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1015 Cards in this Set

  • Front
  • Back
What are the four anatomic segments of the respiratory tract?
naso-oropharynx (upper airway)
conducting airways
respiratory bronchioles
alveolar ducts
What is the responsibility of upper airways?
warm and humidify air
What two things filter out large particles?
nasal hairs and turbinates
Which structure warms and humidifies air?
Upper airways
What is the responsibility of nasal hairs and turbinates?
filter out large particles
What are the 2 responsibilities of conducting airways?
decelerates velocity of air molecules

further cleanses air
Which structure is in charge of decelerating veolocity of air molecules and further cleansing air?
Conducting airways
What is the last surface to capture small particles?
respiratory bronchioles
Where does cuboidal epithelium change to alveolar type I cells?
respiratory bronchioles
Where do mucus secreting cells disappear?
respiratory bronchioles
Where does immune defense change emphasis to macrophage phagocytes, inflammatory cells, and opsonins?
respiratory bronchioles
In the respiratory bronchioles, what 3 things does the immune defense change to?
macrophage phagocytes
inflammatory cells
opsonins
What is an antibody in blood serum that attaches to invading microorganisms and other antigens to make them more susceptible to the action of phagocytes?
opsonin
Where is the site of air exchange?
alveolar space
Where are alveoli intertwined with meshwork of pulmonary artery capillaries?
alveolar space
What in the respiratory tract is the surface area about 130 square feet?
alveolar space
Where does gas diffusion across a thin layer of type I epithelial cells occur?
alveolar space
What are 3 things that can decrease gas exchange?
fluid
smoking
scar tissue
What are 5 items that you need to find out based on the patients history involving lung disease?
smoking or secondary exposure
pollution/industrial exposure
exposure to animal dander
family history
medication history
What are 6 items that need to be addressed pertaining the patient's family history of lung disease?
asthma
allergies
cystic fibrosis
lung cancer
emphysema
alpha-1 antitrypsin
What are 7 items to look for during a physical exam for lung disease?
obesity
increased AP diameter
kyphoscoliosis
accessory muscle use
wheezing
rales and crackles
clubbing
What 2 ways does obesity affects the lungs?
predispose to OSA (obstructive sleep apnea)

affect the mechanics of breathing
What might increased AP diameter suggest?
COPD
What does kyphoscoliosis cause?
restricted breathing
What are the 2 types of wheezing and where are they more likely to occur?
inspiratory (upper airway)

expiratory (lower airway)
What do rales and crackles suggest?
increased luminal fluid
What 3 conditions might clubbing suggest?
hypoxemia from CF, severe brochiectasis, or congenital heart disease
Cough results from stimulation for the cough center in the _____ by _____ _____ _____
brain

vagal afferent receptors
Where does sensory stimuli for cough arise? More specifically, 2 locations.
tracheobronchial tree

carina and larynx
What defends against respiratory pathogens and helps clear mucus, foreign particles and noxious aerosols?
cough
What 3 things does cough help to clear?
mucus
foreign particles
noxious aerosols
What 3 things may be affected by persistent severe cough?
impaired respiration

disrupt sleep

impaired social functioning
What are 5 possible complications of excessive cough?
bronchospasm
syncope
*rib fractures
vomiting
urinary incontinence
What will happen with reduced cough?
reduced clearance of secretions
T/F Cough can be only voluntary.
False Cough can be voluntary or involuntary.
What 2 ways can cough be stimulated?
mechanical or irritative
What is another name for acute cough?
transient cough
What are 5 causes of transient cough?
inflammatory reactions
noxious vapors
aspiration
pulmonary embolism
pulmonary edema
What are 2 types of noxious vapors?
chlorox fumes

cigarette smoke
What most commonly follows URI dealing with acute cough and how long may it persist?
inflammatory reactions on the surface of the trachea or bronchial branches

6-8 weeks
What are 6 causes of persistent cough?
asthma
regurgitation
tumor
sinusitis
*chronic bronchitis
ACE inhibitors
Why does asthma cause persistent cough?
causes allergic inflammatory reaction
What is regurgitated with persistent cough?
gastric contents
Where is the tumor generally located when persistent cough is present?
tracheobronchial tree
Involving persistent cough, what does sinusitis generally secrete?
persistent nasal secretions
What is the most common cause of persistent cough (secondary to what?)?
chronic bronchitis secondary to tobacco smoke exposure
What medication for hypertension has become a common cause of persistent cough?
ACE inhibitors
What symptom of lungs involves a mediastinal or esophageal tumor?
extrabronchial cause of cough
What symptom of lungs invovles an aortic aneurysm that compresses a bronchus?
extrabronchial cause of cough
What symptom of lungs involves an enlarged left atrium?
extrabronchial cause of cough
What are 3 conditions that can lead to extrabronchial causes of cough?
mediastinal or esophageal tumor

aortic aneurysm that compresses a bronchus

enlarged left atrium
What are 4 treatments for chronic cough?
eliminate exposure
intranasal steroid or antihistamine
PPI
antitussives
What is postnasal drip caused by and how should it be treated?
allergic rhinitis

intranasal steroid or antihistamines
How should GERD be treated?
PPI (proton pump inhibitor)
How is acute cough treated?
antitussives
What is defined as the feeling of not getting enough air or labored breathing?
dyspnea (SOB)
What are 2 diseases that can cause dyspnea?
pulmonary disease

circulatory disease
Dyspnea is best related to _____ mechanical work of breathing or _____ventilatory drive
increased

increased
What are 3 causes of increased mechanical work?
decreased pulmonary compliance
increased airway resistance
thoracomuscular dysfunction
What 4 complications can cause decreased pulmonary compliance and what does decreased pulmonary compliance lead to?
fibrosis
edema
congestion
inflammation

increased mechanical work (dyspnea)
What 3 complications can cause increased airway resistance and what does increased airway resistance lead to?
airway inflammation
alveolar destruction
bronchial edema

increased mechanical work (dyspnea)
What 3 complications can cause thoracomuscular dysfunction and what does thoracomuscular dysfunction lead to?
obesity
kyphoscoliosis
neuromuscular disease

increased mechanical work (dyspnea)
What are 3 causes of increased ventilatory drive?
increased sensory stimuli
increased chemical stimuli
primary CNS stimuli
Which 3 places can increased sensory stimuli occur and what does it lead to?
parenchymal interstitium
arteries and veins
chest wall

increased ventilatory drive (dyspnea)
What are 3 things that can cause increased chemical stimuli and what does increased chemical stimuli lead to?
hypoxemia
increased CO2
acidosis

increased ventilatory drive (dyspnea)
What are 2 types of primary CNS stimulation and what can it lead to?
voluntary
involuntary

increased ventilatory drive (dyspnea)
What are 7 causes of acute dyspnea?
asthma
pulmonary infection
pulmonary edema
pneumothorax
pulmonary embolus
metabolic acidosis
ARDS
What are 4 types of orthopnea and nocturnal dyspnea?
asthma
GERD
left ventricular dysfunction
obstructive sleep apnea
What does rapid onset of severe orthopnea suggest?
phrenic nerve impairment
What is PND?
paroxysmal nocturnal dyspnea
What disease is PND more specific for?
cardiac disease
When does PND generally occur?
30 minutes to 2 hours after going to bed
How is PND relieved?
sitting or standing up
When do symptoms for chronic dyspnea first appear?
during exertion
What 4 conditions is constant dyspnea due to?
COPD
interstitial lung disease
pulmonary vascular disease
fixed airflow obstruction
T/F Chronic dyspnea progresses until it occurs with minimal activity or at rest.
true
What 4 things does chronic dyspnea suggest?
CHF
asthma
chronic bronchitis
recurrent PE
T/F Dyspnea is increasingly being recognized as an issue in dying patients and it is often undertreated.
true
What 5 tests can be used to evaluated dyspnea?
CBC
renal function tests
chest x-ray
spirometry
oximetry
Involving dyspnea: patients over ____ or with _____ history of early cardiac disease should have ___
40
family
EKG
If diagnosis of dyspnea is not apparent then what 4 tests can be done?
ABG's
V/Q scan
echocardiography
exercise stress test
What are 6 treatments for dyspnea?
oxygen
benzodiazepines
pulmonary rehab
opioids
fresh air or fan
smoking cessation
Which type of patients does oxygen improve survival?
hypoxemic
What can benxodiazepines help relieve?
anxiety associated with dyspnea
What can pulmonary rehab improve?
respiratory function with dyspnea
What do opiods reduce?
respiratory drive and blunt dyspena
T/F Chest pain is a common presenting symptom of lung disease.
true
What is differentiated from cardiac pain by lack of relation to exertion or radiation to left arm or jaw?
chest pain
What is chest pain differentiated from by lack of relation to exertion or radiation to left arm or jaw?
cardiac pain
How is chest pain differentiated from cardiac pain?
by lack of relation to exertion or radiation to left arm or jaw
What are 3 causes of chest pain?
pleuritic pain
pericarditis pain
pulmonary embolism
Describe pleuritic pain.
sharp and severe, worsened by breathing
Pericarditis pain may not be related to _____; often relieved by _____ _____
breathing

leaning forward
Describe pulmonary embolism pain.
feeling of anterior chest pain that may persist for hours
What is hemoptysis?
expectoration of blood that originates below the vocal cords
What is expectoration of blood that originates below the vocal cords?
hemoptysis
Define massive hemoptysis.
any amount that is hemodynamically significant
What are the 2 most common causes of hemoptysis?
pneumonia
pulmonary infection
T/F Hemoptysis does not subside as the infection is treated.
False. Hemoptysis does subside as the infection is treated.
What is the most often source of hemoptysis?
bronchial arterial circulation
What percentage of pulmonary blood flow is bronchial arterial circulation?
1-2%
T/F Causes of hemoptysis can be classified anatomically.
true
Where are 3 locations that hemoptysis may arise?
airways
pulmonary vasculature
pulmonary parenchyma
What condition in a healthy person does hemoptysis not warrant extensive evaluation?
acute bronchitis
In the absence of infection, what may hemoptysis be caused by?
lung tumor
What are 3 ways to evaluate hemoptysis?
chest x-ray
CT scan
bronchoscopy
What condition almost always results in hemoptysis?
pulmonary embolism leading to infarction
T/F Pulmonary TB is a prominent cause of hemoptysis.
true
What condition is hemoptysis common in where it can be life-threatening?
cystic fibrosis
T/F A small number of otherwise healthy patients can have sudden (usually mild) hemoptysis with no known cause.
true
What other 2 locations may hemoptysis come from that stimulates a cough?
upper airway
GI tract
Is massive hemoptysis life-threatening?
yes
T/F Treatment for hemoptysis is to identify and treat the specific cause.
true
For hemoptysis treatment, the airway must be _____, _____ maintained.
protected

circulation
In treating hemoptysis, bronchoscopy to localize bleeding and embolization is effective in ___% of cases.
85
What are 4 signs/symptoms of lung problems?
cough
dyspnea
chest pain
hemoptysis
What does acute bronchitis usually result from?
infection such as a cold or flu (usually viral)
What are 3 essentials for diagnosis of acute bronchitis?
cough lasting > 3 weeks
fever, constitutional symptoms
productive cough
What is one of the most common medical problems in primary care?
acute bronchitis
Is acute bronchitis greater in the winter or summer?
winter
What are 6 viral infections that can cause acute bronchitis?
influenza
rhinovirus
adenovirus
coronavirus
parainfluenza
RSV
What is RSV?
respiratory sensitial virus
What are 2 bacterial causes of acute bronchitis?
M. pneumoniae
C. pneumoniae
What are 3 signs and symptoms of acute bronchitis?
productive cough
fever
fatigue and malaise
What are 3 differential diagnoses with acute bronchitis?
pneumonia
asthma/allergic bronchospasm
congestive heart failure
What is the proper treatment for acute bronchitis?
antibiotics not neccessary for healty adults

