5 Kpulmonology: Kaplan Companion To First Aid For Usmle Step 2 Ck

Front 1

Q001. What is the most important determinant of the amount of oxygen delivery to tissues?

Back 1

Hemoglobin

Front 2

Q002. Dx:; A married couple comes to the hospital complaining of "flu- like" symptoms including HA, N/V and disorientation. The wife thinks they caught the virus from a neighbor when they borrowed his home generator.

Back 2

Carbon Monoxide Poisoning

Front 3

Q003. Equation for Arterial Oxygen content

Back 3

0.0031(PaO2) + 1.38(Hb x SaO2) = Art O2 content

Front 4

Q004. Definition:; Due to perfusion of poorly ventilated alveoli or due to alveoli not being perfused. What does it respond to?

Back 4

V/Q mismatch; responds to:; supplemental Oxygen; (ex: COPD, CHF, PE, asthma, etc)

Front 5

Q005. What is a Right-to-Left shunt in the lungs do to?

Back 5

Perfusion of a non-ventilated lung

Front 6

Q006. Describe Anemia's effect on hypoxia

Back 6

Anemia = decreased Hb; low Hb causes a decrease in O2 carrying capacity:; Normal PaO2; Decreased PvO2

Front 7

Q007. When does a Low inspired O2 occur?

Back 7

High-altitude

Front 8

Q008. What does not cause cyanosis or discoloration until it reaches toxic levels, where the patient will present with "cherry red" lips and nails?

Back 8

Carbon Monoxide poisoning

Front 9

Q009. Definition:; Gas exchange compromise due to problem with alveolar interface; (ex: interstitial lung Dz)

Back 9

Diffusion defect

Front 10

Q010. With what neuromuscular disorders does Hypoventilation occur?; (3)

Back 10

Myasthenia gravis;; ALS;; Guillain-Barre

Front 11

Q011. What does an increased Fremitus suggest?

Back 11

Consolidation of the lung

Front 12

Q012. What does an decreased Fremitus suggest?; (2)

Back 12

Air or fluid in the chest; (Pneumothorax or PE); or; Overexpansion of the lung

Front 13

Q013. What does a "Dull" percussion represent?

Back 13

Increased density; (increased fluid in the lungs)

Front 14

Q014. What does "hyperresonant" refer to with percussion?

Back 14

Decreased density and more air; (ex: emphysema)

Front 15

Q015. Lung Auscultation definition:; Crackle (rale)

Back 15

Excessive airway secretions; (Pneumonia, pulm edema, bronchitis)

Front 16

Q016. Lung Auscultation definition:; Wheeze

Back 16

Rapid airflow through obstructed airway; (Asthma, bronchitis)

Front 17

Q017. Lung Auscultation definition:; Pleural Rub

Back 17

Inflammation of the pleura; (Pneumonia, pulmonary infarction)

Front 18

Q018. What is it called if you ask the patient to say "eee" and it is heard as "aaa"?; What does it dx?; (2)

Back 18

Egophony; Consolidation;; Compressed lung above a Pleural Effusion

Front 19

Q019. Definition:; A transudate or exudate in the lung

Back 19

Pleural effusion

Front 20

Q020. What are (2) physiologic causes of Transudate pleural effusions?; (3) Dx illnesses

Back 20

Causes:; Increased Hydrostatic Pressure;; Decreased Oncotic Pressure; From:; CHF;; Cirrhosis;; Nephrosis

Front 21

Q021. What is the physiologic cause of Exudate pleural effusions?; (3) Dx illnesses

Back 21

Cause:; Increased Capillary permeability; From:; Tumor;; Infection;; Trauma

Front 22

Q022. What must be present to consider the pleural fluid an exudate?; (3 criteria--only one must be present)

Back 22

1. Ratio of Pleural to Serum Protein > 0.5; 2. Ratio of Pleural to Serum LDH > 0.6; 3. Pleural fluid LDH > 2/3 upper normal limit

Front 23

Q023. When is the pleural effusion considered Parapneumonic?; (2)

Back 23

1. Exudative Pleural fluid Leukocyte count > 10,000 with high PMNs; 2. Empyema

Front 24

Q024. Definition:; Pus in the pleural space; Lab criteria?

Back 24

Empyema; (WBC > 100,000)

Front 25

Q025. What Dx Pleural effusions always require a chest tube?; (3)*

Back 25

Pleural Effusion Line:; Positive Cultures;; Empyema;; Loculated Effusion

Front 26

Q026. What are the causes of gross blood in the pleural fluid?; (4)*

Back 26

blood: A PTT; Aortic Dissection:; Pulmonary Infarction;; Tumor;; Trauma

Front 27

Q027. What are the causes of low glucose in the pleural fluid?; (4)*

Back 27

Glucose is a TREaT:; Tumor;; Rheumatoid Arthritis;; Empyema;; TB

Front 28

Q028. What are the causes of high amylase in the pleural fluid?; (4)*

Back 28

Amy(lase) is PRETty:; Pancreatitis;; Renal failure;; Esophageal rupture;; Tumor

Front 29

Q029. Device that measures the rate at which the lung changes during forceful breathing?

Back 29

Spirometry

Front 30

Q030. Definition:; when the patient inhales normally, then exhales as rapidly and completely as possible that is recorded on Spirometry

Back 30

Forced Vital Capacity; (FVC)

Front 31

Q031. Spirometry Normal values:; 1. FEV1; 2. FVC; 3. FEV1/FVC

Back 31

Normals:; FEV1 = > 80%; FVC = > 80%; FEV1/FVC = > 0.7

Front 32

Q032. Values indicating Obstructive lung disease:; 1. FEV1; 2. FVC; 3. FEV1/FVC; 4. Lung volume

Back 32

FEV1 = DECREASED; FVC = normal or Decreased; FEV1/FVC < 0.7; Lung volume = normal or decreased

Front 33

Q033. Values indicating Restrictive lung disease:; 1. FEV1; 2. FVC; 3. FEV1/FVC; 4. Lung volume

Back 33

FEV1 = normal or Decreased; FVC = DECREASED; FEV1/FVC > 0.7; Lung volumes = Always DECREASED

Front 34

Q034. What are the (3) different types of Restrictive lung defects?

Back 34

Interstitial Lung Dz (fibrosis);; Neuromuscular Dz (ALS, MG);; Chest Wall disorders (obesity, kyphosis)

Front 35

Q035. What does the Obstructive defect look like on Spirogram?

Back 35

"swoopie"

Front 36

Q036. What does the Restrictive defect look like on Spirogram?

Back 36

Tall and thin

Front 37

Q037. *When is a Bronchoscopy the most accurate test?; (2); Only test more accurate?

Back 37

1. Infections such as TB or Pneumocystis; 2. Centrally located Abscess or Tumor; More accurate:; Open Lung Biopsy

Front 38

Q038. Dx:; an epileptic, febrile patient with cough for the last several weeks, weight loss and malodorus sputum; unusual finding in upper lung lobe on CXR; Most accurate test?

Back 38

Lung Abscess; test:; Lung Biopsy

Front 39

Q039. Most accurate diagnostic test of any pulmonary bacterial infection?

Back 39

Gram Stain of the Sputum

Front 40

Q040. Dx:; patient has a fever, cough and shortness of breath. There are crackles and consolidation over a lung lobe. First test?; Most accurate Dx test?

Back 40

Bacterial Pneumonia (MCC Strep); first test: CXR; most accurate: Gram Stain of Sputum

Front 41

Q041. What causes interstitial infiltrates?; (4)

Back 41

causes:; Viral Pneumonia;; PCP;; Mycoplasma;; Legionella

Front 42

Q042. Most accurate test for:; Interstitial Lung Infiltrates caused by PCP

Back 42

Bronchoalveolar Lavage; (also Increased LDH)

Front 43

Q043. *Most accurate test for:; Interstitial Lung Infiltrates caused by Legionella

Back 43

Urine Antigen testing

Front 44

Q044. *Most accurate test for:; Interstitial Lung Infiltrates caused by Mycoplasma or Chlamydia

Back 44

Serology Antibody titers

Front 45

Q045. What is the MC etiology of a Pleural Effusion?; (2); Most accurate test?

Back 45

etiology:; 1. CHF; 2. Pneumonia; test: Thoracentesis for fluid analysis

Front 46

Q046. What is the best test to tell the difference b/t Obstructive and Restrictive lung disease?

Back 46

Flow-Volume Loop

Front 47

Q047. *When is a Pulmonary Function Test the most accurate Dx Test?; What part of the test is most accurate in Dx?

Back 47

Distinguish b/t Obstructive and Restrictive lung disease; most accurate part:; FEV/FVC ratio

Front 48

Q048. Dx:; African-American female with cough, dyspnea, chest pain and bilateral hilar lymphadenopathy. First test?; Most accurate Dx test?

Back 48

Sarcoidosis; first test: ACE levels (increased); most accurate: Noncaseating Granuloma on Biopsy

Front 49

Q049. Dx:; a young non-smoker with emphysema and liver disease; First test?

Back 49

Alpha-1-Antitrypsin Deficiency (low levels); First test: serum A1A levels

Front 50

Q050. *When is Performing an ABG the best answer?; (3)

Back 50

1. COPD; 2. possible Respiratory Acidosis; 3. Low serum Bicarb (possible severe Met acidosis)

Front 51

Q051. Dx:; chronic respiratory problems, cough, SOB, fat malabsorption, vitamin deficiency, sterile. Blood gas reveals hypoxemia. Best test?

Back 51

Cystic Fibrosis; best test: Sweat Chloride; (Pilocarpine is given and Na + Cl is measured in the sweat)

Front 52

Q052. (3) Typical Sx of Pneumonia

Back 52

Fever;; Cough with sputum;; Pleurtic Chest pain

Front 53

Q053. (4) Physical Exam findings with Pneumonia

Back 53

Dullness to Percussion;; Rales (Crackles);; Egophany;; Tactile Fremitus in consolidated segment

Front 54

Q054. Bug Dx:; 27-yo patient has pneumonia, bullous myringitis and a chest film that looks worse then expected

Back 54

Mycoplasma Pneumonia

Front 55

Q055. If a patient comes to the ER with consolidation and pleural effusion on CXR, what is the most important test to determine admission / Tx?

Back 55

Thoracentesis

Front 56

Q056. Bug Dx:; patient with HIV who has a CD-4 count of 52 does not take antiretroviral meds or TMP-SMX, is hypoxic on room air, and has a diffuse bilateral infiltrate on chest film

Back 56

PCP; (Pneumocystis Carinii Pneumonia)

Front 57

Q057. Bug Dx:; Elderly man presents with pneumonia, GI Sx, bradycardia, and hypoN

Back 57

Legionella

Front 58

Q058. Pneumonia Bug Dx:; Currant Jelly sputum

Back 58

Klebsiella

Front 59

Q059. Pneumonia Bug Dx:; Rusty sputum

Back 59

Pneumococcus

Front 60

Q060. Pneumonia Bug Dx:; patient develops a post-influenza pneumonia

Back 60

Pneumococcus

Front 61

Q061. Pneumonia Bug Dx:; Buldging fissure on CXR

Back 61

Klebsiella

Front 62

Q062. Pneumonia Bug Dx:; No bacteria on sputum gram stain culture; (2)

Back 62

Legionella; Mycoplasma

Front 63

Q063. Pneumonia Bug Dx:; signs of pneumonia and Serum LDH is high

Back 63

PCP

Front 64

Q064. MC Community Acquired, typical pneumonia; (2)

Back 64

S. pneumoniae; H. Influenzae

Front 65

Q065. MC Community Acquired, atypical pneumonia; (3)*

Back 65

Community Lung Mess:; Chlamydia pneumoniae;; Legionella;; Mycoplasma

Front 66

Q066. MC Hospital Acquired pneumonia; (3)

Back 66

Pseudomonas aeruginosa;; S. aureus;; Enteric organisms (E. coli)

Front 67

Q067. What is the MCC of pneumonia (bugs) in the HIV patients as the CD-4 count decreases to the following numbers; (in order of occurrence)*:; 1. < 500; 2. < 200; 3. < 200; 4. < 200; 5. < 50; 6. < 50

Back 67

The Pneumonia HIV Causes Are Count-based:; 1. TB (500); 2. PCP (200); 3. Histoplasma (200); 4. Cryptococcus (200); 5. Avium (mycoplasma) (50); 6. CMV (50)

Front 68

Q068. MCC of pneumonia in the immunocompromised host with Neutropenia; (4)*

Back 68

Pseudomonas;; Enterobacteriaceae;; S. Aureus;; Aspergillus

Front 69

Q069. MCC of pneumonia in the immunocompromised host with sickle cell or a splenectomy

Back 69

Encapsulated organisms

Front 70

Q070. MCC of pneumonia in the immunocompromised host with chronic Steroid use; (2)

Back 70

TB;; Nocardia

Front 71

Q071. MCC of pneumonia in Alcoholics; (4)

