Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 2 UWORLD > Respiratory > Flashcards

Respiratory Flashcards

1
Q

How much do you expect pH to decrease with increase in CO2?

A

decrease 0.08 for every 10 mmHg CO2 rise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Infectious insult + Impaired bacterial clearance = dyspnea, hemoptysis, daily mucopurulent sputum, crackles, wheezing

A

Bronchiectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Etiologies of bronchiectasis

A
  • cancer (airway obstruction)
  • autoimmune (RA, Sjogrens)
  • Aspergillosis, TB
  • Hypogammaglobulinemia
  • CF, a1at def (congenital)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

most common causes of digital clubbing

A
  • Cystic Fibrosis
  • Lung Malignancies
  • R to L cardiac shunts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

most common adverse effect of inhaled steroids

A

oral thrush

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Triad in obesity hypoventilation syndrome

A
  • obesity
  • hypercapnia (daytime)
  • alveolar hypoventilation (hypoxmia/resp acidosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

causes of transudate pleural effusions

A

CHF
Cirrhosis
Nephrotic Syndrome
Peritoneal dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

causes of exudative effusions

A

Infections
Malignancy
Pulmonary Embolism

Connective tissue dz
Inflammatory dz
Fluid from abdomen
CABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Light’s criteria for exudative effusions

A

Having at least 1 of the following

Pleural fluid/serum ratio’s:

  • -Protein >.5
  • -LDH>.6
  • -Pleural Fluid LDH > 2/3 of upper limit normal serum LDH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

most common cause of pleural effusion

A

CHF (and thus transudative)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

pt has severe asthma exacerbation with impending resp distress. why is a normal/elevated CO2 a poor sign?

A

asthma exac causes hyperventilation/increased resp drive = decreased CO2. if elevated/normal, shows respiratory muscle fatigue –> inability to meet respiratory demands.

–>these patients require intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

whats the difference between enoxaparin, rivaroxaban, and fondaparinux?

A 
Enoxaparin = LMWH
Rivaroxaban = Oral Factor X inhibitor
Fondaparinux = Injection Factor X inhibitor

None of these can be used in patients with poor renal f(x), use unfractionated heparin instead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why do you need a heparin bridge before warfarin?

A

Warfarin inhibits Protein C and S, which are anti-thrombogenic..= state of thrombosis (heparin is anti-thrombin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Criteria for ARDS (4)

A
  1. Acute onset (<1 week)
  2. Bilateral infiltrates on chest imaging
  3. Pulm edema not explained by fluid overload or CHF (i.e. PCWP <18) –>NONCARDIOGENIC PULM EDEMA
  4. Abnormal PaO2/FiO2 ratios (<300)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pathophys behind ARDS

A

Massive Intrapulmonary shunting of blood, secondary to atelectasis, alveolar collapse and surfactant dysf(x)

–> Increase in lung fluid = stiff lungs, A-a gradient, ineffective gas exchange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Severe hypoxemia that does not improve on 100% oxygen

A

ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

an increase in ____________ causes ARDS, vs _____ causes cardiogenic pulmonary edema

A

Alveolar capillary permeability (ARDS)

Congestive Hydrostatic Forces (CHF/HF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

T/F: ARDS will have increase in lung fluid and signs of JVD, edema, hepatomegaly

A

False. ARDS will have increase in lung fluid without any of those cardiogenic signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Patients with _____ have the highest risk of developing ARDS

A

sepsis/septic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

T/F: Pulmonary vasodilators (nitroprusside) help improve tissue oxygenation

A

False…they should be removed in states of hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Does ARDS have respiratory alkalosis or acidosis?

A

Initially have Alkalosis (PaCO2 <40), which switches to acidosis as the work of breathing increases and thus PaCO2 rises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the most useful parameter in distinguishing ARDS from cardiogenic pulmonary edema?

A

PCWP…this refelcts Left heart filling pressures and indirect marker of intravascular V status….<18 points to ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

MAP> ____ (at rest) = Pulm HTN

A

25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

clinical signs of pulmonary htn

A
  • Loud P2 (pulmonic component of S2)
  • Subtle lift of sternum (RV dilatation)
  • if RV failure occurs, will show JVD/hepatomeg/edema etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how will EKG/Echo help assist in dx of Pulm HTN?

