Pulmonary Flashcards
1
Q
what can dullness on percussion indicate?
A
effusion or pneumonia
2
Q
What can hyperresonance on pulmonary exam indicate?
A
emphysema or pneumothorax
3
Q
what does increased tactile fremitus indicate?
A
pneumonia or tumor
4
Q
what does decreased tactile fremitus indicate?
A
effusion/ pneumothorax
5
Q
total volume of air exhaled after maximal inspiratin
A
forced vital capacity (FVC)
6
Q
normal amount of air with each breath
A
tidal volume
7
Q
normal pH for ABGs
A
7.35-7.45
8
Q
Normal HCO3 for ABG
A
22-26
9
Q
4 main conditions that can cause respiratory acidosis
A
COPD, asthma, CHF pneumonia
10
Q
3 main conditions that can cause respiratory alkalosis
A
hyperventilation, fever, anxiety
11
Q
Conditions that cause metabolic acidosis (MUD piles)
A
methanol uremia DKA Propylene glycol isoniazid lactic acidosis ethylene glycol salicylates
12
Q
2 conditions that can cause metabolic alkalosis
A
vomiting, NG suction
13
Q
triad of asthma
A
airflow obstruction
bronchial hyperreactivity
inflammation
14
Q
prolonged, severe asthmatic attack
that does not respond to treatment with patient at risk
for ventilatory failure
A
Status asthmaticus :
15
Q
what will PFTs look like with asthma
A
Decreased FEV1, decreased FEV1/FVC, increased residual volume and TLC
16
Q
Drugs that – Reverse vagally mediated bronchospasm but not allergen
or exercise induced bronchospasm
A
anticholinergics
17
Q
Destruction of alveolar walls produces widely
dilated air spaces
A
emphysema
18
Q
Excessive mucus secretion in the bronchial tree
causing mucus plugging and inflammation,
peribronchiolar fibrosis, narrowing and
obliteration
• Productive cough for at least 3 months during
each of two successive years
A
chrnoic bronhcitits
19
Q
ABX that help with uncomplicated COPD exacerbations (not >65, FEV1 >50%, >3 exacerbations/year)
A
doxycycline, batrim, macrolide, cephalosporin
20
Q
ABX good for complicated COPD
A
fluoroquinolones (floxacins), augmentin
21
Q
abnormal dilataion of the bronchi, chronic purulent sputum, hemoptysis. Ausculatory crackles, digital clubbing
A
Bronchiectasis
22
Q
Drugs for influenza A
A
rimantadine
23
Q
drug for influenza A or B
A
zanamivir, or oseltamivir
24
Q
Major cause of lower respiratory infections of
newborns and children
• Often an epidemic during winter months
• Causes bronchiolitis – inflammation of small
airways
A
RSV? acute bronchiolitits
25
TX for acute bronchiolitits (RSV)
humidified air, oxygen, ribavirin, albuterol, fluids (steroid not recommended in infants)
26
Highly contagious airborne disease that
| classically lasts for 6 weeks before subsiding. Has 3 stages (catarrhal, paroxysmal, convalescent)
pertussis (bordetella pertussis)
27
Tx for pertussis
vaccine, macrolides, or bactrim
28
Parenchymal lung infection
– 1‐10 day history of increasing cough, yellow sputum,
shortness of breath, tachycardia and pleuritic chest pain
community acquired pneumonia
29
typical bacteria that causes CAP
mycoplasma, chlamydia, legionella
30
Lab with CAP
luekjocytosis w/ left shift, CXR_ lobal infiltrates
31
Outpatient Tx for CAP
macrolides, doxy, fluoroquinolones
32
Inpatient tx for CAP
fluoroquinolones, macrolide + Beta-lactam
33
: low grade fever, nonproductive cough,
myalgia, fatigue, mild pulmonary symptoms
that are self‐limited occurring in young
otherwise healthy adults
atypical pneumonia
34
Tx for chlamydia pneumonia
tetracycline
35
Tx for CMV
ganciclovir
36
Treatment for RSV
ribavirin
37
“Caves, Ohio valley, and lower
Mississippi region”, grows in soil with bird or bat
droppings.
histoplasmosis fungal pneumonia
38
tx for histoplasmosis fungal pneumonia
amphotericin B, itraconazole
39
“California disease, valley fever”,
| New Mexico area, causes mild sx
coccidiomycosis fungal pnuemonia
40
tx for coccidiomycosis fungal pneumonia
fluconazole, or amphotericin B
41
endemic in N. America around Great
Lakes, Ohio river basin and Mississippi river, broad
base budding organism, extrapulmonary lesions :
skin, bone, prostatitis.
