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Respiratory_UW Flashcards

1
Q

Measuring what levels will help establish diagnosis if you see recurrent bacterial infections in an adult patient which may indicate a humoral immunity defect.

A

Serum Ig levels

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2
Q

Recurrent bacterial infections in an adult patient which may indicate?

A

A humoral immunity defect.

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3
Q

What are causes of exudative effusions?

A

Malignancy, infection, pulmonary embolism, connective tissue disease and iatrogenic causes.

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4
Q

Why do exudative effusions occur?

A

Inflammation and increased capillary and pleural membrane permability or impaired lymphatic drainage.

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5
Q

Sudden-onset dyspnea, chest pain, tachycardia, with a hemorrhage, exudative pleural effusion in absence of consolidation on chest imaging suggests?

A

PE

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6
Q

What is aspirin exacerbated respiratory disease?

A

Non-IgE mediated reaction that results from aspirin induced prostaglandin/leukotried misbalance.

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7
Q

Aspirin exacerbated respiratory disease is most commonly seen in which patients?

A

Patients with a hx of asthma or chornic rhinosinusitis with nasal polyposis.

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8
Q

Aspirin exacerbated respiratory disease is characterized by?

A

Bronchospasm and nasal congestion

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9
Q

What is the treatment for aspirin exacerbated respiratory disease?

A

Avoidance of NSAIDS, densensitization if NSAIDS ar required and leukotriene receptor antagonists like montelukast.

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10
Q

What are the two main COPD diseases

A

Chronic bronchitis and emphysema

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11
Q

Signs and sx of COPD

A

progressive dyspnea, cough, decreased breath sounds, PROLONGED EXPIRATORY PHASE. Hypoxemia is common.

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12
Q

What therapy/tx has been proven to prolong the survival of patients with COPD and hypoxemia?

A

Long-term supplemental oxygen therapy

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13
Q

What is the criteria for long-term supplemental oxygen therapy?

A

PaO2= 55%) or evidence of cor pulmonale.

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14
Q

How does the body compensate for chronic hypercapnia (and avoid marked acidosis?)

A

Renal tubular compensation. Retains more bicarbonate.

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15
Q

In COPD, what is FEV1, VC and total lung capacity?

A

Due to progressive expiratory airflow limitation - Total lung capacity increases due to air trapping, VC decreases and FEV1 decreases disproportionately compared to VC.

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16
Q

What are empyemas?

A

Infection in the pleural space. Collection of pus in a naturally existing anatomic cavity

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17
Q

What is Flail chest?

A

When three or more adjacet rib fructures have breaks in 2 places leads to unstable chest wall segment that moves in paradoxical motion with respiration.

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18
Q

What x-ray findings are in flail chest

A

Multiple rib fractures overlying lung contusion.

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19
Q

How do patients with flail chest present?

A

Respiratory distress, tachypnea.

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20
Q

What are the only 2 therapies shown to decreast mortality in COPD

A

Smoking cessation, home oxygen therapy

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21
Q

What is the underlying pathologic lesion in sarcoidosis

A

Noncaseating chronic granuloma.

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22
Q

How is pulmonary sarcoidosis often diagnosed on chest x-ray?

A

Presence of bilateral hilar adenopahy and/or reticular opacities.

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23
Q

What are some common extrathoracic manifestations of sarcoidosis?

A

Skin lesions such as erythema nodosum, uveitis, polyarthralgia.

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24
Q

How is asthma diagnosed with PFTs?

A

Reversible airway obstruction, i.e., greater than 12% increased in FEV1 after bronchodilator challenge with normal diffusion capacity for carbon monoxide suggests asthma regardless of age.

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25
Q

What is the lights critera for exudates

A

1) Pleural fluid protein/serum protein ratio > 0.5, 2) Pleural fluid lactate dehyrodgenase (LDH)/serum LDH ratio > 0.6, 3) Pleural fluid LDH > 2/3 of the upper limit of normal for serum LDH

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26
Q

What are exudates caused by

A

Change In capillary permeability

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27
Q

What is obesity hypoventilation syndrome?

