q

How do Pts w/ asbestosis present

What type of asbestos may be seen in these PTs sputum samples/lung biopsies

A

Dry cough w/ dyspnea
Digital clubbing
Basal crackles

Ferruginous bodies

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15
Q

What is seen on CXRs if asbestosis is early/late

What finding may be the best Dx clue in absence of other findings and Pt w/ + exposure

A

Early: linear streaking in lower fields
Late: hone comb

Pleural calcifications

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16
Q

Mesothelioma is a tumor located where?

What is the best image modality to view ? findings

What type of lung dz is silicosis and asbestosis

A

Pleura and/or Peritoneum

HRCT- fibrosis, pleural plaques

Silicosis: restrictive and obstructive
Asbestosis: restrictive, dec DLCO

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17
Q

Occupational hypersensitive pneumonitis can be from contaminated humidifiers that are infected w/ ? microbes

What is becoming to be one of the MC sources of occupational sources of infections

Most antigenic exposures leading to this issue are ?

A

Protozoa
Fungi

Recirculated coolants w/ Gram Neg or Atypical mycobacteria infections

Thermophilic actinomycetes fungi
Avian/rat proteins
Mycobacteria
Protozoa

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18
Q

What are two less common sources of hypersensitive pneumonitis

What body reaction is responsible for these hypersensitivities

A

PCN, MDI (sealant)

IgG Abs
T-lymphocytes

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19
Q

What will be seen on lab results in PTs w/ acute hypersensitive pneumonitis

What would be seen on PFT/ABG results

What test may be done on these PTs to monitor their reactions in the work place?

A

Neutrophilia w/ L shift
Inc ESR/CRP

Restrictive pattern/red DLCO
Hypoxemia

Work challenge

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20
Q

What would be seen on CXR of acute/chronic hypersensitive pneumonitis

How is a definitive Dx made

A

Acute: Nodular densities but NOT in bases/apex
Chronic: fibrosis, honey comb

Lung biopsy

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21
Q

How is hypersensitivity pneumonitis Tx

What are the 3 obstructive airway d/os

A

Acute: self resolving
Chronic: PO CCS taper over 4-6wks

Byssiniosis
Industrial bronchitis
Occupational asthma

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22
Q

How is occupational asthma Dx

How is it Tx

Industrial bronchitis rarely leads to ?

A

Hx
Spirometry before/after exposure
Peak flow measurement at work

Avoidance and Dilators

Chronic disability

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23
Q

Industrial bronchitis can be caused by ?

Define Byssinosis

How does it present

What happens if exposures are not d/c

A

Coal Cotton Flax Hemp

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

Tight chest, cough, dyspnea on 1st day back to work

Chronic bronchitis

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24
Q

Silo Filler’s Dz

What is a common late finding

This is preventable w/ early ?

A

Toxic pulmonary edema from inhaled NO

Bronchitis obliterans

CCS

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25
Q

What causes “popcorn” lung

What type of Dz is this

What is unique about Byssinosis

A

Diacetyl exposure leading to bronchiolitis obliterans

Constrictive bronchiolitis

Obstructive lung Dz, not restrictive like all other pneumoconioses

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26
Q

Due to the pH being <2.5, what series of events happen after inspiration of gastric contents

This series of events is also one of the MC causes of ?

What will be seen on PE/labs

A

Desquamation
Bronchiolitis
Hemorrhage
Pulmonary edema

ARDS

Cough/wheeze
Fever even w/out infection
Hypoxemia, Leukocytosis

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27
Q

Normally, airway is protected by ? mechanism

What is the name of the syndrome due to aspiration

How are these PTs Tx and what is avoided

A

Cough reflex

Mendelsohn- large single aspiration followed w/ hypoxia

Intubate, Ventialte, Fluids
No CCS or ABX

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28
Q

What habits can decrease the tone of the LES?

What pulmonary d/os are linked to GERD/chronic aspirations?

