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83 Cards in this Set
- Front
- Back
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What are the causes of an acute cough?
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Pneumonia, Acute sinusitis, acute bronchitis, CHF and lung cancer
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P presents with H. fever, facial HA, nighttime cough and has sinus tenderness transillumination
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Acute sinusitis
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P presents with temp >38 pleuritic chest pain and dyspnea. Has crackles
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Pneumonia
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P. presents with dyspnea on exertion, cough, leg swelling and orthopnea. Has inspiration crackles, S3 and high JVP
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CHF
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P. presents with dry cough, weigh loss and fever. Has crackles and absent breath sounds (pleural effusion)
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Lung cancer
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What are the causes of a chronic cough?
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Postnasal drip, GERD, (most common) Asthma, ACE inhibitors
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P presents with cobblestone appearance of nasal mucosa and liquid dropping in back of throat
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Postnasal drip
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Presents with chest pain, sour taste in mouth, heartburn, dysphagia and acid reguritataion
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GERD
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What is involved in the acute cough algorithm?
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History examination investigations of life-threatening Dx and non-life threatening Dx
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What is the sole clinical manifestation of asthma?
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Cough
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What is the definition of a cough?
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an explosive expiration that provides a normal protective mechanism for clearing the tracheobronchial tree of secretions and foreign material
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What is the most important parameter in production of an effective cough?
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linear velocity of the moving air column
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Erosion into bronchial artery or pulmonary artery
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Bronchogenic carcinoma
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In young, healthy patients. May cause massive hemoptysis,
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bronchial adenoma
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What is the most common cause of submassive hemoptysis
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acute bronchitis
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most common cause of massive hemoptysis
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TB, pneumonia, lung abcess, and bronchitis
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how is massive hemoptysis defined?
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expectorating >600ml of blood within a 24-48hr period
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Which dyspnea? Myocardial dysfunction, anemia, deconditioning
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cardiovascular dyspnea
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What are the most common causes of acute cardiac dyspnea?
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Acute MI, CHF, Cardiac tamponade
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What are the most common causes of respiratory dyspnea?
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Acute asthma, pulmonary embolism, pneumothorax, pulmonary infection, upper airway obstruction
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Rx for a full PFT will include?
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Spirometry, lung volumes and diffusion capacity
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What is the purpose of spirometry?
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to detech presence or absence of lung disease. Would be usedul to confirm the presence of underlying disease and to contemplate the extent of the disease. Weed out cardiac disease, smoking and env exposure.
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What are lung volumes used to assess?
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the severity and to confirm an underlying restrictive pattern; how severe the restriction is.
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What is diffusion capacity primarily used for?
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assess disease, parenchymal lung disease; assess involvement of systemic disease- rheumatoid arthritis, sarcoidosis, lupus and systemic sclerosis.
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What is the vital capacity?
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the volume of gas measured from a slow complete expiration after a maximal inspiration, without forced or rapid effort
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What is ERV and how is it measured?
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Largest volume of gas that can be expired from the resting end-expiratory level. Measured by having patient breathe normally for 3 or 4 breaths and then exhale maximally. The change in volume from the end-expiratory level to the maximal expiratory level is the ERV
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What can cause a decrease in the vital capacity?
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airway obstruction, loss of distensible lung tissue, obstructive diseases (asthma, emphysema, chronic bronchitis), restrictive lung disease (lung resection, space-occupying lesions, pleural effusion, pulmonary edema)
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What is the relation of FVC in a healthy patient. In airway restrcition/obstruction
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FVC = VC in a healthy individual. Reduced with airway obstruction and restriction (pulm fibrosis (collagen vascular disease, dust or toxin exposure), pulm congestion (cardiogenic pul edema, pneumonia), space occupying lesion (tumor, pleural effusion) Neuromuscular disorder (myasthenia gravis), chest wall limitation (kyphoscoliosis, obesity, pregnancy)
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Decreased FEV1 is associated with increased..?
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mortality
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What is the flow-volume loop pattern in small airway diseases?
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Scooped out, concave
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Diminished inspiratory flow, normal expiratory flow, inspiratory portion is flattened
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variable extrathoracic ariway obstruction, obstruction in the upper airway in the larynx or pharynx.