Back 71

S. pneumoniae;; H. Influenzae;; Klebsiella;; TB

Front 72

Q072. Pneumonia Bug Dx:; Small gram negative rod with a halo on gram stain

Back 72

H. Influenzae

Front 73

Q073. CXR pneumonia findings:; Upper lobe; (2)

Back 73

TB;; Klebsiella

Front 74

Q074. CXR pneumonia findings:; small cavities w/o air-fluid levels

Back 74

TB; (Mycobacterium)

Front 75

Q075. CXR pneumonia findings:; Large cavities with air-fluid levels that do not culture; (2)

Back 75

Coccidioidomycosis;; Nocardia

Front 76

Q076. CXR pneumonia findings:; Diffuse Bilateral Infiltrates; (2)

Back 76

PCP;; Mycoplasma

Front 77

Q077. Definition:; Idiopathic Eosinophilic Pneumonia

Back 77

Loeffler's pneumonia

Front 78

Q078. Pneumonia bugs causing "Relative Bradycardia"; (slower then expected HR for Temp, but above 60bpm); (3)

Back 78

Legionella;; Salmonella;; Chlamydia Psittaci

Front 79

Q079. What drug prevents respiratory failure and improves survival in PCP pneumonia patients?; Criteria for when it is given?; (2)

Back 79

Steroids; give: A-a gradient > 35, PaO2 < 75

Front 80

Q080. Drug of choice for:; Any Community Acquired Pneumonia with no risk factors

Back 80

Macrolide; (Erythromycin, Azithromycin)

Front 81

Q081. Drug of choice for:; Any Community Acquired Pneumonia with risk factors; (CHF, DM, etc); (2)

Back 81

1. Macrolide + 2nd generation Cephalosporin; 2. FQ (Extended-spectum)

Front 82

Q082. Drug of choice for:; Any Hospital Acquired Pneumonia; (2)

Back 82

1. Cefixime; 2. Piperacillin-tazobactam; [both for Pseudomonas coverage]

Front 83

Q083. Drug of choice for:; Any Immunocompromised patient with Pneumonia

Back 83

TMP-SMX; [for PCP coverage]

Front 84

Q084. Dx:; Productive cough, night sweats, hemoptysis, anorexia, weight loss, chest pain, fever, chills

Back 84

TB

Front 85

Q085. (3) Dx tests for TB

Back 85

Positive PPD;; Granuloma in upper lobes of lung;; Acid-fast bacilli on sputum

Front 86

Q086. How is latent TB treated?

Back 86

INH daily for 9 months; (or Rifampin for 4 if in contact with INH-resistant TB)

Front 87

Q087. How is Active TB treated?

Back 87

RIPE for 2 months:; Rifampin; INH, Pyrazinamide; Ethambutol; followed with 4 months of:; INH and Rifampin

Front 88

Q088. How is tx of TB different with pregnant pt?

Back 88

No pyrazamide; (other med ok)

Front 89

Q089. Toxicity of INH; (2)*

Back 89

INH: Infects Neuro and Hepatic:; Neruopathy;; Seizures;; Hepatitis

Front 90

Q090. Dx:; patient brought by ambulance in status epilepticus. Patient says only medical history is TB; How is it treated?

Back 90

INH toxicity; Tx: Pyridoxine

Front 91

Q091. Toxicity of Rifampin; (2)

Back 91

Induces P450; Gives Red-orange secretions; (tears, urine, sweat, etc)

Front 92

Q092. Toxicity of Ethambutol

Back 92

Optic neuritis and impaired color vision

Front 93

Q093. Risk factors for DVT.

Back 93

stasis; endothelial injury; hypercoagulability; (Virchow's triad)

Front 94

Q094. Criteria for exudative effusion.

Back 94

pleural/serum protein > 0.5; pleural/serum LDH > 0.6

Front 95

Q095. Causes of exudative effusion.

Back 95

Think of leaky capillaries. Malignancy; TB; bacterial or viral infection; pulmonary embolism with infarct; pancreatitis

Front 96

Q096. Causes of transudative effusion.

Back 96

Think of intact capillarie. CHF; liver or kidney disease; protein-losing enteropathy

Front 97

Q097. Normalizing PCO2 in a patient having an asthma exacerbation may indicate?

Back 97

Fatigue & impending respiratory failure

Front 98

Q098. dyspnea; lateral hilar lymphadenopathy on CXR; noncaseating granulomas; increased ACE; hypercalcemia

Back 98

Sarcoidosis

Front 99

Q099. PFT showing decreased FEV1/FVC.

Back 99

Obstructive pulmonary disease (e.g. asthma)

Front 100

Q100. PFT showing increased FEV1/FVC.

Back 100

Restrictive pulmonary disease

Front 101

Q101. Honeycomb pattern on CXR. Diagnosis?; Treatment?

Back 101

Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help.

Front 102

Q102. Treatment for SVC syndrome.

Back 102

Radiation

Front 103

Q103. Treatment for mild, persistent asthma.

Back 103

Inhaled beta-agonists & inhaled corticosteroids

Front 104

Q104. Acid-base disorder in pulmonary embolism.

Back 104

Hypoxia & hypocarbia

Front 105

Q105. Non-small cell lung cancer (NSCLC) associated with hypercalcemia.

Back 105

Squamous cell carcinoma

Front 106

Q106. Lung cancer associated with SIADH.

Back 106

Small cell lung cancer (SCLC)

Front 107

Q107. Lung cancer highly related to cigarette

Back 107

Small cell lung cancer (SCLC)

Front 108

Q108. A tall white male presents with acute shortness of breath. Diagnosis?; Treatment?

Back 108

Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful.

Front 109

Q109. Treatment of tension pneumothorax.

Back 109

Immediate needle thoracostomy

Front 110

Q110. Characteristics favoring carcinoma in an isolated pulmonary nodule.

Back 110

Age > 45-50 yrs; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins

Front 111

Q111. Hypoxemia & pulmonary edema with normal pulmonary capillary wedge pressure.

Back 111

ARDS

Front 112

Q112. Increased risk of what infection with silicosis?

Back 112

Mycobacterium tuberculosis

Front 113

Q113. Causes of hypoxemia.

Back 113

right-to-left shunt; hypoventilation; low inspired O2 tension; diffusion defect; V/Q mismatch

Front 114

Q114. Classic CXR findings for pulmonary edema

Back 114

cardiomegaly; prominent pulmonary vessels; Kerley B lines; "bat's wing" appearance of hilar shadows; perivascular & peribronchial cuffing

Front 115

Q115. pulmonary function tests

Back 115

spirometry (mechanical ventilation); Dlco (gas exchange); methacholine challenge test (bronchial hyperreactivity); TLC

Front 116

Q116. restrictive pattern

Back 116

FEV1/FVC > 80%

Front 117

Q117. obstructive pattern

Back 117

FEV1/FVC < 80%; seen in emphysema, chronic bronchitis, asthma, bronchiectasis

Front 118

Q118. Decreased DLco

Back 118

if FEV1/FVC < 80% suggests emphysema; if FEV1/FVC > 80% suggests interstitial lung disease or mild left heart failure

Front 119

Q119. Increased DLco

Back 119

suggests hemorrhage such as in Goodpasture

Front 120

Q120. methacholine test

Back 120

bronchoprovocation in patients with cough or wheezing who have normal pulmonary function tests, for possible asthma; do basal and postprovocation spirometry; positive test if baseline FEV1 decreased >20%

Front 121

Q121. A-a gradient formula

Back 121

150 - 1.25 x PaCO2 - PaO2 normal: 5-15mmHg;; increases with age and all forms of hypoxemia except hypoventilation and high altitude

Front 122

Q122. solitary pulmonary nodule

Back 122

1/3 are malignant; first step in management is looking for previous image study; if none available then consider if patient is high or low risk for cancer; low risk nonsmoker <35 --> x-ray every 3 months for 2 years, if no growth stop follow-up; high risk smoker >50 --> open-lung biopsy and removal due to cancer risk

Front 123

Q123. transudative pleural effusion

Back 123

Increased hydrostatic pressure or decreased oncotic pressure; usually bilateral and equal; low LDH and proteins in fluid and serum (200, 0.6, 0.5); need all three values for diagnosis, else exudate

Front 124

Q124. exudative pleural effusion

Back 124

due to local process; usually unilateral; need further investigation; high LDH and proteins in fluid and serum (200, 0.6, 0.5); don't need all three values high to make diagnosis

Front 125

Q125. transudative causes of pleural effusion

Back 125

heart failure; nephrotic syndrome; liver disease; pulmonary embolism; atelectasis

Front 126

Q126. exudative causes of pleural effusion

Back 126

pneumonia; cancer (lung, breast or lymphoma); pulmonary embolism; drug-induced; pancreatitis; TB; RA; SLE

Front 127

Q127. transudative pleural effusion with no apparent cause

Back 127

consider pulmonary embolism which can be either transudative or exudative

Front 128

Q128. indications of thoracocentesis

Back 128

any new and unexplained pleural effusion --> rule out empyema; decubitus x-ray --> <1cm free-flowing fluid --> minimal risk; if non-free fluid need ultrasound guidance

Front 129

Q129. malignant pleural effusions

Back 129

due mostly to breast cancer, lung cancer and lymphoma; send thoracocentesis fluid for cytologic exam also

Front 130

Q130. hemorrhagic pleural effusion

Back 130

seen in mesothelioma, metastatic lung or breast cancer, pulmonary embolism with infarction and trauma

Front 131

Q131. lymphocytic-predominant pleural effusions

Back 131

suggests TB due to tuberculin hypersensitivity; check increased adenosine deaminase and positive PCR for TB; acid-fast and culture of fluid are only positive in 30%

Front 132

Q132. respiratory compromise and distress

Back 132

presents with shortness of breath, dyspnea, tachypnea (>30) and associated symptoms such as agitation, confusion or decreased consciousness

Front 133

Q133. evaluation of respiratory distress

Back 133

ensure patent airway; focus on quickness of onset and associated symptoms; most important lab test is arterial blood gases then B- natriuretic peptide and chest x-ray

Front 134

Q134. acute respiratory distress with fever, cough or sputum

Back 134

suggests infectious etiology

Front 135

Q135. acute respiratory distress without systemic symptoms

Back 135

suggests airway obstruction, cardiac disease or thromboembolism

Front 136

Q136. chronic respiratory distress

Back 136

suggests interstitial lung disease or COPD

Front 137

Q137. common lung physical exam findings

Back 137

diffuse wheezing --> asthma; localized wheezing --> foreign object; rales --> pneumonia, interstitial disease, heart failure; dull percussion --> pneumonia or atelectasis; normal exam --> pneumocystis jirovecci, central respiratory problems

Front 138

Q138. B-natriuretic peptide in acute dyspnea

Back 138

elevation is sensitive for heart failure but can also be elevated in cor pulmonale and acute right ventricular failure (thromboembolism)

Front 139

Q139. chest x-ray without parenchymal infiltrates in acute dyspnea

Back 139

suggests thromboembolism; central respiratory depression; neuromuscular disease; upper airway obstruction

Front 140

Q140. chest x-ray hyperinflation in acute dyspnea

Back 140

suggests asthma and COPD

Front 141

Q141. chest x-ray with focal infiltrates in acute dyspnea

Back 141

suggests bacterial, viral or fungal pneumonia, aspiration or pulmonary hemorrhage

Front 142

Q142. chest x-ray with diffuse edema in acute dyspnea

Back 142

suggests heart failure or ARDS

Front 143

Q143. ICU indications in respiratory failure

Back 143

persistent hypoxemia --> hospitalization; ICU indications -->; need for mechanical ventilation; close monitoring; increasing oxygen demand; continuous nursing

Front 144

Q144. indications for intubation and/or mechanical ventilation

Back 144

respiratory acidosis and hypercapnia in asthmatic patient; upper airway injury (burns, laryngeal edema, trauma); neurologic airway depression (often with loss of gag and cough reflexes)

Front 145

Q145. respiratory distress in hospitalized patients

Back 145

inpatient who develops dyspnea, tachypnea and/or hypoxemia should raise possibility of pulmonary embolism or aspiration

Front 146

Q146. types of asthma

Back 146

intrinsic (50%) is secondary to nonimmunologic stimuli (infections, irritating inhalants, cold air and emotional);; extrinsic (20%) due to allergens

Front 147

Q147. asthma stimuli

Back 147

infections (RSV, rhinovirus),; drugs (aspirin/NSAIDs, coloring agents, betablockers),; allergens,; cold air,; emotions

Front 148

Q148. asthma presentation

Back 148

tachypnea,; tachycardia,; diffuse wheezing,; use of accessory muscles,; diminished breath sounds,; hyperresonance,; intercostal retractions

Front 149

Q149. asthma poor prognosis factors

Back 149

fatigue; diaphoresis; pulsus paradoxus; inaudible breath sounds; decreased wheezing; cyanosis; bradycardia

