Pulm Final

Front 1

How are the 2 kinds of CA staged?

Back 1

i)NSCLC: TNM ii)SCLC: a)ltd: chest + supraclav nodes (no cervical or axillary). b)extensive: outside of ltd

Front 2

How do you DX effusion? x3 What is thoracentesis good for? x2

Back 2

i)CXR: blunted costophrenic angle. lateral decubitis is better for small effusions and if loculated vs free flowing ii)CT: better than CXR iii)thoracentesis: a)drains b)4 C's: chemistry (glucose/protein/LDH/pH); cytology; cell count (CBC w/diff); culture (gram)

Front 3

how does IPF present and what is px? Who is it common in?

Back 3

i)gradual onset of progressive dyspnea, nonprod cough. ii)very bad iii)men and smokers

Front 4

How to DX bronchiectasis? x3

Back 4

i)PFTs: obstructive ii)CT scan is study of choice iii)CXR nonsp but abnl. iv)bronchoscopy sometimes

Front 5

How to dx for sarcoid? x4

Back 5

Definitive dx: transbronchial BX: noncaseating granulomas. i)CXR: *bilat hilar lymphadenopathy ii)ACE is elevated iii)hypercalciuria/calcemia iv)Decr FEV1/FVC; decr lung vol; decr DLCO

Front 6

How to treat empyema? x3

Back 6

i)aggressive drainage of pleura and Abx ii)if severe and persistent, rib resect and open drainage

Front 7

How to treat parapneunic effusion? uncomplicated vs complicated?

Back 7

i)uncomp: Abx alone ii)compl: a)chest tube drainage b)intrapleural injection of thrombolytic agents(streptokinase) c)surgical lysis of adhesion

Front 8

How to treat sarcoid?

Back 8

i)most resolve on own ii)steroids if pt w/severe eye dz, heart block, serious lung dz iii)MTX if steroids refractory

Front 9

How to treat tension pneumothorax? Why imp?

Back 9

i)tension in pleural space not relieved->hemodynamic compromise (hypoxemia). ii)chest decompression w/large bore needle, then chest tube placement

Front 10

Wha is cause of empyema? x2

Back 10

i)usually untreated parapneumonic effusion (exudative). ii)other foci of infection like abscess or mediastinitis

Front 11

What are 2 sxs of effusion? What are 3 signs?

Back 11

i)a)dyspnea on exertion b)PND/orthopnea c)peripheral edema ii)a)dull to percussion b)decr breath sounds over effusion c)decr tactile fremitus

Front 12

What are causes of bronchiectasis?x4

Back 12

i)CF ii)infection iii)humoral immunodef (abnl lung defense) iv)airway obstruction

Front 13

What are causes of exudative pleural effusion?x4

Back 13

i)Malignancy (esp lung and breast). ii)bacterial pneumonia iii)PE iv)Collagen vasc dz

Front 14

What are causes of tension pneumothorax? x3

Back 14

i)mechanical ventilation w/ass'd barotrauma ii)CPR iii)trauma

Front 15

What are clinical features of empyema? how to DX?

Back 15

i)those of the underlying cause (ie pneumonia). ii)CXR and CT scan

Front 16

What are clinical features of mediastinal mass? x5

Back 16

i)cough (compressed bronchi/trachea) ii)CP iii)dysphagia iv)SVC syndrome v)compression of nerves (hoarse, Horners, hemidiaphragm paralysis via phrenic)

Front 17

What are clinical features of tension pneumothorax? x4

Back 17

i)hypotension: cardiac filling impaired due to compression of great veins ii)distended neck veins iii)decr breath on side collapsed; hyperresonance

Front 18

What are complications of asthma? x3

Back 18

i)status asthmaticus: no response to std meds ii)acute resp failure iii)pneumothorax, atelectasis, pneumomediastinum

Front 19

What are secondary treatment options besides drugs for COPD? x3

Back 19

i)O2 therapy: improves survival and quality of life in COPD and hypoxemia. It will decr pulm HTN and cor pulmonale b/c hypoxemia leads to that; need ABG to determine need for O2. ii)vaccinate against Strep pneum iii)SX: resect or xplant

Front 20

What are signs of cor pulm?

