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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
Q

obstructive lung diseases have _______ FEV1/FVC

A

decreased

26
Q

restrictive lung diseases have ________ FEV1/FVC

A

high or normal

because decreased total volume

27
Q

examples of dead space?

A

emphysema, PE

28
Q

relationship between PAO2 and PaCO2?

A

inverse

29
Q

what are changes in isovolume flow in obstructive and restrictive diseases?

A

obstructive: low
restrictive: high

30
Q

how to define obstructive lung disease?

A

FEV1/FVC < 0.7

31
Q

what are examples of vocal cord pathology that could cause extrathoracic obstruction on inspiratory limb on PFTs?

A

vocal cord paralysis, tumor, polyp

32
Q

what causes MUD PILES?

A

AG elevated metabolic acidosis

uremia, diabetic ketoacidosis, lactic acidosis most clinically relevant

33
Q

what is cut off for AG?

A

>18 is anion gap –> tells you AG elevated metabolic acidosis

34
Q

ddx for NAG met alkalosis

A

diarrhea

RTA

NaCl

35
Q

ddx for metabolic alkalosis

A

Cl- responsive: vomiting, diuretic

Cl- unresponsive: too much aldosterone (Cushing’s, primary hyperaldo, renal artery stenosis)

36
Q

what does US spine sign tell you?

A

pleural effusion

37
Q

exudative criteria?

A

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
Q

ddx for transudative effusion?

A

CHF

cirrhosis

nephrotic syndrome

39
Q

ddx for exudative effusion?

A

parapneumonic effusion (as result of pneumonia), malignancy, autoimmune, PE, pancreatitis

40
Q

what is ddx for neutrophilic exudative effusion? for lymphocytic exudative effusion?

A

neutrophilic: infection
lymphocytic: malignancy, TB, autoimmune disease

41
Q

pt with Well’s score >4. what to do??

A

CTPA!!

42
Q

pt with Well’s score 4 or less? what to do??

A

D-Dimer. CTPA only if D-dimer positive

43
Q

acute PE tx?

A

most patients heparin

if PE + shock –> fibrinolytic therapy

44
Q

locations of pulm HTN lesions?

A

pulmonary artery: Group 4

pulm arterial branches (pre-cap): Group 1

capilary bed: Group 3

pulmonary venous branch and pulmonary vein: Group 2

45
Q

frontline therapy for COPD?

A

LABA or LAMA

ICS only for recurrent exacerbations

46
Q

frontline therapy for asthma?

A

inhaled corticosteroid

(never LABA without ICS)

47
Q

what lung tumors are neuroendocrine?

A

small cell!!

also carcinoid

48
Q

what to know about PJP?

A

chronic steroids or severe defects cell med immunity (AIDS)

hypoxemia, diffuse infiltrates

BAL direct fluorescent Ab

tx: trimethoprim-sulfamethoxazole

49
Q

what to know about invasive aspergillus?

A

prolonged neutropenia

fever, pleuritic pain, hemoptysis

halo sign on CT

galactomannan

histopath, ag assays, culture

tx: antifungal therapy (voriconazole, amphotericin)

50
Q

community acquired PNA with dense consolidation most commonly caused by

A

strep pneumo or h flu

51
Q

community acquired PNA with interstitial opacities most commonly caused by

A

viruses, mycoplasma, chlamydia

52
Q

what effects on CV does OSA have?

A

HTN

tachyarrhythmias

increased risk of CHF

pulm HTN (group III)

53
Q

obstructive sleep apnea pattern? central sleep apnea pattern?

A

OSA: diaphragm active during no airflow

central: diaphragm not active while no airflow

54
Q

what are the most common sources of community acquired PNA?

A

virus

strep pneumo

h flu

mycoplasma

chlamydia pneumoniae

legionella

55
Q

what are the most common sources of hospital acquired PNA?

A

staph aureus (including MRSA)

enterobacteriaceae

pseudomonas

acinetobacter baumanni

Pulm Module (8 decks)

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