Front 150

Q150. asthma diagnosis

Back 150

initial tests for acute attacks --> decreased PaCO2, increased pH, normal or decreased PaO2; severe attack -->decreased PaO2, increased PaCO2, decreased pH; chest x-ray to rule out infection as cause; spirometry --> obstructive pattern that reverses with beta agonist (FEV1 reverses by 12%); methacholine test --> decreased FEV1/FVC of 20%

Front 151

Q151. acute asthma management

Back 151

O2; metered inhaled beta agonists --> albuterol/salbutamol, terbutaline; salmeterol is long-lasting for nocturnal variant; catecholamines may be used but not routinely; aminophylline and theophyline have modest potency and are not routine; anticholinergics (ipratropium) if heart disease (slow onset, medium potency)

Front 152

Q152. chronic asthma management

Back 152

acute exacerbations: systemic prednisone 10-14 days along with inhaled albuterol;; inhaled corticosteroids are first line maintenance;; cromolyn is first line maintenance in children and prophylaxis in adults;; zileuton, zafirlukast, mmonteleukast for severe asthma resistant to maximum doses of inhaled steroids

Front 153

Q153. mild asthma definition and treatment

Back 153

symptoms ~2 days/week and rare night symptoms; FEV1 is normal; no long-term control needed only inhaled beta agonists for attacks

Front 154

Q154. moderate asthma definition and treatment

Back 154

symptoms on most days and at least 5 nights/month with FEV1 60-80%; treat with daily inhaled steroids (also cromolyn specially in children); maybe also salmeterol

Front 155

Q155. severe asthma definition and treatment

Back 155

daily symptoms, frequent night symptoms and hospital emergencies with FEV1 <60%;; daily inhaled steroids, daily inhaled salmeterol along with antileukotriene drug and possibly low-dose oral steroid

Front 156

Q156. physical exam in emphysema

Back 156

distant breath sounds; pink skin; thin; barrel chest; accessory muscles; symptoms of right heart failure and clubbing

Front 157

Q157. physical exam in chronic bronchitis

Back 157

rhonchi and wheezes; signs of cyanosis; weight gain; symptoms of right heart failure and clubbing

Front 158

Q158. chest x-ray findings in COPD

Back 158

chronic bronchitis --> increased pulmonary markings; emphysema --> bilateral hyperinflantion, diaphragm flattening, small heart size, increase in retrosternal space

Front 159

Q159. COPD diagnosis

Back 159

decreased FEV1/FVC; FEF 25-75; increased RV and TLC; emphysema has decreased DLco and chronic bronchitis has normal DLco; FEV1/FVC after bronchodilation will stay the same

Front 160

Q160. COPD complications

Back 160

hypoxemia with nocturnal desaturation; secondary erythrocytosis; cor pulmonale; chronic ventilatory failure; CO2 retention

Front 161

Q161. maintenance treatment for COPD

Back 161

first-line --> ipratropium via metered inhaler;; inhaled beta agonists can be used concomitantly;; inhaled corticosteroids are not used in COPD;; if above fails --> theophylline (watch for cytochrome inhibitors and inducers)

Front 162

Q162. only treatment that reduces mortality in COPD

Back 162

home O2 supplementation and smoking cessation; home oxygen for hypoxemia (PaO2<55mmHg or saturation <88%); pneumococcal vaccine every 5 years, influenza vaccine yearly and haemophilus vaccine if unvaccinated

Front 163

Q163. COPD exacerbation general management

Back 163

1) measure O2 saturation (pulse oximetry); 2) arterial blood gases; 3) chest x-ray; 4) check theophylline levels; 5) CBC and ECG; 6) hospital admission if significant hypercapnia or hypoxemia; 7) consider intubation and mechanical ventilation; 8) specific treament; spirometry is NOT done or useful in exacerbation

Front 164

Q164. COPD exacerbation specific treatment

Back 164

1) O2 supplementation; 2) inhaled bronchodilators and anticholinergics concomitantly; 3) IV or oral prednisone for 2 weeks; 4) antibiotics despite normal x-ray; 5) council on smoking cessation; 6) teach optimal use of MDI; no benefit in IV theophylline and avoid opiates and sedatives

Front 165

Q165. bronchiectasis etiology

Back 165

secondary to recurrent pneumonias, TB, fungal or abscess; cystic fibrosis, immotile cilia syndrome (50% Kartagener)

Front 166

Q166. bronchiectasis presentation

Back 166

suspect in anyone with; chronic cough; foul-smelling sputum; hemoptysis; recurrent pulmonary infections; sinusitis; immune deficiencies; presents with purulent copious sputum, wheezes, crackles and history of recurrent pneumonias (specially gram- and pseudomonas)

Front 167

Q167. bronchiectasis diagnosis

Back 167

early chest x-ray may be normal or severe cases show 1- 2cm cysts and crowding of bronchi;; chest CT is best noninvasive test

Front 168

Q168. bronchiectasis treatment

Back 168

bronchodilators, chest physical therapy, postural drainage, rotating gram- antibiotics; surgery in cases of localized bronchiectasis or massive hemoptysis; yearly influenza vaccine and pneumococcal vaccine with booster at 5 years

Front 169

Q169. bronchiectasis complications

Back 169

massive hemoptysis,; amyloidosis,; cor pulmonale,; visceral abscesses

Front 170

Q170. interstitial lung disease general presentation

Back 170

exertional dyspnea; nonproductive cough; crackles; pulmonary hypertension; clubbing; restrictive pattern

Front 171

Q171. interstitial lung diseases

Back 171

idiopathic pulmonary fibrosis; sarcoidosis; pneumoconiosis --> asbestosis, silicosis, coal pneumoconiosis

Front 172

Q172. idiopathic pulmonary fibrosis presentation

Back 172

exercise intolerance, dyspnea, coarse crackles

Front 173

Q173. idiopathic pulmonary fibrosis diagnosis

Back 173

reticular or reticulonodular pattern on chest x-ray; restrictive pattern on PFTs; increased macrophages on bronchoalveolar lavage (nonspecific)

Front 174

Q174. idiopathic pulmonary fibrosis treatment

Back 174

steroids with or without azathioprine works in 20%;; the rest develop fatal lung disease

Front 175

Q175. idiopathic pulmonary fibrosis prognosis

Back 175

20-40% 5-year survival;; best prognostic factor is response to steroids as evidenced in PFTs

Front 176

Q176. sarcoidosis presentation

Back 176

"GRAIN"; gammaglubilinemia; rheumatoid arthritis; ACE increase; interstitial fibrosis; non-casseating granuloma; hilar and left paratracheal adenopathy; hypercalcemia due to vitamin activation by macrophages; uveitis/conjunctivitis in >25%; chest x-ray findings; restrictive or normal PFTs

Front 177

Q177. chest x-ray findings in sarcoidosis

Back 177

four stages found (not progressive); bilateral hilar adenopathy; hilar adenopathy with reticulonodular parenchyma; reticulonodular parenchyma alone; honeycombing of bilateral lung fields with fibrosis

Front 178

Q178. sarcoidosis diagnosis

Back 178

biopsy of affected tissue showing noncasseating granulomas;; all patients should have ophthalmologic exam

Front 179

Q179. sarcoidosis prognosis

Back 179

80% remain stable or spontaneously resolves;; 20% progress to organ compromise

Front 180

Q180. sarcoidosis treatment

Back 180

no treatment is effective; if organ compromise may use trial of high-dose steroids; if uveitis, CNS involvement or hypercalcemia --> steroids are mandatory

Front 181

Q181. pneumoconiosis general presentation

Back 181

dyspnea,; shortness of breath,; cough,; sputum,; cor pulmonale,; clubbing,; restrictive pattern,; decreased DLco,; hypoxemia with increased A-a

Front 182

Q182. ocupations associated with asbestosis

Back 182

mining,; milling,; foundry work,; shipyards,; pipes,; break linings,; insulation,; boilers;; history of exposure necessary for Dx

Front 183

Q183. asbestosis x-ray findings

Back 183

diffuse or local pleural thickening,; pleural plaques,; calcifications near diaphragm,; pleural effusions,; lower lobe interstitial infiltrate

Front 184

Q184. asbestosis associated cancers

Back 184

lung adenocarcinoma or SCC; pleural mesothelioma is less common

Front 185

Q185. asbestosis diagnosis

Back 185

history of exposure + lung biopsy showing barbell-shaped asbestos fibers

Front 186

Q186. asbestosis treatment

Back 186

no effective treatment;; must stop smoking due 75x increased risk of cancer

Front 187

Q187. ocupations associated with silicosis

Back 187

mining,; quarrying,; tunneling,; glass and pottery making,; sandblasting

Front 188

Q188. silicosis x-ray findings

Back 188

1-10mm nodules throughout the lungs, most prominent in upper lobes; in progressive massive fibrosis nodules are >10mm and coalesce

Front 189

Q189. silicosis diagnosis

Back 189

history of exposure + lung biopsy showing silica particles; pathologic lesion is the hyaline nodule

Front 190

Q190. silicosis treatment

Back 190

no effective treatment; should have yearly PPD test and if >10mm --> INH prophylaxis for 9 months

Front 191

Q191. Lofgren syndrome

Back 191

acute sarcoidosis presentation with erythema nodosum, arthritis, hilar adenopathy

Front 192

Q192. Heefordt-Waldenstrom syndrome

Back 192

acute sarcoidosis presentation with fever,; parotid enlargement,; uveitis and facial palsy

Front 193

Q193. Caplan syndrome

Back 193

rheumatoid nodules in periphery of lung,; rheumatoid arthritis and coexisting pneumoconiosis (usually CWP)

Front 194

Q194. coal worker's pneumoconiosis x-ray findings

Back 194

small round parenchymal densities; usually in upper half of lungs; progressive massive fibrosis has 1cm densities in whole lung

Front 195

Q195. coal worker's pneumoconiosis immunologic findings

Back 195

increased IgA,; increased IgG,; increased C3, ANA and rheumatoid factor

Front 196

Q196. pulmonary embolus site of origin

Back 196

most are from above-the-knee deep veins which result from distal deep vein thrombosis;; in patients with catheters it can originate from upper limb, subclavian and internal jugular veins

Front 197

Q197. criteria for high-risk pulmonary embolism patients

Back 197

recent surgery (specially orthopedic, knee replacement has 70% risk);; cancer history (prostate, breast, pelvic, abdominal);; immobilized patients;; acquired thrombophilia (lupus anticoagulant, nephrotic syndrome);; oral contraceptives;; inherited thrombophilia (factor V Leiden, protein C/S deficiency, antithrombin III deficiency);; pregnancy;; need 1 risk factor and consistent signs and symptoms for high-risk label

Front 198

Q198. signs and symptoms consistent with pulmonary embolism

Back 198

sudden onset of dyspnea,; tachypnea,; thigh/calf swelling,; pleuritic chest pain,; hemoptysis,; tachycardia,; increased P2

Front 199

Q199. when to consider pulmonary embolism

Back 199

all patients with dyspnea and normal chest x-ray

Front 200

Q200. nonspecific routine tests for dyspnea; may suggest PE

Back 200

arterial blood gases show hypoxemia with increased A-a; chest x-ray (normal in PE); ECG (to exclude others) shows S1, Q3, T3, tachycardia

Front 201

Q201. specific tests for pulmonary embolism

Back 201

best initial test is spiral CT scan;; V/Q scan (if normal excludes PE);; angiogram is gold standard

Front 202

Q202. deep venous thrombosis specific tests

Back 202

best initial test is compression or duplex ultrasound;; venogram is rarely done;; MRI

Front 203

Q203. tests for DVT and PE

Back 203

D-dimer is most sensitive;; can only exclude thromboembolism if normal levels; may also be high in surgery, infection, trauma, pregnancy and DIC; normal D-dimer and CT scan rule out thromboembolism in 98% of low-risk patients

Front 204

Q204. tests results that exclude pulmonary embolism

Back 204

normal CT + normal D-dimer in low-risk patients; normal CT + normal doppler in low-risk patients; V/Q scan is completely normal

Front 205

Q205. generalities of pulmonary embolism diagnosis

Back 205

all patients should be on heparin during diagnosis and imaging;; if PE is suspected start CT scan right after chest x-ray;; if all tests are negative but it's high-risk patient --> angiogram;; normal CT + normal D-dimer or doppler excludes PE in low- risk patients

Front 206

Q206. pulmonary embolism treatment

Back 206

1) O2; 2) start heparin before confirmation and during work-up; 3) concomitant warfarin; 4) if hemodynamically unstable or massive PE --> thrombolytics (tPa, streptokinase)

Front 207

Q207. heparin considerations in pulmonary embolism

Back 207

if LMWH then no need to follow PTT and less chance of heparin-induced thrombocytopenia; HIT is associated with more thrombotic events, not bleeding diathesis, and is treated with new anticoagulants (argatroban, lepirudin); start heparin immediately