A

AKA pickwickian syndrome. Long term consequence of severe obseity and untreated obstructive sleep apnea. These patients don’t have respiratory mechanics that allow them to resume normal ventilation during wakefulness (they have hypoventilation overnight like those with sleep apnea) and they develop chronic respiratory failure.

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28
Q

What do patients with obesity hypoventilation syndrome develop?

A

Chronic hypercapnea/hypoxic respiratory failure, pulmonary hypertension, secondary erythrocytosis, cor pulmonale.

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29
Q

Histoplasma Capsulatum a/w?

A

Endemic to Mississipi, Ohio river valleys and central america. Usually found in soil with high concentration of bird and bat droppings.

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30
Q

Histoplasma Capsulatum infection is usually?

A

Asymptomatic with pulmonary nodule. Extent of disease is determined by amount of exposure and host immune system. Usually it’s self limiting fever, non-productie cough, chills.

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31
Q

How does GERD exacerbate asthma?

A

Through increased vagal tone, microaspiration of gastric contents into upper airway, heightened bronchial reactivity.

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32
Q

What are the symptoms of Goodpasture’s disease?

A

Pulmonary - cough, dyspnea, hemoptysis. Renal - nephritic range of proteinuria (

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33
Q

How is diagnosis for Goodpasture’s made?

A

Renal biopsy showing linear IgG antibodies along glomerular basement membrne.

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34
Q

In respiratory alkalosis, what is the urine pH like?

A

In respiratory alkalosis, there is high serum pH, decreased PaCO2. Kidneys try to excrete bicarbonate ions and retain protons to normalize serum pH. Increased bicarbonate excretion raises urine pH.

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35
Q

Bronchoalveolar Lavage is most useful in evaluation of?

A

Suspected malignancy and opportunistic infection.

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36
Q

Bronchoalveolar Lavage is >90% sensitive and specific for what infection? It has less diagnostic utility for?

A

PCP. Less for other forms of interstitial lung disease such as intersitial pulmonary fibrosis, sarcoidosis and connective tissue diseases.

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37
Q

What should be suspected n COPD patients with catastrophic worsening of respiratory symptoms?

A

Secodnary pneumothorax. Usually due to dilated alveolar blebls that rupture air into pleural space.

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38
Q

What accoutns for >90% of chronic cough in nonsmokers who don’t have pulmonary disease?

A

GERD, post-nasal drip, asthma

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39
Q

What is post-nasal drip

A

Upper-airway cough syndrome.

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40
Q

What is the initial empiric treatment for patients with suspected post-nasal drip?

A

First generation anti-histamine (chlorpheniramine) or combined antihistamine-decongestant (bromphneiramine and psuedoephedrine)

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41
Q

What are the PFTs of Interstitial Lung disease?

A

Decreased TLC, decreased RV, normal or increased FEV1/FVC ratio, decreased DLCO (diffusion lung capacity of carbon monoxide)

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42
Q

Patients with idiopathic pulmonary fibrosis how increased or decreased DLCO and alveolar-arterial gradients?

A

IPF is an interstitial lung disease. Have impaired gas exchange => decreased DLCO and increased alveolar-arterial gradient.

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43
Q

What is present in 75% of asthma patients - can present with adult onset asthma, symptoms worse after meals, exercise or lying down (nocturnal asthma)?

A

GERD. GERD induced asthma disease.

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44
Q

If GERD is suspected in asthma patients, what pharmacotherapy is most helpful initially?

A

PPI to help resvolve the GERD - both therapeutic and diagnostic.

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45
Q

What is the pathophysiology of ARDS?

A

ARDS develop when inflammatory mediators, released secondary to local or distant tissue injury, damage the alveoli. Resultant increased alveolar capillary permeatbility allows fluid to leak into the alveoli, causing non-cardiogenic pulmonary edema.

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46
Q

What is the mainstay of therapy for ARDS?

A

Mechanical ventilation with low tidal volume and PEEP (positive end-expiratory pressure).

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47
Q

What is the best way to provide adequate oxygentation in ARDS

A

PEEP (positeve end-expiratory pressure). This prevents alveolar collapse, which directly counteracts the means by which ARDS causes hpoxemia.

