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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
What causes "popcorn" lung What type of Dz is this What is unique about Byssinosis
Diacetyl exposure leading to bronchiolitis obliterans Constrictive bronchiolitis Obstructive lung Dz, not restrictive like all other pneumoconioses
26
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
Desquamation Bronchiolitis Hemorrhage Pulmonary edema ARDS Cough/wheeze Fever even w/out infection Hypoxemia, Leukocytosis
27
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
Cough reflex Mendelsohn- large single aspiration followed w/ hypoxia Intubate, Ventialte, Fluids No CCS or ABX
28
What habits can decrease the tone of the LES? What pulmonary d/os are linked to GERD/chronic aspirations?
Caffeine Alcohol Nicotine Theophylline Cough Asthma Bronchiectasis Pulmonary fibrosis
29
What are the phases of the development of radiation pneumonitis How long does it take for acute radiation pneumonitis to develop and show?
1: alveolar injury leads to pulmonary edema 2: radiation pneumonitis, spontaneous resolution and fibrotic changes 2-3mon w/ dyspnea, cough, pain, fever
30
What is seen on CXR and PFTs of radiation pneumonitis How is it Tx What can this Dz progress into?
Nodular opacities Red volume, compliance and diffusing Prednisone Pulmonary Radiation Fibrosis Slow dyspnea
31
What is seen on CXR in Pulmonary Radiation Fibrosis Define Pickwickian Syndrome
Tented diaphragm No lung markings Red volume Reticular/dense opacities Obesity Hypoventilation Syndrome: dec ventilatory drive w/ inc mechanical load
32
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 ?
Voluntary hyperventilation BMI +30 Partial CO2 pressure >45mmHg OSA
33
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
Medroxyprednisone Acetazolamide Theophylline Erythrocytosis Snort w/ first breath
34
What may be the first presenting Sx of OSA What at home test is done during Dx work up How is the severity staged?
Personality changes Nocturnal pulse ox Norm: 0-4 Mild: 5-14 Mod: 15-29 Sev: 30+, <90% for >20% of study
35
Pts w/ AHI +30 are at risk for developing ? What is the 3rd leading cause of death in hospitalized PTs?
CHD HTN Arrhythmia DM PEs
36
What can cause a PE What is the MC?
``` Septic emboli Tumor cells Air Foreign bodies Fat Eggs- schistosomiasis ``` Thrombus from deep vein of LE
37
What are the inherited causes of hypercoagulability What is the only reliable sign of PEs seen in half of PTs?
Factor V Laden: resistance to activated Protein C Dysfunction Protein C/S Antithrombin/Prothrombin mutations Hyperhomocysteinemia- lupus anticoagulant Antiphospholipid Abs- anticardiolipin Ab Tachypnea
38
What is seen on ABG during a PE? What does a D-dimer measure What value does it hold in a medical setting
Respiratory alkalosis and hypoxia due to hyperventilation Degraded product of cross linked fibrin Exclusion of PE
39
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?
Pleural effusion Infiltrate Atelectasis Westermark: oligemic pulmonary artery Hampton: parenchymal hemorrhage Normal CXR w/ hypoxemia
40
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
Dyspnea Pain w/ inspiration Tachypnea*- only reliable Syncope Helical CT-PA
41
MC EKG finding during PEs Define McGinn White sign
Sinus Tachy w/ ST/T wave changes S1Q3T3 EKG finding of massive PE
42
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 ?
Rapid ELISA <500ng/ml Troponin and BNP- no value but indicate poor prognosis due to R heart strain Peripheral/sub-segmental
43
How does VQ scan work Ventilation scans are usually done at the same time and show ? When are these two studies most beneficial
Injected radiolabeled albumin to show dec blood flow Xenon gas inhalation to show distribution through lungs Normal/High probability
44
PTs w/ intermediate risks for PEs get ? test which is the TOC for ? What VQ scan result is highly suggestive of a PE
``` Venous US Proximal DVT (Dx= inability to compress femoral/popliteal veins) ``` + Perfusion defect - Ventilation defect
45
What used to be the Gold Standard for DVTs? What is it called now? When is the test conducted?
