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CPD > Week 8 > Flashcards

Week 8 Flashcards

1
Q

Pleural effusion

A

excess fluid in pleural space (10-20 mL)

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2
Q

The normal pleural space contains __mL of fluid.

A

1

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3
Q

Effusion of lymph

A

chylothorax

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4
Q

Effusion of pus

A

empyema

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5
Q

Effusion of blood

A

hemothorax

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6
Q

Effusion of serous fluid

A

hydrothorax

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7
Q

SSx: pleural effusion

A

dyspnea (MC), mild/np cough, chest pain

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8
Q

PE: pleural effusion

A

+egophony at top of fluid, decreased breath sounds, decreased tactile fremitus, pleural friction rub, mediastinal shift away from effusion, dullness to percussion

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9
Q

Lab: pleural effusion

A

CMP, thoracentesis (surgical removal of fluid)

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10
Q

Comparison (cause): exudate vs transudate

A

exudate - local inflammation

transudate - systemic problem (inc hydrostatic/dec osmotic pressure)

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11
Q

Comparison (appearance): exudate vs transudate

A

exudate - cloudy

transudate - clear

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12
Q

Comparison (specific gravity, protein, LDH): exudate vs transudate

A

exudate - high, high, high (low in sugar)

transudate - low, low, low

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13
Q

Etiology: exudate

A

lung infx, malignancy, PE, RA, SLE, TB, asbestos, chest trauma, sarcoidosis

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14
Q

Etiology: transudate

A

CHF, cirrhosis, atelectasis, hypoalbuminemia, constrictive pericarditis, myxedema

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15
Q

Etiology: pleural empyema

A

bacteria, fungi, amoebas (in connection w/ pneumonia, chest wounds, chest surgery, lung abscesses, ruptured esophagus)

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16
Q

Common organisms: pleural empyema

A

S. pneumoniae, H. influenzae, S. aureus

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17
Q

SSx: pleural empyema

A

symptoms of pneumonia (fever, cough, dyspnea, chest pain, bad breath); severe (hemoptysis, high fever, dehydration)

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18
Q

Pneumothorax

A

free air/gas in pleural cavity -> collapse of lung

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19
Q

Etiology: spontaneous pneumothorax

A

idiopathic, 2˚ to emphysema, interstitial lung dz, CF, asthma, abscess, TB, CA;

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20
Q

Population: spontaneous pneumothorax

A

tall/thin people

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21
Q

Etiology: traumatic pneumothorax

A

chest trauma, lung bx, mechanical ventilation

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22
Q

SSx: pneumothorax

A

dyspnea (90%), sharp pain (90%), occ dry cough

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23
Q

PE: pneumothorax

A

dec vocal fremitus, decreased/absent breath sounds, tympanic sounds on percussion, trachial deviation to contralateral side

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24
Q

Dx: pneumothorax

A

CXR (air between lung/pleura, contralateral mediastinal shift)

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25
Q

General clinical features of ILDs

A

progressive dyspnea, persistent np cough, mb hemoptysis, occupational exposure Hx
extrapulmonary sx (musculoskeletal pain, weakness, fatigue, fever, photosensitivity)
PE (crackles, pulmonary HTN, clubbing, nodules, rashes)
PFT (dec TLV/FVC)

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26
Q

Etiology: hypersensitivity pneumonitis

A

inhaled organic dusts (fibers, animal dander, mold birds)

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27
Q

SSx: hypersensitivity pneumonitis

A

usu nonspecific

chronic/recurrent cough, dyspnea

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28
Q

Acute hypersensitivity pneumonitis

A 
acute onset
4-6 hrs after expsosure
Sx - fever/chills, dry cough, malaise, HA, chest tightness
PE - tachypnea, crackles at lung base
usu NO wheezing
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29
Q

Subacute hypersensitivity pneumonitis

A

gradual onset
Sx - cough, dyspnea, fatigue, anorexia, wt loss
PE - tachypnea, diffuse crackles

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30
Q

Chronic hypersensitivity pneumonitis

A

insidious onset
Sx - cough, progressive dyspnea, fatigue, wt loss
PE - crackles, mb clubbing, inspiratory squawk

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31
Q

Pathophysiology: hypersensitivity pneumonitis

A

Type III/IV delayed allergic rxn to triggers

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32
Q

Dx: hypersensitivity pneumonitis

A

CBC, allergy testing, PFT (restrictive changes), BAL (broncho-alveolar lavage shows lymphocytosis)