Back 20

i)loud P2, ii)paradoxical S2 split iii)EKG changes

Front 21

What are signs of ILD? x3

Back 21

i)rales at base ii)digital clubbing iii)signs of pulm HTN and cyanosis

Front 22

What are Sxs of local invasion in lung cancer? x6

Back 22

i)phrenic nerve palsy ii)hoarseness (Recurrent laryngeal) iii)Pancoast iv)Horner's v)malig effusion vi)SVC syndrome

Front 23

What are sxs of pneumothorax? x2 What are signs? x4

Back 23

A)i)ipsilateral CP, usually sudden ii)cough B)i)decr fremitus on that side ii)hyperresonance iii)decr breath sounds iv)mediastinal shift towards pneumothorax

Front 25

What are symptoms of sarcoid for each system involved? What are systems involved (x5) and what is cause of death of sarcoid?

Back 25

i)constitutional sxs: malaise, fever, wt loss. ii)lungs: dry cough, dyspnea. iii)skin: erythema nodosum iv)eyes: ant uveitis v)heart: arrhythmia or sudden death vi)arthralgias

Front 26

What are the 6 types of ILD? What are exs of each?

Back 26

i)Environmental lung dz: silicosis, asbestosis ii)Granulomatous ILD: sarcoid; wegener's; Churg Strauss iii)Aveolar filling dz: goodpastures iv)hypersensitivity lung dz: hypersen pneumonitis; eosino pneumonitis v)drug induced; vi)misc: IPF; ARDS; ILD ass'd w/CT disorders

Front 27

What are the causes of elevated pleural fluid amylase? x3

Back 27

i)esophaeal rupture ii)pancreatitis iii)malignancy

Front 28

What do you give for acute exacerbation in COPD?

Back 28

1st: B agon/anticholin->systemic steroids and ABX. Give O2 to keep O2>90%. Use Noninvasive PPV to help in acute exacerbations. Intubate and mech ventilate if these don't stabilizeDon't give B block in acute COPD or asthma exacerbations.

Front 29

what is a risk factor for COPD besides smoking, A1AT, and environment

Back 29

asthma

Front 30

What is Churg Strauss Syndrome? how does it present x3? What are its ass'n for DX? How to treat?

Back 30

i)vasculitis w/asthma ii)a)pulm infiltrates b)rash c)eosinophilia. iii)a)blood eosinophilia b)P-Anca iv)steroids

Front 31

What is clinical pic of Eaton Lambert Syndrome x3

Back 31

i)paresthesias ii)decr DTR iii)prox muscle weakness/fatigability

Front 32

What is COP? How to treat?

Back 32

i)inflamm lung dz w/similar clinical and radiographic features to infectious pneumonia. ii)resistant to Abx but treat w/steroids. iii)ass'd w/virus, meds, CT dz

Front 33

What is defn of chronic bronchitis? Of emphysema?

Back 33

i)CB: clinical dx; chronic cough w/sputum for 3 mo/year for 2 years. ii)pathologic dx; permanent enlargement distal to TB due to destruction of alveolar walls

Front 34

What is defn of ILD?

Back 34

inflamm process of alveolar wall leading to fibroelastic prolif and collagen deposition->get distorted architecture, fibrosis, impaired gas xchange

Front 35

What is diff b/w parapneumonic effusion vs empyema?

Back 35

parapneumonic is uninfected transudative effusion; empyema is infected parapneumonic effusion

Front 36

What is goodpastures due to and what does it lead to? How does it present? How does it get DXd? How to treat?

Back 36

i)autoimmune IgG to glom and alveolar BM (T2HS). ii)hemorrhagic pneumonitis and glomnephritis iii)present w/hemoptysis and dyspnea iv)anti-GBM Igs v)plasmapheresis, cyclophos, steroid

Front 37

What is histiocytosis X? What is ass'n? What are findings x4?

Back 37

i)chronic interstitial pneumonia caused by abnl prolif of histiocytes ii)smoking iii)a)dyspnea, b)nonprod cough, c)spon pneumothorax, d)DI

Front 38

What is hypersensitivity pneumonitis? What is hallmark finding? What does the acute form present as and what is treatment?

