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Pulmonary Flashcards

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1
Q

Asthma values

A

FEV1/FVC < 70%
Decreased FEV1

Normal or decreased FVC

Increased RV
Increased TLC

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2
Q

Obstructive values

A

FEV/FVC < 0.70 (decreased)
FEV < 80 (decreased)
FVC < 80 (decreased)

FRC increased
TLC increased

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3
Q

Restrictive values

A

FEV/FVC increased/ normal

FEV decreased
FVC decreased
FRC decreased
TLC decreased

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4
Q

Albuterol

A

Short acting beta agonist

First line

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5
Q

Salmeterol

A

Long acting beta agonist

Maintenance therapy

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6
Q

Corticosteriods for asthma

A

Prednisone

Beclomethasone

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7
Q

Steps in Asthma treatment

A
  1. Mild intermittent
    <= 2 days/week
    <= 2 nights/month

No daily medications
SABA (albuterol) PRN

  1. Mild persistent
    >2 times/week
    < 1 time/ day
    >2 nights/month

Daily low dose ICS
Albuterol PRN

3. Moderate persistent
Daily
>1 night/week
Low dose ICS + LABA
or Medium ICS + SABA prn
  1. Severe persistent
    Continual
    Frequently night
    Medium dose ICS + LABA
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8
Q

Productive cough

Yellow green sputum
Dyspnea

Frequent infections

Wheezes, rhonchi

  • Name
  • CXR
  • Tx
A

Bronchiectasis

CXR: increased bronchovascular markings, tram lines (parallel lines outlining dilated bronchi)

Tx: Respiratory fluoroquinolone (levofloxacin, moxifloxacin)

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9
Q

Productive cough > 3 months per year for two years

A

Chronic bronchitis

Blue bloater
Overweight

Type of COPD

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10
Q

Test for COPD

A

Spirometry (PFTs)

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11
Q

Emphysema

A

Type of COPD

PInk puffer

Terminal airway destruction and dilation

Thin, wasted appearance with pursed lips, minimal cough

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12
Q

Medications that cause interstitial lung disease

A 
Amiodarone
Busulfan
Nitrofurantoin
Bleomycin
Methotrexate
Radiation
Long term high O2 concentration
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13
Q

Honeycomb pattern

A

Interstitial lung disease

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14
Q

Features of Sarcoid (10)

A

Sarcoid can be GRUELING

Granulomas
aRthritis
Uveitis
Erythema nodosum
Lymphadenopathy (hilar)
Interstitial fibrosis
Negative TB test
Gammaglobulinemia

[Third degree heart block]
[ Arrhythmias]

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15
Q

Erythema nodosum
Hilar adenopathy
Migratory polyarthralgias
Fever

Tx

A

Lofgren syndrome of Sarcoidosis

Triad:
Fever
Bilateral hilar adenopathy
Erythema nodosum

Tx: NSAIDS

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16
Q

Sarcoidosis favors what part of lung

A

Upper lobe

Hilar adenopathy

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17
Q

Also seen with sarcoidosis labs (5)

A

Increased ACE levels

Hypercalcemia
Hypercalciuria

Increased Alk phos

Lymphopenia

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18
Q

Sarcoidosis tx

A

Asymptomatic: observe

Symptomatic: Systemic corticosteriods

Refractory: Immunosuppressants (methotrexate, azathioprine, TNFalpha inhibitors)

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19
Q

Alveolar thickening
Non caseating granulomas

Fine bilateral rales

SOB
Fever
Shivering
Cough
Chest tightness
A

Hypersensitivity pneumonitis

Check travel/ job exposure

Molds, Hot tubs, birds

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20
Q

Insulation
Construction
Ship building

A

Asbestosis

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21
Q

Linear opacities at lung bases

Calcified pleural plaques

Risk?

A

Asbestosis

Increased risk for mesothelioma and lung cancer

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22
Q

Small nodular poacities in upper lung zones

A

Coal workers disease

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23
Q

Mines of quarries

Small nodular opacities in upper lung zones

Egg shell calcifications

Risk?

