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Pulmonary Exam II Flashcards

1
Q

Pneumonia is the ____th leading cause of death

A

7th

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2
Q

Last part of the upper respiratory tract

A

larynx

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3
Q

Smallest respirable particle

A

less than 10 um

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4
Q

Intrinsic defenses that serve as barriers against inhaled particles or microorganisms

A

surfactant

iron-containing proteins (transferrin, IgG)

complement pathway activation

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5
Q

principle phagocytic cells in the distal air spaces

A

alveolar macrophages

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6
Q

results of cytokind production

A

increases alveolar capillary permeability

decreases lung compliance

increases work of breathing

V/Q mismatch

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7
Q

Infection and proliferation of microorganisms within the alveolar space cause ___, ___, and ___

A

acute inflammatory response

cytokine production

hypoxia

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8
Q

two types of bacterial pneumonia

A

bronchopneumonia and lobar

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9
Q

why may giving oxygen widen V/Q ratios in lobar pneumonia?

A

decreases HPV and activates inflammatory mediators

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10
Q

Types of eartly onset bacterial pneumonia

A

strep, influenza, staph, and e.coli

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11
Q

types of late onset bacterial pneumonia

A

pseudomonas, MRSA

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12
Q

Abx should begin within ____ of presentation to ER with pneumonia

A

4 hours

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13
Q

anti-microbial therapy for patients under 65 y.o for pneumonia

A

oral marcolide or oral doxycycline

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14
Q

which patients have the greatest risk of viral pneunomia?

A

infants and children

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15
Q

most common viruses in adults

A

influenza, adenovirus, and hanta

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16
Q

Diagnosis of viral pneumonia

A

obtain viral cultures or via nasal swabs

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17
Q

Overview of Tuberculosis

A
  • between 1-5 um
  • thrive in high O2 lung zones (zone 1)
  • settle beyond terminal bronchioles
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18
Q

Ghon Complex

A

lesion in the lung caused by tuberculosis that involves a lymph node

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19
Q

Drug treatment for Tuberculosis

A

isoniazid, Rifapentine, and rifampin

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20
Q
A

Tuberculosis

left (cavilary lesion)

right (ghon complex)

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21
Q
A

fungal infection

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22
Q

reflection coefficient of pulmonary capillary endothelium

A

0.5

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23
Q

Stages of Pulmonary Edema

A
  1. Interstitial pulmonary edema
  2. crescentric filing of alveoli
  3. alveolar flooding
  4. froth in air passages
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24
Q

at what stage of pulmonary edema will you have dyspnea at rest?