Pulmonary angiography Reference standard Dx is required All other tests are inconclusive or unavail
46
What is the MC algorith for identifying PEs Well's Criteria
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 ```
47
What are the high probability VQ results What are the low probability? What is the normal
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
48
What meds are used for VTE Tx What are the combined w/?
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
49
What are the new Factor Xa inhibitors What are the benefits What are the adverse
A/R/E-xaban No Warfarin bridging No monitoring A/R reversed w/ Andexxa No compliance check
50
What thrombolytics are used for PE Tx What are the absolute c/i What are the major c/i
Strep/Urokinase rt-PA: Alteplase Internal bleeding Stroke, past 2mon Unctonrolled HTN Trauma/surgery past 6wks
51
Chronic/recurrent PEs can cause ? in 1% of PT population What is the pathophysiology behind ILDz
PHTN ``` Injury Repair attempt Fibrosis Honeycombing 2* PHTN ```
52
What category does Idiopathic Pulmonary Fibrosis fall in What classes of drugs can cause drug induced/iatrogenic interstitial dz
Chronic Fibrosing Interstitial Pneumonia (Idiopathic Interstitial Pneumonia) ``` ABX Anti-inflammatory Cardio immunomodulators Anti-eleptics Illicit drugs ```
53
What are the 4 alveolar filling d/so What are the two under interstitial lung dz associated w/ vasculitis
Good pasture Pulmonary alveolar proteinosis Pulmonary hemosiderosis Chronic eosinophilic pneumonia Granules w/ Poly Eosinophilic Granules w/ Poly
54
Common radiographic findings of ILDz What infiltrate Dzs are in the upper lungs Which ones are found in the lower lobes
Ground glass Air bronchogram (acinar rosettes) Infiltrates Nodules/reticulonodular infiltrate Sarcoidosis Silicosis Idipathic fibrosis Subacute eosinophil pneumonia Asbestosis
55
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
Sarcoid Berylliosis Silicosis Chronic Eosinophilic pneumonia
56
What radiographic finding would not be typical in a CT image of idiopathic pulmonary fibrosis? What 4 findings would be typical?
Migratory infiltrates Dec lung volume Honey comb Reticular changes, peripheral Lower lobe predominence
57
What is the MC form of ILDz Define UIP Define IPF
Idiopathic pulmonary fibrosis Usual interstitial pneumonia- lung injury causing collagen/honeycombing Idiopathic Pulmonary Fibrosis- Dx if cause of UIP is unknown
58
UIP is not specific for IPF and can be seen in ? 4 Dz states What is seen on PE of IPF
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
What is seen on PFT of IPD What meds are used for Tx of IPF
Red TLC RV and FRC Low diffusing capacity Prednisone Nintedanib/Pirfenidone Definitive: transplant
60
What is the 2nd MC ILD When/what PT population does it affect
Sarcoidosis- granulomatous dz w/out known origin AfAm/N European during 3-4th decade
61
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
Hilar adenopathy R paratracheal lymphadenopathy Crackles Lofgren: hilar lymphadenopathy Erythema nodosum Migratory polyarthralgia No biopsy needed for Dx Remission in 2-16wks
62
If meds are needed for Lofgren Syndrome, what can be used What is a more rare presentation of Sarcoidosis
NSAIDs Glucocorticosteroids Colchicine Hydroxychloroquine Heerfordt Syndrome- uveoparotid fever (fever uveitis parotitis) +/- CN7 involvment
63
Heerfordy syndrome can lead to ? Sxs that can mimic ? syndrome What is possibly seen on lab results What is seen on a PFT
Sicca- latin for eyes/mouth Sjogren Leukopenia HyperCa -emia/uria Inc ACE Inc ESR Restrictive, dec volume and DLCO
64
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
CXR Biopsy of skin/parotid/kidney- noncaseating granulomas PO CCS Methotrexate if intolerant/no response to CCS
65
What PT presentation of Sarcoidosis has the best prognosis What f/u tests are done?