bronchodilators
Is acute bronchitis usually viral or bacterial?
viral
Is pneumonia usually viral or bacterial?
bacterial
What are 5 essentials for diagnosis of pneumonia?
fever
cough
tachypnea
crackles/rales
positive chest x-ray
T/F A chest x-ray for pneumonia may or may not be positive due to timing.
true
What is the 6th leading cause of death in the US?
pneumonia
For pneumonia, there are ___ per ___ people annually
12
1000
What are 4 risk factors for community-acquired pneumonia?
age > 60
smoking
debilitation
chronic respiratory diseases
What are 4 common bacterial causes of community-acquired pneumonia?
S. pneumoniae
Mycoplasma pneumoniae
Klebsiella pneumoniae
Gram negative rods
What is the most common cause of community-acquired pneumonia?
Streptococcus pneumoniae
What is "walking bacteria"?
Mycoplasma pneumoniae
What is the consistency of Klebsiella pneumoniae sputum?
currant jelly
How do gram negative rods cause pneumonia?
aspiration
What are 7 symptoms of community-acquired pneumonia?
fever (+/- rigors/chills/sweats)
cough (+/- sputum)
dyspnea
chest pain
hemoptysis
fatigue/malaise
anorexia
What are 7 signs of community-acquired pneumonia?
fever or hypothermia
tachypnea
tachycardia
decreased O2 saturation
altered breath sounds
rales/crackles
dullness to percussion (depends on type)
What are 7 differential diagnoses for pneumonia?
URI/bronchitis
reactive airway diseases
congestive heart failure
BOOP
lung cancer
pulmonary embolus
atelectasis
What are 7 types of laboratory studies that can be done for pneumonia?
CBC with diff
sputum gram stain and culture
blood chemistry
blood cultures
ABG's
HIV testing (pneumocystis pneumonia)
serology/PCR/special cultures
How is a sputum gram stain and culture obtained?
specimen obtained by deep cough or by sputum induction
What is serology, PCR, and special cultures pertaining to community-acquired pneumonia obtained for?
unusual organisms like Legionella, M. pneumoniae, and C. pnuemoniae
What should be noted in a chest x-ray for pneumonia?
patchy airspace infiltrates
lobar consolidation
interstitial infiltrates
pleural effusions
What are 2 types of special studies for community-acquired pneumonia?
bronchoscopy
transthoracic needle aspiration
What is empyema?
collection of pus in space
What should a CBC in an individual with pneumonia show?
increased WBC
What are 3 types of antibiotic therapy for outpatients with community-acquired pneumonia?
macrolides (Biaxin)
doxycycline
fluroquinolones
What type of antibiotic therapy should be done for inpatients with community-acquired pneumonia?
combination of antibiotics

fluroquinolone
What should be given for pneumonia if patient is allergic to PCN?
fluroquinolone (+/- clindamycin for ICU patients)
What are the 2 types of prevention from community-acquired pneumonia?
polyvalent pneumoccocal vaccine

influenza vaccine
How old do you have to be to get the polyvalent pneumococcal vaccine?
age > 65
How many common strains of polyvalent pneumococcal vaccine are available?
23 common strains
What is the second most common cause of hospital-acquired infection?
hospital acquired pneumonia
What is the mortality rate of hospital acquired pneumonia?
20% to 50%
What are the essentials of diagnosis for hospital-acquired pneumonia?
occurs more than 48 hours after hospital admission

two or more of the following: fever, cough, leukocytosis, purulent sputum

new or progressive parenchymal infiltrate on chest x-ray
Hospital-acquired pneumonia occurs more than ___ hours after hospital admission.
48
Hospital aquired pneumonia consists of two or more of the following four???
fever
cough
leukocytosis
purulent sputum
What is shown on an x-ray of a patient with hospital-aquired pneumonia?
new or progressive parenchymal infiltrate
What are the 5 most common organisms of hospital acquired pneumonia?
*Pseudomonas aeruginosa
*Klebsiella
Staph aureus
Enterbacter
E. coli
What are 4 signs/symptoms of patients with hospital-acquired pneumonia?
fever
leukocystosis
purulent sputum
new or progressive infiltrate on CXR
What are 4 ways to do laboratory findings for hospital-acquired pneumonia?
blood cultures
ABG's or pulse oximetry
sputum gram stain and culture
thoracentesis
When should thoracentesis be done?
if pleural effusion is present
What are 2 treatment regimes for hospital acquired pneumonia?
empiric antibiotics initiated as soon as pneumonia is suspected

antibiotic theraphy tailored to cover suspected organism
What are 3 types of pneumonia covered in clin med?
community-acquired
hosptial-acquired
Pneumocystis jiroveci
What are 7 essentials of diagnosis for Pneumocystis jiroveci?
fever
dyspnea
nonproductive cough
bilateral diffuse interstitial infiltrates
bibasilar crackles
decreased PaO2
Pneumocystis jiroveci found
Where would Pneumocystis jiroveci be found?
sputum
lavage fluid
lung tissue
What are the 2 groups that are overtly infected by Pneumocystis jiroveci?
premature or debilitated infants in underdeveloped countries

*children/adults with altered immunity (AIDS)
What is the mode of transmission of Pneumocystis jiroveci thought to be?
airborne
What are 5 symptoms/signs of Pneumocystis jiroveci?
acute onset of fever
tachypnea
dyspnea
nonproductive cough
bibasilar crackles
What will a CXR for Pneumocystis jiroveci show?
diffuse interstitial infiltrates
What will the serum LDH levels show for Pneumocystis jiroveci?
isolated elevation
What will an induced sputum specimen be used for with Pneumocystis jiroveci?
Giemsa stain or PCR test
What are 3 types of treatment for Pneumocystis jiroveci?
TMP/SMX (bactrin/septra)
pentamidine IV or IM
atovaquone
What type of drug is TMP/SMX?
sulfa drug (bactrin/septra)
T/F Oxygen therapy is not a good idea for treatment of Pneumocystis jiroveci.
false
Oxygen is part of the treatment plan for Pneumocystis jiroveci.
What type of drug can be started in the first 72 hours for moderate to severe pneumonia to improve survival of Pneumocystis jiroveci?
prednisone
What type of prevention is available for Pneumocystis jiroveci?
prophylaxis for HIV patients
What is the mortality rate for infants with Pneumocystis jiroveci?
20-50%
What is the mortality rate for AIDS patients with Pneumocystis jiroveci?
3%
What is the mortality rate in other immunodeficient patients?
30-50%
What are the 8 essentials of diagnosis for pulmonary tuberculosis?
fatigue
weight loss
fever
night sweats
cough
apical pulmonary infiltrates on CXR
positive PPD
sputum smear or culture positive
What shows up on a CXR of pulmonary tuberculosis?
pulmonary infiltrates (usually apical)
What % of the world's population is infected with pulmonary tuberculosis?
20-43%
___ million in the US are infected with pulmonary tuberculosis.
15
What are the 4 most common types of people infected with pulmonary tuberculosis?
malnourished
homeless
low-income
HIV positive
T/F Pulmonary tuberculosis is usually silent.
true
What 2 types of cells surround the organisms and contain the infection of pulmonary tuberculosis?
T-cells
macrophages
What percentage of people with pulmonary tuberculosis will develop the active disease?
10%
Drug resistance to pulmonary tuberculosis is increasing up to ____ in the US.
15%
What are 8 signs/symptoms of pulmonary tuberculosis?
malaise
anorexia
weight loss
fever
night sweats
cough
hemoptysis
apical rales
T/F Pulmonary tuberculosis has slowly progressive constitutional symptoms?
true
Desribe the cough of patients with pulmonary tuberculosis?
dry then later becomes productive
T/F Examination of patients with pulmonary tuberculosis may be normal.
true
What are 2 types of labs that may be done for pulmonary tuberculosis?
3 morning sputum samples
bronchoscopy
What are the 3 morning sputum samples for pulmonary tuberculosis used for?
culture or DNA/RNA amplification
What 5 things might a CXR for pulmonary tuberculosis show?
small homogenous infiltrates (apical)
hilar/paratracheal lymph nodes
segmental atelectasis
pleural effusion
cavitation
For the tuberculin skin test, what is the measure of PPD intradermally?
0.1mL
When should a tuberculin skin test be read?
48-72 hours
What is the measurement for
immunocompromised or recent contacts of active TB for the tuberculin skin test?
>5mm
What is the measurement for immigrants, IV drug users, high risk employees, and children < 4 years for the tuberculin skin test?
>10mm
What is the measurement for persons with no risk factors for the tuberculin skin test?
>15mm
>5mm is the measurement of the tuberculin skin test for what group of individuals?
immunocomprimised or recent contacts of active TB
>10mm is the measurement of the tuberculin skin test for what group of individuals?
immigrants, IV drug users, high risk employees, and children < 4 years
>15mm is the measurement of the tuberculin skin test for what group of individuals?
persons with no risk factors
What is the treatment plan for patients with drug-resistant TB?
directly observed therapy (DOT)
What is the control that can be used with the PPD skin test to help rule out false negatives/positives?
Candida
What 4 drugs should HIV-negative patients be treated with for two months daily for pulmonary embolism?
isoniazid
rifampin
pyrazinamide
ethambutol

IRPE
What 2 drugs should HIV-negative patients continue to take daily for 2 months for TB?
isoniazid
rifampin
What drug should not be take by pregnant women regarding pulmonary tuberculosis?
pyrazinamide
What type of specialist should HIV-postive patients with pulmonary tuberculosis be treated by?
ID specialist
T/F HIV-positive patients require a longer duration of therapy for pulmonary tuberculosis.
true
T/F HIV-positive patients with TB may have drug interactions with rifampin and some of the HIV drugs.
true
_____ should be given to HIV-positive patients taking isoniazid.
Pyridoxine (B6)
Why should pyridoxine be given to HIV-positive patients taking isoniazid?
reduces nervous system side effects
What does treatment for latent TB do?
reduces risk of progression to active disease
What are 3 treatment regimens for latent TB?
isoniazid for 9 months (w/ pyridoxine?)

rifampin & pyrazinamide for 2 months

rifampin for 4 months
When would pyridoxine be given with isoniazid in patients with latent TB?
if think at rise for neuropathy
What are 5 essentials of diagnosis for bronchiolitis?
URI symptoms
paroxysmal wheezy cough
dyspnea
tachypnea
diffuse fine crackles
Bronchiolitis is a common disease in ___% of infants.
7
Bronchiolitis is most frequently in first ___ years of life with a peak at ___ months.
2

6
What are the 3 most common viral causes of bronchiolitis?
RSV
parainfluenza
adenovirus
RSV is present in ___% of cases of infants with bronchiolitis.
50
Even though not as common as viral, what is the most common pathogen for bacterial bronchiolitis?
M. pneumoniae
What drug should be given to high risk infants to help prevent bronchiolitis?
Synagis
T/F An IM can be given monthly for 5-6 months for prevention of bronchiolitis.
true
What are 6 signs/symptoms of bronchiolitis?
URI symptoms
irritability
tachypnea
retractions
accessory muscle use
diffuse fine rales
Describe the URI symptoms with bronchiolitis.
gradual onset of respiratory distress with dyspnea and paroxysmal wheezy cough
What 2 laboratory findings can be used for bronchiolitis?
O2 sats
nasal swabbing for RSV culture
What should you look for on a chest x-ray of bronchiolitis?
hyperinflation
scattered areas of consolidation
What is 1 differential diagnosis for bronchiolitis?
acute asthma
What 2 ways can bronchiolitis be treated?
supportive care
bronchodilators if wheezing present
What is the prognosis for bronchiolitis?
increased incidence of airway hyperreactivity that may persist for years
What is croup also know as?
laryngeotracheobronchitis
What are 4 essentials of diagnosis for croup?
URI symptoms
barking cough
symptoms worst on 1st-2nd day
clear lungs
What 3 signs/symptoms may be added to the essentials of diagnosis for croup in severe cases?
inspiratory stridor
respiratory distress
cyanosis
T/F Croup is an uncommon infection.
false Croup is a relatively common infection.
Croup causes about _____ hospitalizations per year.
50,000
What 2 seasons does croup peak?
autumn
early winter
What is the peak age for croup?
3 months to 5 years
What are the 4 etiologies of croup?
parainfluenza virus
adenovirus
RSV
M. pneumoniae
What percentage of cases does parainfluenza cause croup?
75%
Croup will show a ____ with gradual onset of a _____ cough.
URI

barking
Croup shows mild to moderate respiratory distress that is worse _____ and resolves _____.
at night

gradually
Some patients with croup may develop worsening _____ and _____.
stridor

cyanosis
In patients with croup, the lung sounds are usually _____.
normal
What lab tests can be used for croup?
O2 sats
WBC count
Will the O2 saturation of patients with croup be increased or decreased?
decreased
The WBC count of patients with croup will usually be normal or slightly _____.
elevated
Why are chest x-rays for croup generally normal?
because problem is higher than the lungs
Neck x-rays for croup may show classic "_____ _____" in about half of the patients.
"steeple sign"
What 4 conditions are included in the differential diagnosis for croup?
epiglottitis
bronchiolitis
pneumonia
asthma
About ___% of patients with croup will need to be hospitalized and ___% of these patients will need to be intubated.
10%