Back 38

i)inhaled antigenic agent->immune mediated pneumonitis->chronicity=restrictive lung dz. ii)IgG and IgA to inhaled Ag (can have Ig w/o dz tho) iii)flu like feature w/pulm infiltrates on CXR. iv)removal and steroids

Front 39

What is longterm tx of mod asthma? severe?

Back 39

i)mod: daily inhaled steroid OR cromolyn, methylxanthine, or antileukotriene. ii)high dose steroid OR long acting B agonist OR methylxanthine and PO steroid

Front 40

What is most common cause of mediastinal mass? What is most common according to location? x2 for each

Back 40

i)metastatic CA (esp lung). ii)a)ant: thyroid, teratogenic tumor b)Middle: lung Ca; lymphoma c)posterior: neurogenic; esophageal mass

Front 41

what is path of panlobular emphysema? Who gets it? Where in lungs?

Back 41

i)prox and distal acini ii)a1AT def iii)lung bases

Front 42

What is pathophys of exudative effusion?x2

Back 42

i)incr permeability of pleura ii)decr lymphatic flow bc damage to pleural membranes or vasculature (inflamm/malig)

Front 43

What is pathophys of tension pneumo and what happens?

Back 43

i)tissue around opening into pleural space is a flap->air in pleural space. ii)collapses opposite lung

Front 44

What is precipitant of bronchiectasis? x2 What happens?x2

Back 44

i)infection in patient w/airway obstruction; b) impaired defense or drainage. ii)a)permanent, abnl dilation and destruction of bronchial walls b)cilia are damaged

Front 45

What is primary spontaneous pneumothorax? What is it due to? How are the resp reserves?

Back 45

a)primary: no DZ (healthy peeps); due to rupture of sublpleural bleb at apex->collapsed lung. Pts have suff resp reserve.

Front 46

what are causes of 2ndary (complicated)pneumothorax? x4

Back 46

b)secondary (complicated): complication of lung dz (usually COPD; asthma, ILD, TB). Life threatening b/c Lack of pulmonary reserve

Front 48

What is Wegener's charaterized by? Where does it affect x3? What are manifestations x3? How to DX x2? how to treat?

Back 48

i)necrotizing granulomatous vasculitis ii)vessels of lung, kidney, upper airway iii)a)upper/lower RTI; b)glomneph; c)pulm nodules. iv)tissue BX. C-ANCA. v)steroids and immunosuppressants

Front 49

What local invasive/paraneoplastic sxs is SCLC ass'd w/? x4 Sq CC? x4

Back 49

i)Eaton Lambert; SVC; SIADH; ACTH secretion ii)SqCC: Pancoast; PTH pr; long bone pain

Front 50

What nerves does Pancoast affect? What are the sxs? x3

Back 50

i)C8 and T1-2. ii)a)pain in arm b)weakness in arm b/c brachial plexus c)Horner's ass'n

Front 51

What tests should be performed for lung cancer DX? x3 How are each imp?

Back 51

i)CXR: most imp radio study for DX: if stable for 2 years, benign. ii)CT scan: for staging (see mets and mediastinal lympadenopathy). iii)Needle BX: SCLC vs NSCLC

Front 52

Which procedures do you always need CXR b/c of traumatic pneumothorax?

Back 52

i)Central line ii)thoracentesis iii)transthoracic needle aspiration

Front 53

What kinds of test if dyspnea? x10

Back 53

i)Hx/PE w/VS. ii)pulse oximetry iii)ABG: a)If O2 sat low on pulsimetry b)hypercarbia suspected c)evaluate for acid base abnl iv)CXR: pneumothorax, effusion, infiltrates for ILD/pneumonia v)CBC: anemia, infection vi)EKG: IHD or ventricular hypertrophy vii)echo: evaluate CHF or valves viii)PFTs: if above are nl or ostructive lung dz suspect ix)VQ and spiral CT for PE x)FB aspiration=bronchoscope