Only hilar adenopathy is present ``` OC CAPE Optho examp CMP CXR Annual physical PFTs ECG ```
66
What causes pulmonary alveolar proteinosis How is this Dx Unique fact about this dz
Phospholipid accumulation in alveolar spaces from idiopathic or secondary causes Lavage w/ milky appearance, PAS + lipoproteinaceous material Spontaneous remission
67
PTs w/ Pulmonary Alveolar Proteinosis are at increased risk for ? pulmonary infections What are the defining characteristics about Eosinophilic Pulmonary Syndromes
Nocardia Fungi Eosinophils in blood, lung biopsy and lavage Blood result not always there
68
What meds can cause Eosinophilic Pulmonary Syndromes What is the unique presentation of Chronic Eosinophilic Pneumonia
Phenytoin Ranitidine Acetaminophen Nitro Ampicillin Helminth or Filariae infection Women, Non-smokers
69
Granules w/ Poly What characterizes this Dz What unique Sxs does it present w/ What CXR finding is characteristic Dx w/ ?
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
Eosinophilic Granules w/ Poly What does it present w/ What is seen on CXRs How is it Dx?
Churg Strauss Vasculitis in asthma PTs Rhinosinusitis Asthma Blood eosinophilia Transient opacities/nodules Fibrinoid necrotizing granulomas on biopsy
71
How are the two Granules w/ Poly Tx
Gran w/ Poly: Cyclophosphamide PO CCS Rituximab- antiCD20 monoclonal Ab Bactrim E Gran w/ Poly: CCS Mepolizumab- Interlukin5 antagonis/monoclonal Ab Cyclophosphamide
72
Goodpasture Syndrome AKA What is sen on CXR What is seen on labs How is it Dx How is it Tx
Anti-basemement membrane Dz Bilateral alveolar infiltrates Fe deficient anemia Microscopic hematuria IgG/ImmFluorescent stain anti-GBM Abs CCS, Cyclophosphamide, Plasmaphoresis
73
Idiopathic Pulmonary Hemosiderosis How is it Dx What lab result is typical and what does this Dz NOT involve How is it Tx
Younger PTs w/ pulmonary hemorrhage Hemosiderosis macrophages in lavage fluids Fe deficiency- normal No renal/BM Ab involvement CCS
74
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
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
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 ?
Splenic/pulmonary calcifications on x-ray Back ache HIV Endemic areas
76
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/?
CAP Unilateral adenopathy Filipino, Black, Pregnant Inc pulmonary Sxs Lung abscesses Meningitis Skin lesions like warts
77
What is the miliary CXR finding of Coccidio called? How is a mod/sev Coccidio infection Tx
Fungemia, causes death Amphotericin B for severe PTs Fluconazole Itraconazole
78
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
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
Aspergillosis When is the Dx of Allergic Bronchopulmonary Aspergillosis considered What unique presentation can help w/ Dx
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
How is Allergic Bronchopulmonary Aspergillosis Tx? How does PCP present
PO Prednisone Bronchodilators ImmComp PT w/ CD4 <200 Infiltrates on CXR Tx w/ Bactrim
81
Normal pH, PCO2 and HCO3 levels ABGs give you what 3 results What is the ABG criteria for respiratory failure
pH: 7.35-7.45 PCO2: 35-45 HCO3: 22-28 pH PaCO2 PaO2 PaO2 <60 (=SaO2 <90%) PaCO2 >45
82
S/Sxs of respiratory failure include those of the underlying Dz plus ? 2 What is the chief signs of these Sxs?
Hypoxemia Hypercapnea Hypoxemia- dyspnea Hypercapnia: dyspnea and HA
83
What are the signs of hypoxia? What are the signs of hypercapnia
TRAC CAD Tremor Restless Arrhythmia Confusion Cyanosis Anxiety Delerium PACHI Papilledema Astheresis Conjuctival hyperemia Impaired LoC
84
What is the difference between Non-Ventilatory and Ventilatory respiratory support? When giving O2, how much is given?