A

Caffeine Alcohol Nicotine Theophylline

Cough Asthma Bronchiectasis Pulmonary fibrosis

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29
Q

What are the phases of the development of radiation pneumonitis

How long does it take for acute radiation pneumonitis to develop and show?

A

1: alveolar injury leads to pulmonary edema
2: radiation pneumonitis, spontaneous resolution and fibrotic changes

2-3mon w/ dyspnea, cough, pain, fever

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30
Q

What is seen on CXR and PFTs of radiation pneumonitis

How is it Tx

What can this Dz progress into?

A

Nodular opacities
Red volume, compliance and diffusing

Prednisone

Pulmonary Radiation Fibrosis
Slow dyspnea

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31
Q

What is seen on CXR in Pulmonary Radiation Fibrosis

Define Pickwickian Syndrome

A

Tented diaphragm
No lung markings
Red volume
Reticular/dense opacities

Obesity Hypoventilation Syndrome: dec ventilatory drive w/ inc mechanical load

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32
Q

What is a unique compensatory reflex in Pickwickian not seen in other lung Dzs

What are the Dx criteria

Most of these PTs will also have ?

A

Voluntary hyperventilation

BMI +30
Partial CO2 pressure >45mmHg

OSA

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33
Q

What respiratory stimulants can be used when Tx Pickwickian

What lab finding is common when working up OSA

What finding may be heard prior to an apneic episode of a sleeping PT w/ OSA

A

Medroxyprednisone
Acetazolamide
Theophylline

Erythrocytosis

Snort w/ first breath

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34
Q

What may be the first presenting Sx of OSA

What at home test is done during Dx work up

How is the severity staged?

A

Personality changes

Nocturnal pulse ox

Norm: 0-4
Mild: 5-14
Mod: 15-29
Sev: 30+, <90% for >20% of study

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35
Q

Pts w/ AHI +30 are at risk for developing ?

What is the 3rd leading cause of death in hospitalized PTs?

A

CHD HTN Arrhythmia DM

PEs

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36
Q

What can cause a PE

What is the MC?

A 
Septic emboli
Tumor cells
Air
Foreign bodies
Fat
Eggs- schistosomiasis

Thrombus from deep vein of LE

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37
Q

What are the inherited causes of hypercoagulability

What is the only reliable sign of PEs seen in half of PTs?

A

Factor V Laden: resistance to activated Protein C
Dysfunction Protein C/S
Antithrombin/Prothrombin mutations
Hyperhomocysteinemia- lupus anticoagulant
Antiphospholipid Abs- anticardiolipin Ab

Tachypnea

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38
Q

What is seen on ABG during a PE?

What does a D-dimer measure

What value does it hold in a medical setting

A

Respiratory alkalosis and hypoxia due to hyperventilation

Degraded product of cross linked fibrin

Exclusion of PE

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39
Q

What are the MC CXR findings on PTs w/ PEs?

What two findings may be seen?

What findings may be most suggestive of a PE?

A

Pleural effusion
Infiltrate
Atelectasis

Westermark: oligemic pulmonary artery
Hampton: parenchymal hemorrhage

Normal CXR w/ hypoxemia

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40
Q

What are the top 3 S/Sxs of a PE?

Massive PEs can present w/ ? unique Sx

What is the initial study of choice for suspected PEs

A

Dyspnea
Pain w/ inspiration
Tachypnea*- only reliable

Syncope

Helical CT-PA

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41
Q

MC EKG finding during PEs

Define McGinn White sign

A

Sinus Tachy w/ ST/T wave changes

S1Q3T3 EKG finding of massive PE

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42
Q

What D-Dimer result is strongly indicative against a PE

What other blood work findings may be seen

Helical CT have lower sensiivity for detecting PEs located ?

A

Rapid ELISA <500ng/ml

Troponin and BNP- no value but indicate poor prognosis due to R heart strain

Peripheral/sub-segmental

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43
Q

How does VQ scan work

Ventilation scans are usually done at the same time and show ?