Front 54

What are 2 causes of pulm HTN? 2 exs of each

Back 54

i)postcapillary causes: incr left side of heart->incr pulm venous pressure. MS, LV dysfcn. ii)mixed cap and precap causes: dz of lung parenchyma or pulm vessels (all obstructive and parenchymal dz). COPD, ILD

Front 55

What are complications of ARDS? x3

Back 55

i)permanent lung injury: honeycomb lung or scarred. ii)pneumothorax or pneumomediastinum due to mech ventilation: barotrauma due to hi press mech ventilation iii)nosocomial pneumonia b/c of ventilation. iv)line ass'd infections: central lines and pulm A catheters(line sepsis), urinary catheter (uti), nasal tube (sinus infection)

Front 56

What is gold std to DX PE? Other 4 tests that are good? What are they good for?

Back 56

i)pulm angiography: definitive dx or exclusion but invasive: last resort if serious case (unstable, risk of anticoag high, other test not good). ii)Spiral CT: best noninvasive test; C/I w/RF b/c of contrast. Good for small clots but not for peripheral. iii)VQ scan: if spiral is C/I; good sensitivity and treat w/Heparin. If intermediate result and high clinical suspicion, pulm angio. iv)D dimer: Sn; if normal results w/low suspicion, then PE is unlikely

Front 57

How to treat cor pulm? x3

Back 57

i)treat underlying d/o* ii)diuretics cautiously b/c pts might be preload dependent iii)apply O2 longterm if pt hypoxic

Front 58

How to DX pulm HTN? x2

Back 58

i)EKG: RVH->rt axis deviation and rt atrial abnl ii)echo: dilated pulm A; abnl movement of IV septum (b/c incr rt ventricular vol); rt heart cath=incr pulm A pressure

Front 59

How to treat hemoptysis x3?

Back 59

i)treat underlying cause ii)suppress cough if aggravates hemoptysis iii)correct bleeding diathesis (but anticoag is tx for PE)

Front 60

What is presentation of pulm aspiration?x3

Back 60

i)may develop acute resp distress w/no apparent cause or later develops resp dysfcn: cough, SOB, fever, tachypnea, frothy sputum. ii)obstruction w/wheezing iii)+/- fever

Front 61

How to DX respir failure? x4 What are mech for differential?

Back 61

i)ABGs: a)hypoxemia=VQ mismatch, shunt, hypoventilation. b)hypercapnia: hypoventilation c)pH: Resp acidosis w/hypercapnia, unless chronic b/c have compensation. ii)CXR or CT iii)CBC and metabolic iv)if cardiogenic edema: get cardiac enzymes

Front 62

What structures are necessary for maintaining normal respiration? x6 what are 2 causes for each?

Back 62

i)CNS depression or insult: drugs, stroke ii)neuromuscular dz: MG, ALS iii)upper airway: obstruction; paralysis. iv)thorax and pleura: mechanical restriction->kyphoscoliosis, hemothorax. v)CV/blood: a)CHF, b)valve dz, c)PE, d)anemia vi)lower airways/alveoli: a)asthma, b)COPD, c)ARDS

Front 63

How is ventilation monitored? How is oxygenation monitored? How are each changed?

Back 63

i)ventilation: by PaCO2, and to decr PaCO2, need to incr RR or incr TV (minute vent=RRxVT. ii)Oxygenation: by O2 sat and PaO2: decr PaO2 by decr FIO2 or PEEP. Ventilation and oxygenation are unrelated

Front 64

What does hypoxemia lead to? What does hypercapnia (and resp acidosis) lead to?

Back 64

i)irrevers damage to organs (esp CNS and CV system). ii)leads to dyspnea and vasodilation of cerebral vessels: incr ICP, H/A, papilledema, coma

Front 65

How to dx PPH (4)? What is best test?