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48
Q

ARDS causes what refractory to high inspired oxygen concentrations

A

Hypoxemia.

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49
Q

What are some causes of ARDS

A

Sepsis, severe infection, severe bleeding, toxic ingestions and burns. Acute pancreaititis causes ARDS in up to 15% of patients.

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50
Q

What are potential complications of PEEP

A

Barotrauma and tension pneumothorax

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51
Q

In mechanical ventilation, paO2 is mostly influenced by while pCO2 is mainly influenced by?

A

FiO2 and PEEP level. PCO2 = respiratory rate and tidal volume.

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52
Q

What levels of FiO2 are desirable to avoid oxygen toxicity?

A

No strict cut-off by 50-60% is desirable.

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53
Q

What is bronchiectasis?

A

Condition in which damage to the airways causes them to become flabby and scarred.

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54
Q

Recurrent pneumonias in the same lung region is indicative of?

A

Local anatomic obstruction (for example bronchogenic carcinoma or bronchiectasis) or recurrent aspiration (seizures, ethanol or drug use).

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55
Q

Recurrent pneumonias in different lung regions is indicative of?

A

Sinopulmonary diseases (like CF, immotile cilia), noninfectious cuases like (vaculitis), immunodeficiency (HIV, leukemia, decreased immunoglobulins)

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56
Q

How does theophylline toxicity manifest? What can alter its therapeutic window

A

CNS stimulation (headache, insomnia, seizures), GI distrubances (nausea, vomiting), and cardiac toxicity (Arrythmia). Inhibition of cytochrome oxidase system by other meds (like cirpofloxacin), diet, or underlying disease can alater its narrow therapeutic window

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57
Q

What is Pancoast syndrome?

A

When an apical lung neoplasm (superior sulcus/thoracic inlet) compresses the brachial plexus causing pain, paresthesias/weakness in right arm. Characterized by right shoulder pain radiating into the ipsilateral arm in an ulnar distribution.

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58
Q

What kind of germ cell tumors produce AFP?

A

Nonseminomatous germ cell tumors

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59
Q

What kind of germ cell tumors produce beta-HCG?

A

Seminomatous germ cell tumors

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60
Q

Anterior mediastinal mass that produces both AFP and bHCG is consistent with?

A

Non-seminimatous germ cell tumor

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61
Q

What is peak airway pressure

A

Sum of airway resistance + plateau pressure

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62
Q

How do you measure plateau pressure

A

Sum of elastic pressure + PEEP. Calculated by performing end inspiratory hold maneuver.

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63
Q

How do you measure PEEP

A

End expiratory hold maneuver.

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64
Q

What should you suspect ina patient with fever, cough with foul smelling sputum after an upper GI endoscopy/or other instrumentation of upper airway/esophagus?

A

Anaerobic lung infection

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65
Q

What is the most commonly used antibiotich for anaerobic lung infections?

A

Clindamycin

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66
Q

Pulmonary TB presents with? What does chest CT reveal?

A

Fever, cough, hemoptysis. Chest CT reveals upper lobe cavitary lesions

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67
Q

What is ventilation?

A

Respiratory rate X tidal volume

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68
Q

In mechanically ventilated patients with respiratory alkalosis in the setting of an appropriate tidal volume, what should be lowered and why?

A

Respiratory rate should be lowered. If you reduce tidal volume, this can trigger increased ventilatory rate, which can worsen the respiratory alkalosis.

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69
Q

What kind of infection may demonstrate a crescent radiolucency next to a rounded mass?

A

Aspergillosis.

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70
Q

When you read of moving lesions on chest X-ray think what kind of infection?

A

Aspergillosis. Caviatory lesions form because of destrucction of the underlying lung parenchyma. Debris and hyphae colaesce and forms a fungus ball which lies in the cavity and can move around.

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71
Q

What is choriocarcinoma

A

Form of gestational trophoblastic disease that may occur after a normal gestation, molar pregnancy or abortion.

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72
Q

What are the malignant forms of gestational trophoblastic disease? Which form is metastatic. What is the msot common site of metastasis

A

Choriocarcinoma and gestational trophoblastic neoplasia. GTN is almost always locally invasive and choricarcinoma is highly metastatic. Most commonly metastasizes to lungs.

