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CR&R > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

What are the two different blood supplies of the lungs? Which provides blood supply for respiration and which provides supply for ventilation?

A
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2
Q

What is the difference in location of the pulmonary arteries in the hilum of both the R and L lung? What acronym is used to remember?

A

RALS
Right Anterior (to R primary bronchus)
Left Superior (to L primary bronchus)

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3
Q
A
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4
Q
A

Vd is dead space

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5
Q

What is the difference between anatomical and physiological dead space?

A

Anatomical dead space cannot participate in gas exchange by design.

Physiological dead space COULD participate in gas exchange, but often doesn’t

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6
Q

How much anatomical dead space does the average adult have?

A

150mL

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7
Q

What airway passages are considered anatomic dead space?

A
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8
Q

What is CaO2 in blood chemistry?

A

It is the arterial blood oxygen content

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9
Q

What is the equation for CaO2?

A
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10
Q

What is SaO2? How is it measured?

A

SaO2 is hemoblogin saturation

It is measured with pulse ox

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11
Q

What is considered the normal CaO2 level for a person (value, not range)?

A

20.1ml O2/dL of blood

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12
Q

What are the three methods by which CO2 can be transported in the blood?

A

1) Dissolved in plasma as a bicarbonate ion (80%)
2) Bound to hemoglobin (14%)
3) Dissolved in plasma as CO2 (6%)

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13
Q

Where in the systemic circulation is chloride content in RBCs the highest?

A

The right atrium

*Cl- ions diffuse into RBCs to balance the H+ generated from bicarbonate formation from carbonic acid

**Cl- will be highest in RA because that blood has maximal amounts of CO2 and has formed maximal amounts of HCO3-

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14
Q

How does the Bohr effect explain how increased pCO2 allows for increased delivery of oxygen to tissues?

A

Increases in pCO2 will cause an increase in bicarbonate formation which generates a proton as a byproduct

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15
Q

What is carbaminohemoglobin? What situations encourage more carbaminohemoglobin formation?

A

Carbon dioxide bound directly to the amino groups on hemoglobin

Deoxygenated hemoglobin has a higher affinity for CO2, so it will form more often at lower O2 saturation

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16
Q

How does the Haldane effect describe the increased removal of CO2 in an environment of increased pO2?

A

*The formation of which CO2 is able to be removed in the lungs

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17
Q

What are the five notable causes of hypoxemia?

A

Hypoventilation
Low FiO2
V/Q mismatch
Shunt
Diffusion impairment

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18
Q

Which of the 5 causes of hypoxemia will not respond to supplemental O2?

A

Shunts

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19
Q

Explain the following evaluation chart going over each box.

A

Good job!

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20
Q

What are the ABC’s (A-I) of reading a CXR?

A
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21
Q

What structure is indicated by the arrows? What type of interstitial lung disease is this commonly found in?

A

Fibroblastic foci

Idiopathic/Familial pulmonary fibrosis

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22
Q

What structure is indicated by the arrows? What disease process is it indicative of?

A

Asbestos body

Pneumoconiosis, specifically asbestosis

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23
Q

What types of interstial lung disease are likely to present with UIP (usual interstitial pneumonia) pattern?

A

1) Idiopathic pulmonary fibrosis
2) Familial pulmonary fibrosis
3) ILD associated with CTD (connective tissue disease)

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24
Q

Which ILD are associated with non-specific interstitial pneumonia (NSIP)? How can NSIP be differentiated from UIP?

A

ILD associated with CTD such as rheumatoid arthritis and scleroderma (both can also present with UIP)

NSP presents without fibroblastic foci

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25
Q

What are the two defining features of cryptogenic organizing pneumonia?

A

1) Cryptogenic meaning of no known cause
2) Plugging of the alveolar duct with loose fibroconnective tissue (varying degrees of plugging)

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26
Q

What is the main characterization of sarcoidosis? What findings would be indicative of sarcoidosis on BAL?

