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pulmonary Flashcards

1
Q

low vq ratio

A

physiologic at base of lugns
disease: astham, copd, acute pulm edema- due to hypoxemia= hypoxic vasocstriction leads t o pulmonary htn if persistent. Then that leads to right heart failure-

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2
Q

chronic bronchitis

A

associated with COPD!! if untreated!- only medical treatment to reduce mortality in copd is oxygen

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3
Q

high vq ratio

A

physioligcally at apices of lungs

pathalogic: emphysema, pulm embolism or foreign body

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4
Q

ventilation

A

strictly regularted by changes in pac02
central chemoreceptro: medulla
peripheral chemoreceptors: carotid bodies

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5
Q

DKA

A

leads to kussmauls respiration- because DKA stimulate resp centers

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6
Q

forced vital cappacity

A

measurement of the volume of air expelled from a maximally inflated lung- breathing hard and fast as possible

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7
Q

FEV1

A

forced expiratory volume in 1 second

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8
Q

crackles/rales

A

heard during inspiration- discontinuous high pitched sounds

pneumonia, atelectasis, bronchitis, bronchiectasis, pulm edema, or pulm fiboriss

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9
Q

stridor

A

narrowing of the larynx of trachea

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10
Q

asthma

A

associated with increased IGE
airway inflammation and bronchoconstriction
asthma, nasal polyps, ASA/nsaid allergy!!!

prolonged expiration with wheezing, hyperresonance
pulm FUNCTION TEST!- gold standard- reversible obstruction
decreased FEv1, Decreased FEV1/FVC
bronchopvocation test: methacholine challenge- mroe than 20% decrease in FEV1,
bronchodilator test: more than 12% INCREASE in FEV1

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11
Q

Peak expiratory flow rate

A

best way to assess asthma exacerbation severity and response in ED

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12
Q

beta agonists

A

asthma tx:
beta agonists!- saba- 1st line for acute- most effective and fastest
albulterol, terubtaline, epinephrine: bronchodilator esp peripherally

se.: tachycardia, arrhtymias, cns stimulation

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13
Q

anticholinergics

A

ipratroium !!- central bronchodilator

se: thirst, blurry vision, dry mouth, urinary retension, acute glaucoma, BPH, dysphagia

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14
Q

steroids

A

prednisone, methypred, prednisolonoe

se: hyperglycemia, osteopororis,s growth delays, fluid retention

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15
Q

asthma tx: inhated cortico

A

beclomethasone, triamcinolone,
DOC for long term persistent
se: thrush

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16
Q

laba (long acting beta agonists)

A

salmeterol,
- not for acute exacerbation of asthma
add to steroids if needed, but taper offf after it is controled

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17
Q

mast cell modifiers

A

cromolyn- inhibits acute repsone to cold air, exercise

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18
Q

Leukotriene modifiers

A

useful in asthmatics (MONTELUKAST)- useful for the ones with allergic rhinitis/aspirin induced asthma

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19
Q

theophylline

A

main side efect: narrow TI:: tox causes seizures, arrhtymias

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20
Q

intermittent asthmam

A

less than 2 time a day for saba
less than 2x month for night time
fev1 more than 80%

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21
Q

mild asthma

A

more than 2times a week for saba
more than 3-4 months for night time
fev1 more than 80%
- use low dose ICS

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22
Q

mod asthma

A

fev1 60-80%
changes in fev1/FVC ratio- reduced by 5%
use low ICS and laba or medium ics

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23
Q

severe asthma

A

fev 1 less than 60%

high dose ICS

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24
Q

copd

A

loss of elastic recovil and increased airway resistance

emphysema and chronic bronchitis

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25
Q

risk factors for copd

A

smoking
alpha 1 antitrypsin deficiency: genetic disease linked to copd in younger patients less than 40 years old- panlobular EMphysema

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26
Q

emphysema

A

loss of elastic recoil, increased air trapping, - alveolar capillary and alveolar wall destruction- airway obstruction

barrel chest, pursed lip breathing, matched v/q defects, mild hypoxemia, cachectic, pursed lip breathing- pink puffers