Front 208

Q208. warfarin considerations in pulmonary embolism

Back 208

monitor PT; titrate to INR of 2-3; skin necrosis can occur if protein C deficiency already present; contraindicated in pregnancy (use LMWH 6 months instead)

Front 209

Q209. contraindications of anticoagulation therapy in PE

Back 209

contraindicated in patients with recent neurosurgery or eye surgery; use inferior vena cava filter instead

Front 210

Q210. post thrombotic syndrome

Back 210

pain; edema; hyperpigmentation; skin ulceration in 2/3 of PE patients; compression stockings can prevent it

Front 211

Q211. fat embolism

Back 211

acute dyspnea, petechiae in neck or axilla, confusion,; 3 days after long bone fracture or after CPR;; no anticoagulation necessary

Front 212

Q212. ARDS etiology

Back 212

sepsis; trauma; DIC; Goodpasture; SLE; drug overdose; toxin inhalation; drowning

Front 213

Q213. ARDS presentation

Back 213

dyspnea,; tachypnea,; diffuse rales and ronchi

Front 214

Q214. ARDS diagnosis

Back 214

chest x-ray --> diffuse interstitial or alveolar infiltrates; ABGs --> decreased PaO2, increased PaCO2; Swan-Ganz --> normal cardiac output and capillary wedge pressure but increased pulmonary artery pressure

Front 215

Q215. ARDS treatment

Back 215

treat underlying cause;; mechanical ventilation with positive end-expiratory pressure

Front 216

Q216. ARDS prognosis

Back 216

70% mortality

Front 217

Q217. sleep apnea

Back 217

cessation of airflow >10s at least 10-15/hour of sleep + daytime somnolence; confirm with polysomnography; treat obstructive with weight loss and nasal continuous positive airway pressure (CPAP); treat central with acetazolamide, progesterone and O2

Front 218

Q218. lung cancer etiology

Back 218

90% of cases are directly related to cigarette smoke;; nonsmokers develop adenocarcinoma;; all lung cancers are associated with smoking;; active smokers have 10x greater risk;; 40 pack-year history increases risk 60-70x;; asbestos increases risk 75x

Front 219

Q219. types of lung cancer

Back 219

most common is adenocarcinoma (40%);; squamous cell carcinoma,; small cell and large cell

Front 220

Q220. centrally located lung cancers

Back 220

squamous cell and small cell

Front 221

Q221. peripheral located lung cancers

Back 221

adenocarcinoma and large cell

Front 222

Q222. lung cancer paraneoplastic syndromes

Back 222

SCC --> hypercalcemia (PTH-like peptide); small cell --> SIADH and Eaton-Lambert

Front 223

Q223. lung cancer metastasis

Back 223

SCC --> direct extension to hilar node and mediastinum; small cell and adenocarcinoma --> liver, adrenals, brain, bones

Front 224

Q224. lung cancer presentation

Back 224

cough; weight loss; dyspnea; hemoptysis; chest pain; recurrent pneumonic processes; hoarseness

Front 225

Q225. lung cancer diagnosis

Back 225

sputum cytology (specially SCC); bronchoscopy for centrally located lesions; needle aspiration biopsy if highly suspicious and nonspecific bronchoscopy findings or peripheral lesion

Front 226

Q226. symptoms of unresectable lung cancer

Back 226

weight loss >10%; bone pain; extrathoracic metastasis; CNS symptoms; SVC syndrome; hoarseness; contralateral mediastinal adenopathy

Front 227

Q227. lung cancer treatment

Back 227

resectable small cell --> VP16 (etoposide, platinum);; resectable non-small --> CAP (cyclo, adriamycin, platinum) and radio

Front 228

Q228. lung cancer prognosis

Back 228

5-8% 5-year survival; after resection of SCC --> 30-35%; after resection of large-cell and adeno --> 25%

Front 229

Q229. atelectasis etiology

Back 229

most common is postsurgery;; also mucuous plug, foreign body or tumor

Front 230

Q230. atelectasis presentation

Back 230

tachycardia,; dyspnea,; fever,; hypoxemia

Front 231

Q231. atelectasis diagnosis

Back 231

ipsilateral trachea deviation --> upper lobe; mediastinal deviation --> massive atelectasis; elevation of hemidiaphragm --> lower lobe; atelectatic lobe looks denser, consolidated and smaller than normal contralateral lobe

Front 232

Q232. What muscles are responsible for inspiration during exercise?

Back 232

external intercostals; scalenes,; sternocleidomastoid,

Front 233

Q233. What muscles are responsible for expiration during exercise?

Back 233

Internal intercostals,; rectus abdominis,; transversus abdominis,; internal and external obliques

Front 234

Q234. What ratio indicates fetal lung maturity?

Back 234

lecithin: sphingomyelin > 2.0

Front 235

Q235. What is deficiency in neonatal respiratory distress syndrome?

Back 235

dipalmitoyl phosphatidylcholine (lecithin)

Front 236

Q236. How do ACE inhibitors cause cough?

Back 236

Normally ATII inactivates bradykinin;; when blocked, kallikrein is unopposed --> activates bradykinin --> cough and angioedema

Front 237

Q237. Where are ACE and kallikrein synthesized?

Back 237

In the lungs

Front 238

Q238. What is the formula for collapsing pressure?

Back 238

2(tension)/radius; As radius decreases, alveoli are more likely to collapse

Front 239

Q239. How is inspiratory capacity calculated?

Back 239

tidal volume + inspiratory reserve capacity

Front 240

Q240. Formula for calculated Vd - physiologic dead space

Back 240

tidal volume x (PaCO2-PeCo2)/PaCO2; PaCO2 = arterial PCO2; PeCO2 = expired air CO2

Front 241

Q241. At what point in the breath cycle is the tendency for the lungs to collapse equal to the tendency for the chest wall to spring outward?; What is the system pressure at this point?

Back 241

At FRC; System pressure is equal to atmospheric pressure

Front 242

Q242. What is the treatment for methemoglobinemia?

Back 242

Methylene blue

Front 243

Q243. What is the treatment for cyanide poisoning?

Back 243

Give nitrates to oxidize Hb to metHb --> allows cyt oxidase to function; -> thiosulfate to bind cyanide; -> thiocyanide is renally excreted

Front 244

Q244. What is methemoglobin?

Back 244

oxidized form (Fe3+ instead of Fe2+) --> poorer O2 binding

Front 245

Q245. What is the effect of carboxyhemoglobin on the oxygen dissociation curve?

Back 245

Left shift (increased affinity for oxygen, decreased unloading)

Front 246

Q246. What is the effect of increased metabolic needs on the oxygen dissociation curve?

Back 246

Right shift (increased oxygen unloading)

Front 247

Q247. What is the effect of acidemia on the oxygen dissociation curve?

Back 247

Right shift (increased oxygen unloading)

Front 248

Q248. What is the effect of alkalemia on the oxygen dissociation curve?

Back 248

Left shift (increased affinity for oxygen, decreased unloading)

Front 249

Q249. What is the effect of increased 2,3-DPG on the oxygen dissociation curve?

Back 249

Right shift (increased oxygen unloading)

Front 250

Q250. How does the oxygen dissociation curve of fetal Hb differ from adult Hb?

Back 250

Left shift (increased affinity for oxygen, decreased unloading)

Front 251

Q251. What is the effect of a decrease in PAO2?

Back 251

Vasoconstriction that shunts blood towards well-ventilated regions of lung

Front 252

Q252. How do emphysema and pulmonary fibrosis impact diffusion?

Back 252

Both decrease it. Diffusion is proportional to A(rea)/T(hickness). Emphysema reduces area. Fibrosis increases thickness.

Front 253

Q253. What types of gases show perfusion-limited patterns of exchange along pulmonary capillaries?

Back 253

O2 (normally), CO2, N2O. These equilibrate before the end of the capillary. Diffusion can only be increased if blood flow increases.

Front 254

Q254. What types of gases show diffusion-limited patterns of exchange along pulmonary capillaries?

Back 254

O2 (in emphysema or fibrosis); CO

Front 255

Q255. What is the normal pressure in pulmonary arteries?

Back 255

10-14 mmHg; >25 mmHg = HTN; >35 mmHg during exercise = HTN

Front 256

Q256. What histologic changes are seen as a result of pulmonary HTN?

Back 256

medial thickening, intimal fibrosis, atherosclerosis

Front 257

Q257. What causes primary pulmonary HTN?

Back 257

Inactivating mutation in BMPR2 gene (normally inhibits smooth muscle proliferation)

Front 258

Q258. What causes secondary pulmonary HTN?

Back 258

COPD,; mitral stenosis; systemic sclerosis; left-to-right shunt; sleep apnea (hypoxic vasoconstrict); high altitude (hypoxic vasoconstrict); recurrent thromboemboli

Front 259

Q259. What is the formula for pulmonary vascular resistance?

Back 259

PVR = (Ppulm artery - Pleft atrium)/CO; R = (change in P)/Q; R = (8)(viscosity)(length)/(pi)(radius^4)

Front 260

Q260. What is the alveolar gas equation?

Back 260

PAO2 = 150 - (PaCO2)/0.8; 150 = PO2 in inspired air; 0.8 = respiratory quotient

Front 261

Q261. What is the A-a gradient?; When is it increased?

Back 261

PAO2 - PaO2 = 10-15; Increased in hypoxemia (V/Q mismatch, fibrosis)

Front 262

Q262. Where in the lung are ventilation and perfusion greatest?; Where is V/Q = 3?; Where is V/Q = 0.6; Where is V/Q = 1

Back 262

At the bases; At the apices; At the bases; During exercise

Front 263

Q263. In what type of V/Q mismatch should 100% O2 be used?

Back 263

Only in physiologic dead space (V>Q) due to blood flow obstruction. Does not help in physiologic shunt (V<Q) due to airway obstruction.

Front 264

Q264. In zone 2 of the lung, how to the partial pressures of oxygen in the alveoli, veins, and arteries compare?

Back 264

PA > Pa > Pv

Front 265

Q265. What are the 3 forms in which carbon dioxide is transferred from the tissues to the lungs?

Back 265

1. Bicarbonate, HCO3- (90%); 2. Carbaminohemoglobin, bound to Hb at N terminus (5%), favors T form --> O2 unloading; 3. Dissolved CO2 (5%

Front 266

Q266. Pt presents with sudden onset dyspnea, chest pain, and tachycardia. What could be the underlying causes?

Back 266

Embolus (95% from deep leg veins):; Fat (bone fractures, liposuction); Air; Thrombus; Bacteria; Amniotic fluid (--> postpartum DIC); Tumor

Front 267

Q267. Pt presents with calf tenderness occurring with foot dorsiflexion. What is wrong?

Back 267

DVT (positive Homan's sign)

Front 268

Q268. Pt has productive cough, wheezing, crackles, and cyanosis. What is causing this?

Back 268

Chronic bronchitis ("blue bloater") due to hypertrophy of mucus-secreting glands in bronchioles --> early onset hypoxemia, late-onset dyspnea

Front 269

Q269. Pt has dyspnea, decreased breath sounds, tachycardia. What is causing this?

Back 269

Emphysemia ("pink puffer") due to increased elastase activity --> destruction of alveolar walls

Front 270

Q270. What type of emphysema is caused by smoking?

Back 270

Centriacinar

Front 271

Q271. What type of emphysema is caused by alpha1-antitrypsin deficiency?

Back 271

Pancacinar

Front 272

Q272. What type of emphysema is associated with spontaneous pneumothorax in a young male?

Back 272

Paraseptal (cyst/bulla forming)

Front 273

Q273. Pt has dyspnea, cough, wheezing, tachypnea, hypoxemia, decreased inspiratory/expiratory ratio

Back 273

Asthma: bronchial hyperresponsiveness --> bronchoconstriction; Smooth muscle hypertrophy, Curschmann's spirals (shed epithelium from mucus plugs)

Front 274

Q274. Pt has dilated airways, purulent sputum, recurrent infections, and hemoptyis. What is this called?; What is it caused by?; What infection are they at risk for?

Back 274

Bronchiectasis; CF, Kartagener's, poor ciliary motility; Aspergillosis

Front 275

Q275. What are the mechanical causes of restrictive lung disease?

Back 275

Muscle - polio, myasthenia gravis; Structural - scoliosis, obesity

Front 276

Q276. What are the causes of restrictive lung disease that are attributable to lowered diffusing capacity?

Back 276

ARDS; Neonatal RDS (hyaline membrane dz); Sarcoidosis; Pneumoconioses; Idiopathic pulmonary fibrosis (collagen); Goodpasture's syndrome; Wegener's granulomatosis; Eosinophilic granuloma (histiocytosis X); Drug toxicity (bleomycin, amiodarine, busulfan)

Front 277

Q277. Pt presents with cough, dyspnea, morning stiffness, and painful joints. What caused it?; What part of lung is affected?