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33
Q

CXR: 3 types of hypersensitivity pneumonitis

A

acute - diffuse interstitial micronodular “ground glass” opacities
subacute - micronodular, reticular opacities
chronic - loss of lung volume, alveolar destruction (“honeycombing”)
CT - ground-glass opacities
Lung bx

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34
Q

Complications: hypersensitivity pneumonitis

A

permanent lung damage w/ pulmonary fibrosis
spontaneous pneumothorax d/t bleb rupture
cor pulmonale/death d/t chronic resp insufficiency

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35
Q

Eosinophilic pulmonary disorder

A

allergic response w/ accumulation of eosinophils in alveolar spaces/interstitium

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36
Q

Etiology: eosinophilic pulmonary disorder

A

allergic rxn to filaria, medicatoin, intestinal parasites, candida albicans, aspergillus fumigata, inhaled toxins

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37
Q

Acute eosinophilic pneumonia

A

idiopathic
acute eosinophilic infiltration of lung interstitium
Sx - <7 days of fever, dry cough, dyspnea, malaise, night sweats, pleuritic chest pain
PE - tachypnea, crackles, rhonchi, mb pleural effusion
Dx - CT, CBC (eos), pleural fluid analysis (eos, high pH), CXR (opacities), bronchoscopy

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38
Q

Chronic eosinophilic pneumonia

A

idiopathic
Sx - fever, wt loss, fatigue, dyspnea, dry cough, wheezing
Dx - CBC (eos), inc ESR, CXR (opacities in mid/upper lobes)
DDx - community-acquired pneumonia

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39
Q

Drug-induced ILD

A

antibiotics, chemo, anti-arrythmics, statins (cholesterol), illicit drugs, anticoagulants
Dx - response to withdrawal of suspected trigger

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40
Q

Environmental-caused ILD

A

Get Exposure Hx!
Sx - progressive dyspnea, exercise limitation, dry cough (restrictive changes)
PE - mid-to-late inspiratory crackles, tachypnea, late (pulmonary HTN -> cor pulmonale, cyanosis)
Dx - CXR (patchy, subpleural, bibasilar interstitial infiltrates, “honeycombing”)

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41
Q

Asbestosis

A

Source - old houses, mining, milling
Sx - progressive dyspnea, coughing/wheezing w/ smokers
DDx - emphysema, chronic bronchitis
Asbestosis -> pulmonary fibrosis, bronchogenic carcinoma, mesothelioma

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42
Q

Silicosis

A

Source - mining, pottery, sand-blasting, brick-making, foundries, glassmakers
5-20 yrs after exposure
Sx - dry cough, dyspnea, tachypnea, wt loss (late), hemoptysis
Dx: CXR (>1 cm nodules in upper lobes, eggshell calcification of hilar nodes)
DDx: emphysema, chronic bronchitis

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43
Q

Anthracosis

A

“black lung”
> 15 yr exposure, worse in smokers
Sx - mb no resp symptoms, mb prod cough, severe (massive fibrosis)

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44
Q

Berylliosis

A

older fluorescent light bulbs, ceramic, chm plants, electronics, aerospace industry
Sx - dyspnea, cough, wt loss

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45
Q

Anemia is a decrease in ___

A

RBCs, Hct, or Hb content

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46
Q

Bleeding Disorders: questions to ask about the menstrual cycle

A

Do you have to get up in the middle of the night to change a tampon?
How often do you have to change your tampon (< 2 hours)?

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47
Q

Bleeding Disorders: vitals

A

mb tachypnea, tachycardia, orthostatic hypotension, fever

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48
Q

Bleeding Disorders: PE

A

pallor (palm lines, conjunctiva, mucus membrane), abdominal (hepatosplenomegaly), nails (cyanosis), ridges, spooning), peripheral neuropathy (B12/folate), cardiovascular (ht failure, ht murmurs), petechiae

49
Q

Definition: microcytic

A

MCV < 80 fL

50
Q

Etiology: microcytic anemia

A

defective heme/globing synthesis

Ex - iron deficiency, thalassemia, copper deficiency, zinc poisoning, lead poisoning, alcohol

51
Q

Definition: macrocytic

A

MCV > 95 fL

52
Q

Etiology: normocytic anemia

A

bone marrow failure

53
Q

Etiology: macrocytic anemia

A

defective DNA synthesis

Ex - B12, folate deficiencies

54
Q

What is the most common form of anemia?

A

iron-deficiency anemia

55
Q

SSx: iron-deficiency anemia (severe)

A

pica, glossitis, cheilosis, concave nails, tachypnea, dyspnea, restless leg syndrome, xerostomia, alopecia

56
Q

What improves non-heme iron absorption?

