Week 8 Flashcards
1
Q
Pleural effusion
A
excess fluid in pleural space (10-20 mL)
2
Q
The normal pleural space contains __mL of fluid.
A
1
3
Q
Effusion of lymph
A
chylothorax
4
Q
Effusion of pus
A
empyema
5
Q
Effusion of blood
A
hemothorax
6
Q
Effusion of serous fluid
A
hydrothorax
7
Q
SSx: pleural effusion
A
dyspnea (MC), mild/np cough, chest pain
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
9
Q
Lab: pleural effusion
A
CMP, thoracentesis (surgical removal of fluid)
10
Q
Comparison (cause): exudate vs transudate
A
exudate - local inflammation
transudate - systemic problem (inc hydrostatic/dec osmotic pressure)
11
Q
Comparison (appearance): exudate vs transudate
A
exudate - cloudy
transudate - clear
12
Q
Comparison (specific gravity, protein, LDH): exudate vs transudate
A
exudate - high, high, high (low in sugar)
transudate - low, low, low
13
Q
Etiology: exudate
A
lung infx, malignancy, PE, RA, SLE, TB, asbestos, chest trauma, sarcoidosis
14
Q
Etiology: transudate
A
CHF, cirrhosis, atelectasis, hypoalbuminemia, constrictive pericarditis, myxedema
15
Q
Etiology: pleural empyema
A
bacteria, fungi, amoebas (in connection w/ pneumonia, chest wounds, chest surgery, lung abscesses, ruptured esophagus)
16
Q
Common organisms: pleural empyema
A
S. pneumoniae, H. influenzae, S. aureus
17
Q
SSx: pleural empyema
A
symptoms of pneumonia (fever, cough, dyspnea, chest pain, bad breath); severe (hemoptysis, high fever, dehydration)
18
Q
Pneumothorax
A
free air/gas in pleural cavity -> collapse of lung
19
Q
Etiology: spontaneous pneumothorax
A
idiopathic, 2˚ to emphysema, interstitial lung dz, CF, asthma, abscess, TB, CA;
20
Q
Population: spontaneous pneumothorax
A
tall/thin people
21
Q
Etiology: traumatic pneumothorax
A
chest trauma, lung bx, mechanical ventilation
22
Q
SSx: pneumothorax
A
dyspnea (90%), sharp pain (90%), occ dry cough
23
Q
PE: pneumothorax
A
dec vocal fremitus, decreased/absent breath sounds, tympanic sounds on percussion, trachial deviation to contralateral side
24
Q
Dx: pneumothorax
A
CXR (air between lung/pleura, contralateral mediastinal shift)
25
General clinical features of ILDs
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)
26
Etiology: hypersensitivity pneumonitis
inhaled organic dusts (fibers, animal dander, mold birds)
27
SSx: hypersensitivity pneumonitis
usu nonspecific
| chronic/recurrent cough, dyspnea
28
Acute hypersensitivity pneumonitis
```
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
```
29
Subacute hypersensitivity pneumonitis
gradual onset
Sx - cough, dyspnea, fatigue, anorexia, wt loss
PE - tachypnea, diffuse crackles
30
Chronic hypersensitivity pneumonitis
insidious onset
Sx - cough, progressive dyspnea, fatigue, wt loss
PE - crackles, mb clubbing, inspiratory squawk
31
Pathophysiology: hypersensitivity pneumonitis
Type III/IV delayed allergic rxn to triggers
32
Dx: hypersensitivity pneumonitis
CBC, allergy testing, PFT (restrictive changes), BAL (broncho-alveolar lavage shows lymphocytosis)
33
CXR: 3 types of hypersensitivity pneumonitis
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
34
Complications: hypersensitivity pneumonitis
permanent lung damage w/ pulmonary fibrosis
spontaneous pneumothorax d/t bleb rupture
cor pulmonale/death d/t chronic resp insufficiency
35
Eosinophilic pulmonary disorder
allergic response w/ accumulation of eosinophils in alveolar spaces/interstitium
36
Etiology: eosinophilic pulmonary disorder
allergic rxn to filaria, medicatoin, intestinal parasites, candida albicans, aspergillus fumigata, inhaled toxins
37
Acute eosinophilic pneumonia
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
38
Chronic eosinophilic pneumonia
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
39
Drug-induced ILD
antibiotics, chemo, anti-arrythmics, statins (cholesterol), illicit drugs, anticoagulants
Dx - response to withdrawal of suspected trigger
40
Environmental-caused ILD
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")
41
Asbestosis
Source - old houses, mining, milling
Sx - progressive dyspnea, coughing/wheezing w/ smokers
DDx - emphysema, chronic bronchitis
Asbestosis -> pulmonary fibrosis, bronchogenic carcinoma, mesothelioma
42
Silicosis
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
43
Anthracosis
"black lung"
> 15 yr exposure, worse in smokers
Sx - mb no resp symptoms, mb prod cough, severe (massive fibrosis)
44
Berylliosis
older fluorescent light bulbs, ceramic, chm plants, electronics, aerospace industry
Sx - dyspnea, cough, wt loss
45
Anemia is a decrease in ___
#RBCs, Hct, or Hb content
46
Bleeding Disorders: questions to ask about the menstrual cycle
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)?
