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212 Cards in this Set
- Front
- Back
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inc in A-a gradient means hypoxemia of what origin
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pulmonary
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norm A-a gradient means hypoxemia of what origin
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extra-pulm
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Specific A-a gradient indicating pulm def
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30 mmHg
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PAO2 calculation
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% O2 x 713 - PaCO2/.8
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inc A-a gradient etiologies 4
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vent defect, perfusion defect, diffusion defect, R->L shunt
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norm A-a gradient etiologies 3
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depressed resp center, upper airway obstruction, chest bellow dysfxn
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DDx dyspnea 4
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dec compliance, inc airway resistance, chest bellows dz, interstitial infl/fluid accumulation
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most common cause of cough
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post nasal drip
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nocturnal cough with GERD due to
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acid reflux in tree
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most common cause of hemoptysis
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chronic bronchitis
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4 signs of PA
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dec percussion, inc tactile fremitus, E->A egophany, pectosililoquy
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signs of PA but not pleural effusion
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inc tactile fremitus, E->A egophany, pectosililoquy
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bronchial breath sounds: 3
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loud, high pitch, E > I
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vesicular breath sounds 1
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I:E 3:1
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bronchovesicular breath sounds 1
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I = E
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crackles caused by
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edema
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wheezing caused by
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constriction of airways (edema, infl)
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rhonchi caused by
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secretion in large airways
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inspiratory stridor caused by
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upper airway obstruction
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pleural friction rub caused by
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2 inflamed surfaces rubbing against each other
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grunting in newborns after 24 hrs
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RDS
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high pitched inspiratory sound
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stridor
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high pitched expiratory sound
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wheezing
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low pitched insp/exp sound
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rhonchi
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Resp curve shifts left of norm with
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obstructive dz
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resp curve shifts right of norm with
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restrictive dz
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nonuniform emptying on resp curve
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obstructive dz
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cyanosis while breast feeding; crying makes pink again
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choanal atresia
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most common polyp in adults
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allergic polyp
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triad asthma
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aspirin, nasal polyp, asthma
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is triad asthma IgE mediated?
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no
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first step of Tx in child with nasal polyp
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sweat test
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lab findings of OSA?
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apnea causing resp acidosis & hypoxemia
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confirmatory test for OSA
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polysomnography
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OSA is a risk factor for
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cor pulmonale
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most common cause sinusitis
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viral URI
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sinus inf in adults most likely
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maxillary sinus
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sinus inf in child most likely
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ethmoid sinus
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most common bact inf causing sinusitis
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pneumococcus
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sinusitis is
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blockage of sinus drainage into nasal cavity
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gold standard for bact culture in sinusitis
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sinus aspiration
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when use CT for sinusitis
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pre-surgery
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EBV in chinese and African pop is a risk factor for
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nasopharyngeal carcinoma
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most common cause laryngeal carcinoma
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cigarette smoking
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what has synergistic fx w/ smoking for most resp CA
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alcohol
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majority laryngeal carcinomas patho
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keratinizing sq cell carcinoma on true vocal cords
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Sx of laryngeal carcinoma 2
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persistant hoarseness; cervical LAD
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most common cause fever 24-36 hr after surgery
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resorption atelectasis
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dullness to percussion, absent vibratory sounds, absent breath sounds
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resorption atelectasis
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3 risk factors for RDS
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permature, DM, C-section
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RDS is what kind of V/Q defect?
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perfusion w/o vent (intrapulm shunt)
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collapsing pressure eqn
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collapsing pressure = surface tension/radius
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grunting, tachypnea, intercostal retraction in NB
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RDS
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O2 complications of RDS 5
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blindness, bronchopulm dysplasia, PDA, necrotizing enterocolitis, hypoglycemia
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CXR with RDS
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diffuse ground-glass
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most common cause pulm edema
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LHF
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risk factor for ARDS 3
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sepsis, gastric aspiration, severe trauma
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patho for ARDS v. RDS
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neutrophilic destruction of type II pneumocytes dec surfactant
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DDx ARDS from cardiogenic pulm edema
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wedge pressue < 18 mmHg
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most common cause community-acquired PA
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pneumococcus
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bronchopneumonia v. lobar PA
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broncho = diffuse and patchy; lobar = consolidated, confined
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what's more useful for Dx PA - gram stain or culture
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positive gram stain
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most common cause atypical PA
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mycoplasma
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other pathogens for atypical PA
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legionella, c. pneumoniae, c. trachomatis
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most common cause nosomial PA
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pseudomonas, E. coli
