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Pulm Module > Review <3 <3 > Flashcards

Review <3 <3 Flashcards

1
Q

which cause of hypoxemia is NOT responsive to O2?

A

SHUNT

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2
Q

what are causes of hypoxemia with normal A-a?

A

decreased Patm (high altitude) decreased FiO2 (fires, mining) increased PaCO2

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3
Q

what are causes of hypoxemia with increased A-a?

A

shunt (perfusion without ventilation) decreased V/Q diffusion limitation

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4
Q

examples of shunt

A

blood, pus, water, atelectasis intracardiac (PFO, ASD, AV malformation) ARDS diffuse alveolar hemorrhage, pneumonia, pulm edema

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5
Q

examples of decreased V/Q

A

COPD (chronic bronchitis) asthma pE

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6
Q

examples of diffusion limitation

A

fibrotic lung disease emphysema

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7
Q

what are the 4 causes of low SvO2?

A

decreased CO anemia hypoxemia (send out less = less back) increased O2 consumption

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8
Q

what makes low DLCO

A

emphysema

ILD

PAH

anemia

R –> L intracardiac shunt

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9
Q

what makes high DLCO

A

polycythemia

DAH

L –> R intracardiac shunt

obesity

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10
Q

causes of increased PaCO2?

A

low minute vent:

  • won’t breathe (head injury, stroke, ICH, CNS infection, CNS depressant drugs, obesity, hypothyroidism)
  • can’t breathe: (neuromuscular disease- ALS, chest wall deformities, obstructive and restrictive lung diseases)

load/strength imbalance

increased dead space: PE, emphysema

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11
Q

decreased PaCO2 will cause what acid base disturbance? what can cause that?

A

resp alkalosis (increased minute vent)

drugs, fever, sepsis, pain/anxiety, mild resp dz, pregnancy, cirrhosis/liver failure, salicylate toxicity

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12
Q

what are 3 important points on oxyhb dissociation curve?

A
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13
Q

what vessels are interlobular? which are intralobular?

A

interlobular: pulmonary veins and lymphatics
intralobular: pulmonary arteries

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14
Q

what is UIP pattern on CT? what does it suggest (although doesn’t confirm!)

A

honeycombing, traction bronchiectasis, basilar predominant, subpleural, reticulation

IPF

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15
Q

what is UIP pattern on path?

A

temporal and spatial heterogeneity

fibroblastic foci

microscopic honeycombing

could be IPF if clinical context is right but NOT diagnostic for IPF

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16
Q

what are radiographic findings of sarcoidosis?

A

upper lobe

nodules and/or fibrosis in bronchovascular distribution

hilar adenopathy

younger pt

other systemic manifestations

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17
Q

pathologic findings of sarcoid?

A

well formed granulomas

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18
Q

what is on ddx for granulomas

A

sarcoid

HP

MTB

endemic fungal infections (histo, blasto)

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19
Q

ARDS is ____ pressure, _____ protein

A

low pressure, high protein

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20
Q

what are criteria for ARDS?

A

hypoxemic respiratory failure (low PaO2/FiO2)

bilateral opacities on CXR

not HF

within 7 days of inciting event

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21
Q

pathologic correlate for IPF

A

UIP

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22
Q

pathologic correlate for ARDS

A

DAD

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23
Q

pathologic correlate for sarcoid

A

well formed granulomas

24
Q

pathologic correlate for HP

A

loose granulomas

25
obstructive lung diseases have _______ FEV1/FVC
decreased
26
restrictive lung diseases have ________ FEV1/FVC
high or normal because decreased total volume
27
examples of dead space?
emphysema, PE
28
relationship between PAO2 and PaCO2?
inverse
29
what are changes in isovolume flow in obstructive and restrictive diseases?
obstructive: low restrictive: high
30
how to define obstructive lung disease?
FEV1/FVC \< 0.7
31
what are examples of vocal cord pathology that could cause extrathoracic obstruction on inspiratory limb on PFTs?
vocal cord paralysis, tumor, polyp
32
what causes MUD PILES?
AG elevated metabolic acidosis uremia, diabetic ketoacidosis, lactic acidosis most clinically relevant
33
what is cut off for AG?
\>18 is anion gap --\> tells you AG elevated metabolic acidosis
34
ddx for NAG met alkalosis
diarrhea RTA NaCl
35
ddx for metabolic alkalosis
Cl- responsive: vomiting, diuretic Cl- unresponsive: too much aldosterone (Cushing's, primary hyperaldo, renal artery stenosis)
36
what does US spine sign tell you?
pleural effusion
37
exudative criteria?
if any of below: pleural fluid total protein/serum \> 0.5 pleural fluid LDH/serum \> 0.6 pleural fluid LDH \> 2/3 of upper normal value of serum LDH
38
ddx for transudative effusion?
CHF cirrhosis nephrotic syndrome
39
ddx for exudative effusion?
parapneumonic effusion (as result of pneumonia), malignancy, autoimmune, PE, pancreatitis
40
what is ddx for neutrophilic exudative effusion? for lymphocytic exudative effusion?
neutrophilic: infection lymphocytic: malignancy, TB, autoimmune disease
41
pt with Well's score \>4. what to do??
CTPA!!
42
pt with Well's score 4 or less? what to do??
D-Dimer. CTPA only if D-dimer positive
43
acute PE tx?
most patients heparin if PE + shock --\> fibrinolytic therapy
44
locations of pulm HTN lesions?
pulmonary artery: Group 4 pulm arterial branches (pre-cap): Group 1 capilary bed: Group 3 pulmonary venous branch and pulmonary vein: Group 2
45
frontline therapy for COPD?
LABA or LAMA ICS only for recurrent exacerbations
46
frontline therapy for asthma?
inhaled corticosteroid (never LABA without ICS)
47
what lung tumors are neuroendocrine?
small cell!! also carcinoid
48
what to know about PJP?
chronic steroids or severe defects cell med immunity (AIDS) hypoxemia, diffuse infiltrates BAL direct fluorescent Ab tx: trimethoprim-sulfamethoxazole
49
what to know about invasive aspergillus?
prolonged neutropenia fever, pleuritic pain, hemoptysis halo sign on CT galactomannan histopath, ag assays, culture tx: antifungal therapy (voriconazole, amphotericin)
50
community acquired PNA with dense consolidation most commonly caused by
strep pneumo or h flu
51
community acquired PNA with interstitial opacities most commonly caused by
viruses, mycoplasma, chlamydia
52
what effects on CV does OSA have?
HTN tachyarrhythmias increased risk of CHF pulm HTN (group III)
53
obstructive sleep apnea pattern? central sleep apnea pattern?
OSA: diaphragm active during no airflow central: diaphragm not active while no airflow
54
what are the most common sources of community acquired PNA?
virus strep pneumo h flu mycoplasma chlamydia pneumoniae legionella
55
what are the most common sources of hospital acquired PNA?
staph aureus (including MRSA) enterobacteriaceae pseudomonas acinetobacter baumanni

Pulm Module (8 decks)

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