pulmonary UWorld Flashcards
young athlete with episodic dyspnea and noisy breathing during exercise, inspiratory stridor
paradoxical vocal fold motion (vocal cord dysfunction)
in contrast to asthma: expiratory wheezing
young patient with chronic dyspnea on exertion, decreased breath sounds, slight LFT’s elevation, family history of cirrhosis
alpha-1 antitrypsin deficiency – presents like COPD with chronic productive cough, dyspnea, wheezing, recurrent resp infection but can also affect the LIVER
chronic rhino sinusitis with nasal congestion, frontal headaches with nasal polyps, takes over the counter meds
aspirin exacerbated respiratory disease – due to LEUKOTRIENES
pt with wheezing respiratory distress – is given beta-2 agonist albuterol then gets muscle weakness
due to albuterol
during acute asthma exacerbation what would be really concerning indicating pt is getting worse
Normal PaCO2 on ABG, since pt should hyperventilate and thus decrease PaCO2 leading towards respiratory alkalosis
but since they dont can suggest severe air trapping and respiratory collapse
asthma vs COPD
tx for exercise induced bronchoconstriction
asthma management
pt with asthma symptoms, gets better when he goes on vacation
next best step?
peak expiratory flow measurements at home and work
occupational asthma
asthma exacerbation, what should they be discharged with?
course of oral prednisone (to reduce late-phase inflammation, and prevent relapse)
already given SABA (albuterol), SAMA (ipratropium), IV magnesium
AE of inhaled corticosteroids
oral thrush
SABA given and helped symptoms:
leukocyte induced bronchoconstriction (asthma, showing >12% increase in FEV1 or FVC)
TRACHEA DEVIATED to the right, dullness to percussion on the right, breath sounds diminished over right lower lung
atelectasis – mucus plugs
hyperinflation “barrel chest” and flattened diaphragm
what is difficult?
difficulty contracting further to produce force. less capable of generating inspiratory flow
2 years persistent cough, coughs up whitish sputum, pulmonary function shows vital capacity is 65%
why?
COPD with chronic bronchitis (cough with sputum) and emphysema (dyspnea)
airflow limitation increases leading to more air trapping during expiration, total lung volume increases
air trapping*** and airflow obstruction also lead to decrease in vital capacity
**alveolar capillary membrane gets DESTROYED due to excessive lysis
DLCO is normal, CXRAY: prominent thickened bronchovascular markings
chronic bronchitis
long term home oxygen therapy : (2)
Resting arterial oxygen tension PaO2 < 55
or pulse oxygen saturation <88%
acute exacerbation of COPD, dyspnea, sputum volume, sputum purulence: next step
antibiotics: fluoroquinolone
management of COPD exacerbation
1) glucocorticoids (methylprednisone)
2)inhaled bronchodilators
3) antibiotics
4) maintain adequate oxygenation SpO2 88-92%
5) maintain ventilation with NIPPV or invasive mechanical ventilation
COPD: what reduces mortality
smoking cessation
obese patient with dyspnea
alveolar hypoventilation
laryngeal edema
ARDS lung protection and supportive care:
limit alveolar distending volume with tidal volume
avoid a positive fluid balance to reduce pulmonary edema
ARDS: neutrophilic lung inflammation with increased vascular permeability leading to pulmonary edema in the absence of cardiac failure or volume overload
changes in ARDS (3)
- decreased lung compliance d/t loss of surfactant and increased stiffness/wt of edematous lungs
impaired gas exchange leading to hypoxemia d/t VQ mismatch
increased pulmonary arterial pressure d/t hypoxic vasoconstriction and destruction of lung parenchyma
cariogenic pulmonary edema, how does PPV help?
decreases RV preload by raising intrathoracic pressure causing a drop in venous return
increases RV after load by raising intrathoracic pressure compressing alveolar capillaries and raising pulmonary vascular resistance
decreases LV preload
PEEP complications
Pneumothorax, alveolar damage, hypotension
shipbuilding, insulation, pipe work, progressive dyspnea bibasilar end inspiratory crackles
asbestos d/t decreased diffusion capacity of lung with interstitial thickening and pleural plaques ***
subacute cough management
DLCO
fev1
methotrexate lung ae
pneumonia, inflammatory pneumonitis (ground glass), pulmonary fibrosis (reticulation, honeycomb changes)
acute URI leads to persistent dry cough for more than 5 days, no fever or chills, mild wheezing on exam
what is it
what’s next best step?
acute bronchitis
symptomatic tx: NSAIDs and/or *bronchodilators **
lobar pneumonia on R side, when lay on R side worsening SaO2
why?
intrapulmonary shunting – pneumonic consolidations are not ventilated(V) but continue to receive blood flor (Q)
- more profound V/Q mismatch
> 3 mo. symptoms: fever, weight loss fatigue, cough, hemoptysis with CT showing cavitary lesion
dx?
tx?
pulmonary aspergillosis
tx: itraconazole or voriconazole – surgery – bronchial artery embolization if severe hemoptysis
fever, pleuritic chest pain, hemoptysis in pt with transplant
nodules with surrounding ground-glass appearance
dx?
risk factors?
tx?
invasive aspergillosis
neutropenia, glucoroticoids, hiv
voriconzale
recurrent pneumonia in pt with parkisnons or Alzheimers
next best step?
swallow study as likely d/t impaired swallowing mechanisms
nonsmoking pt with chronic production of copious, thick, foul smelling mucus, with streaky hemoptysis, recurrent pulmonary infections
dx?
next best step for dx?
bronchiectasis – recurrent bacterial infections and neutrophilic inflammation leading to bronchial wall damage and permanent airway dilation
dx with High resolution CT to visualize bronchial wall thickening (tram tracking), lack of distal airway tapering, and bronchial dilation
nonsmoking pt with chronic production of copious, thick, foul smelling mucus, with streaky hemoptysis, recurrent pulmonary infections,
growing pseudomonas sputum
dx?
d/t?
bronchiectasis == impaired bacterial clearance (immunodeficiency or structural airway defect)
due to cystic fibrosis *** impaired mucociliary clearance
lots of neutrophil recruitment leads to excessive elastase release leading to airway damage
can also be d/t sjorgens and hypogamaglobinmia
COPD management
inhaled LABA + LAMA
Dullness to percussion with increased breath sounds over the right lower lung field
lobar pneumonia –> lung consolidation
community acquired pneumonia treatment
get an xray
ceftriaxone and azithromycin
exudative fluid causing pleural effusion formation
why?
exudative effusions result d/t inflammatory increase in vascular membrane permeability
parapneumonic effusions are usually uncomplicated d/t displacement of sterile exudate across intact pleural into pleural space
if it was complicated it would involve disruption of pleural membrane and microbial translocation into pleural space
exudative pleural effusion d/t ?
increase capillary permeability
