RESPIRATORY: 602 - 603 Flashcards
Describe the pathophysiology of rhinosinusitis.
Obstruction of sinus drainage into the nasal cavity leads to inflammation and pain over the affected area
Which sinus is most commonly affected in rhinosinusitis in adults?
Maxillary
What is the most common acute cause of rhinosinusitis?
Viral URI (in particular adenovirus)
What can often be superimposed on top of rhinosinusitis?
Bacterial infection
What are common bacteria that cause a superimposed infection on rhinosinusitis?
S. pneumoniae, H. influenzae, M. catarrhalis
What type of hypersensitivity reaction is allergic rhinitis?
Type I
What are two associations with allergic rhinitis?
Asthma and eczema
What do you see histologically with allergic rhinitis?
Inflammatory infiltrate with eosinophils
What is Virchow’s triad for deep venous thrombosis?
- Stasis
- Hypercoagulability (e.g. defect in coagulation cascade proteins)
- Endothelial damage (exposed collagen triggers clotting cascade)
What is the most common defect in coagulation cascade proteins?
Factor V Leiden
Where do 95% of pulmonary emboli arise from?
Deep leg veins
What is Homan sign and what does it check for?
Checks for DVT
When dorsiflexion of the foot causes calf pain
What medication can you give to prevent DVT/for acute management?
Heparin
What medication can you give for long-term prevention of DVT recurrence?
Warfarin
What are the different types of emboli?
Mnemonic: FAT BAT
Fat Air Thrombus Bacteria Amniotic Tumor
How does a pulmonary embolus present?
Sudden-onset dyspnea, chest pain, tachypnea
May also present as sudden death
How does pulmonary emboli lead to respiratory alkalosis?
Pulmonary emboli –> V/Q mismatch –> hypoxemia –> respiratory alkalosis
What are fat emboli often associated with?
Long bone fractures and liposuction
What is the classic triad of fat emboli?
Hypoxemia, neurologic abnormalities, petechial rash
What is a major complication of amniotic fluid emboli?
DIC - especially postpartum
When do gas emboli originate?
Nitrogen bubbles precipitate in ascending divers
How do you treat gas emboli?
Hyperbaric oxygen
What is the ideal imaging test to check for pulmonary emboli?
CT pulmonary angiography - look for filling defects