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73
Q

What helps confirm the diagnosis of choriocarcinoma

A

Elevated beta HCG

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74
Q

What are signs and syptoms of SVC?

A

Dyspnea, venous congestion, swelling of the head, arms and neck.

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75
Q

What is the most common cause of superior vena cava syndrome?

A

Malignancy (lung cancer, especially small cell lung cancer) and Non-Hodgkins Lymphoma. Other possible causes, fibrosing mediastinitis (secondary to histoplasmosis or TB) or thrombosis secondary to indwelling central venous devises.

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76
Q

What test is warranted when superior vena cava sydnrome is suspected?

A

Chest xray. Abnormalities on chest x-ray warrant follow-up with chest CT and histology.

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77
Q

What effect does glucocorticoides have on blood cells?

A

Complex effect. They tend to cause neutrophilia by increasing bone marrow release and mobilizing the marginated neutrophil pool. Eosinophils and lymphocytes are decreased.

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78
Q

What is a characeristic x-ray finding of pneumocystic jiroveci pneumonia?

A

Bilateral diffuse perihilar interstitial infiltrates.

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79
Q

What is the most common adverse effect of inhaled corticosteroid therapy?

A

Oropharyngeal thrush (oral candidiasis)

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80
Q

What physical exam findings are a/w consolidation?

A

Bronchial breaths sounds, increased fremitus, dullness to percussion, egophony, bronchophony. Bronchial breath sounds have full expiratory phase.

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81
Q

Elderly patients with pneumonia may not have what?

A

Fever or elevated white blood cell count.

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82
Q

What criteria can be used to assess pre=test probability of acute PE?

A

Modified Wells criteria

83
Q

Patients with likely PE based on modified Wells critiera should be further evaluated with what?

A

Computed tomography angiography (CTA). Patients with negative CTA are not likely to have PE.

84
Q

What is cor pulmonale

A

Isolated Right heart failure from pulmonary hypertension.

85
Q

What is the most common cause of Cor pulmonale in the US? What are some other causes of cor pulmonale

A

COPD, interstitial lung disease, pulmonary vascular disease (thromboembolic)

86
Q

What are signs of RHF

A

Right ventricular heave (hypertrophy), increased P2 sound, jugular venous distension, hepatomegaly, pitting edema and possible ascites

87
Q

Mitral stenosis is commonly due to what and presents with?

A

Commonly due to rheumatic heart disease and presents with gradual and progressively worsening dyspnea or orthopnea.

88
Q

What can longstanding mitral stenosis show on x-ray?

A

Elevation of left main bronchus due to left atrial enlargement

89
Q

Chest CT shows what in pulmonary embolism?

A

Wedge-shaped infarction

90
Q

Pulmonary embolism classically presents with what?

A

Sudden-onset pleuritic chest pain, cough, dyspnea, and hemoptysis.

91
Q

What pharmacotherapy is the mainstay of symptom management in COPD?

A

Anti-muscarinic agents like ipatropium combined with short acting beta adrenergic agonists.

92
Q

What are the risk factors for aspiration pneumonia

A

Altered consciousness due to excessive alcohol intake, neurologic dysphagia or mechanical disurption of glottic closure.

93
Q

If you see foul smelling sputum in recurrent pneumonia, think?

A

Excessive alcohol intake / aspiration pneumonia.

94
Q

How do ACE inhibitors cause chronic cough?

A

Decreased degradation of bradykinin and substance P leads to the accumulation of these products causing cough. Also possibly due to activation of arachidonic acid pathway.

95
Q

PE has what kind of A-a gradient.

A

Elevated A-a gradient.

96
Q

What is the formula for PAO2?

A

( FiO2x (Patm-Ph20)) - (PCO2/R)

97
Q

In patients with acute asthma axacerbation, normal/elevated PaCO2 suggests what? What is the tx for the patient in this case?