A

Silcosis

Increased risk for TB
Need annual TB skin test

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24
Q

Calcifications upper lobes

A

Silicosis

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25
Q

Calcifications in lower lobes

A

Asbestosis

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26
Q

Aerospace engineer

A

Berylliosis

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27
Q

Interstitial lung disease

Diffuse infiltrates
Hilar adenopathy

A

Berylliosis

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28
Q

25 AA with painful bumps on shins, WL and cough

Exam reveals prominent 1 cm right axillary LN

Diagnosis?

A

Sarcoidosis

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29
Q

Low PaO2

A

Hypoxemia

V/Q mismatch
Right to left shunt
Hypoventilation
Low inspired O2 content (high alt) 
Diffusion impairmetn
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30
Q

Low PaO2

A-a gradient normal

A

Hypoventilation

Low inspired oxygen

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31
Q

Low PaO2

A-a gradient increased

A

V/Q mismatch

R-L Shunting

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32
Q

Low PaO2
A-a gradient increased
PaO2 correctable w/ O2

A

V/Q mismatch

  1. Airway disease (asthma, COPD)
  2. Interstitial lung disease
  3. Alveolar disease (atelectasis, pneumonia, pulmonary edema)
  4. Pulmonary vascular disease
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33
Q

Low PaO2
A-a gradient increased
PaO2 not correctable w/ O2

A

Shunt (right to left)

  1. Intracardiac shunt
  2. Vascular shunt within lungs
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34
Q

Low PaO2
A-a gradient normal

PaCO2 is increased

A

Hypoventilaition

  1. Decreased respiratory drive
  2. Neuromuscular disease
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35
Q

Low PaO2
A-a gradient normal

PaCo2 is not increased

A

Decreased FiO2 (high altitude)

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36
Q

A-a gradient

A

([Patm - 47] X FiO2 - [ PaCO2/ 0.8]) - PaO2

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37
Q

Acute Respiratory Distress syndrome

  • Timeline
  • Features (7)
  • Lung changes (2)
  • CXR appearance
A

Acute onset 12-48 hrs

Tachpnea
Dyspnea
Tachycardia
Fever
Cyanosis
Labored breathing
High pitched rales

Widening A-a gradient
Decreased lung compliance

*Ground glass

Lungs Cant Handle Toxic Toxins For Days

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38
Q

A 25 y.o man in the ICU is intubated following an acute asthma exacerbation. A repeat ABG is sent after intubation and shows a pH of 7.5, PaCO2 of 33 and HCO3 of 26. What adjustments

A

Uncompensated respiratory alkalosis caused by increased ventilation

To decrease ventilation, tidal volume can be decreased of respiratory rate can be slowed

However, reducing tidal volume can trigger an increase in ventilatory rate, exacerbating the situation

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39
Q

Increases oxygenation

A

Increase FiO2

Increase PEEP

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40
Q

Increases Ventilation

A

Increase Respiratory rate

Increase Tidal volume

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41
Q

Just gave birth

Seizure
Bleeding from IV

A

Amniotic fluid embolism

Hypoxemic respiratory failure

Intubate

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42
Q

1 hr after RBC given for anemia

Respiratory distress
Grunting with retractions

Tachycardia
S3 gallop no friction rub

Diffuse crackles bilaterally

Tx

A

Transfusion associated circulatory overload

Tx: Furosemide

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43
Q

Post surgery

Tachypneic
SOB no chest pain

Lab values

A

Post operative atelectasis

Hypoxemia (low PaO2)
V/P mismatch
Increase in RR which compensates for reduce TV

Hyperventilation —> Decreased PaCo2 and increased pH (respiratory alkalosis)

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44
Q

Worsening productive cough with sputum fever and SOB for a week

Blood streaks

Similar episodes in past

Fatigue
WL

Crackles in upper lung fields

A

Bronchiectasis

CF

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45
Q

Exertional SOB

Light headed

Raynaud phenomenon and finger tip ulcerations

Severe heart burn

A

Pulmonary HTN

CREST syndrome

  • Calcinosis cutis
  • Raynaud phenomenon
  • Esophageal dysmotility
  • Sclerodactylyl
  • Telangiectasia