When are these two studies most beneficial

A

Injected radiolabeled albumin to show dec blood flow

Xenon gas inhalation to show distribution through lungs

Normal/High probability

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44
Q

PTs w/ intermediate risks for PEs get ? test which is the TOC for ?

What VQ scan result is highly suggestive of a PE

A 
Venous US
Proximal DVT (Dx= inability to compress femoral/popliteal veins)

+ Perfusion defect
- Ventilation defect

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45
Q

What used to be the Gold Standard for DVTs?

What is it called now?

When is the test conducted?

A

Pulmonary angiography

Reference standard

Dx is required
All other tests are inconclusive or unavail

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46
Q

What is the MC algorith for identifying PEs

Well’s Criteria

A

Rapid D-dime
Helical CT PA (V/Q scan if c/i)

Hot DAMN BC
HR +100 1.5
DVT Sxs 3
Alternative unexplained 3
Mobility 1.5
Nown Hx 1.5
Bloody cough 1
CA 1
5 or more= likely 
4 or less= unlikely
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47
Q

What are the high probability VQ results

What are the low probability?

What is the normal

A

2 or more large defects w/ normal x-ray
Defect larger thatn x-ray abnormality

Nonsegmental
Defect smaller than x-ray
Matched VQ defecit w/ x-ray
Small subsegmental defect

No defect

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48
Q

What meds are used for VTE Tx

What are the combined w/?

A

LMWH
IV UFH
Fondaparinux

Low/UnFx combo w/ Warfarin x 5-7 days, d/c after 6 days when INR is in 2-3 range x 24hrs

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49
Q

What are the new Factor Xa inhibitors

What are the benefits

What are the adverse

A

A/R/E-xaban

No Warfarin bridging
No monitoring
A/R reversed w/ Andexxa

No compliance check

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50
Q

What thrombolytics are used for PE Tx

What are the absolute c/i

What are the major c/i

A

Strep/Urokinase
rt-PA: Alteplase

Internal bleeding
Stroke, past 2mon

Unctonrolled HTN
Trauma/surgery past 6wks

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51
Q

Chronic/recurrent PEs can cause ? in 1% of PT population

What is the pathophysiology behind ILDz

A

PHTN

Injury
Repair attempt
Fibrosis
Honeycombing
2* PHTN
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52
Q

What category does Idiopathic Pulmonary Fibrosis fall in

What classes of drugs can cause drug induced/iatrogenic interstitial dz

A

Chronic Fibrosing Interstitial Pneumonia (Idiopathic Interstitial Pneumonia)

ABX
Anti-inflammatory
Cardio immunomodulators
Anti-eleptics
Illicit drugs
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53
Q

What are the 4 alveolar filling d/so

What are the two under interstitial lung dz associated w/ vasculitis

A

Good pasture
Pulmonary alveolar proteinosis
Pulmonary hemosiderosis
Chronic eosinophilic pneumonia

Granules w/ Poly
Eosinophilic Granules w/ Poly

54
Q

Common radiographic findings of ILDz

What infiltrate Dzs are in the upper lungs

Which ones are found in the lower lobes

A

Ground glass
Air bronchogram (acinar rosettes)
Infiltrates
Nodules/reticulonodular infiltrate

Sarcoidosis
Silicosis

Idipathic fibrosis
Subacute eosinophil pneumonia
Asbestosis

55
Q

Since Hilar and ediastinal adenopathy are not common in ILDzs, which ones cause it

Which Dz presents w/ peripheral locations of upper/middle lobes and clear central zones

A

Sarcoid Berylliosis Silicosis

Chronic Eosinophilic pneumonia

56
Q

What radiographic finding would not be typical in a CT image of idiopathic pulmonary fibrosis?

What 4 findings would be typical?