A

Non-necrotizing granulomatous deposition into tissues (commonly interstitial and hilar)

Increased CD4:CD8 ratio would be supportive of sarcoidosis

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27
Q

What findings are indicated by the arrows? What describes their most common location? What pathology is likely?

A

Granulomas

Distribution along brochovascular bundles and interlobular septa

Sarcoidosis

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28
Q

What describes the findings indicated by the arrows? What are they composed of? What pathology is most likely?

A

Granulomas

Composed of histiocytes and giant cells (typically well-formed)

Sarcoidosis

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29
Q

What is the treatment for sarcoidosis?

A

Many patients do not require treatment if asymptomatic

If critical organ dysfunction or severe constitutional symptoms (i.e. fatigue, hypercalcemia) can treat with corticosteroids

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30
Q

What finding is indicated by the black arrow? Is this finding indicative of sarcoidosis?

A

An ill-defined granuloma composed of giant cells and histiocytes and surrounded by lymphocytes

This is indicatie of hypersensitivity pneumonitis and can be contrasted with the well-differentiated granulomas seen in sarcoidosis

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31
Q

What are three notable history findings and one hallmark PE finding in ILD?

A

Hx
-Dyspnea (usually on exertion, at rest in severe)
-Very slow progression (months)
-Little/no sputum
PE
-High-pitched end-inspiratory crackles (rales) at lung bases

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32
Q

What are the four main injury patterns for ILD?

A

1) Usual interstitial pneumonia (UIP)
2) Nonspecific interstitial pneumonia (NSIP)
3) Organizing pneumonia (OP)
4) Granulomas

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33
Q

What are three notable histopathological features of UIP in ILD?

A
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34
Q

What are three notable histopathological features of NSIP in ILD?

A
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35
Q

What is the notable histopathological feature of OP in ILD?

A
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36
Q

What are three notable histopathological features of granulomas in ILD?

A
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37
Q

What histopathologic features are shown here? What class of ILD histology is it?

A
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38
Q

What histopathologic features are shown here? What class of ILD histology is it?

A
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39
Q

What histopathologic features are shown here? What class of ILD histology is it?

A
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40
Q

What histopathologic features are shown here? What class of ILD histology is it?

A
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41
Q

What are the differences between a collagenized nodule and a granuloma?

A
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42
Q

What are three notable histology findings in hypersensitivity pneumonitis?

A
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43
Q

What is on the differential for causes of UIP in ILD?

A
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44
Q

What is on the differential for causes of NSIP in ILD?

A
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45
Q

What is on the differential for causes of OP in ILD?

A
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46
Q

What is on the differential for causes of granulomas in ILD?

A
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47
Q

Which volume and two capacities can not be determined by spirometry?

A

1) RV
2) FRC
3) TLC

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48
Q

From left to right, which flow volume loops are normal, restrictive, and obstructive?

A
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49
Q

What Flow-volume pattern is displayed here? What is the pathology that is occuring?

A

Variable Intrathoracic Obstruction

50
Q

What Flow-volume pattern is displayed here? What is the pathology that is occuring?

A

Variable Extrathoracic Obstruction

51
Q

What Flow-volume pattern is displayed here? What is the pathology that is occuring?

A

Fixed Airway Obstruction

52
Q

What are the ranges of FEV1 Z- scores for mild, moderate, and severe respiratory obstruction?

A
53
Q

What is a bronchodilator test?

A

A patient presenting with obstruction is adminstered a bronchidilator preceding spirometry in order to measure if there is improvement

54
Q

What is the criteria that a bronchodilator test must meet to demonstrate reversible airflow obstruction?

A
55
Q

At what point during a methacholine test is the test terminated and conisdered postitive for airway hyper-reactivity?

A
56
Q

Does a normal FEV1/FVC with reduced FVC garauntee restrictive disease of the lungs?