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diminished expiratory flow, normal inspiratory flow, expiratory flow is flattened
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variable intrathoracic airway obstruction, Obstruction from the trachea down to the large bronchi
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Diminished expiratory and inspiratory flow, flattened inspiratory and expiratory limbs
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fixed airway obstruction
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How is FRC (functional residual capacity) calculated?
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Adding ERV (expiratory reserve volume) to RV (residiual volume)
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What does plethymography measure?
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gas contained in the thorax whether in commincation with parent airways or trapped in any compartment of the thorax
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What does Dico measure?
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transfer of a diffusion-limited gas (CO) across the alveolocapillary membrane
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What are the muscoloskeletal causes of dyspnea?
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neuromuscular, Guillain-Barre, Myasthenia gravis
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What is the definition of COPD and what other disorders does it include?
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A group of pulmonary disorders characterized by permanent (irreversible) obstruction to expiratory airflow. Includes bronchitis and emphysema
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What is the gold standard that defines COPD? What defines mild COPD
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if FEV1/FVC is equal to or less than 70%. Mild if less than or equal to 80%
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What is the difference between asthma and COPD?
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Asthma has a sensitizing agent, so CD4 response that releases eosinophils, and is reversible. COPD is triggered by a noxious stimulus and triggers a CD8, mac and neutrophil response and is irreversible
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What is the most common symptom of COPD?
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dyspnea that is progressive and worsens over time
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What are the cardiac and noncardiac causes of pulmonary edema?
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cardiac- hydrostatic pressure. Noncardiac- capillary leak syndrome
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what are the heart failure/pulmonary edema cells?
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hemosiderin-laden macrophages
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What is virchow's triad? What is it helpful in diagnosing?
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stasis, hypercoagubility, injury. DVTs
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What is the pathobiology of pulmonary embolism?
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tachypnea, hypoxemia, pul HTN, RV failure and shock
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What does pulmonary HTN commonly cause?
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plexogenic pulmonary arteriopathy, pulmonary artery atherosclerosis, small artery medial hypertrophy/fibrosis, cor pulmonale, RV failure
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What is the pathogenesis of asthma?
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Inhaled antigen is processed by DC to th2/CD4. B cells are stimulated to produce IgE which binds to mast cells, which degranulate which releases mediators of immediate and late response
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What are the non-asthma causes of chronic cough?
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postnasal drip, aspiration from dysphagia, gastroesophogeal reflux
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What is the most common mechanism of pneumonia? And the 2nd
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aspiration of oropharyngeal contents. 2nd is inhalation of aersolized droplets (legionella pneomophilia, mycobacterium TB, bacillus antracis, yersinia pestis (plague)
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What is the most common pathogen in pneumonia?
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streptoccus pneumoniae
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What are the pathogens of atypical pneumonias?
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legionella, mycoplasma, chlamydia, CMV, RSV, influenza
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What is a common childhood pneumonia?
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mycoplasma pneuomonia
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fever, body aches, malaise, diffuse bacterial infiltrates on CxR, postive nasal smear, reyes syndrome
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influenza pneuomnia
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What are the pathogens involved in fungal pneumonia?
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histoplasmosis, coccidiomycosis, aspergillus, cryotococcus
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What is the pathology of a farmer who inhales a lot of organophosphates?
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Irreversible cholinesterase inhibitors
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What is Caplan's syndrome?
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Pneumoconiosis plus Rhematoid arthritis
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What is an eventual effect or complication of complicated coal workeres pneumoconiosis?
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Cor pulmonale
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insidious onset of Dyspnea, slowly progressive upper lobe fibrotic nodules, increased risk of TB, Caplans
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Silicosis
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Which pneumoconiosis is assoc with an increased risk of mesothelioma?
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asbestos
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What is histologically indicative of asbestor poisoning?
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Bronchoalveolar lavage specimen. Central core is covered by iron, hemosiderin (beaded fashion). = asbestos body
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latent period of 20 years, progressive dyspnea on exertion, bibasilar crackles, clubbing of fingers, cor pulmonale
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asbestos
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What is lofgren's syndrome?