Back 277

Coal dust (coal miner's lung) --> Caplan syndrome; Upper lobes

Front 278

Q278. Sandblaster presents with cough, dyspnea, and "eggshell" calcification of hilar lymph nodes. What caused it?; What part of lung is affected?

Back 278

Silicosis (macrophages respond to silica --> fibrogenesis); may increase susceptibility to TB if macrophages are impaired. Upper lobes

Front 279

Q279. Plumber/roofer presents with bronchogenic carcinoma. What caused it?; What part of lung is affected?; What is seen on biopsy?

Back 279

Asbestosis; Lower lobes; "Ivory white" calcified pleural plaques, dumbbell-shaped bodies in macrophages, "ferruginous bodies" on Prussian blue

Front 280

Q280. Baby is born before 35 weeks. What is his L:S ratio?; What did his mom have?; How was he delivered?; What congenital heart defect?; Giving 100% O2 does what?; Treatment?

Back 280

L:S < 1.5; maternal diabetes; Cesarean section; low O2 tension --> PDA; 100% O2 --> retinopathy; Give maternal steroids before birth, artificial surfactant, thyroxine

Front 281

Q281. Protein-rich fluid in alveoli, hyaline membranes. What caused damage?; What incited this diffuse alveolar damage?

Back 281

Toxic neutrophilic substances OR coagulation cascade OR free radicals; Trauma, sepsis, shock, gastric aspiration, uremia, pancreatitis, amniotic fluid embolism

Front 282

Q282. Obese pt who snores, has HTN, is always tired... Has what?; Should do what?; Could die from what?

Back 282

Obstructive sleep apnea (central is no respiratory effort); Get CPAP, lose weight, surgery; Arrhythmia

Front 283

Q283. Decreased breath sounds in one area, decreased resonance to percussion, decreased fremitus, tracheal deviation.

Back 283

Bronchial obstruction (ipsilateral to tracheal deviation), e.g. cancer

Front 284

Q284. Decreased breath sounds, dullness to percussion, decreased fremitus

Back 284

Pleural effusion

Front 285

Q285. Bronchial sounds in one area, dullness to percussion, increased fremitus

Back 285

Lobar pneumonia

Front 286

Q286. Decreased breath sounds, hyperresonance to percussion, absent fremitus, tracheal deviation

Back 286

Tension pneumothorax (on contralateral side to tracheal deviation)

Front 287

Q287. Pt presents with cough, hemoptysis, decreased breath sounds in one area, wheezing, coin lesions. Possible complications?

Back 287

Lung cancer SPHERE:; Superior vena cava syndrome; Pancoast's tumor; Horner syndrome; Endocrine (paraneoplastic); Recurrent laryngeal symptoms; Effusions (pleural or pericardial)

Front 288

Q288. Hx of smoking; Hilar mass arising from bronchus, cavitation, PTHrP production; What would show up on histology?

Back 288

Squamous cell carcinoma

Front 289

Q289. Keratin pearls and intracellular bridges

Back 289

Squamous cell carcinoma

Front 290

Q290. Clara cells --> type II pneumocytes; multiple densities on chest X-ray

Back 290

Bronchial or bronchioloalveolar Adenocarcinoma

Front 291

Q291. Peripheral tumor in site of prior pulmonary inflammation or injury

Back 291

Bronchial adenocarcinoma

Front 292

Q292. Peripheral tumor presenting like pneumonia, grows along airways; Can result in hypertrophic osteoarthropathy

Back 292

Bronchioloalveolar adenocarcinoma

Front 293

Q293. Most common lung cancer in nonsmokers and females?

Back 293

Bronchial adenocarcinoma

Front 294

Q294. Central, aggressive tumor. Associated with ectopic ACTH or ADH, Lambert-Eaton Syndrome (anti-Ca channel Igs)

Back 294

Small (oat) cell carcinoma

Front 295

Q295. Poorly differentiated; neuroendocrine Kulchitsky cells (dark blue)

Back 295

Small (oat) cell carcinoma

Front 296

Q296. Inoperable but responsive to chemotherapy

Back 296

Small (oat) cell carcinoma

Front 297

Q297. Pleomorphic giant cells with leukocyte fragments

Back 297

Large cell carcinoma

Front 298

Q298. Peripheral tumor composed of anaplastic cells; unresponsive to chemotherapy; surgically removed

Back 298

Large cell carcinoma

Front 299

Q299. Secretes serotonin, can cause flushing, diarrhea, wheezing, salivation

Back 299

Carcinoid tumor

Front 300

Q300. Malignancy of the pleura resulting in hemorrhagic pleural effusions and pleural thickening

Back 300

Mesothelioma

Front 301

Q301. Psammoma bodies seen on histology

Back 301

Mesothelioma

Front 302

Q302. Common sites of lung metastases

Back 302

adrenals; brain (seizures); bone (fractures); liver (jaundice, hepatomegaly)

Front 303

Q303. Ptosis, miosis, anyhydrosis can be caused by a lung tumor in what location?

Back 303

Apex (Pancoast's) --> compresses cervical sympathetic plexus

Front 304

Q304. What organisms are usually responsible for lobar pneumonia?; Produce intra-alveolar exudate --> consolidation

Back 304

Streptococcus pneumoniae; Klebsiella

Front 305

Q305. What organisms are usually responsible for bronchopneumonia?; Inflammatory infiltrates from bronchioles --> alveoli; patchy distribution in >1 lobe

Back 305

S. aureus; H. flu; Klebsiella; S. pyogenes

Front 306

Q306. What organisms are usually responsible for interstitial pneumonia?; Diffuse patchy infiltrates localized to interstitial areas at alveolar walls; more indolent

Back 306

Viruses (RSV, adenovirus); Mycoplasma; Legionella; Chlamydia

Front 307

Q307. What situations predispose to lung abscess with S. aureus and anaerobes?

Back 307

Bronchial obstruction (e.g. cancer); Aspiration of oropharyngeal contents (e.g. alcoholics, epileptics)

Front 308

Q308. Pleural effusion with low protein content is due to...

Back 308

(Transudate):; CHF; Nephrotic syndrome; Hepatic cirrhosis; Anything that causes increased hydrostatic or decreased oncotic P

Front 309

Q309. Cloudy pleural effusion with high protein content is due to...

Back 309

(Exudate - must drain):; Malignancy; Pneumonia; Collagen vascular disease; Infection; Trauma; Anything that causes increased vascular permeability

Front 310

Q310. Milky fluid with high triglyceride content is composed of...

Back 310

lymphatic fluid (lymphatic effusion)

Front 311

(H/P) = rhinorrhea (i.e., nasal congestion & increased secretions), nonproductive cough; nasal and throat irritation, sneezing, possible fever, no exudates or productive coughLabs = negative throat culture

Back 311

Upper respiratory infections (URI) Inflammation of the upper airways most commonly caused by rhinovirus, coronavirus, or adenovirus

Hint 311

Treatment = rest, analgesia, treat symptoms; antibiotics are NOT helpful

Front 312

H/P = sore throat, tonsillar exudates (more common w/ bacterial infection), lymphadenopathy, possible nasal congestion; fever, red and swollen pharynx,

Back 312

PharyngitisPharyngeal infection caused by group A β-hemolytic streptococci (“strep throat”) or common cold virusComplications = untreated infection can cause rheumatic heart disease or glomerulonephritis (characterized by a high antistreptolysin O titer)

Hint 312

Labs = throat culture grows streptococcal species, and rapid streptococcal Ag test is + for strep throat; - culture suggests viral etiologyTreatment = self-limited; β-lactam antibiotics (e.g., penicillin, amoxicillin, etc.) reduce infection time

Front 313

H/P = similar to streptococcal pharyngitis, tonsillar exudates; ear pain, difficulty swallowing; possible high fever.

Back 313

Tonsillar infectionsSpread of streptococcal pharyngitis to palatine tonsils leading to tonsillar inflammation (i.e., tonsillitis)Complications = airway compromise; abscess (requires intravenous [IV] antibiotics and surgical incision and drainage followed by tonsillectomy after resolution to prevent recurrence)

Hint 313

Treatment = self-limited; β-lactam antibiotics (e.g., penicillin, amoxicillin, etc.) reduce infection time

Front 314

H/P = myalgias, vomiting, diarrhea; high fevers (typically >100°F/37.8°C and can reach up to 106°F/41°C), arthralgias, sore throat, nasal congestion, nonproductive cough, nausea, lymphadenopathy

Back 314

Viral influenzaGeneralized infection with URI symptoms caused by one of several influenza viruses

Hint 314

Labs = serologic tests are definitive, but rarely required for diagnosisTreatment = treat symptoms; fluid intake important to replace losses from vomiting and diarrhea; self-limited (several days) but amantadine may shorten course of disease; elderly patients, health care workers, immunocompromised patients, and patients with lung disease should receive annual vaccine to reduce risk of infection

Front 315

pain over infected sinuses, purulent nasal discharge, maxillary toothache pain; pain on palpation of affected sinuses, illumination test (i.e., light held close to sinuses) may detect congestion in frontal of maxillary sinuses, but is unreliable

Back 315

SinusitisSinus (most maxillary)infection associated w/ allergic rhinitis, barotrauma, viral infection, prolonged nasogastric tube placement, or asthmaAcute sinusitis is usually caused by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, viral infectionAcute sinusitis can spread to CNS & cause meningitis if untreated.Chronic sinusitis (lasting >3 months) is usually caused by sinus obstruction, anaerobic infection; patients with diabetes mellitus (DM) predisposed to mucormycosis

Hint 315

Radiology = radiograph shows opacification and fluid levels in affected sinuses; computed tomography (CT) is diagnostic; frequently radiologic tests are not needed because of clinical diagnosisTreatment = treat symptoms; amoxicillin × 2 weeks in acute cases and for 6–12 weeks in chronic cases; surgical drainage or correction of anatomic obstruction may be required for full cure

Front 316

H/P = productive cough, sore throat; fever, wheezing, tight breath sounds

Back 316

Acute bronchitisInflammation of trachea and bronchi caused by spread of URI or exposure to inhaled irritants

Hint 316

Labs = sputum culture only performed in persistent cases and is most commonly -;Radiology = chest x-ray (CXR) may show only mild congestionTreatment = self-limited if viral (most cases); patient groups with an increased risk of bacterial infection (e.g., smokers, elderly, patients with other lung disease) may be given antibiotics (e.g., fluoroquinolones, tetracycline, or erythromycin)

Front 317

H/P = pleuritic chest pain; decreased breath sounds, dullness to percussion, tachypnea, productive or nonproductive cough, dyspnea, chills, night sweats, rales, wheezing, egophony (i.e., change in voice quality heard during auscultation over a consolidated region of lung), tactile fremitusLabs = increased white blood cell count (WBC) (slight increase with viral cause, significant increase with bacterial or fungal cause) with left shift (more immature forms); + sputum culture

Back 317

PneumoniaInfection of the bronchoalveolar tree can be caused by common nasopharyngeal bacteria (i.e., typical pneumonia) or bacteria, viruses, or fungi from the surrounding environment (i.e., atypical pneumonia); common causes vary by age group

Hint 317

Treatment = viral pneumonia is self-limited and only requires supportive care; bacterial and fungal pneumonias require antibiotics (started as broad coverage and changed to pathogen-specific therapy as culture results become availableAdmission=elderly, multiple medical comorbidity, significant laboratory abnormalities, multilobar involvement, signs of sepsis

Front 318

H/P=a non-productive cough be used for influenza A virus

Back 318

Viral Pneumonia Viral (influenza, parainfluenza, adenovirus, cytomegalovirus, respiratory syncytial virus) Most common pneumonia in children; common in adults

Hint 318

Treatment=Self-limited; amantidine may

Front 319

H/P=pneumonia, high fevers, pleuritic pain, productive cough

Back 319

Streptococcus pneumoniae Most common pneumonia in adults; higher risk of infection in sickle cell patients

Hint 319

Treatment=β-lactams, macrolides(azithromycin, clarithromycin, erythromycin)

Front 320

H/P=pneumonia, slower onsetPatients with COPD; higher risk of infection in patients with sickle cell disease

Back 320

Haemophilus influenzae

Hint 320

Treatment=β-lactams, TMP-SMX

Front 321

H/P=pneumonia, abscess formationNosocomial pneumonia, immunocompromised patients

Back 321

Staphylococcus aureus

Hint 321

Treatment=β-lactams

Front 322

H/P=pneumonia, “Currant-jelly” sputum; Alcoholics, patients with high risk of aspiration, patients staying in the hospital for extended amounts of time, sickle cell patients

Back 322

Klebsiella pneumoniae

Hint 322

Treatment=Both cephalosporins and aminoglycosides (gentamicin, tobramycin)

Front 323

H/P=pneumonia, Young adults, possible rash; + cold-agglutinin test

Back 323

Mycoplasma pneumoniae

Hint 323

Treatment=Macrolides (azithromycin, clarithromycin, erythromycin)

Front 324

H/P=pneumonia, rapid onsetChronically ill and immunocompromised patients, patients with cystic fibrosis, nosocomial pneumonia

Back 324

Pseudomonas aeruginosa

Hint 324

Treatment=Fluoroquinolones (ciprofloxacin), aminoglycosides, generation 3rd-cephalosporins

Front 325

H/P=pneumonia Slow onset, nausea, diarrhea, confusion, or ataxia

Back 325

Legionella pneumophilaAssociated with aerosolized water (air-conditioners)

Hint 325

Treatment=Macrolides, fluoroquinolones

Front 326

H/P=pneumonia, Slow onset, frequent sinusitisMore common in very young and elderly

Back 326

Chlamydia pneumoniae

Hint 326

Treatment=Doxycycline, macrolides

Front 327

H/P=pneumonia, Respiratory distress, lethargyNeonates and infants

Back 327

Group B Streptococcus

Hint 327

Treatment=β-lactams

Front 328

H/P=pneumoniaNosocomial pneumonia, elderly patients

Back 328

Enterobacter sp.

