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resp failure Flashcards

1
Q

what is type 1 resp failure

A

Type 1: Oxygen Problem (Hypoxemic)
• Definition: Low oxygen (PaO₂ < 8 kPa or 60 mmHg) but normal or low CO₂.
• Think: 1 Gas (O₂) is the problem.
• Cause: A problem with oxygenation (e.g., pneumonia, pulmonary edema, ARDS).
• Key Feature: Ventilation is still working, but oxygen cannot get in.

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2
Q

what is type 2 resp failure

A

Type 2: Ventilation Problem (Hypercapnic)
• Definition: High CO₂ (PaCO₂ > 6.5 kPa or 50 mmHg) with or without low O₂.
• Think: 2 Gases (CO₂ and O₂) are involved.
• Cause: A problem with ventilation (e.g., COPD, chest wall deformities ,neuromuscular disorders).
• Key Feature: Lungs cannot remove CO₂ effectively.

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3
Q

what are signs of resp failure

A

use of accessory muscles
tachypnea
sweating
signs of Co2 retention (asterixis, bounding pulse

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4
Q

what is used as a guide in deterioratiom in acute neuromuscular problems

A

FVC
RR and TV are insensitibe indicators of RF

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5
Q

what will ABG show in type 1 and type 2 RF

A

type 1: resp alkolosis
type 2: resp acidosis

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6
Q

what is acute respiratory distress syndrome

A

type of resp failure characterized by rapid onset of spread of inflammation in the lungs

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7
Q

what would show in chest x ray of ARDS

A

new bilateral diffuse patchy or homogenous pulmonary infiltrates
stiff lungs no comliance more dead space

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8
Q

what are causes ARDS

A

direct lung injury: pneumonia, gastric aspiration, inhalation injury
secondary to severe systemic illness: shock,sepsis,hemorrhage

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9
Q

what can cause death in ARDS

A

multiorgan failure
hemodynamic instability

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10
Q

what is a diagnostic criteria of ARDS

A

4 must exist:
1)Timing: acute onset, symptoms occur within 1 wk
2)bilateral infiltrates
3)pulmonary capillary wedge pressure < 18 or lack of clinical congestive heart failure
4) refractory hypoxemia with Pao2 : fio2 <200 (berlin definition )

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11
Q

management of ARDS

A

admit to icu
sepsis: identify organism
early prone positioning
limit pulmonary edema
resp support: mechanical ventilation

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12
Q

what are symptoms of ILD

A

exertional dysnea
nonproductive cough

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13
Q

what does examination in ILD pt show

A

fine crackles
pulmonary htn
clubbing

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14
Q

chest x ray in ILD would show what pattern

A

reticular or reticulonodulary pattern (ground glass appearance )

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15
Q

pft in ILD would show what

A

restrictive pattern

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16
Q

upper lobe fibrosis distribution of ILD include

A

sarcoidosis
hypersensitiving pnemonitis
silicosis
radiation
ankylosing spondilitis

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17
Q

lower lobe fibrosis iclude

A

idiopathic pulmonary fibrosis
asbestosis

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18
Q

idiopathic pulmonary fibrosis features

A

men in late 60s
no known cause
progressive breathlessness
non- productive cough

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19
Q

on examination of pulmonary fibrosis

A

clubbing in 50%
fine end inspiratory basal crackles

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20
Q

tx of IPF

A

disease is life limiting shoud consider transplanation , survival without transplant is 5 yrs
pirfenidone : anti fibrotic agent slow rate of decline
nintedanib: TK inhibitor that blocks fibrogenic growth factor
treat GERD if present

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21
Q

what causes formation of non- caseating granulomas in multiple organs , most common lungs and LN

A

sarcoidosis

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22
Q

diagnosis of sarcoidosis in chest x ray and lab test

A

xray: bilateral hilar lymphadenopathy
lab test: elevated serum ACE , hypercalcemia , elevated inflam markers

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23
Q

what are other organs affected in sarcoidosis

A

eyes: ant and post uveitis
skin: erythema nodusm , maculopapular lesions, lupus, alopecia
lofgren syndrome: erythema nodusm , arthritis , hilar adenopathy
Heerfordt syndrome: fever, parotid enlargement, uveitis, facial palsy

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24
Q

tx of sarcoidosis

A

first line: CORTICOSTEROIDS
if pt needs long term tx –> steroid sparing agents ( methotrexate, azathioprine, cyclophosphamide)