Back 65

i)cardiac cath is best ii)CXR: large central PA; enlarged RV; clear lung fields. iii)PFTs=restrictive iv)EKG: rt axis deviation and RVH

Front 66

What is defn of acute resp failure? (gen defn and the criteria (x2))

Back 66

i)Gen: happens when there is inadequate O2 of blood or inadeq ventilation (lose CO2)or both. ii)a)hypoxia: PaO2<60mmHg and PaCO2 >50mmHg. b)hypercapnia: PCO2>50mmHg

Front 67

What ABG does hypoventilation lead to? Diffusion impairment? What are causes of hypercapnic respiratory failure? x3

Back 67

i)hypercapnia w/2ndary hypoxemia. ii)hypoxemia w/o hypercapnia. iii)sepsis, DKA, hyperthermia

Front 68

What are complications of mech vent? x5

Back 68

i)anxiety and discomfort: need Benzos for sedation; opioids for analgesia. ii)tracheal secretions: need suction iii)hypotension: incr intrathoracic pressures->decr venous return iv)tracheomalacia: softened tracheal cartilage. v)GI effects: ulcers and cholestasis v)ET doesn't prevent aspiration

Front 69

What is DDX for hemoptysis? x7

Back 69

i)*bronchitis ii)lung CA iii)TB iv)bronchiectasis v)pneumonia vi)Good pastures vii)PE w/pulm infarct

Front 70

How to evaluate pt w/hypoxemia?

Back 70

1st: elevated or non elevated PaCO2? i)nonelevated: A-a grad->if not, then low FIO2; if elev: give O2 and if not better, then shunt (vs VQ mismatch). ii)if elevated: hypoventilation->if Aa grad incr, then another mech is also present like shunt or VQ.

Front 71

What are clinical features of cor pulm? x4

Back 71

i)cyanosis and digital clubbing ii)parasternal lift iii)RVH iv)polycythemia if COPD is cause

Front 72

What are key parameters in mech vent? x4

Back 72

i)Minute vent (RRxTV): adjust to achieve baseline PCO2. Lower TV for COPD and ARDS. 10-12 br/min is good. ii)FIO2: start at 100% and titrate down when PO2 is >60 or O2sat 90%; If FIO2 .5 can't give good PO2, then add PEEP or CPAP (supports PO2 at lower FIO2). iii)Insp:Exp ratio: if incr time in insp, then decr time in exp (1:2 is good ratio). iv)PEEP: pos press maintained at end of passive exhalation to keep alveoli open. Used in ARDS

Front 73

How to DX pulm aspiration? WHat is seen?

Back 73

CXR: infiltrates like pneumonia. atelectasis and local areas of collapse may be present

Front 74

What are 3 dx modalities of ARDS? What do they show?

Back 74

i)CXR: diffuse b/l pulm infiltrates: diuresis improves and vol o/l worsens CXR, but CXR doesn't say if ARDS has improved. ii)ABG: PaO2<60; initial resp alkalosis PaCO2<40, but becomes acidotic. If septic, then may have met acidosis iii)PCWP: indir IV vol status->differentiates from cardiogenic (PCWP <18)

Front 75

What are the 3 info you need for mech of hypoxemia?

Back 75

i)PaCO2 level ii)Aa gradient iii)response to supplemental O2

Front 76

What are causes of ARDS? x5

Back 76

i)sepsis* (pneum, urosepsis, wound infect). ii)aspiration iii)trauma iv)pancreatitis v)intracranial HTN

Front 77

What are DX studies for hemoptysis x3

Back 77

i)CXR: indicates pathogenesis: opacity b/c of pulm infarct; granuloma, irreg mass. Does not exclude CA or PE. ii)fiberoptic bronchoscopy: used even if CXR normal if suspect CA. Or can localize site of bleeding. iii)CT chest: complement to bronchoscopy or substitute if C/I to bronchoscopy

Front 78

What is pathophys of PE? x2

Back 78

i)emboli block some of pulm vasculature->incr pulm A p; PVR; RVP. If large, can get cor pulm. ii)Get incr dead space w/ventilation but no perfusion->hypoxemia and hypercarbia cause tachypnea and tachycardia; if large->SOB.

Front 79

What is pathophysiology of ARDS? x4. What kinds of PFT is seen?