Pulmonary arterial HTN is common

RV heave
RV enlargement

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46
Q

Lung with pulmonary htn

A

Arterial intimal hyperplasia

Normal FEV1
FEV1/FVC ratio

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47
Q

Seen w/ COPD

A

Air trapping during expiration

Increased FRC (Functional reserve capacity)
Increased TLC

Increased lung distensibility
Increased compliance

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48
Q

Elevated triglycerides

Fusion in lung

A

Chylothorax

Disruption of the thoracic duct

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49
Q

Fever
Leukocytes > 60,000
Right lower lung opacity

A

Empyema

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50
Q

Serum osmolality calculation

A

(2 x serum sodium ) + serum glucose/18) + (serum BUN/ 2.8)=

Low < 275
High > 295

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51
Q

Low Serum osmolaity

Euvolemic

A

Uosm < 100 mOsm/kg

  • Psychogenic polydipsia
  • Beer potomania

Uosm >100 mOsm/kg
UNa> 40
- SIADH

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52
Q

Low serum osmolality

Hypovolemic

A

U Na < 40
- Nonrenal salt loss (vomiting, diarrhea, dehydration)

UNa> 40 mEq/L
- Renal salt loss
(diuretics, primary adrenal insufficiency)

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53
Q

Persistent large air leak with chest tube

A

Perform bronchoscopy

Look for tracheobronchial injury

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54
Q

COPD intubated glucocorticoids and antibiotics given

Respirations improve

45 minutes later, hypoxemia with elevated peak and plateau pressures developed

No wheezing, but breath sounds are decreased on the right.

A

Pneumothorax

*Increased peak and plateau pressure

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55
Q

Asthma worsening

Low pH
Low PaO2
High PaCO2

A

Impending respiratory failure

Elevated PaCo2 suggests inability to meet increased respiratory demands

Tx: Endotracheal intubation

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56
Q

Bilateral hilar adenopathy

Feature (1)

A

Sarcoidosis

Noncaseating granulomatous

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57
Q 
Dyspnea
Syncope on exertion
Fatigue
Lethargy
Chest pain
A

Pulmonary HTN

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58
Q

Pulmonary HTN ausculation

A

Loud palpable S2 (often split)
Flow murmur
S4
Parasternal heave

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59
Q

PE causes what acidosis/ alkalosis?

A

Respiratory alkalosis

Caused by hyperventilation

Decreased PaO2

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60
Q

Southwestern US

A

Coccidioidomycosis

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61
Q

Ohio river valley

A

Histoplasmosis

Blastomycosis

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62
Q

Benign lung nodules (7)

A

< 35 y.o
Nonsmoker

Central
Uniform
Popcorn calcifications

Smooth margins

<2 cm

63
Q

Malignant lung nodules (5)

A

> 45-50 y.o
Smoker

Absent or irregular calcifications

Irregular margins (scalloped, spiculated)

> 2 cm

64
Q

Central lung cancer

A

Small cell

Squamous

65
Q

Peripheral lung cancer

A

Large cell

Adenocarcinoma

66
Q

Adenocarcioma of lung

A

Multiple nodules
Prolific sputum production

Not associated with smoking

67
Q

Central lung neoplasm

Hypercalcemia

A

Squamous cell carcinoma

Keratin pearls

68
Q

Central lung neoplasm

Hyponatremia

A

Small cell

69
Q

Pancoast tumor

A

Shoulder pain

Superior sulcus tumors

at apex of lung

70
Q

Transudate effusion due to (3)

MOA

A

Secondary to increased pulmonary capillary wedge pressure (PCWP) or decreased oncotic pressure

CHF
Cirrhosis
Nephrotic syndrome

71
Q

Exudate effusion due to (9)

A

Secondary to increased pleural vascular permeability

Pneumonia
TB
Malignancy
PE
RA, SLE
Pancreatitis
Trauma
Chylothorax
72
Q

Dull percussion
Increased tactile fremitus

Crackles

A

Lung consolidation

73
Q

Dull percussion
Decreased tactile fremitus

No crackles

A

Pleural effusion

74
Q

Hyperresonant percussion

Decreased tactile fremitus

A

Pneumothorax

75
Q

Transdative effusions

A

pH 7.4-7.55

Pleural protein/serum protein <0.5

Pleural LDH/ serum LDH <0.6

Pleural fluid LDH <2/3 the upper limit of normal serum LDH
< 60 U/L

76
Q

Exudative effusions

A

pH 7.30-7.45

Pleural protein/serum protein >0.5

Pleural LDH/ serum LDH >0.6

Pleural fluid LDH >2/3 the upper limit of normal serum LDH
>60 U/L

77
Q

COPD Tx

A

Inhaled bronchodilators like anti-cholinergic medications
- Ipratropium
- Tiotropium
[Anti-muscarinic]