1-5%
What are the 2 outpatient treatment plans for croup?
cool, moist air
single IM of dexamethasone
Are recurrences common for croup?
yes
What are the 4 inpatient treatment plans for cough?
cool, humidified air (croup tent)
supplemental oxygen
racemic epinephrine (nebulizer)
single IM of dexamethasone
What is acute respiratory failure?
dysfunction of the respiratory system which leads to abnormal gas exchange
What is dysfunction of the respiratory system which leads to abnormal gas exchange known as?
acute respiratory failure (ARF)
Is ARF potentially life-threatening?
yes
What significance is almost always present in ARF?
hypoxemia
T/F ARF requires a significant change from baseline.
true
ARF is often defined as when the PaO2 is less then ___mmHg.
55 (often arbitrary)
PaCO2 with ARF is traditionally defined as ___mmHg or higher if accompanied by arterial acidosis with pH of ___ or less.
50

7.30
What are 5 mechanisms that can lead to hypoxemia?
dec. inspired PaO2
hypoventilation
V/Q mismatch
shunting of blood
abnormal diffusion of O2
What are the 3 objectives in diagnosis of ARF?
confirm that ARF is present
classify the type of ARF
determine specific cause
What are 7 causes of hypoxic ARF?
acute lung injury/ARDS
pneumonia
PE
acute lobar atelectasis
pulmonary edema
lung contusion
acute collage-vascular disease
What is acute collagen-vascular disease also known as?
Goodpasture's syndrome
What are 10 causes of hypercapneic-hypoxic ARF?
COPD
asthma
drugs causing resp. depression
Guillain-Barre syndrome
acute myasthenia gravis
spinal cord tumors
metabolic derangements
kyphoscoliosis
ankylosing spondylitis
obesity hypoventilation syndrome
What are 13 clinical manifestations of hypoexmia?
tachypnea
tachycardia-->bradycardia
anxiety
diaphoresis
altered mental status
confusion
cyanosis
hypertension/hypotension
seizures
coma
lactic acidosis
What are 10 clinical manifestations of hypercapnia?
somnolence
lethargy
restlessness
tremor
slurred speech
headache
asterixis
papilledema
coma
diaphoresis
What 2 lung diseases may show normal on a chest x-ray?
asthma
COPD
Which 3 lung diseases show localized alveolar-filling opacities on a chest x-ray?
pneumonia
PE
infarction
Which 3 lung diseases show diffuse alveolar-filling opacities on a chest x-ray?
pulmonary edema
acute lung injury
diffuse pneumonia
What are the 5 goals of treatment of ARF?
improve hypoxemia
improve acidosis if life-threatening
improve cardiac output
treat underlying disease
avoid predictable complications
ARF in COPD is associated with mortality of ___ to ___%.
6

20
ARF may present in cryptic ways such as changes in _____ _____ or _____.
mental status

arrhythmias
What is the most common precipitating event of ARF in COPD?
infection
COPD patients with community-acquired pneumonia are more likely to have gram _____ enteric bacteria or ______ infections.
negative

Legionella
T/F With ARF in COPD, decision to use mechanical ventilation must be made on clinical grounds.
true
What 3 things are increased risks which may lead to complications in ARF?
DVT
PE
gastric stess ulceration
What are 5 prevention measures for ARF?
prophylactic anticoagulation
leg compression devices
use of H2 blocker
head of bed at 45 degrees
early ambulation
When was ARDS first described?
1967
What is ARDS?
abrupt onset of diffuse lung injury characterized by severe hypoxemia and diffuse pulmonary infiltrates on CXR
What is abrupt onset of diffuse lung injury characterized by severe hypoxemia and diffuse pulmonary infiltrates on CXR known as?
ARDS
What is ARDS also known as?
acute lung injury
What requires bilateral infiltrates compatible with pulmonary edema in the absence of clinical heart failure?
ARDS
Considered ARDS if PaO2/FIO2 is less than or equal to ___.
200
ARDS has an annual incidence of ___ - ___ cases per 100,000.
40-75
What is the mortality rate of ARDS?
30 to 50%
What is the most common precipitating cause of ARDS?
severe sepsis
What are the 3 physiologic abnormalities that are dominated by hypoxemia with ARDS?
shunting
decreased compliance
increased work of breathing
As disease progresses, _____ develops...lungs remodel and _____.
fibroproliferation
scar
What are 2 diagnoses that are made with ARDS?
acute respiratory disress

diffuse infiltrates on CXR
What is key to distinguish ARDS from?
cardiogenic pulmonary edema
What are 4 types of treatment for ARDS?
respiratory support
treatment of underlying disease
PEEP
?inhaled nitric oxide?
What is PEEP treatment used for with ARDS?
for acute lung injury
What is PEEP treatment considered better than involving ARDS?
endotracheal intubation
Treatment of ARDS should involve changing from supine to prone position to reduce ____, which may cause facial _____ and it is a difficult position for nursing care.
shunting

edema
What is a common, often fatal complication of thrombus formation within the deep venous circulation?
pulmonary embolism
Pulmonary embolism and _____ _____ _____ are two manifestations of the same disease.
deep venous thrombosis
PE causes _____ deaths per year in the US and is the _____ leading cause of death among hospitalized patients.
200,000

3rd
What is the 3rd leading cause of death among hospitalized patients?
pulmonary embolism
T/F Symptoms for PE are very specific.
false Symptoms for PE are very non-specific.
What is the most common embolus?
thrombus
What 2 places do emboli arise?
anywhere in the venous circulation or heart
Where do emboli most often originate?
in the deep venous circulation of the major calf muscles
Thrombi confined to the calf rarely embolize to _____ circulation.
pulmonary
___% of calf thrombi propagate to popliteal and ileofemoral veins and then embolizes to pulmonary circulation.
20%
50% to 60% of patients with ___ will develop PE.
DVT
Name 7 types of emboli other than thrombus.
fat
air
amniotic fluid
septic (endocarditis)
tumor
foreign body
parasite eggs
What is an example of a foreign body emboli that may cause PE?
talc in IV drug use
What is the condition of parasite eggs known as?
schistosomiasis
What are 5 risk factors/etiology of PE?
immobility
hyperviscosity
increased central venous pressures
vessel damage
hypercoagulable states
What are 3 things thay may cause immobility which may be a risk for PE?
bed rest
stroke
obesity
What may hyperviscosity cause?
polycythemia
What 2 things may cause increased central venous pressures which may be a risk for PE?
low cardiac output
pregnancy
What 3 things may cause vessel damage which may be a risk for PE?
prior DVT
surgery
trauma
What are 3 hypercoagulble states that may be a risk for PE?
HRT medications
disease
gene defect
What is the most common gene defect?
factor 5
What 2 things cause increased pulmonary vesicular resistance which is part of the pathophysiology of PE?
physical obstruction of vascular bed
vasoconstriction
Physiologic dead space is wasted _____.
ventilation
What 3 things deal with hypoxemia which is part of the pathophysiology of PE?
right-to-left shunting
decreased cardiac output
surfactant depletion-->atelectasis
What 4 things are part of the pathophysiology of PE?
increase pulmonary vascular resistance
physiologic dead space
hypoxemia
bronchoconstriction
Massive PE presents with systemic arterial hypo- or hyper-tension?
hypotension
_____ to _____ have RV hypokinesis but normal systemic arterial pressure.
moderate to large
_____ to _____ PE have both normal RH function and normal systemic arterial pressure.
small to moderate
*Pulmonary infarction is usually from a _____ PE but is very painful as it lodges near innervation of pleural nerves.
small
What 4 signs/symptoms indicate a massive PE?
dyspnea
syncope
hypotension
cyanosis
What 3 signs/symptoms suggest a small embolism located distally near the pleura?
pleuritic pain
cough
hemoptysis
_____ is most frequent symptom of PE with ___ to ___% of patients.
dyspnea

75-85%
_____ is the most frequent sign of PE.
tachypnea
Pain on respiration for PE in ___ to ___%.
65-75%
What are the 3 "classic signs" of PE?
low-grade fever
neck vein distension
accentuated pulmonic 2nd heart sound
What are 12 differential diagnoses for PE?
MI
unstable angina
pneumonia
bronchitis
COPD exacerbation
congestive heart failure
asthma
pericarditis
primry pulmonary hypertension
rib fracture
pneumothorax
costochondritis
What is adequate provision of fresh air to alveoli?
ventilation
What is adequate circulation of blood through pulmonary vascularization?
perfusion
What is ventilation-perfusion matching (V-Q)?
appropriate contact between alveolar gas and pulmonary capillary blood
What does gas exchange depend critically on?
proper matching of V/Q in which delivery of O2 and removal of CO2 between alveolar-capillary unit matches blood flow though pulmonary capillary bed
What is it called when PE can result in less fresh air delivered to alveoli and thus impede O2 and CO2 exchange as well as inadequate blood flow to pulmonary capillaries to perfuse pulmonary capillary bed for exposure to alveoli?
V-Q mismatch
What type of test excludes common lung diseases and interpets V-Q scan?
chest x-ray
What 3 things are the most frequent findings with CXR?
atelectasis
infiltrates
pleural effusion
What is lung scanning in which patient breathes radioactive gas to observe distribution in lungs?
V/Q scan
T/F Defect of V/Q scan points to diminished blood flow to region on lung affected by PE.
true
T/F V/Q scan can give high, low, or intermediate probability of PE.
true
What is high probability V/Q often defined as?
two or more segmental perfusion defects and can make diagnosis of PE in most instances
What type of scan can make diagnosis of PE in most instances?
V/Q scan
What type of study is very sensitive for detection of thrombus in proximal pulmonary arteries?
*spiral CT
What is the test of choice to detect proximal DVT in most centers?
venous ultrasonography (Doppler)
___% of patients with PE will have DVT.
70%
What 2 types of studies are useful in serial examination of patients with high clinical suspicion of venous thromboembolism but negative leg studies?
ultrasonography and plethysmography
What is the gold standard for diagnosis of PE?
pulmonary angiography
T/F With pulmonary angiography, an intraluminal filling defect in more than one projection establishes a definitive diagnosis.
true
What are the 3 secondary findings that are highly suggestive of PE?
abrupt arterial cut-off
asymmetry blood flow
slow filling
ECG is abnormal in ___% of patients showing sinus tachycaria and non-specific St-T changes.
70%
What does ABG for PE reveal?
acute respiratory alkalosis due to hyperventilation
____ is elevated in thrombus.
D-dimer
What are 2 types of preventative measures for PE?
compression stockings
heparin
What are 9 types of patients that may receive preventive measures for PE?
general surgery
orthopedic surgery
neurosurgery
trauma
medical patients (AMI)
ischemic stroke w/ impaired mobility
cancer patients
CHF
severe pulmonary disease
What is the secondary prevention of recurrent PE?
anticoagulation with heparin or warfarin (coumodin)
What 2 types of treatments are reserved for PE patients at high risk of death from right heart failure?
clot dissolution (thrombolysis)

embolectomy
_____ and _____ should be given to PE patients until therapeutic, and then the patient should be sent home with _____.
heparin and warafin

warafin
Failure to achieve therapeutic _____ levels within 24 hours is associated with ___-fold increase of clot propagation.
heparin