A

Pulm HTN can lead to RV failure…
-EKG will show RV hypertrophy (Right axis deviation/right atrial abnormality)

-ECHO = dilated pulm artery, dilatation of RA and RV, abnormal movement of ventricular septum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

which vasoactive agents can be used in tx of PAH (after R heart cath and trial of vasodilators tried first)

A

They lower pulm vascular resistance

  • PDE inibitors (sildenafil)
  • CCB
  • Prostacyclins (Epoprostenol)
  • Endothelin receptor antagonists (bosentan)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is cor pulmonale usually secondary to?

A

COPD!
Defined as RV hypertrophy/failure from pulm htn secondary to pulm disease

PE/Asthma/CF/OSA/ILD also can cause it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Clinical features of cor pulmonale

A
  • decrease exercise tolerance
  • Cyanosis and digital clubbing
  • RV failure (JVD, edema, hepatomegaly)
  • Parasternal lift (RV dilatation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

why is there tachypnea in PE ?

A

PE causes dead space in areas of the lung because there is ventilation but no perfusion (dec blood flow)
–> causes Hypercarbia and Hypoxemia, which drive respiratory effort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

T/F: Most often, PE is clinically silent

A

True

–>Recurrences are common, leading to chronic pulm HTN and cor pulmonale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What causes most PE-related deaths?

A

Recurrent PE within first few hours of inital PE…tx with anticoagulatns decreases mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Signs of PE

A

-Tachypnea, Rales, Tachycardia, S4, Increased P2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

PaO2 and PaCO2 levels in PE?

A

Both are low…PaCO2 is low due to hyperventilation (because dec perfusion= hypoxemia and hypercarbia = stimulation to respiratory drive)

=Resp ALKalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Initial study of choice for PE

A

CTa (spiral ct)…only contraindicated if renal dz, for whom V/Q scan works well

Pulmonary angiography = gold standard, but is invasive (rarely performed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

PE clinically likely, do a ______study

PE clinically unlikely, do a ______ study

A

likely: Spiral CT. if inconclusive, LE ultrasound
Unlikely: D-Dimer. If abnormal, Spiral CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what should you consider as long term prevention in a patient who had PE but has CI to anticoagulation

A

IVC filter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Tx for PE

A
  1. Heparin drip: start as soon as their is any clinical suspicion (prevent recurrent PE)
  2. Oxygen
  3. Consider thrombolytic therapy (not always given tho)
  4. Consider IVC filter if anticoag CI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

where is aspiration most likely to go?

A

lower portion RUL

upper portion of RLL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

most common causes of acute dyspnea

A 
CHF exacerbation
pneumonia
bronchospasm
PE
anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

causes of high DLCO

A
  • Asthma (increases pulm capillary blood V)
  • Obesity
  • Intracardiac L-R shunt
  • Exercise
  • Pulmonary hemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

causes of low DLCO

A
  • Emphysema
  • Sarocoidosis
  • Fibrosis
  • Pulmonary vascular dz
  • Anemia (reduced binding of CO to Hgb)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

For every 10mm Hg change in PaCO2, there should be a change in pH by ___

A

.08

  • if change is in same direction as change in PaCO2, its metabolic
  • if inverse, respiratory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

T/F: Restrictive dz has reduced FEV1 and reduced FEV1/FVC ratio

A

False.
Restrictive has reduced FEV1.
However, ratio is actually normal or increased because of FVC decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

signs of ILD

A
  • Inspiratory crackles, digital clubbing
  • Progressive exertional dyspnea, persistent dry cough
  • CXR = reticular/nodular opacities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Pulmonary function tests in ILD

A
  • normal or increased FEV1/FVC
  • decreased DLCO
  • decreased TLC
  • decreased RV

will also see increased A-a gradient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the pathophys behind changes to A-a gradient and DLCO in ILD (i.e. pulmonary fibrosis)?

A

Get peri-alveolar collagen deposition

=decreased gas exchange (A-a) and reduced diffusion capacity of CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Tx of SIADH

A

FLUID RESTRICTION +/- salt tablets

Hypertonic saline is only used for severe hyponatremia (sxs of coma, seizure, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Progressive exertional dyspnea + dry cough

A 
ILD
ILD
ILD
ILD
ILD
ILD
ILD
ILD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Low FEV1/FVC ratio + increased or decreased DLCO

A

Low ratio = Obstructive dz

Increased DLCO = Asthma (inc. pulm capillary blood V)
Decreased DLCO = COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Normal/high FEV1/FVC ratio + increased or decreased DLCO

A

Normal/high ratio = Restrictive dz

Increased DLCO = Chest wall weakness
Decreased DLCO = ILD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

why is there pulmonary hypertension in ARDS?

