Cp Iib: Wks 3-5 Misc. Lectures

Front 1

What are the stages of the change model of smoking cessation

Back 1

pre-contemplation, contemplation, action, maintenance, relapse, recycle

Front 2

What are the FIve A's to help your pt.s stop smoking?

Back 2

1. Ask (med and smoking hx)
2. Advise (consequences, ways to quit)
3. Assess (level of addiction)
4. Assist (counsel, pharm)
5. Arrange (focus groups, stress management, referrals to specialists)

Front 3

What 3 things make up Primary Prevention of CHD With LDL-Lowering Therapy

Back 3

1. reduced intake of saturated fat and cholesterol
2. inc. physical activity
3. weight control

Front 4

There remains good evidence that reducing what reduces
morbidity in patients with CVD?

Back 4

saturated fat

Front 5

Reducing salt intake by how many grams per day would potentially result in billion saved?

Back 5

3 grams/day

Front 6

Egg consumption is related to increased risk of CVD in what patients?

Back 6

diabetics

Front 7

Use of what during food prep. is associated w/ protection from CHD?

Back 7

olive oil (exclusively)

Front 8

Individuals with high intakes of dietary fiber
appear to be at significantly lower risk for developing what?

Back 8

coronary heart disease, stroke, hypertension, diabetes, obesity

Front 9

Increased intake of soluble fiber improves what?

Back 9

improves glycemia and insulin sensitivity (and wt. loss in obese pts)

Front 10

The recommended dietary fiber intakes for children and adults
are what?

Back 10

14 g/1000 kcal.

Front 11

Resveratrol activates what?

Back 11

sirtuin, or SIRT1 (increasing lifespan, cell survival, and neuroprotection)... mimics effects of calorie restriction

Front 12

True or False. Vitamins C & E have been shown to help prevent CAD.

Back 12

False

Front 13

What % of sleep is spent in REM and nonREM?

Back 13

REM- 25%
non- 75% split in 4 stages

Front 14

What are characteristics in the EEG, EMG, EOG when awake?

Back 14

EEG: alpha wave, low voltage, 8-13 cycles/sec
EMG-high tone
EOG-active

Front 15

NREM stage 1: What are characteristics in the EEG, EMG, EOG?

Back 15

Transition phase
EEG: slower mixed-freq.
EMG: tone reduces
EOG: slow eye movements

Front 16

NREM stage II: What are characteristics in the EEG?

Back 16

slow-wave begins
slow w/ brief bursts of rapid activity (sleep spindles), high voltage K complexes

Front 17

NREM stage III/IV: What are characteristics in the EEG, EMG, EOG?

Back 17

Deep sleep
EEG: large, slow waves (<2 cycles/sec)
EMG: minimal activity
EOG: minimal activity

Front 18

REM, What are characteristics in the EEG, EMG, EOG?

Back 18

EEG: fast, irregular (sawtooth waves), similar to wakefulness
EMG- complete relaxation
EOG: rapid eye movement... hence REM

Front 19

After falling asleep, when is REM stage reached?

Back 19

about 90 minutes after sleep onset

Front 20

In what stage does dreaming occur?

Back 20

REM, mostly

Front 21

What is the trend in duration of REM and NREM as sleep progresses?

Back 21

deep sleep becomes shorter (eventually no deep sleep) and REM increases in lake

Front 22

What is apnea? What is the difference b/w central and obstructive sleep apnea?

Back 22

apnea: cessation of airflow > 10 sec.
Central: absence of respiratory efforts
Obstructive: cessation despite CONTINUED resp. efforts
Mixed: both occuring

Front 23

What are the characteristics of Upper Airway Resistance Syndrome?

Back 23

inc. daytime sleepiness
inc. respiratory effort
frequent arousal
NO overt apneas

Front 24

What are the characteristics of obstructive sleep apnea?

Back 24

inc. daytime sleepiness
irregular snoring
usually obese
5 or more obstructed breathing events per hour

Front 25

How does one grade the severity of obstructive sleep apnea?

Back 25

AHI (apnea hypopnea index):
(apnea + hypopnea) / hours of sleep

Front 26

What hormone is associated w/ worse SDB?

Back 26

testosterone (inc. truncal deposition)

Front 27

What are the respiratory and cardiac responses to obstructive apneas?

Back 27

Major: oxygen desaturation
BP: systolic inc. by 1 mmHg for every 1% fall in O2 sat
Pulmonary arteries: cyclic oscillations similar to systemic circulation

Front 28

Major symptoms of OSAS?

Back 28

loud snoring, excessive daytime hypersomnolence, restless sleep, morning headaches, impotence, abnormal mentation, personality changes, enuresis, insomnia, nocturnal choking

Front 29

What are common physical findings of OSAS?

