Pulmo 2 Flashcards
Uncomplicated parapneumonic effusion -
due to:
pleural fluid analysis:
increased flow of interstitial edema into pleural space
pH >7.20 normal glucose (nearly that of serum)
complicated parapneumonic effusion - pleural fluid analysis:
pH <7.20
low glucose <60 mg/dL
Malignant effusion
Lymphocyte predominant
erythrocytes >10,000
pH <7.20
low glucose
______ can be used in patients with severe renal insufficiency (estimated glomerular filtration rate <30 mL/min/1.73 m2) for anticoagulation
unfractionated heparin
Treatment of pulmonary embolism:
Once the heparin produces therapeutic anticoagulation (goal PTT >1.5-2 times normal), warfarin is initiated. Warfarin can take up to 5-7 days to reach therapeutic levels. After reaching a therapeutic INR, heparin can be stopped and warfarin can be continued long-term
granulomatosis with polyangiitis (GPA)
Lower respiratory tract involvement may lead to
■ tracheal narrowing with ulceration,
c chest x-ray findings:
•multiple lung nodules with cavitation
•alveolar opacities.
Cor pulmonale Chest x-ray findings
- enlarged central pulmonary arteries without evidence of vascular congestion.
- loss of retrosternal air space due to right ventricular hypertrophy.
Antibiotics requirement in COPD exacerbation in:
■ Moderate to severe COPD exacerbation (defined as >2 cardinal symptoms), especially with increased sputum purulence or
■ Mechanical ventilation needed
Roflumilast
phosphodiesterase inhibitor with anti-inflammatory properties that helps decrease mucociliary malfunction and pulmonary remodeling.
It is useful as maintenance therapy to reduce future exacerbations in patients with severe COPD and history of exacerbations, but it is not indicated during an acute exacerbation.
_________ are the three tumors that cause approximately 75% of all malignant pleural effusions.
Lung carcinoma, breast carcinoma, and lymphoma
Undiagnosed pleural effusion is best evaluated with _____ , except in patients ______
thoracentesis
with clear-cut evidence of congestive heart failure.
Alkylosing spodylitis
Pulmonary function tests (PFT) may reveal
a mildly restrictive pattern with
■ ↓vital capacity (VC) and ↓ total lung capacity (TLC) but normal FEV1/FVC ratio.
■ Functional residual capacity (FRC) and residual volume (RV) are normal or increased due to fixation of the rib cage in an inspiratory position.
Theophylline toxicity can manifest as
central nervous system stimulation (eg, headache, insomnia, seizures), gastrointestinal disturbances (eg, nausea, vomiting), and cardiac toxicity (arrhythmia).
Theophylline toxicity antidote
Beta blocker
The 3 most common causes of chronic cough (lasting _________ ) are ____________
> 8 weeks
■ upper-airway cough syndrome (postnasal drip),
■ asthma,
■ gastroesophageal reflux disease (GERD).
DLCO increased, FEV1 and TLC are normal.
Alveolar hemorrhage
Pneumothorax and Pulmonary edema follows _______ pattern of FLOW VOLUME CURVES
Restrictive
In acute exacerbation of COPD Jugular venous distension (JVD) may be observed, especially during _______
expiration, due to increased intrathoracic pressure.
The _______ nerve can be injured during cardiac surgery.
Symptoms:
phrenic nerve
■ dyspnea on exertion,
■ orthopnea,
■ paradoxical breathing movement (ie, abdomen moving inward on inspiration).
Contraindications of NPPV:
- Uncooperative / agitated patient
- Inability to clear secretions or risk of aspiration (unconscious)
- Severe acidosis <7.10
- GI bleed
- Encephalopathy (Glasgow coma scale <10
- ARDS
- Airway obstruction
Systemic glucocorticoids decrease _____ associated with COPD exacerbation, improve lung function and hypoxemia, and have been shown to decrease __________
inflammation
risk of relapse, treatment failure, and length of hospital stay.
Asthma and COPD are fundamentally distinguished by the ______. Therefore, the best test for discriminating between them is __________
reversibility of airflow obstruction
spirometry before and after a short-acting bronchodilator (eg, albuterol)
Proper distinction is critical for the selection of long-term controller therapy: inhaled corticosteroids are preferred for_______, whereas inhaled antimuscarinic therapy is preferred for ________.
asthma
COPD
Intermittent asthma is caused by _______
leukocyte-induced acute and reversible bronchoconstriction.
a rare exception when left-sided preload and PCWP are discordant.
In tamponade, left-sided preload is decreased, but measured PCWP is paradoxically increased due to external compression by pericardial fluid.
Medications such as ____ or ______ can exacerbate anaphylaxis by resulting in, __________ or __________ respectively.
nonsteroidal anti-inflammatory drugs or
beta-adrenergic blockers
nonimmunologic mast cell activation or unopposed alpha-adrenergic effects
Acute Hypersensitivity pneumonitis. CXR findings
Chest x-ray: scattered micronodular interstitial opacities
chronic Hypersensitivity pneumonitis Chest x-ray
Chest x-ray: diffuse reticular interstitial opacities
