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110 Cards in this Set
- Front
- Back
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Which is more common restrictive or obstructive lung dz
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obstructive dz
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What are the lungs like in obstructive dz
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Hyperinflated lungs b/c loss of recoil. Can't get air out
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What are the lungs like in restrictive
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They are unable to expand b/c there is fibrosis
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What is peak flow used for acutely
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Asthma - goes down with poor control
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What happens in CO poisoning in O2 saturation
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50% saturation
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How does a pulmonary emboli present on xray and how long does it take to appear this way
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It appears as a wedge shape of consolidation on xray and it takes about 2-3 days for this to show up
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What is the only micro-organism that is seen on the upper lobe of the lung
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TB
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What do you do if you see something suspicious on an xray of the chest
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CT scan
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What is albuterol and what is it used for? Why does it work
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Albuterol is a beta adranergic agonist and therefore works as a parasympathetic mimetic to cause bronchodialation. It is used for asthma, especially exercise induced.
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What is phenylephrine
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Sympathomimetic - Simulates α1 receptors causing vasoconstriction. Used for Hypotension. can cause Arrythmia, anaphylaxis, asthmatic episodes, headache.
Do not use with MAO inhibitors! |
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What is Pseudoephedrine
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Decongestant
Simulates α1 receptors in respiratory tract causing vasoconstriction Don't use with MAO inhibitors! |
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Glucocorticoids
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End in ‘sone’ ‘onide’ or ‘zone’..
Decrease respiratory irritation and inflammation Use with bronchodialators |
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What are the side effects of glucocorticoids
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Water retention and CV problems; long term osteoporosis, peptic ulcer
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What is the inhaler that should be used in a rescue situation
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Epinephrine, Albuterol,
Don't use a steroid, b/c it won't work in time!!! |
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How does consolidation sound on percussion of the lungs
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Dull
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What direction does the trachea move in atalectasis
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It moves towards the effected lung
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What direction does the trachea move in a pneumothorax
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It moves away from the affected lung - imagine an air space filled lesion
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Describe findings of a Pneumothorax
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breath sounds with hyperresonance to percussion
ABGs show hypoxemia; CXR shows free air and contralateral shift of mediastinal structures |
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What pattern does consolidation make in infectious pneumonia
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starts as lobular and becomes lobar, also tends to move from lower areas to upper areas
The more aggressive the more dangerous |
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What are the two most common types of pleural effusion
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Transudate (found CHF) (breaking of starling's forces) and Exudate (Found in infection) (high protein)
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What usually causes bronchiolitis
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Viruses
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What is the typical cause of acute bronchitis
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Viruses
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Is there consolidation in actue bronchitis
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No
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What are the most common pathogens that cause pneumonia
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Pathogens Strep pneumo, H. flu, Gram (-) bacteria, Moraxella catarrhalis, Staph aureus
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What population is Klebsiella pneumonia common in
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chronic alcoholics
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What population is pneumonia from E. coli is almost always assocaited with
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diabetes
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What agent are you most likely to see bilateral infiltrates in
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Mycoplasma pneumonea (more common than typical pneumonia and aspiration pneumonia)
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How might pneumonia present differently in an elderly pt
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less severe symptoms and change in mental status
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When are the most common cause of lung abscess
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50% of lung abscesses are due to aspiration of bacteria when pt is recumbent e.g. coma, anesthesia, substance abuse or stroke or those with problems swallowing or coughing
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What are the symptoms of a lung abscess
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Symptoms include fever, chills, pain, weakness, wt loss and in 75% of cases foul or musty-smelling sputum mixed with blood
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What are the most common cases of TB
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Majority of new TB cases are reactivation of untreated tuberculous infection
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When should TB be on the DDX
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Pulmonary tuberculosis (disease) presents as a chronic pneumonia with fever, wt loss, night sweats and malaise; cough, sputum, hemoptysis and pleurisy
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What is seen in xray of a fungal ball
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Can see a ball that is in different areas when pt is in different positions
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Describe Cryptococcus neoformans
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Cryptococcus neoformans is an encapsulated yeast