5
What compared to UFH are easier to dose, require no monitoring, have similar bleed rates, and are at least as effective?
low-molecular weight heparin (LMWH)
Which drug is contraindicated in pregnancy?
coumadin (warfarin)
T/F Warfarin should be monitored with heparin until warafarin becomes therapeutic.
true
How long should full anticoagulation be given to patients for an initial episode of PE with reversible risk factor?
6 months
How long should full anticoagulation be given to patients for irreversible risk factor?
6-12 months to indefinitely
What is an example of an irreversible factor?
inherited coagulopathy
What is a major complication of anticoagulation?
hemorrhage
What 3 things does thrombolytic therapy consist of?
streptokinase
urokinase
recombinant tissue plasminogen activator
What accelerates resolution of emboli within the first 24 hours?
thrombolytic therapy
T/F There is no evidence that thrombolytic therapy improves mortality.
true
Thrombolytics carry a ___-fold greater risk of intracranial bleed compared to heparin.
ten
What is indicated in patients who are hemodynamically unstable while on heparin?
thrombolytic therapy
What are 2 absolute contraindications to thrombolytic therapy?
active internal bleed
stroke w/in past 2 months
What are 3 major contraindications to thrombolytic therapy?
uncontrolled HTN
surgery
trauma w/in past 6 weeks
_____ _____ _____ filter in patients with major contraindication to anticoagulation or at high risk for developing proximal DVT or PE.
inferior vena cava
What are 2 types of adjunctive therapy for PE?
pain relief
supplemental oxygenation
What is an emergency procedure of last resort with a very high mortality rate dealing with PE?
pulmonary embolectomy
What 3 types of experts should patients be evaulated by for a diagnosis of PE?
pulmonologist
hematologist
internist
The pleura is composed of _____ cells which give the pleura a smooth semitransparent appearance.
mesothelial
What is the most important function of the pleura?
to make glycoproteins rich in hyaluronic acid to decrease friction between the lung and the chest wall
What has the function to make glycoproteins rich in hyaluronic acid to decrease friction between the lung and the chest wall?
the pleura
What covers the surface of the chest wall?
parietal pleura
What covers the surface of the lungs?
visceral pleura
The parietal pleura is supplied with blood from _____ circulation and it contains _____ nerves.
systemic

sensory
The visceral pleura is supplied with blood from _____ circulation.
pulmonary
T/F The visceral pleura contains sensory nerves.
false The visceral pleura dos not contain sensory nerves, but the parietal pleura does contain sensory nerves.
The pleural fluid has _____ protein concentration with pH and glucose _____ to blood.
low

similar
Is the pleural fluid formed mostly by the parietal or visceral pleura?
parietal pleura (mesothelial cells)
Where does the pleural fluid drain?
lymphatic system
About how much pleural fluid is in the pleural space?
5-15mL
What are the 2 types of pleural fluids?
transudate

exudate
What type of pleural fluid forms from increased hydrostatic pressure or decreased oncotic pressure?
transudate
What type of pleural fluid is similar to normal fluid?
transudate
What type of pleural fluid is formed by increased outpouring by capillaries or cells and/or blocking of the lymphatic system?
exudates
What are 6 types of conditions from increased pleural fluid?
heart failure
low albumin
collapsed lung
pneumonia
malignant effusion
ascites
What are 3 conditions that are from increased transudate pleural fluid?
heart failure
low albumin
collapsed lung
What are 3 conditions that are from increased exudate pleural fluid?
pneumonia
malignant effusion
ascites
With increased pleural fluid, increased pressure in microvascular circulation may cause _____ _____.
heart failure
With increased pleural fluid, decreased oncotic pressure may cause _____ _____.
low albumin
With increased pleural fluid, decreased pressure in the pleural space may cause a _____ _____.
collapsed lung
With increased pleural fluid, increased permeability may cause _____.
pneumonia
With increased pleural fluid, impaired lymphatic drainage may cause _____ _____.
malignant effusion
With increased pleural fluid, movement of fluid from peritoneal space may cause _____.
ascites
What are 3 signs/symptoms that a patient with pleural effusion may present with?
pain
dyspnea
cough
Pain for pleural effusion is usually _____ and _____, worse with _____ or _____ and may radiate to the _____, _____, or _____.
unilateral/sharp
cough/inspiration
shoulder/neck/abdomen
Will a patient with pleural effusion generally have increased or decreased breath sounds?
decreased
T/F Patients with pleural effusion will usually have dullness to percussion with no tactile fremitus.
true
For pleural effusion, egophony is at _____ fluid border where lung _____ is compressed.
upper

parenchyma
With pleural effusion, radiologic findings show _____ and medial displacement of _____ costophrenic angle.
blunting

sharp
T/F With pleural effusion, radiologic findings show elevation of hemidiaphragm.
true
_____ _____ _____ is more sensitive than an AP film for pleural effusion.
lateral decubitus film
_____ or CT scans may provide better definition for pleural effusion.
ultrasound
T/F Supine film for pleural effusion is not helpful.
true
What is the use of thoracentesis?
diagnosis or therapy
Thoracentesis is diagnostic in ___% of patients.
75%
All newly discovered effusions should be _____.
tapped
Only ___ to ___ mL required for pleural effusion.
30-50 mL
What are 4 contraindications of thoracentesis?
bleeding diathesis
anticoagulation
small volume
mechanical ventilation
What is the maximum amount that can be removed at once with thoracentesis?
1000 to 1500 mL
If everything is normal with pleural effusion, then what is the source?
transudate
If one thing is different with pleural effusion, then what is the source?
exudate
What are 4 things that can cause exudate pleural effusion?
high-protein
LDH>200
glucose>60
cholesterol>45
What are 5 things that can cause transudate pleural effusion?
protein<3
LDH<200
glucose>60
WBC<1000
cholesterol<45
What are 7 diagnoses that can be found with thoracentesis?
malignancy
empyema
TB (acid fast bacillus on culture)
fungal infection
chylothorax
urinothorax
esophageal rupture
What are 5 complications of thoracentesis?
pain
bleeding
pneumothorax
infection
puncture of liver or spleen
With therapeutic thoracentesis, about half of patients have a temporary decrease in _____.
PaO2
What is the most common cause of transudative effusion?
heart failure
What are 3 key points with heart failure being the cause of transudative effusion?
bilateral

larger on right

associated w/ cardiomegaly & vascular congestion
What are 3 things that can cause transudative effusion?
heart failure
liver cirrhosis
nephrotic syndrome
With transudative effusion, liver cirrhosis causes movement of _____ fluid, usually on the _____.
ascitic

right
With transudative effusion, nephrotic syndrome is due to low _____.
albumin
What is the most common cause of exudative effusion?
parapneumonic effusion
T/F Uncomplicated parapneumonic effusion resolves with antibiotics.
true
If parapneumonic effusion has bacteria in it (empyema), then it must be _____, usually with a _____ _____.
drained

chest tube
With exudative effusion, an upper abdominal abscess is usually _____.
subphrenic
What are 3 sign's symptoms of upper abdominal abscess (exudative effusion)?
fever
dyspnea
elevated hemidiaphragm (CXR)
What are 9 conditions that can cause exudative effusion?
parapneumonic effusion
upper abdominal abscess
esophageal rupture
TB
hemothorax
chylothorax
rheumatoid arthritis
asbestosis
uremia
What are half the cases for esophageal rupture due to?
endoscopy or esophageal dilation
What are 5 signs/symptoms with esophageal rupture?
chest pain
dyspnea
dysphagia
fever
1/2 w/ subcutaneous emphysema
What are 3 signs/symptoms of TB?
fever
cough
chest pain
What are 3 things that can cause hemothorax?
trauma
malignancy
pulmonary infarction
What do larger effusions require?
drainage with chest tube
Chylothorax is usually a _____ malignancy and has a ____ appearance
mediastinal
milky
What is an example of a mediastinal malignancy?
lymphoma
What is the treatment for chylothorax?
drainage of the pleural space
Is rheumatoid arthritis with exudative effusion greater in males or females?
males
What are 2 signs/symptoms of rheumatoid arthritis with exudative effusion?
pleuritic pain
dyspnea
What are the 2 treatments for rheumatoid arthritis with exudative effusion?
corticosteroids
anti-inflammatory agents
Malignant effusion is the most common cause of exudate in patients over ___.
60
Malignant effusion is the most frequently invasion by _____ cancer.
lung
What are 3 signs/symptoms of malignant effusion?
cough
pain
dyspnea
What 2 types of cells are increased with malignant effusion?
RBC's
mononuclear cells
Cytology in malignant effusion is positive in ___%.
60%
Malignant effusion has a poor prognosis except for _____ cancer or small cell ____ cancer.
breast
lung
What is one type of malignant effusion?
malignant mesothelioma
Malignant mesothelioma has _____ in 80-90% of cases.
asbestos
What are 4 signs/symptoms of malignant mesothelioma?
dyspnea
cough
weight loss
pain
For malignant mesothelioma, effusion may be _____ and is often _____.
massive
bloody
How long is the median survival of malignant mesothelioma after diagnosis?
8-12 months
How is malignant mesothelioma treated?
removal of tumor

chemotherapy
What is accumulation of air or gas in the pleural space?
pneumothorax
What are the 3 ways that pneumothorax can be classified?
primary spontaneous
secondary spontaneous
traumatic
Perforation of the visceral pleura, penetration of chest wall/diaphragm/mediastinum/esophagus, or gas generated by microorganisms in an empyema are all causes of _____.
pneumothorax
Which type of pneumothorax is most common in healthy men b/t 20 and 40 years old?
primary/simple spontaneous pneumothorax
Which type of pneumothorax is due to spontaneous rupture of subpleural blebs at the apex of the lungs?
primary/simple spontaneous pneumothorax
Primary/simple spontaneous pneumothorax is due to spontaneous rupture of subpleural _____ at the _____ of the lungs.
blebs

apex
For primary/simple spontaneous pneumothorax is the right lung or left lung more common?
right lung
Is recurrence for primary/simple spontaneous pneumothorax frequent?
yes
What are 3 symptoms of primary/simple spontaneous pneumothorax?
*ACUTE pain
dyspnea
cough
What differentiates primary/simple spontaneous pneumothorax from pleural effusion?
primary/simple spontaneous pneumothorax has ACUTE onset of pain
What are 3 signs of primary/simple spontaneous pneumothorax?
decreased breath sounds
decreased tactile fremitus
hyperresonance
What type of CXR is primary/simple spontaneous pneumothorax seen with?
lateral decubitus CXR
A _____ pneumothroax can be life-threatening.
tension
A tension pneumothorax is caused by increased _____ pressure.
postitive
What 2 things can tension pneumothorax cause?
mediastinal shift
compromise circulation
Tension pneumothorax is treated with air _____ from a _____ _____ attached to suction if pneumothorax occupies more than ___% of the hemithorax.
aspiration
chest tube
50%
What type of pneumothorax is caused by blunt or penetrating trauma?
traumatic pneumothorax
What are 2 examples of traumatic pneumothorax?
breaking a rib
puncturing diaphragm
What type of pneumothrax results from trauma or pulmonary disease?
secondary/complicated pneumothorax
What is the most common cause of secondary/complicated pneumothorax?
widespread emphysema
T/F Patients with secondary/complicated pneumothorax should be hospitalized and given a chest tube.
true
For pneumothroax, chest pain is on the _____ side and _____ is present.
affected
dyspnea
Pneumothorax starts at _____ and usually resolves within ___ hours, even if the pneumothorax persists.
rest
24
Pneumothroax shows _____ breath sounds, _____ movement of chest, and _____ tactile fremitus.
diminished
decreased
decreased
Tracheal shift may be present in _____ penumothorax.
tension
What 2 things does ABG for pneumothorax show?
hypoxemia

acute respiratory alkalosis
Left-sided primary pnumothorax can cause _____ changes that mimic ___.
EKG

AMI
What are 5 frequent complications dealing with a chest tube?
pulmonary edema
lung trauma/infarction
subcutaneous emphysema
bleeding
infection
What is air in mediastinum specifically called?
pneumomediastinum
What are 4 complications of pneumothorax?
chest tube
pneumomediastinum
subcutaneous emphysema
death
Many small pneumothoraces will resolve _____.
spontaneously
What are 2 types of chest tubes?
one-way valve
suction
What are 4 types of treatment for pnuemothorax?
spontaneously
aspiration
one-way valve chest tube
suction chest tube
What can recurrent pneumothroaces be treated with?
pleurodesis
Following chest tube drainage, an _____ is placed in the pleural space.
irritant
What is the goal of pleurodesis?
to form fibrous adhesions b/t the visceral and parietal pleura
What are the 2 most common agents used for pleurodesis?
doxycycline
sterile talc
What are 2 major side effects of pleurodesis?
pain
fever
What percentage of patients with pneumothorax will have recurrence?
30%
Recurrent pneumothoraces is less frequent after _____ therapy, known as _____.
surgical

pleurodesis
Are there long term complications following successful treatment of pneumothorax?
no
What percentage of people have no experience with asthma?
only 23%
Is asthma a restictive or obstructive lung disease?
obstructive
What is a chronic inflammatory disorder of the airways characterized by episodic airway narrowing, increased airway reactivity to a variety of stimuli, and pharmacologic or spontaneous reversibility?
asthma
Asthma is a _____ inflammatory disorder of the airways characterized by _____ airway narrowing, _____ airway reactivity to a variety of stimuli, and pharmacologic or spontaneous _____.
chronic
episodic
increased
reversibility
*What are 2 related asthma diseases?
allergic rhinitis
eczema
What are 2 examples of things that cause increased airway reactivity?
cigarette smoke
cold air
What are the 3 main components that interact with asthma?
smooth muscle dysfunction
airway inflammation
airway remodeling
What component of asthma causes bronchoconstriction, hyperplasia, and hypertrophy?
smooth muscle dysfunction
What 3 things does smooth muscle dysfunction of asthma cause?
bronchoconstriction
hyperplasia
hypertrophy
What are 2 results of smooth muscle dysfunction of asthma?
increased hyperreactivity