A

ascorbic acid

57
Q

What can reduce absorption of iron?

A

antacids (calcium), phytates (wheat), tannins, lead, soy protein

58
Q

What malabsorption disorder can affect iron absorption?

A

achloryhydria, atrophic gastritis, H. plyori infx, SIBO, gastric bypass, celiac dz

59
Q

Anisocytosis

A

RBCs w/ excessive size variation

60
Q

Poikilocytosis

A

RBCs w/ excessive shape variation

61
Q

Etiology (male): iron-deficiency anemia

A

chronic bleeding (colon cancer, colitis, PUD, ASA use), malabsorption/malnutrition

62
Q

Etiology (female): iron-deficiency anemia

A

menstruation (MC), repeated pregnancy, malabsorption/malnutrition

63
Q

Etiology (infants): iron-deficiency anemia

A

growth spurts

64
Q

Lab: iron-deficiency anemia

A

stool occult blood, iron absorption test, CBC w/ peripheral smear, serum iron/ferritin, iron-binding capacity

65
Q

SSx: iron-deficiency anemia (mild)

A

fatigue, HA, irritability, unable to concentrate, weakness, pallor

66
Q

Pathophysiology: sideroblastic anemia

A

abnormal utilization of marrow iron despite adequate stores (not a deficiency)

67
Q

Pathophysiology: G6P deficiency

A

reduced available energy for RBC membrane integrity -> hemolysis of cells exposed to peroxide/oxidants (fava beans)

68
Q

Etiology: G6P deficiency

A

abnormal enzymes, genetic polymorphism, drug sensitivity; X-linked disorder; 12% AFAM males, Mediterranean descent

69
Q

SSx: G6P deficiency

A

anemia; sudden onset of jaundice, pallor and dark urine; mb renal failure

70
Q

Lab Findings: G6P deficiency

A

anemia, reticulocytosis, mb Heinz bodies, bite cells

71
Q

Prognosis: G6P deficiency

A

usu self-limited

72
Q

Triggers: G6P deficiency

A

stress, fever, acute infx, diabetes

73
Q

Pathophysiology: hypophosphatemia

A

low phosphate depletes RBC ATP -> rigid RBC that are more susceptible to injury

74
Q

Lab findings: hypophosphatemia

A

small, spheroid RBCs

75
Q

Etiology: stomatocytosis

A

congenital or acquired (excessive alcohol ingestion)

76
Q

SSx: stomatocytosis

A

same as anemia

77
Q

Lab findings: stomatocytosis

A

straight/rectangular area of central pallor

78
Q

Pathophysiology: stomatocytosis

A

increased RBC membrane fragility

79
Q

Etiology: spherocytosis/elliptocytosis

A

congenital (autosomal dominant)

80
Q

SSx: spherocytosis/elliptocytosis

A

mod jaundice and anemia, mb hepatomegaly, splenomegaly, cholelithiasis

81
Q

Lab findings: spherocytosis/elliptocytosis

A

spheroidal/oval RBCs, anisocytosis, normal/low MCV, inc MCHC, reticulocytosis/leukocytosis common, RBC osmotic fragility normal, inc LDH and unconjugated bilirubin, decreased serum haptoglobin

82
Q

Pathophysiology: autoimmune hemolytic anemia

A

body make antibodies for its own RBC -> hemolysis

83
Q

2 types of autoimmune hemolytic anemia

A

warm (MC, women) and cold

84
Q

Etiology: warm autoimmune hemolytic anemia

A

viral infx, immune deficiency, drugs, SLE, lymphoma, CLL

85
Q

SSx: warm autoimmune hemolytic anemia

A

anemia, mild splenomegaly; severe (fever, chest pain, syncope, ht failure)

86
Q

Etiology: cold autoimmune hemolytic anemia

A

infx (myco. pneu.), lymphoproliferative state, idiopathic (50%)

