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STEP 2 Pulmonary > Pulmo. Hypox/ch.cough/acu+ch bronch/UACS 10-28 (1) > Flashcards

Pulmo. Hypox/ch.cough/acu+ch bronch/UACS 10-28 (1) Flashcards

1
Q

Hypoxemia.
Reduced PiO2 examples?

A

High altitude

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2
Q

Hypoxemia.
PiO2 A-a gradient?

A

normal

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3
Q

Hypoxemia.
Reduced PiO2 corrects with supplemental O2?

A

yes

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4
Q

Hypoxemia.
Hypoventilation examples?

A

CNS depression, morbid obesity, neuromuscular weakness

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5
Q

Hypoxemia.
Hypoventilation A-a gradient?

A

normal

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6
Q

Hypoxemia.
Hypoventilation corrects with supplemental O2?

A

yes

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7
Q

Hypoxemia.
Diffusion limitation examples?

A

Emphysema, ILD

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8
Q

Hypoxemia.
Diffusion limitation A-a gradient?

A

Increased

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9
Q

Hypoxemia.
Diffusion limitation corrects with supplemental O2?

A

yes

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10
Q

Hypoxemia.
V/Q mismatch*
examples?

*caused by localized dead-space ventilation and/or intrapulmonary shunting.

A

Small PE, lobar pneumonia

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11
Q

Hypoxemia.
V/Q mismatch A-a gradient?

A

Increased

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12
Q

Hypoxemia.
V/Q mismatch corrects with supplemental O2?

A

Yes

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13
Q

Hypoxemia.
Large intrapulmonary shunt examples?

A

Diffuse pulmonary edema
+ atelectasis, pneumonia

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14
Q

Hypoxemia.
Large intrapulmonary shunt A-a gradient?

A

Increased

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15
Q

Hypoxemia.
Large intrapulmonary shunt corrects with supplemental O2?

A

No

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16
Q

Hypoxemia.
Large dead space ventilation examples?

A

Massive PE, right-to-left intracardiac shunt

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17
Q

Hypoxemia.
Large dead space ventilation A-a gradient?

A

Increased

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18
Q

Hypoxemia.
Large dead space ventilation corrects with supplemental O2?

A

No

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19
Q

Hypoxemia. Intracardiac shunt (right to left), examples?

A

Tetralogy of Fallot, Eisenmenger syndrome

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20
Q

Hypoxemia. Intracardiac shunt (right to left), A-a gradient?

A

Increased

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21
Q

Hypoxemia. Intracardiac shunt (right to left), corrects with supplemental O2?

A

No

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22
Q

Chronic cough. Duration in adults and children?

A

> 8 weeks in adults and >4 weeks in children

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23
Q

Chronic cough.
Most common causes. Upper airway disorders? 2

A

Upper airways cough syndrome (UACS) (postnasal drip) - Allergic rhinitis, Nonallergic rhinitis (vasomotor), Acute nasopharyngitis, Sinusitis.

Chronic sinusitis

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24
Q

Chronic cough.
Most common causes. Lower airway and parenchymal disorders?

A

Asthma
Post respiratory tract infection
Chronic bronchitis
Bronchiectasis
Lung cancer
Nonasthmatic eosinophilic bronchitis

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25
Q

Chronic cough.
Most common causes. Other causes?

A

GERL
ACEI

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26
Q

Chronic cough. scheme.
1st step - suspected etiology on history and physical –> evaluate and treat as indicated. ACEI?

27
Q

Chronic cough. scheme.
1st step - suspected etiology on history and physical –> evaluate and treat as indicated. UACS?

A

First generation H1 blockers

28
Q

Chronic cough. scheme.
1st step - suspected etiology on history and physical –> evaluate and treat as indicated. Asthma?

A

PFTs (pulmonary function tests)

29
Q

Chronic cough. scheme.
1st step - suspected etiology on history and physical –> evaluate and treat as indicated. GERD?

30
Q

Chronic cough. scheme.
1st step - suspected etiology on history and physical –> evaluate and treat as indicated. ACEI, UACS, Asthma, GERD –> no improvement –>?

A

Chest X ray

31
Q

Chronic cough. scheme.
1st step - suspected etiology on history and physical –> kitas langelis su simptomais (ne vaistu langelis) ? 3

A

Parenchymal disease

Purulent sputum/immunocompromised

No specific etiology

After this evaluation next step is chest xray

32
Q

Chronic cough. asthma evaluation?

A

PFTs or 2-4 weeks of inhaled glucocorticoids (if the cough improves
–> diagnosis is made).