Short acting beta agonists (albuterol)

78
Q

Central venous catheter removed

Sudden onset of respiratory distress

Place in what position

A

Venous air embolism

Place in left lateral decubitus

or left lateral Trendelenburg (head down) which traps VAE on lateral wall of right ventricle

High flow oxygen

79
Q

Seen with fat embolism (5)

A

Tachypnea
Hypoxemia

Neurological abnormalities

petechial rash

Bilateral scattered ground glass opacities

80
Q

Dyspnea on exertion due to?

Back pain which improves as day goes on

VC 75%
FEV1/FVC 95%
FRC 110% of predicted

A

Ankylosing spondylitis

Chest wall motion restriction

81
Q

Post surgery

Falls

Confused
Slurred speech
Hypotension
Decrased bibasilar lung sounds

Distended neck veins

New RBBB

Pupils dilate

A

Massive pulmonary thromboembolism

  • JVD
  • RBBB
82
Q

Necrotizing fascitis debridement

Several hours later dyspnea and hypoxemia

New bilateral lung infiltrates

A

Acute respiratory distress syndrome

Due to sepsis from necrotizing fasciitis

Leads to diffuse pulmonary edema

No correction w/ O2
Low Lung compiance
High A-a gradient

83
Q

Cavitary lesion on CXR

A

Aspergillus

84
Q

Fever
Productive cough with green sputum

Develops chest pain

Pleural effusion on left side

A

Empyema

85
Q

Nonsmoker

Chronic cough with productive large amounts of purulent sputum

Recurrent

  • Name
  • Seen on imaging (3)
  • Get what imaging
A

Bronchiectasis

Linear atelectasis
Dilated and thickened airways
Irregular peripheral opacities

Get high-resolution CT

86
Q

Linear atelectasis

A

Bronchiectasis

87
Q

Chlorpheniramine

A

H1 antihistamine receptor blocker

Decreases allergic response

Exhibits anti-inflammatory effects by blocking histamine release from mast cells

Reduces nasal secretions

88
Q

pH 7.23
pCO2 69 [33-45]
pO2 57 [75-100]
HCO3 25 [22-28]

A

Acidosis

Is is respiratory of metabolic look at pCO2
- elevated pCO2 is respiratory acidosis due to hypoventilation

89
Q

Lactic acidosis labs

A

pH low

Metabolic acidosis with a decreased HCO3

90
Q

Labs seen with Obstructive sleep apnea

A

Chronic hypoxia
Hypercapnia

Increased bicarb
Decreased chloride reabsorption to main normal pH

91
Q

Alpha 1 antitrypsin deficiency causes destruction in

A

lower lobes

92
Q

Increased dead space

A

Seen patients who take short shallow breaths or when ventilation perfusion mismatch (pulmonary embolism)

93
Q

Mediastinal fullness and scattered reticular opacities in upper lobe

Hypercalcemia

  • Name
  • Lung values (3)
A

Sarcoidosis

Normal FEV1
Decreased TLC
Decreased DLCO

94
Q

Congestion
Rhinorrhea
Harsh cough
Inspiratory stridor

  • Name
  • MOA
A

Croup

Edema and narrowing of proximal trachea

95
Q

Asthma exacerbation and now leukocytosis

A

Common effect of systemic glucocorticoids

96
Q

See with PE

A

Right ventricle dysfunction

97
Q 
pH 7.19
PaO2 110 (high)
PaCo2 70 (high)
HCO3 26 (normal)

Management?

A

Increase respiratory rate

Primary respiratory acidosis (low pH and high PaCo2)

Correction of hypercapnia requires increased ventilation to faciliate removal of excess CO2

98
Q

Continuous cough
Nasal drip

Few weeks after infection

Do what?