Hint 328

Treatment=TMP-SMX

Front 329

H/P=pneumonia, Less severe symptoms; subacute disease for initial history

Back 329

FungiTravelers to southwest U.S. (coccidioidomycosis), caves (histoplasmosis), or Central America (blastomycosis)

Hint 329

Treatment=Antifungal agents (amphotericin B, ketoconazole)

Front 330

H/P=pneumonia, Slow onset, GI symptomsImmunocompromised patients (HIV) (CD4 count <200)

Back 330

Pneumocystis carinii (fungi-like)

Hint 330

Treatment=TMP-SMX

Front 331

H/P = cough, hemoptysis, dyspnea, weight loss, night sweats; fever, ralesRisk factors = immunosuppression, alcoholism, lung disease, DM, advanced age, homelessness, malnourishment, crowded living conditions, and close proximity to infected patientsRadiology = CXR may show apical fibronodular infiltrates (reactivated disease), lower-lobe infiltrates (primary lesion), and calcified granulomas/lymph nodes (Ghon complexes)

Back 331

Tuberculosis (TB)Pulmonary infection caused by Mycobacterium tuberculosisFollowing primary infection, disease enters inactive state; untreated infections can become reactivated (most active cases) and extend to extrapulmonary sites (i.e., miliary TB)

Hint 331

Labs = + purified protein derivative (PPD) tuberculin skin test is screening test for exposure (followed by a CXR to look for signs of TB), anergy test (subcutaneous Candida preparation) in addition to a PPD to check for an appropriate immune response; + sputum acid-fast stain, + culture (may take weeks, so not useful in planning therapy); 1 bronchoscopy is considered equal to 3 sputum samples for specimen collectionTreatment = respiratory isolation for any inpatient; report all diagnosed cases to local and state health agencies; multidrug treatment initially w/ isoniazid (INH), rifampin, pyrazinamide, & ethambutol followed by INH & rifampin for a total of 6 months; give vitamin B6 w/ INH to prevent peripheral neuritis (INH competes with vitamin B6 as a cofactor in neurotransmitter synthesis, so supplemental vitamin B6 helps offset this competition); give prophylactic INH to patients with an asymptomatic positive PPD who are immunocompromised, have a history of IV drug abuse (IVDA), are <35 years of age, a history of close contact with TB-infected people, or are indigent patients (reporting is unnecessary unless TB is diagnosed); monthly sputum acid-fast tests should be performed during therapy to confirm adequate treatment

Front 332

H/P = acute dyspnea and pulmonary decompensation in setting of serious underlying condition; cyanosis, tachypnea (begins within 48 hours of initial insult), wheezing, rales, rhonchiLabs = arterial blood gas (ABG) shows respiratory alkalosis, decreased O2 (caused by impairment of O2 transfer to pulmonary capillaries by pulmonary edema), decreased CO2 (caused by hyperventilation); other tests should reflect underlying pathology; Swan-Ganz catheterization shows wedge pressure <18 mm Hg; Pao2:Fio2 ratio will be <200 during mechanical ventilation

Back 332

Acute respiratory distress syndrome (ARDS)Acute respiratory failure caused by sepsis, trauma, aspiration, near drowning, drug overdose, shock, or lung infection that is characterized by refractory hypoxemia, decreased lung compliance, and pulmonary edema, and carries a high mortalityEtiology=ARDS: Aspiration/Acute pancreatitis/Air or Amniotic embolism, Radiation, Drug overdose/Diffuse lung disease/DIC/Drowning, Shock/Sepsis/Smoke inhalation.

Hint 332

Radiology = bilateral pulmonary edema and infiltratesTreatment = treatment in intensive care unit with mechanical ventilation frequently required; mechanical ventilation should include positive end-expiratory pressure (PEEP), increased inspiratory times, and Fio2 adjusted to maintain O2 saturation (Sao2) >90%; underlying cause must be treated; keep fluid volumes low to prevent pulmonary edema; use of extracorporeal membrane oxygenation (ECMO) may improve outcome in severe cases

Front 333

H/P = prolonged expiratory duration, accessory muscle use, cough, dyspnea, wheezing, chest tightness; tachypnea, tachycardia, decreased breath sounds, wheezing, possible pulsus paradoxus; cyanosis, decreased arterial O2 saturation (Sao2) on pulse oximetry, or difficulty talking in severe attacks

Back 333

AsthmaReversible airway obstruction secondary to bronchial hyperactivity, acute airway inflammation, mucous plugging, and smooth muscle hypertrophyExacerbations (i.e., sudden bronchoconstriction and airway inflammation) are triggered by allergens (e.g., dust, smoke, pollen, fumes, pet dander), URI, exercise, stress, β-antagonist drugs, aspirin (rare), and sulfites (rare)Risk factors = family history of asthma, allergies, atopic dermatitis, low socioeconomic statusDisease can be worse in childhood and improve with age

Hint 333

Labs = peak expiratory flow rate (PEFR) decreased and used along with clinical symptoms and frequency of medication use to classify disease as mild intermittent, mild persistent, moderate persistent, or severe (see Table 2-8); PFT show decreased FEV1, normal/elevated DLcoRadiology = CXR shows hyperinflationTreatment=Inhaled short-acting β2-agonist IV corticosteroids if persistent during exacerbation. daily corticosteroid inhaler (+long long-acting β2-agonist, considerleukotriene inhibitor or theophylline) from Mild Persisent up

Front 334

prolonged, nonresponsive asthma attack

Back 334

Status asthmaticus

Hint 334

Treatment=aggressive bronchodilator therapy, corticosteroids, O2, and, possibly, intubation

Front 335

H/P = productive cough, recurrent respiratory infections, dyspnea; wheezing, rhonchihistory of productive cough for 3 months of the year for >2 years

Back 335

Chronic bronchitisChronic bronchial inflammation associated with tobacco use (common) or chronic asthma (uncommon); occurs in continuum with emphysema as chronic obstructive pulmonary disease (COPD)“blue bloaters,” because secondary development of cor pulmonale causes cyanosis and peripheral edema;Complications = emphysema frequently results without smoking cessation

Hint 335

Labs = PFTs show gradually worsening signs of obstructive disease as condition progressesTreatment = tobacco cessation, antibiotics given for URI because of the greater incidence of a bacterial etiology; bronchodilators during exacerbations

Front 336

H/P = dyspnea, possible productive cough, morning headache; barrel-chested, pursed-lip breathing, prolonged expiratory duration, decreased heart sounds, decreased breath sounds, wheezing, rhonchi, accessory muscle use, jugular venous distension (JVD); exacerbations present with worsening symptoms

Back 336

Emphysema (later stage—COPD)Long-term tobacco use leads to chronic bronchoalveolar inflammation associated with release of proteolytic enzymes by neutrophils and macrophages; destruction of alveoli and bronchioles results with panacinar airspace enlargement and a decreased capillary bedLess common form (appears at younger age) caused by α1-antitrypsin deficiencycommon form of emphysema has a centrilobular distribution, whereas the form associated with α1-antitrypsin deficiency has a panlobular distribution.

Hint 336

Labs = PFTs show decreased FEV1, decreased FEV1/FVC, increased total lung capacity (TLC), decreased PEFR; ABG during acute exacerbations shows decreased O2, increased CO2 (beyond a baseline increase already seen in these patients)Radiology = CXR shows flat diaphragm, hyperinflated lungs, subpleural blebs and bullae (i.e., small fluid-filled sacs), and decreased vascular markingsTreatment = smoking cessation; supplemental O2; inhaled, short-acting β2-agonists; inhaled anticholinergics; inhaled corticosteroids and long-acting β2-agonists may be useful in severe cases; antibiotics given for respiratory infections; pneumococcal and influenza vaccines important to reduce infection risk; enzyme replacement may have a role in α1-antitrypsin deficiency therapy; lung transplant may be an option in late severe disease

Front 337

H/P = copious sputum, persistent, productive cough; hemoptysis, frequent respiratory infections, dyspnea; wheezing, rales, and hypoxemia

Back 337

D. BronchiectasisPermanent dilation of small and medium bronchi because of destruction of bronchial elastic componentsOccurs secondary to chronic airway obstruction, chronic tobacco use, TB, fungal infections, severe pneumonia, or cystic fibrosisComplications = cor pulmonale, massive hemoptysis, abscess formation

Hint 337

Radiology = multiple cysts and bronchial crowding seen on CXR; CT shows dilation of bronchi, bronchial wall thickening, bronchial wall cystsTreatment = pulmonary hygiene (e.g., hydration, sputum removal), chest physical therapy; antibiotics given when sputum production increases; inhaled β2-agonists and corticosteroids may reduce symptoms; resection of severely diseased regions of lung indicated for hemorrhage, substantial sputum production, or inviability

Front 338

H/P = possibly asymptomatic; hemoptysis, cough, dyspnea, pleuritic chest pain, fatigue, weight loss, frequent pulmonary infections;

Back 338

Lung cancerMost frequently associated with tobacco use (~90% of cases); also can be caused by occupational exposures (e.g., smoke, asbestos)Complications = poor prognosis (~10% 5-yr survival); recurrence common for primary tumors

Hint 338

Radiology = initially seen on CXR or CT as pulmonary nodule; bronchoscopy with biopsy and brushings or fine needle aspiration of lesion are diagnosticTreatment = use of surgical resection, chemotherapy, and/or radiation therapy based on type of lung cancer (large cell, squamous cell, or adenocarcinoma vs. small cell) and staging of disease (based on local extension, lymph node involvement, and presence of metastases) (see Table 2-11)

Front 339

miosis, ptosis, and anhidrosis

Back 339

Horner's syndrome

Front 340

Horner's syndrome plus brachial plexus involvement

Back 340

Pancoast's syndrome

Front 341

obstruction of venous drainage through superior vena cava and associated head swelling and CNS symptoms

Back 341

Superior vena cava syndrome

Front 342

Lung Cancer, CentralCavitary lesions; direct extension to hilar lymph nodesParaneoplastic Syndromes= Hypercalcemia, Dermatomyositis

Back 342

Squamous cell carcinoma

Hint 342

Treatment=Chemotherapy as primary, Radiation Therapy as adjuvant

Front 343

Lung Cancer,PeripheralWide metastases; can be caused by asbestos; pleural effusions show increased hyaluronidase levels; bronchiolar cancer is subtype that is low grade and occurs in single nodulesParaneoplastic Syndromes= DIC, Thrombophlebitis,, Microangiopathic hemolytic anemiaDermatomyositis

Back 343

Adenocarcinoma

Hint 343

Treatment for all non-small:no lymph node involvement beyond ipsilateral hilar nodes, No mediastinal invasion, no metastases->Surgical resection, radiation as primary or postop adjuvant, chemo as adjuvant

Front 344

Lung Cancer, CentralRapidly growing; early distant metastases; several paraneoplastic syndromesParaneoplastic Syndromes= Cushing's syndrome, Syndrome of inappropriate ADH secretion (SIADH), Ectopic growth hormone and ACTH secretion, Peripheral neuropathy, Subacute cerebellar degeneration, Eaton-Lambert syndrome (similar presentation to myasthenia gravis), Subacute sensory neuropathy, Limbic encephalitis, Dermatomyositis

Back 344

Small cell carcinoma

Hint 344

Treatment for all non-small:has extension to ipsilateral mediastinal nodes, No mediastinal invasion or metastases->radiation as primary, surgery if tumor shrinik, chemo as induction for surgery or adjuvant

Front 345

Lung Cancer, PeripheralLate distant metastases, early cavitationParaneoplastic Syndromes=Gynecomastia, Dermatomyositis

Back 345

Large cell carcinoma

Hint 345

Treatment for all non-small:Mediastinal invasion, distant nodes, and/or metastases-> chemo or radiation as palliative