Back 79

i)*Widespread shunting of blood w/no improvement w/100% O2. Due to atelectasis, collapse of alveoli, surfactant dysfcn. ii)Interstitial edema and alveolar collapse due to incr lung fluid->stiff lungs, incr Aa grad, ineff gas xchange (same effects as cardiogenic pulm edema, but diff cause: cardio is b/c of HSP, whereas ARDS is incr cap permeability). iii)decr pulm compliance: incr WoB. iv)incr dead space: b/c of obstruction and destroyed pulm cap bed. v)Low VC, Low FRC

Front 80

How to treat ARDS?x5

Back 80

i)give O2; sat>90% ii)mech ventilate w/PEEP: opens alveoli and decr shunt iii)fluid manage: low IV vol (PCWP 12-15) but if septic, need more fluid. iv)tube feed nutrition v)treat the cause

Front 81

What are the 4 kinds of ventilator settings?

Back 81

i)Assisted controlled ventilation(resp failure): pt can go over determined rate but not under, and every breath over delivers predetermined tidal vol. ii)SIMV(failure and weaning): breath over the determined rate but the TV not determined; if not breathing, the ventilator gives predetermined breath. iii)CPAP(wean): Pos pressure delivered continously but pt breaths on own. Used to assess if pt can breath on own. Use PEEP or pressure support iv)PressSupportVent (wean): pressure delivered in response to initiated breath to enhance resp efforts. Can add PEEP

Front 82

What are clinical features of sarcoid lung? x3

Back 82

i)incr WoB: dyspnea, tachycard, tachypnea. ii)progressive hypoxemia: not helped by O2 iii)pt diff to ventilate b/c of high peak airway pressures b/c stiff, noncompliant lungs

Front 83

What are the sxs of PE? x3 Signs? x3

Back 83

i)a)Dyspnea b)pleuritic CP c)cough ii)a)tachypnea b)rales c)tachycardia. 1/3 of PE pts have signs and sxs of DVT

Front 84

What are adv to PEEP? x3 What are disadv?x2

Back 84

A)i)incr lung compliance and oxygenation: improves gas xchange. ii)prevents alv collapse and atelectasis B)i)barotrauma->pneumothorax. ii)low CO b/c decr venous return, esp if hypovolemic. This is b/c PEEP (like any pos intrathoracic pressure) lowers venous return and incr Pulm VR.

Front 85

What is pathophysio of shunt? What are causes x3?

Back 85

i)Little ventilation in perfused areas (b/c collapsed or fluid filled alveoli)->venous blood shunted to arterial side w/o O2. ii)a)atelectasis b)fluid build up: pnemonia or edema c)congenital dz causing rt to left flow

Front 86

What are 5 risk factors for DVT/PE?

Back 86

i)malignancy ii)hypercoag states iii)CHF iv)nephrotic syndrome v)trauma or SX

Front 87

How to DX cor pulm? x3

Back 87

i)CXR: enlarged RA, RV, pulm A's. ii)EKG: rt axis deviation and RVH; "P pulmonale" (peaked P waves). iii)echo: RV dilated w/nl LV size and fcn (to exclude LV cause)

Front 88

What is TX of pulm aspiration?

Back 88

i)If see aspiration: a)ABCs b)O2 c)supportive ii)if aspiration pneumonia suspected, give ABx (don't give prophylactically if aspirate) iii)prevention: keep head elevated, NG tube to decompress stomach

Front 89

What are the 6 pathophysiologic of pulm HTN causes? 2 exs of each?

Back 89

i)passive type: resistance to pulm venous drainage (no dz in pulm vasc bed): MS, LVF. ii)hyperkinetic type: high pulm blood flow (L-R cardiac shunts). VSD, ASD. iii)obstructive type: resistance to flow thru large pulm A's->PE, stenosis of pulm A. iv)obliterative type: resistance to flow thru small pulm vessels (arterioles) due to some parenchymal inflamm leading to fibrosis; PPH, Coll Vasc Dz. v)vasoconstrictive type: resistance to flow due to hypoxia induced vasoconstriction; chronic hypoxemia causes, COPD. vi)increased intrathoracic pressure: mech vent w/PEEP, COPD. vii)increased blood viscosity: P vera

Front 90

What is TX for PE? x5

Back 90

i)O2 for hypoxemia ii)Heparin immediately if suspicious->1.5-2.5 aPTT; C/I: active bleeding, uncontrolled HTN, recent stroke, HIT. iii)Warfarin to INR 2-3 x3-6 mths. (lifelong if hypercoag state or malignancy). iv)thrombolytics: a)massive PE who are unstable b)evidence of RHF (they reverse it). v)IVC filter: if C/I anticoag; current complication w/anticoag; pt w/low pulm reserve who may die