A

stage II

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25
normal mean pulmonary arterial pressures (mPAP)
12-14 mmHg
26
SVR equation
(MAP - CVP) / CO
27
PVR equation
(PAP - PCWP) / CO
28
Normal PCWP (pulmonary capillary wedege pressure) OR left atrial pressure
6-8 mmHg
29
determinants of mPAP
left atrial pressure, pulmonary blood flow, and PVR
30
normal albumin levels
3.5 - 5.5 g/dL
31
How does albumin affect the oncotic pressure?
increases allows the fluid to not leak into interstital space
32
Interstital pressure equation
(HPinterstital - HPcapillary) - omega(piin - picap) HP - hydrostatic pressure pi - protein osmotic pressure
33
Increased capillary hydrostatic pressure may imply \_\_\_\_
transudate
34
Elevated pulmonary capillary pressure is caused by what 4 things?
* hypervolemia * redistribution of circulating blood volume * T-berg, vasopressors * increased pulmonary vensou pressure * left heart failure, cardiogenic pulmonary edema * increased pulmonary blood flow * left-to-right shunt
35
what may cause pulmonary edema?
increased permeability of alveolar/capillary membrane * stress failiure * inflammation * aspiration * drowning * TRALI * exudate
36
NPE
neurogenic pulmonary edema
37
Neurogenic Pulmonary Edema
acute pulmonary edema following a CNS insult * large surge of catecholamines resulting in ventricular dysfunction * increase in pulmonary venous pressure
38
Etiology of Pulmonary Edema
* neurogenic pulmonary edema * re-expansion pulmonary edema * osmotic pressure * lymphatic obstruction or reduced drainage
39
Treatment for cardiogenic pulmonary edema
* decrease left atrial pressure (Pc) * decrease preload * increase inotropy * volume overload * vasodilators or diuretics
40
Permeability treatment for pulmonary edema
increase plasma albumin
41
NPPE
negative pressure pulmonary edema
42
Type I NPPE
occurs immediately after onset of airway obstruction (hanging, chocking, croup)
43
Type II NPPE
occurs after relief of airway obstruction (removal of tonsils)
44
under what pressures may cause NPPE
-50 to -100 cmH2O
45
Treatment of NPPE
* relieve obstruction * diuretics * artifical ventilation
46
Dyspnea in pulmonary edema
stimulaiton of J receptors minimizes low compliance of lungs hypoxemia
47
where should you see the end of an ETT on chest x-ray?
clavicle
48
Pulmonary Edema
49
acute sigs of PE
increases dead space and right heart failure
50
early signs of pulmonary air embolism
reduction in EtCO2 and decrease in PaO2 an increase in EtN2 is most sensitive
51
late signs of pulmonary air embolism
hypotension, tachycardia, dysrhythmias, and cyanosis
52
most sensitive sign of a PE
increase in EtN2 must have a mass spec
53
anatomical variation with increased risk of PE
patent foramen ovale
54
causes of pulmonary venous HTN
LV failure and mitral insufficiency
55
Drugs for Treatment in PHTN
* phosphodiesterase III inhibitors * B-Type Natriuretic Peptide * PGI2 * prostacyclin * PGE1 * alprostadil
56
Isoproterenol
* non-selective Beta agonist * positive chronotropy and inotropy * pulmonary and systemic vasodilator
57
Dobutamine
* Beta agonist with minimal alpha * positive chronotropy and inotropy * pulmonary and systemic vasodilator
58
Epinephrine
* alpha and beta agonist * pulmonary vasodilator * potent right ventricular inotrope
59
distance between pleural of lung
10-20 um
60
how much fluid is contained within the pleural space?
0.1 - 0.2 mL/kg
61
which pleura is painful when inflammed?
pleuritic no innervation of the visceral pleura
62
physical exam for pleural effusions
diminised breath sounds dullness on percussion pleuritic chest pain
63
left sided effusion
64
Transudate
systemic process * favors fluid accumulation * imbalance between hydrostatic and oncotic pressures * premeability is not changed
65
Exudate
local process * alters permeability * formation of fluid * _high protein content_
66
Light's Critera
determines wheter exudative or transudate * pleural:protein ratio \> 0.5 * pleural:LDH ratio \> 0.6 * pleural LDH \> 2/3 if more than one are present, \>95% sensitivity of the lfuid being exudative
67
causes of exudate
* infectious * bacterial pneumonia, parasitic, viral * autoimmune * lupus, RA * neoplastic malignancies
68
causes of transudate
* heart failure, nephrotic syndrome, dialysis * autoimmune * sarcoidosis * thyroid * myoxedema * ovarian * megis syndrome
69
Myxoedema
swellin gof the skin and underlying tissues giving a waxy appearance * due to an underactive thyroid gland
70
Meigs Syndrome
triad of ascites, pleural effusions, and benign ovarian tumor
71
In "trapped lung" the _____ pleural forms a fibrous peel overlying the tissue
visceral
72
Fibrothorax
visceral pleura is covered by a dense, thick, fibrous layer of connective tissue results in a restrictie lung disease and chronic hypoventilation
73
causes of fibrothorax
* hemothorax * tuberculosus * pancreatitis * uremia
74
Fibrothorax * "pleural peel" surrounding the lungs
75
Chylothorax
chyle leak into the pleural cavity * due to disruption of toracic duct
76
Pleurodesis
procedure where the pleural space is obliterated
