Im Resp Basics Usmle 2

Front 1

What is the most important determinant of the amount of oxygen delivery to tissues?

Back 1

Hemoglobin

Front 2

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.

Back 2

Carbon Monoxide Poisoning

Front 3

Equation for Arterial Oxygen content

Back 3

0.0031(PaO2) + 1.38(Hb x SaO2) = Art O2 content

Front 4

Definition:
Due to perfusion of poorly ventilated alveoli or due to alveoli not being perfused.

What does it respond to?

Back 4

V/Q mismatch

responds to:
supplemental Oxygen

(ex: COPD, CHF, PE, asthma, etc)

Front 5

What is a Right-to-Left shunt in the lungs do to?

Back 5

Perfusion of a non-ventilated lung

Front 6

Describe Anemia's effect on hypoxia

Back 6

Anemia = decreased Hb

low Hb causes a decrease in O2 carrying capacity:
Normal PaO2
Decreased PvO2

Front 7

When does a Low inspired O2 occur?

Back 7

High-altitude

Front 8

What does not cause cyanosis or discoloration until it reaches toxic levels, where the patient will present w/ "cherry red" lips and nails?

Back 8

Carbon Monoxide poisoning

Front 9

Definition:
Gas exchange compromise due to problem w/ alveolar interface
(ex: interstitial lung Dz)

Back 9

Diffusion defect

Front 10

With what neuromuscular disorders does Hypoventilation occur?
(3)

Back 10

Myasthenia gravis;

ALS;

Guillain-Barre

Front 11

What does an increased Fremitus suggest?

Back 11

Consolidation of the lung

Front 12

What does an decreased Fremitus suggest?
(2)

Back 12

Air or fluid in the chest
(Pneumothorax or PE)

or

Overexpansion of the lung

Front 13

What does a "Dull" percussion represent?

Back 13

Increased density
(increased fluid in the lungs)

Front 14

What does "hyperresonant" refer to w/ percussion?

Back 14

Decreased density and more air
(ex: emphysema)

Front 15

Lung Auscultation definition:

Crackle
(rale)

Back 15

Excessive airway secretions

(Pneumonia, pulm edema, bronchitis)

Front 16

Lung Auscultation definition:

Wheeze

Back 16

Rapid airflow through obstructed airway

(Asthma, bronchitis)

Front 17

Lung Auscultation definition:

Pleural Rub

Back 17

Inflammation of the pleura

(Pneumonia, pulmonary infarction)

Front 18

What is it called if you ask the patient to say "eee" and it is heard as "aaa"?

What does it dx?
(2)

Back 18

Egophony


Consolidation;

Compressed lung above a Pleural Effusion

Front 19

Definition:
A transudate or exudate in the lung

Back 19

Pleural effusion

Front 20

What are (2) physiologic causes of Transudate pleural effusions?

(3) Dx illnesses

Back 20

Causes:
Increased Hydrostatic Pressure;
Decreased Oncotic Pressure

From:

CHF;
Cirrhosis;
Nephrosis

Front 21

What is the physiologic cause of Exudate pleural effusions?

(3) Dx illnesses

Back 21

Cause:
Increased Capillary permeability


From:

Tumor;
Infection;
Trauma

Front 22

What must be present to consider the pleural fluid an exudate?
(3 criteria--only one must be present)

Back 22

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

Front 23

When is the pleural effusion considered Parapneumonic?
(2)

Back 23

1. Exudative Pleural fluid Leukocyte count > 10,000 w/ high PMNs

2. Empyema

Front 24

Definition:
Pus in the pleural space


-Lab criteria?

Back 24

Empyema

(WBC > 100,000)

Front 25

What Dx Pleural effusions always require a chest tube?
(3)*

Back 25

Pleural Effusion Line:

Positive Cultures;

Empyema;

Loculated Effusion

Hint 25

Pleural Effusion Line

Front 26

What are the causes of gross blood in the pleural fluid?
(4)*

Back 26

blood: A PTT

Aortic Dissection:

Pulmonary Infarction;

Tumor;

Trauma

Hint 26

blood: A PTT

Front 27

What are the causes of low glucose in the pleural fluid?
(4)*

Back 27

Glucose is a TREaT:

Tumor;

Rheumatoid Arthritis;

Empyema;

TB

Hint 27

Glucose is a TREaT

Front 28

What are the causes of high amylase in the pleural fluid?
(4)*

Back 28

Amy(lase) is PRETty:

Pancreatitis;

Renal failure;

Esophageal rupture;

Tumor

Hint 28

Amy(lase) is PRETty

Front 29

Device that measures the rate at which the lung changes during forceful breathing?