A

hypoxic vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

2 ways by which oxygenation can be improved in ARDS pt

A
  1. Increasing fraction of inspired O2 (FiO2)
  2. PEEP (via mechanical ventilator)

–>You want to wean FiO2 to <60% asap to avoid risk of oxygen toxicity (free radicals), so once you’re higher than this you should increase PEEP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

most common trigger of COPD exacerbation

A

URI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Why is FVC decreased in COPD

A

Air Trapping due to progressive airflow limitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

solitary nodule > ____ likely malignancy

A

2cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

most common primary lung cancer in smokers and nonsmokers

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

non-allergic vs allergic rhinitis

A

Allergic: predom eye sxs, itching, sneezing, identifiable triggers

NAR: Predominant nasal congestion w/o obvious triggers. antihistamine or glucocorticoids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

in patient tx for CAP (esp in pt >65)

A

Fluoroquinolone or beta lactam/macrolide (cef/azithro)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Name the mediastinal mass by location:

  • Anterior mediastinum
  • Middle
  • Posterior
A

Anterior: THYMOMA, retrosternal thyroid, teratoma

Middle: Bronchogenic Cyst, Aortic arch aneurysm

Posterior: all neurogenics i.e. neuroblastoma, esophageal tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

t/f: panacinar emphysema of a1-antitrypsin def is present diffusely throughout the lungs

A

false, it is predominantly in the lower bases (vs smoking emphysema which is in upper lobes). Presents in 30-40s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Whats the next step if you suspect CAP based on sxs (few days of fever, cough, and crackles on exam)?

A

Need CXR to make dx!! Then you can do empiric antibiotics (don’t need cultures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

3 most common causes of chronic cough

A
  1. Upper-airway cough syndrome (POSTNASAL DRIP)
    - ->responds to anti-histamines
  2. Asthma
  3. GERD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Simple rule of thumb for pleural effusions (exudative vs transudative)

A

Transudative: Organs failure…heart (chf), liver (cirrhosis, low albumin), lung (PE, atelectasis), kidneys (nephrotic, low albumin)

Exudative: Infectious, Cancerous (ICE ICE Baby)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

If someone has a parapneumonic effusion, what should you be looking out for?

A

Empyema. Look for a pt who has received antibiotics but continues to be ill.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Empyema vs parapnuemonic effusion

  • pH
  • Glucose
  • Protein
  • wbcs
A

Parapneumonic: Glucose dec, protein inc, pH >7.2, wbc <50k

Empyema: Glucose dec, protein inc, pH <7.2, wbc >50k

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

orthostatic hypotension usually presents in elder patients, due to _______ ; which lab value should you follow?

A 
Hypovolemia
Urine Na (hypovolemia = dec renal perfusion = RAAS = decreased urine Na)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

classic triad of fat emboli

A

Hypoxemia
NEURO dysf(x)
RASH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Why would an asthmatic have elevated wbc’s after an acute exacerbation?

A

Most likely will get some glucocorticoid therapy, which causes leukocytosis (by released marginated neutrophils)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

most common complications of PEEP (i.e. pt in ARDS put on PEEP)

A

PNEUMOTHORAX
ALVEOLAR DAMAGE
HYPOTENSION

70
Q

t/f: you suspect PE in a pt, next step is CTa

A

False, next step is heparin drip! and then CTa

71
Q

CT findings PE

A

WEDGE SHAPED infarction = pathogneumonic (don’t call it cancer kid!)