A
57
Q

What should be done if a reduced FVC is found on spirometry in order to evaluate for restrictive diseases?

A

Evaluate TLC with plethysmography (gas dilution is sometimes used)

58
Q

What are four causes of low DLCO?

A
59
Q

Why does emphysema cause a reduced DLCO?

A
60
Q

Explain the changes from normal seen in chronic bronchitis using this diagram:

A

Good job!

61
Q

What are the expected results in DLCO for asthma, emphysema, chronic bronchitis and bronchiectasis?

A

Normal: Asthma, Chronic bronchitis, Bronchiectasis

Reduced: Emphysema

62
Q

How is a diagnosis of pneumonia made in CR&R?

A

Clinical history + radiographic opacity

63
Q

Can pneumonia by diagnosed by H&P findings alone?

A
64
Q

What are the five criteria in the CURB-65 (used to decide on admission to ER/hospital)?

A
65
Q

What CURB-65 scores are used to determine where a patient should be treated (Outpatient, inpatient, ICU)? Where are CURB-65 scores mostly used?

A

They are mostly used in the ER

66
Q

What treatments are appropriate for uncomplicated CAP? What treatments could be used for complicated CAP?

A
67
Q

What is the most common pathogen causing CAP for patients being admitted to inpatient care?

A

Staphylococcus aureus/gram-negative bacilli

68
Q

How should Non-ICU inpatient pneumonia be treated? How should atypical pneumonia be treated?

A
69
Q

How should ICU pneumonia be treated?

A
70
Q

Compare transudative vs. exudative pleural effusion as well as common causes of each:

A
71
Q

Will a transudative or exudative effusion present with pleural liquid high in LDH and protein?

A

Exudative pleural effusion

72
Q

What are the two functions of thoracentesis in management of a pleural effusion?

A
73
Q

What does Light’s criteria evaluate? What are the criteria?

A
74
Q

When is chest tube drainage used in pleural effusion treatment?

A
75
Q

What would be the expected pressure at FRC of the following in a pneumothorax: Alveoli, Intrapulmonary pressure, TPP

A

All would be 0 due to lung collapse

76
Q

What four treatments can be implemented for pneumothorax?

A
77
Q

Are these gross findings more consistant with centriacinar or panacinar emphysema?

A

Centrilobular (centriacinar) emphysema

*Note the large holes in the upper lung and interspersed areas of normal lung

78
Q

Are these gross findings more consistant with centriacinar or panacinar emphysema?

A

Panacinar emphysema

*Note the diffuse distribution

79
Q

What criteria are used to evlauate COPD after spirometry? What are the four grades?

A

The Gold criteria

80
Q

What is the model for treatment (Groups A-D) for patients with stable COPD?

A

*mMRC scale of 2+ indicates dyspnea with even mild exertion (more severe)

81
Q

What are 5 notable features of Potter sequence?

A
82
Q

What is an Extralobuar sequestration (pulmonary)?

A
83
Q

What is the embryological origin of a pulmonry extralobar sequestration? By what age is it usually identified? What are 3 symptoms seen in an affected infant?

A
84
Q

What pathology is shown here?

A
85
Q

What is an intralobar sequestration (pulmonary)?

A
86
Q

What is the etiolgoy of an intralobar sequestration? In what patient population is it seen (rarely)? What are 3 notable symptoms?

A

*Rarely seen before 5 years, often diagnosed before 20yo

87
Q

What is indicated by a score of 25 on the ACT (asthma control test)? Of less than 19? Less than 15?

A
88
Q

What are the three classes of RF for VTE?

A
89
Q

What is the usefulness of D-dimer testing for suspected PE/DVT?

A
90
Q

What are four other sources of emboli besides DVT?

A
91
Q

What acid-base disturbance is expected with a PE?

