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COMAT - IM > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are some common triggers for ARDS?

A

Sepsis
Infection/Aspiration
Blood transfusions

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2
Q

What is ARDS?

A

Respiratory failure with lung edema and decreased compliance

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3
Q

What are the 3 initial tests to get when lung pathology presents?

A

ABG
CXR
A-a gradient

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4
Q

How will the CXR look with ARDS?

A

Bilateral ground glass appearance

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5
Q

What will the PaO2:FiO2 ratio be with ARDS?

A

< 300

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6
Q

Treatment for ARDS?

A

Intubation and mechanical ventilation

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7
Q

When a patient is intubated and mechanically ventilated, what 2 things need to be remembered?

A
  1. Prone position can help
  2. LOW tidal volume in order to prevent alveolar over distention injury
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8
Q

What defines Pulmonary HTN?

A

Pulmonary arterial pressure > 25mmHg

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9
Q

What defines Cor Pulmonale?

A

Alteration of RV structure/function due to disorder of the lungs

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10
Q

What will be some symptoms of Pulmonary HTN?

A

Dyspnea on exertion
Lethargy
Right CHF signs – edema, JVD, abdominal distention

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11
Q

What will be some symptoms of Pulmonary HTN?

A

Dyspnea on exertion
Lethargy
Right CHF sign – edema, JVD, abdominal distention

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12
Q

What may be heard with auscultation of the heart with pulmonary HTN?

A

Loud split S2
RV heave

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13
Q

What is the best initial test if you suspect Pulmonary HTN?

A

Echo to estimate pulmonary A. pressure and assess RV

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14
Q

What will a CXR show with Pulmonary HTN?

A

Enlargement of central pulmonary arteries with distal tapering

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15
Q

What may an ECG show with Pulmonary HTN?

A

Right ventricular hypertrophy

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16
Q

What is the most accurate test to diagnose pulmonary HTN?

A

Right heart catheterization!

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17
Q

What are 3 medication options for Pulmonary HTN?

A
  1. IV prostanoids
  2. Bosentan (endothelin antagonist)
  3. PDE inhibitors
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18
Q

What occurs with Alpha-1-Antitrypsin deficiency?

A

Proteases like Neutrophil Elastase go unchecked and destroy lung tissue

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19
Q

Alpha-1-Antitrypsin will present with what specific lung pathology?

A

Panacinar emphysema in the lower lobes

20
Q

Alpha-1-Antitrypsin will present with what specific lung pathology?

A

Panacinar emphysema in the lower lobes

21
Q

Patients with Alpha-1-Antitrypsin deficiency will also present with what other things besides COPD?

A

Liver diseases
- Cirrhosis
- HCC

22
Q

On CXR, what word may be used to describe the COPD that is present with Alpha-1-Antitrypsin deficiency?

A

Basilar COPD

23
Q

What physiology causes a Transudative pleural effusion?

A

Increased pulmonary capillary wedge pressure or decreased oncotic pressure

24
Q

What are 3 common things that cause a Transudative pleural effusion?

A

CHF
Cirrhosis
Nephrotic syndrome

25
Q

What is typical of the pH with a Transudative pleural effusion?

A

Alkalotic pH (high)

26
Q

What physiology causes an Exudative pleural effusion?

A

Increased vascular permeability

27
Q

What are some common things to cause an Exudative pleural effusion?

A

Pneumonia
Malignancy
PE
– All other things

28
Q

How will a pleural effusion present?

A

Dyspnea
Pleuritic chest pain
Cough

29
Q

What 2 lab values diagnose an Exudative pleural effusion?

A

Pleural protein:Serum protein > 0.5
Pleural LDH:Serum LDH > 0.6

30
Q

What 2 lab values diagnose an Exudative pleural effusion?

A

Pleural protein:Serum protein > 0.5
Pleural LDH:Serum LDH > 0.6

31
Q

What is present with an Uncomplicated Parapneumonic Effusion?

A

Pneumonia + Pleural effusion
– (-) gram stain with clear/cloudy fluid

32
Q

Treatment for an Uncomplicated Parapneumonic Effusion?

A

Antibiotics
– Pneumonia + Pleural effusion with clear/cloudy fluid and a (-) gram stain

33
Q

What is present with a Complicated Parapneumonic Effusion?

A

Pneumonia + Bacterial invasion into pleural space

34
Q

What will the pH be of the pleural fluid if a Complicated Parapneumonic Effusion is present?

A

pH < 7.2
– Pneumonia + Bacterial invasion into pleural space

35
Q

What is the treatment for a Complicated Parapneumonic Effusion?

A

Antibiotics + Chest tube

36
Q

What is an Empyema?

A

Bacterial colonization of the pleural space that produces pus and purulent fluid

37
Q

Treatment for an Empyema?

A

Antibiotics + chest tube

38
Q

VIRchow’s Triad

A
  • Vascular trauma
  • Increased coagulability
  • Reduced flow (stasis)
39
Q

What is the best initial step if you suspect a PE?

A

Calculate the Well’s Score

40
Q

If the Well’s Score is ______ a PE is unlikely

A

< 4

41
Q

If a PE is unlikely, what test can be helpful to rule it out?

A

D-Dimer

42
Q

If the Well’s Score is > 4, what test should be done?

A

CT with contrast

43
Q

What is the most common finding on EKG with a PE? Rare finding?

A

Common = sinus tachycardia
Rare = S1Q3T3

44
Q

If the probability of a PE is high, what treatment should be done and when?

A

Anticoagulation BEFORE confirmatory testing is done

45
Q

In a patient that is on supplemental O2 who develops rapid neurologic decline, what should be suspected?

A

Hypercapnia from dead space ventilation

COMAT - IM (17 decks)

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