47
Bleeding Disorders: vitals
mb tachypnea, tachycardia, orthostatic hypotension, fever
48
Bleeding Disorders: PE
pallor (palm lines, conjunctiva, mucus membrane), abdominal (hepatosplenomegaly), nails (cyanosis), ridges, spooning), peripheral neuropathy (B12/folate), cardiovascular (ht failure, ht murmurs), petechiae
49
Definition: microcytic
MCV < 80 fL
50
Etiology: microcytic anemia
defective heme/globing synthesis
| Ex - iron deficiency, thalassemia, copper deficiency, zinc poisoning, lead poisoning, alcohol
51
Definition: macrocytic
MCV > 95 fL
52
Etiology: normocytic anemia
bone marrow failure
53
Etiology: macrocytic anemia
defective DNA synthesis
| Ex - B12, folate deficiencies
54
What is the most common form of anemia?
iron-deficiency anemia
55
SSx: iron-deficiency anemia (severe)
pica, glossitis, cheilosis, concave nails, tachypnea, dyspnea, restless leg syndrome, xerostomia, alopecia
56
What improves non-heme iron absorption?
ascorbic acid
57
What can reduce absorption of iron?
antacids (calcium), phytates (wheat), tannins, lead, soy protein
58
What malabsorption disorder can affect iron absorption?
achloryhydria, atrophic gastritis, H. plyori infx, SIBO, gastric bypass, celiac dz
59
Anisocytosis
RBCs w/ excessive size variation
60
Poikilocytosis
RBCs w/ excessive shape variation
61
Etiology (male): iron-deficiency anemia
chronic bleeding (colon cancer, colitis, PUD, ASA use), malabsorption/malnutrition
62
Etiology (female): iron-deficiency anemia
menstruation (MC), repeated pregnancy, malabsorption/malnutrition
63
Etiology (infants): iron-deficiency anemia
growth spurts
64
Lab: iron-deficiency anemia
stool occult blood, iron absorption test, CBC w/ peripheral smear, serum iron/ferritin, iron-binding capacity
65
SSx: iron-deficiency anemia (mild)
fatigue, HA, irritability, unable to concentrate, weakness, pallor
66
Pathophysiology: sideroblastic anemia
abnormal utilization of marrow iron despite adequate stores (not a deficiency)
67
Pathophysiology: G6P deficiency
reduced available energy for RBC membrane integrity -> hemolysis of cells exposed to peroxide/oxidants (fava beans)
68
Etiology: G6P deficiency
abnormal enzymes, genetic polymorphism, drug sensitivity; X-linked disorder; 12% AFAM males, Mediterranean descent
69
SSx: G6P deficiency
anemia; sudden onset of jaundice, pallor and dark urine; mb renal failure
70
Lab Findings: G6P deficiency
anemia, reticulocytosis, mb Heinz bodies, bite cells
71
Prognosis: G6P deficiency
usu self-limited
72
Triggers: G6P deficiency
stress, fever, acute infx, diabetes
73
Pathophysiology: hypophosphatemia
low phosphate depletes RBC ATP -> rigid RBC that are more susceptible to injury
74
Lab findings: hypophosphatemia
small, spheroid RBCs
75
Etiology: stomatocytosis
congenital or acquired (excessive alcohol ingestion)
76
SSx: stomatocytosis
same as anemia
77
Lab findings: stomatocytosis
straight/rectangular area of central pallor
78
Pathophysiology: stomatocytosis
increased RBC membrane fragility
79
Etiology: spherocytosis/elliptocytosis
congenital (autosomal dominant)
80
SSx: spherocytosis/elliptocytosis
mod jaundice and anemia, mb hepatomegaly, splenomegaly, cholelithiasis
81
Lab findings: spherocytosis/elliptocytosis
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
Pathophysiology: autoimmune hemolytic anemia
body make antibodies for its own RBC -> hemolysis
83
2 types of autoimmune hemolytic anemia
warm (MC, women) and cold
84
Etiology: warm autoimmune hemolytic anemia
viral infx, immune deficiency, drugs, SLE, lymphoma, CLL
85
SSx: warm autoimmune hemolytic anemia
anemia, mild splenomegaly; severe (fever, chest pain, syncope, ht failure)
86
Etiology: cold autoimmune hemolytic anemia
infx (myco. pneu.), lymphoproliferative state, idiopathic (50%)
87
Comparison (location): warm vs cold autoimmune hemolytic anemia