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27
Q

chronic bronchitis

A

productive cough more than 3 months X 2 years
increased airway resistance- then obstruction- prone to microbial infections
productive cough, rales, rhonihi, signs of cor pulmonale, severe V/q mismatch, obses and cyanotic- blue bloaters

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28
Q

copd

A 
PFT/spirometry: gold standard
FEV1 is IMPORTANT FACTOR FOR prognosis and mortaliity!!
decreased DLCO in emphysema
emphysema: ass with bullae
multifocal atrial tach
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29
Q

TX COPD

A
  • stop smoking
    combo with antichol and beta agaonists!!- BEST
    tiotropium, ipratroipum- antichol preferred over beta

beta agonists: abuterol etc
theophilyine

steroids- not as monoteherapy - CAN ADD TO BRONCHODILATORS like salmeterol.

oxygen11!!!: only medical therapy proven to decrease mortality!!!- decreases pulm HTN/cor pulmonale!!
use if +cor pulmonale, o2 sat is less than 88% or pa02 less than 55 mm

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30
Q

copd prevention

A

vaccinations (pneumo and influenza), pulm rehab, smoking cessation, surgery

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31
Q

copd stage

A

mild: fev1 more than 80
mod; fev1 50-79
severe: fev1 30-50
very severE: fev1: less than 30

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32
Q

bronchiectasis

A

transmural inflammation of medium sized bronchi- irreversible bronchial dilation!!
inflammaed airways collapse easily- obstruction- lung infections

H/influenza MC!!!- of bronchiectasis!!
if due to cystic fibrosis: pseudomonals mc
cystic fibrosis mc cause of bronchiectasis

THICK mucopurulet foul smelling, hemoptysis!!!
MC CAUSE OF MASSIVE HEMOPTYSIS

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33
Q

study of chocie for bronchiectasis

A

high resolution CT SCANS!- tram track appearnace

obstructive pattern in PFT!!

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34
Q

mac treatment

A

clarithromycin and ethambutol

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35
Q

bronchiectasis tx

A

abx
flouroquinolone, aminoglycoside, cephalosporin
azithro

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36
Q

cystic fibrosis

A

prevents chloride trasport- thick viscous mucus buildsup in lungs, pancreas, liver, intestines and reproductive tracts

growth delays and infertility
meconium ileus at birth
steattorhea, vitamin ADEK deficiency
recurrent resp infections - pseudomonas, chronic sinusitis

elevated sweat chloride test- pilocarpine induces sweating
bronchiectasis seen in CXR

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37
Q

tx for cystic fibrosis

A

airway clearance treatment
pancreatic enzyme repalcement
fat soluble vitamins replacement (ADEK)

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38
Q

restrictive disroders

A

decreased lung volume, normal or increased FEV1/FVC!!!
decreased total lung capacity, decreased FVC
decreased compliance
ex: sarcoidosis, pneumoconiosis, idiopathic pulm fiboriss

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39
Q

sarcoidosis

A

grannulomatous disorder of unknown
african american women
exaggerated t cell response to antigens—accumulation causes granuloma to form- they take up space and disrupt structure or function

dry cough, dyspena, chest pain, lymphadenopathy - hilar nodes, erhythema nodosum, lupus pernio (violaceous discoloration of nose, ear, cheek, chin), ANTERIOR UVEITIS - inflammation of iris/ciliary body- ciliary flush!
mycoardial, rheumatologic, neurologic

TISSUE biopsy: non ceseating granulomas!!- no central necorosis, bilateral hilar lymphadenopathy, interstitial lung disease

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40
Q

sarcoidsis

A

increased ace, hypercalcemia, eosinophilia,
spontaneous remisson in 2 years usually
ORAL CORTICOSTEROIDS TX OF CHOICE!!