A

Decreaed respiratory drive and impending respiratory failure. Tx: endotracheal intubation and mechanical ventilation, inhaled short acting beta2 agonist, inhaled ipratropium and systemic corticosteroid (note that the steroids is for symptomatic improvement but its effects aren’t clinically apparent for hours after administration.). 1 time infusion of IV magnesium sulfate is also recommended for severe asthma exacerbation without improvement after 1 hour of therapy.

98
Q

What is hypersensitivity pneumonitis?

A

Alveolar inflammatino caused by repeated inhalation of inciting antigen.

99
Q

What are the classifc x-ray findings for hypersensitivity pneumonitis

A

Ground glass opacity, “haziness” of lower lung fields, honeycombing of lungs.

100
Q

How do acute episodes of hypersensitivity pneumonitis present?

A

Cough, breathlessness, fever and malaise occur within 4-6 hours after antigen exposure and lasts several days

101
Q

What is the best tx for hypersensitivity pneumonitis (bird fancier’s lung, farmer’s lung)

A

Avoidance of antigen exposure. In many patients this produces complete remission.

102
Q

Is Brain death a legally acceptable definition of death?

A

Yes. It refers to a total loss of brain function. No additional steps are needed when deciding to take patient off ventilation

103
Q

What is the most common acid base distrubance in PE?

A

Respiratory alkalosis due to hyeprventiation to overcome hypoxia and v/Q mismatch.

104
Q

Low Ph and elevated PCO2 is consistent with what acid-base disturbance.

A

Respiratory acidosis due to hypoventilation

105
Q

Low Ph and low bicarbonate is consistent with what acid-base disturbance.

A

Metabolic acidosis

106
Q

What are the primary theraptuetics for asthma and COPD

A

Asthma: primary long term intervention - inhaled corticodsteroids. COPD: long-acting anticholinergic inhaler.

107
Q

What is mild intermittent asthma, what are the PFTs?

A

sx

108
Q

For mild intermittent asthma, what are the required drugs?

A

Short acting beta2 agonist like albuterol PRN.

109
Q

What are typical signs and sx of asbestosis?

A

Progressive dyspnea, clubbing, end-inspiratory crackles.

110
Q

What are the PFTs with asbestosis?

A

Restrictive lung pattern: decreased residual lung volume, decreased diffusion lung capacity, normal FEV1/FVC ratio.

111
Q

What are the hallmarks (imaging) of asbestosis?

A

Pleural plaques

112
Q

What lab test is the most helpful in determining whether a chest tube placement is needed for parapneumonic effusion?

A

pH test. When less than 7.2, probably is very high that it needs to be drained. Glucose of less than 60mg/dL in pleural fluid also indication for tube thoracostomy. Infected pleural space is usually initially drained with chest tube.

113
Q

What is the most common medical cause of excessive daytime sleepiness in the US and what is it due to?

A

Obstructive sleep apnea. It is due to poor oropharyngeal tone and results in daytime sleepiness, morning headaches and depression.

114
Q

Why is sputum testing for microbial diagnosis option in the outpatient setting?

A

Due to low yield of cultue and high success rate of tx with empiric antibiotics

115
Q

What is the treatment for acute exacerbation of COPD?

A

Supplemental oxygen with target oxygen saturation of 88-92%, inhaled bronchodilators (short acting beta 2 agonists and anticholinergics), antibiotics, and systemic glucocorticoids.

116
Q

What kind of glucocorticoid is methylpredisolone?

A

IV glucocorticoids

117
Q

What fungal infection is endemic to Ohio River basins, Mississipi River and Great Lakes?

A

Blastomycosis

118
Q

Characteristics of extra-pulmonary manifestations of blastomycosis?

A

Ulcerated skin lesions and lytic bone lesions.

119
Q

What confirms the diagnosis of blastomycosis?

A

Broad-based budding yeast grown from sputum

120
Q

What drugs are used to treat symptomatic disease?

A

Itraconazole or amphotericin B

121
Q

Patients with chronic nocturnal cough should be suspected of having ?

A

Asthma. Therefore should be evaluated with spirometry.

122
Q

What sx sets apart Legionnaire’s pneumonia with other community acquired pneumonia?

A

Concurrent GI and CNS sx.

123
Q

How is dx made for legionnaire’s pneumonia?