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Sarcoidosis presenting as stage 1 sarcoid, bilateral hilar adenopathy, erythema nodosum- skin manifestations, arthritis or athralgia and fever
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What is cardiogenic vs noncardiogenic causes of pulm edema?
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cardiogenic- increased hydrostatic pressure (LHF, mitral valve stenosis, fluid overload). Noncardio- decreased oncotoc pressure, blood transfuision, microvascular injury, high altitude, neurogenic, reperfusion, eclampsia
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What is the pathology of pulm edema?
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heavy wet lungs, engorged alv capillaries, pink proteinaceous staining in alveoli, hemosiderin-laden mac's, fibrosis and thickening of alv walls
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Accumulation of fluid and protein in the alveolar space with resultant decreased diffusing capacity, hypoxemia, and SOB
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ARDS
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What is the criteria for ARDS?
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No evidence of CHF, bilateral infiltrates on CX, hypoxia
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What are the 3 stages of ARDS?
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Exudative (edema, intra-alv hemorrhage, fibrin depostion), Proliferative (hyaline membranes, interstitial inflammation, alv lining cell hyperplase, lose type 1 pneumocytes) and Fibrotic (irreversible fibrosis)
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Lymphopenia, increased Ck, increased LDH. Bilateral infiltrates, local consolidation, small cysts on CT, pneumothorax/pneumediastinum
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SARS
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Respiratory insufficiency, tachypnea, costal retraction, nasal flaring, accessory muscle use, expiratory grunt, cyanosis, poor feeding. Ground glass reticulonodular changes, hyaline membrane formation, atelectasis, lecithin:sphingomyelin ration <2
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RDS of newborn
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velcro rales heard in?, path = UIP
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idiopathic pulmonary fibrosis
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What is Hamman Rich Syndrom?
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aka Acute Interstitial Pneumonitis. Fulminant or rapidly progressive form of lung injury
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Accumuulation of eosinophilic granular material in the alveolar spaces which is PAS positive. Foamy alveolar mac's and hyperplaseia of type 2 pneumocytes
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PAP pulmonary alveolar proteinosis
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What is PAP associated with?
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Aluminum and silica expsure, immunodeificiency, malignancies (lymphoma), infections (nocardia), volcanic ash, chemotherapy
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Plugs of fibroblastic tissue within small airspaces with chronic interstitial inflammtion,
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COP Cryptogenic Organizing Pneumonia or BOOP Bronchiolitis obliterans organizing pneumonia
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What are the different types of lung cancer?
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Carcinomas-of endothelial calls, neuroendorcrine tumors- carcinoids, sarcomas-CT, muscle, cartilage, Mesothelioma and Metastic cancer.
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Bronchoalveolar carcinoma, spread along walls/areas of scar. Gland formation with mucin production, peripheral, slow grower, early mets
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Adenocarcinoma
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Central necrosis/cavitations, bulky with bronchial obstruction, nest of squamos cells, intracellular bridges, kertin pearls
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Squamos cell carcinoma
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Oat cell carcinoma and intermediate cell carcinoma. Cetral, rapid grower, early met, paraneoplastic
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Small cell carcinoma
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What is Lofflers syndrome?
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Simple Eosinophilic pneumonia. Migratory pulmonary infiltrates, peripheral eosinophilia, ascaris
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Aspiration of mineral oil or other oily substances
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lipoid pneumonia
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Transudate vs. exudate
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transudate- systemic factors alter hydrostatic and oncotic pressures. Exudate- local factors influence formation and absorptionof fluid
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Causes of restrictive lung disease?
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PAINT. Pleural (fibrosis, effusions, empyema, pneumothorax), Alveolar (edema, hemorrhage, pus), Inflammatory (sarcoid, cryptogenic pneumo), Neuromuscular (myasthenia, phrenic nerve palsy, myopathy), Thoracic wall (kyphoscoliosis, obesity, ascites, pregnancy, spondylitis)
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Causes of obstructive lung disease?
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ABCT. Asthma, Bronchiectasis, Cystic fibrosis, Tracheal or bronchial obstruction
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