A

Oral first generation antihistamine

99
Q

Fever
Pleuritic chest pain
Hypoxemia
Dullness to percussion with bronchial breath sounds in left lung

Why does oxygen saturation change from laying supine to left lateral recumbant

A

Acute pneumonia

*Intrapulmonary shunting

100
Q

All white left lung

Narrowing of rib spaces

A

Atelectasis due to left mainstem bronchial mucus plug

Mediastinal shift

101
Q

COPD

Irregular rhythm

P waves with 3 different morphologies

Atrial Rate > 100

A

Multifocal atrial tachycardia (MAT)

Tx COPD

102
Q

Exudative effusion

A

Low glucose < 60
Low pH < 7.2
High protein

103
Q

Recurrent sinusitis and otitis media

Auditory canal ulceration

Anemia

Hematuria

A

Granulomatosis with polyangiitis

ANCA

C-ANCA

104
Q

Bibasilar crackles

pH 7.46
pO2 73 (low)
pCO2 31 (low)
A

Respiratory alkalosis

Has CHF

105
Q

normal pH
normal Pco2
normal PO2

A

pH 7.35-7.45

PCO2 33-45

PO2 75-105

106
Q

How to adjust ventilation for respiraotry alkalosis

A

Hyperventilation

Decrease respiratory rate

Decrease tidal volume

107
Q

Tracheal narrowing with ulceration

Multiple lung nodules with cavitation

Anemia

A

Granulomatosis with polyangiitis

108
Q

Seen with cystic fibrosis

A

Absence of vas deferens

109
Q

Once stable decrease what on ventilator

A

Fraction of inspired oxygen FiO2

110
Q

Elevated pulmonary artery and right atrial pressure

A

Pulmonary htn which can be due to PE

111
Q

Patchy irregular alveolar infiltrates of the peripheral right middle and lower lobes

A

Pulmonary contusion

112
Q

2 episodes of hemoptysis over a week span

2 yr history of morning cough with white sputum

Smoked for 30 years

A

Chronic bronchitis

113
Q

Myelocytes

Night sweats

A

Chronic myeloid leukemia

Decreased leukocyte alkaline phosphatase score

114
Q

Decompression sickness

A

Vascular air embolism

Mottling and cyanosis of extremities

115
Q

Ventilation what to avoid

A

Alveolar overdistension

Low tidal volume ventilation

116
Q

Pleural/ serum protein > 0.5

or pleural/ serum LDH > 0.6

A

Exudative effusion

Leaky capillaries (secondary to inflammation)

Malignancy
TB
Bacterial or viral infxn
PE with infarct
Pancreatitis
117
Q

Causes of transudative effusion (4)

MOA

A

Intact capillaries and increased hydrostatic pressure

HF
Liver disease
Kidney disease
Protein losing enteropathy

118
Q

Tx acute COPD exacerbation

A 
O2
Beta 2 agonist
- albuterol
Muscarinic antagonist
- ipratropium
Corticosteriods

+- antibiotics

119
Q

See with sarcoidosis (5)

A 
Dyspnea
Bilateral hilar lymphadenopathy
Noncaseating granulomas
Increase ACE
Hypercalcemia
120
Q

Tx SVC syndrome

A

Radiation

Endocascular stenting

121
Q

Acid base disorder in PE

A

Respiratory alkalosis with hypoxia and decreased PaCO2

122
Q

Lung cancer with hypercalcemia

A

SCC

Ectopic PTHrP

123
Q

Lung cancer with SIADH

A

Small cell lung cancer

Ectopic ADH

124
Q

Lung cancer associated with Lambert Eaton syndrome

A

SCLC

125
Q

ARDS (3)

A

Hypoxemia
Pulmonary edema

Normal PCWP

126
Q

Increase risk of what infection with silicosis

A

Mycobacterium tuberculosis

127
Q

Coccidioidmycosis on CXR

A

Unilateral infiltrate with ipsilateral hilar LAD

Spherules with endospores

128
Q

HIstoplasmosis on CXR

A

Hilar lymphadenopathy

Bronchoscopic biopsy reveals granulomas with yeast forms

129
Q

Acute respiratory distress syndrome how to adjust

A. Increase fraction of inspired oxygen
B. Increased positive end expiratory pressure
C. Increased respiratory rate
D. Increased tidal volume
E. Keep current respiratory settings
A

B. Increased positive end expiratory pressure

Oxygen improved by increasing the fraction of inspired oxygen or positive end expiratory pressure

130
Q

New onset CHF effusion

A

Transudative

CHF
Cirrhosis
Nephrotic syndrome
Peritoneal dialysis

Hydrostatic pressure
Hypoalbuminemia

7.4-7.55 pH

131
Q

42 y.o with difficulty breathing and wheezing

Seen otolaryngologist for persistent nasal blockage 2 weeks ago

Take aspirin, diltiazem, atorvastatin and albuterol as needed

Cause of respiratory symptoms?