A

Urine antigen testing is highly specific. Also, in combination with culture.

124
Q

Anaphylaxis requires emergency adminstration of what?

A

Intramuscular epinephrine to prevent and treat respiratory distress and circulatory collapse.

125
Q

How does the administration of epinenphrine help in anaphylatctic shock?

A

Acts on adrenergic alpha 1 receptors to increase vasocontriction and beta 2 adrenergic receptors to relax bronchial smooth muscle contraction.

126
Q

Consolidation of the lungs has what kind of breath sounds.

A

Dullness to percussion, bronchial breath sounds that are louder and more prominent in the expiratory component (assuming patent airways), egophony. Crackles also often heard.

127
Q

What is the pathophysiology of consolidation that occurs in pneumonia?

A

Alveoli in the affected lung segments become filled with exudative fluid and cellular debris

128
Q

What is the preferred method of respiratory support for AECOPD?

A

Noninvasive postive pressure ventilation.

129
Q

What should be started prior to pursuing diagnostic testing in patients with high clinical supsicion for PE?

A

Anticoagulation (low molecular or unfranctionated heparin)

130
Q

What are the useful diagnostic tests for PE?

A

CT angiography or V/Q scan.

131
Q

What is found in V/Q scan for pulmonary thromboembolism

A

Large perfusion defect with normal ventilation - mismatched defect.

132
Q

Alpha 1 antitrypsin deficiency is suspected in which patients?

A

Non-smoking patients

133
Q

What’s seen on chest x ray for alpha 1 antitrypsin defieincy?

A

Pan lobular emphysema on chest x-ray

134
Q

Patients with alpha 1 antitrypsin deficiency are at risk for?

A

Liver disease - neonatal hepatitis, cirrhosis, liver failure.

135
Q

What is the most common inherited disorder causing hypercoagulability and predisposition to thromboses?

A

Factor V Leidin which is a point multation that results in factor 5 being resistant to inactivation by protein C.

136
Q

How does non allergic rhinitis present esp compared to allergic rhinitis?

A

NAR: post-nasal drip/cough, nasah congestion, sneezing, rhinorrhea without a specific etiology. AR: eye sx, rhinorrhea, sneezing with identifiable allergn/seasonal pattern.

137
Q

How are patients with non-allergic rhinitis treated?

A

Intranasal Antihistamines or intralnasal glucocorticoids or a combination, depending on the severity. Routine allergy testing is NOT needed prior to starting empiric treatment.

138
Q

What is the first treatment for mild to moderate sleep apnea syndrome?

A

Weight loss, no sedatives/alcohol and avoidance of supine position during sleep

139
Q

In patients with severe renal insufficiency (which is GFR

A

Unfractionated heparin over low-molecular weight heparain, fondaparinux, and vivaroxaban because reduced renal clearance increased anti-Xa activity levels and bleeding risks.

140
Q

What is Wegener’s / Granulomatosis with Polyangiitis

A

Vasculitis of small adnd medium sized arteries.

141
Q

How do patients with Wegener’s present?

A

Kidney sx ( RBCs, glomerulonephritis) and upper/lower respiratory tract disease.

142
Q

How is dx of Wegener’s made?

A

Test for C-Anca. 90% of patients have positivity. Definitive diagnosis is made by tissue biopsy.

143
Q

How is wegener’s treated?

A

High dose corticosteroids and cytotoxic agents.

144
Q

Bronchgenic cysts are found in which mediastinum?

A

Middle

145
Q

Pathophysiology of CHF exacerbation causing tachypnea?

A

Left ventricular dysfunction allows fluid to pool into lungs => pleural effusion and hypoxemia due to reduced ventilation.

146
Q

What are the blood gas findings in CHF?

A

Hypoxia, hypocapnia and respiratory alkalosis.

147
Q

In COPD exacerbation, wha tis the main acid base distrubance

A

Respiratory acidosis. Hypocapnia.

148
Q

What are the PE findings for CHF?

A

Fluid overload, S3 and S4 gallops, cardiomegaly, bibasilar crackles. Could also have decreased breath sounds from pleural effusions from cHF.

149
Q

What are indicators of a severe asthma attack.