Back 29

upper body obesity (neck): most predictive finding is central obesity w/ BMI > 28
nasopharyngeal narrowing
tonsillar or soft palate enlargement
small chin, malocclusion w/ overbite (females)
HTN, cor pulmonale

Front 30

What are some conditions associated w/ OSAS?

Back 30

nasal obstruction, polio, thyroid disease, Down's syndrome, COPD, CHF

Front 31

What is the gold standard for diagnosis of OSAS?

Back 31

formal polysomnography w/ full-time technical attendace
(also can do nocturnal oximetry)

Front 32

What are the ranges of number of obstructive events in AHI grading?

Back 32

normal: 0-4
Mild: 5-20
Moderate: 21-50
Severe: >50

Front 33

What is some behavioral therapy for OSAS?

Back 33

weight loss, sleep positioning (not supine), antidepressants

Front 34

What is the first line mechanical treatment for OSAS?

Back 34

nasal CPAP (for pt. w/ high AHI)

Front 35

What treatment is fairly successful for younger, non-obese OSAS pts.?

Back 35

UVPP

Front 36

What are key characteristics of Obesity hypoventilation (pickwickian)?

Back 36

morbid obesity
EXTREME daytime hypersomnolence
daytime hypercarbia
secondary erythrocytosis

Front 37

What is the treatment regimen for Pickwickian pts.?

Back 37

WEIGHT LOSS
CPAP or NIPPV
medroxyprogesterone (resp. stim)

Front 38

What is used in addition to a polysomnogram to screen for narcolepsy?

Back 38

multiple sleep latency test (MSLT): fall asleep every 2 hours and monitored

Front 39

What are the pharmacological treatments for narcolepsy?

Back 39

stimulants and antidepressants

Front 40

What can be used to treat RLS?

Back 40

dopaminergic agents, benzos, opioids, anticonvulsants

Front 41

What is invaluable in chest radiography for cancer screening?

Back 41

comparison to prior chest films (if lesions hasn't changed for > 2 years, probably benign)

Front 42

What technique has greater sensitivity than bronchoscopy for malignant peripheral solitary nodules?

Back 42

fine needle aspiration

Front 43

What is the TNM system?

Back 43

Staging for cancer (in lungs, for NSCLC):
T: Tumor (size, location, involvement w/ adjacent structures)
N: nodes (presence/loc. of regional lymph nodes)
M: metastasis

Front 44

Tumors are sometimes still resectable up to what stage of cancer (NSCLC)?

Back 44

Stage IIIA

Front 45

T or F. Majority of patients w/ SCLC present w/ extensive disease.

Back 45

True

Front 46

What are the pitfalls of evaluating lung cancer mets on abdominal CT?

Back 46

cyst, hemangiomas, and adenomas are indistinguishable on CT

Front 47

What FEV1 value is required for surgical removal of NSCLC to be considered helpful?

Back 47

FEV1 > 40% predicted is required to be candidate for surgery

Front 48

What % of all surgically resectable NSCLC recur?

Back 48

50% recur (1/3 locally, 2/3 distant sites)

Front 49

What is the usual cause of death in SCLC?

Back 49

metastatic involvement (not chest disease)

Front 50

What 3 factors affect tissue oxygen delivery (w/ no blockages)?

Back 50

arterial pO2
hemoglobin level
CO

Front 51

What is the definition of hypoxic respiratory failure?

Back 51

inability to achieve/maintain a PO2 of >60 torr on supplemental O2

Front 52

What are some general indications for mechanical ventilation?

Back 52

maintenance of oxygenation
maintain alveolar vent.
Need to protect airway (risk of aspiration)
if you think it is needed- do it

Front 53

What are the two ways ventilators can deliver gas?

Back 53

volume controlled (fixed volume)
pressure controlled (pressure is set, depends on compliance): used in peds and severe ARDS

Front 54

What are the four "modes" of invasive mechanical ventilation?

Back 54

assist control
intermittent mandatory vent.
pressure support
pressure control

Front 55

Describe Assist Control ventilation.

Back 55

Vent. supplied entirely by ventilator (TV, FiO2, and RR is set), but pt. can still take their own breath.
High degree of control (why it is used the most)

Front 56

What is the most commonly utilized mode of mechanical ventilation?

Back 56

Assist Control (indicated for most forms of respiratory failure)

Front 57

Describe IMV.

Back 57

TV, RR, and FiO2 are set (like AC), so there is a min. minute volume set.
Machine DOES NOT assist in pt.-initiated breaths

Front 58

Describe pressure support ventilation.

Back 58

Burst of positive pressure delivered to assist the pt.'s OWN resp. effort (pt. must be awake and breathing regularly).
NO set RR or TV
Machine stops providing assistance as flow rate falls below specified level.

Front 59

What invasive mechanical ventilation mode is indicated as a weaning tool and can also be useful in combination w/ other modes (IMV)?