Commonly found in pigeon droppings Portal of entry is the lung, but more commonly causes meningitis Can be asymptomatic; x-ray can show large solitary nodule, pneumonitis Dx by biopsy and culture; all pts with crypto pneumonia should have LP to r/o meningitis Amphotericin B is Rx |
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Describe Histoplasmosis
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Most common mycosis in US, found in Midwest and south central US
If symptoms do occur, will appear as “atypical pneumonia”; patchy infiltrates on x-ray,with hilar or mediastinal adenopathy, flu-like symptoms X-rays show apical lung lesions, cavitation and fibrosis; calcifications are seen in> 75% Dx is by sputum culture or biopsy; serology is less useful than with coccidioidomycosis |
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What fungal infection should be considered in a After an incubation pd of 7-28 days, fever, malaise, dry cough, chest pain, night sweats and anorexia may develop seen after rain storm
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Coccidioidomycosis - Valley Fever found in South West
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Describe Aspergillosis
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Soil pathogens; airborne route (outbreaks have occurred in hospitals related to construction)
After inhalation, aspergillus can colonize preexisting pulmonary cavities or bronchi leading to fungus balls X-ray makes diagnosis; shows solitary lesion, 3-5 cm in diameter, round intracavitary mass Sputum culture + in 50% of cases; antibodies seen in > 90% |
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Describe Asthma
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episodic Wheezing, non-productive cough, dyspnea w/o COPD that gets better with vasodialtors.
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In asthma like symptoms w/o a foreign body what do you need to r/o
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you NEED to r/o tumor in the lung
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What is specific to asthma and lung fnx
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Lung fnx is normal between attacks
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What conditions can mimic asthma
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CHF
PE GE reflux Foreign body aspiration Upper airway obstructions that cause stridor e.g. tumors, tracheal stenosis |
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What drugs can induce asthma
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Drug induced: ASA, NSAID’S, beta blockers, histamine
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What are the top ddx for hemoptysis and what should be done first to r/o these two things
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TB lung cancer
do a chest xray |
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What are the time criteria for cough
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acute < month
sub acute 1-2 months chronic > 2 months |
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What is the definition of a chronic cough
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(over 15 y/o) Any cough lasting longer than 8 weeks
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who do we do a chest xray in?
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Pneumonea
Hemoptosis Cough > 3 weeks |
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Common causes of chronic cough
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Post nasal drip
Asthma GERD Smoker ACE inhibitor |
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“pink puffers”
Normal pCO2 Permanent dilation of part or all of the acinus with eventual destruction of alveolar walls; Cigarette smoking or def. of serum alpha 1 protease inhibitor in non-smokers; Barrel chest, pursed lips, slow forced expiration |
Emphysema
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Why is COPD the #1 cause of Reactive Polycythemia
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B/C they produce a lot of errythropoiten
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“blue bloaters”
Increased pCO2 Persistent cough with sputum for at least 3 mos in at least two consecutive yrs; Obese, cor pulmonale, cyanotic Do not retain hypercapnic drive to breathe |
Chronic Bronchitis
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In a pt with chronic bronchitis who suddenly develops a fever and a productive cough with sputum what is the concern
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AECB - Acute Exacerbation of Chronic Bronchitis
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What are the common causes of COPD
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SMOKING is most common cause of emphysema and chronic bronchitis
Occupational exposure may lead to emphysema Air pollution: minor factor in emphysema Alpha-1 ante-trypsin deficiency is hereditary cause of emphysema Familial tendency in emphysema and asthma |
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What is a normal O2 saturation
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High 90s to 100
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What populations are at risk for sleep apnea
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Children with reactive asthma
Obese people |
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what are the sx of ARDS
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shortness of breath
labored, rapid breathing low blood pressure or shock (low blood pressure accompanied by organ failure) often, persons affected by ARDS are so sick, they are unable to complain of symptoms |
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How can costochondritis be differentiated btw a heart attack
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press on the chest and this will make it worse if it is costo chondritis, MI won't be changed
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What remedies are good for coughs
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Antimonium tartaricum
Bryonia alba Cuprum metallicum Drosera rotundifolia Kali carbonicum Medorrhinum Nat Sulph Rumex crispus Phosphorus Sanguinaria canadensis Silica Spongea tosta Stannum Metallicum |
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Antimonium Tart
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Audibly rattling mucus in chest, can’t expectorate, bronchitis, asthma, pneumonia. WEAKNESS. Nausea
>Expectoration >Warmth < Lying Aversion to being looked at |
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Bryonia alba
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Dryness of synovia and mucus
membranes. Painful pleurisy. Pnful dry cough. |
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What is FVC
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Forced Vital Capacity is the amount of air a person can exhale after a full inspiration
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What is FEV1
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Volume of air exhaled in 1 second
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In Obstructive pulmonary dz is FEV1/FVC increased or decreased
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decreased b/c FEV1 gets smaller
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In Restrictive pulmonary dz is FEV1/FVC increased or decreased
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Unchanged or can go up b/c FEV1 & FVC both go down
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What condition does a person have if they have not had trauma but have hemoptysis and hematuria?