Front 346

H/P = hoarseness that worsens with time (over several weeks), dysphagia, ear pain, hemoptysis; laryngoscopy may visualize mass and airway obstruction

Back 346

Laryngeal cancer Squamous cell cancer of the larynx associated with tobacco and alcohol use

Hint 346

Labs = biopsy is diagnosticRadiology = magnetic resonance imaging (MRI) or CT with contrast detects soft tissue mass; PET may be useful for detecting lesions earlier in disease courseTreatment = partial or total laryngectomy used to remove lesions confined to larynx; radiation therapy can be used in conjunction with surgery or as sole therapy in extensive lesions; advanced cases may require combination of surgery, radiation, and chemotherapy to resect lesion while preserving surrounding structures

Front 347

H/P = progressive exercise intolerance, dyspnea; dry crackles, JVD, tachypnea, and possible digital clubbingpatients >50 years of ageLabs = PFT will show restrictive lung disease characteristics (e.g., FEV1/FVC normal, decreased FVC, decreased TLC, decreased compliance); bronchioalveolar lavage shows increased polymorphonuclear (PMN) cells; lung biopsy demonstrates extensive fibrosis and loss of parenchymal architectureRadiology = CXR shows reticulonodular pattern and “honeycomb” lung in advanced cases; CT will show lung fields with “ground glass” appearance

Back 347

Idiopathic pulmonary fibrosis (IPF)Inflammatory lung disease causing lung fibrosis;Complications = progressive lung fibrosis with frequent mortality within 5 years; most patients do not survive sufficiently long to receive a lung transplant

Hint 347

Treatment = corticosteroids combined with either azathioprine or cyclophosphamide are helpful in some patients (follow PFTs to evaluate effectiveness); worsening PFTs should indicate need to change drug regimen; lung transplant is frequently indicated

Front 348

H/P = cough, malaise, weight loss, dyspnea, arthritis (knees, ankles), chest pain; fever, erythema nodosum (i.e., tender red nodules on shins and arms), lymphadenopathy, vision loss, cranial nerve palsiesLabs = increased serum angiotensin-converting enzyme (ACE), increased calcium, hypercalciuria, increased alkaline phosphatase, decreased WBC, increased erythrocyte sedimentation rate (ESR); PFT show decreased FVC, decreased DLcoRadiology = CXR shows bilateral hilar lymphadenopathy, pulmonary infiltrates (ground glass appearance)

Back 348

SarcoidosisSystemic disease characterized by noncaseating granulomas, hilar adenopathy, pulmonary infiltrates, and skin lesions; unknown etiologyRisk factors = blacks > whites; females > males; most frequently occurs between 10 and 40 years of agePatients with sarcoidosis frequently show anergy (no reaction) to a skin test or PPD.

Hint 348

Treatment = occasionally self-resolving; corticosteroids in chronic cases; cytotoxic drugs can be used with failure of steroid therapy; lung transplantation is rarely required (only in severe cases)

Front 349

H/P = symptoms begin when significant pulmonary fibrosis has occurred (several years between exposure to onset of symptoms is common); cough, dyspnea on exertion, heavy sputum production; rales and wheezing are heard on auscultation, digital clubbing

Back 349

PneumoconiosesInterstitial lung diseases that result from long-term occupational exposure to substances that cause pulmonary inflammation

Hint 349

Labs = PFT show a restrictive patternRadiology = CXR shows multinodular opacities; CT shows signs of pulmonary fibrosisTreatment = usually, no successful treatments are available for these conditions; prevention (e.g., proper air filters, following safe-handling recommendations) is vital to avoiding disease

Front 350

H/P = hemoptysis, dyspnea, recent respiratory infectionLabs = + anti-GBM Ab; PFT show restrictive pattern, but increased DLco (caused by the presence of Hgb in alveoli); urinalysis shows proteinuria and granular casts; renal biopsy shows crescentic glomerulonephritis and IgG deposition along glomerular capillaries

Back 350

Goodpasture's syndromeProgressive autoimmune disease of lungs and kidneys caused by anti-glomerular basement membrane (anti-GBM) antibodies and characterized by intra-alveolar hemorrhage and glomerulonephritis

Hint 350

Radiology = CXR shows bilateral alveolar infiltrationTreatment = plasmapheresis to remove auto-antibodies; corticosteroids and immunosuppressive agents

Front 351

H/P = ulcerations of nasopharynx, fever; hemoptysis, dyspnea, myalgias, chronic sinusitis; additional symptoms from renal (e.g., mild hematuria), CNS (e.g., hearing loss, sensory neuropathy, cranial nerve dysfunction), ophthalmologic (e.g., conjunctivitis, proptosis, corneal ulceration, diplopia), and cardiac (e.g., arrhythmia) involvementLabs = + cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA); biopsy shows noncaseating granulomas; renal biopsy detects vasculitic process

Back 351

Wegener granulomatosisRare disease with granulomatous inflammation and necrosis of lung and other organ systemsCaused by systemic vasculitis that mainly affects lung and kidney causing formation of noncaseating granulomas and destruction of lung parenchymaComplications = rapidly fatal if untreated

Hint 351

Treatment = cytotoxic therapy (e.g., cyclophosphamide), corticosteroids

Front 352

PneumoconiosesWorking with insulation, construction, demolition, building maintenance, automobiles

Back 352

AsbestosisComplications=Increased risk of malignant mesothelioma and lung cancer; synergistic effect with tobacco

Hint 352

Labs=pleural biopsy show asbestos fibersRadiology= Multinodular opacities, pleural effusions, blurring of heart/diaphragm; chest CT shows linear pleural/parenchymal fibrosis

Front 353

PneumoconiosesMining, pottery making, sandblasting, cutting granite

Back 353

SilicosisComplications=Increase risk of TB infection; progressive fibrosis

Hint 353

Radiology=Small apical nodular opacities; hilar adenopathy

Front 354

Pneumoconioses.Coal mining

Back 354

Coal worker's diseaseComplications=Progressive fibrosis

Hint 354

Radiology=Small apical nodular opacities

Front 355

PneumoconiosesElectronics, ceramics, tool, die manufacturing

Back 355

BerylliosisComplications=Increased risk of lung cancer;

Hint 355

Labs=Pulmonary edema, diffuse granuloma formationRadiology=Diffuse infiltrates; hilar adenopathyTreatment=may need chronic corticosteroid treatment to maintain respiratory function

Front 356

H/P = sudden dyspnea, pleuritic chest pain, cough, syncope, hemoptysis, feeling of impending doom; fever, tachypnea, tachycardia, cyanosis, loud S2, decreased breath sounds over regions of effusionLabs = increased A-a gradient; increased D-dimer; ABG shows increased CO2, decreased O2 (<80 mm Hg), ventilation-perfusion scan (V/Q scan) may show areas of mismatchECG = tachycardia, may show S wave in lead I and T-wave inversion in lead III

Back 356

Pulmonary embolism (PE)Occlusion of pulmonary vasculature by a dislodged thrombusIncreasing pulmonary artery pressure caused by occlusion leads to right-sided heart failure, hypoxia, and pulmonary infarctionRisk factors = 7 Hs: Heredity (genetic hypocoagulability), History (prior DVT or PE), Hypomobility (fracture, prolonged travel, surgery, obesity), Hypovolemia (dehydration), Hypercoagulability (cancer, smoking), Hormones (pregnancy, oral contraceptive pill [OCP] use), and Hyperhomocysteinemia.

Hint 356

Radiology = CXR may be normal or may show pleural effusion or wedge-shaped infarct; pulmonary angiography is diagnostic, but a higher risk study; spiral CT may detect proximal PE; ventilation-perfusion (V/Q) scan can detect areas of ventilation-perfusion mismatchA positive or negative V/Q scan is diagnostic or rules out PE, but an equivocal scan indicates need for angiographyTreatment = supplemental O2 to maximize saturation; IV fluids or cardiac pressors as needed for hypotension; anticoagulate initially with either low molecular weight heparin (LMWH) or unfractionated heparin (titrated for PTT 1.5–2.5 times normal); patients treated with unfractionated heparin need to be converted to either LMWH or warfarin (given to achieve goal international normalized ratio [INR] 2 -3) for 3–6 months; inferior vena cava filter can be placed if anticoagulation is contraindicated; thrombolysis may be considered for patients with massive PE or those with no cardiac contraindications, recent trauma, or surgery

Front 357

H/P = dyspnea, fatigue, deep chest pain, cough, syncope, cyanosis; digital clubbing, loud S2, JVD, hepatomegalyLabs = increased red blood cell count (RBC) and WBCECG = right ventricular hypertrophyRadiology = CXR shows large pulmonary artery and large right ventricle; echocardiogram useful for measuring pulmonary artery pressure noninvasively and detecting valvular disease; cardiac catheterization is the gold standard test for measuring pressures, but carries greater risks than other studies; PFTs may be useful in diagnosing underlying pulmonary disease

Back 357

Pulmonary hypertensionIncreased pulmonary artery pressure caused by PE, valvular disease, left-to-right shunts, COPD, or idiopathic causesIdiopathic pulmonary hypertension has a high mortality rate within a few years of diagnosis

Hint 357

Treatment = treat underlying condition; supplemental O2 helps maintain blood oxygenation; vasodilators indicated for idiopathic and pulmonary causes to decrease pulmonary vascular resistance; anticoagulants indicated in patients with idiopathic, embolic, or cardiac causes to decrease risk of pulmonary thrombus formation

Front 358

H/P = orthopnea, paroxysmal nocturnal dyspnea, dyspnea; tachycardia, frothy sputum, wheezing, rhonchi, rales, dullness to percussion, peripheral edema, S3 or S4 heart sound, hypertensionLabs = increased brain natriuretic peptide (BNP) or abnormal cardiac enzymes help elucidate a cardiac causeECG = T-wave abnormalities or QT prolongation are common changes and can occur suddenly with acute onset

Back 358

Pulmonary edemaIncreased fluid in lungs caused by increased pulmonary venous pressure and hydrostatic leak of fluid from vesselsCaused by left-sided heart failure, myocardial infarction (MI), valvular disease, arrhythmias, ARDS(pulmonary wedge pressure <18 mm Hg).A pulmonary wedge pressure measured with a Swan-Ganz catheter is suggestive of a cardiac cause for pulmonary edema if >18 mm Hg

Hint 358

Radiology = CXR shows fluid throughout lungs, cephalization of vessels (i.e., increased vascular markings in upper lung fields), Kerley B lines (i.e., prominent horizontal interstitial markings in lower lung fields)Treatment = treat underlying condition; diuretics, salt restriction, O2, morphine, vasodilators; nesiritide improves outcomes in cases with a cardiac cause; pressors may be required to improve cardiac output if perfusion is inadequate; Swan-Ganz catheter placement useful for monitoring response to therapy

Front 359

H/P = possibly asymptomatic; dyspnea, pleuritic chest pain, weakness; decreased breath sounds, dullness to percussion, decreased tactile fremitus, egophonyRadiology = CXR shows blunting of costophrenic angles; decubitus CXR can demonstrate whether fluid is loculated or free flowing; CT is useful for measuring pleural thickness, distinguishing a discrete collection from a diffuse one (e.g., abscess vs. empyema)

Back 359

Pleural effusionSerous or lymphatic fluid collection in pleural space is classified according to protein and lactate dehydrogenase (LDH) content and is caused by changes in hydrostatic and oncotic pressure (transudative), inflammation (exudative), or lymphatic duct rupture (lymphatic)1/4 of pleural effusions are associated with neoplasm

Hint 359

Labs = pleural fluid analysis used for protein and LDH levels (i.e., transudate vs. exudates), glucose (low in TB, malignancy, autoimmune diseases), pH (acidic in malignancy, TB, empyema), amylase (high in pancreatitis, esophageal rupture, some malignancies), triglycerides (high in thoracic duct rupture), complete blood cell count (CBC), Gram stain, and cytologyTreatment = treat underlying condition; relieve pressure on lung with thoracocentesis and chest tube placement; for cases with empyema (i.e., effusion of pus due to infection), a chest tube is required; if recurrent malignant effusion occurs, use pleurodesis (talc or other irritant) to scar the pleural layers together

Front 360

Pleural effusionPleural: Serum Protein Ratio <0.5;Pleural: Serum LDH Ratio <0.6;Total Pleural Protein <3 g/dL

Back 360

Transudateetiology=CHF, cirrhosis, kidney diseases (nephrotic syndrome)

Front 361

Pleural effusionPleural: Serum Protein Ratio >0.5;Pleural: Serum LDH Ratio >0.6;Total Pleural Protein >3 g/dL

Back 361

Exudateetiology=Infection, cancer, vasculitis

Front 362

H/P = unilateral chest pain, dyspnea; decreased chest wall movement, unilateral decreased breath sounds, increased resonance to percussion, decreased tactile fremitus; respiratory distress, decreased Sao2, hypotension, JVD, or tracheal deviation suggest tension pneumothoraxRadiology = CXR shows lung retraction and mediastinal shift away from affected side; tension PTX will demonstrate tracheal deviation