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water-loving bacteria in PA
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pseudomonas, Legionella
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PA in AIDS
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pneumocystis
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TB in the apex is
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REACTIVATION
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TB in middle of lung is
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primary
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Pott's dz is
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TB in vertebrae
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lung abscess most often due to
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aspiration oropharyngeal material
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bact in lung abscess
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usu mixed an/aerobic
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cavitation and fluid level on CXR
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lung abscess
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site of aspiration when supine
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superior segment of R lower lobe
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site of aspiration when sitting, standing
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posterobasal segment of R lower lobe
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site of aspiration when lying on R side 2
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post segment of R upper lobe, R middle lobe
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site of aspiration when lying on L side
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lingula
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what vessels protect lung from infarct
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bronchial arteries
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small emboli produce what type of infarct
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small, wedge-shaped (hampton's hump)
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gold standard for pulm infarct
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pulm angiogram
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key Dx test for pulm infarct 3
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V/Q scan, spiral CT, D-dimers
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primary PHTN more commin on F or M
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women
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main cause of secondary PHTN
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resp acidosis & hypoxemia (cause SM hyperplasia/trophy)
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most common Sx of PHTN
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exertional dyspnea
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CXR of PHTN
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tapering pulm arteries
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In Goodpastures, what often precedes renal failure
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pulm hemorrhage
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compliance deals with
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filling (inspiration)
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elasticity deals with
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emptying (expiration)
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restrictive lung dz fx on compliance, elasticity
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dec compliance, inc elasticity
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FEV1 in RLD is
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dec
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FVC in RLD is
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dec (more so than FEV1)
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Resp alkalosis or acidosis in restrictive lung dz
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alkalosis (CO2 can get out just fine)
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pneumoconiosis is
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inhalation of mineral dust
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Caplan syndrome is
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pneumoconiosis + rheumatoid nodules in lung
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particles 1-5 mm get stuck where
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resp bronchiole bifurcation, alv ducts
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particles < 0.5 mm get stuch where
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alveoli
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inhalant in coal worker's pneumoconiosis
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coal dust (anthracotic pigment)
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occupations related to CWP 3
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coal mines, large urban center, tobacco smoke
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dust cells are
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alveolar macrophages with anthracotic pigment (coal dust)
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black lung dz is really
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complicated coal worker's pneumoconiosis
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DDx of simple v. complicated CWP
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complicated > 1 cm
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CWP relation to TB, CA
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no relation
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most common occupational dz
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silicosis
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inhalant in silicosis
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quartz
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occupations related to silicosis 3
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foundries, sandblasting, mines
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CXR finding in silicosis
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egg shell calcification (rimmed dystrophic)
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silicosis relation to TB, CA
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inc risk lung CA and TB in silicosis
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inhalant in absetosis
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asbestos
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occupations related to asbestos 4
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pipes in naval ships, roofing, tiling, building demolition
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ferruginous bodies are
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Fe-coated asbestos fibers
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relation of absetosis & TB
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no inc risk
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most common lesion of asbestos
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BENIGN pleural plaques
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most common CA related to asbestos
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bronchogenic carcinoma
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inhalant in berylliosis
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beryllium
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occupations related to beryllium 2
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nuclear, aerospace
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inc risk of which CA with berylliosis
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1o lung CA
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epidemiology of sarcoidosis
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black female
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primary target organ of sarcoidosis
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lung
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most common Sx assoc w/ sarcoid
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dyspnea
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most common noninfectious dz of lung
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sarcoidosis
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most common noninfectious dz of liver
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sarcoidosis
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Sx of sarcoid 5
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dyspnea (most common), blurry vision uveitis, inc ACE, hypercalcemia (hypervitaminosis D), potato nodes (large hilar nodes)
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honeycomb is seen in
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prox dilation, IPF
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young woman with pleuritis -> pleural effusion
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SLE
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collagen vasc dz assoc w/ interstitial fibrosis
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SLE, SS
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HSR pneumonitis in farmer 2
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farmer's lung; silo filler's dz
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Patho for farmer's lung
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Type 3 & 4 HSR to thermophilic actinomycetes in moldy hay
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patho for silo filler's dz
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HSR to nitrous oxides inhalation from plant material
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HSR pneumonitis in textiler
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byssinosis
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patho for byssinosis
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HSR to bact endotoxin on cotton (goes away over weekend)
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radiation-induce lung dz occur
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1-6m s/p Tx
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obstructive lung dz fx on compliance & elasticity?