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25
whar are symptoms of hypersensitivity pneumonitis
hours after exposure --> fever, malaise, SOB, cough, tachypnea, course inspiratory crackles
26
hypersensitivity pneumonitis also called what and why
extrinsic allergic alveolitis : immune mediated ILD caused by repeated inhalation of environmental antigeens . these antigens trigger an inflam response affecting alveoli and small airways
27
causes of HP
farmers lung: moldy hay bird fanciers lung : bird droppings or feathers fungi
28
investigation in HP
igG antibodies against antigen are evidence of exposure labs show neutrophilia and eosinophilia xray: fluffy nodular shadowing esp in upper zones tx: corticosteroids
29
what is prolonged inhalation of asbestosis leading to pulmonary fibrosis presents 15-20 yrs after initial exposure
asbestosis
30
what is a typical CXR of asbestosis pt
pleural thickening and diaphragmatic thickening
31
what is silicosis
caused by inhalation of silica dust similar to asbestosis but may have an acute form caused by massive exposure that causes lung failure in months
32
starts as simple coal workers pneumonioconiosis with small pulmonary nodules then what
small coal particles reach acinus --> initiate inflam reaction and fibrosis. continued exposure --> progressive massive fibrosis with large fibrotic masses
33
symptoms of coal workers pneumoconiosis
breathlessness cough productive black sputum resp failure
34
metastases of the lungs are commom from what organs mostly
kidney , prostate, breats , bone, gi , cervix , ovary
35
risk factors of lung cancer
tobacco smoking radon asbestos exposure
36
symptoms of lung cancer
cough hemoptysis dysnea wheezing pneumonia chest pain weigh loss hoarseness (reccurent laryngeal nerve involvement)
37
what can lung cancer present with a syndrome
SVC syndrome compressing it its the main vein for upper body so causes facial swelling
38
what type of lung cancer is highly associated with cigarette smoking and paraneoplastic syndrome
small cell lung cancer
39
paraneoplastic syndrome in small cell lung cancer produces what
ACTH (cushing syndrome) , SIADH, Lambert eaton myasthenic syndrome , amplification of myc gene
40
what is in histology of SCLC
neoplasm of neuroendocrine kulchitsky cells chomogranin A+
41
SCLC location
central
42
what are types of NSCLC
adenocarcinoma, squamous cell, large cell , bronchial carcinoid tumor
43
what type of lung cancer most common in non smokers includes bronchoalveolar carcinoma
adenocarcinoma
44
what mutations are in adenocarcinoma
KRAs , EDFR, ALK
45
what do u see o/e and on xray of adenocarcinoma
clubbing hazy infiltrates on cxr
46
on histology of adenocarcinoma and location
glamdular pattern stain mucin + thickening of alveolar walls located peripheraly
47
what is located centraly hilar mass , cavitation, cigarrete, hypercalcemia, produces PTH
squamous cell carcinoma
48
what does squamous cell carcinoma show on histology
keratin pearl intracellular bridges
49
what is anaplastic, undifferentiated tumor , poor prognosis
large cell carcinoma
50
what can large cell carcinoma secrete
can secrete B-HCG pleomorphic giant cells
51
in bronchial carcinoid tumor what are symptoms due to
mass effect and carcinoid syndrome (5HT secretion) ---> flushing, diarrhea , wheezing
52
what is shown in histology of bronchial carcinoid tumor
nests of neuroendocrine cells chomogranin A+
53
what are indications to use oxygen therapy
hypoxia acute hypotension breathing inadequacy trauma acute illness CO poisoning severe anemia
54
what are mechanisms of hypoxemia
v/q mismatch high altitude right to left shunt impaired diffusion alveolar hypoventilation
55
nasal cannula
simplest way pf o2 delivery v convenient to pt used for minor resp distress
56
venturi mask
simple face mask w a valve / adapter w a certain diameter that controls the flow gives a controlled way of o2 delivery
57
when is it best touse a venturi mask
useful for delivering low conc of o2 in copd pts who depend on hypoxic drive and should only be given a controlled amount of o2
58
non breather mask used for who
acutely ill and not responding to other methods
59
high flow NC
huge flow of o2 w v gd humidfy for those w persistent hypoxemic H heated and humidified I inspiratory demands better met F high functional residual capacity by delivery of PEEP L lighter and easily tolerable than non invasive O o2 dilution minimized W washout of dead space
60
indications of PFT
45 yr or older smoker or ex smoker prolonged or excess cough or sputum production hx of lung irritation

resp (4 decks)

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