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
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 ?
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
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?
CMV/A-C SIMV PSV PCV CPAP Atelectasis- contralateral lung Over distension- intubated lung
87
What are the signs of ventilator induced barotrauma How do we avoid this injury? What causes resp acidosis/alkalosis
SubQ emphysema Pneumomediastinum Subpleural cysts Deliberate hypoventilation w/ low tidal volume/respiratory rates Alk: over ventilate Acid: under ventilate
88
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
Inc intrathoracic pressure dec venous return Inc CO2 production- can worsen hypercapnea HypoK HypoPO4
89
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
PPIs LMWH or Compression devices ARDS associated sepsis
90
# Define ARDS What Berlin ratio characterizes this issue
Non cardiogenic form of pulmonary edema causing hypoxemic respiratory failure <300mmHg PaO2/FlO2 ratio
91
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
Mild: 200-300 Mod: 100-200 Sev: <100 _% of air / PaO2 __ Inc permeability/Dec surfactant Edema Atelectasis Hypoxemia Hypoxemia refractory to O2
92
How does ARDS appear on CXR ARDS is a ? not a ? What is it's DDx
Spares angles, norm heart size + air bronchograms Pleural effusions Sydrome, not a Dz Pulmonary edema, cardiogenic
93
How is ARDS Tx Respiratory distress syndrome is AKA ? and mainly affects ? PTs
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
Infants w/ Respiratory Distress Syndrome don't have surfactant which leads to ? two issues What would be seen on CXR and ABG
Neutrophil accumulation= Pulmonary edema Atelecatsis= cytokine mediated inflammatory response Ground glass Hypoxemia
95
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
23-34wks PEEP and nCPAP w/ exogenous surfactant therapy
96
What is the criteria to intubate and provide surfactant to infant Pleuritis usually has ? 3 etiologies How would it present
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
Why does pleuritis cause pain How is it Tx How is pleural fluid removed from the chest cavity and how much is normally there?
Parietal pleura +innervation Indomethacin Codeine- pain, no cough supression Intercostal nerve blocks (rare) Lymphatics, 5-15mL
98
# Define Transudate Define Exudate
Inc production of fluid due to inc hydrostatic/dec oncotic pressure Inc production due to abnormal permeability/dec clearance
99
# Define Empyema Define Hemothorax
Infection in pleural space Bleeding into pleural space
100
# Define Hydrostatic Pressure Define Oncotic Pressure What is their relation to each other
Pressure exerted by fluid Proteins in blood, displace molecules making appearance of less fluid Work opposite to each other
101
What is seen on PE of pleural effusions What appearance does empyema have What appearance does chylous effusion have?
Dullness to percussion Hyporesonance Clear fluid over white cells Constantly turbid, inc chylomicrons and TGs
102
How much blood in pleural fluid is Dx for hemothorax Define Hemorrhagic effusion What are the 3 things tested for after a thoracentesis
Hct >0.5 Mix of blood and pleural fluid Protein Glucose Lactate dehydrogenase
103
# Define Light's Criteria What is the MC cause of transudate effusion
Exudate if one of 3: Protein >0.5 LD ratio >0.6 Pleural LD >2/3 of upper limit of normal serum HF
104
What are the causes of transudates
``` CHAMPS PCN Cirrhosis HF Acute atelectasis Myxedema PE SVC obstruction ``` Peritoneal dialysis Constrictive pericarditis Nephrotic syndrome
105
What are 4 unique causes of exudative pleural effusions
TB: inc Protein Rheumatoid: empyema, cholesterol crystals, low complement Esophageal rupture and Pancreatitis: high amylase, L sided effusion Chylothorax: TGs >100
106
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?
CA: lung, breast CXR 75-100mL on upright lateral 175-200 on upright frontal 1cm on lateral decubitus to do blind thoracentesis
107
CTs can ID _mL of effusion and help ID the ? What sign would be seen on CXR of large effusions?