A

Normal to increased PCO2 values, speech difficult, diaphoresis, altered sensorium, cyanosis and silent lungs

150
Q

Pancoast tumors most commoly present with?

A

Shoulder pain

151
Q

What are the findings in pancoast tumors?

A

Shoulder pain, Horner’s syndrom, weaness and atrophy of the hand muscles, pain and or paresthesias in the arm/forearm, enlarged supraclavicular lymph nodes

152
Q

What is the initial evaluation in someone with suspected lung cancer?

A

Chest imaging such as X-ray

153
Q

Reactivation of TB presents with?

A

Non specific symptoms such as fever, cough, weight loss, and night sweats

154
Q

Chest X ray for reactivation of TB shows?

A

Upper lobe infiltrates with cavities.

155
Q

In pneumonia what happens to the A-a gradient and why?

A

Hypoxia results in increased A-a gradient. There is alveolar and interstitial inflammation leading to a V/Q mismatch.

156
Q

What is the definition of obesity hypoventilation syndrome

A

BMI => 30kg/m2, daytime hypercapnia (PaCO2 >45mmHg) and alveolar hypoventilation

157
Q

What does ABG show for obesity hypoventilation syndrome?

A

Respiratory acdisosi, hypercapnia, hypoxemia

158
Q

What is first line treatment for obesity hypoventilation syndrome?

A

Noninvasive postive pressure ventilation and weight loss

159
Q

What is the most common source of symptompatic pulmonary embolisms?

A

Proximal deep leg veins

160
Q

PE in patients with pleural effusion show increased or decreased 1) tactile fremitus 2) percussion 3) breath sounds over the effusion

A

1) Increased 2) dullness 3) decreased breath sounds.

161
Q

Development of clubbing and sudden-onset joint arthropathy in a chronic smoker is suggestive of?

A

Hypertrophic osteoarthropathy

162
Q

Hypertrophic osteoarthropathy is associated with what?

A

Lung cancer (and would need to order chest x-ray) and other lung diseases like TB, bronchiectasis and emphysema.

163
Q

What kind of organism is legionella pneumophila and what does sputum gram stain show

A

Intracellular gram negative. Gram sputum stain shows neutrophils with no organisms

164
Q

What is the tx option for legionnaire’s pneumonia

A

Fluoquinolines like levofloxacin or newer macrolides.

165
Q

Undiagnosed pleural effusion is best evaluated with what procedure?

A

Thoracocentesis to determine whether it is a transudate or exudate

166
Q

Thoracocentesis is the best way to evaluate undiagnosed pleural effusion except in patients with?

A

clear cut evidence of CHF

167
Q

When should antibiotics be given to a patient with acute exacerbation of COPD?

A

2 of 3 cardinal symptoms (increased cough, sputum production, dyspnea), Moderate to severe exacerbation, Or those needing mechanical ventilation

168
Q

Recommended antibiotics for patient with acute exacerbation of COPD?

A

Recommendend antibiotics: macrolides (azithromycin), fluoroquinolones (levofloxin) or pencillins/beta-lactamase inhibitors. Duration of antibiotic therapy – 3-7days

169
Q

What does chest x ray show for ARDS?

A

Bilateral alveolar infiltrates.

170
Q

ARDS is a dx of?

A

Exclusion. Objective assessment is needed to definitely exclude hydrostatic pulmonary edema

171
Q

What is required in an empyema that shows a complex loculated effusion with a thick surrounding peel?

A

Surgery. Removal of the peel is called decortication. Pus then needs to be drained.

172
Q

Asbestos exposure increases risk of?

A

Pulmonary fibrosis and malignancy. Bronchogenic carcinoma is the most common malignancy.

173
Q

CHF commonly causes what kind of effusions

A

Transudative effusions (bilateral 61%, uinlateral right sided 27%, unilateral left sided 12%).

174
Q

Normal pleural fluid, transudate and exudate pH?

A

Normal is 7.6, transudate is 7.4-7.55, exudate is 7.3-7.45.

175
Q

What is common in Hodgkin lymphoma patients treated with chemotherapy and radiation?

