Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
118 Cards in this Set
- Front
- Back
What is Virchow's triad?
|
Stasis (post-op--in bed, long trips, cast, pregnancy)
Hypercoagulability--sickle cell, polycythemia, CHF, estrogen excess, smoking Endothelial damage--fracture, post-op, postpartum ALL RISKS OF THROMBI/EMBOLI |
|
DVT:
Symptoms Prophylaxis Treatment |
Swollen foot/ankle, ±pain
Prevention: sq heparin, compression stockings, long-term warfarin Tx: heparin until warfarin therapeutic |
|
Pulmonary embolism:
Symptoms Diagnostics Treatment |
Pleuritic chest pain, SOB, cough, hemoptysis (rare), fever, tachypnea, tachycardia, confusion, altered mental status
Elevated D-dimer ±DVT on LE u/s, nl CXR, large Aa gradient on ABG Tx: If massive PE-->thrombolysis (tPA, streptokinase), but usually just heparin/warfarin |
|
Fat emboli can be the result of _____.
|
Long bone fractures, liposuction
|
|
Which emboli increase risk of DIC?
|
Amniotic fluid emboli (esp. postpartum)
|
|
A patient suffers a stroke after incurring multiple long bone fractures in a skiing accident?
Cause of infarct? |
Fat embolus going through patent foramen ovale and causing stroke
|
|
A patient with a recent tibial fracture and no history of COPD or asthma presents with hypoxia. CXR is normal.
Cause of hypoxia? What disease process does this mimic? |
Could be PE or fat embolus, probably a PE.
Mimics MI. |
|
Obstructive Lung Disease:
Pathophys Lung volumes Causes |
Obstruction of air flow resulting in air trapping in lungs.
Airways close preamturely at high lung volumes, resulting in: High RV Low FVC Low FEV1 Low FVC HALLMARK = LOW FEV1/FVC (UNDER 80%) V/Q mismatch Causes: Chronic bronchitis (blue bloater) Emphysema (pink puffer) Asthma Bronchiectasis |
|
Chronic Bronchitis:
Pathophys Presentation |
Hypertrophy of mucus-secreting glands in bronchioles
Blue bloater--productive cough for >3 consecutive months in >2 years. FIndings: wheezing, crackles, cyanosis, late-onset dyspnea |
|
Emphysema:
Pathophys Suptypes and Causes Presentation |
Enlargement of air spaces and dec'd recoil resulting from destruction of alveolar walls, inc'd compliance
Centriacinar--smoking Panacinar--alpha-1 antitrypsin deficiency-->inc'd elastase activity (loss of elasticity) Presentation: PInk puffer, barrel-shaped chest Dyspnea, dec'd breath sounds, tachycardia, early-onset dyspnea, late-onset hypoxemia |
|
Asthma:
Pathophys Presentation |
Bronchial hyperresponsiveness causes REVERSIBLE bronchoconstriction
Smooth muscle hypertrophy and CURSCHMANN'S SPIRALS, CHARCOT-LEYDEN CRYSTALS Findings: Cough, wheezing, dyspnea, tachypnea, hypoxemia, pulsus paradoxus, mucus plugging |
|
What is the differential diagnosis for eosinophilia?
|
DNAAACP
Drugs Neoplasm Allergy, asthma (Churg-Straus) Addison's (adrenal insuff) Acute interstitial nephritis Collagen vascular dz Parasites (ephilic pneumonitis due to Ascaris lumbricoides--a hookworm) |
|
Isoproterenol:
MOA Use |
NONSELECTIVE beta-blocker; iso means 'same', same effect on beta-1 and beta-2
Relaxes bronchial smooth muscle (beta-2), AE is tachycardia (beta-1) Use in asthma to relax bronchial SM |
|
Selective Beta-2 agonists:
Examples Use |
Albuterol--acute asthma exacerbation
Salmeterol--LA agent for prophyslaxis, may lead to arrhythmia (some beta-1 activity); salmeterol is Slow |
|
Theophylline:
MOA Use |
Causes bronchodilation by inhibiting PDE-->dec'd cAMP hydrolysis
Narrow therapeutic index (cardiotox, neurotox); blocks actions of adenosine (~caffeien) |
|
Ipratropium:
MOA Use |
Competitive blocker of muscarinig receptors (has -trop- in it!)