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41
Q

idiopathic fibrosisng interstitial pneumonia (pulm fiborisis)

A

restrictive component
clubbing of fingers
HONEY COMBING- diffuse reticular opacities- ground glass opacities, decreased lung volumes, increased or normal FEV1/fvc

tX: only curative is lung transplant

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42
Q

penumonocinosis

A

inahlation of mineral dustr- trigers inflmmation- restrictive lung disease

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43
Q

silicosis

A

minig, quarry work with granite, slate, pottery, sandblasting
EGG SHELL CALCIFICATIONS of the hilar and mediastinal nodes!
nodular opacities in upper lobes
no proven treatment

44
Q

coal workers

A

coal

small upper lobe nodules- may have OBSTRUCTIVE PATTERN!!!

45
Q

berryliosis

A

electronics, aeorspace, cermaics, tool and dye, flourescent light bulbs-
dyspena, cough, weight loss, fever
tx: corticosteroids, or supportive o2,

46
Q

byssinosis

A

cotton exposure

47
Q

asbestosis

A

destriction or renovation of old building, ship building, pipe fitting, insulation
risk of bronchogenic carcinoma MC
malignant mesothelioma of the pleura (rare)
dyspnea on exertion, nonproductive cough
LOWER LOBES AFFECTED!!!- pleural plaques- pleural thickening,
supportive tx

48
Q

pleural effusion

A

CHF is most common cause of transudate effusion, nephrotic sydnrome, cirrhosis, hypoalubminemia

exudate: infeciton/inflammation- increase vascular perameability

decreased tactile fremitus, decreased breath sounds, dull to percussion
blunting of costophrenic angles!!
exudates: more than 0.5 protein
more than 0.6 LDH

THORACENTEISS: gold standard
if empyema- pleural fluid ph less than 7.2, glucose less than 40, positive gram stain of pleural fluid

49
Q

pneumothorax

A

collapse of lung due to incresed positive pleural pressure

  • bleb rupture
    primary: no lung disease;: tal, thin men, smokers
    secondary: underlying lung disease (COPD, asthma)
    trumatic: cpr, peep, subclavian line placement, thoracentiesis
    tesnion: pushes lungs trachea and vessels of heart to CONTRALATERAL SIDE!!

hyperresonance to epercussion, decreased fremitus, decreased breath sounds

TENSION: JVP, pulsus paradoxus, hypotension

OBSERVATION IF less than 15-20% with oxygen and repeat CDR
chest tube placement if large or severe-
needle aspiration: if tension pneumothorax followed by chest tube placement- needle at 2nd intercostal space @ midclavicular line

50
Q

pulm nodules

A 
pulmoary mass if more than 3 cm
TB most comon cause- grnulomatous!
tumors
inflammation
THYMOMA- mc mediastinal tumor
calcification in benign tumors, cavitary
malig : irregular, speculated, rapid,

needle asp or bronchosopy: needle for peripheral, bronchoscopy for middle lesions
resection

51
Q

bronchial CARCINOID TUMORS

A

slow growth, low METS
well diffeentiated- neuroendocrine tumors
may secrete SERATONIN, ACTH, ADH, melanocyte stimulating hormone

carcinoid syndrome: diarrhea due to too much seratonin, wheezing, flushing,
bronchoscopy shows pink to purple well vascularized central tumor

52
Q

bronchogenic carcinoma

A

cigg most common cause
asbestosis 2nd cause

METS TO BRAIN, BONE, LIVEr, lymph nodes and adrenals!!!

53
Q

adenocarcinoma

A

peripheral, smokers, women, nonsmokers 0- MC type

typicaly peripheral!

54
Q

squamous cell

A

CENTRAL location!!- hemoptysis, sputum cytolgy can pick it up, CAVITARY lesions (central necrosis), hyper CALCEMIA, & pancoast syndrome- ALL C!
pancoast : shulder pain, horner’s- miosis, ptosis, anhydrosis, atrophy of hand and arm muscles

HYPERCALCEMIA!