Back 59

Pressure support (req. spontaneously breathing pt.)

Front 60

What mode of mechanical ventilation is used when lung compliance is a problem (ARDS)?

Back 60

pressure control
volume will vary based on compliance

Front 61

What is PEEP and why is it useful?

Back 61

positive end expiratory pressure
prevent alveoli from collapsing at end of expiration
IMPROVES OXYGENATION AND GAS EXCHANGE

Front 62

Describe BiPAP ventilation.

Back 62

higher pressure during inspiration
Can assist w/ both oxygenation and ventilation!

Front 63

What cell type lines the pleural surface?

Back 63

mesothelial cells

Front 64

Describe the vasculature of the visceral pleura.

Back 64

BV's supplied by systemic circulation but VENOUS drainage goes into pulmonary venous system

Front 65

What is the normal amount of pleural fluid and how is it maintained?

Back 65

10 ml is normal. secreted by the visceral and parietal pleura and resorbed through stomas into lymphatics

Front 66

What pathological conditions can lead to pleural effusions?

Back 66

inflammatory disease, neoplasia, CHF (also fluid movement from peritoneum via diaphragm defect and blockage of lymphatic drainage)

Front 67

How is transudate differentiated from exudate?

Back 67

Pleural/serum protein:
trans- <0.5; Ex- >0.5
Pleural/serum LDH:
trans- < 0.6; Ex- >0.6
Pleural fluid LDH:
trans- <2/3 ULN serum; ex- >2/3 ULN serum
Note: if any of the exudative criteria are met, it IS exudate

Front 68

What diseases are associated w/ pleural effusions?

Back 68

CHF, pneumonia, malignancy, PE, cirrhosis, collagen-vascular disease

Front 69

What are auscultory findings of pleural effusions?

Back 69

Dec. breath sounds
dullness to percussion
Friction rub (maybe) if inflammatory

Front 70

How much fluid must be present to see on CXR?

Back 70

200 ml

Front 71

What modality may be useful in detecting if the pleural effusion is still free flowing (not gelatinous)?

Back 71

lateral decubitus xray

Front 72

What criteria (effusion size) must be met for thoracentesis to be possible?

Back 72

size of effusion > 10mm wide in lat. decubitus view

Front 73

What defines pleural fluid as hemothorax? What are some causes?

Back 73

hematocrit fluid is >50% of that of blood
causes: trauma, iatrogenic, spontaneous rupture of BV, bleeding disorders/anticoag Tx

Front 74

What are some clinical manifestations of pleural metastasis?

Back 74

dyspnea, cough, weight loss, CP, malaise, fever/chills, but may be asymptomatic (23%)

Front 75

What are some common organisms that can cause pleural effusion?

Back 75

anaerobes, staph, pneumococcus
40-50% of pt.s w/ bac. pneumonia develop effusion

Front 76

What are the 3 stages of a parapneumonic effusion?

Back 76

1. exudative (capillary leak)
2. fibrinopurulent (bac. invasion)
3. organizational (empyema)

Front 77

What pH, glucose, LDH values are definitive of simple, complicated, and empyema parapneumonic effusions?

Back 77

Simple: pH >7.2, glucose> 40, LDH <3x ULN serum
Complicated: pH <7, glu <40, LDH >3x ULN
Empyema: same as complicated + frank pus and culture is +

Front 78

What invasive interventions are indicated in simple, complicated, and empyema parapneumonic effusions?

Back 78

simple: thoracentesis
complicated: tube thoracostomy (chest tube)
Empyema: VATS

Front 79

T or F. Primary and secondary spontaneous pneumothorax result from a breach in the parietal pleura.

Back 79

False.
Breach in visceral pleura= primary/secondary spontaneous
Breach in parietal pleura= iatrogenic or traumatic

Front 80

Air in pleural space under positive pressure = what?

Back 80

tension pneumothorax

Front 81

Tall and skinny young pt, presents w/ acute onset of CP and dyspnea, no previous health problems. What's probable diagnosis? Treatment?

Back 81

primary pneumothorax
Tx: oxygen, chest tube if still a leak, bleb resection and pleurodesis, OR simply observe if air entry is definitely closed

Front 82

Why is oxygen treatment helpful in pneumothorax?

Back 82

favors rapid resportion of nitrogen (main component of gas in pneumothorax)

Front 83

What are some underlying lung diseases associated w/ secondary spontaneous pneumothorax?

Back 83

disease w/ subpleural air pockets:
COPD, CF, ILD, pneumocystis

Front 84

Two-step treatment for tension pneumothorax?

Back 84

needle decompression and chest tube

Front 85

Treatment for traumatic pneumothorax?

Back 85

chest tube

Front 86

Typical placement of chest tube?

Back 86

around 5th intercostal space anterior to midaxillary line

Front 87

What cause of cancer accounts for 30% of ALL cancer deaths?

