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84 Cards in this Set

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How much of the pulmonary vascular bed must be occluded before reistance or pressure increases?
~50%
What mediators released b/c of platelets adhering results in the systemic phenomenon including bronchconstriction?
histamine, serotonin, prostoglandins
Common symptoms of pulmonary embolism?
SOB, CP, cough, but often ASYMPTOMATIC
Common compensatory feature seen in patients suffering from PE?
hyperventilating, but overall there is not hallmark symptom
What lab value is elevated in the presence of a clot?
D-dimer
How do you find DVT's?
doppler ultrasound
What are two findings on CXR that are highly suggestive of PE?
Westermark's sign (enlarged left hilum, L lung hyperlucent) & Hampton's hump (infarct is opacified region)
Common ABG findings in PE?
resp. alkalosis + hypoxemia
What imaging test is highly sensitive and specific for PE?
Spiral CT
What is the first step if you have any suspicion of DVT or PE?
start on heparin or LMWH
What lab do you use to monitor anticoagulation TX and what range is effective?
INR: 2-3 is effective
What is the minimum length of coumadin therapy post-PE?
3 months
When is it good to use to inferior vena cava filter to prevent future VTEs?
bled on coumadin, or still clotted despite appropriate treatment
Major complication of inferior vena cava filter?
leg swelling
What in-hospital patients are at highest risk of developing DVT/PE?
orthopedic surgery
What is the most common origin of DVTs?
distal calf veins
Virchow's Triad?
hypercoagulability, venous stasis, vessel wall damage
How many people have latent TB?
1/3 of the world
Three types of TB infection?
primary infection, primary progressive, and reactivation infection
Who is likely to get TB?
greater innoculum, less defense
Common pathological finding of TB?
Ghon lesion (focus): organism reaches distal lung parenchyma
When does reactivation normally occur in TB patients?
months, years, decades later
Common pathological finding in healing TB lesions?
fibrosis, scarring, and calcium deposition
Common clinical featues of active TB infection?
weight loss, anorexia, fever, night sweats, cough, sputum, CP, hemoptysis
CXR findings in TB primary progressive versus reactivation?
primary: lower lobe infiltrate, reactivation: upper lobe infiltrate
What TB test is a better diagnostically than mantoux?
Quantiferon gold assay
What is the regimen for treating LTBI?
INH 300 mg daily for 9 mos
What is the genetic defect of CF?
CFTR mutation in >70% of cases (gene codes for transmembrane conductance regulator)
What cells are affected by CF mutations?
epithelial cells
What organs (systems) are affected in CF?
lungs, GI tract (pancrease too), sweat glands, reproductive glands
What is the significance of CF PANCREAS
clinical presentation: Chronic resp. disease, Failure to thrive, Polyps, Alkalosis (metabolic), Neonatal intestinal obstruction, Clubbing of fingers, Rectal prolapse, Electrolyte inc. in sweat, Aspermia, Sputum (stap and pseudomonas)
What is the direct effect of a mutated CF gene?
normal CFTR inhibits Na channel; mutated allows inc. Na absorption (and water) leaving airway surface liquid depletion (thick mucous)
80% of CF pts. eventually become chronically infected w/ what?
Pseudomonas aeruginosa
Excluding pseudomonas, what are 3 common pediatric pathogens in CF pts.?
S. aureus, H. influenza, and burkholderia cepacia
Common neonatal GI problem seen in CF pts.?
meconium ileus
What is a common childhood clinical presentation of CF?
failure to thrive
What lab value is highly suggestive of CF?
>70 meq/L Cl of sweat
in the sweat chloride test, what range is considered positive
60-165 meq/L Cl
What is the primary cause of death in most CF pts?
respiratory failure
Hallmark of chronic bronchitis?
Cough w/ chronic mucous hypersecretion
Hypertrophy of what 2 things in CB?
bronchial mucous glands and smooth muscle
How do you estimate "pack-years" of smoking history?
# packs/day x # years
What lab value is increased in CB?
hematocrit (polycythemia)
What three types of drugs may improve bronchoconstriction associated with CB?
beta-agonists, anti-cholinergics, and methylxanthines (theophylline)
What are common pathogens seen in acute exacerbations of CB?