72
Q

describe why R-L intrapulmonary shunting occurs with pneumonia

A

Alveoli filled with inflammatory exudate = impaired alveolar ventilation in that portion of lung = R to L shunting, meaning perfusion of lung tissue in absence of alveolar ventilation (extreme V/Q mismatch)
–>characteristically cannot improve hypoxemia with increased FiO2 (due to shunting)

73
Q

Patient with urticaria and acute-onset difficulty breathing

A

Laryngeal Edema = Upper Airway Obstruction!!! aka allergic rxn son

74
Q

Features that make a solitary pulmonary nodule more likely to be malignant

A
  • pt’s age (>50)
  • hx of smoking
  • > 2cm
  • Irregular borders
  • Eccentric asymmetric calcification (vs dense, central calcification = benign)
  • enlarging

if suspicious for malignancy, BIOPSY/RESECTION
low probability: serial CT scan
Intermediate probability nodule 1cm or larger: PET scan

75
Q

initial mgmt of acute COPD exacerbation

A

short acting bronchodilator, glucocorticoids, antibiotic

–>if sxs persist, go to Non-invasive PPV (facemask support instead of intubation)

76
Q

pathophys behind atelectasis causing pleural effusion

A

Decreased intrapulmonary effusion (transudative)

other transudative pathophys = increased hydro P (CHF) or dec plasma oncotic p (nephrotic)

77
Q

what is a positive bronchodilator test for asthma (quantitatively)?

A

> 12% improvement of FEV1 post-bronchodilator

78
Q

T/F: Breath sounds and tactile fremitus are decreased with consolidation and pleural effusion

A

False!
They are increased with consolidation
They are decreased with pleural effusion

79
Q

Examples of resonance, dullness, and hyperresonance with percussion of lung

A

Resonant: Normal Lung
Dull: Consolidation, Pleural Effusion, Atelectasis (mucus plugging)
Hyperresonant: Emphysema, Pneumothorax

80
Q

3 clinical sxs of asbestosis

A

Progressive dyspnea
Digital Clubbing
End-inspiratory crackles

81
Q

PFT of asbestosis

A

Restrictive pattern: decreased lung volume, decreased DLCO, normal FEV1/FVC

82
Q

Cancer in asbestos patient

A

Bronchogenic cancer&raquo_space;»> Mesothelioma

83
Q

Major difference btwn chronic bronchitis and bronchiectasis (both have coughing up of mucus)

A

CB: Mucus narrows the airways. Seen in smokers, older age.

Bronchiectasis: persistent, abnormal dilation of bronchial walls. Might be a younger patient who doesn’t smoke, signs of cystic fibrosis

84
Q

most common cause of hemoptysis

A

Bronchitis lmao fam

85
Q

In acute COPD exacerbation, do you use inhaled or systemic glucocorticoids?

A

Systemic!

Inhaled steroids are for long-term albuterol tx; for COPD, dec exacerbation frequency/sxs for do not play a role in acute exacerbation.

86
Q

cardinal sxs of acute COPD exacerbation

A

increased dyspnea
increased cough
sputum production (change in volume/color)

–>give antibiotics if at least 2 of these present

87
Q

T/F: Secondary malignancy is common in patients with Hodgkins lymphoma tx w/chemo and radiation

88
Q

Where does an aspergilloma collect/form?

A

Previous cavitary lesion

89
Q

Assist Control (AC) mode delivers a predetermined ____ ____ with every breath

A

Tidal Volume (6ml/kg body wt)

90
Q

Hemoptysis + chest pain on inspiration in patient on OCP and recent travel

A

Pulmonary Embolism (with likely pulm infarction)

91
Q

Fever, chest pain, and hemoptysis with pulmonary nodules with ground-glass opacities surrounding

A 
Invasive aspergillosis (non-cavitary lesion; seen in transplant, immunocomp, or AIDS patients)
-->CT findings = Halo Sign
(PCP unlikely with hemoptysis)
92
Q

lots of cough with production of sputum. How can you tell based on responsiveness to medications and smoking status if its bronchitis or bronchiectasis?

A

Bronchitis is usually exacerbated by viral infections. Usually a smoker.

Bronchiectasis is usually from recurrent bacterial infections and is responsive to antibiotics. usually a non-smoker.

93
Q

T/F: CXR is the best dx test for bronchiectasis

A

False, need high-resolution CT.

CXR will show linear atelectasis, dilated/thickened airways, irregular peripheral opacities.

94
Q

Increased permeability of the right hemidiaphragm in cirrhosis patients leading to pleural effusion =

A

Hepatic hydrothorax

95
Q

low glucose concentrations in empyema are due to:

A

high metabolic activity of wbcs and/or bacteria

96
Q

Empyemas and parapneumonic effusions are _____ effusions

97
Q

_________ effusions are due to pleural and lung inflammation

98
Q

Patients with COPD are candidates for home oxygen therapy when:

A

SaO2<88% or PaO2<55mmHg

99
Q

Obesity and malignancy as risk factors for _______ in a patient with dyspnea and chest pain

A

Pulmonary Embolism

100
Q

carcinoma in the apex of the lung that can lead to shoulder/arm pain, hoarseness, and Horner’s syndrome

A 
Pancoast tumor (Superior sulcus tumor)
-->typically a squamous cell lung cancer or adenocarcinoma (SMOKERS)
101
Q

Why would a patient treated for acute asthma exacerbation develop muscle weakness and tremors?

A

Beta-agonists (albuterol) can cause hypokalemia = muscle weakness, EKG changes, arrythmias, tremors, palpitations, HA

102
Q

JVD and RBBB on EKG developing few days after operation

A

Massive pulmonary thromboembolism…PE causing Right heart failure

103
Q

noncardiogenic pulmonary edema

104
Q

causes of ards

A
  • infection
  • trauma
  • transfusion
  • pancreatitis
105
Q

tx of ARDS

A

ventilation: high PEEP, low tidal volume, high FiO2

106
Q

what is cough in ACE-I due to?

A

increased substance P, kinins, PGs, Txa2

107
Q

T/F: Consolidation presents with decreased breath sounds, dullness to percussion

A

False, dullness to percussion but INCREASED breath sounds…will hear egophany, tactile fremitus etc

108
Q

PE findings of consolidation vs pleural effusion vs pneumothorax

A

Consolidation: breaths sounds inc; tactile frem inc; dull

effusion: dec/absent breath sounds; dec tf; dull
pneumo: dec/absent breath sounds; dec tf; hyperresonant

109
Q

PE findings of emphysema and atelectasis (mucus plugging)

A

Emphysema: breath sounds dec; tactile frem dec; hyperresonant

Atelectasis: breath sounds dec; tf dec; dull

110
Q

lung cancer, gynecomastia, galactorrhea

A

large cell

111
Q

T/F: JVD on expiration = kussmaul sign = constrictive pericarditis/RCM

A

False. Kussmaul = jvd on INSPIRATION. JVD on expiration seen in COPD etc

112
Q

T/F: Infusion of saline may worsen hyponatremia in a patient with SIADH

A

True (tx is usually fluid restriction)

113
Q

Why do we tx ARDS patients (tx: ventilation with PEEP) with the tidal volume low?

A

Low tidal volume prevents overdistention of the alveoli ( a complication of ventilation). this improves mortality

114
Q

T/F: Pleuritic chest pain is not a feature of pneumonia

115
Q

signs of invasive aspergillosis

A

-Triad: Chest pain, Fever, Hemoptysis
-Imaging: Solitary nodule with halo sign
cell markers (beta-d-glucan, galactomannan)

116
Q

causes of low DLCO

A

Obstructive: Emphysema
Restrictive: ILD; sarcoid, asbestosis, HF
Normal: anemia, PE, Pulm htn

117
Q

causes of high DLCO

A

Obstructive: Asthma (can also be normal)
Restrictive: obesity
Normal: pulm hem; polycythemia

118
Q

normal DLCO

A

Obstructive: chronic bronchitis, asthma
restrictive: MSK deformity; neuromuscular dz

119
Q

Smoker with productive cough, DOE, PFT: dec FEV1, normal FVC, dec ratio, normal DLCO

A

Chronic bronchitis

120
Q

Why is DLCO normal in chronic bronchitis?

A

DLCO measures gas exchange btwn alveoli and pulm capillaries. CB has no destruction of alveoli (vs emphysema).( However, CB patients may have worse hypoxemia than E. )

121
Q

Why is DLCO low in emphysema?

A

DLCO measures gas exchange btwn alveoli and pulm caps. Emphysema causes destruction of alveolar walls, so decreased diffusion capacity.

122
Q

CXR dif btwn emphysema and chronic bronchitis

A

Emphysema: Hyperinflated lungs, dec lung markings
CB: Flattened diaphragm, inc lung markings

123
Q

T/F: CB is associated with more predominant mucus production than bronchiectasis

A

False, my mneumonic for CB is misleading. Bronchiectasis is associated with literally buckets of mucus, CB can have mild production

124
Q

Low FVC (due to airway destruction from repeated infx), dilated conducting airways on CXR, chronic recurring and resolving episodes of lung infection with high amounts of sputum. May have hemoptysis/fever/clubbing

A

Bronchiectasis

125
Q

Shoulder pain and Horner’s in a smoker

126
Q

what are the features of a pancoast tumor?

A
  • horners
  • shoulder pain
  • c8-t2 involvement: weakness/atrophy of intrinsic hand muscles; pain/paresthesias of 4th/5th digits, medial arm and forearm
  • Supraclavicular LN
  • weight loss
127
Q

elevated right atrial pressure, elevated pulmonary artery pressure, normal PCWP in a patient presenting with chest pain/shock/syncope

128
Q

Wells criteria for PE

A

+3: signs of DVT
+1.5: hx of PE/DVT; HR>100; recent surg/immob
+1: Hemoptysis; cancer

> 4: PE likely

129
Q

Empyemas are ___ pleural effusions with ____ glucose due to _____

A

exudative; low; wbc activity/bacteria

130
Q

Patient has DOE and CXR shows pleural effusion. What’s the dx standard and when would you do something different?

A

Diagnostic thoracentesis –> determine whether it is transudative (tx underlying cause) or exudative.

Only time you don’t do this is if you suspect CHF…then, you do ECHO and trial of diuretics.

131
Q

3 biggest causes of malignant pleural effusions (exudative)

A

Lung carcinoma, Breast carcinoma, Lymphoma

132
Q

T/F: Next best step in all pleural effusions = diagnostic thoracentesis

A

False. This is USUALLY the best next step.

Exception: if the patient has CHF, you do ECHO and diuretics instead

133
Q

T/F: A patient with 6months of productive cough with mucus and obstructive PFTs likely has chronic bronchitis

A

False. Need at least 3 consecutive months in 2 successive years

134
Q

When should you consider A1AT def?

A
  • young patient with COPD
  • COPD with minimal smoking hx
  • FHx of emphysema or liver dz
  • ->LFTs may not be elevated until very late in the dz so don’t be a peasant
135
Q

airway hyperreactivity is associated with:

136
Q

3 most common causes of chronic cough (>8 weeks)

A
  1. Post-nasal drip (upper-airway cough syndrome), i.e. allergic rhinitis etc. Improves with H1 blockers (chlorpheniramine)
  2. Asthma
  3. GERD
137
Q

what kind of pleural effusions does a PE cause?

A

Exudative…usually hemorrhagic or inflammatory. Grossly bloody and painful.

138
Q

Asthmatic patients typically have a respiratory ______, with ____pCO2

A

alkalosis; low pCO2 due to hyperventiilation

–>elevated/normal pCO2 indicate increasing severity

139
Q

Assist control ventilator mode determines a predetermined ____ with every breath

A 
tidal volume (should be 6ml/kg body wt)
-->patient can breathe on their own, but if they don't have a minimum resp rate, then that tidal volume is delivered
140
Q

development of digital clubbing and joint pain (acute onset) in a smoker

A

Hypertrophic osteoarthropathy (get a CXR). Usually ass. w/underlying lung dz like lung cancer, TB, bronchiectasis, emphysema etc

141
Q

T/F: All pleural effusions need drainage (i.e. chest tube)

A

False.
Small ones do NOT need therapy. Use diuretics…especially if CHF related
Large ones , especially infection related (parapneumonic/Empyema!) need a chest tube

142
Q

What are the options for a recurrent pleural effusion despite chest tube drainage?

A

Pleurodesis: infuse irritative agent (bleomycin/talcum powder)
Decortication: stripping of pleura from lung

143
Q

Exudative pleural effusion with low pH (<7.2) and low glucose (<60)

A

Parapneumonic or Empyema

144
Q

uncomplicated vs complicated parapneumonic pleural effusions (exudative)

A

Un: pH>7.2, Glucose >60, wbc <50K, Tx = ABx
C: pH<7.2, Glucose <60, wbc>50k, Tx= drainage (chest tube) and ABx

145
Q

T/F: Wedge shaped infarct on imaging = PE

146
Q

most common tumors causing Pancoast (superior sulcus) tumor

A

Squamous cell

Lung adenocarcinoma

147
Q

T/F: COPD decreased total lung volume, functional residual capacity, and residual volume

A

false, it actually increases all of these (think increased AP diameter)

148
Q

Patient with a hx of asthma/chronic sinusitis w/nasal polyps should be careful of _______ potentially causing ____-exacerbated respiratory disease

A

Aspirinx2, causes nasal congestion/bronchospasm. Avoid NSAID, give LT-R blockers (montelukast)

149
Q

T/F: In a patient with a hx of asthma and current episode of respiratory distress, absence of wheeze is a positive sign

A

False, sign of impending resp failure

150
Q

What levels of FiO2 do you not really want to be above?

A

Worried about oxygen toxicity when >60%. It can be higher but wean down to below this asap. If patient is having problem with oxygenation, increase PEEP instead.

151
Q

A-a gradient bullshit

A

PAO2 = 150 - (PaCO2/.8)
PAO2 - PaO2 = A-a gradient: normal is 10-15.
Increased A-a = V/Q mismatch (PE is a big one), R-L shunt, diffusion limitation
Normal A-a and hypoxemia= hypoventilation, altitude

152
Q

Tx for hospitalized CAP patient

A 
Either: 
1. Beta lactam + Macrolide
(ceftriaxone + azithromycin)
or
2. Fluoroquinolone (moxifloxacin)
153
Q

how do you decide if CAP patient needs hospitalization?

A 
Confusion
Urea>20
RR>30
BP<90/60
65: (age older than this)
Score 0 = outpatient
1-2 = likely inpatient
3-4 = urgent inpatient possibly ICU
154
Q

What does pulmonary infarction in the setting of PE cause?

A

Pleuritic pain and hemoptysis (through inflammation and occlusion of peripheral artery)

155
Q

complications of positive pressure ventilation

A
  • alveolar damage
  • PNEUMOTHORAX
  • hypotension
156
Q

Post-op patient with hypotension, distended JVP, and new-onset RBBB

157
Q

T/F: PE patients usually have tachypnea, tachycardia and hypoexmia, sometimes have loluidw grade fever

158
Q

T/F: Pulmonary contusion is made worse by fluids/intravascular volume expansion

159
Q

Someone comes in with suspected PE. What do you do?

A

1: supportive stuff (oxygen, fluids)
2: assess for absolute CI to anti-coagulation (active bleeding, recent hemorrhagic stroke)
- ->if yes, do dx testing and then IVC filter
3. No CI then proceed by Wells criteria
- ->low prob of PE: Do dx’ic testing
- ->if PE likely, you don’t wait for a CT you give anticoagulation now

160
Q

How could blood gases help you distinguish COPD exacerbation from CHF?

A

COPD: Respiratory ACIDOSIS and hypoxia
CHF: Respiratory alkalosis, hypocapnia and hypoxia

161
Q

Why does your cystic fibrosis patient bruise easily?

A

Pancreatic insuff –> Vit k defic

162
Q

Chronic nasosinopulmonary infxs, digital clubbing, bronchiectasis, and nasal polyps

A

Either CF or Kartegeners.
Specifics:
CF = FTT and panc insuff, infertility b/c absent vas def
K: situs inversus, infertility b/c immotile sperm

163
Q

exudative effusion from disruption of the lymphatic flow in the thoracic duct

A

chylothorax (lots of TGs and leukocytes)

164
Q

what is the first fucking thing youre going to do in a patient with asthma and they provide ABG?

A

Check to see if he has hypercarbia and need to intubate the fuck out of him

165
Q

Restrictive lung dz: decreased DLCO vs normal

A

decreased: ILD
normal: chest wall weakness

166
Q

patchy alveolar infiltrate (not necessarily in the anatomical borders), tachypnea/tachycardia/hypoxia within 24 hours of trauma

A

pulmonary contusion

167
Q

why do glucocorticoids cause changes in CBC labs?

A

demargination of neutrophils habibi –> leukocytosis

168
Q

chronic cough that is worse at night in the absence of major pathology, regardless of age of onset, should be worked up for:

A

asthma, PFT the homeboy. chronic means >2months

169
Q

first line for preventing post op pneumonia

A

incentive spirometry (promotes lung expansion)

170
Q

young guy with chronic low back pain, worse at night and improved with exercise, elevated ESR

A

ankylosing spondylitis

171
Q

_____ exacerbations are associated with wheezing

Step 2 UWORLD (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions