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Step 2 > Step Up- Pulmonary > Flashcards

Step Up- Pulmonary Flashcards

1
Q

Acid base derrangement present in chronic COPD’ers

A

Respiratory acidosis with metabolic alkylosis

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2
Q

These two agents together are good for control of COPD

A

B-agonist with inhaled anticholinergic like ipratropium

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3
Q

This therapy has been shown to increase survival and quality of life in patients with COPD and chronic hypoxemia

A

Continuous O2

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4
Q

These vaccines should be given to all COPD’ers

A

Pneumococcal

Influensza

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5
Q

Interventions important in acute COPD exacerbation

A

B2 agonist with anticholinergic

ABX (azithro or levoflox)

Supplemental O2 to Sat>90%

PPV (invasive or non)

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6
Q

Asthmatic patient with increasing PCO2…cause? Tx?

A

Cause: Impending respiratory failure

Treatment: Mechanical ventilation

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7
Q

Most common cause of bronchiectasis

A

CF

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8
Q

PFT in bronchiectasis

A

reveal obstructive pattern

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9
Q

Infections frequently seen in CF patient?

A

Pseudomonas

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10
Q

Type of lung cancer that is least associated with smoking?

A

Adenocarcinoma

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11
Q

65 Year old smoker presents with right sided facial fullness and arm swelling as well as redness and sweating on the right face…dx?

A

SVC syndrome- obstruction of SVC by mediastinal tumor

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12
Q

65 year old smoke with shoulder pain radiating down the arm and arm weakness

A

pancoast tumor

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13
Q

Most common sites of lung cancer metastasis?

A

Brain, bone, liver, and adrenal glands

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14
Q

Proximal muscle weakness and fatigability in a 65 year old smoker? What subtype?

A

Eaton-lambert syndrome

typically SCLC– Ab again Ca channels presynaptic

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15
Q

What features of the following suggest malignancy in lung nodules…

Age-

Smoking-

Size-

Borders-

Calcification-

Change in size-

A

Age- >50=50% malignant

Smoking- increses risk

Size- <1cm less likely >2cm more likely

Borders- More irregular= more likely malignant

Calcification- eccentric and asymmetric=more likely malignant. dense and central = less likely

Change in size- enlarging suggests malignancy

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16
Q

Causes of masses in the anterior mediastinum…

A

4 Ts

Thymoma

Teratoma

Terrible lymphoma

Thyroid tumor

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17
Q

Three general causes of pleural effusions

A
  • increased drainage of fluid in to the pleural space
  • Increased production of fluid by pleural cells
  • Decreased drainage from the pleural space
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18
Q

Tests to be performed on an exudative effusion…

A

cell count

pH

Glucose

amylase

triglycerides

micro

cytology

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19
Q

Characteristics of an exudative effusion….

A

Protien (pleural)/(serum) >0.5

LDH (pleural)/(serum) >0.6

Pleural LDH > upper two thrids of normal serum

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20
Q

With a pleural effusion glucose of <60, what disease should be ruled out….

A

RA

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21
Q

FEV1/FVC in intersitial lung disease?

A

increased (restrictive pattern)

Both findings are decreased but the ratio is increased

22
Q

Most popular extrapulmonary manifestation of sarcoidosis?

A

Anterior uveitis and erythema nodosum

23
Q

Granulomatous vasculitis seen in patients with asthma?

A

Chrug-strauss syndrome

24
Q

pulmonary infiltrates with rash and eosinophilia and +p-ANCA

A

Churg-strauss syndrome

25
Q

egg shell calcifications on CXR

A

Silicosis

26
Q

Bilateral linear opcities and hazyn infiltrates on CXR combined with pleural plaques increase the risk of previous exposure to…

A

Asbestos

27
Q

Silicosis is associated with an increased risk of this infection

A

TB

28
Q

autoimmune disease caused by IgG Ab against glomerular and alveolar basement membranes

A

Goodpasture syndrome

Presents with hymoptyisis and dyspnea

29
Q

Causes of acute hypoxemic respiratory failure?

Main mechanism leading to it?

A

Causes are intrinsic lung pathology- ARDS, PNA, pulmonary edema

Mechanism is a V/Q mismatch

THINK– if PaO2 is low but PCO2 is normal or low then this mean CO2 exchange is taking place however O2 is not!

30
Q

Cuases of hypercarbic respiratory failure

A

Underlying lung disease: COPD, Asthma, CF, severe bronchitis

31
Q

Mechanism of hypercarbic respiratory failure

A

Either a decrease in minute ventilation or increase in dead space

Minute vent= Tv * f

32
Q

Will a V/Q mismatch respond to supplemental O2?

A

Yes

33
Q

Is hypoxemia 2/2 a shunt responsive to O2?

A

No– blood flow is good, however there is reduced ventilation in the area of the shunt.

34
Q

Criteria to Dx ARDS

A

Hypoxia resistent to O2 supplementation

Bilateral

r/o other causes (like cardiac)

35
Q

Physiologic event leading to ARDS

A

Massive atelectasis leading to shunting and poor oxygenation

Damage to alveolar membranes causes increased dead space

36
Q

How does PCWP help differentiate ARDS from cardiogenic pulmonary edema

A

PCWP elevated (>18) cardiac cause more likely

PCWP normal/low (<18) ARDS more likely

37
Q

PCWP goal in ARDS to avoid fluid overload?

A

12-15mm Hg

38
Q

Initial Vt in intubated patient?

A

8-10mL/kg

rate 10-12/min

39
Q

Should tidal volumes be lower or higher in ARDS?

A

Lower

40
Q

What is the effect of PEEP on cardiac output?

A

decreases it due to decreased venous return

41
Q

Pressure associated with pumonary HTN?

A

>25mmHg at rest

>30mmHg during exercise

42
Q

Patient with RVH and right atrial abnormality with substernal heave

A

pulmonary HTN

43
Q

This drug promotes the action of ATIII

A

Heparin

44
Q

When to put COPD’ers on O2

A

PO2 <55 (<60 in right heart failure)

O2 sat <88% (<90% in R sided heart failure)

45
Q

Asmatic patient with recurrent episodes of brown-flecked sputum on xray

A

Allergic brochopulmonary aspergillosis

46
Q

This is the best alternative to TMP/SMX in PCP tx

A

Pentamadine or primaquine

IV

47
Q

Alternative to TMP/SMX for PCP prophylaxis

A

atovaquone or dapsone

48
Q

This value is diagnostic for ARDS

A

pO2/FIO2= <300

O2 on abg is 105

Room air= FIO2 of .21 (21%)

105/.21= 500= ARDS

49
Q

CT finding in ARDS

A

Consolidation with air bronchograms

50
Q

Appropriate TV for ARDS?

A

6mL/kg

Low tidal volumes are best to avoid barotrauma

51
Q

Target plateau pressure in ARDS

A

less than 30cmH20

Step 2 (14 decks)

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