increased inflammatory mediator release
What is airway inflammation of asthma activated by?
inflammatory cells and their mediators
What is activated by inflammatory cells and their mediators?
airway inflammation of asthma
What results in mucosal edema, cellular proliferation, epithelial damage, basement membrane thickening, and enhanced vascular permeability?
airway inflammation of asthma
What are 5 results of airway inflammation of asthma?
mucosal edema
cellular proliferation
epithelial damage
basement membrane thickening
enhanced vascular permeability
What results from cellular proliferation of both smooth muscle, mucous glands, increased matrix protein deposition, increased basement membrane thickening, and angiogenesis?
airway remodeling of asthma
What are 5 results of airway remodeling of asthma?
cellular proliferation of smooth muscle & mucuous glands
increased matrix protein deposition
increased basement membrane thickening
angiogenesis
What is caused by fibroblast growth, tumor necrosis growth, and vascular endothelial growth factors and endothelin?
angiogenesis
What are 3 things that cause angiogenesis?
fibroblast growth
tumor necrosis growth
vascular endothelial growth factors/endothelin
T/F Angiogenesis will ultimately result in increased airway wall thickness and a larger amount of mediator cell delivery to the lungs.
true
T/F Questions and answers regarding the remodeling concept have not been fully addressed.
true
What are 6 types of asthma?
exercise induced
extrinsic
intrinsic
occupational
aspirin/NSAID precipitated
rhinitis/sinusitis link
Which type of asthma is caused by loss of heat/water from the lungs during exercise?
exercise induced asthma
Exercise induced asthma occurs within _____ of starting exercise and peaks ___ to ___ minutes post exercise and resolves after ___ to ___ minutes.
minutes

5-10 minutes

20-30 minutes
What type of test can be done for exercise induced asthma?
exercise challenge test
For the exercise challenge test, the heart rate should be increased to ___% of max for ___ to ___ minutes.
80%

4-6 minutes
What indicates a positive exercise challege test?
a 15% decrease in FEV/PEF taken before and after exercise at 5 minute intervals for 20-30 minutes
What are 2 types of prevention for exercise induced asthma?
lengthy warm up

beta-2 agonists (albuterol) used shortly before
What is one type of beta-2 agonists?
albuterol
Albuterol is helful for about ___% of patients with exercise induced asthma.
80%
What are 2 things that albuterol does?
bronchodilates smooth muscle
increases HR
Which type of asthma has cases in which worsening of the asthma can be clearly associated with exposure to a specific allergen?
extrinsic asthma
Which type of asthma diagnosis requires a clear history of worsening asthma after exposure, improvement after allergen is removed, positive wheal and flare reaction on allergen skin testing?
extrinsic asthma
What are the 8 most common allergens that may cause extrinsic asthma?
dust mites
cockroaches
pet danders (cats)
pollen
ragweed
spring trees
summer grass
molds
Which type of astma is a condition where there is no clear association with a specific allergen?
intrinsic asthma
Intrinsic asthma is more common in ____ and is usually _____.
adults

perennial
Which type of asthma has many patients that show some traits of allergeic tendencies with elevated serum IgE and sputum eosinophilia but skin allergen testing is usually negative?
intrinsic asthma
What percentage of people have family members with asthma?
35%
What percentage of people have friends/coworkers with asthma?
29%
What percentage of people have asthma themselves?
7%
What percentage of people have a past history of asthma?
6%
Which type of asthma occurs due to workplace exposure to a wide variety of possible agents?
occupational asthma
Which type of asthma if recognized early may lead to being able to stop the exposure and possible resolution?
occupational asthma
Which type of asthma will typically have cases that will worsen as the work week progresses and resolution as the weekend winds down?
occupational asthma
In pool analyses, 1 in ___ adults with asthma and ___% of children were found to have sensitivity to _____ on provocative testing. These patients also had sensitivity to NSAIDs.
5
5%
aspirin
NSAIDs
What is the gatekeeper to the lung?
the nose
T/F The same allergens trigger the same responses in both the nose and the lungs.
true
What are 2 conditions that may precede or coexist with asthma?
allergic rhinitis
chronic sinusitis
_____ exposure in early life to microbial organisms may lead to _____ risk later in life.
decreased
increased
What are 8 historical factors that should be taken for asthma?
known allergen exposure
family history
premature birth
pets in home
African American ethnicity
tobacco exposure
obesity
reduced exposure to germs
In asking questions to the patient about asthma, what are 3 conditions that should be asked under the family history?
asthma
rhinitis
hayfever
In acute asthma attacks the patient may appear ____ and ____, speech may be ____ or diminished, _____ may be deep and slow with a prolonged ____ phase, ____ of the nostrils, intercostal ____, ____ and ____ retractions and other accessory muscle use.
frightened and fatigued
telegraphic
respirations
expiratory
flaring
supraclavicular
suprasternal
With an asthma attack, what diminishes after awhile, meaning that there is no air getting through?
wheezing
In acute asthma attacks, the patient may sit on the table in a _____ like configuration and there may be slight ______ of the distal body parts like nail beds.
tripod
cyanosis
What are 4 episodic or chronic symptoms of airflow obstruction?
dyspnea
cough
wheezing
chest tightness
When are symptoms of asthma the worst?
at night or early morning
Asthma shows prolonged _____ and diffuse _____ on exam.
expiration
wheezes
T/F Asthma shows limitation of airflow on pulmonary function testing.
true
Is there reversibility of airflow obstruction?
yes
Asthma may show _____ muscle use, probable diffuse _____, diffuse ______ wheezes, and chest exam _____ b/t attacks.
accessory
hyperresonance
expiratory
normal
For asthma, mild airflow obstruction may be elicited by hearing wheezes on forced _____.
expiration
A CXR for asthma is usually normal but may show _____ during attacks.
hyperinflation
CBC for asthma usually has normal WBC or slightly _____; diff may show ______.
incresed
eosinophilia
What does eosinophilia indicate?
allergic reaction
What are 4 things that may show up in asthma sputum?
eosinophilia
Charcot-Leyden crystals
Curschman spirals
Creola bodies
The arterial blood gas initially has a _____ pO2 and respiratory _____. Late or ominous signs O2 sat of less than ___, increasing P___ and respiratory _____.
lowered
alkalosis
90
CO2
acidosis
With asthma, PFT shows vital capacity _____, PEFR _____, and FEV is _____.
decreased
decreased
diminished
T/F For peak expiratory flow meter, normal readings have been calibrated for height and weight for various ages to obtain a baseline.
true
A change in more than ___% for peak expiratory flow meter indicates a problem.
20%
Peak expiratory flow should increase or decrease with age?
increase
Are upper airway disorders usually inspiratory or expiratory?
inspiratory
Are lower airway disorders usually inspiratory or expiratory?
expiratory
What are 3 types of upper airway disorders that are part of the differential diagnosis for asthma?
vocal cord paralysis
foreign body aspiration
laryngotracheal mass
What are 3 types of lower airway disorders that are part of the differential diagnosis for asthma?
COPD
cystic fibrosis
bronchiectasis
What are 7 differential diagnoses for asthma?
vocal cord paralysis
foreign body aspiration
laryngotracheal mass
COPD
cystic fibrosis
bronchiectasis
congestive heart failure
GERD
What are the 4 asthma classifications/categories?
mild intermittent
mild persistent
moderate persistent
severe persistent
Which asthma category has daytime symptoms less than twice a week?
mild intermittent
Which asthma category has night-time symptoms less than 2 times a month?
mild intermittent
T/F Mild intermittent asthma shows normal pulmonary function and minimal variabilty in peak expiratory flows.
true
How should mild intermittent asthma be treated?
beta-2 agonists (albuterol) as needed with spacer
Which asthma category has day time symptoms more that 2 times per week but not daily?
mild persistent
Which asthma category has has night time symptoms more than 2 times monthly?
mild persistent
Which 2 categories of asthma are more likely to cause death due to under diagnosis?
mild intermittent
mild persistent
T/F Mild persistent asthma may show variabilty in PFT/PEF but may be normal.
true
Does mild persistent asthma generally affect activity level?
yes
How should mild persistent asthma be treated?
albuterol for rescue and low dose inhaled corticosteroids (Flovent)
Which asthma category has daily day time symptoms?
moderate persistent
Which asthma category has night time symptoms more than once per week?
moderate persistent
Moderate persistent asthma shows FEV greater than ___% but less than ___% of predicted. PEF variability greater than ___%.
60%
80%
30%
T/F Exacerbations of moderate persistent asthma affect activity and can last for days.
true
What type of treatment should be used for moderate persistent asthma?
long acting albuterol (scheduled)
low-medium does inhaled corticosteroids (Advair)
Which asthma category has continual day time symptoms with several exacerbations daily?
severe persistent
Which asthma category has frequent night-time symptoms?
severe persistent
Severe persistent asthma shows FEV less than ___% of perdicted; PEF variablity greater than ___%.
60%
30%
For severe persistent asthma, _____ steroids should be given if needed; not to exceed ___mg/day and they should be tapered/reduced/stopped as soon as possible.
oral
60
Review therapy for asthma should be done about every ___ months to see if step down or up is needed.
2
PFT should be done at least _____ per year and peak flows ____ times per week recording the results.
once

1-2
What are the 5 main goals of treatment for asthma patients?
minimal day/night symptoms
min. exacerbations
no physical activity limits
less than 1 MDI/month
no hospital
COPD has slowly _____ airway obstruction, usually associated with _____.
progressive

smoking
Is COPD reversible?
no
What are the varying degrees of 3 pathological processes for COPD?
chronic bronchitis
small airways obstruction
emphysema
About how many Americans have COPD and how many are diagnosed?
28 million

only about half are diagnosed
Together with asthma, COPD is the ___th most common cause of death in the US.
4th
T/F The death rate for COPD is increasing rapidly, especially among elderly men.
true
COPD usually develops after smoking for at least ___ pack years.
20
What type of condition has chronic cough and sputum production for at least 3 months/year for at least 2 consecutive years?
chronic bronchitis
What affects at least 1/3 of smokers ages 35-59 years?
chronic bronchitis
What is caused by hypertrophy and hyperplasia of mucus secreting glands?
chronic bronchitis
Chronic bronchitis has a clinical diagnosis of presence of chronic ____ and ____ production for at least ___ months/year for at least ____ consecutive years.
cough
sputum
3
2
What is associated with increased tendency to develop repeated episodes of acute bronchitis?
chronic bronchitis
What type of disease has increased resistance to airflow in bronchioles in smokers due to narrowed lumen?
peripheral airway disease
T/F Mechanisms of changes with peripheral airway disease are unknown.
true
What are 3 things that occur with peripheral airway disease?
increased bronchiolar smooth muscle (hypertrophy)

inflammation

fibrosis (scarring)
What condition has enlargement of the air spaces distal to the conduction airways due to destruction of the bronchioles and alveoli?
emphysema
What are 2 important types of emphysema?
centrilobular
panacinar
Emphysema shows enlargement of the airspaces distal to the conducting airways due to destruction of the _____ and _____.
bronchioles
alveoli
Which type of emphysema involves primarily the bronchioles often with normal distal alveoli?
centrilobular
Which type of emphysema is almost exclusively in smokers?
centrilobular
Which type of emphysema tends to occur in the upper lung lobes?
centrilobular
Which type of emphysema involves the entire distal lung unit?
panacinar
Which type of emphysema can occur throughout the lung, but chiefly the lower lobes?
panacinar
Which type of emphysema can be associated with alpha-1 antitrypsin deficiency?
panacinar
What is alpha-1 antitrypsin deficiency?
unable to inactivate elastase --> tissue damage in the lungs
Does the parasympathetic system in a normal lung cause constriction or dilation?
constriction
What are 6 types of pulmonary infections?
acute bronchitis
bacterial pneumonia
pulmonary tuberculosis
opportunistic infections (HIV)
bronchiolitis (RSV)
croup
What are 4 signs/symptoms of COPD?
cough
sputum
dyspnea
frequent exacerbations
T/F COPD shows reduction in FEV and FVC.
true
With COPD, FEV may improve with _____ use, but not return to normal as in _____.
bronchodilator

asthma
With COPD, what is hyperinflation of the lungs due to?
loss of recoil and limitation of expiratory flow
COPD has reduced diffusing capacity for _____.
CO2
In severe COPD, there is arterial _____ with or without _____ retention.
hypoxemia