55
Q

large cell

A

very aggressive

56
Q

smal oat cell

A

mets early, centra, aggressive, surgery not treatment

SVC syndrome - dilated neck veins, prominent chest veins Superior vena cava (SVC) syndrome (facial swelling, cyanosis, dilated neck veins).
SIADH/hyponatremia
cushing’s syndrome
lambert- eaton syndrome- abx against calcium gated channels @ neuromuscular junction

57
Q

PE

A

lower extremities ABOVE THE KNEEES- iliofemoral or pelvis
fat emboli, air emboli (central lines)
helical Ct scan- best initial test for suspected PE
pulmonary angiography; gold standard
vq scan: for low probability- to rule it out
doppler ultrasound: lower extremity DVT

CXR mostl normal!!-
westermark’s sign- avascular markings
hamptons hump: wedge shaped infiltrate
S1Q3T3

58
Q

heparin overdose

A

protamine sulfate is antidote

59
Q

heparin induced thrombocytopenia

A

stimulates immuen response- complex activates platelets, causing thromboycytopniea and thrombosis- use other anticoags not WARFARIN!

60
Q

tx for pe

A

warfarin for at least 3 months

overalp with herapin for 5 days and INR 2-3 for at least 24 hours

61
Q

IVC filter

A

for those anticoag contradicted or unsuccessful

62
Q

thrombolysis of clot

A

if unstable/MASSIVE PE!

63
Q

pulmonary htn

A

idopathic pulmonary arterial hypertension- primary
SECONDARY: copd most common cause
accentuated s2, right sided heart failure, cor pulmonale,
gold standard: right-heart catheterization
cbc: polycythemia

tx: calcium channel blockers for primary or sildenafil, oxygen

64
Q

h.influenza

A

gram negtaive ros
2nd mc cause of CAP after strep pneumo
COPD, bronchiectasis, cystic fibrosis,

65
Q

mycoplasma

A

mc cause of atypical, less than 40
bullous myringits
doesn’t respond to beta lactams- no cell walls

66
Q

legionella

A

contaminated water supplies- air conditionser
GI symptoms, hyponatremia
intracellular GNR

67
Q

klebsiella

A

ETOH, gram negative rods

currant jelly

68
Q

pseudomonas

A

hiv, cysstic fibrosis, bronchiectasis, gram neg rods

69
Q

histoplasma

A

missisippi and ohio river valley- bird/bat droppigns

70
Q

coccidioides

A

southwest united states (in desert areas)

71
Q

hospital aquired

A

pseudomans, MRSA, 48 hours after hospitalization admission

72
Q

signs of consolidated pneumnoia

A

bronchial breat hsounds, dullness to percu, increased tactile fremitus, egophany , crackles

73
Q

cap

A

macrolides or doxy first line

74
Q

cap inpatient

A

beta lactam and macrolides or broad spectrum FQ

75
Q

cap in icu

A

beta lactam and macrolide

beta lactam and FQ

76
Q

hospital acquired

A

anti pseduomonal beta lactam and anti psuedomonal AG or FQ
vanco if MRSA
levoflox or azithro if legionella
bactrim

77
Q

abx

A

beta lactams: ceftriaxone, cefotaxime,
macrolides: clarithro, azithro
respiratory fq: omxi, levo
aminoglycosides: amika, gentamicin, tobramycin

78
Q

pneumo vaccine

A

pcv13: less than 2 years old get 4 doses
high risk children: also get ppsv23 after pcv13

adults more than 65 get ppsv23 if more than 5 years since last dose.
ages 2-64 with chronic disease! - need ppsv23

79
Q

TB

A

granuloma formation
chronic latent: ceseating - central necrosis- granuloa formation- makes ith ostile forMTB to grow- not contagious

reactivation tb: localized in APEX/upper lobes with CAVITARY lesions- contagious`

80
Q

more than 5mm

A

hiv, immunocomp p(pred therapy), close contacts of patients with active TB

81
Q

more than 10

A

high risk populations, recent conversation

82
Q

more than 15 mm

A

no known risk factors for TB

83
Q

false positive for ppd

A

improper reading, cross reaction with an atypical (MAC), within 2-10 years of BCG

84
Q

active tb diagnosis

A

AFB cultures- gold standard, acid fast smear and sputum culture X 3 days!!
reactivation: apical (upper lobe)
primary tb: middle/lower lobe

85
Q

ghon’s complex:

A

residual evidence of healed primary TB
ghon’s : calcified primary focus and lymph nodes
ranke’s : healed fibrocalcific ghon complex

86
Q

tx for active tb

A

ripe: rifampin, inh, pyrzazinamide, ethambultol- no longer infectious after 2 weeks after initiation
ripe for 2 months and thenINH and RIF for 4 months
total duration is 6 months

87
Q

rifampin

A

thrombocytopenia, orange colored secretions

88
Q

inh

A

hepatitis, peripheral neuropathy - give with b6

89
Q

pyrazinamide

A

hepatitis and hyperuricemia: caution in gout or liver disease
photosens derm rash

90
Q

ethambutol

A

ooptic neuritis- visual changes- color problems,

91
Q

streptomycin

A

ototox, neephrotox

92
Q

latent tb

A

inh+pyroxidine (b6) times 9 months

inh and vitamin b6 X 12 months

93
Q

acute bronchitis

A

adenovirus most likely- infl of trachea and bronchi

symptomatic treatment

94
Q

pertussis

A

very contageoious
cattharal- uri symptoms- most contagious
paroxysmal: cough fits with inspiratory whooping and after cough fits- post cough emesis
convalescent: resolution of the cough

PCR- gold standard
MACROLIDES IS DOCL erythryo and azithro
bactrim if allergic to macrolides

95
Q

bronchiolitis

A

2 months-2 year old- after RSV, adenovirus

96
Q

acute bronchiolitis

A 
RSV most common reason- paramyxovirus!
wheezing, tachypnea, nasal flare, cyanosis, retractions
hyperinflation, peribronchial cuffing
pulse OX!
humidiefied O2 !!!- MAIN ONE~
97
Q

epiglotitits

A

h flu most common
inspiratory stridor, tripod!1
drool, dysphagia, distress

laryngoscope- definitive
thumb print sign on lateral cervical radiograph
DO NOT USE TONGUE DEPRESSORS! if high suspicion

management: dexamethason to reduce edema, ceftriaxone

98
Q

croup

A

barking cough
parainfluenza virus mc cause
stridor- inspiratory and exporatory, hoarseness, dyspnea,
steeple sign (subglotting narrow of trachea(

mild: humidifed air mist and , hydration, DExamethasone
moderate: dexamethasone +nebulized EPI, +supportive
severe: dexamethasone +nebulized epi, +hospitalization

99
Q

infelunza

A

abrupt onset.
myagias in legs and lumbosacral area
supportive therapy for healthy
antivirals for high risk: WITHIN 48 hours of the onset of symptoms: neuraminidase inhibitors: ostemavir

100
Q

infelunza vaccine

A

given annually.

CI: eggs, gelatin or thimerosal allergies

101
Q

ards acute respiratory distress syndrome

A

acute hypoxemic respiratory failure!!
SEPSIS most common
pro- inflammatory cytokines- alveolar damage- pulm edema- loss of surfactant- decreased blood oxygeniation
SEVERE refractory hypoxemia is ARDS
bilateral pul infiltrates on CXR
pcwp more than 18 mmg- cardiac pulm edema
pcwp: less than 18 mmg- ARDS

pulmoarny capillary wedge pressure

TX: PEEP

102
Q

sleep apnea

A

obstructive or central (CNS reduced respiratory drive)

CPAP tx

103
Q

cheyne-stokes

A

cyclic breathing in response to hypercapnia- period of apnea about 15-60 seconds-

104
Q

mudpilers- anion gap metabolic acidosis

A

methanol, uremia, dka, propylene glycol, ISoniazid, lactic acidosis, ethylene glycol, renal failure/rhabdo, salicylates

105
Q

cocciodiomycosis

A

Fungal infection
fluconozaole tx

The patient presented a week ago with signs and symptoms of coccidioidomycosis, also known as San Joaquin Valley fever. The treatment for coccidioidomycosis is antifungals, so the patient was most likely started on fluconazole. A severe side effect of antifungals is hepatotoxicity which presents with fatigue, nausea, vomiting, and jaundice.

106
Q

glucagon

A

treatment for beta blocker overdose

PANRE (18 decks)

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