A

Migratory infiltrates

Dec lung volume
Honey comb
Reticular changes, peripheral
Lower lobe predominence

57
Q

What is the MC form of ILDz

Define UIP

Define IPF

A

Idiopathic pulmonary fibrosis

Usual interstitial pneumonia- lung injury causing collagen/honeycombing

Idiopathic Pulmonary Fibrosis- Dx if cause of UIP is unknown

58
Q

UIP is not specific for IPF and can be seen in ? 4 Dz states

What is seen on PE of IPF

A

CT Dzs
Asbestosis
Drug induced lung Dz
Chronic hypersensitive pneumonitis

5-6th decade PT w/ exertional dyspnea/cough
Velcro rales
Clubbing
Normal resting SpO2, dec w/ exertion

59
Q

What is seen on PFT of IPD

What meds are used for Tx of IPF

A

Red TLC RV and FRC
Low diffusing capacity

Prednisone
Nintedanib/Pirfenidone
Definitive: transplant

60
Q

What is the 2nd MC ILD

When/what PT population does it affect

A

Sarcoidosis- granulomatous dz w/out known origin

AfAm/N European during 3-4th decade

61
Q

Since Sarcoidosis is usually ASx, what incidental CXR findings may be seen?

What PE findings are uncommon

What is the Trfiecta of this Dz that is benefial for PTs

A

Hilar adenopathy
R paratracheal lymphadenopathy

Crackles

Lofgren: hilar lymphadenopathy Erythema nodosum
Migratory polyarthralgia
No biopsy needed for Dx
Remission in 2-16wks

62
Q

If meds are needed for Lofgren Syndrome, what can be used

What is a more rare presentation of Sarcoidosis

A

NSAIDs
Glucocorticosteroids
Colchicine
Hydroxychloroquine

Heerfordt Syndrome- uveoparotid fever (fever uveitis parotitis)
+/- CN7 involvment

63
Q

Heerfordy syndrome can lead to ? Sxs that can mimic ? syndrome

What is possibly seen on lab results

What is seen on a PFT

A

Sicca- latin for eyes/mouth
Sjogren

Leukopenia
HyperCa -emia/uria
Inc ACE
Inc ESR

Restrictive, dec volume and DLCO

64
Q

How is Sarcoidosis Dz staging accomplished

If there’s low clinical suspicion or no Lofgren Syndrome, what test is ordered and seen for suspected Sarcoidosis

How is Sarcoidosis Tx

A

CXR

Biopsy of skin/parotid/kidney- noncaseating granulomas

PO CCS
Methotrexate if intolerant/no response to CCS

65
Q

What PT presentation of Sarcoidosis has the best prognosis

What f/u tests are done?

A

Only hilar adenopathy is present

OC CAPE
Optho examp
CMP
CXR
Annual physical
PFTs
ECG
66
Q

What causes pulmonary alveolar proteinosis

How is this Dx

Unique fact about this dz

A

Phospholipid accumulation in alveolar spaces from idiopathic or secondary causes

Lavage w/ milky appearance, PAS + lipoproteinaceous material

Spontaneous remission

67
Q

PTs w/ Pulmonary Alveolar Proteinosis are at increased risk for ? pulmonary infections

What are the defining characteristics about Eosinophilic Pulmonary Syndromes

A

Nocardia
Fungi

Eosinophils in blood, lung biopsy and lavage
Blood result not always there

68
Q

What meds can cause Eosinophilic Pulmonary Syndromes

What is the unique presentation of Chronic Eosinophilic Pneumonia

A

Phenytoin Ranitidine Acetaminophen Nitro Ampicillin
Helminth or Filariae infection

Women, Non-smokers

69
Q

Granules w/ Poly

What characterizes this Dz

What unique Sxs does it present w/

What CXR finding is characteristic

Dx w/ ?