CO2
Is dyspnea in COPD progressive?
yes
Degree of _____ in COPD patients generally correlates with the _____ for the patient, but different patients may experience different degress of _____ with similar degress of _____.
dyspnea
FEV
dyspnea
obstruction
With COPD, dyspnea typically does not occur until the FEV is reuduced to about ___% of normal and by this time the disease has likely been present for decades.
50%
With COPD, often there is a history of _____ _____ antedating the dyspnea.
chronic bronchitis
T/F Wheezing is not common in COPD.
false Wheezing is common in COPD.
What are 4 symptoms with COPD exacerbation?
increased dyspnea
wheezing
cough
sputum production
COPD exacerbation may show a change in sputum color, possibly _____-_____.
blood-streaked
COPD is usually in the summer or winter and is associated with what?
winter

URI
What is the most common cause of hospitalization for COPD patients?
COPD exacerbation
What type of COPD is known as "blue bloater"?
bronchitis
What type of COPD is known as "pink puffer"?
emphysema
What is the appearance, age, degree of dysnpea, amount of sputum with cough, description of airway resistance, elastic recoil, and chest x-ray for bronchitis?
"blue bloater"
40-45
mild
copious sputum
increased
normal
prominent vessels, large heart
What is the appearance, age, degree of dyspnea, amount of sputum with cough, description of airway resistance, elastic recoil, and chest x-ray for emphysema?
"pink puffer"
50-75
severe
scant sputum
normal/slightly increased
low
hyperinflation, small heart
T/F Physical exam usually normal for mild to moderate COPD.
true
What are 6 signs of COPD?
tachypnea
barrel chest
faint heart sounds
accessory muscle use
diminished breath sounds
wheezes/crackles
What is the gold standard of diagnosis for COPD?
spirometry
For COPD, FEV/FVC < ___ is hallmark.
0.70
Are chest x-rays for COPD sensitive?
yes
What type of test is valuable for assessing type of emphysema?
chest CT
What are 5 differential diagnoses for COPD?
asthma
cystic fibrosis
bronchiectasis
eosinophilic granuloma
bronchiolitis obliterans
For clinical evaluation of COPD, full pulmonary function testing should be followed by at least annual _____.
spirometry
For clinical evaluation of COPD, ____ if FEV is less than 40% of predicted.
ABGs
For clinical evaluation of COPD, what 3 things should be monitored?
degree of dyspnea
weight
# of exacerbations
What is the #1 treatment plan for COPD?
smoking cessastion
What should be used for symptomatic relief of stable COPD?
inhaled bronchodilators (Ipratropium bromide)

short-acting beta-agonists

longer acting salmeterol/formoterol
What is the 3rd line of treatment for stable COPD?
oral Theophylline
What is Theophylline less effective than for stable COPD?
inhaled bronchodilators
What treatment plan is still controversial for stable COPD, but it may reduce frequency of exacerbations?
inhaled steroids
What treatment plan for stable COPD improves exercise tolerance and quality of life?
pulmonary rehabilitation
What should be used as treatment of stable COPD for hypoxemic patients and what does it do?
home O2

prolongs life
What are the 2 types of surgeries that can be done for stable COPD?
lung transplant :(
lung volume reduction
What are the 9 treatment plans for stable COPD?
smoking cessation
inhaled bronchodilators
Theophylline (oral)
inhaled steroids
pulmonary rehabilitation
home O2
surgery
influenza vaccine
pneumococcal vaccine
What are 3 treatment plans for a COPD exacerbation?
inc. bronchodilator therapy
antibiotic therapy
oral steroids (severe)
Why should antibiotic therapy be done for a COPD exacerbation?
for increased sputum or change in sputum color
What should be given to low risk patients as antibiotic therapy for a COPD exacerbation?
amoxicillin or TMP-SMX (septra)
What should be given to high risk patients as antibiotic therapy for a COPD exacerbation?
Zithromax z-pack
Levaquin
For severe COPD exacerbation, hosptialization with _____ therapy should be given and ___ should be monitored.
oxygen

ABGs
What 3 things must be ruled out with severe COPD exacerbation?
pneumonia
pneumothorax
PE
For a severe COPD exacerbation, it may be difficult to distinguish from acute _____ _____, _____ or _____ levels may be helpful.
heart failure

echocardiogram

BNP
The disease course for COPD can be quite _____, but is always _____.
variable
progressive
What are the 5 most important predictors for COPD?
age
severity of obstruction (FEV)
weight loss
poor quality of life
exacerbations needing hospitalizations (ICU?)
What is any form of emphysema that produces large subpleural blebs/bullae (more than 1cm)?
bullous emphysema
Bullous emphysema is most often near the _____.
apices
Bullous emphysema can be in relation to old _____ scarring.
TB
With bullous emphysema, rupture to bullae may cause significant _____.
pneumothorax
What is a type of diffuse parenchymal lung disease?
interstitial lung disease
Which type of lung disease is a common response to injury?
interstitial lung disease
What are the 2 injuries that are common responses of interstitial lung disease?
alveolitis and fibrosis of the interalveolar septum
Is interstitial lung disease truly interstitial?
no
What does interstitial lung disease begin with?
injury to capillary and epithelial cells
What does interstitial lung disease lead to?
reorganization of the lung parenchyma along with irreversible fibrosis
What type of lung disease leads to reorganization of the lung parenchyma along with irreversible fibrosis?
interstitial lung disease
What type of lung disease begins with injury to capillary and epithelial cells?
interstitial lung disease
At least ___ disease entities can present as ILD.
180
What are 5 disease entities of ILD?
drug-related
environmental exposures
infections
primary pulmonary disorders
systemic disorders
Which type of lung condition has diminished lung compliance which presents as restrictive lung disease?
interstitial lung disease
Which type of lung condition has insidious onset of dyspnea on exertion and cough, minimal sputum, and fine late inspiratory crackles?
interstitial lung disease
What are 6 signs/symptoms of interstitial lung disease?
dyspnea
cough
inspiratory crackles
clubbing (25-50%)
bilateral rales
Clubbing is seen in ___ to ___% of patients with interstitial lung disease.
25-50%
What type of rales is seen in most patients with interstitial lung disease?
bilateral basilar Velcro-like rales
What do pulmonary function tests for interstitial lung disease show?
loss of lung volume with normal or increased air flow rates
Interstitial lung disease shows _____ diffusing capacity for CO, _____ with exertion, chest x-ray with patchy ground-glass infiltrates or _____.
decreased

hypoxemia

honeycombing
What is the gold standard to diagnose Idiopathic Pulmonary Fibrosis?
surgical lung biopsy (open or thoracoscopic)
What is a surgical lung biopsy (open or thoracoscopic) the gold standard for?
Idiopathic Pulmonary Fibrosis
What 2 conditions should a transbronchial biopsy be used for?
sarcoidosis
miliary TB
Which type of diagnostic technique may provide a specific diagnosis in cases of infection?
bronchoalveolar lavage
A high resolution ___ shows greater detail than a chest x-ray.
CT (HRCT)
What is Idiopathic Pulmonary Fibrosis also known as?
Idiopathic Fibrosing Interstitial Pneumonia
What is the most common diagnosis among ILD?
Idiopathic Pulmonary Fibrosis
What is the age group most commonly affected by Idiopathic Pulmonary Fibrosis?
55-60 years
Are males or females slightly greater with Idiopathic Pulmonary Fibrosis?
males
With Idiopathic Pulmonary Fibrosis, ANA and RF are positive in ___% with no documented collagen-vascular disease.
25%
What is the treatment for Idiopathic Pulmonary Fibrosis?
supportive care
(controversial)
What is the median survival for Idiopathic Pulmonary Fibrosis?
3 years
What type of medication may help with Idiopathic Pulmonary Fibrosis, but is not recommended?
oral corticosteroids, prednisone
What is the area of intense research for Idiopathic Pulmonary Fibrosis?
anti-fibrotic therapy
What type of treatment can be done for end-stage ILD?
lung transplant
What is the name of a systemic disease of unknown cause?
sarcoidosis
90% of patients with sarcoidosis have _____ inflammation of the lung.
granulomatous
The highest incidence of sarcoidosis is among North American ____ and northern _____ whites.
blacks

European
Is men or women more likely to have sarcoidosis?
women
What is the peak age group of incidence for sarcoidosis?
20's or 30's
What are 3 symptoms that sarcoidosis patients may present with?
malaise
fever
dyspnea of insidious onset
What type of adventitous lung sounds are uncommon for sarcoidosis?
crackles
What are 5 other manifestations of sarcoidosis?
erythema nodosum
uveitis
parotid gland enlargement
lymphadenopathy
hepatosplenomegaly
What are 5 laboratory findings with sarcoidosis?
leukopenia
elevated sed rate
hypercalcemia
hypercalciuria
elevated ACE levels in 40-80%
What type of condition shows laboratory findings of leukopenia, elevated sed rate, hypercalcemia, hypercalciuria, and elevated ACE levels in 40-80%?
sarcoidosis
Radiographic findings of sarcoidosis show bilateral _____ adenopathy, diffuse reticular _____, and _____ _____ in less than 10% of patients.
hilar
infiltrates
pleural effusion
Is hilar adenopathy or infiltrates a better determining factor for sarcoidosis?
hilar adenopathy
What signifies a worse prognosis with sarcoidosis?
lung parenchyma
Sarcoidosis diagnosis generally requires histologic demonstration of noncaseating _____ in _____ from patient with typical symptoms/findings.
granulomas
biopsies
T/F Sarcoidosis can be treated quickly.
false Sarcoidosis has to be treated for a long time.
For sarcoidosis, what 3 things are oral corticosteroids used for?
symptomatic pulmonary lesions
constitututional symptoms
hypercalcemia
For sarcoidosis, serum ____ levels usually fall with clinical improvement.
ACE
With sarcoidosis, about ___% of patients with lung involvement have irreversible impairment.
20%
About what percentage of patients with sarcoidosis die from pulmonary insufficiency?
5%
How many deaths/year does rheumatic disease account for?
1600
Do more men or women have rheumatoid arthritis associated with ILD?
men
What is the most common ages of rheumatoid arthritis associated with ILD?
ages 50-60
Does rheumatoid arthritis associated with ILD show bradypnea or tachypnea?
tachypnea
Does rheumatoid arthritis associated with ILD have a late onset?
yes
Rheumatoid arthritis associated with ILD has ___-like bibasilar rales.
velcro
Rheumatoid arthritis associated with ILD shows clubbing in ___% of cases.
75%
Rheumatoid arthritis associated with ILD shows pleural disease/rub in ___% of cases.
20%
What does a lung biopsy of rheumatoid arthritis associated with ILD reveal?
prominent lymphocytic infiltrate
What type of nodules may be present with rheumatoid arthritis associated with ILD?
rheumatoid nodules
What are 2 things that can induce ILD?
gold salts
methotrexate
What is the treatment plan for rheumatoid arthritis associated with ILD?
oral corticosteroids with/without immunosuppressive agents
What are 4 types of chronic infiltrate lung diseases?
idiopathic pulmonary fibrosis
sarcoidosis
rheumatoid arthritis
hypersensitivity pneumonitis
What is acute lupus pneumonitis?
systemic lupus erythematosus (SLE)
What are 6 signs/symptoms of SLE?
tachypnea
tachycardia
dyspnea
cough
cyanosis
fever common
What type of disease is systemic lupus erythematosus?
rheumatic disease
Rheumatic disease is the cause of death in ___% of SLE patients.
2.5%
What does SLE present like?
pneumonia
What is the treatment for SLE?
high dose oral corticosteroids with azathioprine for refractory cases
What are 2 types of rheumatoid arthritis diseses associated with ILD?
systemic lupus erythematosus
systemic sclerosis
ILD is the most common pulmonary manifestation of _____.
scleroderma
What are 3 signs/symptoms of systemic sclerosis?
dyspnea
cough
pulmonary hypertension
For systemic sclerosis, pulmonary symptoms may occur as many as ___ years before ____ changes.
14