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Goodpasture's syndrome
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What sx are typically present with lung cancer
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hemotysis, chronic cough gradual progression, hx chronic smoke exposure, wt loss (unintentional)
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What should be on the ddx with someone with hemotysis
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Lung Cancer
TB Goodpastures |
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What should be at the top of your ddx if you have a pt with endocrine sx and hemoptysis
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Small Cell Bronhiocarcinoma
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What are some conditions caused by sleep apnea
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HTN, HA, ADHD like sx (in a child)
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What condition is pulmonary edema usually 2ary to
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CHF
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What % of costochondritis is B/L
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90%
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What is Plummer Vinson syndrome
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Upper esophageal webs
Iron def anemia add dysphagia |
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What are the non-small cell cancers of the lung
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adenocarcinoma
squamous/epipemoid large cell broncho-alveolar carcinoma |
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how does lung cancer present on plain films
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>2 cm
not calcified poorly defined margins crosses a fissure (ddx locculated pleural effusion) pt usually > 35 y/o |
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What type of conjunctivitis in the neonate is txed with silver nitrate drops
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gonococcal
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What does profuse d/c, mild puritis, conjuncitivis with lymphoblastic cells suggest
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Chlamydial
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What herb is good for conjunctivitis
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Euphedra
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What is dacryocystitis
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lacrimal sac inflammation
May express pus through punctum pn, local erythema, local edema, epiphoria, fever, conjunctivits |
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How does acute glaucoma present
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dilated pupil
extremely severe pn vision very blurry IOP elevated |
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ophthalmoplegia (paralysis of eye mm)
ptosis, purulent d/c unilateral fever HA eyelid edema and erythema |
orbital cellulitis
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Causative agents for orbital cellulitis
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Strep or staph
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How is Orbital cellulitis managed
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referral to the ER or specialist
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pnless vision loss
blurred vision halos around lights absense of red reflex sight worse than 20/30 and not corrected with glasses |
Cataract
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What is the most common type of glaucoma
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open angle
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What is a chalazion
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Meibomian cyst - chronic enlargement of the meibomian cyst
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What are cotton wool spots and lipid deposits seen in
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diabetic retinopathy
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of the two types of glaucome which is a medical emergency
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angle closure - rare
optic cupping, mydriasis, inflammation of conjunctiva |
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What is another name or a stye
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hordeolum
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Piguecula
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white yellowish benign neoplasm of conjunctive - does not invade the cornea
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Conductive loss - findings with Renni and Webber
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Webber - hear better in effected ear
Renni - negative BC>AC or BC=AC |
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Sensory loss - findings with Renni and Webber
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Webber - better in unaffected ear
Renni - post AC > BC |
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What is the concern with red (erthroplasia) leukoplakia
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usually malignant
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What is hairy leukoplakia
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EBV induced dysplastic condition of the tongue
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Unilateral, severe pain
rapid loss of vision nausea & vomiting. Prodromal symptoms: transitory episodes of diminished visual acuity, colored halos around lights and pain in eye and head. Signs: Hazy cornea (Hypopion), fixed mid-dilated pupil, eye is usually firm to palpation |
Acute closed angle glaucoma
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proptosis, ophthalmoplegia, and edema and erythema of the eyelids. The patient also exhibited pain on eye movement, fever, headache, and malaise.