Prevents bronchoconstriction Use to tx COPD |
|
Glucocorticoids in treatment of asthma:
MOA |
Inhibit synthesis of cytokines; inactivate NF-kappa B (which normally induces production of TNF-alpha)
1st line tx for CHRONIC asthma |
|
Zilueton:
MOA |
5-lipoxygenase inhibitor; blocks conversion of arachidonic acid to leukotrienes
|
|
Zafirlukast:
MOA Use |
Block leukotriene receptors. good for ASA-induced asthma.
Patients 5 years and up |
|
Montelukast:
MOA Use |
Block leukotriene receptors. Good for ASA-induced asthma
Patients 1 year and up |
|
A patient presents with an asthma attack.
What immunological reaction is responsible for anaphylaxis in this patient? |
Asthma is mast-cell mediated; antigen is crosslinking IgE on pre-sensitized mast cells (Type I hypersens)
|
|
Which asthma drug:
Inhaled treatment of choice for chronic asthma |
Inhaled steroids
|
|
Which asthma drug:
Inhaled treatment of choice for acute exacerbations |
Albuterol ± ipratropium
|
|
Which asthma drug:
Narrow therapeutic index, drug of last resort |
Theophylline
|
|
Which asthma drug:
Blocks conversion of arachidonic acid to leukotriene |
Zileuton
|
|
Which asthma drug:
Inhibits mast cell release of mediators, used for prophylaxis only |
Cromolyn
|
|
Which asthma drug:
Inhaled treatment that blocks muscarinic receptors |
Ipratropium
|
|
Which asthma drug:
Inhaled long-acting beta-2 agonist |
Salmeterol
|
|
Which asthma drug:
Blocks leukotriene receptors |
Zafirlukast (5 years and up)
Montelukast (1 year and up) |
|
A patient has an extended expiratory phase.
Diagnosis? |
Some type of obstructive lung dz
|
|
H1 blockers:
First vs Second-Generation Drugs-- Examples Uses AEs |
First gen:
Diphenhydramine, dimenhydrinate, chlopheniramine use: Allergy, motion sickness, sleep aid AE: Sedation, antimuscarinig, anti-alpha-adrenergic Second generation: Ex: Loratadine, desloratadine, fexofenadine, cetirizine Use: Allergy AE: Farr less sedating than 1st generation bc there's dec'd entry into CNS |
|
Bronchiectasis:
Pathophys Causes |
Chronic necrotizing infection of bronchi-->permanently dilated airways, purulent sputum, recurrent infections, hemoptysis
Presentation: Cough, wheezing, dyspnea, tachypnea, hypoxemia, mucus plugging Causes: CF, poor ciliary motility, Kartagener's syndrome; can develop aspegillosis |
|
Restrictive lung disease:
Pathophys Lung volumes |
Restricted lung expansion causes dec'd lung volumes:
Dev'd FVC Dec'd TLC FEV1/FVC ratio >80% Caused by poor breathing mechanics or interstitial lung dz |
|
Poor breathing mechanics:
Causes Obstructive/Restrictive |
Poor muscular effort--polio, myasthenia gravis
Poor structural apparatus--scoliosis, morbid obestiy RESTRICTIVE |
|
Acute Respiratory Distress Syndrome:
Pathophys |
Shock, infection, toxic gas inhalation, aspiration, high [O2], pancreatitis, heroin OD
--> Inflammatory cells/mediators and Oxygen free radicals --> Damage to endothelial or alveolar epithelial (type I) cells --> Diffuse alveolar damage and hyaline membrane disease |
|
|
Empysema
|
|
|
Emphysema--heavy black carbon deposits typical of smoking
|
|
|
Acute respiratory distress syndrome; persistent inflammn leads to poor pulmonary compliance and edema
Note both alveolar fluid and hyaline membranes |
|
Neonatal respiratory distress syndrome:
Pathophys Risk factors Treatment |
Surfactant deficiency leading to inc'd surfact tension-->alveolar collapse