cutaneous
T/F There is no consistently effective treatment for systemic sclerosis.
true
What is hypersensitivity pneumonitis also known as?
extrinsic allergic alveolitis
What is the name of a nonasthmatic allergic pulmonary disease?
hypersensitivity pneumonitis
What is mainly an occupational disease?
hypersensitivity pneumonitis
What are 6 signs/symptoms of acute hypersensitivity pneumonitis?
malaise
chills
fever
cough
dyspnea
nausea 4-8 hours after exposure
What type of condition shows interstitial infiltrates of lymphocytes and plasma cells with noncaseating granulomas?
hypersensitivity pneumonitis
What type of chronic infiltrative lung disease can become chronic after repeated exposure?
hypersensitivity pneumonitis
What is the treatment plan for hypersensitivity pneumonitis?
identify offending agent
avoidance of exposure
oral corticosteroids (acute)
What are the 3 most common occupational lung diseases?
asbestosis
coal workers' pneumoconiosis
silicosis
Which type of occupational lung disease is a chronic fibrotic lung disease caused by the inhalation of coal dust and other inert dust?
pneumoconioses
What are 3 types of pneumoconioses?
asbestosis
coal workers' pneumoconiosis
silicosis
What are 3 types of restrictive lung diseases?
asbestosis
coal worker's pneumoconiosis
silicosis
Which type of diseases may be asymptomatic with diffuse nodular infiltrates on CXR?
pneumoconioses
What type of condition occurs when inhaled coal dust is ingested by alveolar macrophages to form coal macules?
coal worker's pneumoconiosis
What is the size of the coal macules with coal worker's pneumoconiosis?
2-5mm
What appears as diffuse small opacities on CXR especially in upper lobes?
coal macules of coal worker's pneumoconiosis
With coal worker's pneumoconiosis, where are coal macules that appear as diffuse small opacities on CXR usually seen?
upper lobes
T/F Coal worker's pneumoconiosis is usually symptomatic.
false Coal worker's pneumoconiosis is usually asymptomatic.
For coal worker's pneumoconiosis, _____ ______ does not increase prevalence, but can have _____ effect.
cigarette smoking
additive
What is "Progressive massive fibrosis"?
coal worker's pneumoconiosis
With "Progressive massive fibrosis" the upper lobes may _____ and it appears on x-ray like complicated _____.
contract
silicosis
What type of syndrome can coal worker's pneumoconiosis have?
Caplan's syndrome
What is a rare condition in patients with RA and coal workers?
Caplan's syndrome
Caplan's syndrome shows necrobiotic rheumatoid _____ in the _____ of the lung.
nodules
periphery
What condition has extensive or prolonged inhalation of free silica particles?
silicosis
What are 6 jobs that may cause silicosis?
rock mining
quarrying
stone cutting
tunneling
sandblasting
pottery
What condition can also see calcification of the periphery of hilar lymph nodes?
silicosis
What does "eggshell" calcification deal with?
silicosis
What type of calcification is seen in the periphery of hilar lymph nodes?
"eggshell" calcification
Is simple silicosis usually asymptomatic or symptomatic?
asymptomatic
In complicated silicosis, there is _____ and _____ and _____ dysfunction.
dyspnea
obstructive
restrictive
There is increased pulmonary ____ in patients with silicoses. If positive PPD, the patient should have _____ prophylaxis.
TB
multidrug
What is the treatment plan for silicosis?
suppotive care
Are the opacities on CXR very dense for silicosis?
no
What condition has nodular interstitial fibrosis as a consequence of exposure to asbestos dust?
asbestosis
For asbestosis, the patients must have documented exposure of evidence of excessive _____ fibers in the lung _____ to diagnose.
asbestos
tissue
What are 4 signs/symptoms of asbestosis?
progressive dyspnea
inspiratory crackles
clubbing
cyanosis
Are the upper or lower lungs more affected by asbestosis?
lower lungs
What 3 things show on CXR of asbestosis?
interstitial fibrosis
thickened pleura
calcified plaques
What increased prevalence of asbestosis in asbestos workers?
smoking
What markedly increases incidence of lung cancer with asbestosis?
smoking
For asbestosis, pulmonary function studies showed _____ dysfunction and _____ diffusing capacity.
restrictive
reduced
What is the treatment for asbestosis?
no specific treatment
What are the 4 types of complications associated with thermal injury of the lungs?
immediate reaction
CO and cyanide poisoning
ARDS
late-onset pulmonary complications
What are 3 late-onset pulmonary complications of thermal injuries?
pneumonia
atelectasis
thromboembolism
What is the major complication of thermal injuries?
infection
Smoke inhalation rarely causes ____ injury to the lung parenchyma.
thermal
What are the initial 7 signs/symptoms of thermal injuries?
tachypnea
cough
dyspnea
wheezing
cyanosis
hoarseness
stridor
What are the 2 exceptions of thermal injuries in an enclosed space?
steam burns
explosions
What are the 2 immediate life-threatening complications with thermal injuries?
upper airway obstruction
CO poisoning
What can help treat edema of upper airways, but can increase risk of infection for thermal injuries?
corticosteroids
For thermal injuries, corticosteroids can help treat _____ of ____ airways, but can _____ risk of _____. Hence the risks versus the benefits need to weighed.
edema
upper
increase
infection
What are 3 ways to get CO poisoning?
smoke inhalation
automobile exhaust
faulty furnace
What is the leading cause of accidental poisoning in the US?
CO Poisoning
What type of condition causes tissue hypoxia from displacement of oxygen from the hemoglobin?
CO Poisoning
The affinity for CO is ____ time greater than oxygen.
200
Why do tissues become hypoxic with CO Poisoning?
CO blocking O2 to bind to hemoglobin
CO Poisoning shifts affintiy for ___ so that the hemoglobin does not release ___ in the tissue leading to _____.
oxygen
oxygen
hypoxemia
What type of antibiotics do not prevent pneumonia with thermal injuries?
prophylactic antibiotics
When does CO Poisoning appear?
when carboxyhemoglobin level reaches 10%
Can smokers tolerate higher or lower levels of CO Poisoning?
higher
What are 5 symptoms of CO Poisoning?
headache
nausea
vomitting
confusion
visual disturbances
What are 3 things that severe CO poisoning can cause?
seizures
coma
death
What are the 2 "classic findings" of CO Poisoning which are actually rare?
cherry red lips & nail beds
With CO Poisoning, about ___% of patients suffer a delayed neurologic syndrome 2-30 days after initial poisoning; _____ to resolve.
10%

slow
What are 2 things that CO Poisoning diagnosis is based on?
history of exposure
elevated HbCO level
_____ level does not correlate with the severity of the illess from CO Poisoning.
HbCO
What are 3 treatment plans for CO Poisoning?
remove from CO enviornment
breathe 100% oxygen
hyperbaric chamber
What are the 2 reasons that a hyperbaric chamber should be used for CO Poisoning?
neurologic impairment
HbCO levels of 20-25%
What is hyperbaric therapy effective for?
averting neurologic injury
What are 3 unproven therapies for CO Poisoning?
steroids
mannitol
hypothermia
For CO Poisoning, prognosis in mild poisoning is _____, prognosis in severe poisoning is _____.
good
variable
For CO Poisoning, delayed neurologic syndrome usually improves gradually over ___ to ___ months.
6-12
What are 2 common conditions fo toxic inhaled gases?
bronchiolitis
pulmonary edema
What are 6 highly irritating gases that can cause acute chemical pneumonitis?
chlorine
ammonia
sulfur dioxide
ozone
nitrogen dioxide
phosgene
For toxic inhaled gases, less irritating gases cause _____ injury and more irritation injury cause _____ injury to _____ airways.
diffuse
immediate
upper
Are there typically symptoms during toxic inhaled gas exposure?
no
Toxic inhaled gas syndrome can have a cough lasting up to ___ hours, then can develop _____, myalgias, _____, and progressive _____.
48
fever
dyspnea
hypoxemia
What does the x-ray for toxic inhaled gases show?
pulmonary edema
Symptoms for the typical syndrome of toxic inhaled gases generally resolve and may return in 2-5 _____.
weeks
What are 4 treatment plans for toxic inhaled gases?
remove from environment
bronchodilators
supplemental oxygen
prednisone?
What type of disease involving toxic inhaled gases should prednisone be given?
acute silo-filler's disease
Oxygen toxicity is usually seen in _____ patients on ventilators.
ICU
T/F Oxygen is toxic in high concentrations for prolonged periods.
true
What 3 things happen to the lungs with oxygen toxicity?
atelectasis
congestion
edematous
What 2 things can happen with advanced oxygen toxicity injury?
destruction of alveoli
death
The earliest symptoms of oxygen toxicity are acute ______ with ___, hacking _____ and _____ pain.
tracheobronchitis
dry
cough
substernal
What is the only proven treatment of oxygen toxicity?
prevention
Are corticosteroids beneficial for oxygen toxicity?
no
If patient survives oxygen toxicity, there is _____ damage to lung _____.
residual
parenchyma
Radiation lung injury is related to _____ of _____ exposure.
degree
radiation
Total dose of less that ___ rads is not associated with radiation lung injury.
2000
Total dose greater than ___ cGy is ___% associated with radiation pneumonitis.
4000
100%
What are the 3 phases of radiation lung injury?
acute phase
subacute phase
fibrotic phase
When does the acute phase of radiation lung injury occur and what are 4 signs?
1-2 months after exposure

vascular damage
congestion
edema
mononuclear cell infiltration
When does the subacute phase of radiation lung injury occur and what is a sign?
2-9 months later

infiltration of alveolar walls
When does the fibrotic phase of radiation lung injury occur and what are 2 signs?
more than 9 months later

alveolar fibrosis
capillary sclerosis
What are 5 signs/symptoms of radiation lung injury?
cough
dyspnea
tachypnea
fever
lung fibrosis
What does x-ray show for radiation lung injury?
ground glass opacities in area that was irradiated
What type of injury has complication of small pleural effusions and spontaneous pneumothorax?
radiation lung injury
What are 2 complications of radiation lung injury?
small pleural effusions
spontaneous pneumothorax
What is the main treatment for radiation lung injury?
supportive care
What are 3 treatment plans for radiation lung injury other than supportive?
oxygen
cough suppression
coricosteroids (severe)
What is one condition that will never change or that cannot be helped with treatment from radiation lung injury?
fibrosis
Which lung does aspiration pneumonitis most commonly occur?
right
What is an injury from aspirating acid gastric contents?
aspiration pneumonitis
What are the 4 main factors that determine the extent of the aspiration pneumonitis injury?
pH of aspirate
presence of food particles
volume of aspirate
distribution of aspirate
What 3 things does aspiration pneumonitis cause chemical burns of?
bronchi
bronchioles
alveolar walls
Does lung compliance increase or decrease with aspiration pneumonitis?
decrease
Is hypoxemia usually severe with aspiration pneumonitis?
yes
What are 3 signs/symptoms of aspiration pneumonitis?
dyspnea
cough
frothy sputum
What condition does aspiration pneumonitis resemble?
near drowning
With aspiration pneumonitis, _____ is present in first 36 hours in ____ of patients.
fever
half
For aspiration pneumonitis, abnormalities on chest x-rays are _____.
variable
T/F A high index of suspicion is needed for aspiration pneumonitis.
true
What are 6 treatment plans for aspiration pneumonitis?
#1 establish airway
suction
supplemental oxygen
PEEP (severe)
elevating head of bed
NG tube
Why should PEEP be used in severe cases of aspiration pneumonitis?
to improve arterial oxygen tension
What is the mortality rate for aspiration pneumonitis?
30-50%
What are 5 things that a high mortality rate for aspiration pneumonitis is associated with?
age > 50 years
early shock development
severe/prolonged hypoxemia
low pH of aspirate
secondary bacterial pneumonia
What condition is from direct toxic effects of volatile hydrocarbons on the lung's epithelium?
hydrocarbon pneumonitis
Is hydrocarbon pneumonitis common in adults?
no
What are 4 things that hydrocarbon pneumonitis may cause?
hemorrhage
pulmonary edema
atelectasis
necrosis
Hydrocarbon pneumonitis also has _____ toxicity.
systemic
What are 8 clinical manifestations of hydrocarbon pneumonitis?
dyspnea
tachypnea
tachycardia
high fever
lethargy
coma
seizures
rales/rhonchi/normal?
What may show up on CXR of hydrocarbon pneumonitis?
fluffy infiltrates
What is the diagnosis of hydrocarbon pneumonitis suggested by?
odor of patient's breath
What is contraindicated for hydrocarbon pneumonitis?
emesis/vomiting
For hydrocarbon pneumonitis, death occurs in ___% of children, but most have prompt clinical recovery.
10%
What are the 5 treatment plans for hydrocarbon pneumonitis?
no emesis
ET tube before gastric lavage
supplemental oxygen
mechanical ventilation?
corticosteroids (anecdotal)
What is a chronic imflammatory reaction to aspiration of vegetable, animal, or mineral oils?
lipoid pneumonia
What is the most common chronic inflammatory reaction in lipoid pneumonia?
mineral oils
What is mineral oil most frequently used as?
laxative
What does mineral oil impede?
ciliary action
Mineral oils cannot be _____ by the body.
hydrolyzed
What causes thickening of the alveolar septum leading to fibrosis?
lipoid pneumonia
With lipoid pneumonia, most patients are _____ and only have _____ CXR.
asymptomatic
abnormal
What are 8 symptoms that may be included with lipoid pneumonia?
cough
exertional dyspnea
hemoptysis
fever
night sweats
tachypnea
dull percussion
some rales/rhonchi
What is the key to diagnosis for lipoid pneumonia?
history
What are the 2 keys to diagnosis in history for lipoid pneumonia?
chronic ingestion of mineral oil