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orbital cellulitis
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What are possible causes of chronic uveitis
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Bechet’s, IBD, Juvenile RA, Reiters, Sarcoidosis, Syphilis, Tuberculosis, and Lyme’s disease, AS
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Photophobia, pain, excessive tearing, boring eye pain, foreign body sensation, and periorbital radiating pains. Visual acuity may be unaffected, but accommodation is typically painful. Ciliary injection is present, as well as protein and inflammatory cell matter in the aqueous.
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Uveitis - needs to be tx with something that will paralyze eye then topical steroids
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Most asymptomatic (early)
Slow progressive loss of peripheral vision and when uncontrolled, late loss of central vision and ultimate blindness. Possible early indications, frequent glass changes, mild headaches, vague visual disturbances, halo’s around lights, impaired dark adaptation. Scotomas (areas of absent or reduced vision) present. Signs: 1. Intraocular pressure rises gradually (elevated slightly 22-30 mm HG or markedly 30-45 mm Hg) or a difference of 5 mmHg between eyes. A single normal reading does not rule out glaucoma. 2. The fundus shows nasal displacement of the vessels 3. Enlargement of the cup:disc ratio (0.5 or greater) or a difference of between eyes 4. Temporal pallor of the optic nerve |
Chronic open angle glaucoma
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What type of vision loss is seen in Macular degeneration
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central
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What type of vision loss is seen in Glaucoma
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peripheral
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ND tx for macular degeneration
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Taurine – found in high concentrations in the eye, may be protective on retina – Marz
2. Zinc (90-120 mg zinc picolinate) – Marz 3. Selenium IV or oral – Marz 4. Anti-oxidants: protective against oxidative damage, low levels may increase risk 5. Carotenoids: Protective effect on retina. 6. Vitamin C & E 7. Vitamin E |
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What is a normal artery to vein ratio in the eye
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A normal ratio is Artery to Vein 4/5
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What is seen in HTN retinopathy
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cotton wool spots and flame shaped hemorrhages. In advanced cases, there will be a macular star (ring of exudates from the disc to the macula) and disc edema.
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ND tx for DM retinopathy
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Vitamin C to bowel tolerance
-- Bioflavinoids, especially Rutin, @ 1000 to 2000 mg / tid -- Vitamin E @ 800 to 1200 iu / d -- Co-Q-10 @ 75 - 200 mg / d -- Taurine @ 1000 mg / bid -- EPA / DHA 2 – 6 grams daily -- Chromium @ 300 to 450 mcg / bid - tid -- Zinc @ 50 to 100 mg / bid -- Magnesium (citrate) @ 150 to 250 mg / bid -- Selenium @ 100 mcg / bid |
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Reports of sudden onset of single or multiple floating spots, and flashes of light. Recent Hx of trauma to the head or eye is common. A vitreous hemorrhage will produce multiple floaters. The vision loss will range from severe to none.
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Retinal detachment
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RETINITIS PIGMENTOSA
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Slowly progressive, bilateral, loss of night vision. A ring scotoma is often present on perimetry, which tends to widen, decreasing central vision. Dark “bone- spicule” pigmentary changes are often present in the retina.
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What must be done with a recurrent chalazia
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Biopsy recurrent Chalazia, to R/O Sebaceous gland carcinoma
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What CI are there to be concerned with diphenydramine
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MAO inhibitors
acute glacoma PUD elderly bronchial asthma pneumonia seizures |
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What conditions are chronic obstructive pulmonary dz
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Asthma
Chronic Bronchitis Emphysema Cystic Fibrosis |
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What is fluticasone and what is it use for
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corticosteroid
Asthma CI - status asthmaticus, Pregnancy |
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What lung conditions are restrictive
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Pneumoconiosis
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