A. Cell mediated hypersensitivity
B. Cytotoxic antibodies
C. IgE mediated reaction
D. Immune complex disease
E. Pseudoallergic drug rxn
A

E. Pseudoallergic drug reaction

Aspirin exacerbated respiratory disease (AERD)

Not IgE mediated

132
Q

How to improve high altitude sickness

A

Increased urinary excretion of HCO3

  1. Decrease ambient PiO2 —>
  2. Peripheral chemoreceptors sense this —>
  3. Increase minuted ventilation
  4. Increased PaO2
    Decreased PaCo2
    Increased pH
  5. Central chemoreceptors sense increase in pH

Ventilation inhibited and Increase PaO2 limited

  1. Slow renal HCo3 excretion, gradually increase PaO2 ceiling

[If you give acetazolamide —> accelerated HCO3 excretion and decrease in pH —> Rapid increase in PaO2 ceiling]

133
Q

Patient with fever, shakes, chills and sob

Lower lobe consolidation

12 hrs later develops significant SOB and is intubated

Hazy CXR

  • Name

Prior to intubation?
A. Decreased lung compliance
B. Increased left ventricular end diastolic pressure
C. Increased ratio of arterial oxygen tension to fraction of inspired oxygen
D. Normal alveolar arterial oxygen gradient
E. Normal pulmonary arterial pressure

A

Acute respiratory distress syndrome

Lung injury —> release of proteins, inflammatory cytokines and neutrophils into alveolar space

—> Leakage of bloody and proteinaceous fluid in alveoli, alveolar collapse due to loss of surfactant and diffuse alveolar damage

Ventilation perfusion mismatch

Lung compliance is decreased

Pulmonary arterial pressure in increased due to hypoxic vasoconstriction

Partial pressure of arterial oxygen (PaO2) decreases —> increased fraction of inspired oxygen (FiO2) requirement
PaO2/FiO2 is decreased

134
Q

Right lower lobe crackles

A

Pulmonary consolidation = community acquired pneumonia

Get CXR

Azithromycin (outpatient)

Azithromycin + ceftriaxone

135
Q

43 y.o CHF, RA, Chronic hep C and liver cirrhosis has difficulty breathing

Dullness to percussion
Right pleural effusion

Thoracentesis: glucose of 28 and lactate dehydrogenase 252 (45-90)

Why low glucose

A. High amylase content in pleural fluid
B. High WBC content in pleural fluid
C. Increased capillary hydrostatic pressure
D. Increased permeability of the right hemidiaphragm
E. Increased pleural membrane permeability

A

Pneumonia with parapneumonic effusion

Exudative

LDH of 252 is > 2/3 upper limit for serum LDH= Exudative

Low glucose < 60 is usually due to pheumatoid pleurisy or empyema, malignant effusion, tuberculous pleurisy, lupus pleuritis, or esophageal rupture

< 30 suggests empyema or rheumatic effusion

Glucose in empyema is decreased due to high metabolic activity of leukocytes in fluid
* High WBC content in pleural fluid

[A. High amylase= esophageal rupture]

[C. high capillary hydrostatic pressure= transudative effusions]

[D. Increased perm of right hemidiaphragm= effusions in cirrhosis, transudative]

[E. Increase pleural membrane perm due to inflammatory conditions, just established effusion not cause of low glucose]

136
Q

Aspiration pneumonia caused by

A

Impaired cough reflex

137
Q

COPD long term survival

A

Long term supplemental oxygen at home

[Not vaccinations]
[ Not low dose oral corticosteroids]