occupational exposure to oil mists
Later in lipoid pneumonia, linear and nodular _____ may appear.
infiltrates
CXR of lipoid pneumonia shows air space _____ in dependent areas of the lungs.
infiltrates
With lipoid pneumonia, _____ lavage may show lipid-laden macrophages.
bronchoaveolar
What are the 3 treatment plans for lipoid pneumonia?
stop exposure
cough exercises
corticosteroids (severe)
Why should cough exercises be done for treatment of lipoid pneumonia?
to expectorate oil several times daily for months
For lipoid pneumonia, what should use of corticosteroids be limited to?
severe cases and short-term
What is one of the 3rd leading causes of death in children and young adults?
submersion incidents
What are the 2 types of drowning?
wet
dry
Which type of drowning has a laryngospasm followed by relaxation with ingestion of copious amounts of water?
wet drowning
Which type of drowning has asphyxiation secondary to intense glottic spasm?
dry drowing
What percentage of cases is from dry drowning?
10-20%
What is the immediate cause of death in submersion incidents?
cardiac arrhythmia
Victims who survive submersion incidents often develop ____.
ARDS
What 2 things does submersion lead to?
asphyxia
severe hypoxemia
What can the initial appearance of submersion incidents range from?
coma to agitation
What are 4 things that are common in submersion incidents?
cyanosis
coughing
frothy pink sputum
rales/rhonchi
Why are rales/rhonchi present after submersion incidents?
due to fluid in the lungs
What occasionally occurs with submersion incidents tha causes you to bleed from places you don't usually bleed?
DIC
T/F The CXR for submersion incidents may initially be normal.
true
CXR for submersion incidents later shows _____ infiltrates or _____ edema.
patchy
pulmonary
What are the 4 treatment plans for submersion incidents?
establish airway
CPR
high concentration of O2
hospitalized (observation)
With submersion incidents, what is PEEP helpful for?
hypoxemia
What is the outcome of submerison incidents best related to?
neurologic status
coma?
With submersion incidents, survival without neurologic damage is best in children who are _____ when recovered.
hypothermic
Hyperventilation appears at ___ to ___ feet.
8,000 to 10,000
Above 10,000 feet patients may develop impaired _____, judgement and ability to perform _____ calculations.
memory
complex
What are symptoms of high-altitude disease due to?
shift in oxygen-hemoglobin dissociation curve
What are the 3 types of high-altitude diseases?
acute mountain sickness
high altitude pulmonary edema
high altitude cerebreal edema
Where does exposure to high altitude diseases most commonly occur?
airline travel
What are the 5 self-limited symtoms of acute mountain sickness?
headache
anorexia
malaise
distrubed sleep
dyspnea
When do symptoms of acute mountain sickness get worse?
with exercise
What is a potentially fatal complication of rapid ascent?
high altitude pulmonary edema
High altitude pulmonary edema is non-_____ and symptoms begin after __ to ___ hours.
cardiogenic

6-36 hours
What are 3 signs/symptoms of high altitude pulmonary edema?
dyspnea at rest
tachypnea
crackles
What are 3 signs/symptoms that more severe cases of high altitude pulmonary edema show?
cyanosis
orthopnea
hemoptysis
T/F High altitude cerebral edema is relatively uncommon.
true
With high altitude cerebral edema, hypoxemia lead to cerebral vaso_____ and _____ cerebral blood flow.
dilation

incresed
How can high altitude diseases be prevented?
slow ascending
What medication is effective to prevent acute mountain sickness?
acetazolamide
What is the 2 definitive treatments of high altitude diseases?
oxygen
descent
With high altitude diseases, if cannot descend, the ____ and placing in _____ chamber is effective.
PEEP

pressurized
What are 3 managements that AMS is conservative with?
rest
mild analgesics
hydration
What type of treatment can be used to prevent high altitude pulmonary edema in susceptible patients?
prophylactic inhaled salmeterol
What is caused by rapid ascent to a high altitude or from underwater to the surface?
decompression illess
What type of illness does not give inert gases (nitrogen) enough time to decompress?
decompression illness
What is one type of inert gas?
nitrogen
What type of illness causes bubbles of inert gas to form within the tissues?
decompression illness
What type of illness is most commonly seen in divers using compressed air?
decompression illness
For decompression illness, the symptoms appear within _____ to ___ hours after end of dive.
minutes
24
What are 5 signs/symptoms of mild decompression illness?
pruritus
mottling of skin
pain (bends)
numbness
edema
What are 11 signs/symptoms of serious decompression illness?
loss of consciousness
ataxia
vertigo
nystagmus
back pain
paraparesis
bladder/bowel dysfunction
cough
substernal pain
asphyxia (chokes)
extreme fatigue
What are 2 treatment plans for decompression illness?
supplemental oxygen

hyperbaric chamber recompression
If treatment of decompression illness is delayed, the illness is more _____.
refractory
With decompression illness, there is complete recovery in more than ___% with prompt treatment.
95%
Pulmonary _____ and arterial gas embolism may occur in compressed air divers when ascending, especially if they do not exhale normally.
barotrauma
What 2 conditions may occur in compressed air divers when ascending, especially if they do not exhale normally?
pulmonary barotrauma
arterial gas embolism
What may occur in blast injury to the thorax or explosive decompress at high altitude?
pulmonary barotrauma
With pulmonary barotrauma, if _____ cannot escape, the pressure exceeds lung _____.
gas
compliance
What leads to alveolar disruption and interstitial emphysema?
pulmonary barotrauma
What 2 things does pulmonary barotrauma lead to?
alveolar disruption
interstitial emphysema
With pulmonary barotrauma, free gas may enter _____ and _____ arteries --> ___ embolus.
circulation
obstruct
air
T/F Clinical signs/symptoms of pulmonary barotrauma occur within minutes of surfacing.
true
What are 4 things that may be included with acute cerebral dysfunction with pulmonary barotrauma?
severe headache
blindness
loss of consciousness
seizures/paralysis
Pulmonary barotrauma is a true medical _____ and can occur even after _____ dives.
emergency
brief
Without adequate treatment of pulmonary barotrauma, defects can be permanently _____.
disabling
For pulmonary barotrauma, _____ therapy needs to be started within _____.
recompression
minutes
For pulmonary barotrauma, if delayed more than 12-24 hours, _______ will have only _____ benefit.
recompression
minimal
What are 15 types of occupational lung diseases?
asbestosis
coal worker's pneumoconiosis
silicosis
thermal injuries
CO poisoning
toxic inhaled gases
oxygen toxicity
radiation lung injury
aspiration pneumonitis
hydrocarbon pneumonitis
lipoid pneumonia
submersion incidents
high altitude diseases
decompression illness
pulmonary barotrauma
What are 4 causes of upper airway obstruction?
Laryngeal obstruction
Epiglottitis
Croup
Sleep apnea
What are 3 classifications of sleep apnea?
Obstructive sleep apnea
Central sleep apnea
Mixed sleep apnea
What type of process can be done on a person that is choking?
Heimlich maneuver
What are 7 possible causes of acute upper airway obstruction?
Foreign body aspiration
Laryngospasm
Laryngeal edema (burn
Angioedema
Trauma
Infection
Acute allergic laryngitis
What is the initial treatment for epiglottitis?
Hospitalization for IV antibiotics with close observation of the airway
What complication of acute epiglottitis is of most concern?
Complete airway obstruction
A barking cough that is usually worse at night is typical of what disease?
croup
Narrowing of the upper airway, as in an obstruction, causes what typical sound?
stridor
What test is best to evaluate upper airway obstruction?
Laryngoscopy (flexible or indirect)
What is a period of no respiration during sleep, lasts more than 10 seconds?
sleep apnea
What is a 50 – 80% reduction in airflow during sleep?
hypopnea
What is obstructive sleep apnea?
Sleep apnea that occurs when respiratory efforts persist, but there is no airflow at the nose and mouth
What is central sleep apnea?
Sleep apnea that occurs when both airflow and respiratory efforts are absent
What is the overall prevalence of sleep apnea?
2-4%
Is sleep apnea more common in men or in women?
Men by 2:1 to 4:1
What are 4 of the essential features of sleep apnea?
Loud disruptive snoring
Excessive daytime sleepiness
Nocturnal choking/gasping
Impaired concentration
What are 4 chronic diseases that are associated with sleep apnea?
Hypertension
Stroke
Diabetes
Heart disease
What is the definitive test for sleep apnea?
Sleep studies with continuous measurement of breathing and gas exchange
How is the AHI computed?
Total number of episodes of apnea and hypopnea/hours of sleep time
What are 6 other disorders that may cause excessive daytime sleepiness?
Sleep restriction
Narcolepsy
Restless leg syndrome
Drug addiction
Depression
What does CPAP stand for?
(Nasal) Continuous Positive Airway Pressure
What are 2 absolute contraindications to CPAP?
Complete nasal obstruction
Communicating fx of base of skull
What is the most effective therapeutic procedure for obstructive sleep apnea?
tracheostomy
What is the leading cause of cancer death in men and women?
lung cancer
What are 3 diseases associated with increased risk of lung cancer?
pulmonary fibrosis
COPD
sarcoidosis
What are 2 histologic types of lung cancer?
squamous cell
adenocarcinoma
What are 3 common symptoms that are present with from lung cancer patients?
anorexia
weight loss
asthenia
What are 3 syndromes that can occur with lung cancer?
Superior vena cava syndrome
Horner's syndrome
Paraneoplastic syndrome
Which type of syndrome with lung cancer is a medical emergency?
Superior vena cava syndrome
Which type of syndrome with lung cancer has ipsilateral ptosis, miosis and anhidrosis from involvement of the inferior cervical ganglion?
Horner's syndrome
Which type of syndrome with lung cancer is a group of signs and symptoms caused by a blockage of the SVC leading to visible engorgement of the veins above the blockage?
superior vena cava syndrome
Which type of syndrome is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells?
paraneoplastic syndrome
Which type of lung cancer is paraneoplastic syndrome linked to?
small cell lung cancer
What is a condition characterized by excessive release of antidiuretic hormone as a result of small cell lung cancer?
syndrome of inappropriate antidiuretic hormone
What gland normally releases ADH?
posterior pituitary
SIADH results in fluid overload and _____from excess fluid retention caused by the abnormal release of ADH.
hyponatremia
What 2 things can be things for diagnosis of lung cancer?
examination of tissue
cytology specimen
What are the 2 reasons that lung cancer is divided into 2 categories?
staging
treatment
What are the 2 categories of lung cancer?
small cell lung cancer
non-small cell lung cancer
Which type of lung cancer is prone to early hematogenous spread, rarely amenable to surgery, and has a very aggressive course?
SCLC
Which type of lung cancer spreads more slowly, may be cured in early stages with resection, and responds to chemotherapy?
NSCLC
What is the staging system for NSCLC?
TNM
What is the worst stage (T, N, M) of NSCLC?
M --> metastases
Why is SCLC not staged using the TNM system?
micrometastases
What are the 2 categories of SCLC?
limited

extensive
Which type of SCLC is only in unilateral hemithorax?
limited SCLC
Which type of SCLC is extended beyond the hemithorax?
extensive SCLC
Is SCLC staged?
no
Which type of lung cancer is staged?
NSCLC
When is cancer considered "non-curable"?
once it has metastasized
What are the 2 types of treatment plans for NSCLC?
neoadjuvant chemotherapy
adjuvant therapy
What are 3 types of lung surgery?
lobectomy
pneumonectomy
wedge resection
What condition can occur with too much radiation?
radiation pneumonitis
Can SCLC be cut out?
no
With SCLC, if tumor is progressing or there is no response then a _____ in chemotherapy is attempted to get a tumor response.
change