blastomycosis fungal pneumonia
42
tx for blastomycosis fungal pneumonia
oral itraconazole
43
potentially fatal disease,
| opportunistic infection in AIDS
cryptococcosis fungal pnuemonia
44
tx for cryptococcosis fungal pneumonia
IV amphotericin B + oral flucytosine
45
immunocompromised individuals,
| waterfowl, fungal ball on CXR.
treat with any antifungal
46
Nonproductive cough, dyspnea, fever in an individual with HIV pneumonia. 50% will ahve a normal exam. Increased LDH and ilver stain on sputum. Ground glass ppearance on CXR/CT
PCP (pneumocystis jiroveci pneumonia)
47
Tx for PCP pnuemonia
bactrim ?clinda
48
– Walking pneumonia
– + cold agglutinins
– Bullous myringitis
mycoplasma pneumoniae
49
pneumonia if around
| poultry, pet shops
chlamydia psittaci
50
“currant
| jelly sputum” common in alcoholics
Klebsiella pneumonia
51
common organism in pneumonia in individuals with cystic fibrosis
Pseudomonas
52
pneumonias from rabbit exposure
Tularemia, francisella, tularensis
53
cough, fever, chills, night sweats,
| anorexia, fatigue, weight loss , caused from inhaling aerosol droplets
Tuberculosis
54
what will you see on CXR with TB
cavitary infiltrate in a posterior apical
segment of an upper lobe or in a superior
segment of a lower lobe
55
what will sputum show with TB
positive acid fast bacilli
56
Tx for latent dz of TB
isoniazid for 9 months
57
4 drug tx for TB
isoniazid
rifampin
pyrazinamide
ethambutol
58
```
• Acute onset of respiratory failure due to
↑ permeability of the alveolar capillary
membranes leading to severe pulmonary
edema, hypoxia and dyspnea
– 30‐40 % mortality
```
ARDS
59
what will the PaO2:FIO2 ratio be with ARDS
<200
60
causes of ARDS
sepsis, multiple trauma, aspiration, DIC< shock, blood transfusion, pancreatitis
61
Symptoms tachypnea, frothy pink or red sputum, diffuse
| rales, dyspnea, severe hypoxemia
ARDS
62
what will an ABG show with ARDS?
respiratory aidosis (possible acute respiratory alkalosis initially)
63
TX for ARDS
reverse the program, broad spectrum abx for sepsis, , diuretics
64
chest pain caused by pleural inflammation, sharp stabbing pain w/ breathing. Sneezing / coughign makes it worse
Pleurisy
65
Tx for pleurisy
analgesic, NSAIDs, antimicrobials PRN
66
3 main occupational lung diseaes
asbestosis, silicosis, coal workers' pneumoconiosis
67
Diffuse interstitial cellular and fibrotic reaction of the lung to inhaled asbestos fibers
asbestosis
68
lung condition that presents with breathlessness, digital clubbing, basilar rales. CSR will show hazy infiltrats in the lwoer lung zones, interstitial fibrosis, thickened pleura, calcified plaques on the diaphragms or lateral chest wall
asbestosis
69
what cancer does asbestosis cause
mesothelioma
70
lung condition on CXR will show numerous small, rounded opacitites scattered throughout the lungs and hilar lymph nodes may be calcified
silicosis
71
lung condition- CXR shows small opacities that are prominent in the upper lung fields. Restrictive dysfunction on PFTs
coal workrs pneumoconiosis
72
accumulation of fluid between teh lung and thoracic wall
pleural effusion
73
what causes a transudative pleural effusion
CHF
74
what are some causes of exudative pleural effusions
malignancy, blood (trauma), infection
75
PE with pleural effusion
dullness to percussion in lower lung field, decreased breath sounds, decreased tactile fremitus
76
Tx for pleural effusion
thoracentesis
77
accumulation of pus in the pleural space
empyema
78
Tx for empyema
chest tube, abx (will often need thoracoscop or thoracotomy)
79
lymph fluid accumulation int he pleural space to to injury of the thoracic duct by laceration of obstruction by trauma or tumor
Chylothorax
80
what will be present in the fluid from a chylothorax
triglycerides, it will be milk white
81
Tx for chylothorax
chest tube, NPO, TPN
82
PE with pneumothorax
Hyperresonance, decreased tactile fremitus, decreased breath sounds
83
Air in the pleural space causing a mediastinal
shift to the contralateral side and impaired
ventilation leading to cardiovascular
compromise
tension pneumothorax
84
What will ABGs show with pulmonary embolism
respiratory alkalosis, hypoxia
85
What will ECG show with pulmonary embolism
tachycardia, anterior ST segment changes, T wave inversion. RBBB, S1Q3T3
86
what is the first choice diagnosis for PE?