Surfactant made by type II pneumocytes after 35th week of gestation. Lecithin:sphingomyelin ratio usually <1.5 in neonatal RDS. RIsk PDA. Risk factors: prematurity, maternal DM (due to elevated insulin), cesarean delivery (dec'd release of fetal glucocorticoids) Tx: Maternal steroids before birth, artificial surfactant for infant |
|
Coal workers' pneumoconiosis:
Anthracosis vs Simple CWP vs Complicated CWP Lobes affected? |
UPPER LOBES AFFECTED
Anthracosis = mild; black pigment in lung Simple CWP = small fibrotic lung nodules Complicated CWP--progressive massive fibrosis |
|
Silicosis pneumoconioses:
Pathophys Populations affected Presentation Lobes affected? |
Assocd w/foundries, sandblasting, mines
Macs respond to silica and release fibrogenic factors-->fibrosis Affects upper lobes Presents with EGGSHELL CALCIFICATION on hilar LNs AFFECTS UPPER LOBES |
|
Asbestosis:
Pathophys Populations affected Risks Presentation Lobes affected? |
Assocd w/shipbuilding, roofing, pulmbing
Results in ivory white, calcified pleural plaques Inc'd incidence of bronchogenic carcinoma and mesothelioma AFFECTS LOWER LOBES Golden-brown fusiform rods resembling dumbbells! (located inside macs) |
|
|
Asbestosis--ferruginous bodies (asbestos bodies w/Prussian blue iron stain) in lung, microscopic. Inhaled asbestos fibers are ingested by macs.
|
|
|
Amiodarone toxicity--diffuse interstitial bilateral pulmonary markings in a reticular nodular pattern; e/o pulmonary fibrosis
SHOULD NOT BE ABLE TO SEE OUTLINE OF BRONCHI |
|
Sleep apnea:
Central vs Obstructive Treatment |
Central sleep apnea--no respiratory effort
Obstructive sleep apnea--respiratory effort against airway obstruction Tx: weight loss, CPAP, surgery (T&A ) |
|
Lung biopsy from a plumber shows elongated structures with clubbed ends in tissue.
Diagnosis? Risks? |
Asbestosis; inc'd risk mesothelioma, bronchogenic carcinoma
|
|
A preterm infant has difficulty breathing.
X-ray reveals diffuse ground glass appearance with air bronchograms. What is the diagnosis and what could have prevented this condition? |
Neonatal distress syndrome
Could have been prevented with steroids |
|
A patient develops ARDS from occupational inhalation of nitrogen dioxide.
What histologic change is seen in a patient recovering from ARDS? |
ARDS-->damaged endothelium/epithelium
Type II pneumocytes proliferate and form Type I pneumocytes |
|
Breath sounds:
Bronchial obstruction Tracheal deviation |
Sounds absent/diminished over affected area
Dec'd resonance Dec'd fremitus Trachea deviates toward side of lesion due to atelectasis |
|
Pleural effusion:
Bronchial obstruction Tracheal deviation |
Dec'd sounds over effusion
Dull resonance DEc'd fremitus No tracheal deviation |
|
Pneumonia (lobar):
Bronchial obstruction Tracheal deviation |
Bronchial breath sounds over lesion
Dull resonance Inc'd fremitus |
|
Tension pneumothorax:
Bronchial obstruction Tracheal deviation |
Breath sounds diminished
Hyperresonant No fremitus Tracheal deviation away from side of lzn Pneumothorax--puncture lung, air occupies space where lung was. |
|
|
Tension pneumothorax (collapsed lung)
|
|
Spontaneous pneumothorax:
Causes |
Bullous emphysema
|
|
|
Pneumothorax--Right lung is collapsed
Straight line off rightmost edge of pleural space indicated by arrow (shows edge of collapsed lung) |
|
|
Pneumothorax--CT chest image shows collapsed left lung w/ipsilateral inc'd density lung parenchyma
|
|
What are the complications of lung cancer?