Back 29

Spirometry

Front 30

Definition:
when the patient inhales normally, then exhales as rapidly and completely as possible that is recorded on Spirometry

Back 30

Forced Vital Capacity
(FVC)

Front 31

Spirometry Normal values:

1. FEV1

2. FVC

3. FEV1/FVC

Back 31

Normals:

FEV1 = > 80%

FVC = > 80%

FEV1/FVC = > 0.7

Front 32

Values indicating Obstructive lung disease:

1. FEV1

2. FVC

3. FEV1/FVC

4. Lung volume

Back 32

FEV1 = DECREASED

FVC = normal or Decreased

FEV1/FVC < 0.7

Lung volume = normal or decreased

Front 33

Values indicating Restrictive lung disease:

1. FEV1

2. FVC

3. FEV1/FVC

4. Lung volume

Back 33

FEV1 = normal or Decreased

FVC = DECREASED

FEV1/FVC > 0.7

Lung volumes = Always DECREASED

Front 34

What are the (3) different types of Restrictive lung defects?

Back 34

Interstitial Lung Dz (fibrosis);

Neuromuscular Dz (ALS, MG);

Chest Wall disorders (obesity, kyphosis)

Front 35

What does the Obstructive defect look like on Spirogram?

Back 35

"swoopie"

Front 36

What does the Restrictive defect look like on Spirogram?

Back 36

Tall and thin

Front 37

*When is a Bronchoscopy the most accurate test?
(2)

Only test more accurate?

Back 37

1. Infections such as TB or Pneumocystis

2. Centrally located Abscess or Tumor

More accurate:
Open Lung Bx

Front 38

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?

Back 38

Lung Abscess

test:
Lung Bx

Front 39

Most accurate diagnostic test of any pulmonary bacterial infection?

Back 39

Gram Stain of the Sputum

Front 40

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?

Back 40

Bacterial Pneumonia
(MCC Strep)

first test: CXR

most accurate: Gram Stain of Sputum

Front 41

What causes interstitial infiltrates?
(4)

Back 41

causes:
Viral Pneumonia;
PCP;
Mycoplasma;
Legionella

Front 42

Most accurate test for:

Interstitial Lung Infiltrates caused by PCP

Back 42

Bronchoalveolar Lavage

(also Increased LDH)

Front 43

*Most accurate test for:

Interstitial Lung Infiltrates caused by Legionella

Back 43

Urine Antigen testing

Front 44

*Most accurate test for:

Interstitial Lung Infiltrates caused by Mycoplasma or Chlamydia

Back 44

Serology Antibody titers

Front 45

What is the MC etiology of a Pleural Effusion?
(2)

Most accurate test?

Back 45

etiology:

1. CHF
2. Pneumonia

test: Thoracentesis for fluid analysis

Front 46

What is the best test to tell the difference b/t Obstructive and Restrictive lung disease?

Back 46

Flow-Volume Loop

Front 47

*When is a Pulmonary Function Test the most accurate Dx Test?

What part of the test is most accurate in Dx?

Back 47

Distinguish b/t Obstructive and Restrictive lung disease

most accurate part:
FEV/FVC ratio

Front 48

Dx:
African-American female w/ cough, dyspnea, chest pain and bilateral hilar lymphadenopathy.

First test?

Most accurate Dx test?

Back 48

Sarcoidosis

first test: ACE levels (increased)

most accurate: Noncaseating Granuloma on Bx

Front 49

Dx:
a young non-smoker w/ emphysema and liver disease

First test?

Back 49

Alpha-1-Antitrypsin Deficiency
(low levels)

First test: serum A1A levels

Front 50

*When is Performing an ABG the best answer?
(3)

Back 50

1. COPD

2. possible Respiratory Acidosis

3. Low serum Bicarb
(possible severe Met acidosis)

Front 51

Dx:
chronic respiratory problems, cough, SOB, fat malabsorption, vitamin deficiency, sterile. Blood gas reveals hypoxemia.

Best test?

Back 51

Cystic Fibrosis


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