A

Wegeners

Glomerulonephritis
Necrotizing granule vasculitis
Small vessel vasculitis

Sinusitis, Otitis
Tracheal stenosis
Saddle nose
Strawberry gums

Nodular infiltrates w/ cavitation

C-ANCA and biopsy

70
Q

Eosinophilic Granules w/ Poly

What does it present w/

What is seen on CXRs

How is it Dx?

A

Churg Strauss
Vasculitis in asthma PTs

Rhinosinusitis
Asthma
Blood eosinophilia

Transient opacities/nodules

Fibrinoid necrotizing granulomas on biopsy

71
Q

How are the two Granules w/ Poly Tx

A

Gran w/ Poly: Cyclophosphamide
PO CCS
Rituximab- antiCD20 monoclonal Ab
Bactrim

E Gran w/ Poly:
CCS
Mepolizumab- Interlukin5 antagonis/monoclonal Ab
Cyclophosphamide

72
Q

Goodpasture Syndrome AKA

What is sen on CXR

What is seen on labs

How is it Dx

How is it Tx

A

Anti-basemement membrane Dz

Bilateral alveolar infiltrates

Fe deficient anemia
Microscopic hematuria

IgG/ImmFluorescent stain
anti-GBM Abs

CCS, Cyclophosphamide, Plasmaphoresis

73
Q

Idiopathic Pulmonary Hemosiderosis

How is it Dx

What lab result is typical and what does this Dz NOT involve

How is it Tx

A

Younger PTs w/ pulmonary hemorrhage

Hemosiderosis macrophages in lavage fluids

Fe deficiency- normal
No renal/BM Ab involvement

CCS

74
Q

Histoplasmosis

What is seen on CXR

What is this commonly confused as and how is it differentiated?

How is it Dx

How is it Tx

A

Ohio-Mississippi valley

Adenopathy of nodes

CAP, re-Dx when PT doesn’t respond to ABX

Urine/Serum Ags
BALavage
Blood/marrow culture

Mild: Itraconazole
Severe (meningitis): Amphotericin B IV

75
Q

Since Histoplasmosis is usually ASx, Dx can be made w/ incidental findings of ?

Coccidio infections can present w/ ? unique Sx

Coccidio is common opportunistic infection ?

A

Splenic/pulmonary calcifications on x-ray

Back ache

HIV
Endemic areas

76
Q

Coccidio infections most frequently present as ? and will have ? CXR finding

Who is more likely to have the disseminated version of this Dz

What does this form of the infection present w/?

A

CAP
Unilateral adenopathy

Filipino, Black, Pregnant

Inc pulmonary Sxs
Lung abscesses
Meningitis
Skin lesions like warts

77
Q

What is the miliary CXR finding of Coccidio called?

How is a mod/sev Coccidio infection Tx

A

Fungemia, causes death

Amphotericin B for severe PTs
Fluconazole
Itraconazole

78
Q

Blastomycosis

Since this usually is ASx, if it is disseminated, how does it present?

How is it Dx

How are mild and mod/sev cases Tx

A

MC form is primary pulmonary infection in SC/Midwest US and Canada

Skin/bone lesions
Urogenital: prostatitis, epididymitis

CXR
Sputum culture
BALavage
Calcofluo. staining of sputum

Azoles (I/K)
Amphotericin B

79
Q

Aspergillosis

When is the Dx of Allergic Bronchopulmonary Aspergillosis considered

What unique presentation can help w/ Dx

A

Unbiquitous in nature
Usually ASx unless ImmSupp (transplant Pt w/ neutropenia)

Asthatic w/ worse Sxs
CXR infiltrates w/ eosinophilia and high IgE

Waxes and wanes until resolution

80
Q

How is Allergic Bronchopulmonary Aspergillosis Tx?

How does PCP present

A

PO Prednisone
Bronchodilators

ImmComp PT w/ CD4 <200
Infiltrates on CXR
Tx w/ Bactrim

81
Q

Normal pH, PCO2 and HCO3 levels

ABGs give you what 3 results

What is the ABG criteria for respiratory failure

A

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

pH PaCO2 PaO2

PaO2 <60 (=SaO2 <90%)
PaCO2 >45

82
Q

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

What is the chief signs of these Sxs?