|
SPHERE
Superior vena cava syndrome--compression of SVC, can't drain face/neck Pancoast's Tumpor Horner's Syndrome--ptosis, eyelid drooping Endocrine (paraneoplastic) Recurrent laryngeal syx (hoarseness) Effusions--plueral or pericardial |
|
Squamous cell carcinoma of lung:
Location Characteristics Histology |
Squamous, Sentral, Smoking
Sentral (central): located in hilum Parathyroid like activity (PTHrP) Kerain pearls, intercellular bridges |
|
Adenocarcinoma of lung:
Location Characteristics |
Peripheral (lobes)
Not related to smoking, can develop in site of prior inflammn |
|
Small cell carcinoma of lung:
Location Characteristics |
Central
Undiff'd; very aggressive. Often assocd w/ectopic produciton of ACTH (Cushing's, not suppressible by dexamethasone) or ADH-->Lambert-Eaton syndrome (autoab's against calcium channels) Appear as small dark blue cells |
|
|
Small cell carcinoma in pulmonary hilar LN.
Almost all related to tobacco use. Arise anywhere in lung, most often near hilum; quickly spread along bronchi. |
|
Carcinoid tumor of lung:
Characteristics |
Secretes serotonin-->Carcinoid syndrome
Presents with: Bronchospasm, wheezing Flushing Diarrhea Right-sided heart lesions |
|
CXR shows pleural effusions.
Clinical findings? |
Dullness to Resonance
Dec'd fremitus Dec'd breath sounds of affected areas |
|
A tall, thin male teenager has abrupt onset dyspnea and left-sided chest pain. Percussion on the affected side reveals hyperresonance, and diminished breath sounds.
Diagnosis? |
Spontaneous pneumothorax
|
|
CXR shows collapse of middle lobe of right lung and mass in right bronchus; pt has history of recurrent pneumonias.
Diagnosis? |
Bronchogenic Carcinoma -->pneumonias
|
|
A never-smoker develops bronchogenic lung cancer. He is a coal miner.
Exposure to what substance has put him at risk for developing lung cancer? |
Radon--heavy gas that settles into basements and coal mines
|
|
Which infectious agent:
Common cause of pneumonia in immunocompromised pts |
PCP pneumo
|
|
Which infectious agent:
Most common cause of atypical/ walking pneumonia |
Mycoplasma pneumoniae
|
|
Which infectious agent:
Common causative agent for pneumonia in alcoholics |
Klebsiella
|
|
Which infectious agent:
Can cause an interstitial pneumonia in bird handlers |
Chlamydia psitecci (sp??)
|
|
Which infectious agent:
Often the cause of pneumonia in a pt with a history of exposure to bats and bat droppings |
Histo
|
|
Which infectious agent:
Often the cause of pneumonia in a pt who has recently visited South California, New Mexico, or West Texas |
Coccidoides
|
|
Which infectious agent:
Pneumonia associated with "currant jelly" sputum |
Klebsiella
|
|
Which infectious agent:
Q fever |
Coxiella burnetti
|
|
Which infectious agent:
Associated with pneumonia acquired from air conditioners |
Legionella
|
|
Which infectious agent:
Most common cause of pneumonia in children 1 year-old or younger |
RSV
|
|
Which infectious agent:
Most common cause of pneumonia in the neonate (B-28d) |
GBS
E coli |
|
Which infectious agent:
Most common cause of pneumonia in children and young adults (including college students, military recruits, and prison inmates) |
Mycoplasma
|
|
Which infectious agent:
Common cause of pneumonia in pts with other health problems |
Klebsiella
|
|
Which infectious agent:
Mosl common cause of viral pneumonia |
RSV
|
|
Which infectious agent:
Causes a wool-sorter's disease (a life-threatening pneumonia) |
Bacillus anthracis
|
|
Which infectious agent:
Endogenous flora in 20% of adults |
Strep pneumo
|
|
Which infectious agent:
Common bacterial cause of COPD exacerbation |
H flu
|
|
Which infectious agent:
Pontiac fever |
Legionella
|
|
Which infectious agent:
Common pneumonia in ventilator pts and those with cystic fibrosis |
Pseudomonas aeruginosa
|
|
Examination of a lung at autopsy reveals a peripheral lesion with caseous necrosis.
What is the diagnosis? |
TB
|
|
A 30 year-old comatose man on ventilatory support in the ICU develops an infection and dies.
Autopsy reveals a pus-filled cavity in his right lung. What is the likely etiology? |
Aspiration-->Lung abscess
|
|
A 55 year-old man who is a smoker and heavy drinker presents with a new cough and flu-like symptoms.
