Uworld Respiratory Flashcards
Next steps depending on the risk of a solitary pulmonary nodule?
Low risk: serial CT scans
Intermediate risk:
1. If 1 cm – PET scan
High risk: surgical excision
Assessment of malignancy risk for solitary pulmonary nodule? (Diameter, age, smoking, smoking cessation, nodule characteristics)
Low risk: less than 1.5 cm, less than 45 years, never, quit in seven years ago, smooth
Intermediate risk: 1.5 to 2.2 cm, 45 to 60 years, less than 20 per day, quit less than seven years ago, scalloped
High risk: > 2.3 cm, >60 years, >20 per day, never, Corona Radiate/spiculated
Peak airway pressure?
Resistive pressure (flow x resistance) + Plateau pressure
Plateau pressure?
Elastic pressure + PEEP
Elastic pressure?
Tidal volume / compliance
Causes of Increased peak pressure with normal plateau pressure?
Bronchospasm, mucous plug, biting ET tube
Causes of increased peak pressure and increased plateau pressure
Pneumothorax, pulmonary edema, pneumonia, atelectasis
Shunt versus dead space?
Perfusion without ventilation (atelectasus) versus Ventilation without perfusion (PE)
In ventilation, goal FiO2 level?
50 to 60%
Bacterial causes of empyema?
Strep pneumonia, staph aureus, Klebsiella
Patient with PE. Best way to anticoagulate?
Start heparin and warfarin. Stop heparin in 5 to 6 days.
Recurrent bacterial infections in an adult patient indicates? Work up?
Humoral immunity defect. Quantitative measurement of serum immunoglobulin levels
Wedge shaped pleural-based opacification on x-ray signifies?
PE
Diarrhea increases chance of what pulmonary pathology?
PE via dehydration
Patient with dry cough, weight loss, pain in the right arm?
Pancoast tumor
90% of PEs come from which veins?
Deep veins (iliac, femoral, popliteal)
Can present with erythema multiforme and interstitial infiltrates?
Mycoplasma pneumonia
Patient with parapneumonic effusion. Aspiration result that would necessitate chest tube for drainage?
Empyema. pH <7.2
Common causes of hemoptysis?
- Pulmonary (bronchitis, PE, bronchiectasis, PNA, lung cancer)
- Cardiac (mitral stenosis)
- Infectious (tuberculosis, aspergillosis, lung abscess)
- Hematologic (coagulopathy)
Pickwickian syndrome? Leads to?
Obesity hypoventilation syndrome – obesity impedes expansion of chest and abdominal wall doing breathing. Leads to chronically elevated PaCO2.
pH ranges of pleural effusions?
7.64 – normal pleural fluid pH
<7.2 indicates empyema
Glucose level <60 in pleural effusion suggests what causes?
Parapneumonic effusion, tuberculosis, rheumatoid arthritis
Indicators of a severe asthma attack?
- Normal/increased PCO2
- Speech difficulty
- Diaphoresis
- Cyanosis
Theophylline mechanism of action? Toxicities?
1 Bronchodilation via phosphodiesterase inhibition
2. Increased diaphragm contraction via increased calcium uptake through adenosine channels
Toxicity:
- CNS stimulation (headache, insomnia, seizures)
- Cardiac toxicity (arrhythmia)
- G.I. disturbances (n/v)
Antimuscarinics used in COPD?
Ipratropium and Tiotropium
Complications of ventilation with a high PEEP?
Alveolar damage, tension pneumothorax, hypotension
Lofgren’s syndrome?
Erythema nodosum, hilar lymphadenopathy, migratory polyarthralgias, fever
Most common adverse associated with inhaled steroids?
Oral thrush
When to use non-invasive positive pressure ventilation?
When pt is refractory to medical therapy but not crashing (before intubation)
Specifically, when pH25
SVC syndrome?
Dyspnea
Venous congestion
Swelling of head, neck and arms
ARDs vs Cardiogenic pulmonary edema?
Wedge pressure < 18 in ARDs
Causes of exudative effusions?
- Infection
- malignancy
- pulmonary embolism
- connective tissue disease
- iatrogenic
COPD, when does oxygen have a mortality benefit?
PaO2 55
Cor pulmonale
Complications of PEEP?
Alveolar damage, tension pneumothorax, hypotension
dyspnea from long standing HTN leads to? Tx?
Left sided heart failure. Nitroglycerin