A

Hypoxemia
Hypercapnea

Hypoxemia- dyspnea
Hypercapnia: dyspnea and HA

83
Q

What are the signs of hypoxia?

What are the signs of hypercapnia

A

TRAC CAD
Tremor Restless Arrhythmia Confusion Cyanosis Anxiety Delerium

PACHI
Papilledema Astheresis Conjuctival hyperemia Impaired LoC

84
Q

What is the difference between Non-Ventilatory and Ventilatory respiratory support?

When giving O2, how much is given?

A

Non-Vent: oxygenation of organs w/ O2 administration

Vent: maintain patency of airway and ensure alveolar ventilation

Enough to maintain SPO2 at 90%/+60mmHg of Po2 or higher

85
Q

What respiratory support is first line choice for COPD pPTs w/ hypercapnic failure

Why is this form preferred?

After intubation, verification must be done to ensure it’s located ?

A

NPPV, but only if they can manage secretions, maintain airway and tolerate the mask

Dec need to intubate, length of hospitalization and mortality

Level of aortic arch

86
Q

What are the two modes on mechanical ventilators

What are the alternative modes

What will be seen if an ET tube is migrating into the main bronchus?

A

CMV/A-C
SIMV

PSV PCV CPAP

Atelectasis- contralateral lung
Over distension- intubated lung

87
Q

What are the signs of ventilator induced barotrauma

How do we avoid this injury?

What causes resp acidosis/alkalosis

A

SubQ emphysema
Pneumomediastinum
Subpleural cysts

Deliberate hypoventilation w/ low tidal volume/respiratory rates

Alk: over ventilate
Acid: under ventilate

88
Q

Why do PTs on ventilators get HOTN?

Why are carb rich nutrients avoided in these PTs

What E+ have to be monitored due to their absence can worsen hypoventilation

A

Inc intrathoracic pressure dec venous return

Inc CO2 production- can worsen hypercapnea

HypoK
HypoPO4

89
Q

What are PTs on ventilators fiven to reduce stress on GI system?

What are they put on to dec DVT/PE formation

PTs w/ ? issues put on vents have very low prognosis

A

PPIs

LMWH or
Compression devices

ARDS associated sepsis

90
Q

Define ARDS

What Berlin ratio characterizes this issue

A

Non cardiogenic form of pulmonary edema causing hypoxemic respiratory failure

<300mmHg PaO2/FlO2 ratio

91
Q

What are the 3 severity levels of ARDS

Regardless of injury, what is the response process leading to ARDS

Since this can develop in 12-48hrs, what major PE finding is indicative of Dx

A

Mild: 200-300
Mod: 100-200
Sev: <100
_% of air / PaO2 __

Inc permeability/Dec surfactant
Edema Atelectasis Hypoxemia

Hypoxemia refractory to O2

92
Q

How does ARDS appear on CXR

ARDS is a ? not a ?

What is it’s DDx

A

Spares angles, norm heart size
+ air bronchograms
Pleural effusions

Sydrome, not a Dz

Pulmonary edema, cardiogenic

93
Q

How is ARDS Tx

Respiratory distress syndrome is AKA ? and mainly affects ? PTs

A

Broad ABX
Intubation/ventilation
Low PEEP and tidal volume
FIO2 <60% to maintain SPO2 >88%

Hyaline Membrane Dz
Premature infants due to deficient surfactant

94
Q

Infants w/ Respiratory Distress Syndrome don’t have surfactant which leads to ? two issues

What would be seen on CXR and ABG

A

Neutrophil accumulation=
Pulmonary edema

Atelecatsis= cytokine mediated inflammatory response

Ground glass
Hypoxemia

95
Q

When do we give pregnant PTs steroid prophylactically to prevent Respiratory Distress Syndrome