138
Q

Community acquired Pneumonia Tx

A

Fluoroquinolone
- Moxifloxacin

Or beta lactam plus macrolide
- azithromycin + ceftraixone

139
Q

Hypoxemia in pneumonia caused by

A

V/Q mismatch

Impairment of alveolar ventilaiton —> R to L intrapulmonary shunting

140
Q

COPD

Two types
- DLCO

A

Centriacinar emphysema (low diffusing capacity of lung for carbon monoxide)

Chronic bronchitis (normal DLCO)

[Asthma increased DLCO]

141
Q

Panacinar emphysema

A

Alpha 1 antitrypsin deficiency

142
Q

Recurrent infxn

Lots of sputum

Dilated airways

FVC low

A

Bronchiectasis

143
Q

Feature of interstital lung disease

A

Increased A/a gradient

144
Q

Persistent dry cough following upper respiratory infection

Tx

A

Acute bronchitis

CXR only to rule out pneumonia

NSAIDS and bronchodilator

145
Q

COPD acute exacerbation

A

Oxygen
Inhaled bronchodilators
Systemic glucocorticoids
- Methylprednisolone

146
Q

Digital clubbing

A

Lung malignancies

Cystic fibrosis

147
Q

Obesity on lung

A

Obesity hypoventilation syndrome

Alveolar hypoventilation

148
Q

79 y.o with fatigue, poor appetite and WL. 4 weeks on nonproductive cough and SOB

99.3
148/72

Patient is thin.

There is a dullness to percussion and decreased breath sounds in the right lower and middle chest. A bedside portable ultrasound reveals a right sided pleural effusion.

Thoracentesis removes 1.5 L of yellow pleural fluid

Protein 4.9
Glucose 40
Nucleated cell count 1200
Lymphocytes 90%
Neutrophils 4%
Monocytes 6%
A. Chylothorax
B. CHF
C. Empyema
D. Hypoalbuminemia
E. Pulmonary infarction
F. Tuberculosis
A

F. Tuberculosis

Exudative

Protein> 0.5
Low glucose < 60

Lymphocytic leukocytosis

149
Q

Headaches
Worse when leans forward.

No fever, vomiting or chest pain

Chronic cough

Recently diagnosed with small cell lung cancer

BP 100/60

JVD

What would relieve symptoms

A

Radiation therapy

Superior vena cava syndrome caused by compression of SVC

150
Q

Way to prevent aspiration pneumonia

A

Elevation of head of bed

151
Q

Needle decompression increased what

A. End-expiratory pressure
B. Intravascular volume
C. Left ventricular contractility
D. Systemic vascular resistance
E. Venous return
A

E. Venous return

Increased intrapleural pressure —> tracheal deviation and neck vein distension —> superior vena cava compression

152
Q

Metabolic acidosis

Fever
Hypotension
Tachycardia

Bronchial breath sounds over the right lung base

Elevated glucose

ABG due to

A. Alveolar ventilation/perfusion mismatch
B. Impaired renal bicarbonate reabsorption
C. Increased gastrointestinal chloride loss
D. Increased hepatic fatty acid metabolism
E. Increased tissue metabolic acid production

A

E. Increased tissue metabolic acid production

Fever
Tachycardia
Hypotension
Bronchial breath sounds in right lung base

= septic shock due to pneumnia

Septic shock causes hypermetabolic state, insuffient oxygen delivery to meet metabolic demands of peripheral tissues —> build up lactic acid

153
Q

Left sided pleural effusion

Thoracentesis drains 2 liters of yellowish fluid

Dizziness after procedure and hypotension

Tachycardia

On exam, dullness to percussion and absent breath sounds on left side.

Caused by?

A. Left ventricular outflow obstruction
B. Decreased left ventricular preload
C. Obstruction of pulmonary artery blood flow
D. Increase left ventricular end-diastolic volume
E. Decreased left ventricular afterload

A

Decreased left ventricular preload

Hypotension resulting from decreased left ventricular preload secondary to hemothorax

Left hemothorax occuring as complication of thoracentesis (effusion wouldnt reaccumulate that rapidly)

Bleeding —> intravascular volume depletion —> decreased left ventricular preload

154
Q

Hasten recovery of COPD exacerbation

A. ACE inhibitor
B. Alpha adrenergic antagonist
C. Beta-adrenergic antagonist
D. Glucocorticoids
E. Leukotriene receptor antagonist
F. Loop diuretics
A

D. Glucocorticoids

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