Respiratory system Flashcards
Diagnostic test for esophageal anastomotic leak
oral contrast study with water soluble contrast - most definitive
Clinical features of esophageal anastomotic leak
sudden onset atrial fibrilation, pleural collection, sepsis
Patient in MVA presents with: Cardiogenic shock with elevated CVP and distended neck veins; muffled heart sounds, cardiac dullness to percussion; boot-shaped heart on CXR
Cardiac tamponade from hemopericardium
Patient in MVA presents with: dyspnea, paradoxical respiration
Flail chest
Differentiate chest findings of pneumothorax vs hemothorax
Both: diminished breath sounds, dyspnea
percussion findings: in pneumothorax - tympanitic; hemothorax - dull
Physical sign that can differentiate ascites caused by CHF versus cirrhosis
Increased JVP - ascites d/t cirrhosis is usually associated with low or normal cardiac filling pressure. therefore increased CVP is more indicative of heart failure
Atypical pneumonia presenting with gastrointestinal symptoms - etiology
Legionella spp.
DOC for atypical pneumonia (Legionella, m, pneumonia, chlamydia)
Azithromycin (Macrolides)
Initial treatment for flail chest
1) Intubation -> establish controlled positive pressure ventilation
2) Insertion of intercostal catheters to prevent tension pneumothorax
Most common etiologic agent for lobar pneumonia
s. pneumoniae (95%)
at risk for klebsiella pneumoniae infection
patients with increased risk for aspiration - elderly, alcoholics, diabetics (remember: klebsiella pneumoniae is normal enteric flora)
pneumonia with thick gelatinous sputum (currant jelly)
klebsiella pneumoniae - d/t thick mucoid capsule
4 phases of lobar pneumonia
Congestion
red hepatization
grey hepatization
resolution
Pneumonia in cystic fiubrosis patients
p. aeurginosa
atypical pneumonia that can cause autoimmune hemolytic anemia
m. pneumoniae
IgM against I antigen on RBCs
most common cause of atypical pneumonia in infants
Respiratory syncytial virus (RSV)
Most common cause of atypical pneumonia in patients undergoing posttransplant immunosuppresive therapy
Cytomegalovirus (CMV)
Most common lobe involvement of aspiration pneumonia
Right lower lobe
Chronic productive cough lasting at least 3 months over a minimum of 2 years; highly associated with smoking
Chronic Bronchitis
Destruction of alveolar air sacs causing physiological obstruction d/t collapse of bronchioles d/t loss of elastic recoil
Emphysema
Protective against normal inflammatory proteases in alveolar air sac
Alpha 1 Antitrypsin (Anti-protease)
Emphysema in smokers - distribution
Centriacinar; more severe in upper lobes; most common
Emphysema in A1AT deficiency - distribution
Panacinar; more severe in lower lobes; may also develop liver cirrhosis
Most common Mutation in A1AT deficiency
PiZ (PiM is normal)
others: PiMZ, PiZZ