10mL Etiology- lymphadenopathy, masses, thoracic duct anatomy Meniscal sign
108
How are parapneumonic effusion Tx
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
How is empyema effusions Tx What benefit does doing a thoracostomy have? How are they Tx if the infection is refractory to ABX
Low pH and Pos Gram stain ABX and tube thoracostomy Prevents fibrous encasement in lung and promotes infection clearance Drain w/ surgical debridement
110
What causes Primary Spot Pneumos What is seen on PE? How is the PE different if it's a tension pneumo?
Ruptured sub-pleural blebs Tachycardia Dec sounds/fremitus Unilateral hyper resonance Severe tachy HOTN Mediastinal/tracheal shift
111
How are Spot Pneumos Tx What is the definitive Tx What 3 things need to be avoided after?
<15%/<3cm- observe, O2 Repeat CXR, discharge Tube thoracostomy High altitude Smoking Diving
112
What surgical procedure is a possibility post-spot pneumo? What pathological change is characteristic of COPD
Open thoracotomy w/ resection of the bleb/pleurodesis Dec elastic recoil pressure
113
? Dz is characterized by bronchial hyperactivity and reversible airway obstruction What is the best initial Dx study for PT w/ suspected PHTN
Asthma Echo
114
? PT population w/ influenza is at increased risk for complications What other medical Hx puts PTs at risk w/ this Dx
Influenza Prior MI CHF
115
Lung tumors are ? tumors and secrete What type of appearance would be most concerning?
Neuroendocrine Serotonin Development in adolescence
116
What are the top 2 MC neuroendocrine tumors If tumor is secreting serotonin, how do the PTs present
GI Lung Flushing Diarrhea Bronchospasms
117
Preventative steps to decrease aspirations include Define bronchiectasis
Thick fluids Feeding in upright Proper PO hygeine No rushing feed time Bronchial wall thickening w/ permanent airway dilation due to inflammation
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? is the cause of fever, SoB, leukocytosis, HypoNa? This infection is the only one presenting w/ ? Sxs How is it Tx
Legionella GI Inc liver enzymes Macrolide Levlofloxacine Doxy
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What is the most useful Dx test for sarcoidosis What is the MC Tx approach for lung abscesses
Biopsy of skin lesion ABX
120
? microbe is the cause of hot tub infections What body system is MC involved w/ initial Sxs of Blastomycosis
Legionella Pulmonary 2nd MC: skin
121
What is the Dx TOC for Idiopathic Pulmonary Fibrosis Small pulmonary nodules are ? size and best Dx w/
CT <30mm CT w/out contrast
122
What CXR finding is indicative of Pnemo Jeriveci ? microbe causes croup
Diffuse bilateral infiltrates Parainfluenza
123
What med is given for asthma after O2, albuterol, ipratropium, and IV methylprednisone? What is the acronym for asthma exacerbation Tx
IV MgSulfate ``` BIOMES Beta agonist Ipratropium O2 Mg Sulfate Epi/Terbutaline Steroids ```
124
? tumor causes arm/shoulder pain What is the MC declared drug allergy?
Non-small cell lung CA w/ pancoast syndrome Reaction to beta-lactam (amoxicillin)
125
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
ILDz 55-80 w/ Hx smoking 30 pack/year and current smoker or Quit in past 15yrs
126
What is the best TOC to confirm a Dx of malignant mesothelioma ? condition creates a restrictive spirometry patter
Biopsy RA
127
? procedure is done to biopsy a peripheral nodule Older PTs w/ pertussis present ? and are Tx w/ ?
Wedge resection Congestion Watery eyes Coughing fits Dyspnea Azithromycin
128
Tx of CAP outPT w/ no MedHx What meds can be used for Acute bronchitis if PT insists
Amox Guaifenesin
129
TB med turns severtions orange Most likely finding on PE on PT w/ CAP
Rifampin Crackles on auscultation
130
? type of microbe is Pertussis 4 phases of allergic reaction
Gram - coccobacillus Anaphylactic Cytotoxic Immune compelx Cell mediated

IPAP (212 decks)

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