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51 Cards in this Set

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What is the most important determinant of the amount of oxygen delivery to tissues?
Hemoglobin
Dx:
A married couple comes to the hospital complaining of "flu-like" symptoms including HA, N/V and disorientation. The wife thinks they caught the virus from a neighbor when they borrowed his home generator.
Carbon Monoxide Poisoning
Equation for Arterial Oxygen content
0.0031(PaO2) + 1.38(Hb x SaO2) = Art O2 content
Definition:
Due to perfusion of poorly ventilated alveoli or due to alveoli not being perfused.

What does it respond to?
V/Q mismatch

responds to:
supplemental Oxygen

(ex: COPD, CHF, PE, asthma, etc)
What is a Right-to-Left shunt in the lungs do to?
Perfusion of a non-ventilated lung
Describe Anemia's effect on hypoxia
Anemia = decreased Hb

low Hb causes a decrease in O2 carrying capacity:
Normal PaO2
Decreased PvO2
When does a Low inspired O2 occur?
High-altitude
What does not cause cyanosis or discoloration until it reaches toxic levels, where the patient will present w/ "cherry red" lips and nails?
Carbon Monoxide poisoning
Definition:
Gas exchange compromise due to problem w/ alveolar interface
(ex: interstitial lung Dz)
Diffusion defect
With what neuromuscular disorders does Hypoventilation occur?
(3)
Myasthenia gravis;

ALS;

Guillain-Barre
What does an increased Fremitus suggest?
Consolidation of the lung
What does an decreased Fremitus suggest?
(2)
Air or fluid in the chest
(Pneumothorax or PE)

or

Overexpansion of the lung
What does a "Dull" percussion represent?
Increased density
(increased fluid in the lungs)
What does "hyperresonant" refer to w/ percussion?
Decreased density and more air
(ex: emphysema)
Lung Auscultation definition:

Crackle
(rale)
Excessive airway secretions

(Pneumonia, pulm edema, bronchitis)
Lung Auscultation definition:

Wheeze
Rapid airflow through obstructed airway

(Asthma, bronchitis)
Lung Auscultation definition:

Pleural Rub
Inflammation of the pleura

(Pneumonia, pulmonary infarction)
What is it called if you ask the patient to say "eee" and it is heard as "aaa"?

What does it dx?
(2)
Egophony


Consolidation;

Compressed lung above a Pleural Effusion
Definition:
A transudate or exudate in the lung
Pleural effusion
What are (2) physiologic causes of Transudate pleural effusions?

(3) Dx illnesses
Causes:
Increased Hydrostatic Pressure;
Decreased Oncotic Pressure

From:

CHF;
Cirrhosis;
Nephrosis
What is the physiologic cause of Exudate pleural effusions?

(3) Dx illnesses
Cause:
Increased Capillary permeability


From:

Tumor;
Infection;
Trauma
What must be present to consider the pleural fluid an exudate?
(3 criteria--only one must be present)
1. Ratio of Pleural to Serum Protein > 0.5

2. Ratio of Pleural to Serum LDH > 0.6

3. Pleural fluid LDH > 2/3 upper normal limit
When is the pleural effusion considered Parapneumonic?
(2)
1. Exudative Pleural fluid Leukocyte count > 10,000 w/ high PMNs

2. Empyema
Definition:
Pus in the pleural space


-Lab criteria?
Empyema

(WBC > 100,000)
What Dx Pleural effusions always require a chest tube?
(3)*
Pleural Effusion Line:

Positive Cultures;

Empyema;

Loculated Effusion
Pleural Effusion Line
What are the causes of gross blood in the pleural fluid?
(4)*
blood: A PTT

Aortic Dissection:

Pulmonary Infarction;

Tumor;

Trauma
blood: A PTT
What are the causes of low glucose in the pleural fluid?
(4)*
Glucose is a TREaT:

Tumor;

Rheumatoid Arthritis;

Empyema;

TB
Glucose is a TREaT
What are the causes of high amylase in the pleural fluid?
(4)*
Amy(lase) is PRETty:

Pancreatitis;

Renal failure;

Esophageal rupture;

Tumor
Amy(lase) is PRETty
Device that measures the rate at which the lung changes during forceful breathing?
Spirometry
Definition:
when the patient inhales normally, then exhales as rapidly and completely as possible that is recorded on Spirometry
Forced Vital Capacity
(FVC)
Spirometry Normal values:

1. FEV1

2. FVC

3. FEV1/FVC
Normals:

FEV1 = > 80%

FVC = > 80%

FEV1/FVC = > 0.7
Values indicating Obstructive lung disease:

1. FEV1

2. FVC

3. FEV1/FVC

4. Lung volume
FEV1 = DECREASED

FVC = normal or Decreased

FEV1/FVC < 0.7

Lung volume = normal or decreased
Values indicating Restrictive lung disease:

1. FEV1

2. FVC

3. FEV1/FVC

4. Lung volume
FEV1 = normal or Decreased

FVC = DECREASED

FEV1/FVC > 0.7

Lung volumes = Always DECREASED
What are the (3) different types of Restrictive lung defects?
Interstitial Lung Dz (fibrosis);

Neuromuscular Dz (ALS, MG);

Chest Wall disorders (obesity, kyphosis)
What does the Obstructive defect look like on Spirogram?
"swoopie"
What does the Restrictive defect look like on Spirogram?
Tall and thin
*When is a Bronchoscopy the most accurate test?
(2)

Only test more accurate?
1. Infections such as TB or Pneumocystis

2. Centrally located Abscess or Tumor

More accurate:
Open Lung Bx
Dx:
an epileptic, febrile patient w/ cough for the last several weeks, weight loss and malodorus sputum; unusual finding in upper lung lobe on CXR

Most accurate test?
Lung Abscess

test:
Lung Bx
Most accurate diagnostic test of any pulmonary bacterial infection?
Gram Stain of the Sputum
Dx:
patient has a fever, cough and shortness of breath. There are crackles and consolidation over a lung lobe.
First test?

Most accurate Dx test?
Bacterial Pneumonia
(MCC Strep)

first test: CXR

most accurate: Gram Stain of Sputum
What causes interstitial infiltrates?
(4)
causes:
Viral Pneumonia;
PCP;
Mycoplasma;
Legionella
Most accurate test for:

Interstitial Lung Infiltrates caused by PCP
Bronchoalveolar Lavage

(also Increased LDH)
*Most accurate test for:

Interstitial Lung Infiltrates caused by Legionella
Urine Antigen testing
*Most accurate test for:

Interstitial Lung Infiltrates caused by Mycoplasma or Chlamydia
Serology Antibody titers
What is the MC etiology of a Pleural Effusion?
(2)

Most accurate test?
etiology:

1. CHF
2. Pneumonia

test: Thoracentesis for fluid analysis
What is the best test to tell the difference b/t Obstructive and Restrictive lung disease?
Flow-Volume Loop
*When is a Pulmonary Function Test the most accurate Dx Test?

What part of the test is most accurate in Dx?
Distinguish b/t Obstructive and Restrictive lung disease

most accurate part:
FEV/FVC ratio
Dx:
African-American female w/ cough, dyspnea, chest pain and bilateral hilar lymphadenopathy.

First test?

Most accurate Dx test?
Sarcoidosis

first test: ACE levels (increased)

most accurate: Noncaseating Granuloma on Bx
Dx:
a young non-smoker w/ emphysema and liver disease

First test?
Alpha-1-Antitrypsin Deficiency
(low levels)

First test: serum A1A levels
*When is Performing an ABG the best answer?
(3)
1. COPD

2. possible Respiratory Acidosis

3. Low serum Bicarb
(possible severe Met acidosis)
Dx:
chronic respiratory problems, cough, SOB, fat malabsorption, vitamin deficiency, sterile. Blood gas reveals hypoxemia.

Best test?
Cystic Fibrosis


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