Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EM Board exam > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

A-a gradient

Description

Shorthand formula

A

A-a gradient = Measured PaO2 - Calculated PaO2

Quick A-a formula: 150 – (PaCO2 x 1.2 + PaO2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Elevated A-a gradient ddx

A

V/Q Mismatch

–(PE, pneumonia, asthma)

Impaired O2 diffusion

–(interstitial pneumonia, PCP)

Right to Left Shunt

–(congenital heart disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Normal A-a gradient ddx

A

Hypoventilation

–(opioid OD)

Decreased FiO2

–(high altitude)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Central cyanosis clinically apparent with hemoglobin greater than

saturated carboxyhemoglobin looks like SaO2

saturated methemoglobin looks like SaO2

A

5 g/dL

100%
85%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Asthma pathophysiology

Bronchial *** and ***

Mucous ***

Increased *** cells

Bronchial muscle ***

A

Bronchial constriction and edema

Mucous plugging

Increased goblet cells

Bronchial muscle hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Samter’s triad

A

asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Asthma miscellaneous

measurement predicting need for admission

Hemodynamic sequelae

A

FEV1

hypotension, pulsus paradoxus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Death risk factors (just for review)

A
  • Hx of sudden severe exacerbations
  • Prior intubation
  • Prior ICU admit
  • >1 admission or >2 ED visits in past year
  • ED visit in past month
  • >2 adrenergic MDIs per month
  • Current/recent systemic steroid use
  • “Poor perceivers”
  • Concomitant disease – cardiopulmonary or psychosocial
  • Illicit drug use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Asthma
beta-2 agonists comparison review

A

–Inhaled superior to oral and parenteral routes, fewer side effects

–Intermittent equal to continuous administration

–MDIs equal to nebulizers

–Racemic equal to “R” enantiomer preparations (levalbuterol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Asthma, mechanism of action
steroids (3)

inhaled anticholinergic
magnesium

ketamine

A

steroids: immunomodulatory, up regulates beta receptors, immediately causes vasoconstriction

inhaled anticholinergic: relaxes bronchial smooth muscle
magnesium: relaxes bronchial smooth muscle

ketamine: sedation and bronchodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cardiac arrest, intubated asthma patient steps (4)

A

1 Disconnect ventilator

2 Compress chest

3 Bilateral chest tubes

4 Fluid bolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Bronchiolitis medication for congenitally ill child

A

Ribavirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

COPD
unique pathophysiology from asthma

A

–Different inflammatory markers from asthma (e.g. neutrophils, not eosinophils)

–Proteases and oxidants result in tissue destruction

  • airflow reduction is not fully reversible and generally progressive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

COPD

long-term natural history (4)

A

–Destruction of pulmonary vascular bed and thickened vessel walls

–Pulmonary hypertension

–Polycythemia

–Right sided heart failure (cor pulmonale)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In the setting of COPD exacerbation

A

Deep sulcus sign on the left suggestive of occult pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

COPD pneumothorax caveat

A

Blebs can mimic pneumothorax as shown on the x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In the setting of COPD exacerbation

A

Lobar atelectasis distinguished from pneumonia by
sudden decompensation
volume loss on the affected side
may be treated by bronchoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

COPD therapy

indication for antibiotics

disease altering interventions (3)

A

abx: increased sputum production and purulent

smoking cessation and home oxygen (for PaO2 < 55 or Cor Pulmonale)- > mortality benefit
pneumococcal vaccination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ARDS
description
diagnostic criteria (3)

A

Non-cardiogenic pulmonary edema due to leaky alveolar capillary membranes
Diagnosis:

1 HypoxiaPaO2 < 60 mm Hg with FiO2 > 0.5

2 Normal ventricular function: PCWP < 18 mm Hg

3 Diffuse alveolar infiltrates: with normal heart size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ARDS
review of causes with most common

A

–Sepsis (most common)

–Trauma

–Near-drowning

–Aspiration

–Toxicologic (ASA, opiates, hydrocarbons)

–Pancreatitis

–Environmental (high-altitude)

–Fat or amniotic fluid embolus

–CNS catastrophe (e.g. SAH)

22
Q

ARDS
treatment (4)