Front 91

What are 2 types of Noninvasive pos pressure ventilation-NPPV? What is diff? What is the indication of NPPV? Who does it work best in? What must be intact to use it--if not, then use what

Back 91

i)CPAP vs BIPAP. BIPAP has diff insp and expir pressures. ii)pt in impending resp failure to avoid intubation and mech ventilation. iii)hypercarbic resp failure (esp COPD). iv)a)neuro intact b)awake and cooperative c)can protect airway. v)intubate and mechanical ventilation

Front 92

What are 3 causes of pulm aspiration and which lung does it go to?

Back 92

i)a)acidic gastric contents: damaging to lungs b)aspiration of oropharyngeal flora c)FB/fluid aspiration. ii)rt lung b/c of more straight (lower segments of upper lobe and upper seg of lower lobe)

Front 93

What is Cor pulmonale? What are 4 causes?

Back 93

i)rt sided LVH 2ndary to HTN (RVH 2ndary to pulm htn). Not due to causes of pulm HTN 2ndary to L sided dz. ii)a)COPD* b)recurrent PE c)ILD d)asthma

Front 94

What are 2 causes of pulm aspiration?

Back 94

i)GERD ii)Neuromuscular dz

Front 95

What is ARDS? what is the primary mechanism? Is it a primary dz?

Back 95

i)diffuse inflamm process (not only infectious) involving both lungs. ii)neutrophil activation in systemic or pulmonary circulations. iii)2ndary to other conditions causing widespread inflamm process.

Front 96

What are reasons for mech ventilation? x5

Back 96

i)impaired or reduced level of consciousness w/inability to protect airway (absent gag or cough reflexes) ii)metabolic acidosis (can't hyperventilate). iii)resp muscle fatigue iv)significant hypoxemia (<70mmHg) or hypercapnia (PaCO2>50). v)resp acidosis (pH<7.2) w/hypercapnia

Front 97

What are the 2 types of acute respiratory failure? What are their causes? What are the pathophys of each?

Back 97

i)hypoxemic respiratory failure: a)low PaO2 w/PaCO2 low or normal (O2 sat <90%). b)cause: dz process of lung (ARDS, severe pneumonia, edema). c)VQ mismatch; shunt. ii)Hypercarbic (ventilatory) respiratory failure (failure of alveolar ventilation). a)decr in minute ventilation or incr in dead space->CO2 retention and get hypoxemia. b)cause: lung dz (COPD, asthma, bronchitis). c)or NM dz, resp fatigue (hypervent in DKA)

Front 98

ow to treat PPH? x3

Back 98

i)1st do vasodilator trial: inhaled NO, IV adenosine or oral CCBii)pulm vasodilaters: IV prostacyclin; CCBs. iii)warfarin w/INR around 2 iv)lung xplant

Front 99

What tests tell you that you can you treat PE w/anticoag? x3. What tests r/o PE x3?

Back 99

i)a)intraluminal filling defects on helical CT+suspicion b)DVT dx'd w/U/S+suspicion. c)pos pulm angiogram: proves PE. ii)a)low probability VQ scan+low suspicion b)Neg pulm angiogram (definite). c)Neg D dimer+low suspicion

Front 100

How to treat resp failure? x4

Back 100

i)treat underlying d/o (bronchodilate, steroids, Abx, etc). ii)Give O2: a)hypoxemic failure->lowest [O2] b/c of possible O2 tox w/radicals. b)hypercarbic: give some O2, tho hx says hypoxia drives breathing, so that the pt can get worse (esp COPD). iii)NPPV:conscious pts who can breath iv)may need intubation and ventilation w/resp failure

Front 101

What are other sources of emboli to lungs besides thrombus? x5

Back 101

i)fat embolism (bone) ii)amniotic fluid embolism: during or after deliver iii)air embolism: trauma to thorax; indwelling lines. iv)septic embolism (IVDU) v)schistosomiasis