77
primary spontaneous pneumothorax
results from rupture of apical subpleural bullae
78
secondary causes of sponatenous pneumothorax
* COPD * pulmonary fibrosis * asthma * CF * pulmonary tissue necrosis
79
gold standard in diagnosing a pneumothorax
chest radiograph
80
small pneumo that will resolve on its own is under ____ cm
2
81
signs of stage II sleep
sleep spindles and K-complexes breathing can be irregular due to fluctuations in respiratory drive
82
Dyssomias
initiating and maintaining sleep that produces excessive sleepiness
83
Parasomias
Rhythmic body movements or rocking that occur exclusively during sleep and are manifestations of nervous system activity
84
Medicopsychiatric Sleep Disorders
disturbed sleep and wakefullness
85
VT decreases _____ during sleep
15-25%
86
VE decreases _____ during sleep
0.5 - 1.5 L/min
87
PaCO2 increases _____ during sleep
2-3 mmHg
88
PaO2 decreass _____ during sleep
3-10 mmHg
89
decrease in MAP in stage I vs stage 3 of sleep
I = 5-9% III = 4-8%
90
change in heart rate during sleep
in NREM, HR decreases 5-8% increases to waking levels during REM sleep
91
Hypopnea
incomplete or absence of airflow resultin gin arousal from sleep
92
central apnea
cessation in oronasal airflow which coincides with the lack of effort detected in muscles of inspriation * due to absence of CNS respiratory drive
93
Apnea-Hypopea Index (AHI)
refers to number of A-H that occurs in 1 hour of sleep * \<5 normal * \> 30 severe
94
desaturation during apnea does not begin until PaO2 falls below _____ mmHg
60 | (90% saturation)
95
carotid and aortic chemoreceptors detect \_\_\_\_\_
low PaO2 high PaCO2 low arterial pH
96
Pickwickian Syndrome
obestiy hypoventilaiton syndrome * everely overweight people fail to breathe rapidly enough or deeply enough, resulting in low blood oxygen levels and high blood carbon dioxide
97
Cheyne-Stokes Respiration
starts off with huge breaths which get more and more shallow until eventually releasing apnea. Catecholamines will then cause a giant increase in breathing, and the cycle repeats.
98
Cheyne-Stokes respiration is often associated with \_\_\_\_\_
severe CHF
99
Kussmaul breathing
fast, deep breaths
100
major site of upper airway obstruction in OSA
pharynx
101
cardinal symptom of OSA
daytime hypersomnia
102
oral appliances are affective if \_\_\_, \_\_\_, and \_\_\_\_
person is not over 125% of normal body weight apnec episodes are not over 30 per hour oxygen saturation is not less than 80%
103
GGA
Genio-Glossus-Advancement opens the upper breathing passageway by tightening the front tongue tendon
104
STOP
snoring tiredness observed apnea high blood pressure
105
2 types of respiratory failure
hypoxic respiratory failure hypercapnic-hypoxic respiratory failure
106
acute hypoxic respiratory failure
severe arterial hypoxemia that cannot be correct by increased FiO2 \> 0.5 * A-a gradient increases * PaO2/FiO2 ratio decreases
107
Acute Respiratory Distress Syndrome
ALI that causes acute and persistent lung inflammation with increased capillary permeability
108
hypercapnia-Hypoxic Respiratory Failure
ventillatory insufficiency resulting from a reduciton in VE, or increased VD, that is associated with a direct reduction in VA
109
PCO2 and PO2 in hypoventilation
80mmHg pCO2 40 mmHg pO2
110
PCO2 and PO2 in hyperventilation
PCO2 20 mmHg PO2 115 mmHg
111
clinical presentation of HHRF
papilledema
112
early complications of O2 therapy in COPD
abolishes HPV response worsening of V/Q ratio increased Vd/Vt
113
when should you start mechanical ventilation
PaO2 \< 70 mmHg on FiO2 \> 0.5 RR \> 30 A-a gradient \> 400 mmHg on FiO2 1.0 VC \< 15 mL/kg
114
two mechanisms of fluid accumulation
cardiogenic or hydrostatic
115
increased HP in the pulmonary capillaries leading to fluid accumulation may be cuased by ____ or \_\_\_\_
LV failure (CHF) or mitral stenosis
116
major cause of non-cardiogenic pulmonary edema
ARDS
117
PCP in cardiogenic pulmonary edema
increased
118
PCP in non-cardiogenic pulmonary edema
normal
119
PC permeability in non-cardiogenic pulmonary edema
increased
120
protein content in cardiogenic pulmonary edema
low
121
protein content in non-cardiogenic pulmonary edema
high
122
most common precipitant for ARDS
sepsis
123
ARDS diffuse, patchy infiltrates
124
3 treatments in ARDS
* treat precipitating disorder * interrupt pathogenic event * support gas exchange
125
mechanical ventilation in ARDS/ALI
6-6 mL/kg Tv limit alveolar pressure to \< 35 cmH2O inverse I:E ratios
126
limit FiO2 to _____ in ALI/ARDS
\< 0.65
127
symptoms of TRALI
* hypoxemia * hypotension * fever * severe bilateral pulmonary edema
128
TRALI is treated the same as ALI without using \_\_\_\_
diuretics
129
Acute Phase of ALI
"exudative" * damaged alveolar membrane * neutrophils * type I epithelial cells are destroyed * interstitial edema * increased permeability
130
Chronic Phase of ALI
chronic/fibroproliferative stage * thickening of endothelium and epithelium * Type II cells replace Type I * extracellular fibrin deposition and remodeling
131

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