Resp III Flashcards
NRDS
low surfactant
-alveolar collapse - ground glass on CXR
L:S ratio less than 1.5
risk of PDA, retinopathy, IV hemorrhage, bronchopulmonary dysplasia
risk fx NRDS
premature
maternal diabetes - fetal insulin increase
C-section - less release of glucocorticoids
tx NRDS
maternal steroid before birth
ARDS
acute onset resp failure
-B/L opacities
causes - shock, sepsis, gastric aspiration, acute pancreatitis
diffuse alveoli damage - protein rich - leak to alveoli
formation of intraalveolar hylaine membrane
tx - mechanical ventilation with low tidal volume
-tx underlying cause
sleep apnea
repeated stop breathing more than 10 sec during sleep
daytime sleepiness
nocturnal hypoxia
-systemic/pulm HTN, arrhythmia, sudden death
see EPO release - erythropoiesis
obstructive sleep apnea
res effort against obstructed airway
with obesity and loud snoring
excess pharyngeal tissue
tx - weight loss, CPAP, surgery
central sleep apnea
no resp effort - CNS injury/toxicity
pulmonary HTN
greater than 25mmHg at rest
get arteriolosclerosis, medial hypertrophy, intimal fibrosis
death - decompensated cor pulmonale
pulmonary arterial HTN
idiopathic
- heritable - BMPR2 - inactivated
- normally inhibit vasc smooth m proliferation
bad prognosis
also with cocaine, amphetamine use, HIV, CT disease, portal HTN, cngenital heart disease
pulmonary HTN with left heart disese
systolic/diastolic dysfxn - and valvular disease
pulmonary HTN due to lung disease or hypoxia
destruction parenchyma - COPD
hypoxemia vasoconstriction
-sleep apnea/living at altitude
chronic thromboembolic PH
recurrent microthrombi
tension pneumo
trachea away from side of lesion
hyperresonant on percussion
atelectasis
bronchial obstruction
tracheal deviation toward side of lesion
transudate
low protein content
increased hydrostatic P and low oncotic P
exudate
high protein content
malignancy, pneumona, collagen vasc disease, trauma
drained - risk infetion
chylothorax
lymphatic pleural effusion
milky appearing - high triglycerides
thoracic duct injury
primary spontaneous pneumothorax
rupture apical bleb or cyst
-tall thin young male
secondary spontaneous pneumothorax
barotrauma
or diseased lung - bulla in emphysema/infection
traumatic pneumothorax
rib fx or penetrating trauma
tension pneumo
when air enter and cannot exit - trachea deviate away from affected side
lobar pneumonia
strep pneumo
legionella
klebsiella
intraalveolar exudate - consolidation to lobe
bronchopneumonia
strep pneumo
staph aureus
h. flu
klebsiella
acute inflammatory infiltrate
- bronchioles to adjacent alveoli
- patch often with more than 1 lobe
interstitial pneumonia
atypical
virus - influenza, CMV, RSV, adenovirus
mycoplasma
legionella
chlamydia
diffuse patchy inflammation - interstitial areas at alveolar walls
diffuse more than 1 lobe
lung abscess
aspiration - loss consciousness, alcoholic, epileptic
air fluid level
anaerobe infection - bacteriode, fusobacterium, peptostreptococcus
or staph aureus
mesothelioma
malignancy of pleura
-asbestosis
pleural thickening
see psammoma bodies
pancoast tumor
superiro sulcus tumor
pancoast syndrome - horners, SVC syndrome, sensorimotor deficit, hoarseness
SVC syndrome
facial plethora - JVD, edema upper extremities
with malignancy - pancoast tumor
or thrombosis from indwelling catheters
HA, dizzy, risk of aneurysm and rupture cranial arteries
lung cancer
leading cause of cancer death
cough, hemoptysis, bronchial obstruction, wheezing, coin lesion, etc.
lung cancer mets
adrenal
brain
bone
liver
lung mets
more common than primary neoplasm
from breast, colon, prostate, baldder
hoarseness
recurrent laryngeal n compression - with lung cancer
oat cell carcinoma
small cell
central location
paraneoplastic
- ACTH - cushing
- SIADH
- Abs - presynaptic Ca - lambert eaton
- amplify myc
tx - cannot operate
- aggressive - mets before diagnosis
- chemotherapy
kulchitsky cell
neuroendocrine neoplasm cells of small cell carcinoma
chromogranin positive
non-small cell cancer of lung
- adenocarcinoma - peripheral
- SCC - central
- large cell - peripheral
- bronchial carcinoid
adenocarcinoma of lung
peripheral
MC lung cancer nonsmokers - except mets
activation KRAS, EGFR, LK
hypertrophic osteoarthropathy - clubbing
CXR - hazy infiltrate
good prognosis
glandular pattern - stains with mucin
bronchioalveolar subtype - thick alveolar walls
SCC of lung
central located
hilar mass from bronchus
cavitation
cigarettes
hyperCa - produce PTHrP
keratin pearls
intercellular bridges
large cell carcinoma of lung
peripheral
anaplastic undifferentiated
poor prognosis
less response to chemo
-remove with surgery
secrete B-hCG
pleomorphic giant cells
bronchial carcinoid tumor
good prognosis
sx - mass effect
secrete serotonin - flushing, diarrhea, wheezing
nests endocrine cells
chromogranin positive