A

Secondary malignancy

176
Q

What are the most common secondary solid tumor malignancies for Hodgkin Lymphoma patients?

A

Lung (especially smokers), breast, thyroid, bone and GI. Note. HL patients txed with chemotherapy and radiation also have increased risk of developing non HL and acute leukemia.

177
Q

Patients on high doses of beta-2 agonists (for example for acute asthma attacs) may develop?

A

Hypokalemia, which may present as muscle weakness, EKG abnormalities, arrythmias. Other common side effects are tremors, palpitations and headaches.

178
Q

Empyemas most commonly occur due to?

A

Untreated pneumonia due to bacterial seeding of pleural effusion.

179
Q

ARDS is a/w what what PF ratio?

A

PaO2/FIO2

180
Q

ARDS is due to (pathophysiology)

A

Impaired gas exchange, pulmonary hypertension, decreased lung compliance (stiff lungs).

181
Q

Exudative pleural effusion along with pleural fluid acidosis (pH

A

Patients with complicated parapneumonic effusions, rheumatoid pleurisy, drug-induced lupus, TB and malignancy

182
Q

DLCO is what in emphysema, chronic bronchitis and interstitial lung disease?

A

Decreased in emphysema, normal in chronic bronchitis and decreaed in interstitial lung diseases.

183
Q

Patients with layrngeal edema typically present with?

A

Acute onset dyspnea

184
Q

What should be immediately ruled out in a patient with presents with acute onset dyspnea?

A

Upper airway obstruction

185
Q

How does bronchiectasis present?

A

Cough, mucopurulent sputum, and hemoptysis that responds to antibiotices

186
Q

What imaging is done for definitiive dx of bronchiectasis?

A

High resolution Chest CT. Chest x-ray is frequently abnormal but it’s not as sensitive nor specific as high rest CT

187
Q

What are the most common causes of secondary digital clubbing?

A

Lung malignancies (bronchogenic carcinoma, metastatic cancers, malignant mesothelioma, lymphoma)

188
Q

Does COPD with or without hypoxemia cause digital clubbing?

A

No

189
Q

Presence of digital clubbing should prompt?

A

Search of occult malignancy

190
Q

What is hypertrophic osteoarthropathy?

A

Digital clubbing along with painful joint enlargement, periostosis (excessive bone formation) of long bones, and synovial effusions.

191
Q

What are the criteria for COPD patients to receive home oxygen therapy.

A

Patients with PaO255% should be started on home oxygen when the PaO2

192
Q

How is atypical pneumonia different from pyogenic pneumonia in its presentation?

A

More indolent course, non-producrive cough and high incidence of extrapulmonary manifestations

193
Q

What skin lesion is characteristic of mycoplasma pneumoniae?

A

Erythema multiforme.

194
Q

What is the most common atypical pneumonia in the ambulatory setting?

A

Mycoplasma pneumoniae.

195
Q

Granulomatosis with Polyangitis (Wegener’s) is defined clinically as the triad of?

A

Systemic vasculitis, upper and lower airway granulomatous inflmammation and glomeruloneprhtiis.

196
Q

What is the gold standfard for diagnosing obstructive sleep apnea

A

Nocturnal polysomnography

197
Q

What is the ppt for pulmonary sarcoidosis?

A

Insidious onset dyspnea, dry cough in the absence of constitutional symptoms

198
Q

What are the common skin and eye manifestations of sarcoidosis?

A

Erythema nodosum and anterior uveitis.

199
Q

Patients with ankylosing spondylistis can develop what kind of lung disease?

A

Restrictive lung disease due to diminished chest wall and spinal mobility

200
Q

What do PFTs show for ankylosting spondylitis?

A

Midly restrictive pattern with reduced vital capacity and total lung capacity but normal FEV1/FVC

201
Q

ESR has greatest clinical utility in diagnosing?

A

Temporal arteritis, polymyalgia rheumatica

202
Q

Thymomas are generally found in which mediastinum?

A

Anterior

203
Q

Neurogenic cysts are generally found in which mediastinum?

A

Posterior

204
Q

Rhonchi are usually caused by?

A

Secretions in the airway

Medicine Shelf (11 decks)

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