A

PEEP/CPAP

pressure controlled/high-frequency ventilation
low tidal volume ~6 mL/kg

prone position

23
Q

Pneumonia mimics
including “*** lung”, *** gas

A
  • Cancer
  • Tuberculosis
  • Pulmonary embolus
  • Toxicologic / environmental: Chlorine gas, Farmer’s lung (allergic reaction to inhalation of moldy crops – hay, grain, tobacco)
  • ARDS e.g. from chronic ASA toxicity or other treatable cause
  • Atelectasis
  • Right-sided endocarditis with Septic emboli
  • Diffuse alveolar hemorrhage: Low hemoglobin, immune disease
24
Q
A

Multiple “cannonball” infiltrates

Suggestive of metastatic disease, septic emboli, right sided-endocarditis

25
Q
A

Hamptons hump: wedge-shaped pulmonary infarction broadest at the pleural edge suggestive of pulmonary embolism

26
Q

Pneumonia microbial risk associations
COPD/smoker
post viral/IVDA

alcoholics, COPD, diabetics
nosocomial, immunocompromised, CF

alcoholics, poor dentition

A

COPD/smoker: Haemophilus influenza
post viral/IVDA: staph aureus

alcoholics, COPD, diabetics: Klebsiella
nosocomial, immunocompromised, CF: Pseudomonas

alcoholics, poor dentition: anaerobes

27
Q

Noninfectious plural effusion associations

right (2)

left (3)

A

right (2): aortic dissection, Boerhaave’s

left (3): CHF, pancreatitis, hepatitis

28
Q

Infectious pleural effusion associations (5)

A

Strep pneumonia, staph aureus, Haemophilus influenza, TB, Legionella

29
Q

Lung abscess associations (4) including most common

A

Anaerobes (most common cause), Staph aureus, Pseudomonas, TB

30
Q

Atypical pneumonia associations

Mycoplasma
chlamydia pneumonia (age, assoc clinical finding)

Legionella (source, assoc clincal findings, transmission pearl, sputum smear result)

A

Mycoplasma: young adults, extra pulmonary findings (see below)*
chlamydia pneumonia: infants and young adults, conjunctivitis

Legionella: water, air conditioning, older man, no person to person spread, sputum smear negative)

*Guillain-Barré, encephalitis, hemolysis, cold agglutinins, bullous myringitis, erythema multiforme

31
Q

Really atypical pneumonia

Fungal (3), CXR findings

Zoonotic (2) and sources

A

Cocci (Southwest), Histo (Miss river valley), Blasto (SE US); CXR: hilar adenopathy, patchy infiltrates

Q fever (Coxiella Burnetii - Vets, farmers -> sheep, goats, cattle); Hepatitis and endocarditis

Psittacosis: Bird handler; brady, sepsis, low WBC

32
Q

Pneumonia Gram stains

A
33
Q

Pneumonia treatment by class

outpatient, young, healthy
inpatient, older, sicker

healthcare associated

A

outpatient, young, healthy: macrolide
inpatient, older, sicker: macrolide plus cephalosporin or quinolone

healthcare associated: antipseudomonal penicillin, carbopenem or aminoglycoside

34
Q

Uncommon pneumonias

  1. Southwest US, rodent excreta; tx
  2. fleas/rodents, squirrels; tx
  3. Inhaled bioagent; spread, classic xray, tx (3)
A
  1. Hantavirus, supportive therapy only
  2. Yersinia pestis (plague); doxycycline, fluoroquinolone, aminoglycoside
  3. Anthrax; no person-to-person spread, prominent mediastinum due to hemorrhagic mediastinitis; doxycycline, FQ, PCN
35
Q

Pneumonia in HIV, common types

Bacterial:

Mycobacterial:

Parasitic:

Viruses:

Fungal:

A

Bacterial: Most common, Same pathogens as non-AIDS

Mycobacterial: TB, Mycobacterium avium complex (MAC)

Parasitic: Toxoplasmosis

Viruses: CMV, HSV

Fungal: PCP

Often disseminated

Cryptococcosis, histoplasmosis, aspergillosis, candidiasis

Noninfectious: Kaposi’s sarcoma and non-Hodgkin’s lymphoma

36
Q

Pneumonia and HIV by CD4

< 200 (2), dx pearl, tx (3 + 1)