warm - spleen
| cold - liver
88
SSx: cold autoimmune hemolytic anemia
acrocyanosis, Raynaud's, levido reticularis, scleral icterus, splenomegaly
89
Dx: autoimmune hemolytic anemia
direct antiglobulin test
90
Intrinsic causes of hemolytic anemia
abnormal RBC membranes, RBC metabolism disorder, hemoglobinopathies
91
Extrinsic causes of hemolytic anemia
hypersplenism, toxic exposure, autoimmune dz, mechanical injury, infx
92
3 main labs/PE to do when hemolytic anemia is suspected
check for splenomegaly, Coombs' test (autoimmunity), peripheral smear
93
Lab findings: hemolytic anemia
inc bilirubin, LDH; normal ALT; anemia, reticulocytosis
94
SSx: hemolytic anemia
acute (uncommon) - fever, chills, back/abd pain, shock
| severe - jaundice, splenomegaly
95
Pathophysiology: macrocytic anemia
defective DNA synthesis
96
Etiology: macrocytic anemia
alcoholism and B12/folate deficiency MC; drugs, hypothyroid, liver dz
97
SSx: macrocytic anemia
usu no sxs until severe; neurological signs (dementia, stocking/glove neuropathy), glossitis, diarrhea, muscle wasting
98
Labs: macrocytic anemia
CBC w/ peripheral smear, B12/folate levels
99
Lab findings: macrocytic anemia
MCV > 95-100, anisocytosis, poikilocytosis, inc RDW, Howell-Jolly bodies, hypersegmented PMNs -> neutropenia
100
Pathophysiology: myelophthisic anemia
bone marrow is replaced by tumor/granuloma/lipid storage dz/fibrosis
101
SSx: myelophthisic anemia
those of underlying dz, mb splenomegaly
102
Labs: myelophthisic anemia
CBC w/ peripheral smear, marrow bx (definitive)
103
Lab findings: myelophthisic anemia
anisocytosis, poikilocytosis, nucleated RBC, immature myeloid cells
104
What constitues aplastic or hypoplastic anemia?
pancytopenia or pure red cell aplasia
105
Etiology: aplastic/hypoplastic anemia
genetic or acquired (drugs, pesticides, industrial chemicals, benzenes, anti-cancer agents, infx)
106
Fanconi's anemia
rare, inherited aplastic anemia; anemia, bone abnormalities, microcephaly, hypopigmentation/cafe-au-lait spots; usu dx in childhood
107
SSx: aplastic/hypoplastic anemia
insidious or acute; agranulocytosis, thrombocytopenia (petechiae, ecchymosis, bleeding gums), anemia (pallor, tachycardia, fatigue, dizziness)
108
Aplastic anemia should be suspected in ___
young patients with pancytopenia
109
Dx: aplastic/hypoplastic anemia
CBC w/ peripheral smear, iron, reticulocytes, bone marrow bx
110
Lab findings: aplastic/hypoplastic anemia
dec RBCs, WBCs, platelets, reticulocytes; inc serum iron; acellular bone marrow (diagnostic)
111
Etiology: anemia of chronic dz
infx, inflammatory dz, neoplastic dz, severe trauma, ht failure, DM, anemia of elderly
112
Anemia of chronic dz should be suspected in ___
microcytic or marginal normocytic anemia w/ chronic infx, cancer or inflammation
113
Labs: anemia of chronic dz
CBC w/ peripheral smear, serum iron, transferrin, transferring receptor, serum ferritin; ESR/CRP if underlying cause unknown
114
SSx: anemia of chronic dz
sxs of the underlying dz
115
Lab findings: anemia of chronic dz
mild-mod anemia, initially normochromic/normocytic -> microcytic/hypochromic, RDW in early stages, low serum iron/TIBC, low EPO
116
Lab findings: iron-deficiency anemia
microcytic anemia, inc RDW, dec Red cell count, low iron and/or ferritin, inc TIBC, low Hb/Hct/RBC/MCV
117
Findings (sideroblastic anemia): CBC
microcytic (hypochromic or normochromic), inc RDW, anisocytosis, siderocytes (targeted RBCs), inc serum iron/transferrin/ferritin, ringed sideroblasts, erythroid hypoplasia
118
Bleeding Disorders: history
diet, GI assessment, menstruation, CA, COPD, CHF, Ht dz, marathon running, FHx, alcoholism, drugs
119
Labs: sideroblastic anemia
CBC w/ peripheral smear, iron, ferritin, bone marrow bx, erythrocyte protoporphyrin, lead screen if cause is unknown