Back 362

Pneumothorax (PTX)Collection of air in pleural space that predisposes patient to pulmonary collapseCan occur spontaneously (less common) or secondary to trauma or a pulmonary medical condition (more common)

Hint 362

TreatmentSmall (<15% lung field) PTX may resolve with supplemental O2 onlyLarger (>15%) PTX requires chest tube placementOpen PTX with small wound is treated with chest tube and occlusive dressingOpen PTX with larger wounds should be treated with attempted closure and should carry a low threshold for intubationTension pneumothorax requires immediate needle decompression (4th or 5th intercostal space at the maxillary line) and chest tube placementRecurrent pneumothorax may require pleurodesis

Front 363

H/P = dyspnea, pleuritic chest pain, weakness; decreased breath sounds, dullness to percussion, decreased tactile fremitus, egophonyLabs = thoracocentesis shows bloody effusion

Back 363

HemothoraxCollection of blood in pleural space caused by trauma, malignancy, TB, or pulmonary infarctionComplications = thrombi formation, fibrosis can occur if blood is not drained from pleural space

Hint 363

Radiology = CXR resembles that for pleural effusion (i.e., lung retraction, mediastinal shift from affected side)Treatment = supplemental O2; chest tube placement; treat underlying cause

Front 364

H/P = nonpleuritic chest pain, dyspnea; dullness to percussion over lung bases, palpable chest wall mass, scoliosis toward lesion

Back 364

Malignant mesotheliomaUncommon tumor occurring on visceral pleura or pericardium with very poor prognosisIncreased incidence with asbestos exposure (occurs 20 years after exposure)

Hint 364

Labs = pleural biopsy is usually diagnostic; thoracocentesis of an associated pleural effusion can be used for cytology studiesRadiology = CXR shows pleural thickening, pleural effusion; chest CT can display extent of local disease; PET scan can be used to detect extrathoracic diseaseTreatment = extrapleural pneumonectomy with adjuvant chemotherapy and radiation therapy; chemotherapy alone used for unresectable disease

Front 365

H/P = fatigue, daytime sleepiness, snoring, gasping or choking during sleep, morning headaches or confusion, impaired daytime function because of sleepiness; obesity common, anatomic abnormalities of palate or pharynx may be visibleLabs = Epworth sleepiness scale is useful for predicting likelihood of sleep apnea as cause for daytime somnolence (score >10 common in sleep apnea); polysomnography is definitive test that measures Apnea Index (AI, average apneic episodes per hour), Sao2, and number of arousals

Back 365

Sleep apneaEpisodic cessation of airflow during sleep leading to desaturations and frequent arousalsTypesObstructive: obstruction of upper airway during sleep with continued respiratory effort; most often associated with obesity or abnormal pharyngeal anatomyCentral: loss of central respiratory drive leads to cessation of airflow and respiratory effortMixed: combines both obstructive and central characteristicsRisk factors = obesity, sedative use; males more than femalesEtiology is unknown, but may be linked to abnormal feedback control during sleep or decreased sensitivity of upper airway muscles to stimulation

Hint 365

TreatmentObstructive = consider weight loss (possibly bariatric surgery) and stop sedative use; continuous positive airway pressure (CPAP) is helpful in chronic cases to maintain airway patency; surgical correction of tonsillar hypertrophy, polyp removal, correction of congenital upper airway deformities, or tracheostomy may be necessary in severe or refractory casesCentral = respiratory stimulants; phrenic nerve pacemaking may be needed in severe casesBariatric surgery is associated with resolution of sleep apnea in 86% of cases.

Front 366

H/P = asymptomatic if mild or slow development; pleuritic chest pain, dyspnea; fever, decreased breath sounds, dullness to percussion over affected areaRadiology = CXR will show fluffy infiltrates in mild cases and lobar collapse in cases of airway obstruction

Back 366

AtelectasisLocalized alveolar collapse; common after surgery (especially abdominal) and anesthesia (generally not clinically serious); can also occur in asthmatics, after foreign body aspiration, or from mass effect (e.g., tumors, pulmonary lesions, or lymphadenopathy)If atelectasis lasts >72 hr, pneumonia is likely to develop.

Hint 366

Treatment = inspiratory spirometry, ambulation, and inpatient physical therapy are important for prevention in the hospital and postoperatively; severe cases require upper airway suctioning or bronchoscopy with deeper suctioning

Front 367

Mechanical VentilationUse=General anesthesia, overdosePatient=No effort

Back 367

Mode=Controlled mechanical ventilation (CMV)

Hint 367

Machine Determines and automatically delivers tidal volume (TV) and rate

Front 368

Mechanical VentilationUse=Weaning patient from ventilatorPatient=Can breathe spontaneously between mechanical breaths

Back 368

Mode=Intermittent mandatory ventilation (IMV)

Hint 368

Machine Determines and automatically delivers TV and rate

Front 369

Mechanical VentilationUse=More comfortable for patient because of attempted synchronization; frequently used in place of IMVPatient=Can breathe spontaneously between mechanical breaths

Back 369

Mode=Synchronized intermittent mandatory ventilation (SIMV)

Hint 369

Machine Machine tries to synchronize rate with patient-initiated breaths; automatically delivers TV and rate

Front 370

Mechanical VentilationUse=Used when patient is more awake and in progressive weaningPatient driven unless no attempts to breathe (backup rate)

Back 370

Mode=Assist-control ventilation (AC)

Hint 370

Machine senses patient's attempt to breathe and delivers full preset TV; backup rate if no spontaneous breaths

Front 371

Mechanical VentilationUse=Used when patient relies less on ventilator; intubation not requiredPatient does all breathing

Back 371

Mode=Continuous positive airway pressure (CPAP)

Hint 371

Machine maintains airway patency to decrease work of breathing

Front 372

H/P = barking cough, inspiratory stridor, dyspnea, nasal congestion; fever, mild pharyngeal erythema, lymphadenopathy; respiratory distress in severe casesRadiology = neck radiographs may show subglottic narrowing of airway (i.e., steeple sign)

Back 372

CroupAcute inflammation of larynx caused by parainfluenzae virus type 1; less commonly, by parainfluenzae virus types 2 and 3, respiratory syncytial virus (RSV) influenza virus, rubeola, adenovirus, or Mycoplasma pneumoniae3 Ss: Seal-bark cough, Subglottic swelling, and Stridor.

Hint 372

Treatment = supportive care (e.g., hydration, humidified air, rest, analgesia); aerosolized epinephrine and inhaled corticosteroids can be used in severe cases to decrease pharyngeal inflammation; with concerns for respiratory distress, the child should be admitted for observationIf child develops stridor at rest, hospitalization and respiratory monitoring is needed.

Front 373

H/P = dysphagia, muffled voice, drooling, soft stridor, anxiety from symptoms; sudden high fever, inspiratory retractions; child may lean forward with hands on knees to aid breathing; erythematous and swollen epiglottisRadiology = neck radiographs show swollen opacified epiglottis that partially obstructs the airway (i.e., thumbprint sign); laryngoscope (only used in controlled situations) can visualize red and swollen epiglottis

Back 373

EpiglottitisRapidly progressive infection of epiglottis and surrounding tissues that can cause airway obstructionMost common in children from 2–7 years of ageCaused by Haemophilus influenzae type B (Hib) infection; can also be caused by streptococcal or other H. influenzae bacteria

Hint 373

Labs = culture from swab of epiglottis can determine causative bacteria (should only be performed if patient intubated)Treatment = keep child calm; admit for close observation and respiratory monitoring; unless airway obstruction is mild, intubate (nasotracheal) to maintain airway patency; antibiotics for 7–10 days; airway obstruction preventing intubation requires emergent tracheostomyIn cases of suspected epiglottitis, examine the patient's throat only in a setting in which prompt intubation is possible because examination of the patient's throat can lead to additional throat irritation and resulting occlusion.

Front 374

H/P = nasal congestion, cough, respiratory distress; wheezing, fever, tachypnea, crackles, prolonged expiration, hyperresonance to percussionRadiology = CXR shows hyperinflation of lungs and patchy infiltrates

Back 374

BronchiolitisViral infection of bronchioles caused by RSV (most cases) or parainfluenzae virus type 3 (less common)Most commonly occurs in winter and spring; usually found in children <2 years of ageComplications = increased risk of developing asthma

Hint 374

Treatment = adequate hydration, humidified air, inhaled corticosteroids and β2-agonists; ribavirin can be used in severe cases to shorten disease course; children with respiratory distress or hypoxemia should be admitted for observation and respiratory monitoring

Front 375

H/P = presentation within 2 days of birth; cyanosis, nasal flaring, expiratory grunting, intercostal retractions, respiratory rate >60 breaths/min, crackles, decreased breath soundsRadiology = CXR shows bilateral atelectasis with ground glass appearance and decreased lung volumes

Back 375

Respiratory distress syndrome of the newbornPreterm infants (e.g., 24–37 wks' gestation and especially before 30 wks' gestation) have surfactant deficiency because of lung immaturity that leads to decreased lung compliance, atelectasis, and respiratory failureComplications = increased risk of developing asthma in childhood compared with other children

Hint 375

Labs = ABG shows increased CO2, decreased O2; amniotic fluid analysis (see Figure 2-9) not usually helpful, but may guide treatment between 34 and 37 wks' gestation by determining fetal lung maturity with the amniotic lecithin:sphingomyelin ratio (always treat for <34 weeks, treatment typically unnecessary for >37 weeks)Treatment = maternal administration of corticosteroids before initiation of labor helps to speed fetal lung maturation; neonatal intensive care unit (ICU) admission appropriate for close observation; supplemental O2 and surfactant replacement therapy mainstays of therapy; intubation should be performed for any neonate not responding to treatment or requiring high levels of O2 to maintain adequate Sao2

Front 376

H/P = meconium stained-amniotic fluid seen during delivery; cyanosis, intercostal retractions; distended chest, tachypnea

Back 376

Meconium aspiration syndromeAspiration of meconium (i.e., fetal stool passed into amniotic sac) predelivery causing obstruction of airways and pneumoniaComplications = pulmonary hypertension can develop if not promptly treated; increased risk of developing asthma during childhood

Hint 376

Labs = consider blood culture to rule out sepsisTreatment = suction nose, mouth, and upper airway at birth; supplemental O2; intubate for worsening respiratory distress; surfactant therapy may be useful for improving respiratory function; consider empiric antibiotic therapy if concerned for development of pneumonia

Front 377

H/P = recurrent pulmonary infections (e.g., Pseudomonas, S. aureus), dyspnea, hemoptysis, chronic sinusitis, cough, meconium ileus at birth, steatorrhea, failure to thrive; cyanosis, digital clubbing, esophageal varices, rectal prolapseLabs = decreased serum Na; sweat test shows increased Na and increased Cl (>60 mEq/L in children, >80 in adults); genetic testing can locate mutation in CF transmembrane conductance regulator (CFTR) gene in suspected cases or in carriers of the gene considering pregnancy

Back 377

Cystic fibrosis (CF)Autosomal recessive disorder caused by defect in chloride-pumping channel in exocrine glands; ducts of exocrine glands (e.g., lungs, pancreas, reproductive glands) become clogged with thick secretionsPresents in childhood and universally fatal, but proper treatment may allow survival into late 20s or early 30sAffects both pulmonary (recurrent infections, chronic sinusitis) and gastrointestinal systems (pancreatic enzyme deficiencies, malabsorption)Risk factors = whites at higher risk than other races

Hint 377

Treatment = deoxyribonuclease (DNase) aids in decreasing the viscosity of secretions; chest physical therapy helps to clear secretions; bronchodilators, non-steroidal anti-inflammatory drugs (NSAID), antibiotics for any suspected pulmonary exacerbation or infection; supplemental pancreatic enzymes and vitamins A, D, E, and K given for malabsorption

Front 378

Tidal volume (TV)

Back 378

Inspiratory volume during Normal respiratioN

Front 379

Inspiratory reserve volume (IRV)

Back 379

Air volume beyond normal tidal volume that is filled during maximal inspiration

Front 380

Inspiratory capacity (IC)

Back 380

Total inspiratory air volumE considering both tidal volume and inspiratory reserve volume (IC = TV + IRV)

Front 381

Expiratory reserve volume (ERV)

Back 381

Air volume beyond tidal volume that can be expired during normal respiration

Front 382

Residual volume (RV)

Back 382

Remaining air volume left in lung ollowing maximal expiration

Front 383

Functional reserve capacity (FRC)

Back 383

Air volume remaining in lungs after expiration of tidal volume (FRC = RV + ERV)

Front 384

Functional vital capacity (FVC)

Back 384

Maximal air volume that can be inspired and expired (FVC = IC + ERV)

Front 385

Total lung capacity (TLC)

Back 385

Total air volume of lungs (TLC = FVC + RV)