< 50 (3)

A

< 200: PCP (elevated LDH, sens not spec), TB

< 50: CMV, MAC, fungal,

PCP tx: Septra, Pentamadine, Dapsone, steroids pO2 < 70 or A-a gradient > 35

37
Q
A
38
Q

Foreign body aspiration

method to detect occult aspiration

A

Decubitus film showing failure of affected lung to deflate when mainstem bronchus is blocked

39
Q

Aspiration PNA abx timing

A

Hold antibiotics until febrile to avoid selecting out resistant organisms

40
Q

Tuberculosis
location-primary
location - reactivation

progression within and after two years rate

sensitivity of AFB smear

A

Right lower or middle lobe
upper lobe, can be cavitary
5% for each

x-ray shows cavitary right upper lobe lesion

sensitivity: only 60%

41
Q
A

Miliary TB from hematogenous spread

42
Q

Tuberculosis

isoniazid side effects (2)

positive TB skin test

A

Hepatitis and peripheral neuropathy

5 mm: high-risk (HIV, close contacts, chest x-ray changes, immunosuppressed)
10 mm: medium risk (immigration less than five years from high-risk area, IVDU, working high-risk setting, comorbidities, children < 5 etc)

15 mm: low risk

43
Q

Sarcoidosis

classic quadrad (4) of findings

Treat flares/complications with

A

Bilateral hilar adenopathy, pulmonary infiltrates, ocular and skin lesions

Tx: steroids

44
Q

Mediastinal masses

anterior - most common and mnemonic (5)

A

Bronchogenic cancer

•Mass in anterior mediastinum: five “T”s

–Thymoma (consider myasthenia gravis)

–Thyroid (retrosternal)

–Teratoma (teeth, hair, etc.)

–T cell lymphoma

–”Terrible“ (carcinoma)

45
Q

Hemoptysis

most common cause
definition of massive

Tx massive:

Breathing (2),

definitive (2)

A

most common cause: bronchitis
definition of massive: > 600 ML 24 hours were 50 ML in single cough

Breathing (2): decubitus with bleeding side down, selective mainstem intubation

definitive (2): surgery, bronchial artery embolization, bronchoscopy

46
Q

Pneumomediastinum, often benign but

In trauma consider
non-trauma consider
eponym for physical finding

A

In trauma consider: tracheobronchial injury
non-trauma consider: Boerhaave’s
eponym for physical finding: Hamman’s crunch synchronus with heart sounds

47
Q
A

Pneumomediastinum

also seen on lateral neck film just anterior to vertebral bodies

48
Q

Pleural effusion

transudative versus exudative

Transudate lab findings (3)

A

transudative: increased hydrostatic or decreased oncotic pressure (eg CHF, cirrhosis)
exudative: neoplastic, inflammatory, infectious

Transudate lab findings: low protein (<3 mg/dL), LDH < 200, pleural:serum prot < 0.5

49
Q

Pulmonary embolism

Westermark’s Sign

EKG signs of right ventricular strain (6)

D-dimer ELISA vs Latex agluttination

A

Westermark’s Sign: relative oligemia (decreased vascular lung markings) distal to large PE

ELISA superior

RV strain:

Inverted T waves V1-V4

S1Q3T3

RBBB

P pulmonale

Right axis deviation

Tachycardia

50
Q

Pulmonary embolism

Treatment options (4)

A

Heparin: 80u/kg bolus, followed by 18u/hour infusion

IVC Filter (Greenfield): when anticoagulation is contraindicated

Fibrinolytics (tPA): Now indicated only for PE causing shock with RV strain

Surgical embolectomy: Rarely indicated, needs bypass

51
Q

Tracheostomy respiratory distress steps (3)

Bleeding steps (life threatening bleed can come from innominate artery)

A
  1. Remove inner cannula, suction, irrigate with saline
  2. Replace entire trach (over catheter as needed)
  3. Look for other cause

Bleeding: hyperinflation of balloon with levering of tube posteriorly; inntubate patient, place finger in trach hole (but not in trachea) and apply posterior pressure

EM Board exam (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions