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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

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2
Q

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

A

Bronchiectasis

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3
Q

Etiologies of bronchiectasis

A
  • cancer (airway obstruction)
  • autoimmune (RA, Sjogrens)
  • Aspergillosis, TB
  • Hypogammaglobulinemia
  • CF, a1at def (congenital)
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4
Q

most common causes of digital clubbing

A
  • Cystic Fibrosis
  • Lung Malignancies
  • R to L cardiac shunts
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5
Q

most common adverse effect of inhaled steroids

A

oral thrush

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6
Q

Triad in obesity hypoventilation syndrome

A
  • obesity
  • hypercapnia (daytime)
  • alveolar hypoventilation (hypoxmia/resp acidosis)
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7
Q

causes of transudate pleural effusions

A

CHF
Cirrhosis
Nephrotic Syndrome
Peritoneal dialysis

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8
Q

causes of exudative effusions

A

Infections
Malignancy
Pulmonary Embolism

Connective tissue dz
Inflammatory dz
Fluid from abdomen
CABG

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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
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10
Q

most common cause of pleural effusion

A

CHF (and thus transudative)

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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

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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

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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)

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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)
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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

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16
Q

Severe hypoxemia that does not improve on 100% oxygen

A

ARDS

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17
Q

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

A

Alveolar capillary permeability (ARDS)

Congestive Hydrostatic Forces (CHF/HF)

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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

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19
Q

Patients with _____ have the highest risk of developing ARDS

A

sepsis/septic shock

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20
Q

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

A

False…they should be removed in states of hypoxia

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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

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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

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23
Q

MAP> ____ (at rest) = Pulm HTN

A

25

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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
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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

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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)
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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

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28
Q

Clinical features of cor pulmonale

A
  • decrease exercise tolerance
  • Cyanosis and digital clubbing
  • RV failure (JVD, edema, hepatomegaly)
  • Parasternal lift (RV dilatation)
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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

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30
Q

T/F: Most often, PE is clinically silent

A

True

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

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31
Q

What causes most PE-related deaths?

A

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

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32
Q

Signs of PE

A

-Tachypnea, Rales, Tachycardia, S4, Increased P2

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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

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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)

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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

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36
Q

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

A

IVC filter

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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
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38
Q

where is aspiration most likely to go?

A

lower portion RUL

upper portion of RLL

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39
Q

most common causes of acute dyspnea

A 
CHF exacerbation
pneumonia
bronchospasm
PE
anxiety
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40
Q

causes of high DLCO

A
  • Asthma (increases pulm capillary blood V)
  • Obesity
  • Intracardiac L-R shunt
  • Exercise
  • Pulmonary hemorrhage
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41
Q

causes of low DLCO

A
  • Emphysema
  • Sarocoidosis
  • Fibrosis
  • Pulmonary vascular dz
  • Anemia (reduced binding of CO to Hgb)
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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
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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

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44
Q

signs of ILD

A
  • Inspiratory crackles, digital clubbing
  • Progressive exertional dyspnea, persistent dry cough
  • CXR = reticular/nodular opacities
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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

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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

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47
Q

Tx of SIADH

A

FLUID RESTRICTION +/- salt tablets

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

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48
Q

Progressive exertional dyspnea + dry cough

A 
ILD
ILD
ILD
ILD
ILD
ILD
ILD
ILD
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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

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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

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51
Q

why is there pulmonary hypertension in ARDS?

A

hypoxic vasoconstriction

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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

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53
Q

most common trigger of COPD exacerbation

A

URI

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54
Q

Why is FVC decreased in COPD

A

Air Trapping due to progressive airflow limitation

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55
Q

solitary nodule > ____ likely malignancy

A

2cm

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56
Q

most common primary lung cancer in smokers and nonsmokers

A

Adenocarcinoma

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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.

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58
Q

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

A

Fluoroquinolone or beta lactam/macrolide (cef/azithro)

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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

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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

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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)

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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
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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)

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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.

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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

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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)
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67
Q

classic triad of fat emboli

A

Hypoxemia
NEURO dysf(x)
RASH

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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)

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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

A

True

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

A

exudative

97
Q

_________ effusions are due to pleural and lung inflammation

A

Exudative

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

A

ARDS

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

A

False

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

A

Pancoast

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

A

PE

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:

A

asthma

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

A

True

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

A

PE

157
Q

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

A

true

158
Q

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

A

true

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

A

asthma

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