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Rosh Review > Thoracic Respiratory Disorders > Flashcards

Thoracic Respiratory Disorders Flashcards

1
Q

What is pulsus paradoxus?

A
  • Increased intrathoracic or right heart pressure inhibits venous return during deep inspiration causing a drop in blood pressure
  • Generally >10 mm Hg
  • **pic Q766713
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2
Q

Conditions associated with pulsus paradoxus

A
  • Obstructive lung disease
  • Cardiac tamponade
  • Constrictive pericarditis
  • Vena cava thrombus
  • Pulmonary embolism
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3
Q

What are three complications of acute sinusitis?

A
  • Cavernous sinus thrombosis
  • Meningitis
  • Orbital cellulitis
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4
Q

Most common cause of developing empyema?

A

Pneumonia with parapneumonic effusion

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5
Q

Diagnosis of empyema

A

Aspiration of grossly purulent material or one of the following:

  • positive gram stain or culture
  • pleural glucose <60
  • pH <7.2
  • LDH >1,000
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6
Q

Tx of empyema

A
  • Zosyn or imipenem with addition of vanc if MRSA is a concern
  • Fibrinolytics administered intrapleurally may be necessary if empyema is loculated
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7
Q

Most common organisms that cause empyema

A

Strep pneumo and staph aureus

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8
Q

Phases of pertussis

A
  1. Catarrhal phase (1-2 weeks)
    - Mild fever, cough, rhinorrhea
    - Conjunctival injection
    - Excessive lacrimation
  2. Paroxysmal phase (2-6 weeks)
    - “whooping” cough
    - Inspiratory stridor
  3. Convalescent phase (1-2 months)
    - Gradual reduction in symptoms
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9
Q

Diagnosis clues to pertussis

A
  • lymphocytosis

- radiograph showing peribronchial thickening, atelectasis, pulm consolidation

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10
Q

Bugs that are the culprit in cystic fibrosis infections

A
  • Staph aureus
  • H. Flu
  • Pseudomonas
  • Burkholderia
  • Stenotrophomonas
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11
Q

Most common cause of bacterial superinfection complicating influenza virus infection

A

Strep pneumo (staph aureus is second most common)

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12
Q

Light Criteria for Pleural Effusion

A

Transudate:
Pleural:Serum protein = 0.5
Pleural:Serum LDH = 0.6
Pleural fluid LDH <2/3 upper limit of normal

Exudate:
Pleural:Serum protein >0.5
Pleural:Serum LDH >0.6
Pleural fluid LDH >2/3 upper limit of normal

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13
Q

Causes of transudative pleural effusion

A
  • Heart Failure
  • Cirrhosis
  • Nephrotic Syndrome
  • Pulmonary Embolism
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14
Q

Causes of Exudative Pleural Effusion

A
  • Malignancy
  • Bacterial/Viral PNA
  • TB
  • Pancreatitis
  • Esophageal Rupture
  • Collagen Vascular Disease
  • Chylothorax/hemothorax
  • Pulmonary Embolism
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15
Q

How many mLs of a pleural effusion can be detected on x-ray?

A

200mL

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16
Q

Differences between aspiration pneumonitis vs. aspiration pneumonia: Mechanism

A

Pneumonitis: aspiration of sterile gastric contents
Pneumonia: aspiration of colonized oropharyngeal material

17
Q

Differences between aspiration pneumonitis vs. aspiration pneumonia: pathophysiologic process

A

Pneumonitis: acute lung injury from acidic and particulate gastric material
Pneumonia: acute pulmonary inflammatory response to bacterial and bacterial products

18
Q

Differences between aspiration pneumonitis vs. aspiration pneumonia: Bacteriologic findings

A

Pneumonitis: Initially sterile, with subsequent bacterial infection possible
Pneumonia: Gram-positive cocci, gram-negative rods, and anaerobic bacteria

19
Q

Differences between aspiration pneumonitis vs. aspiration pneumonia: chief predisposing factors

A

Pneumonitis: Markedly depressed level of consciousness
Pneumonia: Dysphagia and gastric dysmotility

20
Q

Differences between aspiration pneumonitis vs. aspiration pneumonia: Age group affected

A

Pneumonitis: any age group, usually young
Pneumonia: usually elderly

21
Q

Differences between aspiration pneumonitis vs. aspiration pneumonia: Clinical features

A

Pneumonitis: No sx or symptoms ranging from a nonproductive cough to tachypnea, bronchospasm, bloody or frothy sputum, and respiratory distress 2-5 hours after aspiration

Pneumonia: Tachypnea, cough, signs of pneumonia

22
Q

In patients with COPD, best changes in vent settings?

A

Increase tidal volume over increasing respiratory rate as this would increase expiratory phase, resulting in a buildup of pressure prior to the lungs emptying completely

23
Q

Which lung cancer causes paraneoplastic hypercalcemia?

A

Squamous cell carcinoma

24
Q

What type of lung cancer is associated with SIADH?

A

Small cell lung cancer

25
Q

Causes of ARDS

A
  • Sepsis
  • High-altitude pulmonary edema
  • Re-expansion pulmonary edema s/p large volume thoracentesis
  • Drugs and toxins
  • Inhalation injuries
  • Aspiration syndromes
  • Fat emboli
26
Q

What drugs/toxins can cause ARDS?

A
  • Meprobamate
  • Opioids
  • Naloxone
  • Phencyclidine
  • Salicylates
27
Q

What pulmonary artery wedge pressure indicates non-cardiogenic pulmonary edema?

A

<18 mm Hg

28
Q

Extrapulmonary findings that support diagnosis of asthma

A
  • Pharyngeal cobblestoning - suggests allergic rhinitis

- Atopic dermatitis with lichenified plaques in flexural areas such as antecubital fossa

29
Q

Spectrum of diseases associated with EVALI (e-cigarette and vaping associated lung injury)

A
  • Fibrinous pneumonitis
  • Diffuse alveolar hemorrhage
  • Eosinophilic or lipoid pneumonia
30
Q

What is the typical CXR finding in EVALI?

A

Diffuse bilateral hazy opacities

31
Q

Tx of EVALI in ED?

A

Supportive care with O2 vs. need for mechanical ventilation
Empiric abx coverage for potential bacterial pneumonia
Systemic glucocorticoids are controversial

32
Q

Most common sites of metastasis of breast cancer?

A

Bone, liver, and lungs

33
Q

Two common pediatric respiratory illnesses RSV is known to cause?

A

Bronchiolitis and Laryngotracheitis (croup)

34
Q

What is the typical presentation of familial Mediterranean fever?

A

Recurrent fever lasting 1-4 days with associated pleuritic chest pain

35
Q

What are the three stages of ARDS?

A
  1. Exudative
  2. Fibroproliferative
  3. Fibrotic
36
Q

Which medications can lead to lactic acidosis?

A

Metformin
Salicylates
Propylene glycol

37
Q

Community-Acquired Pneumonia Tx Guidelines

A

Q292953
OUTPATIENT:
Healthy adult, no co morbidities or RF for MRSA or P. Aeruginosa -> amoxicillin (high dose) OR doxy OR macrolide (in areas with <25% resistance)

Adult with comorbidities: Augmentin or cephalosporin AND doxy or macrolide OR respiratory fluoroquinolone monotherapy

INPATIENT:
Standard: Beta-lactam + macrolide OR respiratory monotherapy in nonsevere; beta-lactam + macrolide OR beta-lactam + respiratory fluoroquinolone in severe

Add vanc for prior respiratory MRSA
Add zosyn or cefepime or other coverage if prior pseudomonas

Rosh Review (22 decks)

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