H. Flu (35-70%), S. pneumo, moraxella catarrhalis, and viral infections (1/3 of pts)
What are the 3 cardinal symptoms of acute CB?
worsening dyspnea, inc. sputum production, inc. sputum purulence (onset > 2 wks suggests worsening condition)
When do you give antibiotics to a CB pt. ?
2/3 cardinal symptoms
Low risk CB treatment drugs?
macrolide, 2nd cephalosporin, doxycycline
High risk CB treatment drugs?
amox-clavulanate, fluoroquinolones
What part of the lungs is effected bronchiectasis and to what extent?
bronchi dilation; may involve only one segment of lung or entire lung DEPENDING ON CAUSE
What are the 2 prerequisites for developing bronchiectasis?
1. infectious insult
2. impariment of drainage, airway obstruction, or defect in host defense
What are 4 causes of DIFFUSE bronchiectasis?
post-Infectious, Immunodeficiecy, Immune-mediated disease, congenital (Infancy) = 4 I's
What is the most common cause of bronchiectasis?
CF
What are 4 findings on CT indicative of bronchiectasis?
peribronchial thickening, dilated bronchioles, tram tracks, ring shadows
What can corticosteroids positively affect in pts. w/ bronchiectasis?
preserve FEV1 by decreasing inflammation
Are mucolytics effective treatment of bronchiectasis?
not enough evidence to support
What is the most common bleeding disorder?
thrombocytopenia
What defines thrombocytopenia (lab value)?
platelet count <100,000
What is the best treatment for drug-induced thrombocytopenic purpura?
discontinue and avoid the offending agent.... duh
What are 5 commonly implicated drugs of drug-induced thrombocytopenic purpura?
heparin, digitalis/digoxin, loop diuretic (furosemide) and H2 blockers
What is an associated feature of antiphospholipid syndrome found on MRI?
an unidentified bright object (UBO)
What are the 2 main components of primary hemostasis?
platelets and vascular endothelium
What is an important question to ask in regards to clinical assessment of bleeding disorders?
Have you had any bleeding problems related to medications before?
What is normal PT?
10-13 seconds
What is the range of normal PTT?
25-40 seconds
Common findings in the history of pts. w/ idiopathic thrombocytopenic purpura?
history of viral URI, IgG antibodies on platelet surface
What is the common treatment for seevre ITP?
prednisone (1-2 mg/kg/d)
What are the 3 components of TTP?
microangiopathic hemolytic anemia (MAHA), thrombocytopenia (<50,000), and fever
What are the 5 components of hemolytic uremic syndrome (HUS)?
TTP + renal failure + hepatic dysfunction
What labs can help you distinguish early TTP from DIC?
early in TTP, PT and PTT are normal, in DIC they would be abnormal
Besides treating the underlying cause, how can one quickly treat TTP?
plasmapheresis (100% life-saving)
Pt. presents w/ large platelets, bleeding time of 20+ minutes, and mucocutaneous hemorrhaging. Diagnosis?
Bernard-Soulier syndrome
Inherited factor VIII deficiency. What disease?
hemophilia A
Inherited factor IX deficiency. What disease?
hemophilia B
Treatment for pt. w/ deficiency of Vit. K-dependent factors and liver disease?
fresh frozen plasma
What is the only (inherited) endothelial syndrome associated w/ hemostatic complications?
hereditary hemorrhagic telangiectasia
What is the pattern of inheritance and defective gene in hereditary hemorrhagic telangiectasia
AD inheritance, defect in endoglin
Chronic treatment for AT-III deficiency?
warfarin for life
Action of Protein C?
inactivates factors V and VIII (dependent on Vit K)
Action of protein S?
cofactor for Protein C
What is the action of vWF?
allows platelets to bind to exposed collagen via glycoprotein receptors
What substances are associated with the anticoagulant properties of intact endothelium?
ADPase, NO, PGI2, heparan sulfate, tPA, and thrombomodulin
What is required to turn a soft clot into a hard clot?
calcium, XIIIa, and covalent cross-links between fibrin monomers
What is the most common mutation leading to CF?
CTT deletion (functionally deletes phenylalanine)
the F508 is where this takes place