Back 87

smoking

Front 88

What are the cardiovascular effects of nicotine?

Back 88

– Increased systolic/diastolic BP and Pulse
– Increased force of myocardial contraction,
myocardial oxygen consumption and coronary artery blood flow
– Increased myocardial excitation
– Increased peripheral vasoconstriction

Front 89

What will happen to your risk of a heart attack w/in 1 year of quitting smoking?

Back 89

reduce by 50%

Front 90

What are the side effects of Bupropion?

Back 90

insomnia and dry mouth
(aka zyban)

Front 91

Max pieces of nicorette a day?

Back 91

24/day max

Front 92

What drug is a nicotine receptor blocker?

Back 92

chantix (never use more than 6 months)

Front 93

Number one cause of death in the US?

Back 93

coronary artery disease

Front 94

What were some important "milestones" of the framingham heart study (excluding dates)?

Back 94

1. cigarette smoking increases risk for CHD
2. cholesterol level, BP, and ECG abnormalities inc. risk for CHD
3. physical activity reduces risk, obesity increases
4. HTN increases risk of stroke
5. menopause inc. risk of CHD
6. HDL reduces risk

Front 95

strongest predictor for CHD? other uncontrollable risk factors?

Back 95

age (men over 45, women over 55)
others: being male, family history of premature CHD, HTN... ok that's controllable (to a degree)

Front 96

Desirable HDL and LDL levles?

Back 96

men: HDL of 35, LDL of 160
Women: HDL of 50

Front 97

preferred triglyceride level?

Back 97

150 (>200 is bad)

Front 98

Definition of intermittent claudication?

Back 98

lower extremity muscular pain in the calves (less frequently the buttocks or thighs) induced by exercise and relieved by short periods of rest

Front 99

Physical exam reveals:• Absent or decreased pulses
• Thin shiny pre-tibial skin
• Alopecia
• Thick, brittle nails
• Dependent rubor

Diagnosis?

Back 99

claudication

Front 100

What are the 5 P's of acute limb ischemia?

Back 100

– Pain
– Paralysis
– Paresthesias
– Poikilothermia
– Pulselessness

Front 101

What is the classic triad of aortic stenosis?

Back 101

angina, HF, and syncope

Front 102

What defines a massive hemothorax?

Back 102

Massive: > 200 mL/hr for > 4 hours –or‐ > 1500 mL
upon tube placement.

Front 103

What do you do if you suspect infection w/ any of these organisms?

Back 103

Report to health authorities immediately!

Front 104

What are the top 4 Category A bioterrorism agents?

Back 104

anthrax, plague, tularemia, small pox

Front 105

T or F. Inhalation anthrax (aka woolsorter's disease) can be transmitted person to person.

Back 105

false

Front 106

Anthrax. What is general incubation time, initial symptoms, appearance on CXR?

Back 106

incubation: 1-43 days
initial symptoms (2-5d): fever, cough, myalgia, malaise
CXR: widened mediastinum

Front 107

Gram +, aerobic, spore-forming, catalase + rod. Presumptive identification?

Back 107

bacillus anthracis

Front 108

A rabbit-tamer presents to you w/ abrupt onset of fever, chills, HA, myalgia and non-productive cough. Respiratory specimen Gram stain reveals tiny, poorly staining negative coccobacilli that grows best on cysteine heart agar. Diagnosis?

Back 108

Francisella tularensis

Front 109

What are the three clinical types of the plague?

Back 109

– bubonic (infected lymph nodes)
– septicemic (blood-borne organisms)
– pneumonic (transmissible by aerosol; deadliest)

Front 110

T or F. plague can be transmitted person to person.

Back 110

TRUE. pneumonic (aerosol) form

Front 111

Pt. presents w/ severe dyspnea, cyanosis, and other symptoms suggestive of pneumonia. Respiratory specimen reveals a small gram negative coccobacillus, Wayson stain shows safety-pin cells, specimen hangs on the walls of BHI broth. Diagnosis?

Back 111

Yersinia pestis (the plague)

Front 112

What is the most potent lethal substance known to man?

Back 112

botulinum toxin

Front 113

An unprofessional veggie-canner presents w/ blurry/double vision, difficulty swallowing/talking, decreased salivation, flaccid paralysis in limbs bilaterally. Based on clinical presentation, what's your diagnosis?

Back 113

botulism

Front 114

What is the most common mode of transmission for brucellosis?

Back 114

ingestion

Front 115

Pt. presents w/ undulating fever, profuse sweating, malaise, headache and muscle/back pain. Blood specimen gram stain reveals a faintly gram-neg. coccobacilli that is urease and catalase positive. Growth on SBA media reveals fastidious organism. Diagnosis?

Back 115

Brucellosis (any of the brucella species... this is category B bioterrorism agent)