A

Respiratory alkalosis

Hypoxemia -> respiratory drive -> Increased breathing removes too much CO2

92
Q

What are the five classes of the Pulmonary Embolism Severity Index (PESI)? What is the relative risk of mortality associated with each class?

A
93
Q

For which PESI risk classes should outpatient treatment be considered?

A
94
Q

Of intermediate to high-risk PE cases, what is used to differentiate admission to the MICU vs. the medical floor?

A
95
Q

What is Ohm’s law in the pulmonary vasculate?

A
96
Q

What are normal values for the following:
mPAP
PCWP
CO
PVR

A
97
Q

What does pulmonary capillary wedge pressure (PCWP) estimate?

A

Left ventricular end-diastolic pressure (LVEDP)

98
Q

What are the five WHO classifications for pulmonary hypertension?

A
99
Q

What value of mPAP defines pulmonary hypertension? What is the difference in PCWP and PVR in pre vs. post capillary pulmonary hypertension?

A

BONUS: Using the diagram, explain why PCWP and PVR values are altered in pre vs. post capillary PH

100
Q

What is the gold standard for diagnosing pulmonary hypertension?

A

Right heart catheterization (RHC)

101
Q

What is the most common cause of pulmonary hypertension?

A

Left heart disease

102
Q

How does lung disease cause pre-capillary hemodynamics in pulmonary hypertension?

A

Hypoxemic pulmonary vasoconstriction

103
Q

What EKG findings would be expected in pulmonary hypertension?

A

Right atrial enlargement
Mediastinal fullness

104
Q

What is the difference between pulmonary hypertension and pulmonary arterial hypertension (PAH)?

A

PAH is a subtype of pulmonary hypertension involving narrowing of the pulmonary arteries (excludes capillaries and veins)

105
Q

Recall the following information in the chart:

A
106
Q

Which WHO pulmonary hypertension group is notable for a post-capillary cause of PH?

A

Left-heart disease

107
Q

Which WHO pulmonary hypertension group is notable for a pre, post or combined capillary etiology for PH?

A

Group 5; multisystem or unknown

108
Q

Which WHO pulmonary hypertension group is notable for a normal PVR?

A

Left heart disease

109
Q

What treatments are appropriate for each WHO pulmonary hypertension group?

A
110
Q

How is fluid obtained through thoracentesis evaluated for the liklihood of a transudative or exudative effusion? What are the three criteria?

A
111
Q

What are the four main types of pneumoconiosis?

A

Coal
Silica
Asbestos
Beryllium

112
Q

The finding in this biopsy is most consistent with what type of pneumoconiosis? Why?

A

Silicosis

*The silicotic nodule is composed mostly of bundles of interlacing pink collagen

113
Q

What type of pneumoconiosis is indicated here? What findings are consistant with this?

A
114
Q

What cell type is instrumental in the fibrogenic response of silicosis?

A

Macrophages

115
Q

Can silicosis and coal worker’s pneumoconiosis (CWP) coexist?

A

Yes, called mixed-dust pneumoconiosis

116
Q

What type of pneumoconiosis is indicated here? What findings are significant?

A

Coal worker’s pneumoconiosis (CWP)

*The coal macule is visible in the interstitium, note they is more common in the upper lung zones

117
Q

What are the findings seen here on the left (A) and right (B)? What type of pneumoconiosis do they suggest?

A

A: Coal macule
B: Coal nodule

CWP

118
Q

What histological pattern is associated with berylliosis?

A

Sarcoid (up to 6% of sarcoid dx may actually be berylliosis)

119
Q

In what three trades is beryllium used signifcantly?

A

-Nuclear weapons manufacturing
-Aerospace industry
-Metal machining, scrap reclaimation

120
Q

What is the most common CFTR mutation? What is one other notable mutation?

A
121
Q

What type of CFTR modulators are used to treat Class II mutations? Which are used for class III-IV mutations? Name two drug examples of each type

A
122
Q
A

CR&R (8 decks)

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