Pulmonary General Review Flashcards
In the erect position, pleural pressure is most negative in the ____
apex
Where is capillary pressure highest?
bases
What is the eqn for O2 content of blood?
1.34HbSaO2 + 0.003*PaO2
What is the most importantcontributor to oxygen content of blood
Hemoglobin
PND suggest what?
suggestive of LV dysfunction however present in other conditions therefore requires further evaluation
Describe normal vesicular breath sounds?
prominent inspiration, short passive exhalation with no gap between I & E
Describe bronchial breath sounds?
exhalation also prominent; there is a gap between I & E
High-pitched BBS and Egophony are heard in what?
consolidation
Difference between CB and emphysema in PFT
both have low FEV1:FVC but CB has normal DLCO and emphysema has low DLCO
A restrictive like PFT (low FVC but normal FEV1:FVC) with LOW DLCO is suggestive of what?
intrisnic lung disease (IPF, lung resection)
If lung resection, DLCO/Va will be near 100%
Isolated reduced DLCO on PFT suggests what?
‘pulmonary vascular disease pattern’
seen in PAH and PE
What is the rescue DOC for COPD?
ipratropium
What is the rescue DOC for asthma?
albuterol
What is the only modality shown to increase survival other than smoking cessation in COPD?
Continuous oxygen therapy if the patient has hypoxia (SpO2 less than 89%)
T or F. Smoking cessation should be addressed at every visit in COPD
T.
What is the first controller for COPD?
Tiotropium
COPD definition
A common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.
T or F. Airflow obstruction is fully reversible in COPD
T.
How can you try to prevent exercise-induced bronchospasm?
pre-treatment with B-agonist or cromolyn and
slow warm-up helps
How to target eosinophils in asthma?
steroids
How is asthma treated?
-Albuterol for intermittent asthma
-Add ICS, then LABA, then LTRA, then LAMA/
Omalizumab
Why are LABA used before LAMA in asthma?
less prominent vagal tone in asthma (conversely, in COPD vagal tone is increased so LAMA is better)
Repeated Beta agonist usage can lead to tachyphylaxis. How?
by way of down regulation of beta-2 receptors
How long does it take pulmonary hemodynamics to return to original levels following PE?
in 2-8 weeks
How does a PE present on a CXR?
Most common is a normal Chest radiograph
Atelectasis (discoid) may be present
Pleural effusions when present are small
Why might SaO2 be normal with a PE?
Vasodilatation of uninvolved vasculature
helps to decrease the increase in PVR and improves V/Q relationship in uninvolved areas
This improves overall Oxygenation
Lab data for a PE?
low PaO2, PaCo2 and increased A-a gradient
Lights criteria for exudate in pleural effusion
- Fluid protein/serum protein > 0.5
- Fluid LDH/serum LDH > 0.6
- Cholesterol over 50
ANY ONE of them= exudate
What are some characteristics of a benign lesion in the lungs?
- Well defined nodules (singular)
- No associated lymph node or mediastinal masses
- No satellite lesions
- Calcified nodules
What are some types of benign calcifications?
-dense, popcorn, lamellar
What lung cancer is most associated with smoking?
small cell
Staging of small cell?
limited versus extensive
● Limited→ can include the tumor in one radiation port
○ goal of therapy - cure by radiation + chemo (Etoposide + -platin)
● Extensive→ need multiple radiation ports
○ goal of therapy - improve survival, patients live 3 months w/o therapy, 1 year w/ therapy
How are Stage I and II NSCLC treated?
Stage I surgery (if surgery cant happen, XRT is given)
II- surgery then chemo
How is Stage III NSCLC treated?
XRT AND chemo
IIIB- lung tumor is confined to the chest but there is an integral structure involved which means the cancer cannot be removed → not eligible for surgery
How is Stage IV NSCLC treated?
Chemo (targeted if appropriate); palliative XRT
A positive CK-7 (cytokeratin) suggests what?
adenocarcinoma/squamous cell
A positive CK-20 (cytokeratin) suggests what?
colon cancer
A positive TTF-1/Napsin A suggests what?
lung adenocarcinoma
A positive P40/P63 suggests what?
squamous cell center
What paraneoplastic syndrome is associated what adenocarcinoma?
Hypertrophic pulmonary osteoarthropathy (HPO)
/ Clubbing
Painful clubbing, wrists and ankles; new bone formation
What are the goals of ‘goal directed resuscitation’ in sepsis?
Central venous pressure: 8–12 mm Hg
Mean arterial pressure > 65 mm Hg
Urine output > 0.5 mL/kg/hr
Central venous O2 saturation > 70%
What are some patient populations that may be afebrile in sepsis?
Very young/old, CKD, DM, Steroid use , NSAIDs, immunocompromised
T or F. ARDS is associated with intense inflammation
T.
Characteristics of ARDS?
Severe non-cardiogenic pulmonary edema
Severe hypoxemia due to shunting
Acute decrease in lung compliance
What is the purpose of PEEP in ARDS?
improves oxygenation by recruiting atelectatic alveoli and increasing functional residual capacity (FRC)
What is the most common cause of death in ARDS?
multi-organ failure
What things improve survival in ARDS?
Use of lower tidal volume during mechanical ventilation (MV) reduces mortality
Prone ventilation improves survival
Pneumothorax usually seen after the ___ week of ARDS.
2nd week
Proven therapy for PAH?
Epoprostenol and Bosentan
What are the 4 Causes of Increased CO2 retention after Supplemental Oxygen?
Blunting of Hypoxic Drive
Worsening V/Q mismatch
Haldane Effect
Neuromuscular fatigue
Respectability of a tumor depends on what?
not only depends on the stage but also the condition/ability of the patient to undergo surgery
For this reason clinicians evaluate patients by way of “performance status”. If performance status is poor, patients will not be able to tolerate surgery, chemotherapy, or even radiation therapy