What is done after birth to prevent the development of thi Dz

A

23-34wks

PEEP and nCPAP w/ exogenous surfactant therapy

96
Q

What is the criteria to intubate and provide surfactant to infant

Pleuritis usually has ? 3 etiologies

How would it present

A

FiO2 of 0.40 or higher to maintain O2 sat >90% or,
Apneic

Viral URI
Autoimmune
Pneumonia

Pain worse w/ breathing/cough
Radiating to ipsilateral shoulder if phrenic nerve involved/irritated
Squeaky sound

97
Q

Why does pleuritis cause pain

How is it Tx

How is pleural fluid removed from the chest cavity and how much is normally there?

A

Parietal pleura +innervation

Indomethacin
Codeine- pain, no cough supression
Intercostal nerve blocks (rare)

Lymphatics, 5-15mL

98
Q

Define Transudate

Define Exudate

A

Inc production of fluid due to inc hydrostatic/dec oncotic pressure

Inc production due to abnormal permeability/dec clearance

99
Q

Define Empyema

Define Hemothorax

A

Infection in pleural space

Bleeding into pleural space

100
Q

Define Hydrostatic Pressure

Define Oncotic Pressure

What is their relation to each other

A

Pressure exerted by fluid

Proteins in blood, displace molecules making appearance of less fluid

Work opposite to each other

101
Q

What is seen on PE of pleural effusions

What appearance does empyema have

What appearance does chylous effusion have?

A

Dullness to percussion
Hyporesonance

Clear fluid over white cells

Constantly turbid, inc chylomicrons and TGs

102
Q

How much blood in pleural fluid is Dx for hemothorax

Define Hemorrhagic effusion

What are the 3 things tested for after a thoracentesis

A

Hct >0.5

Mix of blood and pleural fluid

Protein
Glucose
Lactate dehydrogenase

103
Q

Define Light’s Criteria

What is the MC cause of transudate effusion

A

Exudate if one of 3:
Protein >0.5
LD ratio >0.6
Pleural LD >2/3 of upper limit of normal serum

HF

104
Q

What are the causes of transudates

A 
CHAMPS PCN
Cirrhosis
HF
Acute atelectasis
Myxedema
PE
SVC obstruction

Peritoneal dialysis
Constrictive pericarditis
Nephrotic syndrome

105
Q

What are 4 unique causes of exudative pleural effusions

A

TB: inc Protein

Rheumatoid: empyema, cholesterol crystals, low complement

Esophageal rupture and Pancreatitis: high amylase, L sided effusion

Chylothorax: TGs >100

106
Q

Most exudative effusions are due to ? of what 2 types

What is the first image ordered for effusions and how much is needed to be seen?

A

CA: lung, breast

CXR
75-100mL on upright lateral
175-200 on upright frontal
1cm on lateral decubitus to do blind thoracentesis

107
Q

CTs can ID _mL of effusion and help ID the ?

What sign would be seen on CXR of large effusions?

A

10mL
Etiology- lymphadenopathy, masses, thoracic duct anatomy

Meniscal sign

108
Q

How are parapneumonic effusion Tx

A

Uncomplicated= sterile pleural fluids: ABX for pneumonia

Complicated= bacteria invasion= acidosis, low glucose/Neg gram stain; ABX and tube thorocostomy if glucose <60 or pH <7.2

109
Q

How is empyema effusions Tx

What benefit does doing a thoracostomy have?

How are they Tx if the infection is refractory to ABX

A

Low pH and Pos Gram stain
ABX and tube thoracostomy

Prevents fibrous encasement in lung and promotes infection clearance

Drain w/ surgical debridement

110
Q

What causes Primary Spot Pneumos

What is seen on PE?

How is the PE different if it’s a tension pneumo?

A

Ruptured sub-pleural blebs

Tachycardia
Dec sounds/fremitus
Unilateral hyper resonance

Severe tachy
HOTN
Mediastinal/tracheal shift

111
Q

How are Spot Pneumos Tx

What is the definitive Tx

What 3 things need to be avoided after?