CT pulmonary angiography
87
Tx for PE
oxygen, bed rest, anticoags (heparin, coumadin), thrombolytics (streptokinase, etc), surgery- IVC filter or thromboembolectomy
88
how to diagnose pulmonary HTN
right heart catheterization
89
Tx for pulmonary HTN
oxygen, diuretics, anticoags
90
• Disease of the right ventricle that results from
pulmonary HTN secondary to pulmonary
disease
cor pulmonale
91
causes of acute cor pulmonale
PE, ARDS
92
causes of chronic cor pulmonale
COPD, restrictive lung disease
93
S/S of cor pulmonale
peripheral edema, liver enlargement, neck vein engorgement.
94
medical tx for cor pulmonale
oxygen, diuretics, vasodilators
95
what will interstitial lung dz look like on CXR
honeycomb lung, ground grass infiltrate
96
how do you diagnose interstitital lung dz
biopsy
97
Dz with noncaseating granulomatous inflammation in in affected organs
sarcoidosis
98
what will labs with sarcoidosis show
hypercalcemia, hypercalciuria, increase in ACE levels
99
CXR have bilateral hilar and right paratracheal adenopathy with diffuse reticular infilatrates
sarcoidosis
100
Tx for sarcoidosis
corticosteroids
101
• Progressive autoimmune disease of the lungs
and kidneys
• Produces intra‐alveolar hemorrhage and
glomerulonephritis
goodpasture syndrome
102
what causes goodpasture syndrome
ati-glomerular basement membrane (anti-GBM) antibodies
103
Tx for goodpasture syndrome
plasmapharesis and corticosteroids
104
Classic triad : upper respiratory vasculitis, lower
respiratory vasculitis & glomerulonephritis
Often bloody nasal polyps, chronic sinusitis
Wegener's granulomatosis
105
what 2 labs values will be present with wegener's granulomatosis
+ANCA, ESR
106
Tx for Wegener's granulomatosis
cyclophosphamide +/- prednisone
107
Skeletal abnormality that leads to chronic
deterioration in lung function
• Causes increased stiffness of the chest wall
kyphoscoliosis
108
Tx for kyphoscoliosis
possible meachnical vent support, corrective intervention when angulation >40
109
what are the 5 main anterior mediastinal masses
```
thymomas
thyroid tumor
teratoma
parathyroid tumor
lymphoma
```
110
what is the common middle mediastinal mass
bronchogenic tumor/ cyst
111
5 common posterior mediastinal masses
neurogenic tumor, esophageal tumor, hiatal hernia, meningocele, thoracic spine dz
112
are most solitary pulmonary nodules benign or malignant
benign (usually <2 cm, with distrinct margins)
113
What makes a solitary pulmonary nodule more likely to be malignant?
patient >45, >2 cm, indistinct margins, rarely calcified
114
Tx for solitary pulmonary nodules
thorascopy or thoracotomy w/ biopsy
115
most common benign lung tumor, is a malformation that resembles a neoplasm. On CXR will look like a popcorn lesion.
hamartoma
116
most common type of lung cancer, typically metastasizes. Lung periphery, CEA positive
Adenocarcinoma
117
2nd most common type of lung cancer. Central bronchi and metastasizes to regional lymph nodes. Will be a hilar mass w/ cavitation on CXR. Hypercalcemia
squamous cell carcinoma
118
neuroendocrine lung cancer, quick to metastizie.
small cell carcinoma
119
Tx for small cell carcinoma
chemotherapy
120
S/S with small cell carcinoma
SIADH, paraneoplastic syndrome
121
slow growing lugn tumro often in central bronchi. Patient can have flushing, diarrhea, wheezing, haert valve lesions, HPOTN
carcinoid tumor
122
Tx for carcinoid tumor
octreotide
123
standard method for determining if someone has a TB infection
Mantoux tuberculin skin test (TST)
124
What causes transient tachypnea of the newborn (tachypnea, nasal flaring, subcostal retractions, cyanosis)?
retention of fetal lung fluid
125
lung condition with upper and lower respiratory tract vasculitits. Glomerulonephritis and positive ANCA
wegner's granulomatosis
126
tx for wegner's granulomatosis
cyclophosphamide +/- prednisone
127
when will tactile fremitus be decreased
effusion or pneumothorax
128
what is decreased with restrictive lung diseases
FVC, lung volume
129
cotton dust exposure causes chest tightness and decreased FEV1
byssinosis