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inc compliance; dec elasticity
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FEV1 in OLD is
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dec much
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FVC in OLD is
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dec
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FEV1/FVC in OLD is
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dec b/c FEV1 so low
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CXR of COPD: 4
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hyperlucent, inc AP, vertically oriented heart, depressed diaphragm
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most common cause emphysema
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cigarette smoking
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mech of cig smoke causing emphysema
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neutrophils inactivate AAT and GSH
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air trapping in emphysema
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during expiration, collapsed distal bronchiole
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centriacinar emphysema occur in which lung lobe
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upper lobe
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centriacinar emphysema occur in which part of tree
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resp bronchioles
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panacinar emphysema occur in which lung lobe
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lower lobe
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panacinar emphysema occur in which part of tree
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entire resp unit (resp bronchioles down)
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panacinar emphysema show loss of which peak on serum protein electrophoresis
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a1-globulin pk
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which type of emphysema frequently coexists with chronic bronchitis
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centriacinar
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AAT def genetics
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auto dom
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AAT def demonstrate which type of emphysema
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panacinar
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paraseptal emphysema localized to
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subpleural location
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paraseptal emphysema is risk for
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spontaneous PTX
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irregular emphysema is assoc with
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scar tissue
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chronic bronchitis (CB) defined as
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cough 3+ m x 2 consecutive years
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most common cause CB
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cigarette smoking
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CB patho
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mucus hypersecretion -> terminal bronchiole obstruction -> irreversible fibrosis
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mucus hypersecretion in CB caused by 2
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globet cell metaplasia; mucus gland hypertrophy
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cor pulmonale more assoc w/ CB or emphysema
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CB
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DDx emphysema v. chronic bronchitis 3
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Emphysema have norm to dec PCO2, later hypoxemia onset, earlier dyspnea onset
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extrinsic asthma patho
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Type 1 HSR
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intrinsic asthma patho
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non-immune: viral-induced, air pollutants, NSAID, stress, exercise etc
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bronchoconstriction mediated by? 2
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LTC-E, Ach
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histo changes in bronchi of asthmatic 4
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thickened BM, infl, mucosal hypertrophy, SM hyperplasia
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Shed epithelial cells seen in asthma
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Curshmann spirals
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bronchial asthma initial pH status
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alkalosis (pt work hard to expel air)
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bronchial asthma req intubation if
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resp acidosis occurs
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define bronchiectasis
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permanent dilation bronchi/oles
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most common cause bronchiectasis in US
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cystic fibrosis
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most common cause bronchiectasis worldwide
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TB
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primarily cilia dyskinesia patho
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absent dynein arm in cilia
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dilated bronchi extending to periphery is
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bronchiectasis
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Cupfuls of productive sputum
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bronchiectasis
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Sx of bronchiectasis
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huge production, digital clubbing, cor pulmonale
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genetics of CF 2
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auto R; 3 nuc del on chr 7 -> missing phe
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patho CF 4
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Defective CFTR -> dec NaCl resorption in sweat glands -> inc Na resorption & dec Cl secretion in luminal secretion -> dehydrated ducts
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Dx CF
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sweat test
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NB screen for CF
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inc serum immunoreactive trypsin
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CA that's dec in men but inc in women
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smoking
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centrally located lung CA 3
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SCC, SCLC, carcinoid
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peripherally located lung CA 3
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adenocarcinoma, LCLC, bronchial hamartoma (usu)
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solitary pulm nodule/coin lesion most often are
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granulomas
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most important initial step in solitary coin lesion work up
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compare previous CXR for changes in size
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most common CA in lung
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mets
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most common mets in lung
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breast
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lung CA more common in women 1
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adenocarcinoma
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lung CA more common in men 2
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SCC, SCLC
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in bronchioalv adenocarcinoma, malig cells spread along
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alv walls (look like pegs)
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CA that radiologically mimics lobar PA
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bronchioalv adenocarcinoma
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bronchioalv adenocarcinoma derived from
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Clara (nonciliated) cells
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most common presenting Sx in bronchial carcinoid tumor
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hemoptysis
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lung CA ectopically secreted ACTH
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SCLC
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lung CA ectopically secreted ADH
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SCLC
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lung CA ectopically secreted PTHrP
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SCC
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scar adenocarcinomas seen in nonsmoker?
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yes; CA form in scar tissue - no relation to smoking
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undifferentiated lung CA w/ early mets & no relation to smoking
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LCLC
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lung CA arising from neuroendocrine cells
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SCLC
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most common primary lung tumor in children
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bronchial carcinoid
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most common site of mets in lung
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parenchyma
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popcorn calcifications
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bronchial hamartoma
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Horner syndrome assoc w/
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Pancoast tumor (destroy sup cervical SNS ganglion)
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Horner syndrome triad
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lig lag, miosis, anhydrosis
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Eaton-Lambert syndrome often assoc w/ which CA
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SCLC
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most common site for mediastinal masses
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ant compartment
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most common mediastinal mass in post compartment
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neurogenic tumor
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most Sx in thymomas assoc w/
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myasthenia gravis
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most common cause pleural effusion
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CHF
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most common cause pleural exudate 2
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TB & malig
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most common cause chylous pleural effusion
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malig
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pleural effusion in RA
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pseudochylous (inc chol in pleural fluid)
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additional criteria to differentiate transudate v. exudate in pleural effusion
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pH (transudate basic to blood)
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CXR findings in pleural effusion 2
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blunted costophrenic angle; diaphragm obscure
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PTX common in tall, thin, young men
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spontaneous PTX
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patho of spont PTX
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rupture of apical subplerual bleb
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most common secondary cause spont PTX
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emphysema
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patho of tension PTX
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trauma creates flap that lets in but not out
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