A

<15%/<3cm- observe, O2
Repeat CXR, discharge

Tube thoracostomy

High altitude Smoking Diving

112
Q

What surgical procedure is a possibility post-spot pneumo?

What pathological change is characteristic of COPD

A

Open thoracotomy w/ resection of the bleb/pleurodesis

Dec elastic recoil pressure

113
Q

? Dz is characterized by bronchial hyperactivity and reversible airway obstruction

What is the best initial Dx study for PT w/ suspected PHTN

A

Asthma

Echo

114
Q

? PT population w/ influenza is at increased risk for complications

What other medical Hx puts PTs at risk w/ this Dx

A

Influenza

Prior MI
CHF

115
Q

Lung tumors are ? tumors and secrete

What type of appearance would be most concerning?

A

Neuroendocrine
Serotonin

Development in adolescence

116
Q

What are the top 2 MC neuroendocrine tumors

If tumor is secreting serotonin, how do the PTs present

A

GI
Lung

Flushing
Diarrhea
Bronchospasms

117
Q

Preventative steps to decrease aspirations include

Define bronchiectasis

A

Thick fluids
Feeding in upright
Proper PO hygeine
No rushing feed time

Bronchial wall thickening w/ permanent airway dilation due to inflammation

118
Q

? is the cause of fever, SoB, leukocytosis, HypoNa?

This infection is the only one presenting w/ ? Sxs

How is it Tx

A

Legionella

GI
Inc liver enzymes

Macrolide
Levlofloxacine
Doxy

119
Q

What is the most useful Dx test for sarcoidosis

What is the MC Tx approach for lung abscesses

A

Biopsy of skin lesion

ABX

120
Q

? microbe is the cause of hot tub infections

What body system is MC involved w/ initial Sxs of Blastomycosis

A

Legionella

Pulmonary
2nd MC: skin

121
Q

What is the Dx TOC for Idiopathic Pulmonary Fibrosis

Small pulmonary nodules are ? size and best Dx w/

A

CT

<30mm
CT w/out contrast

122
Q

What CXR finding is indicative of Pnemo Jeriveci

? microbe causes croup

A

Diffuse bilateral infiltrates

Parainfluenza

123
Q

What med is given for asthma after O2, albuterol, ipratropium, and IV methylprednisone?

What is the acronym for asthma exacerbation Tx

A

IV MgSulfate

BIOMES
Beta agonist
Ipratropium
O2
Mg Sulfate
Epi/Terbutaline
Steroids
124
Q

? tumor causes arm/shoulder pain

What is the MC declared drug allergy?

A

Non-small cell lung CA w/ pancoast syndrome

Reaction to beta-lactam (amoxicillin)

125
Q

What lung dz would present w/ PFT results of Dec TLV, Dec residual volume but normal FEV

What PT population is screened annualy for lung CA

A

ILDz

55-80 w/ Hx smoking 30 pack/year and current smoker or
Quit in past 15yrs

126
Q

What is the best TOC to confirm a Dx of malignant mesothelioma

? condition creates a restrictive spirometry patter

A

Biopsy

RA

127
Q

? procedure is done to biopsy a peripheral nodule

Older PTs w/ pertussis present ? and are Tx w/ ?

A

Wedge resection

Congestion
Watery eyes
Coughing fits
Dyspnea

Azithromycin

128
Q

Tx of CAP outPT w/ no MedHx

What meds can be used for Acute bronchitis if PT insists

A

Amox

Guaifenesin

129
Q

TB med turns severtions orange

Most likely finding on PE on PT w/ CAP

A

Rifampin

Crackles on auscultation

130
Q

? type of microbe is Pertussis

4 phases of allergic reaction

A

Gram - coccobacillus

Anaphylactic
Cytotoxic
Immune compelx
Cell mediated

IPAP (212 decks)

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