Gram stains shows no organisms; silver stain of sputum shows gram-negative rods. Diagnosis? |
Legionella
|
|
Lobar pneumonia:
Cause Pathophys |
Pneumococcus
Klebsiella Intra-alveolar exudate-->consolidation; may involve entire lung |
|
Bronchopneumonia:
Cause Pathophys |
Staph aureus
H flu Klebsiella Strep pyogenes Acute inflammatory infiltrates (nphils) from bronchioles into adjacent alveoli; patchy distribution involving ≥1 lobes |
|
Interstitial pneumonia:
Cause Pathophys |
Viruses--RSV, adenoviruses, Mycoplasma, legionella, chlamydia
Diffuse patchy inflammn localized to interstitial areas at alveolar walls |
|
Exudate vs Transudate
|
Exudate: high protein content, cloudy; due to malignancy, pneumonia, trauma; must be drained in light of risk of infection
Transudate: low protein content; due to CHF, nephrotic syndrome, hepatic cirrhosis |
|
Describe the appearance of lymphatic effusion.
|
Milky, high TGs
|
|
N-acetylcysteine:
Use |
mucolytic expectorant--loosen mucous plugs in CF patients
also used as antidote for acetaminophen OD (regenerates glutathione) |
|
Which pathology:
Most common cause of SIADH |
Small cell lung cancer
Brain injury |
|
Which pathology:
Most common testicular tumor |
Seminoma
|
|
Which pathology:
Most common tumor of infancy |
Hemangioma
|
|
Which pathology:
Traslocation 9;22 and drug used to treat |
Phil chrom; CML, imatinib
|
|
What is the triad of Kartagener's syndrome?
Underlying defect? |
Sterility, Bronchiectasis, recurrent sinusitis
Dynein arm defect |
|
What are the 3 most common locations of lung cancer mets?
|
Brain
Bone Liver |
|
What is the V/Q at the apex of the lung?
|
3
|
|
What is the V/Q at the base of the lung?
|
0.6
|
|
What is the V/Q during airway obstruction?
|
Toward 0 (shunting)
|
|
What is the V/Q during blood flow obstruction?
|
Toward ∞ (dead space)
|
|
How does the emphysema caused by smoking differ from the emphysema caused by alpha-1-antitrypsin deficiency?
|
Smoking = centriacinar
alpha-1-antitrypsin def = panacinar |
|
What is the hallmark sign of COPD?
|
Dec'd FEV1/FVC
|
|
What is the hallmark sign of restrictive lung disease?
|
Dec'd TLC, nl FEV1/FVC
|
|
Which tumors arise centrally in the lung and are linked to smoking?
|
Squamous cell
Small cell |
|
Which tumors arise peripherally in the lung and are less linked to smoking (if at all)?
|
Adenocarcinoma
Large Cell |
|
How does the body compensate for hypoxia at high altitude.
|
Inc'd ventilation
Inc'd EPO Inc'd 2,3-DPG Inc'd mitochondria Inc'd renal excretion of HCO3 |
|
Which cause of pneumonia:
Gram (+)cocci in clusters |
Staph aureus
|
|
Which cause of pneumonia:
Gram(+) cocci in pairs |
Strep pneumo
|
|
Which cause of pneumonia:
Gram(-) rods in 80 year-old |
E coli
|
|
Which cause of pneumonia:
Gram(+) cocci in neonate |
GBS
|
|
Which cause of pneumonia:
Gram(-) rods in neonate |
E coli
|
|
What are the common causes of ARDS?
|
Shock
Infection Toxic gas inspiration Heroin OD High concentrations of O2 for extended pd of time Aspiration |
|
A 75 year-old patient with a 60 pack/year history presents with difficulty standing from bed when he wakes in the morning. He also presents with difficulty raising his arms in the morning to wash his hair.
Diagnosis? |
Lambert-Eaton Syndrome from Small Cell Lung Cancer
|
|
What is pulsus paradoxus?
Causes? |
Systolic BP drops more than 10 mmHg upon inspiration
Caused by things that hyperinflate lungs: Asthma COPD Group Cardiac tamponade |