Pulmonary Flashcards
Tx for PE in pt with GFR <30
Unfractionated heparin - more convenient to monitor therapeutic level with PTT
- Avoid LMWH (enoxaparin), fondaparinux, rivaroxaban
Pt with sudden onset chest pain, dyspnea, and hemoptysis with wedge-shaped plearual base opacification. Patient has HIV and chronic smoker
Pulmonary infarction from pulmonary embolism
38 year old with progressive SOB and cough. Smoked cigarettes for 5 years. CXR show bilateral basal lucency.
alpha 1 antitrypsin deficiency
- classically results in destruction of lower lobes
- COPD at young age, COPD with minimal smoking hx, basilar predominant COPD
Most common cause of PNA in cystic fibrosis pts
<20: staph aureus
>20: pseudomonas
Light’s Criteria
Protein (pleural/serum) >0.5
LDH (pleural/serum) >0.5
Pleural LDH >2/3 ULN serum LDH
Transudative vs exudative
Transudative: decreased intrapleural and plasma oncotic pressures or elevated hydrostatic pressure
Exudative: increased capillary or pleural membrane permeability or disruptions to lymphatic outflow
9 year old girl with frequent sinus infections and pneumonia. Vitamin D deficiency. Multiple nasal polyps. Digital clubbing
Cystic fibrosis
54 year old man emigrated from Vietnam where he was treated for TB had fatigue, cough with blood-tinged sputum, and 15 pound weight loss. Cavitary lesion present on CT filled with stuff.
Chronic pulmonary aspergillosis
- fungus ball on CT
- > 3 months of sx (fever, weight loss, cough, hemoptysis)
- immunocompetent pts with past hx of lung dz have a hard time clearing it
Tachypnea begins shortly after birth and resolves by day 2
Transient tachypnea of the newborn
- inadequate alveolar fluid clearance at birth results in mild pulmonary edema
- CXR: bilateral perihilar streaking, hyperextended, wet lungs
- near term infants
- tx: ppv
Severe respiratory distress and cyanosis after premature birth
Respiratory distress syndrome
- surfactant deficiency results in alveolar collapse and diffuse atelectasis
- CXR: diffuse, reticulogranular (ground-glass) appearance, air bronchograms, low lung volume
Obstructive pattern (<70%)
- low DLCO
- normal DLCO
- increased DLCO
- emphysema
- chronic bronchitis, asthma
- asthma
Restrictive pattern (>70%)
- low DLCO
- normal DLCO
- increased DLCO
- interstitial lung dz, sarcoidosis, asbestosis, heart failue
- MSK deformity, neuromuscular dz
- morbid obesity
Normal spirometry
- low DLCO
- increased DLCO
- anemia, PE, pulm HTN
- pulmonary hemorrhage, polycythemia
PEEP
prevents alveolar collapse and may reopen some already collapsed alveoli
- improves oxygenation
- counteracts one of the mechanisms of ARDS
- if high levels of FiO2 (>60%) are required to maintain oxygenation, PEEP should be increased as well to prevent oxygen toxicity
Premature newborn develops respiratory distress after birth. Is given surfactant and put on mechanical ventilation. Comes of mechanical ventilation but remains hypoxic. Cause?
Bronchopulmonary dysplasia
- due to repeated insult to neonatal lungs from mechanical ventilation, prolonged oxygen exposure, and inflammation
pH of pleural fluid
normal: 7.6
transudate: 7.4-7.55
exudate: 7.3-7.45
Empyema, tumor, pleuritis, pleural fibrosis: <7.3
Post hemicolectomy, pt develops SOB and unilateral white out on CXR. Mediastinum is shifted towards side of opacification. Pt is a smoker. Most likely cause
Atelectasis due to bronchial mucus plug
Causes of pleural effusion with high amylase
- pancreatitis
- esophageal rupture
Pt with sudden onset of digital clubbing (convex nail beds) and hypertrophic osteoarthropathy (thickening of distal fingers) of wrists and fingers
often associated with lung cancer
- get cxr
Side effect of tuberculosis
primary adrenal insufficiency
- leads to low aldosterone
- non-anion gap metabolic acidosis
Most common pathogenic organism in children with CF
staph aureus
- cefepime: covers MSSA and pseudomonas
- vancomycin: covers MRSA
COPD acute exacerbation
change in
- cough
- sputum
- dyspnea
Respiratory distress, confusion, and petechial rash following femur fracture from an ATV accident.
fat embolism
Parapneumonic effusions and empyemas fluid findings
low glucose (<60) low pH (<7.2)
Pleural effusion with >50,000 lymphocytes
empyema
MOA for cromolyn
inhibits mast cell degranulation
- used in exercise induced asthma
asthmatics with poorly-controlled disease who are unable to wean themselves from corticosteroids. Pt with productive coughing, mucous plugging (sometimes forming bronchial casts), and hemoptysis
aspergillosis
initial tx for nasal polyps
steroid nose spray
rheumatologic effusion
exudative with high LDH (>700) and low glucose (<50)
why is glucose low in an empyema
high metabolic activity of leukocytes
supplemental oxygen in patients with advanced COPD
can worsen hypercapnia
- increased dead space causing VQ mismatch
- decreased affinity of oxyhemoglobin for CO2 and reduced alveolar ventilation
- decreases respiratory drive
- the goal oxyhemoglobin saturation is 90-93%
What has been shown to prolong survival in COPD patients
long term O2 therapy
respiratory distress, confusion, petechial rash after orthopedic surgery
fat embolism
hoarseness and multiple finger shaped lesions on vocal cords in a 3 year old
laryngeal papillomas due to recurrent respiratory papillomatosis
- caused by HPV 6 and 11
- most likely transmitted vertically
Theophylline toxicity
CNS stimulation (HA, insomnia, seizures), GI disturbances (N/V), and cardiac toxicity (arrhythmia)
safe FiO2 levels to prevent oxygen toxicity
<60%
ARDS
impaired gas exchange, decreased lung compliance. pulmonary htn
peritonsillar abscess tx
aspirate and IV Abx
TLC in obstructive (asthma) and restictive (obesity) lung disease
obstructive: increased
restrictive: decreased
method of removing swallowed foreign objects
kids: rigid bronchoscopy
adults: flexible bronchoscopy