87
Q

Comparison (location): warm vs cold autoimmune hemolytic anemia

A

warm - spleen

cold - liver

88
Q

SSx: cold autoimmune hemolytic anemia

A

acrocyanosis, Raynaud’s, levido reticularis, scleral icterus, splenomegaly

89
Q

Dx: autoimmune hemolytic anemia

A

direct antiglobulin test

90
Q

Intrinsic causes of hemolytic anemia

A

abnormal RBC membranes, RBC metabolism disorder, hemoglobinopathies

91
Q

Extrinsic causes of hemolytic anemia

A

hypersplenism, toxic exposure, autoimmune dz, mechanical injury, infx

92
Q

3 main labs/PE to do when hemolytic anemia is suspected

A

check for splenomegaly, Coombs’ test (autoimmunity), peripheral smear

93
Q

Lab findings: hemolytic anemia

A

inc bilirubin, LDH; normal ALT; anemia, reticulocytosis

94
Q

SSx: hemolytic anemia

A

acute (uncommon) - fever, chills, back/abd pain, shock

severe - jaundice, splenomegaly

95
Q

Pathophysiology: macrocytic anemia

A

defective DNA synthesis

96
Q

Etiology: macrocytic anemia

A

alcoholism and B12/folate deficiency MC; drugs, hypothyroid, liver dz

97
Q

SSx: macrocytic anemia

A

usu no sxs until severe; neurological signs (dementia, stocking/glove neuropathy), glossitis, diarrhea, muscle wasting

98
Q

Labs: macrocytic anemia

A

CBC w/ peripheral smear, B12/folate levels

99
Q

Lab findings: macrocytic anemia

A

MCV > 95-100, anisocytosis, poikilocytosis, inc RDW, Howell-Jolly bodies, hypersegmented PMNs -> neutropenia

100
Q

Pathophysiology: myelophthisic anemia

A

bone marrow is replaced by tumor/granuloma/lipid storage dz/fibrosis

101
Q

SSx: myelophthisic anemia

A

those of underlying dz, mb splenomegaly

102
Q

Labs: myelophthisic anemia

A

CBC w/ peripheral smear, marrow bx (definitive)

103
Q

Lab findings: myelophthisic anemia

A

anisocytosis, poikilocytosis, nucleated RBC, immature myeloid cells

104
Q

What constitues aplastic or hypoplastic anemia?

A

pancytopenia or pure red cell aplasia

105
Q

Etiology: aplastic/hypoplastic anemia

A

genetic or acquired (drugs, pesticides, industrial chemicals, benzenes, anti-cancer agents, infx)

106
Q

Fanconi’s anemia

A

rare, inherited aplastic anemia; anemia, bone abnormalities, microcephaly, hypopigmentation/cafe-au-lait spots; usu dx in childhood

107
Q

SSx: aplastic/hypoplastic anemia

A

insidious or acute; agranulocytosis, thrombocytopenia (petechiae, ecchymosis, bleeding gums), anemia (pallor, tachycardia, fatigue, dizziness)

108
Q

Aplastic anemia should be suspected in ___

A

young patients with pancytopenia

109
Q

Dx: aplastic/hypoplastic anemia

A

CBC w/ peripheral smear, iron, reticulocytes, bone marrow bx

110
Q

Lab findings: aplastic/hypoplastic anemia

A

dec RBCs, WBCs, platelets, reticulocytes; inc serum iron; acellular bone marrow (diagnostic)

111
Q

Etiology: anemia of chronic dz

A

infx, inflammatory dz, neoplastic dz, severe trauma, ht failure, DM, anemia of elderly

112
Q

Anemia of chronic dz should be suspected in ___

A

microcytic or marginal normocytic anemia w/ chronic infx, cancer or inflammation

113
Q

Labs: anemia of chronic dz

A

CBC w/ peripheral smear, serum iron, transferrin, transferring receptor, serum ferritin; ESR/CRP if underlying cause unknown

114
Q

SSx: anemia of chronic dz

A

sxs of the underlying dz

115
Q

Lab findings: anemia of chronic dz

A

mild-mod anemia, initially normochromic/normocytic -> microcytic/hypochromic, RDW in early stages, low serum iron/TIBC, low EPO

116
Q

Lab findings: iron-deficiency anemia

A

microcytic anemia, inc RDW, dec Red cell count, low iron and/or ferritin, inc TIBC, low Hb/Hct/RBC/MCV

117
Q

Findings (sideroblastic anemia): CBC

A

microcytic (hypochromic or normochromic), inc RDW, anisocytosis, siderocytes (targeted RBCs), inc serum iron/transferrin/ferritin, ringed sideroblasts, erythroid hypoplasia

118
Q

Bleeding Disorders: history

A

diet, GI assessment, menstruation, CA, COPD, CHF, Ht dz, marathon running, FHx, alcoholism, drugs

119
Q

Labs: sideroblastic anemia

A

CBC w/ peripheral smear, iron, ferritin, bone marrow bx, erythrocyte protoporphyrin, lead screen if cause is unknown

CPD (8 decks)

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