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50 Cards in this Set

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RLD: extrapulmonary causes
-muscular dystrophy
-kyphoscoliosis
-obesity hyperventilation syndrome
RLD: parenchymal diseases (interstitial lung disease)
-Ideopathic pulmonary fibrosis
-Systemic disease
-hyaline membrane disease
-ARDS
-autoimmune disease
-environmental & occupational
-infections
-drug induce
Hyaline membrane disease: aka infant resp. distress disease
-primarily pre-mature infants
-inadequate surfactant
-
hyaline membrane disease
-decreased air movement heard on auscultation
-tachypnea
-cyanosis
Hyaline membrane disease: CXR shows:
-bilateral atelectasis
-hypoextension and domed diaphragm
Fetal lung maturity
indicated by:
-lecithin/spingomyelin ratio >2
-presence of phosphatidyl glycerol
Treatment of hyaline membrane disease in the premie:
-antenatal cortiscosteroid admin. to mother more than 24 hours prior to birth
-intratracheal exogenous surfactant
Tx has a synergistic effect
Adult resp. distress syndrome
-acute onset of resp. distress
-decreased arterial pO2 and HbO2 saturation
-CXR shows diffuse pulmonary infiltrates without evidence of L heart failure
Causes of ARD
-Infection - sepsis
-diffuse Pul. infx
-gastric aspiration
-O2 toxicity
ARD clinical features
-dyspnea
-crackles, rhonchi, and or wheezes
-cyanosis
DX of ARD
-must have high suspicion of dyspnea in setting known to cause
-ABG shows acute resp. alkalosis
-CXR shows bilat. infiltrates similar to tose of CHF but heart is normal size
Sarcoidosis
systemic disease characterized by non-caseating epithelioid granulomas
Sarcoidosis
-decreased CD4+ lymphocytes
-increased CD4+ lymphos in bronchoalveolar lavage fluid
Sarcoidosis S/S
-cough and dyspnea
-fatigue
-arthralgias
-fever (high or low)
-weight loss
Other manifestations of Sarcoidosis
Skin: erythema nodosum
Liver: granulomas
Cardiac: Dysrhythmias, CHF
Neurologic: HA, CN palsies, meningitis, seizures
Renal: RF, hypercalcemia,
Heerfords's syndrome aka Uneoparotid fever
triad of:
-uveitis
-parotis
-CN7 palsy
Lofgren's syndrome
triad:
-erythema nodosum
-hilar adenopathy
DX of sarcoidosis
-hypergammaglobulinemia
-PFTs show decreased compliance
-CXR shows b/l hilar adenopathy
-Kveim test is +
-Serum ACE levels are increased
Treatment of Sarcoidosis
-steroids with held as long as poss.
Prognosis of Sarcoidosis
-1/3 remit spontaneously
-1/3 remain stable at some level
-1/3 progress withh 10% developing severe restrictive pulmonary
Pneumoconiosis
3 major:
-asbestos
-silica
-coal dust
Asbestos
-restrictive manifestations range from pleural effusion to slowly progressing pulmonary fibrosis
-inc'd risk of lung CA and plural mesothelioma
-latency from asbestos exposure to Lung CA is 20-40 years
Silicosis
-silica exposure
-found in sand
-produces lung inflammation and massive pulmonary fibrosis
-CXR shows eggshell calcification of hilar nodes
Coal dust
-black lung
-concurrent exposure to silica
Emboli
-air embolus
amniotic fluid
-fat embolus
-foreign body
-tumor cell embolus
Risk factors for PE
-non-ambulatory
-recent sx
-woman on oral contraceptives that smokes
-obesity
-CA
-Hereditary ypercoagulability
-dehydration
Sarcoidosis
systemic disease characterized by non-caseating epithelioid granulomas
Sarcoidosis
-decreased CD4+ lymphocytes
-increased CD4+ lymphos in bronchoalveolar lavage fluid
Sarcoidosis S/S
-cough and dyspnea
-fatigue
-arthralgias
-fever (high or low)
-weight loss
Other manifestations of Sarcoidosis
Skin: erythema nodosum
Liver: granulomas
Cardiac: Dysrhythmias, CHF
Neurologic: HA, CN palsies, meningitis, seizures
Renal: RF, hypercalcemia,
Heerfords's syndrome aka Uneoparotid fever
triad of:
-uveitis
-parotis
-CN7 palsy
Lofgren's syndrome
triad:
-erythema nodosum
-hilar adenopathy
DX of sarcoidosis
-hypergammaglobulinemia
-PFTs show decreased compliance
-CXR shows b/l hilar adenopathy
-Kveim test is +
-Serum ACE levels are increased
Treatment of Sarcoidosis
-steroids with held as long as poss.
Prognosis of Sarcoidosis
-1/3 remit spontaneously
-1/3 remain stable at some level
-1/3 progress withh 10% developing severe restrictive pulmonary
Pneumoconiosis
3 major:
-asbestos
-silica
-coal dust
Asbestos
-restrictive manifestations range from pleural effusion to slowly progressing pulmonary fibrosis
-inc'd risk of lung CA and plural mesothelioma
-latency from asbestos exposure to Lung CA is 20-40 years
Silicosis
-silica exposure
-found in sand
-produces lung inflammation and massive pulmonary fibrosis
-CXR shows eggshell calcification of hilar nodes
Coal dust
-black lung
-concurrent exposure to silica
Emboli
-air embolus
amniotic fluid
-fat embolus
-foreign body
-tumor cell embolus
Risk factors for PE
-non-ambulatory
-recent sx
-woman on oral contraceptives that smokes
-obesity
-CA
-Hereditary ypercoagulability
-dehydration
thromboemboli arise from:
-ant. and post. tibial veins
-peroneal vein
NOT great or small saphenous
thromboemboli propogate proximally into the:
-popliteal vine
-ileofemoral vein to form a proximal DVT
S/S of DVT
(50%) have NO symptoms
-dull ache
-distention
-homan's sign
Sx of PE
-dyspnea
-tachypnea
-tachycardia
-cough, wheezing, crackles, hemoptysis,
-accentuated P2
-homan's sing
Lab findings of DVT or PE
-CXR: can r/o other dx
-ABGs: hypoxemia, usually resp. alkalosis due to hyperventilation
-ECG: sinus tach
non-specific ST segment changes
T wave changes
ECG
S1Q3-T3:
-s wave in Lead I
-Q wave in lead III
-T wave inversion in lead III
ALL abnormalities must be present at once
DX of DVT:
-Plasma D-dimer level
-doppler
-MRI with gadolinium
DX of PE
-spiral CT
-pulmonary angiography
-V/Q scan
-
Treatment of PE
Best: prevention
-heparin
-coumadin