33
Q

Chronic cough.
ACEI: due to impaired metabolism of kinins and substance P.
Increased production of prostaglandins by kinins. Increased thromboxane
levels as well.

34
Q

Acute bronchitis.
Etiology?

A

Preceding respiratory illness (90 proc viral)

35
Q

Acute bronchitis. clinical? 3

A

Cough
Absent systemic fundings (fever, chills)
Wheezing or rhonchi, chest wall tenderness

36
Q

Acute bronchitis. clinical. cough characteristic?

A

> 5 days to 3 weeks
Can be productive (yellow, green, or purulent sputum)

37
Q

Acute bronchitis.
Diagnosis?

A

Diagnosis is clinical

38
Q

Acute bronchitis.
Diagnosis. when do xray?

A

only when suspected pneumonia

39
Q

Acute bronchitis.
Symptomatic treatment?

Abs?

A

Nsaids/acetaminophen and or bronchodilators

abs ARE NOT recommended

40
Q

Acute bronchitis. what viruses?

A

Influenza A or B, parainfluenza, adenovirus

41
Q

Acute bronchitis. what may be sputum?

A

bloddy sputum

42
Q

Upper airway cough syndrome. called ,,postnasal drip syndrome”

43
Q

Upper airway cough syndrome. presentation?

A

It presents as chronic cough caused by:
a. Rhinosinus conditions: Allergic rhinitis, perennial nonallergic rhinitis, Vasomotor rhinitis

b. Acute nasopharyngitis

c. Sinusitis

44
Q

Upper airway cough syndrome. what clinical may be reported?

A

Some patients report liquid dripping into the back of the throat or frequent throat clearing
episodes

45
Q

Upper airway cough syndrome. treatment?

A

1st generation H1 blocker (eg, diphenhydramine)

OR

Combined antihistamine-decongestant (eg, brompheniramine and pseudoephedrine)

46
Q

Upper airway cough syndrome. if do not respond to treatment after 2-3 weeks?

A

i. Further investigation (eg, sinus imaging, PFTs, high-resolution CT scan of chest)

ii. Empiric sequential therapy for GERD, cough-variant asthma, chronic sinusitis,
and non-asthmatic eosinophilic bronchitis

47
Q

Acute bronchitis. symptomatic treatment?

A

nonprescription pain relievers

48
Q

Acute bronchitis. treatment for cough?

A

Throat lozenges and OTC cough suppressants (eg, dextromethorphan/guaifenesin)

49
Q

Acute bronchitis. treatment. bronchodilators?

A

Inhaled bronchodilators (eg, albuterol) are recommended in patients with wheezing in the setting of underlying pulmonary disease (eg, asthma)

50
Q

Acute bronchitis. treatment. abs??

A

Antibiotics should NOT be given

51
Q

Acute bronchitis. xray for what? 3

A

i. Suspicion of pneumonia
ii. Elderly patients (because signs of pneumonia may be subtle in these patients)
iii. Patients with advanced lung disease (eg, COPD)

52
Q

Chronic bronchitis. definition?

A

3 consecutive months of productive cough in 2 successive years.

53
Q

Chronic bronchitis. leading cause?

54
Q

Chronic bronchitis. symptoms?

A

a. Chronic smoking (>=1 pack a day for at least 20 years)
b. Productive cough
c. Dyspnea on exertion

55
Q

Chronic bronchitis. diagnosis, test?

56
Q

Chronic bronchitis. PFTs pattern? DLCO?

A

i. Obstructive pattern on spirometry
ii. Normal DLCO

57
Q

Chronic bronchitis. Differentials?

A

iCompared to chronic bronchitis, bronchiectasis is associated with a history of recurrent respiratory tract infections and chronic cough with daily production of copious mucopurulent sputum.

58
Q

Chronic bronchitis vs emphysema.
bronchitis DLCO?

59
Q

Chronic bronchitis vs emphysema.
emphysema DLCO?

A

decr. DLCO

60
Q

Chronic bronchitis vs emphysema.
bronchitis xray?

A

prominent bronchovascular markings and a mildly flattened diaphragm

61
Q

Chronic bronchitis vs emphysema.
emphysema xray?

A

decreased vascular markings and hyperinflated lung

62
Q

Chronic bronchitis vs emphysema.
bronchitis hypoxemia?

A

more pronounced hypoxemia

63
Q

Chronic bronchitis vs emphysema.
emphysema hypoxemia?

A

less pronounced hypoxemia

STEP 2 Pulmonary (30 decks)

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